Acronyms

5 a's of schizophrenia

apathy, alogia, attention, anhedonia, affect MENTAL STATUS EXAMINATION A – Appearance and behavior S- Speech

E- Emotion ( Mood and affect ) P- perception ( any Hallucination ) T- Though form and content

I-Insight

C-cognitive function S- Suicidal ideation

THE 6-2 RULE for paediatric inguinal hernia: Birth to 6 weeks ( surgery within 2 days) 6 weeks to 6 months ( surgery with in 2 weeks) Over 6 months (surgery with in 2 months)

Remember the “Bs” (problems for young doctors!)

AMPLE (Allergy, Medications, Past medical history, Last meal and events cardiac risk factors – ABCDEFS

A – Age (given in stem)

B – BP. Do you have high blood pressure? No C – Cholesterol problem? No

D- D.M. (you or family history)? No Drugs and alcohol? No

Diet? He had bad eating habits, junk food and take aways.

E- Exercise- how often do you exercise? He send he doesn’t do any. I also asked about his occupation- he had sedentary lifestyle, he was a clerk and sat most of the time.

F- Family history of CVS, D.M, B.P? Mother had some heart disease. S- Smoking and stress? No

Cardiac murmurs: SQIRT:

S ite Q uality I ntensity R aditation T iming S everity

AVPU:

BAR:

Benefit of treatment Adverse effects Risks

BINDARS: birth history, immunizations, nutrition , development, allergies, (excema), rashes

and siblings CAGE questions: “Have you ever:

(1) felt the need to cut down your drinking; (2) felt annoyed by criticism of your drinking; (3) had guilty feelings about drinking; and (4) taken a morning eye opener?

COST VMPF- (PE /DVT)

coagulation problmes/family h/o -no, obesity- no,Leg pain-nad

smoking/surgery- no,

trauma- no , travel as above mentioned Varicose veins- no Malignancy-no Pregnancy /pills- no Family h/o-no DELIRIUM: D: drugs

E: Emotional means Depression, central nervous system: trauma, stroke. L: Lung, Hypoxia

E: environmental means social reasons R: Renal problem or respiratory I: Trauma especially head injury U: Uremia

M:Metabolic, diabetes or thyroid, “HIDEMAP”:

I – infection (UTI, pneumonia)

E - endocrine, e.g. diabetes

M - metabolic, e.g. hyper/hypocalcaemia A - alcohol

P - psychosis

DEMENTIA:

D: depression, drugs and alcohol E: ears /eyes

M: metabolic, e.g. hyponatraemia, diabetes, hypothyroidism E: emotional problems (e.g. loneliness)

N: nutrition: diet, vit B12, folate, Iron, teeth problems T: trauma, tumour

I: infections

A: arteriovascular disease, CVA,stroke,TIA,AF etc. D-distractability I-impulsive,idea of persecution G-grandiosity F-flight of ideas A-activity(hyperactivity) S-sexual promiscuity,sleep(insomnia) T-thoughts (racing);excessive talking The “F’s” of the acute abdomen:

1. Fluid 2. Flatus 3. Faeces 4. Fat 5. Fetus 6. Focal mass

7. False impressions of pseudopregnancy

FLK: funny looking kid

 Avoid “HARM” in soft tissue or orthopaedic injuries!! Heat (increase blood supple and swelling)

Alcohol Run/dance/ Massage

HEADSSS assessment (Psychosocial Screening):

Taking a psychosocial history is an important part of the health interview of young people as physical, emotional and social well being are closely interlinked.

Parents, family members or other involved adults should not be present during the psychosocial assessment.

Preface the discussion by saying that you are about to ask lots of personal questions that include drugs, sex and depressed mood and that you are asking because these behaviours may affect a person's health.

It can be useful to make a general statement instead of personalising questions, such as "Some young people experiment with cigarettes and alcohol. In your year at school, do people

smoke/drink/use illicit drugs? What about your friends? And you?"

Home: including who, where, recent moves, relationships, violence. Education &

Employment:

including where, attendance, year, performance, relationships, supports, recent moves, bullying, disciplinary actions, future plans, and work details

Eating: including weight (heaviest, lightest, recent changes), dieting, exercise and menstrual history.

Activities Affect Ambition Anxieties

outside of school, including sport, organized groups, clubs, parties, TV/ computer use

Drugs and Alcohol: Depression

including cigarettes, alcohol and illicit drug use by friends, family and the patient. Enquire into patterns & frequency of use & about any regrets from using these substances.

Also ask about how use is financed and about negative consequences.

Sexuality: Stress: Self-esteem

including close relationships, sexual experiences, number of partners (total and in the last 3 months), gender of sexual partners (don't assume sexual preferences), uncomfortable situations/ sexual abuse, risk of pregnancy and previous pregnancies (relevant to males as well as females), contraception, condoms and STIs.

Suicide, Depression & Self-harm:

Presence and frequency feeling down or sad as well as current feelings eg. "How do you feel in yourself at the moment on a scale of 1 to 10?" Actions when down, supports. Self-harm- thoughts and actions. Suicide risk- thoughts, attempts, plans, means and hopes for future.

Safety from injury &Violence:

including serious injuries, use of safety gear for sports and seatbelts for cars, riding with an intoxicated driver and exposure to violence at school and in neighbourhood.

For high risk youths ask about carrying or use of weapons and other criminal behaviours/ incarceration of youth or family/ friends.

With HEADSSS, sometimes there is an “R” for ‘relationships’ added:

HEARDSSS

HEMIFAD (mnemonic for TIREDNESS) H – Haemochromatosis

E – Endocrine Disorders (Hypothyroidism, Hyperthyroidism, DM, Cushing’s Syndrome) M - Malignancy

I – Infection (Infective Endocarditis, TB, Malaria) F - Chronic Fatigue Syndrome

A – Anxiety, Anaemia/ Atypical Pneumonia D - Drugs/ Depression

TIREDNESS: (NEW) (By Shahab Khan)

I AM TIREDO

I - Iron (anemia, hemochromatosis)

A- Anxiety / Depression / Somatisation / Bereavement M- Myocardial (IHD/CCF)

T- Thyroid (hypo/hyper)

I- Infection (endocarditis, TB, Viral)

R- Rheumatoid / Polymyalgia / Chronic fatigue syndrome / Fibromyalgia E- Endocrine (Addison, DM, CRF, Liver, Hypercal, Hypokal, Hypomag) D- Drugs (Med, abuse, withdrawal)

O- OSA / Chronic Pain

A mnemonic that can be used to remember the characteristics of histrionic

personality disorder is "PRAISE ME":

▪ Provocative (or seductive) behavior

▪ Relationships are considered more intimate than they actually are

▪ Attention-seeking

▪ Influenced easily

▪ Speech (style) wants to impress; lacks detail ▪ Emotional lability; shallowness

▪ Make-up; physical appearance is used to draw attention to self

Exaggerated emotions; theatrical

KNOWS Why (a useful mnemonic for BREAKING BAD NEWS):

“Mr/Ms …, / I understand you are here today for your HIV test results”. Instead of “what brings you here today?”

 K nowledge: “What do you know about HIV? Or What is your understanding about HIV?”

 N eed: “What would you like to know about HIV?, What questions did you hope to get answered today?”…. “I assume, you want to know…. ”

 O bserved: “Have you had any experience with HIV in the past?”

 W orry: “Is there something you’re worried about concerning the HIV?”

 S earched: “Have you talked to someone about HIV or read some information or searched the net?”

 W hy: “Why now?,.. What triggered this issue? Why did you want to be tested?”.

Lifestyle modification: ABCDEF A Alcohol free

B BMI

C Cigarette free D Diet control E Exercise

F Free from stress

LLS : looks like a syndrome

LOL NAD: “Little Old Lady in No Apparent Distress”. LOTSRADIO

L- location O- onset & offset T- time

S- severity

R- radiation & relieving factors A- aggrevating factors

D- duration I- intensity

0- other associated factors

Lump examination: The Ss, Cs, Ts, Fs and Ps: “She Cuts The Fish PERfectly”:

Site,Size, Shape (round, regular, irregular), Surroundings, Surface, Single (or multiple) Contour (well defined, irregular), Consistency (soft, firm, hard) , Colour, Compressibility, Cough impulse

Tenderness, Temperature, Transillumination

Fluctuation (fluid filled cyst), Fixity (mobile against underlying structures or against the

skin), Fields (draining lymphglands for this area)

Expansile (Is it an aneurysm?)

Reducible (is it a hernia?)

MANIA: D-distractability I-impulsive,idea of persecution G-grandiosity F-flight of ideas A-activity(hyperactivity) S-sexual promiscuity,sleep(insomnia) T-thoughts (racing);excessive talking

causes of carpal tunnel syndrome (MEDIAN TRAPS) M=median artey persistence

E= edema of pregnancy D= diabetus I = idiopathic A= acromegaly N= neoplasm -- gangllioneuroma T = thyroid--myxdema R= Rhamtoid arthitis A= amyloid

P = pneumatic drill usuage S= SLE

MONA:

Morpoine, oxygen, nitroglycerin, aspirin in AMI!!! Ottawa Ankle rules: 44-55-66-PM

4: Unable to make 4 steps immediately

4: Unable to make 4 steps in the emergency department 5: Pain at that base of the 5th metatarsal

5: Pain at the 5caphoid (the 5 is supposed to look like an “S,” and scaphoid is another word for navicular)

6: Tenderness along the posterior 6 cm of the lateral malleolus 6: Tenderness along the posterior 6 cm of the medial malleolus PM: Refers to the posterior malleolus

Ottawa Knee rules: 44-55-90-FP

4: Unable to make 4 steps immediately

4: Unable to make 4 steps in the emergency department 55: Age 55 years or older

90: Inability to flex the knee to 90° F: Tenderness at the head of the fibula P: Isolated tenderness of the patella

O+G P’s: Periods Pills Pregnancy Partner(s) Pap smear Pain(the 6th P)

Pelvic infections (STD’s, the 7th _P)

“Personal circumstances” (depression, social problems etc., the 8th _P)

Pee for urinary symptoms (9thP) PV bleeding (10thP)

Procedures (11th _P)

Blood GrouP (the dyslexic P)

Oesophageal cancer risk factors (PC BASTARDS) Plummer-Vinson syndrome Coeliac disease Barrett's Alcohol Smoking Tylosis Achalasia

Russia (geographical distribution) Diet

Stricture

Post-operative complications-immediate (Post-op PROBS) Pain Primary haemorrhage Reactionary haemorrhage Oliguria Basal atelectasis Shock/ Sepsis RICEARS: R est I ce Compression E levation A nalgesics R eview S trapping These include 5 R’s = 2 S.

 R-Rx- treatment—Explain treatment options, including non pharmacological options

 R-Review- Follow up in a fixed time, often the next day or may be few weeks or days

 R-Referral-Refer to a specialist if needed but explain what to expect

 R-Red flags-Explain red flags I.e. dangerous things e.g. Hypoglycemia & Hyperglycemia in Diabetes & what to do

 R-reading material-Handover reading material so that patient can remember what you said to him

 S – support group  S – social issues

SADAM (smoking , alcohol, drugs, allergies, medical problems and medications) or SADMA

SAD PERSON INDEX for suicide risk assessment: simple score: modified scale:

Sex: males more at risk than females 1 1

Age: <20 years of > 45 years 1 1

Depression: major / hopelessness 1 2

Psychiatric history or previous attempts 1 1

Excessive drug use like alcohol or other drugs 1 1

Rationality loss, psychosis, severe depression 1 2

Seperated: loss of spouse or other single 1 1

Organised plan, determined suicide plan 1 2

No support, no community back-up, generally isolated 1 1

Sickness: chronic illness / stated future intent 1 2

A score of more than 7 equals a high suicide risk!!!

0–4 Low

5–6 Medium

7–10 High

The modified scale risk assessment ranges from:

 0–5: May be safe to discharge (depending upon circumstances)

 6-8: Probably requires psychiatric consultation

 >8: Probably requires hospital admission

SAW EMAILS- sleep, appetide,

weight,energy,mood,anhedronia,interest,libido,suicide

Seeing that Lack of ENERGY is common to most episodes, the mnemonic relates to “treating “ this symptom by ”prescribing energy capsules” as SIG: E(nergy) CAPS:

S: sleep changes

I: interest (decreased / anhedonia) G: guilt (excessive)

E: energy (decreased)

C: concentration (decreased) A: appetite changes

P: psychomotor agitation or retardation S: suicidal ideation

SOCRATES:

 Site - Where is the pain? Or the maximal side of the pain.

 Onset - When did the pain start, and was it sudden or gradual? Include also Progress

whether if it is progressive or regressive

 Character - What is the pain like? An ache? Stabbing?

 Radiation - Does the pain radiate anywhere? (See also Radiation.)

 Associations / Alleviating factors - Any other signs or symptoms associated with the pain? What makes it better, what makes it worse?

 Time course - Does the pain follow any pattern?

 Exacerbating/Relieving factors - Does anything change the pain?  Severity - How bad is the pain?

Splenomegaly-causes (CHINA) Congestion/ Cellular infiltration

Haematological (eg haemolytic anaemia, Sickle cell) Infection/ Infarction (eg malaria, GF, CMV)

Neoplasia (eg CML, lymphoma, other myeloproliferative) Autoimmune

TIREDNESS:

HEMIFAD

H- Hemochromatosis

E- Endocrine ( DM, Cushing’s, Addison, Hypothyroid ) M- Malignancy

I – Infection ( Infective endocarditis ) F- Chronic Fatigue syndrome

A-Anaemia , atypical pneumonia D-drugs , depression TIRED T umor I nfection I Ron overload R enal failure E ndocarditis, E ndocrine D rug, D epression

TONG: coma cocktail

Thiamine 100 mg Oxygen

Naloxone 0.1 - 0.2 - 0.4 mg i.v Glucose 50 ml 50 %

Weight, Appetite, Sleep, Thirst, Energy, Fever and Sweats (WASTE FN)

6-Post Operative Fever Wind (Pulmonary) Water (Urine-UTI) Wound Walk (DVT/PE) Wonder Drugs (Drug Fever) Weins (Thrombophlebitis)

Mnemonic for Day of appearance of rash in a febrile patient is : Very Sick Person Must Take Double Tablets

Very – Varicella (day 1) Sick – Scarlet fever (day 2) Person – Pox – small pox (day 3)

Must – Measles (day 4) Take – Typhus (day 5) Double – Dengue (day 6) Tablets – Typhoid (day 7)