Internal Medicine Mnemonics

(1)

Friday, 6 November 2009, 11:06 AM Site: Memorable Medicine - free online medical training

Course: Internal Medicine (IntMed) Glossary: Mnemonics 1

10s:

Regarding phaeochromocytomas: 10% malignant 10% bilateral 10% extra-adrenal 10% calcified 10% children

10% familial (now known to be closer to 25%) discussed 10 times more often than actually seen!

2

2Cs:

Regarding MEN II:

C - Carcinoma of the thyroid (medullary)

C - Catacholamines (phaeochromocytoma)

plus:

MEN IIa = parathyroid hyperplasia

MEN IIb = mucocutaneous neuromas (aka MEN III) Compare MEN I (3Ps)

2s:

Causes of mediastinal (and tracheal) deviation: • 2 pull the mediastinum:

• Collapse • Fibrosis • 2 push the mediastinum:

(2)

• Pleural effusion • Tension pneumothorax • 2 don't move the mediastinum:

• Cavity • Consolidation

3

33-92-CHEST:

Signs of life-threatening asthma:

33 - PEFR < 33% predicted/best 92 - Pulse oximetry < 92% C - Cyanosis H - Hypotension E - Exhaustion or confusion S - Silent chest T - Tachycardia or bradycardia

3Ds:

Beck's triad:

D - Distant heart sounds D - Distended jugular veins D - Decreased arterial pressure

3Ps:

Regarding MEN I: P - Pituitary adenoma P - Parathyroid hyperplasia P - Pancreatic tumours Compare MEN II (2Cs) 4

(3)

4Hs 4Ts:

Reversible causes of cardiac arrest:

H - Hypothermia

H - Hypo & hyper-electrolytes H - Hypovolaemia

H - Hypoxia

T - Toxic (including drugs) T - Trauma

T - Tamponade

T - Tension pneumothorax

4Ts:

Differential diagnosis of an anterior mediastinal mass:

T - Thyroid tumour T - Thymoma T - Teratoma T - Terrible Lymphoma 5

5Ss:

Causes of leucoplakia: S - Spirits S - Smoke S - Sepsis S - Syphillis S - Sore teeth 6

6As:

Features of ankylosing spondylitis:

A - Axial arthropathy A - Ankylosis

(4)

A - Anterior uveitis

A - Apical lung fibrosis A - Aortic regurgitation

A - Achilles tendonitis

8

8Ss:

Features of innocent murmurs:

S - Soft S - Systolic S - Short

S - Sounds (S1 & S2) normal S - Symptomless

S - Special tests normal (X-ray, EKG) S - Standing/ Sitting (vary with

position)

S - Sternal depression

A

A-B-C-D:

Causes of normocytic anaemia (normal MCV):

A - Acute blood loss

B - Bone marrow failure C - Chronic disease

D - Destruction (haemolysis) = SHEEP TIT

ABC:

Risk factors for aortic dissection:

A - Atherosclerosis / Ageing / Aortic aneurysm

B - Blood pressure high / Baby (pregnancy)

C - Connective tissue disorders (eg Marfan's syndrome, Ehlers-Danlos syndrome) / Cystic medial necrosis

(5)

In treating hypertension:

A - ACE inhibitors B - Beta blockers

C - Calcium channel antagonists D - Diuretics (thiazide)

A&B are usually indicated for under 55 year-olds and C&D are usually indicated for those 55 years or over and black patients. This is due to the aetiology of hypertension in these groups. When dual therapy is required one from A&B and one from C&D are usually chosen.

ABCDE:

Management choices of supraventricular tachycardia:

A - Adenosine

B - Beta-blocker

C - Calcium channel antagonist

D - Digoxin / DC cardioversion

E - Excitation (vagal stimulation)

ABCDEx2:

Possible complications of an MI:

A - Arrhythmias / Aneurysm

B - Bradycardia / ↓ Blood pressure

C - Cardiac failure / Cardiac tamponade D - Dressler's syndrome / Death!

E - Embolism / Extra (VSD, papillary muscle rupture)

ACID:

Types of hypersensitivity reaction:

A - I Anaphylaxis

C - II Cytotoxic mediated

I - III Immune complex

D - IV Delayed hypersensitivity or cell mediated

(6)

ARHYTHMIAL 3PC:

Causes of arrhythmias:

A - Atrial myxoma

R - Rheumatic heart disease HY - HYpertension

TH - THyrotoxicosis

M - Mitral valve dis I - IHD

AL - ALcohol

3P - Pneumonia / PE / Pericardial effusion

C - Cardiomyopathy

ARITHMATIC:

Causes of AF:

A - Alcohol

R - Rheumatic fever

I - Ischaemic heart disease T - Thyrotoxicosis

H - Hypertension

M - Mitral stenosis / Myocardial infarction / atrial Myxoma

A - Atrial septal defect T - Toxins

I - Idiopathic / Infective endocarditis

C - Cardiomyopathy / Constrictive pericarditis

ASD:

Symptoms of aortic stenosis:

A - Angina (2 year prognosis)

S - Syncope (1 year prognosis) D - Dyspnoea (6 month prognosis)

ASK ME:

JVP wave form:

(7)

S - Systole

K - Klosure (closure) of tricuspid valve, so atrial filling M - Maximal atrial filling

E - Emptying of atrium

[Larger Image]

C

CARDIAC RIND:

Causes of pericarditis:

C - Collagen vascular disease A - Aortic aneurysm

R - Radiation

D - Drugs (such as hydralazine) I - Infections

A - Acute renal failure

C - Cardiac (myocardial) infarction R - Rheumatic fever

I - Injury N - Neoplasms

D - Dressler's syndrome

CHARM:

Causes of transudative pleural effusions:

C - Carditis H - Hypothyroidism A - Albumin ↓

R - Renal failure

M - Meigs' syndrome / Malabsorption

(8)

Causes of peripheral cyanosis:

C - Cold O - Obstruction L - LVF and shock

D - Decreased cardiac output

Causes of central cyanosis:

P - Polycythemia A - Altitude L - Lung disease M - Methaemoglobinaemia, sulphaemoglobinaemia S - Shunt

COPD:

Causes of an impalpable apex beat:

C - COPD O - Obesity

P - Pleural, Pericardial effusion D - Dextrocardia

CREAMS:

Causes of aortic regurgitation:

C - Congenital

R - Rheumatic fever / Rheumatoid arthritis E - Endocarditis

A - Aortic dissection / Aortic root dilatation / Ankylosing spondylitis M - Marfan's syndrome

S - Syphilis

CURB:

To make a quick assessment of the severity of pneumonia:

C - Confusion U - Urea

R - Respiratory rate B - Blood pressure

(9)

CUSHINGOID:

Side-effects of steroids:

C - Cataracts U - Ulcers (peptic)

S - Skin (thin, briusing, striae)

H - Hypertension / Hirsuitism / buffalo Hump I - Infections

N - Necrosis (femoral head AVN) G - Glycosuria

O - Osteoporosis / Obesity (centripetal & moon face) I - Immunosuppression

D - Diabetes mellitus

D

DANISH:

Signs of cerebellar disease:

D - Dysdiadochokinesis

A - Ataxia

N - Nystagmus (ipsilateral) I - Intention tremor S - Slurred speech

H - Hypotonia / Heel-toe walking impaired

DISK MASS:

Differential diagnosis of back pain:

D - Degeneration: degenerative joints, osteoporosis, spondylosis

I - Infection: UTI, PID, Pott's disease, osteomyelitis, prostatitis, injury/fracture, compression fracture.

S - Spondylitis, ankylosing spondyloarthropathies (RA, Reiter's disease, SLE)

K - Kidney stones/infarction/infection (pyelonephritis/abscess)

M - Metastasis from breast, prostate, lung, thyroid, kidney cancer, Multiple myeloma

A - AAA

S - Slipped disk, Spondylolisthesis

S - Strain, Scoliosis/lordosis, Skin: herpes zoster

(10)

The reasons for no palpable apex beat:

D - Dextrocardia (don't say this first!) O - Obesity P - Pleural/Pericardial effusion E - Emphysema S - Shock

DRUMSTICX:

Causes of pericarditis: D - Dressler's syndrome R - Rheumatic fever / RA U - Uraemia M - MI S - SLE T - Trauma I - Idiopathic C - Coxsackie virus X - X–ray

DULL JAM:

D - DM U - Uraemia L - Lymphoma L - Leukaemia J - Jaundice A - Anaemia M - Myxoedema E

ELEVATION:

Causes of ST elevation: E - Electrolyte imbalance L - Left bundle branch block E - Early repolarization V - Ventricular hypertrophy

A - Aneurysm

(11)

I - Injury (myocardial infarction, contusion)

O - Osborn waves (hypothermia)

N - Non-occlusive vasospasm (Prinzmetal's angina)

F

FAB:

Causes of macrocytic anaemia (high MCV; MacDonalds do FAB burgers!):

F - Folate deficiency

A - Alcohol abuse (since concurrent thiamine deficiency)

B - B12 (thiamine) deficiency

Note B₁₂ deficiency causes neurological signs.

FAILURE:

Causes of acute CCF:

F - Forgot medication A - Arrhythmia / Anaemia

I - Ischaemia / Infarction / Infection

L - Lifestyle: too much salt

U - Upregulation of CO: pregnancy, hyperthyroidism

R - Renal failure

E - Embolism: pulmonary

FIPPY:

Causes of a third heart sound:

F - Failure

I - Incompetence (mitral valve / tricuspid

valve)

P - Pregnancy / Pill

P - Pulmonary embolus / Pericarditis

Y - Youth

(12)

Management of acute LVF:

F - Frusemide O - Oxygen

A - Atrovent (& ventolin)

nebuliser

M - Morphine

FOAMS:

In the treatment of acute pulmonary oedema (LVF):

F - Frusemide (iv) O - Oxygen

A - Atrovent (& Ventolin) nebuliers M - Morphine (iv)

S - Sit up!

H

HANDI:

Causes of postural hypotension:

H - Hypovolaemia / Hypopituitarism

A - Addison's disease N - Neuropathy (autonomic)

D - Drugs (vasodilators, diuretics, antipsychotics)

I - Idiopathic

HARD:

Types of cardiomyopathy:

H - Hypertrophic cardiomyopathy A - Arrhythmogenic right ventricular

cardiomyopathy

R - Restrictive cardiomyopathy D - Dilated cardiomyopathy

(13)

Some causes of AF:

H - Heart failure (including cardiomyopathies)

E - Enlargement of the atria A - Alcohol

R - Rheumatic heart disease T - Thyroxine ↑

HILT:

Findings with an apex beat:

H - Heaving I - Impalpable (COPD) L - Laterally displaced T - Thrusting / Tapping

HOLT:

Causes of JVP elevation: H - Heart failure

O - Obstruction of vena cava

L - Lymphatic enlargement - supraclavicular T - (intra) Thoracic pressure increase

HOPEFULSSS:

Risk factors for coronary artery disease:

H - Hypertension O - Obesity P - PVD E - Elevated LDL F - Family history U - Up glucose - DM L - Low HDL S - Smoking S - Sex - male S - Sedentary lifestyle

HOT ACROMEGALY:

(14)

Clinical features of acromegaly:

H - Heart failure / Hypertension O - Organomegaly

T - Teeth widely spaced A - Amenorrhoea

C - Carpal tunnel syndrome / Coarse skin/voice / Cardiovascular disease

R - Respiratory - sleep apnoea and upper airway obstruction O - Oily skin

M - Myopathy / Malignancy (higher risk of several types)

E - Eye (prominent supra-orbital ridge)

G - Goitre / Gain weight / Galactorhoea / Glucosuria

A - Arthropathy

L - Large tongue, nose, hands and feet

Y - Young get gigantism (since growth plates not yet fused)

I

I PUNCH EAR:

Areas to cover in a systems review:

I - Integumental P - Pulmonary U - Urogenital N - Nervous C - Cardiovascular H - Hematolymphoid E - Endocrine A - Alimentary R - Reproductive

ICE:

When in a consultation remember to address patient:

I - Ideas (what they think might be wrong) C - Concerns (what they are worried about) E - Expectations (what they want done)

(15)

When performing a PNS examination: I - Inspection T - Tone P - Power R - Reflexes C - Co-ordination

S - Sensation (light touch, pain, vibration, proprioception)

INVERT:

Causes of T wave inversion:

I - Ischaemia

N - Normal (especially young, black) V - Ventricular hypertrophy

E - Ectopic foci (eg calcified plaques) R - RBBB, LBBB

T - Treatments (digoxin)

IPPA:

When examining a patient, stick to the order:

I - Inspection P - Palpation P - Percussion A - Ausculation

IT'S COMA:

Causes of a coma:

I - Infection (meningitis, encephalitis, sepsis) T - Trauma

S - Seizures C - CVA

O - Overdose (opioids, poisoning, eg carbon monoxide) M - Metabolic, eg hypoglycemia, hyponatremia

A - Alcohol

(16)

JONES cRITERIA:

Revised Jones' criteria for rheumatic fever. Major criteria:

J - Joints (migratory polyarthritis)

O - Obvious (cardiac = carditis with heart failure, pericarditis, or new murmur) N - Nodule (subcutaneous rheumatic)

E - Erythema marginatum S - Sydenham's chorea

Minor criteria:

R - Rheumatic fever previously I - Inflammatory cells (leukocytosis) T - Temperature (fever)

E - Elevated ESR / CRP R - Raised PR interval

I - Infection (evidence of Group A Streptococcal infection) A - Arthralgia

L

LAMB:

Choiced of medical management of ventricular tachycardias include:

L - Lidocaine A - Amiodarone

M - Magnesium / Mexiltene B - Beta-blocker

LOSS:

Features of osteoarthritis on an X-ray:

L - Loss of joint space (if x-ray is taken whilst weight-bearing) O - Osteophytes

S - Subcondral Cysts S - Sclerosis

M

(17)

Causes of delirium:

M - Metabolic, eg liver failure, renal failure A - Alcohol withdrawal D - Drugs H - Hypoxia, eg COPD I - Infection, eg UTI V - Vascular, eg CVA, MI E - Epilepsy (postictal) S - Subdural haemorrhage

MBA College:

Anti-arrhythmics in order from class I to IV:

M - Membrane stabilisers B - Beta-blockers

A - Action potential wideners C - Calcium channel antagonists

MI CHAM:

Causes of lymphoedema (non-pitting oedema):

M - Milroys I - Infection (filariasis) C - Congenital H - Hypothyroid A - Allergy M - Malignancy

MONA:

Immediate treatment of an MI:

M - Morphine O - Oxygen N - Nitrates A - Aspirin

(18)

OH BATMAN is a bit more inclusive.

MOP HAIR:

Characteristics of a JVP:

M - Multiple wave form O - Occludable P - Postural changes H - Hepatojugular reflex

A - Above (fills from) I - Impalpable

R - Respiratory changes

MUDPILES:

Causes of a high anion gap: M - Methanol U - Uraemia D - DKA P - Propylene glycol I - Isoniazid L - Lactic acidosis E - Ethylene glycol S - Salicylates N

NERO:

X-ray features of RA:

N - Nodules

E - Erosions

R - Reduced joint space O - Osteoporosis (peri-articular)

(19)

Never Let Monkeys Eat Bananas: 60, 30, 6, 3, 1:

As a normal proportion of the total WCC:

N - Neutrophils 60% L - Lymphocytes 30% M - Monocytes 6% E - Eosinophils 3% B - Basophils 1% O

OH BATMAN:

In the treatment of an MI:

O - Oxygen H - Heparin (NSTEMI) B - Beta blockers A - Aspirin T - Thrombolysis (STEMI) M - Morphine A - Angioplasty N - Nitrates P

PAD HIM:

Causes of bradycardia:

P - Physiological (athlete, sleep) / Paroxysmal A - AV block (heart block) (Mobitz II & third degree)

D - Drugs (beta blockers, digoxin, amiodarone) H - Hypothyroid / Hypothermia

I - Icteric (severe) M - MI

(20)

P - Pulmonary and A - Aortic I - Insufficiency produce D -Diastolic murmurs

PAM:

Horner's syndrome consists of (PAM Horner!):

P - Ptosis

A - Anhydrosis

M - Miosis

PANIC:

In the first hour of treating DKA think about:

P - Potassium (20 mmol KCl if no tented T waves on ECG)

A - Acidosis (if pH < 7.30 get urgent advice)

N - Normal saline (1 litre in the first hour) I - Insulin (6 units stat then 6 units per hour)

C - Catheter and Cultures (urine, blood, sputum, etc)

PASS:

P - Pulmonary and A - Aortic S - Stenosis produce S - Systolic murmurs

PASTRI:

Complications of mitral stenosis:

P - Pulmonary hypertension

A - AF

S - Systemic embolism T - Tricuspid regurgitation R - Right heart failure I - Infective endocarditis

(21)

PINTARS:

Causes of exudative pleural effusions: P - Pneumonia / Pancreatitis I - Infarction (PE) N - Neoplasm T - TB / Trauma A - Abscess R - RA

S - Systemic stuff (SLE, Sarcoidosis, Systemic sclerosis)

PIRATES:

Causes of AF:

P - Pulmonary: PE, COPD

I - Iatrogenic

R - Rheumatic heart: mirtral regurgitation A - Atherosclerotic: MI, CAD

T - Thyroid: hyperthyroid E - Endocarditis

S - Sick sinus syndrome

Ps:

In psoriasis:

psilver pscale over psalmon psikn!

R

RAISE:

Causes of metabolic acidosis with a normal anion gap and RAISEd K+ (hyperkaleamia):

R - Renal tubular acidosis type 4

A - Alsosterone or meralocordicoid deficiency I - Iatrogenic: NH₄Cl, HCl

S - Stenosis: obstructive uropathy E - Early uraemia

(22)

RAMP:

Contraindications to exercise ECGs:

R - Recent MI A - Aortic stenosis M - MI in the last 7 days P - Pulmonary hypertension

Really Sick Children Must Take No Exercise:

Number of days after fever onset, that the rash appears:

R - 1: Rubella

S - 2: Scarlet fever / Smallpox C - 3: Chickenpox

M - 4: Measles (with Koplik spots 1 day earlier) T - 5: Typhus, rickettsia (variable)

N - 6: Nothing

E - 7: Enteric fever (salmonella)

ReDUCE:

Causes of metabolic acidosis with normal anion gap and ReDUCEd K+ (hypokalaemia):

Re - Renal tubular acidosis types 1 & 2

D - Diarrhoea

U - Urine diversion into gut C - Carbonic anhydrase inhibitor E - Ex-hyperventilation

RILE:

Effect of respiration on intensity of heart murmurs:

R - Right sided murmurs loudest on I - Inspiration

L - Left sided murmurs loudest on E - Expiration

(23)

S

SAVER:

Compensatory mechanisms in shock:

S - Sympathoadrenal system

A - Atrial natriuretic peptide V - Vasopressin

E - Endogenous digitalis-like factor R - Renin-angiotensin-aldosterone system

SCRIPT:

Things to think about when hearing a murmur:

S - Site

C - Character (eg harsh, soft, blowing) R - Radiation I - Intensity P - Pitch T - Timing

SHEEP TIT:

Causes of haemolysis:

S - Sickle cell disease H - Hereditary spherocytosis

E - Enzyme deficiencies (G6PD, pyruvate kinase)

E - Erythroblastosis fetalis

P - Paroxysmal nocturnal haemoglobinuria

T - Trauma to RBCs

I - Immunohaemolytics (warm Ab, cold Ag)

T - Thalassaemias

SHIFT MAID:

Risk factors for atherosclerosis:

(24)

S - Smoking H - Hypertension I - IDDM / NIDDM F - Family history T - Triglycerides, fats M - Male A - Age (increasing) I - Inactivity D - Diet / Drink

SHIT:

Causes of a fourth heart sound:

S - Stenosis (aortic/pulmonary)

H - Hypertension/Heart Block

I - Ischaemic heart disease T - Tamponade

SHOVED:

When enquiring about the nervous system:

S - Syncope, Speech defect, Swallowing difficulty H - Headache

O - Ocular distubances: diplopia, visual field defects V - Vertigo

E - Epilepsy: seizures

D - Don't forget motor and sensory components of all nerves (pain, paraesthesia, weakness, incoordination...)

SLIM CV:

Causes of CAP:

S - Streptococcus pneumoniae L - Legionella

I - Influenzae Hemophilus (HiB) M - Mycoplasma

C - Chlamydia V - Viral

(25)

SNAP:

Causes of SVT:

S - Sinus tachycardia

N - Nodal tachycardia A - Atrial fibrillation

P - Paroxysmal atrial tachycardia

Some Hot Dude Better Give Iced Fluids Today:

Treatment of malignant hyperthermia:

S - Stop all triggering agents, give 100% O2 H - Hyperventilate

D - Dantrolene 2.5mg/kg B - Bicarbonate

G - Glucose and Insulin

I - IV Fluids, cooling blanket

F - Fluid output; furosemide

T - Tachycardia, be prepared to treat ventricular tachycardia

SPLINT:

Causes of splinter haemorrhages:

S - Sepsis elsewhere

P - PAN / SLE / RA

L - Limey (vitamin C deficiency) I - Infective endocarditis

N - Neoplasm (haematological) T - Trauma

SSAALL:

Areas of the heart the ECG chest leads 'look' at:

S - V1 Septum S - V2 Septum A - V3 Anterior A - V4 Anterior L - V5 Lateral L - V6 Lateral

(26)

T

TAPED TORCH:

Signs of heart failure:

T - Tachycardia A - Ascites

P - Pulsus alternans

E - Elevated jugular venous pressure D - Displaced apex beat

T - Third heart sound O - Oedema

R - Right ventricular heave C - Crepitations or wheeze H - Hepatomegaly (tender)

TICS:

Causes of microcytic anaemia (low MCV; Mics are TICS):

T - Thalassemia I - Iron deficiency

C - Chronic disease

S - Sideroblastic anemia (can be secondary to lead)

TOM SCHREPFER:

Predisposing conditions for PE:

T - trauma O - obesity M - malignancy S - surgery C - cardiac disease H - hospitalisation R - rest (bed-bound)

E - estrogen, pregnancy, post-partum P - past history

F - fracture E - elderly R - road trip

(27)

TONS:

Things to consider giving to a patient in a coma:

T - Thiaminie O - O2 N - Naloxone

S - Sugar, eg 50% dextrose

TRACKPADS:

Causes of secondary hypertension:

T - Thyroid disease (hyperthyroidism)

R - Renovascular disease (renal artery stenosis)

A - Aorta, coarctation of C - Cushing's syndrome

K - Kidney disease, chronic (CKD)

P - Pheochromocytoma

A - Aldosteronism (hyper-)

D - Drugs (eg OCP, decongestants, NSAIDs)

S - Sleep apnoea

TRIP SAM:

Causes of splinter haemorrhages:

T - Trauma

R - Rheumatoid arthritis I - Infective Endocarditis

P - Poly arteritis nodosum

S - Systemic lupus erythematosus / Sepsis

A - Anaemia (profound)

M - Malignancy (haematological)

W

WiLLiaM MaRRoW:

WiLLiaM - W pattern in V1 & V2 and M pattern in V3, V4 & V6 is Left bundle branch block.

(28)

MaRRoW - M pattern in V1 & V2 and W in V3, V4 & V6 is Right bundle branch block.

WORD:

Causes of a dominant R wave in V1:

W - WPW

O - Old MI / pOsterior MI

R - RBBB