Internal Medicine Mnemonics

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:

•

•

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

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

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

ABCD:

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

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: A - Atrial contraction

S - Systole K - Klosure (closure) of tricuspid valve, so atrial filling M - Maximal atrial filling E - Emptying of atrium

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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

COLD PALMS:

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 See CURB-65 for mortality etc.

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

DOPES:

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 T - Treatment (eg pericardiocentesis)

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

FOAM:

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

HEART:

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:

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)

If Testing Plantar Reflexes, Carefully Stroke:

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

J

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

MAD HIVES:

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

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 See also ASK ME.

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)

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

PAID:

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

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 See also ReDUCE.

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 See also RAISE.

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

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:

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

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

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

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.

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 D - Dextrocardia