Mnemonics - Clinical

Note: Many of these mnemonics are decades old. I hope no one is offended by any of them.

Mnemonics

Mnemonics - Anatomy

Acute Rheumatic Fever

"JENSH"
J oints (polyarthritis)
E rythema marginatum
N odules (subcutaneous)
S ydenham's chorea
H eart (pancarditis)

Addison's Disease

President Kennedy had Addison's disease.

He always had a great tan (increased skin pigmentation due to increased
levels of ACTH, MSH, etc.).

Alcohol Abuse Screening

"CAGE"
1. Have you ever felt it necessary to CUT DOWN on your drinking?
2. Has anyone ever told you they were ANNOYED by your drinking?
3. Have you ever felt GUILTY about your drinking?
4. Have you ever felt the need to have a drink in the morning for an EYE
OPENER?

Altered Mental Status

"AEIOU TIPS"
Alcohol/drugs
Endocrine
 Insulin
Opiates
Uremia

Toxins/trauma
Infections
Psych/porhyria
SAH, shock, stroke, seizure, space occupying lesion

Angina Pectoris or MI Precipitating Factors

"4 E's"
E ating
E motion
E nvironment
E xercise

Antidysrrthmics

"LARC"
L ocal anesthetics
beta A drenergic blockers
"R efractory period prolongators"
C alcium channel blockers

Argyll-Robertson Pupil

Sign of neurosyphilis
"ARP" - Accommodation Reflex Present, but Pupillary Reflex Absent
("PRA" - "ARP" backwards).

Asystole

"3 Hypo's & 3 Hyper's"

Hypoxia
Hypothermia
Hypokalemia

Hyperkalemia
Hyper H+ (acidosis)
Hyper Rx (drugs)

Atherosclerosis

Risk factors
Constitutional
 G enetic
A ge
S ex
Major
Hyper- tension
Hyper- lipidemia
Hyper- glycemia
smoking
Minor
S edentary lifestyle
O besity
S tress

Complications

S tenosis
T hromosis
A neurysm
B leeding

B Vitamins

"Train private-first class"

"TRN PFC"
B1 - T hiamine
B2 - R iboflavin
B3 - N iacin (nicotinic acid)
B6 - P yridoxine
B9 - F olic acid
B12 - C yanocobalamin
Back Pain
"DISK MASSS"
D egeneration: DJD, osteoporosis, spondylosis
I nfection: UTI, PID, Pott's disease, osteomyelitis, prostatitis;
Injury/fracture, compression fracture
S pondylitis, ankylosing Spondyloarthropathies (rheumatoid
arthritis, Reiters, SLE)
K idney stones/infarction/infection
M ultiple Myeloma, Metastasis from breast, prostate, lung, thyroid,
kidney cancers
A neurysm, Abdominal pain referred to the back
S lipped disk, spondylolisthesis
S train, Scoliosis/lordosis
S kin: herpes zoster

Bilateral Hilar Adenopathy

 "Please Helen, Lick My Popsicle Stick."
Primary TB
Histoplasmosis
Lymphoma
Metastases
Pneumoconiosis
Sarcoidosis

Cancer

Cancer Warning Signs

"CHB Limbss"
C ough - unexplained, persistent
H oarseness
B owel or Bladder - change in habits
L ump
I ndigestion
M elanoma
B leeding or discharge - unusual
S ore - that does not heal
S wallowing - difficulty

Carcinomas that have a Propensity to Metastasize to Bone

"Kinds Of Tumours Leaping Promptly To Bone"
Kidney, Ovary, Testis, Lung, Prostate, Thyroid, Breast

Dermatomyositis or Polymyositis - Risk of underlying Malignancy

30% at age 30
40% at age 40
etc.

Malignant Melanoma Warning Signs

"ABCDE"
A symmetry
B order irregular
C olour irregular
D iameter > 0.5 cm
E levation

Malignant Melanoma Sites with a Poor Prognosis

"BANS"
Back of the Arm, Neck, or Scalp

Multiple Endocrine Neoplasia (MEN)

 MEN I
"3 P's"
Pituitary
Parathyroid
Pancreas

MEN IIa

"MPH"
M edullary thyroid carcinoma
P heochromocytoma
H yperparathyroidism

MEN IIb

"MPM"
M edullary thyroid carcinoma
P heochromocytoma
M ucosal neuromas

Oral Cancer Risk Factors

"5 S's"
Smoking, Spirits (alcohol), Spicy food, Syphilis, Sharp teeth/dentures

Chest Radiograph

Check technical quality

"RIP"
R otation
I nspiration
P enetration

Structures to check

"LAMBS"
L ungs (e.g. interstitial disease, alveolar disease, atelectasis,
nodules, hyperlucency)
A bdomen (e.g. pneumoperitoneum)
M ediastinum (e.g. masses, tracheal shift)
B ones (e.g. fractures, rib notching)
S oft tissues (e.g. subcutaneous emphysema)

CHF Symptoms

"DOPEN"
 D OE
O rthopnea
P ND
E dema
N octuria

Childhood Rashes

Acute maculopapular rashes

Rubeola - Cough, Coryza, Conjunctivitis, & fever; Koplik's spots
precede rash
Rubella - post-auricular lympadenopathy
Erythema infectosum (5th disease) - "slapped cheeks" appearance
Roseola infantosum - rash appears after fever defervesces
Varicella - "Dew drop on a rose petal" appearance

Cholinergic Crisis - parasympathetic overstimulation

"SLUD"
Salivation, Lacrimation, Urination, and Defecation

Coagulation tests

"PiTT" (PTT - I for Intrinsic pathway) - PiTTsburgh

"PeT" (PT - E for Extrinsic pathway)

Compartment Syndrome

"5 P’s"
Pain, Passive stretch (induces pain), Pallor, Pulselessness, and
Paresthesias.

Depression

"SIGECAPS"
Sleep (increased/decreased)
Interests/hobbies decreased
Guilt/worthlessness
Energy decreased
Concentration decreased
Appetite (increased/decreased)
Psychomotor movements
Suicidal ideations

Differential Diagnosis
 "VINDICATE"
Vascular
Infection
Neoplasm
Drugs
Inflammatory/Idiopathic
Congenital
Autoimmune
Trauma
Endocrine/Metabolic
Drugs that can be given via Endotracheal Tube
"NAVEL"
N arcan
A tropine
V alium
E pinephrine
L idocaine
Elbow Ossification Centers
"Come Rub My Tree Of Love"
C apitellum
R adial head
M edial epicondyle
T rochlea
O lecranon
L ateral epicondyle
These appear at 2, 4, 6, 8, 10, and 12 years of age, respectively, and
disappear two years later.

Endocarditis

"FAM"
F ever
A nemia
M urmur

Eosinophilia

"NAACP"
N eoplasm
A llergy
A ddison's
C irrhosis, CVD
P arasite (visceral larva migrans), Periarteritis nodosa

Erectile Dysfunction (ED)

 "Very Nervous People Hesitate and Disappoint"
V ascular
N eurologic
P sychogenic
H ormonal
D rugs

Gell & Goombs Classification of Hypersensitivity reactions

"ACID"
Type I A naphylaxis
Type II C ytotoxic-mediated
Type III I mmune-complex
Type IV D elayed hypersensitivity

Henoch-Schonlein Purpura

"JARS"
J oints
A bdominal pain
R enal
S kin

Hypercalcemia

"SHAMPOO DIRT"
S arcoidosis
H yperparathypoidism, Hyperthyroidism
A lkali-milk syndrome
M etastases, Myeloma
P aget disease
O steogenesis imperfecta
O steoporosis

vitamin D toxicity
I mmobility
R TA
T hiazides

Hypertension

Condition
Diastolic Systolic
Optimal BP <80 <120
 120 -
Normal BP 80 - 84
129
130 -
High normal BP 85 - 89
139
140 -
Stage I hypertension (mild) 90 - 99
159
Stage II hypertension 100 - 160 -
(moderate) 109 179
Stage III hypertension 180 -
110 - 119
(severe) 209
Stage IV hypertension (very
>120 >210
severe)
Isolated systolic
<90 >140
hypertension

Hypertension - First Line Drug Therapy

"ABCD"
A CE inhibitors
B eta-blockers
C alcium channel blockers
D iuretics (thiazide)

Levels of Consciousness

"AVPU"
A - Alert
V - resonds to Verbal stimuli
P - responds to Painful stimuli
U - Unconscious

Malignant Hyperthermia treatment

"Some Hot Dude Better Give Iced Fluids Fast!"

S: Stop all triggering agents
H: Hyperventilate; 100% O2
D: Dantrolene 2.5mg/kg
B: Bicarbonate
G: Glucose and insulin
I: IV Fluids, cooling blanket
F: Fluid output monitoring; Furosemide
F: Fast heart (tachycardia) - be prepared to treat V tach.
Meckel's diverticulum

Rule of 2's:
Affects 2% of population, 2 inches long, first 2 years of life, 2 feet
proximal to ileocecal valve, 2 types of epithelium: gastric and
pancreatic.

The most common congenital GI anomaly. Predominantly affects males.

Mediastinal Mass

Anterior

"4 T's"
Thymoma
Teratoma
Thyroid tumor/goiter
Terrible lymphoma

Middle

"HABIT(5)"
Hernia, hematoma
Aneurysm
Bronchogenic cyst/duplication cyst
Inflammation (sarcoid, histo, coccidio, TB)
Tumors (5): lung, lymphoma, leukemia, leiomyoma, lymph
node hyperplasia

Posterior

"ANS"
Aneurysm
Neural
Spine
Metabolic Acidosis

With Anion Gap

"MUDPILES"
M ethanol
U remia
D KA/AKA
P araldehyde/phenformin
I ron/INH
L actic acidosis
 E thylene glycol
S alicylates

Without Anion Gap

"HARDUP"
H yperalimentation/hyperventilation
A cetazolamide
R TA
D iarrhea
U reteral diversion
P ancreatic fistula/parenteral saline

Microcytic Anemia

"TICS"
T hallasemia
I ron deficiency
C hronic disease
S ideroblastic anemia

Mucopolysaccharidoses

Distingushing Hunter's from Hurler's: Children with Hunter's Syndrome

do not have corneal clouding because you need to "see" in order to hunt.
To remember that it is "X-Linked," picture a hunter with a bow and arrow.
The bow and arrow cross each other forming an "X."

Non-Cardiogenic Pulmonary Edema

"PONS"
P hosgene, paraquat, phenothiazines
O pioids, organophosphates
N itrogen dioxide
S alicylates

Obstructive Sleep Apnea Screening

"SAD"
S noring
A pnea
D aytime sleepiness

Organisms that Spread from Blood to Urine

"CASH CML"
 C andida
A ureus (staph)
S almonella
H istoplasma

C ytomegalovirus
M ycobacteria
L eptospira

Pain

A - Associated symptoms
O - Onset
P - Palliative factors
P - Provocative factors
Q - Quality of pain(burning, stabbing, aching, etc.)
R - Region of body affected
R - Radiation
S - Severity of pain (e.g. 1-10 scale)
T - Timing of pain (e.g. after meals, in the morning, etc.)
T - Treatments tried

Causes of Acute Pancreatitis

"GET SMASH'D"
G allstones
E thanol
T rauma
S teroids
M umps
A utoimmune (e.g. PAN)
S corpion bites
H yperlipidemia
D rugs(e.g. azathioprine, diuretics)

Causes of Pericarditis

"CARDIAC RIND"
Collagen vascular disease, Aortic aneurysm, Radiation, Drugs eg.
hydralazine, Infections, Acute renal failure, Cardiac infarction, Rheumatic
fever, Injury, Neoplasms, Dressler's syndrome.

Pheochromocytoma

Rule of 10's:
 10% malignant
10% bilateral
10% extra-adrenal
10% calcify
10% familial
10% children
Comprises 0.2% of patients with hypertension and is the most common
adrenal medullary tumor in adults. The Pheochromocytomas are
associated with MEN IIa (Sipple's syndrome: pheochromocytoma,
medullary carcinoma of the thyroid, and parathyroid adenoma) and MEN
IIb syndrome (pheochromocytoma, medullary carcinoma of the thyroid,
and oral and intestinal ganglioneuromatosis) as well as with von Hippel-
Lindau disease and neurofibromatosis.
Post-op Fever
Wind - atelectasis
Water - urinary tract infection
Wound - wound infections
Wind - pneumonia
Wonder drugs - especially anesthetics

Rat Poisons

"RATS PANIC"
R ed squill
A rsenicals
T hallium
S trychnine

P NU/Phosphorus/Zn Phosphide
A lpha naphtha thiurea (ANTU)
N orbormide
I ndanediones
C oumadin/cholcalciferol

Small Bowel Obstruction

"SHAVIT"
S tone (gallstone ileus)
H ernia
A dhesions
V olvulus
I ntussusception
T umor

Sports Injuries
 - in particular, sprains, contusions, muscle strain, fractures.
"RICE"
R est
I ce
C ompression
E levation

Causes of ST Elevation:

"ELEVATION"
E lectrolytes
L BBB
E arly Repolarization
V entricular hypertrophy
A neurysm
T reatment (e.g. pericardiocentesis)
I njury (AMI, contusion)
O sborne waves (hypothermia)
N on-occlusive vasospasm

Syncope

If the face is red, raise the head.

If the face is pale, raise the tail.

"HEAD, HEART, VESSLS"

H ypoglycemia, Hypoxia
E pilepsy
A nxiety
D ysfunction of brain stem (e.g. brain stem TIA)

H eart attack
E mbolism (pulmonary)
A ortic obstruction (aortic stenosis, myxoma, IHSS)
R hythm disturbance
T achycardia (esp. VT)

V asovagal
E ctopic (e.g. hemorrhage - obvious or not)
S ituational (micturation, defecation, etc.)
S ubclavian steal
L ow SVR (e.g. anaphalaxis)
S ensitive carotid sinus

Systemic Lupus Erythematosis

 "SOAP BRAIN"
S erositis (pleuritis, pericarditis)
O ral ulcers
A rthritis
P hotosensitivity

B lood (all are low - anemia, leukopenia, thrombocytopenia)

R enal (proteinuria)
A NA
I mmunologic (dsDNA, etc.)
N eurologic (e.g. seizures)

Takayasu's Disease

Pulseless disease. Therefore, when you have Takayasu's, I can't "taka yu"
pulse.

Thalassemia major

"Bad mafia"
B - Basophilic stippling
A – Anemia, Anisocytosis
D - Deferoxamine

M – MCV is low
A - HbA is decreased
F - HbF is increased
I – Ineffective erythropoiesis
A – HbA2 is increased

Reprinted with permission from the author Sung Kim at MD4sure.com

Vertebral/Basilar Ischemia

"4D's"
D izziness (nystagmus)
D iplopia (skew deviation)
D ysarthria
D ysphagia

Vomiting: Non-GI Causes

"A, B, C, D, E, F, G, H, I"
A cute renal failure
B rain (increased ICP)
C ardiac (inferior MI)
 D KA
E ars (labyrinthitis)
F oreign substances (Tylenol, theo, etc.)
G laucoma
H yperemesis gravidarum
I nfections (pyelonephritis, meningitis)

WBC Count

"Nobody Likes My Educational Background"

e.g. 60, 30, 6, 3, 1
Neutrophils 60%
Lymphocytes 30%
Monocytes 6%
Eosinophils 3%
Basophils 1%