Mne mo nics for M edic ine & S ur ge ry

Ba si c Si gn s & Sy mpt om s:
--Chill s & Rigor s CAMP (Cholangitis, Abscess, Malaria / Meningitis, Pylonephritis/Pneumonia) --It ching Non- de rmatolo gical c au se s of DU LL JA M (DM, Uraemia, Lymphoma, Leukaemia, Jaundice, Anaemia, Myxoedema) --Non-pitting low er limb oe dema MI CHAM (Milroys, infection (filariasis), Congenital, Hypothyroid, Allergy, Malignancy) --Shock HEN SCAM (Hypovolaemia, Endocrine (adrenal, thyroid), Neuropathic (autonomic) Spinal cord injury/ Sepsis, Cardiac, anapyhlaxis/ anaesthesia, anti HPT, Massive PE)

Ca rd io lo gy :
--No ap ex beat DOPES (Dextrocardia (dont say this first!), Obesity, Pleural/Pericardial effusion, Emphysema, Shock.) --3rd Heart Soun d FIPP Y (Failure, Incompetence (mitral/tricuspid), Pregnancy/Pill/PE/Pericarditis, Youth) --4th H eart Soun d SHIT (Stenosis (aortic/pulmonary), Hypertension/Heart Block, Ischaemic HD, Tamponade) --Arr hythmias ARH YTH MIAL 4PC (Atrial Myxoma, Rh heart dis, HYpertension, THyrotoxicosis, Mitral valve dis, IHD, Alcohol, Pneumonia / PE / Pericardial eff, cardiomyopathy) --Atrial Fib rillation ARITH MATIC (Alcohol, Rh fever, IHD, Thyrotoxicosis, Hypertension, Mitral stenosis / MI / Myxoma (atrial),ASD, Toxins, Idiopathic/Infective endocarditis ,Cardiomyopathy/Constrictive pericarditis) --Bradycar dia, re gu lar PAD HI M (Physiological (athlete, sleep) / paroxysmal, AV block (2II, 3), Drugs (, dig, amiodarone), Hypothyroid / hypothermia, Icteric (severe), MI) --Dominan t R wave i n V1 WORD (WPW, Old MI, RBBB, Dextrocardia) --EMD Arr est 4Hs 4 Ts (Hypothermia, Hypo & hyper-electrolytes, Hypovolaemia, Hypoxia Toxic (including drugs), Trauma, Tamponade, Tension pneumothorax) --JVP MOP HAIR (Multiple wave form, Occludable, Postural changes Hepatojugular reflex, Above (fills from), Impalpable, Respiratory changes) --LVF Manag ement of FOAM (Frusemide 40mg iv, Oxygen, Atrovent (& Ventolin) nebs, Morphine 2.5 - 5 mg --Mitral Steno sis Com plications PASTRI (Pulm BP, A fib, Systemic embolism, Tricuspid regurg, Right heart failure, Infective endocarditis --Myocar dial infarct complications ABCDE x2 (Arrhythmias / Aneurysm, Bradycardia / BP, Cardiac failure / cardiac tamponade, Dresslers / Death, Embolism / Extra (VSD, pap muscle rupture) --Pe ricarditis DRU MSTICX

(Dresslers, Rh fever / RA, Uraemia, MI, SLE, Trauma, Idiopathic, Coxsackie, Xray) --Postu ral Hyp otension HA NDI (Hypovolaemia / hypopituitarism, Addisons, Neuropathy (autonomic), Drugs (vasodilators / TCADs, diuretics, antipsychotics), Idiopathic) --Rhe umatic feve r: Majo r crite ria: CASES (Carditis, Arthritis (migratory), Subcut nodules, Erythema marginatum, Syndenhams chorea) Min or crite ria: 4PA (Pyrexia, prolonged PR, past Hx, positive (ie )ESR/CRP, Arthralgia) --Oc cl usiv e arte rial dis ease 6Ps (Pain, pallor, pulseless, parasthesia. Paralysis, perishing with cold) --Splinter haemo rr hage s TRIP SAM (Trauma, RA, Infective Endo, PAN, SLE / Sepsis, Anaemia (profound), Malignancy (haematological) --ST e levation ELEVATIO N (Electrolytes, LBBB, Early Repolarization, Ventricular hypertrophy, Aneurysm, Treatment (eg pericardiocentesis), Injury (AMI, contusion), Osborne waves (hypothermia), Non-occlusive vasospasm (prinzmetals) --SVT C au se s SNAP (Sinus tachy, nodal tachy, a fib, paroxysmal atrial tachy) --Symptoms of aortic stenosi s ASD (Angina 2 years, Syncope 1 year, Dyspnoea 6/12)

En doc ri no lo gy & Bi och em ist ry :

--Ac rome ga ly HOT ACROM EGA LY (Heart failure, / hypertension, Oedema, teeth wide spaced Appearance / Amenorrhoea, carpal tunnel syn / coarse skin / voice, reek, Oily skin, myopathy, eye (prominent supra-orbital ridge), goitre / gain wt/ galactorhoea / glycosuria, arthropathy,, large tongue & nose, yonser) --Ac idos is Met abo li c LUSK (Lactic, Uraemic, Salicylate, Ketoacidosis --Ket oa cido sis SAD (Starvation, Alcohol, DM) --In creased An io n Ga p MUD PIL ES (Methanol / metformin, Uraemia, DKA / AKA, Paraldehyde / phenformin, Iron / INH, lactic, ethylene glycol, salicylate / shock / sepsis / starvation) --No rmal Anio n Ga p Acid osi s HARD UP (Hyperventilation /hyperalimentation, Acetazolamide, RTA, diarrhoea Ureteral diversion (ureterosigmoidostomy), pancreatic fistula / parenteral NaCl) --Addis ons c auses of ANTA M (Autoimmune, Neoplastic, TB, Amyloid, Meningococcal (Waterhouse-Freidhrick)) --Diabete s, com pl ic ati ons KN IV ES (Kidney, Neuropathy, Infection, Vascular, Eyes, Skin lesions) --Hy perc al caemi a NHS MTV FAP D (Neoplastic (Bony mets, Myeloma, Sq lung), Hyperparathyroidism, Sarcoid Milk-alkali syn., Thyrotoxicosis, Vit D intoxication, Pagets (acute), Addisons, Familial, Drugs) --Hy po gly caem ia RE- EXP LAIN (Renal failure, exogenous, pituitary, liver failure, alcohol, infection, neoplasm (insulinoma) --Mult ip le endo cri ne neo pl asi a

M EN I T3P (Thyroid adenoma, Parathyroid, pituitary, pancreas (islet cell, ZE syndrome)) MEN IIa 2P M (Parathyroid, phaeo, Medullary thyroid carcinoma (MTC calcitonin)) MEN IIb 2 PM MG (As above, plus, marfanoid phenotypes, ganglioneuroma (intestinal & visceral)) --Osm ol ar Ga ps ME DIE (Methanol, ethanol, Diuretics (mannitol, sorbitol, glycerol), Isopropranolol, ethylene glycol) --Pha eo ch rom oc yto ma 4Ps (Pain, pallor, palpitations, perspiration)

Gast ro ent er olo gy :

--Ext ra- co lo nic manifest ati on s of UC & Cro hn s A P IE SACK (Aphthous ulcers, pyoderma gangrenosum, Iritis (uveitis), Erythema nodosum Sclerosing cholangitis, Ank spon & arthritis, clubbing, kidney nephritic) --Hep ati c En cep ha lo pat hy HE PATICUS (Haemorrhage, Electrolye imbalance (K+ alkalosis), protein XS (NH4 + XS), Alcohol/ Analgesics, Trauma, Infxn, Constipation, Uraemia, Surgery (post systemic shunt) --Haem orr ha gi c Asc ites MARA (Malignancy, Acute pancreatitis, Ruptured ectopic, abdominal trauma) --Gal lst ones 5F s (Fat, female, fair, fertile, forty) --Gastr ic M al ig na ncy 5As (Anaemia, Anorexia, Aesthenia, Acanthosis Nigricans, blood Group A) --Jau ndice ABCD EF GHIJ (Anaesthetics (halothane), Blood transfusions, Contacts, Drugs, Ethanol, Foreign travel, Gallstones / Gilberts, Homosexual / Haemophilia / Hepatitis, Idiopathic / IVDA Job - farmers, sewage workers (leptospirosis - Weils)) --Mout h Ul cers DR AG TIE (Drug (gold, steroid), Rheumatological (bechet, reiter), Apthous, ?? Trauma, Infecion (HSV, VZV; syphilis, TB, Erythema Multiforme))

Hae matol og y & O ncol og y:

--Mac ro cyt ic An aemia Ma cr oc yti c Anaemi a Leave s Big Fa t Ret icu lo cytes (Myxoedema, Alcohol, Liver disease, B12 def., Folate def., Reticulocytosis) --Targe t Cell s HOT LI PS (Haemoglobinopathy, Obs jaundice, Thalasaemia, Liver abscess, Iron def., Polycythaemia, Sideroblastic anaemia) --Mult ip le Mye lom a BAHRAIN UV (Bone pain, Anaemia, Hyper Ca2+, Renal failure, Amyloidosis, Infection, Neuropathy (hyper) Uricaemia / viscosity) --Sus pect ma li gn anc y in mela nom a BITCHES (Bleeds, Irregular / Itch, Tender, Colour change, Halo, Enlargement, Satellite lesions) --Tum ours w hi ch s pre ad to bo ne PUBLIK T (Prostate, Uterine, Breast, Lung, Intestine (stomach), Kidney, Thyroid)

Neph ro lo gy :
--Chro ni c v s- Acute rena l disea se SNAB (Small kidney, Neuropathy (periph), Anaemia, Bone disease) --Chro ni c Ren al F ai lure GLA D SHOP (Glomerulonephritis, Lupus, Analgesics, DM, Systemic vascular disease, Hypertension, Obstruction, Polycystic kidney disease) --Nep hr oti c Syndr ome GLA DD ER (Glomerulonephritis, SLE, DM, Eclampsia, Renal vein thrombosis)

--Uni late ra l pa lp ab le kidney Wilm s HARP (Wilms, Hydronephrosis, Acute Renal Vein thrombosis, acute pylonephritis, Renal Cell Ca, PKD, pyonephrosis)

Neur ol og y:
--Absent ank le jer ks but extens or p la nt ars Sex can make the F*in g ank les Dorsif lex (Subacute combined degeneration of the cord, Conus Medullaris, Motor Neurone disease Tabes dorsalis, Fredreichs Ataxia, Diabetic neuropathy) --Al tered Ment al State AEIOU TI PS (Alcohol (drugs), Endocrine, Insulin, Opiates, Ureamia, Toxins / trauma / tumour, Infections, Psychosis / Porphyria, SOL / stroke / seizure / shock) --Cerebel la r sig ns VANISH D DT (Vertigo, Ataxia, Nystagmus, Intention tremor, Slurred speech, Hypotonia, Dysdiadocokinesia, Dysmetria, Titubation) or PINAR DS (Past-pointing, Intention tremor, Nystagmus, Ataxia, Rebound, Dysdiad, Slurred Speech) --Confusi on DI M F ACES (Drugs / Dehydration, Infection, Metabolic / MI, Fracture / Failure, Alcohol / Anaemia, CVA, Electrolyte disturbances, S.O.L.) --Dystr op hia M yo to nic a BIG CHI PS (Balding (frontal), Intellectual impairment, Glucose intolerance, Cataracts / Cardiomyopathy, Handshake / Hyporeflexia, IgG, Ptosis, Small gonads) --Mon oneu riti s Mu lti plex DRAW CLA PS (DM, RA, AIDS, Wegeners, Carcinomatosis / Churg-Strass, Leprosy, Amyloid, PAN, SLE) --Mult ip le sc lero sis CURSE D HIV (Cerebellar signs, UMNL, Retrobulbar neuritis, Spastic paraparesis, Euphoria, Dementia / Depression / Diplopia, Horners, Incontinence, Vertigo / Vomiting) --Musc les su pp lied by Medi an Nerve LOAF (Lumbricales, Opp pollicus, Abd pollicus, Flex pollicus brevis) --Neuro pa th ic Ulcers TADS (Tabes Dorsalis, Alcohol, DM, Syringomyelia) --Par kin so ns PA RKINSO NS (Pill rolling, akinesia, rigidity, kyphosis, instability, neck titubation, shuffling gait, occulogyric crisis, nose tap (glabellar), small writing) --Pe rip he ra l neuro pa th y DANG TH E PA PIST (DM, Alcohol, Nutrition (B1, B2, B12), Guillian Barre, Trauma, Hereditary, Environmental (lead, drugs), Paraneoplastic, Amyloid, Porphyria, Inflammatory, Syphilis, Tumours of nerves (HMSN) --Pol yneur op at hy VITA MINS (Vit def / vasculitides, infection (TB, leprosy, syphillis, polio), Toxins (amiodarone, antiseptics, INH, lead, metronidazole, phenytoin, vincristine), Amyloid, Metabolic (alcohol, DM, thyroid, porphyria, liver & renal failure), Idiopathic / Inherited, Neoplasm, Systemic (SLE, PAN, multiple myeloma) --Pon tine Haem orr ha ges 3Ps (Paralysis, Pin-point pupils, Pyrexia) --Prematu re senile dement ia DE EP SHIT (Deficiency B12, Epilepsy, Endocrine (myxoedema), Parkinsonism Syphilis (GPI), Huntingtons, Injury, Tumour) --Prox ima l My op at hy PD HEN (Polymyositis, Dermatomyositis, Hereditary Muscular Dystrophies, Endocrine (DM, Cushings, Osteomalacia, Thyrotoxicosis - DM COT), Neuropathy --Pupils: Smal l HAPP Y (Horners, Argyll-Robertson, Pontine haemorrhage, Pilocarpine, Happy (morphine)

--Ar gyl l Ro berts on SAD E (a cc ommod ates but does nt react c.f. pro stitu te) (Syphilis, Alcohol, DM, Encephalitis) --Sma ll musc le was tin g MARS BAR (MND / Myopathies, Apical tumours, RA, Syringomyelia, Brachial Plexus injuries, Ageing, cervical Rib) --Syn co pe HEAD , HEA RT & V ESSLS (Hypoglycaemia / hypoxia, epilepsy, anxiety, drop attack (brain stem Dysfunction - TIA) Heart attack, embolism, aortic obstruction (stenosis, myxoma, IHSS), rhythm, tachy - VT Vasovagal, ectopic preg, situational (on the crapper), subclavian steal, low SVR (anaphylaxis, shock, DIC), Sick sinus syndrome) --Werni cke s and Ko rsa koffs CANON (Confusion, Ataxia, Nystagmus, Ocular palsy, Neuritis) --Pe s Ca vus Dise ase Can Sho rten The Foo t (DM, Charcot Marie Tooth, Syringomyelia, Tabes dorsalis, Fredreichs Ataxia)

Pha rm acol og y & T oxic ol og y:

--ACEI , Side FX CA PTO PRIL (Cough, anaphylaxis, palpitations, taste, orthostatic BP, Potassium (K+), Renal impairment, impotence, leucocytosis) --Ant i-epi lep ti c Side FX ABC DE FGH (Ataxia, blood dyscrasia, cleft lip, dupuytrens / vit D def, exfoliation of skin & Stevens Johnsons. Fits, GI upset / gum hypertrophy, hepatitis / hairy) --Ba rbitur ate Side FX ABC D (Ataxia, behavioural disturbance, concentration / coma, depression / drowsy / diplopia) --Cho line rg ic OD Side F X DUM B BELS (Diarrhoea, Urination, Miosis / muscle weakness, bronchorrea, Bradycardia, emesis, lacrimation, salivation / sweating) --Cy cl osp or in Side FX 4HRT (4H - Hyper K+, hypertension, gum hypertrophy, hairy; R Renal toxicity; T Tremor) --Dig oxi n S/E GECCKO (GIT n&v, abdo pain, ulcers; Eyes blurring, halo, xanthopsia; CNS depression, confusion, delirium, hallucinations; Cardiac ANY arrhythmia; K low) --Gy naec om asti a (drug s) DISCO MTV (Digoxin, Isoniazid, Spironolactone, Cimetidine, Oestrogens, Methyldopa/metronidazole, TCAD, Verapamil) --MAOI Side FX 3Hs (Hepatocellular jaundice, Hyperthermia, hypertension) --Pro pr an ol ol C ont ra-i ndic ati ons ABCD E (Asthma, heart Block, cardiac failure, DM (hypoglycaemic shock), Extremities (occlusive arterial disease) --Pulm ona ry Oedema, n on-c ardi ac PONS (Phosgene / paraquat / phenothiazines, opioids / organophosphates, Nitrous dioxide, salicylate) --TCA D Side FX CAN WOO (Cvs, Anticholinergic, Neuro, Withdrawal, Overdose, Others) --Rat p oi so n RATS PANIC (Red squill, arsenic, thallium, strychnine, PNU, phosphorus, ZN phosphide, alpha naphtha thiurea (ANTU), norbormide, indanediones, coumarin / cholecalciferol) --Ster oids Side F X HIGH COMP ACT I MPS (Hypertension, Immunosuppression, Gastric Ulcer (bleeding), Heartburn, Cataract, Osteoporosis, Muscle weakness, Path # / Psychosis, Acne / Altered Glucose, Cushingoid, Thin skin, Increased appetite, Myopathy, poor wound healing, stress response reduced) Or AM CUSHINGOID (Acne, Myopathy (prox) / muscle wasting (prox)

Cushingoid / Cataract, Ulcers, Striae, skin thin (bruising), Hypertension / hairy, Infection, Glycosuria, Obesity / Osteoporosis / Oedema, Immunosuppression / Insomnia, Depression) --Warfa rin WEP T (Warfarin, Extrinsic pathway, measure PT)

Ps ych iatr y:
--De pre ssi on PISS CAG E (Psychomotor movts, interest, suicidal, sleep, concentration, appetite, guilt, energy) --Suic ide risk fact ors SAD PERSON (Sex / single / sickness, age, depression, Previous attempt, EtOH, reality testing, social support, organised plan, note / no spouse)

Rad iol og y:
--Bi late ra l hi la r lymp ha deno pa th y Ple ase Helen Lic k My Pop si cle Sti ck (Primary TB, histoplasmosis, lymphoma, mets, pneumoconiosis, sarcoid) --Med ias tin al M as s Ante rio r 4Ts (Thyroid, Thymoma, Teratoma, Terrible lymphoma) M iddle HABIT5 (Hernia / haematoma, aneurysm, bronchogenic Ca / duplication cyst, inflammation (sarcoid, histio, coccidio, TB), Tumour 5 lung, lymphoma, leukaemia, leiomyoma, lymph nodes) --Oss ific ati on ce ntres a t elbow CITRO En (Capitellum, internal (med epicond), trochlea, radial head, olecranon, external (lat epicond) --Radio- op aque in gest ant s CHIP ES (Cocaine condoms / chloral hydrate / calcium, heavy metals, iron / iodides, psychotropics (TCADs, phenothiazines), enteric coated Ba, Solvents (CCl4)

Re spi rat or y:
--Acu te Asthm a NOAH (Nebulisers, Oxygen, Antibiotics / Aminophylline, Hydrocortisone) --Ast hma Trig ger s ASTH MAD (Allergens, Stress/Sports, Temp, Hereditary, Microbiology, Anxiety, Drugs) --Chro ni c co ug h, non- smo ker, norm al CX R HARD (Heart failure (MS), Asthma, reflux (GORD), drip / drugs) --Cry pt og eni c Fibr os ing Alve ol itis 5Cs (Clubbing, Cyanosis, Crackles, Cough, Corticosteroids) --Fibro sis Up per l obe CHAR TS (Coal workers pneumoconiosis (PMF), Histiocytosis X, Ank spon / ABPA, Radiation, TB, Silicosis (PMF) / Sarcoidosis) L ower lobe RASIO (RA, Asbestosis, Scleroderma, Idiopathic fibrosing alveolitis, Other (durgs Amiodarone, busulphan, bleomycin, hydralazine, MTX, nitrofurantoin) --Lun g abs cess SOAP (Spread (hepatic, subphrenic) / Septic emboli, Obstruction (FB, tumour), Aspiration (alcohol, bulbar palsy, achalasia, CVA), pulmonary infarct / pneumonia Pleural effusions) --Exud ati ve PIN TARS (Pneumonia / Pancreatitis, Infarction, Neoplasm, TB/ Trauma, Abscess, RA, Systemic stuff (SLE, Sarcoidosis, Systemic sclerosis)

--Tr ansud ati ve CHAR M (Al l the failure s - he art , li ver , ren al et c.) (Carditis, Hypothyroid, Hypo-Albuminaemia, Renal, Meigs / Malabsorption) --Pneumo th or ax ST PATS F C (Spontaneous / Sport, Trauma, Pneumonia, Positive Ventilation, Abscess/ Asthma/ Ascend (in aeroplane), TB, Sarcoid, Fibrosing Alveolitis, Carcinoma / COAD / CF

Rheu mat olo gy :

--An kyl osi ng Spo ndyli tis 4As (Apical fibrosis, Anterior uveitis, Aortic regurgitation, Achilles tendonitis) --Ca rp al Tunne l Syndrome DOG ARM P IT (Dialysis, Obesity, Gout, Amyloid/Acromegaly, RA, Myxoedema, Pregnancy/Pill, Idiopathic, Trauma/TB) --Dupuy trens Cont ra cture POT FACE D (Peyronies Disease, Occupation, Trauma; Familial, Alcohol, Cirrhosis, Epliepsy (antiepileptics), DM) --Sero neg ati ve Art hr op at hies SCRAP BW (Stills, Colitis, Reiters, Ankylosing Spondylitis, Psoriasis, Bechets, Whipples) --Sar co ido sis SARCOID S - Skin (erythema nodosum, nodules, lupus pernio, scar infiltrations) A Arthritis, ACE R - Respiratory (bilateral hilar lymphadenopathy) C - Calcium , CNS, Cranial & periph nerve palsies O - Orbit (keratoconjunctivitis, glaucoma, uveitis), Organomegaly I - Interstitial lung fibrosis D - Diabetes insipidus Or P ERNIO (Pulmonary, Eyes, Renal, Nerves, Infiltration (scars), Organomegaly) --Swo lle n DI P jo int s SPRO G (Sarcoid, Psoriasis, Reiters, OA, Gout)

Su rg er y:
--Abdomi na l disten sio n 5Fs (Fat, Fluid, Faeces, Flatus, Fetus) --Acu te Ab domen ME DIC CURSES A MOP (Mesenteric Adenitis, Enteritis, Diverticulitis, Ischaemic Colitis, Cholycystitis, Ulcers, Renal Colic, Salphingitis, E ctopic Pregnanc y , Small bowel obstruction, Appendicitis Meckels Diverticulum, Ovarian Cyst, Pancreatitis) --Bleedi ng PR Haemor rh oid al D RAIN (Haemorrhoids, Diverticulitis, Radiation enteritis, AV malformation, Ischaemia, Neoplasm) --GI ob stru cti on PV D& C (Pain, Vomiting, Distension, Constipation) --Haem atemesis GU M BLE EDIN G (Gastritis, Ulcer, Mallory-Weiss, Biliary (Haemobilia), Large varices, Esophagitis, Entero-aortic fistula, Duodenitis, IBD, Neovascularisation, Gastric carcinoma) --NG tube remo va l po st o p 4 Ps (Peristalsis, Passage of flatus, Paucity of aspirate, Patient Peckish) --Le g Ulcers VAIN PAIN (Venous, Arterial, Infection (e.g. syphilis), Neuropathic, Pressure sores, Arthritis (e.g. RA, PAN), Injury / IDB, Neoplastic) --Pan cre atit is GET SMASHED (Gallstones / Gravid, Ethanol, Trauma (incl. surgery), Steroids, Mumps, Autoimune (PAN), Scorpion bites, Hyper-lipid / calcium / hypothermia, ERCP, Drugs (azothioprine, thiazide diuretics) Ronsons criteria: ACUTELY (Wh at A GAL) > 48 h our s (FUCH BO)

Fluid sequestered (>6L) Urea (>10mmol) Ca2+ (<2mmol) Haematocrit (>10%) Base XS (>-4) O2 (<8kPa) --Pro ph yl ac ti c ant ibio tic s APPL E (Amputations, Prosthesis, Penetrating wounds, Large bowel surgery, Endocarditis) --Sma ll bowe l obs truc tio n SHAVIT (Stone, Hernia, Adhesions, Volvulus, Intussusception, Tumour)

WCC Age Glu AST LDH