internal medicine mnemonics

[drfaten]

i will try to collect mnemonics from internet or some i did to make a great libraray ISA.

all of u can put urs but plz try to conserve the order so as any one want to print them,he can do it easily e out difficulty.if any one can not do that.he can send his to me in personal message

also lease avoid thanks phrase. no need fr that

[drfaten]

ELECTROLYTES
Hypercalcemia causes

MD PIMPS ME:
Malignancy
Diuretics (thiazide the main culprit)
Parathyroid (hyperparathyroidism)
Immobilization/ Idiopathic
Megadoses of vitamins A,D
Paget's disease
Sarcoidosis
Milk alkali syndrome
Endocrine (Addison's disease, thyrotoxicosis

OR
GRIM FED:
Granulomas (sarcoid, TB),
Renal faliure
Immobility (esp. long term)
Malignancy
Familial (eg familial hypocalciuric hypercalcemia)
Endocrine (see below for subtypes)
Drugs (esp. thiazide diuretics, lithium)
· Endocrine causes are PATH:
Phaeochromocytoma
Addison's disease
Thyrotoxicosis
Hyperparathyroidism

OR
VITAMIN TRAPS:
Vitamin A and D intoxication
Immobilization
Thyrotoxicosis
Addison's disease/ Acidosis
Milk-alkali syndrome
Inflammatory disorders
Neoplastic disease
Thiazides, other drugs
Rhabdomyolysis
AIDS
Paget's disease/ Parenteral nutrition/ Parathyroid disease
Sarcoidosis

Hypernatremia: causes
6 D's:
Diuretics
Dehydration
Diabetes insipidus
Docs (iatrogenic)
Diarrhea
Disease: kidney, sickle cell, etc

[b]Na+/K+ pump: movement of ions and quantity [/b]
K+ and in each consist of 2 characters, so so 2 K+ are pumped in.
Na+ and out each consist of 3 characters, so 3 Na+ are pumped out

OR
DDx of Hyperkalemia: ART x 3
A rtifact, e.g. hemolytic sample
A CEi treatment
A ddison’s

R enal failure
R habdomyolysis
R TA type 4

T umor lysis syndrome
T ranscellular shift, e.g. in acidosis
T reatment – urgent treatment required if K+ > 6

DDx of Hypokalemia: BAD LOAD
B arter’s, Conn’s syndrome (hyperaldosteronism)
A lkalosis
D iuretics

L axative abuse
O ther cause, e.g. insulin overdose
A cute glucose load
D iarrhea

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Acid base disorder
Alkalosis: metabolic changes in alkalosis
"Al-K-loss, Al-Ca-loss":
There is loss of K+ (hypokalemia) and Ca++ (hypocalcemia) in state of alkalosis


Metabolic acidosis (normal anion-gap): causes
· With hyperkalemia: RAISE K+:
RTA type 4
Aldosterone or mineralocorticord deficiency
Iatrogenic: NH4Cl, HCl
"Stenosis": obstructive uropathy
Early uremia
· With hypokalemia: ReDUCE K+:
Renal TA type 1 and 2
Diarrhoea
Urine diversion into gut
Carbonate anhydrase inhibitor
Ex-hyperventilation
 

Metabolic acidosis: causes
KUSSMAL:
Ketoacidosis
Uraemia
Sepsis
Salicylates
Methanol
Alcohol
Lactic acidosis

OR
Metabolic acidosis: causes
USED CAR:
Ureteroenterostomy
Saline hydration
Endocrinopathies (hyperparathyroid, hyperthyroid, Addison's)
Diarrhea/ DKA/ Drugs
Carbonic anhydrase inhibitors
Ammonium chloride
Renal tubular acidosis
· Alternatively: USED CARP, to include Parenteral nutrition/ Pancreatic fistula

OR
RAGE:
R : renal tubular acidosis, respiratory acidosis
A : acetazolamide, ammonium chloride
G : GI (diarrhea, enteroenteric fistula, ureterosigmoidostomy)
E : endocrine (same as above endocrine list)
 
Non-gap acidosis: causes
HARD UP:
Hyperalimentation
Acetazolamide (carbonic anhydrase inhibitors)
RTA
Diarrhea
Ureterosigmoidostomy
Pancreatic fistula
 
Anion gap metabolic acidosis: causes
A MUDPILE CAT:
Alcohol
Methanol
Uremia
Diabetic ketoacidosis
Paraldehyde
Iron/ Isoniazid
Lactic acidosis
Ethylene glycol
Carbamazepine
Aspirin
Toluene

OR
 
DULSI:
  D : diabetic ketoacidosis
U : uremia
L : lactic acidosis
S : salicylate poisoning
I : intoxicants (methanol, ethanol, ethylene glycol

ARMADA - Acid-base balance work-up in 6 steps by answering 6 questions:

1. A cidosis or Alkalosis?

2. R espiratory disorder? – acidosis or alkalosis – check PaCO2

3. M etabolic disorder? – acidosis or alkalosis – check HCO3

4. A nion Gap?

5. D elta AG?

6. A ssess compensation

Top 10 Clinical Pearls in Acid-base Disorders
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Osmolar Gaps
"ME DIE"
M - Methanol
E - Ethanol
D - Diuretics (mannitol, sorbitol, glycerol)
I - Isopropanol
E - Ethylene glycol

Respiratory Alkalosis: Asthmatic Sally poisoned POPE's HEN
• Asthma
• Salicylate poisoning
• PO= Pulmonary Oedema
• PE= Pulmonary Embolism
• HEN= Hepatic Encephalopathy

[Manal Alshamikh]

Wooow, those mnemonics should be helpful for my Clinical exam
Thanks Dr.

[drfaten]

pancreatitis
Pancreatitis (acute): causes
I GET SMASHED:
Idiopathitic
Gallstones
Ethanol
Trauma
Steroids
Mumps
Autoimmune (PAN)
Scorpion stings
Hyperlipidemia/ Hypercalcemia
ERCP
Drugs (including azathioprine and diuretics)
· Note: 'Get Smashed' is slang in some countries for drinking, and ethanol is an important pancreatitis cause.
· Note: Shortest answer is gallstones for women, and ethanol for men. And scorpian stings for people from Trinidad

Pancreatitis: Ranson criteria for pancreatitis at admission
LEGAL:
Leukocytes > 16.000
Enzyme AST > 250
Glucose > 200
Age > 55
LDH > 350
 
Pancreatitis: Ranson criteria for pancreatitis: initial 48 hours
"C & HOBBS" (Calvin and Hobbes):
Calcium < 8
Hct drop > 10%
Oxygen < 60 mm
BUN > 5
Base deficit > 4
Sequestration of fluid > 6L
 

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LIVER AND GALL BLADDER
Hepatic encephalopathy: precipitating factors
ABCDEFI:
Alcohol withdrawal
Bleeding (GI)
Constipation
Drugs: withdraw any sedatives/narcotics
Electrolyte imbalances
Fluid depletion: stop diuretics
Infections: treat vigorously

OR
Hepatic encephalopathy: precipitating factors
HEPATICS:
Hemorrhage in GIT/ Hyperkalemia
Excess protein in diet
Paracentesis
Acidosis/ Anemia
Trauma
Infection
Colon surgery
Sedatives

Cirrhosis: differential: common and rarer
· Common causes are ABC:
Alcohol
B (Hepatitis)
C (Hepatitis)
· Rarer are also ABC:
Autoimmune
Biliary cirrhosis
Copper (Wilson's)
 
Liver failure (chronic): signs found on the arms
CLAPS:
Clubbing
Leukonychia
Asterixis
Palmar erythema
Scratch marks

Cirrhosis: causes of hepatic cirrhosis
HEPATIC:
Hemochromatosis (primary)
Enzyme deficiency (alpha-1-anti-trypsin)
Post hepatic (infection + drug induced)
Alcoholic
Tyrosinosis
Indian childhood (galactosemia)
Cardiac/ Cholestatic (biliary)/ Cancer/ Copper (Wilson's

Liver failure: decompensating chronic liver failure differential
HEPATICUS:
Haemorrhage
Electrolyte disturbance
Protein load/ Paracetamol
Alcohol binge
Trauma
Infection
Constipation
Uraemia
Sedatives/ Shunt/ Surgery
 
IBD: extraintestinal manifestations
A PIE SAC:
Aphthous ulcers
Pyoderma gangrenosum
Iritis
Erythema nodosum
Sclerosing cholangitis
Arthritis
Clubbing of fingertips
 
OR
IBD: surgery indications
"I CHOP":
Infection
Carcinoma
Haemorrhage
Obstruction
Perforation
· "Chop" convenient since surgery chops them open

Bilirubin: common causes for increased levels
"HOT Liver":
Hemolysis
Obstruction
Tumor
Liver disease

 Charcot's triad (gallstones)
"Charcot's Triad is 3 C's":
Color change (jaundice)
Colic (biliary) pain, aka RUQ pain
Chills and fever

[Shahad M. Ajmi]

Thanks Doctor for these mnemonics =) ,,

[drfaten]

Cardiology
Aortic stenosis characteristics
 SAD:
Syncope
Angina
Dyspnoea

MI: basic management
 BOOMAR:
Bed rest
Oxygen
Opiate
Monitor
Anticoagulate
Reduce clot size

ECG: left vs. right bundle block "WiLLiaM MaRRoW":
W pattern in V1-V2 and M pattern in V3-V6 is Left bundle block.
M pattern in V1-V2 and W in V3-V6 is Right bundle block.
· Note: consider bundle branch blocks when QRS complex is wide

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Pericarditis:[/u][/b]
causes CARDIAC RIND:
Collagen vascular disease
Aortic aneurysm
Radiation
Drugs (such as hydralazine)
Infections
Acute renal failure
Cardiac infarction
Rheumatic fever
Injury
Neoplasms
Dressler's syndrome

Murmurs: systolic types SAPS:
Systolic
Aortic
Pulmonic
Stenosis
· Systolic murmurs include aortic and pulmonary stenosis.
· Similarly, it's common sense that if it is aortic and pulmonary stenosis it could also be mitral and tricusp regurgitation].

MI: signs and symptoms PULSE:
Persistent chest pains
Upset stomach
Lightheadedness
Shortness of breath
Excessive sweating

Heart compensatory mechanisms that 'save' organ blood flow during shock "Heart SAVER":
Symphatoadrenal system
Atrial natriuretic factor
Vasopressin
Endogenous digitalis-like factor
Renin-angiotensin-aldosterone system
· In all 5, system is activated/factor is released

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Murmurs: right vs. left loudness "RILE":
Right sided heart murmurs are louder on Inspiration.
Left sided heart murmurs are loudest on Expiration.
· If get confused about which is which, remember LIRE=liar which will be inherently false.

ST elevation causes in ECG, ELEVATION:
Electrolytes
LBBB
Early repolarization
Ventricular hypertrophy
Aneurysm
Treatment (eg pericardiocentesis)
Injury (AMI, contusion)
Osborne waves (hypothermia)
Non-occlusive vasospasm

Beck's triad (cardiac tamponade) 3 D's:
Distant heart sounds
Distended jugular veins
Decreased arterial pressure

MI: therapeutic treatment ROAMBAL:
Reassure
Oxygen
Aspirin
Morphine (diamorphine)
Beta blocker
Arthroplasty
Lignocaine

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CHF: causes of exacerbation FAILURE:
Forgot medication
Arrhythmia/ Anaemia
Ischemia/ Infarction/ Infection
Lifestyle: taken too much salt
Upregulation of CO: pregnancy, hyperthyroidism
Renal failure
Embolism: pulmonary

Murmurs: systolic vs. diastolic PASS: Pulmonic & Aortic Stenosis=Systolic.
PAID: Pulmonic & Aortic Insufficiency=Diastolic

Murmurs: systolic vs. diastolic Systolic murmurs: MRAS: "MR. ASner".
Diastolic murmurs: MS AR: "MS. ARden".
· The famous people with those surnames are Mr. Ed Asner and Ms. Jane Arden

Mitral stenosis (MS) vs. regurgitation (MR): epidemiology MS is a female title (Ms.) and it is female predominant.
MR is a male title (Mr.) and it is male predominant.

Pericarditis: EKG "PericarditiS":
PR depression in precordial leads.
ST elevation

Jugular venous pressure (JVP) elevation: causes HOLT: Grab Harold Holt around the neck and throw him in the ocean:
Heart failure
Obstruction of venea cava
Lymphatic enlargement - supraclavicular
Intra-Thoracic pressure increase

Depressed ST-segment: causes DEPRESSED ST:
Drooping valve (MVP)
Enlargement of LV with strain
Potassium loss (hypokalemia)
Reciprocal ST- depression (in I/W AMI)
Embolism in lungs (pulmonary embolism)
Subendocardial ischemia
Subendocardial infarct
Encephalon haemorrhage (intracranial haemorrhage)
Dilated cardiomyopathy
Shock
Toxicity of digitalis, quinidine
Murmurs: innocent murmur features 8 S's:
Soft
Systolic
Short
Sounds (S1 & S2) normal
Symptomless
Special tests normal (X-ray, EKG)
Standing/ Sitting (vary with position)
Sternal depression


Murmur attributes "IL PQRST" (person has ill PQRST heart waves):
Intensity
Location
Pitch
Quality
Radiation
Shape
Timing

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Murmurs: locations and descriptions "MRS butt":
MRS: Mitral Regurgitation--Systolic
butt: Aortic Stenosis--Systolic
· The other two murmurs, Mitral stenosis and Aortic regurgitation, are obviously diastolic

Betablockers: cardioselective betablockers "Betablockers Acting Exclusively At Myocardium"
· Cardioselective betablockers are:
Betaxolol
Acebutelol
Esmolol
Atenolol
Metoprolol

Apex beat: abnormalities found on palpation, causes of impalpable HILT:
Heaving
Impalpable
Laterally displaced
Thrusting/ Tapping
· If it is impalpable, causes are COPD:
COPD
Obesity
Pleural, Pericardial effusion
Dextrocardia

MI: treatment of acute MI COAG:
Cyclomorph
Oxygen
Aspirin
Glycerol trinitrate

Coronary artery bypass graft: indications DUST:
Depressed ventricular function
Unstable angina
Stenosis of the left main stem
Triple vessel disease
Peripheral vascular insufficiency: inspection criteria SICVD:
Symmetry of leg musculature
Integrity of skin
Color of toenails
Varicose veins
Distribution of hair

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Heart murmurs "hARD ASS MRS. MSD":
hARD: Aortic Regurg = Diastolic
ASS: Aortic Stenosis = Systolic
MRS: Mitral Regurg = Systolic
MSD: Mitral Stenosis = Diastolic

Mitral regurgitation When you hear holosystolic murmurs, think "MR-THEM ARE holosystolic murmurs

Sino-atrial node: innervation Sympathetic acts on Sodium channels (SS).
Parasympathetic acts on Potassium channels (PS
Supraventricular tachycardia: treatment ABCDE:
Adenosine
Beta-blocker
Calcium channel antagonist
Digoxin
Excitation (vagal stimulation)


Ventricular tachycardia: treatment LAMB:
Lidocaine
Amiodarone
Mexiltene/ Magnesium
Beta-blocker

Pulseless electrical activity: causes PATCH MED:
Pulmonary embolus
Acidosis
Tension pneumothorax
Cardiac tamponade
Hypokalemia/ Hyperkalemia/ Hypoxia/ Hypothermia/ Hypovolemia
Myocardial infarction
Electrolyte derangements
Drugs
Sinus bradycardia: aetiology "SINUS BRADICARDIA" (sinus bradycardia):
Sleep
Infections (myocarditis)
Neap thyroid (hypothyroid)
Unconsciousness (vasovagal syncope)
Subnormal temperatures (hypothermia)
Biliary obstruction
Raised CO2 (hypercapnia)
Acidosis
Deficient blood sugar (hypoglycemia)
Imbalance of electrolytes
Cushing's reflex (raised ICP)
Aging
Rx (drugs, such as high-dose atropine)
Deep anaesthesia
Ischemic heart disease
Athletes


Rheumatic fever: Jones criteria · Major criteria: CANCER:
Carditis
Arthritis
Nodules
Chorea
Erythema
Rheumatic anamnesis
· Minor criteria: CAFE PAL:
CRP increased
Arthralgia
Fever
Elevated ESR
Prolonged PR interval
Anamnesis of rheumatism
Leucocytosis

JVP: wave form ASK ME:
Atrial contraction
Systole (ventricular contraction)
Klosure (closure) of tricusps, so atrial filling
Maximal atrial filling
Emptying of atrium


Coronary artery bypass graft: indications DUST:
Depressed ventricular function
Unstable angina
Stenosis of the left main stem
Triple vessel disease

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Exercise ramp ECG: contraindications RAMP:
Recent MI
Aortic stenosis
MI in the last 7 days
Pulmonary hypertension

ECG: T wave inversion causes INVERT:
Ischemia
Normality [esp. young, black]
Ventricular hypertrophy
Ectopic foci [eg calcified plaques]
RBBB, LBBB
Treatments [digoxin]

Rheumatic fever: Jones major criteria JONES:
Joints (migrating polyarthritis)
Obvious, the heart (carditis, pancarditis, pericarditis, endocarditis or valvulits)
Nodes (subcutaneous nodules)
Erythema marginatum
Sydenham's chorea

Myocardial infarctions: treatment INFARCTIONS:
IV access
Narcotic analgesics (eg morphine, pethidine)
Facilities for defibrillation (DF)
Aspirin/ Anticoagulant (heparin)
Rest
Converting enzyme inhibitor
Thrombolysis
IV beta blocker
Oxygen 60%
Nitrates
Stool Softeners

Atrial fibrillation: causes PIRATES:
Pulmonary: PE, COPD
Iatrogenic
Rheumatic heart: mirtral regurgitation
Atherosclerotic: MI, CAD
Thyroid: hyperthyroid
Endocarditis
Sick sinus syndrome

Atrial fibrillation: management ABCD:
Anti-coagulate
Beta-block to control rate
Cardiovert
DigoxiN
Anti-arrythmics: for AV nodes "Do Block AV":
Digoxin
B-blockers
Adenosine
Verapamil


Murmurs: systolic MR PV TRAPS:
Mitral
Regurgitation and
Prolaspe
VSD
Tricupsid
Regurgitation
Aortic and
Pulmonary
Stenosis

Apex beat: differential for impalpable apex beat DOPES:
Dextrocardia
Obesity
Pericarditis or pericardial tamponade
Emphysema
Sinus inversus/ Student incompetence