مهم جدا قبل امتحانات الشفوي mnimonics in medicine :part I

This document contains mnemonics on the following topics:

CLINICAL SKILLS

CARDIOVASCULAR

CLINICAL CHEMISTRY

DERMATOLOGY
...

ENDOCRINOLOGY

GASTROENTEROLOGY

HAEMATOLOGY

INFECTIOUS DISEASES

NEUROLOGY

OBSTETRICS AND GYNAECOLOGY

OPHTHALMOLOGY

PAEDIATRICS

PSYCHIATRY

RENAL

RESPIRATORY

RHEUMATOLOGY

SURGERY

TRAUMA AND ORTHOPAEDIC



CLINICAL SKILL





Full Medical History

When taking a history:

Mnemonic: OPERATES

O Onset of complaint

P Progress of complaint

E Exacerbating factors

R Relieving factors

A Associated symptoms

T Timing

E Episodes of being symptom-free

S Relevant Systemic and general inquiry can be added here

Medications/allergies

Mnemonic: PILLS

P Pills, is the patient taking any?

I Injections/Insulin/Inhalers (as some patients forget to mention when asked

about their medications)

LL ILLicit drug use

S Sensitivities to anything, ie allergies

In every history, donʼt forget to ask about the ʻFAWRʼ non-specific symptoms that the

patient may exhibit

Mnemonic: FAWR

F Fever

A Appetite

W Weight loss (unintentional)

R Reduced energy (i.e. fatigue/lethargy)

When assessing psychological state:

Mnemonic: SAD CASE

S Suicidal ideations

A Anxiety

D Decreased mood/Delusions/Disordered thought

C Difficulty Concentrating

A Auditory or other hallucinations?

S Difficulties Sleeping

E Eating normally?

Information organization

When asked to discuss a particular disease, the following surgical sieve is widely

regarded as the best way to proceed:

Mnemonic: Dressed In a Surgeons Gown A Physician Might Make Progress

D Definition

I Incidence

S Sex

G Geography

A Aetiology

P Pathogenesis

M Macroscopic pathology



M Microscopic pathology

P Prognosis





CARDIOVASCULAR

Anatomy

To remember heart valve auscultation sites:

Mnemonic: All Patients Take Medications

Starting from top left:

Aortic – 2nd intercostal space, right sternal edge

Pulmonary – 2nd intercostal space, left sternal edge

Tricuspid – 4th intercostal space, right sternal edge

Mitral – 5th intercostal space, mid-clavicular line

Angina

Management through lifestyle alterations

Mnemonic: SLEW

S Smoking cessation

L Low-fat diet

E Exercise

W Weight loss

Management of acute unstable angina

Mnemonic: 2 As and BALI

A Admit, bed rest, high-flow oxygen

A Analgesia

A Aspirin and clopidogrel

B Beta blockers

A Angiography with or without angioplasty/CABG if symptoms fail to improve

L Low molecular weight heparin (LMWH)

I Infusion of nitrates

Presentation

Mnemonic: SCAR

S Sudden central pain, ʻtearingʼ in nature, may radiate to the back

C Coronary artery occlusion can lead to chest pain, MI or angina

pectoris/Carotid obstruction can lead to hemiparesis, dysphasia or blackouts

A Anterior spinal artery can be affected leading to paraplegia

R Renal artery can be affected leading to anuria or renal failure

Cardiac arrest

Management, Basic Life Support (BLS)

Mnemonic: ABC

A Airway: clear and maintain with chin lift/jaw thrust/head tilt (if no spinal injury)

B Breathing: look, listen and feel, if not breathing give two life saving breaths

immediately

C Circulation: carotid pulse for at least 10 s, if absent give 15 chest

compressions at 100/min

Continue the cycle of 2 breaths and 30 compressions and check the circulation every

minute, proceed to more advanced life support when possible.

Management, Advanced Life Support (ALS)

Mnemonic: CDE (with A after every step)

C Cardiac monitor and defibrillator should be attached to the patient

A Assess rhythm and pulse

D Defibrillate x 3 if VF or pulseless VT, CPR for 1 min

A Assess rhythm and pulse

E EMD (no cardiac output despite ECG showing electrical activity) or asystole

warrants CPR for 3 min

A Assess rhythm and pulse

Hypertension

Treatment

Mnemonic: ABCD

A ACE inhibitors/Angiotensin-II-anta

gonists (sometimes Alpha-agonists also)

B Beta blockers

C Calcium channel blockers

D Diuretics (Thiazides)

CLINICAL CHEMISTRY

Aspirin

Aspirin overdose – early symptoms

Mnemonic: DAFT HID

D Deafness

A Appear flushed

F Fever

T Tinnitus

H Hyperventilation

I Increased sweating

D Dizziness

Metabolic acidosis

Causes

Mnemonic: UK SLAMS

U Uraemia

K Ketoacidosis

S Salicylates

L Lactic acidosis

A Alcohol

M Methanol

S Sepsis

Paracetamol

Paracetamol overdose – (the most common intentional drug overdose in the UK).

Risk factors

Mnemonic: COMAH

C Chronic alcohol abusers

O On drugs that increase cytochrome P450 activity, anti-TB drugs

M Malnourished individuals

A Anorexic patients

H HIV patients

DERMATOLOGY

Skin

Functions of the skin

Mnemonic: SKIN

S Specialised sensory innervation/Synthesise Vitamin D/Secretes pheromones

for Sex

K Keeps out unwanted molecules, microbes or radiation/Keeps in water,

electrolytes and solutes

I Immunological function; contains antigen-presenting cells

N Normalises heat regulation

Common allergens for allergic contact dermatitis

Mnemonic: CONTACT

C Cutaneous type IV reaction

O Ointments and cosmetics containing lanolin

N Nickel

T Topical antibiotics can cause it (e.g. neomycin)

A Autosensitisation can occur (secondary spread elsewhere)

C Chromates (cement, leather)/Colophony (plasters, glues, inks)

T Topical antihistamines and topical anaesthetics (haemorrhoid creams) can

cause it

Infestations

Clinical presentation of impetigo

Mnemonic: IMPETIGO

I Infection with Staphylococcus aureus, Streptococcus pyogenes or both

M Mostly in young children

P Particularly around nose and surrounding parts of face

E Erythematous base with honey-coloured crusts

T Treat with Topical antibiotic such as fusidic acid for localized lesions

I Individuals are highly contagious from skin-to-skin contact; Improve hygiene;

do not share towels

G Gram stain and culture of swab diagnostic

O Oral flucloxacillin required for widespread impetigo

Squamous cell carcinoma

Clinical presentation

Mnemonic: S, CELL, C

S Sun-exposed areas are usually affected: ears, dorsum of the hands, bald

scalp

C Crusted, firm, irregular lesion

E Excision used as treatment

L Lower lip can be affected in smokers

L Less likely to metastasise

C Associated with Chronic inflammation such as venous leg ulcers

ENDOCRINOLOGY

Thyroid gland

Symptoms of hypothyroidism

Hypothyroidism is 10 times more common in females & occurs mainly in middle life.

Mnemonic: MOMʼS SO TIRED

M Memory loss

O Obesity

M Malar flush/Menorrhagia

S Slowness

S Skin and hair become dry

O Onset is gradual

T Tired

I Intolerance to cold

R Raised blood pressure

E Energy levels are low

D Depressed

Symptoms of hyperthyroidism

Mnemonic: SWEATING

S Sweating

W Weight loss

E Emotional lability

A Appetite is increased

T Tremor/Tachycardia due to AF

I Intolerance to heat/Irregular menstruation/Irritability

N Nervousness

G Goitre and Gastrointestinal problems (loose stools/diarrhoea)

Adrenal glands

Causes of Addisonʼs Disease

Mnemonic: ADDISON

A Autoimmune (90% cases)

D Degenerative (amyloid)

D Drugs (ketoconazole)

I Infections (TB, HIV)

S Secondary (low ACTH); hypopituitarism

O Others – adrenal bleeding

N Neoplasia (secondary carcinoma)

Pancreas

Complications of diabetes mellitus

Mnemonic: KEVINS

K Kidney: Nephropathy

E Eye disease: retinopathy and cataracts

V Vascular: coronary artery disease, cerebrovascular disease, peripheral

vascular disease

I Infective: TB, recurrent UTIs

N Neuromuscular; Peripheral neuropathy

S Skin: Necrobiosis lipoidica diabeticorum, granuloma annulare, diabetic

dermopathy

GASTROENTEROLOGY

Abdomen distension

Causes

Mnemonic: 6 Fʼs

F Fat

F Fetus

F Flatus

F Faeces

F Fluid

F Flipping great tumour

Chronic liver disease

Signs

Mnemonic: ABCDEFGHIJ

A Asterixis (ʻliver flapʼ)/Ascites/Ankle oedema/Atrophy of testicles

B Bruising/BP.

C Clubbing/Colour change of nails; white (leuconychia)

D Dupuytrenʼs contracture

E Erythema (palmar)/Encephalopathy

F hepatic Foetor

G Gynaecomastia

H Hepato splenomegaly

I Increase in size of parotids

J Jaundice

Inflammatory bowel disease (IBD)

Features of ulcerative colitis

Mnemonic: ULCERS IN Abdomen

U Ulcers (mucosal and submucosal)

L Large intestine (rectum always involved. May extend proximally to involve

entire colon)

C Clubbing

E Extra-intestinal manifestations

R Remnants of old ulcers (pseudopolyps)

S Stools bloody

I Inflamed, red, granular mucosa and sub mucosa

N Neutrophil invasion

A Abscesses in crypts

Complications of ulcerative colitis

Mnemonic: How To Perform GI Colonoscopy

H Haemorrhage

T Toxic megacolon

P Perforation

G Gallstones

C Colorectal carcinoma (in those with extensive disease for > 10 years)

Morphology and symptoms of Crohnʼs disease

Mnemonic: CHRIS Has Too Much Diarrhoea and Abdominal pain

C Cobblestone appearance of mucosa

H High temperature

R Reduced lumen/Rose-thorn ulcers

I Intestinal fistulae/Ileo-caecal region commonly involved (40% of cases)

S Skip lesions

H Hyperplasia of mesenteric lymph nodes

T Transmural inflammation (all layers, may ulcerate)

M Malabsorption

D Diarrhoea (watery)

A Abdominal pain

HAEMATOLOGY

Sickle cell disease

Signs

Mnemonic: SICKLE

S Splenomegaly/Sludging

I Infection

C Cholelithiasis

K Kidney – haematuria

L Liver congestion/Leg ulcers

E Eye changes

Leukaemia

Symptoms and sings

Mnemonic: LEUKEMIA (the US spelling!)

L Light skin (pallor)

E Energy decreased/Enlarged spleen, liver, lymph nodes

U Underweight

K Kidney failure

E Excess heat (fever)

M Mottled skin (haemorrhage)

I Infections

A Anaemia

Thrombocytopenia

Causes

Mnemonic: PLATELETS

P Platelet disorders: TTP, ITP, DIC

L Leukaemia

A Anaemia

T Trauma

E Enlarged spleen

L Liver disease

E Ethanol

T Toxins: benzene, heparin, aspirin, chemotherapy.

S Sepsis

Immune thromobocytopenic purpura (ITP)

Causes

Mnemonic: MAID

M Malignancy

A Autoimmune diseases: SLE, thyroid disease, RA

I Infections: malaria, EBV, HIV/Idiopathic (commonest cause)

D Drugs, e.g. quinine

Symptoms

Mnemonic: BBC

B Bruising

B Bleeding: mucosal and nasal

C Cycles heavy; menorrhagia

INFECTIOUS DISEASES

Gastroenteritis

Causes

Mnemonic: LESS GERMS

L Listeria

E Escherichia coli

S Staphylococcus aureus

S Salmonella

G Giardia lamblia

E Entamoeba histolytica

R Rotavirus

M Mushrooms

S Shigella

Malaria

Common early symptoms

Mnemonic: Heard A Mosquito

H Headache

A Anorexia

M Myalgia/Malaise

Common later symptoms

Mnemonic: Feel Rather Cold

F Fever (peaks every third day, i.e. tertian)

R Rigors

C Chills

Leprosy

Clinical presentation

Mnemonic: LEProsy

L Loss of sensation in affected skin/Loss of function (paralysis)

E Enlargement of affected superficial nerves (tender too)

P Positive identification of M. leprae under microscope

HIV

Groups at high risk of developing infection

Mnemonic: HIV

H Homosexuals (note the rising incidence in Heterosexuals too)/Haemophiliacs

IV IV drug abusers

NEUROLOGY

Anatomy

Cranial bones

Mnemonic: PEST OF 6

P Parietal

E Ethmoidal

S Sphenoid

T Temporal

O Occipital

F Frontal

6 This indicates the number of bones

Branches of the facial nerve

Mnemonic: To Zanzibar By Motorcar

T Temporal nerve

Z Zygomatic nerve

B Buccal nerve

M Marginal mandibular nerve

C Cervical nerve

Clinical conditions

Stroke – investigations

Mnemonic: The 4 Ps

P Plasma: FBC, U&E, ESR, glucose, lipids

P Pump, i.e heart (ECG, echocardiogram)

P Pipes: carotid Doppler ultrasound

P Picture of brain: CT/MRI; detects ischaemia or haemorrhages

Stroke – management

Mnemonic: ABCDEFGHI

A Advice – lifestyle changes e.g. stop smoking, reduce alcohol intake, lose

weight

B BP control

C Cholesterol control

D Diabetes control

E Elastic stockings (prophylaxis for DVT, PE)

F Fibrillation (anticoagulate, rate control and cardiovert as required)

G Guardian drugs (aspirin, ACE inhibitors, etc)

H Help from occupational therapy (OT), speech and language therapy (SALT)

and specialist stroke nurse

I Incontinence care and limit Immobility (pressure sores and contractures may

develop otherwise)

Meningitis

Aetiology - Bacterial

Mnemonic: NHS

N Neisseria meningitides (children and adults; meningococcus)

H Haemophilus influenzae (children)



S Streptococcus pneumoniae (adults and elderly)/(Streptococcus produces the

Severest meningitis)/Viral

Aetiology - Viral

Mnemonic: V MECH

V VZV

M Mumps

E Enterovirus/EBV

C Coxsackie virus types A and B

H Haemophilus influenzae/HIV/HSV

Aetiology - Fungal

Mnemonic: 2 Cʼs

C Cryptococcus (associated with HIV infection)

C Candida

Migraine

Features

Mnemonic: EAT FUN

E Episodic

A Aura – zigzag lines

T Throbbing headache

F Family history/F(p)hoto-phobia

U Unilateral

N Nausea and vomitin