Medical Mnemonics - St. Michael's Hospital

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Medical MnemonicsA politically correct, non-inclusive approachto remembering things you mightotherwise forget in med schoolJoel G Ray, MD MSc FRCPCProfessor, Departments of Medicine, Health Policy Management and Evaluation, andObstetrics and Gynecology, St. Michael’s HospitalToronto, Ontarioe-mail: rayj@smh.caMatthew L. SteinPhD Candidate at the University of Waterloo, School of Public Health and Health SystemsMHSc, University of Ontario Institute of TechnologyHBA, McMaster University

Table of contentsSection and title (click on section name to get there faster)Page number1. ANATOMY4-62. ANESTHESIA73. CARDIOLOGY8-134. COMMUNITY HEALTH AND OCCUPATIONAL MEDICINE145. DERMATOLOGY156. EMERGENCY MEDICINE/TRAUMA16-177. ENDOCRINOLOGY18-218. ETHICS229. GASTROENTEROLOGY23-2610. GENERAL SURGERY2711. GYNECOLOGY28-2912. HEMEATOLOGY30-3113. INFECTIOUS DISEASE32-3314. METABOLIC DISEASES3415. NEPHROLOGY35-3616. NEUROLOGY37-4017. NEUROSURGERY412

18. OBSTETRICS42-4419. ONCOLOGY4520. OPTHAMOLOGY4621. ORTHOPEDICS4722. OTOLARYNGOLOGY4823. PATIENT HISTORY AND EXAMINATIONS49-5024. PEDIATRICS AND NEONATOLOGY51-5425. PHARMACOLOGY5526. PLASTIC SURGERY5627. PSYCHIATRY57-6128. REHABILITTATION MEDICINE6229. RESPIROLOGY6330. RHEUMATOLOGY64-6631. UROLOGY67-683

ANATOMYCarpal Bones of the Hand:Simply Learn The Positions That The Carpals zoid,CapitateHamateCarpal bones: trapezium vs. trapezoid location ·Since there's two T's in carpal bone mnemonic sentences,need to know which T is where:TrapeziUM is by the thUMB, TrapeziOID is inSIDE.---Tom BallMedian Nerve Supply to the Hand: LOAFLumbricals of digits 1 and 2OpponensAbductor pollicis brevisFlexor pollicisRotator Cuff Tendons: SITSSuprapinatusInfraspinatusTeres minorSubscapularis4

Adrenal Cortex, Three Zones of: GFRZona Glomerulosa (produces mineralocorticoids)Zona Fasciculata (produces glucocorticoids)Zona Reticularis (produces androgens)Systems review: systems checklist: I PUNCH --- Beth Ann Young and Robert O'ConnorFemoral triangle: arrangement of contents: NAVELFrom lateral hip towards medial navel:Nerve (directly behind sheath)Artery (within sheath)Vein (within sheath)Empty space (between vein and lymph)Lymphatics (with deep inguinal node)Nerve/Artery/Vein are all called Femoral.--- Andrew J. VasilBalance organsUtricle and Saccule keep US balanced.5

Nasal Cavity: Never Call Me Needle NoseNares (external)ConchaeMeatusesNares (internal)Nasopharynx.Three TonsilsPeople (or PPL, for short) have three tonsils:PharyngealPalatineLingual.Airflow Passages: Mouthy People are Loud TalkersMouthPharynxLarynxTracheaScalp nerve supply: GLASSGreater occipital/ Greater auricularLesser l6

ANESTHESIASix Questions to ask a conscious patient or his/her relative in a life-threatening emergencyprior to taking him/her to the operating room: SAMPLE?Smoking history?Allergies to medications or previous anesthetics?Medications or alcohol use?Past medical history?Last meal?Events leading up to present injury or collapse?Maintenance Intravenous Fluids in the Adult or Child: 4, 2, 14 mL/kg/hr for the first 10 kg2 mL/kg/hr for the next 10 kg1 mL/kg/hr for each remaining kgEg: A 37 kg adolescent requires (4x10) (2x10) (1x17) 77 mL/hr IV fluid7

CARDIOLOGYBradycardia, causes: STAGeRD JSick sinus syndromeThyroid (ie, hypothyroidism)Athletic heartGastrointestinal mesenteric tractionRest/sleepDrugs (eg, beta-blockers, digitalis)JaundiceCardiomyopathy, Classification: DR. HODilatedRestrictiveHypertrophicObliterativeHeart Sounds, Corresponding Order of Valve Closure:“Many Things Are Possible”Mitral valve closure 1st part of 1st heart sound A1Tricuspid valve closure 2nd part of 1st heart sound A2Aortic valve closure 1st part of 2nd heart sound P2Pulmonic valve closure 2nd part of 2nd heart sound P2Chest Pain, Acute, Causes: CHEST MAPPPEDCardiac anoxia (ie, ischemia or infarction)Hematological (e.g., sickle cell chest crisis)Esophagus (ie, spasm, esophagitis, rupure)Spinal (ie, nerve root damage, spinal column disease)Trachea or bronchusMediastinum: infection or mediastinal emphysemaAorta: Dissection or aneurysmParietal surfaces (ie, pleural, pericardial, diaphragm)Pulmonary embolusPneumoniaExtra-thoracic organs (eg, stomach, gallbladder, liver,pancreas)Diseases of viral origin (eg, epidemic pleurodynia, herpesZoster, costochondritis)8

Endocarditis, Clinical Manifestations: LIMELocal (ie, valvular vegetations and destruction)Immune complexes (ie, retinal Roth spots, renal lesions,Janeway lesions, Osler's nodes)Metastatic lesions (ie, bacterial "mycotic" aneurysms)Embolism (ie, splenic, cerebral, renal and adrenal infarcts)Hypertension, Effects on Organs: HIgHER PEaHeart (ie, left ventricular hypertrophy, angina, myocardial infarction)Infarction in braingHemorrhage in brainEncephalopathyRenal disease (eg, glomerulosclerosis)Peripheral vascular diseaseEyes (ie, arteriolar narrowing, retinal hemorrhages and exudates,papilledema)aHypertension, Secondary Causes: RENALSRenal (eg, glomerulonephritis, renal artery stenosis)Endocrine (eg, Cushing's disease, Conn's syndrome,pheochromocytoma, acromegaly, corticosteroids, oral contraceptive pill)Neurogenic (eg, raised intracranial pressure)Aortic coarctationLittle people (ie, pregnancy-induced hypertension)Stress (eg, trauma, white coat hypertension)Digoxin, Drug Interactions: QuAcKQuinidineAmiodaroneKalcium-channel blockers (especially verapamil)9

Tachycardia, Causes: MD PISH 3Metabolic (eg, thyrotoxicosis)Drugs (eg, sympathomimetics, xiaHypercarbiaThrombolysis, Contraindications to Use of Streptokinase or TPA: S 5Stroke within 3 monthsStomach ulcer or other GI bleedSurgery within the past six weeksSevere hypertensionStreptokinase received previously (then can give tPA)Chest X-ray: cavitating lesions differential: WEIRD HOLESWegener's diseaseEmbolic (pulmonary, septic)Infection (anaerobes, pneumocystis, TB)Rheumatoid (necrobiotic nodules)Developmental cysts eiomyomatosisEnvironmental, occupationalSarcoid---LW MasonMurmurs: systolic types: SAPSSystolicAorticPulmonicStenosisSystolic murmurs include aortic and pulmonary stenosis.Similarly, it's common sense that if it is aortic and pulmonary stenosis itcould also be mitral and tricusp regurgitation].10

Myocardial Infarction: signs and symptomsPULSEPersistent chest painUpset stomachLightheadednessShortness of breathExcessive sweating---Sara NemetzCongestive Heart Failure: causes of exacerbationFAILUREForgot medicationArrhythmia/ AnaemiaIschemia/ Infarction/ InfectionLifestyle: taken too much saltUpregulation of CO: pregnancy, hyperthyroidismRenal failureEmbolism: pulmonary---Lau Yue Young GeoffreyMurmurs: systolic vs. diastolicPASS: Pulmonic & Aortic Stenosis Systolic.PAID: Pulmonic & Aortic Insufficiency Diastolic.---W. CiullaMyocarcdial Infarction: therapeutic treatmentO BATMAN!OxygenBeta blockerASAThrombolytics (eg heparin)MorphineAce prnNitroglycerin---Kristy Thomas11

Coronary artery bypass graft indications: DUSTDepressed ventricular functionUnstable anginaStenosis of the left main stemTriple vessel disease---Sushant VarmaExercise ECG testing contraindications:RAMPRecent MIAortic stenosisMI in the last 7 daysPulmonary hypertension---Sushant VarmaECG T wave inversion causes: INVERTIschemiaNormality [esp. young, black]Ventricular hypertrophyEctopic foci [eg calcified plaques]RBBB, LBBBTreatments [digoxin]---Robert O'ConnorAtrial fibrillation causes: PIRATESPulmonary: PE, COPDIatrogenicRheumatic heart: mitral regurgitationAtherosclerotic: MI, CADThyroid: hyperthyroidEndocarditisSick sinus syndromeBlue toe (microembolic toe)CAVEMANCholesterol embolizationsAtrial fib with electricity or digitoxinValvular problemsEndocarditisMural thrimbosisAneurysm/ AV fistulaNothing---Samuel Atom Baek-Kim12

Angina Pectoris, Precipitants: 4 E'sEmotional upsetExertionExposure to cold airEating large mealHypertension, Treatment: ABCDEACE inhibitorsBeta-blockersCalcium-channel blockersDiureticsExercise, weight loss, and dietary modifications (try first)Myocardial Infarction, Medical Management: ABCDEASABeta-blockerCagulation (i.e., thrombolytic; add heparin for anterior MI)Dilator (i.e., ACE inhibitor)Elevated lipids (measure fasting lipids within 48 hours of admission, and start a statin agent if total cholesterol or LDL areelevated).T-Wave Inversion on the ECG, Causes: BIND HEPBundle-branch blockInfarctionNormal (in AVR and V1)Digoxin effectHypertrophy of left ventricle with strainEmbolus (ie, pulmonary embolism)PericarditisValve Disease, Causes: DICDegenerative (most common in North America)Inflammatory (e.g., lupus, rheumatic fever)Congenital (e.g., bicuspid aortic valve, Marfan's syndrome)13

COMMUNITY HEALTH AND OCCUPATIONAL MEDICINECarcinogens, Known Types: A 2B 2C 2Arsenic (causes skin cancer)Asbestos (causes mesothelioma, laryngeal cancer)Benzidine dye (causes bladder cancer)Beta-naphthylamine (causes bladder cancer)Chromium (causes nasal cancer)Chloride vinyl (causes liver angiosarcoma)Lead Poisoning, Clinical Manifestations: CRACKCNS (headache, memory loss, personality changes,encephalopathy)Reproductive (abortion, stillbirth)Anemia (microcytic)Colic ("lead colic" abdominal pain)Kidney (proximal tubular damage, interstitial fibrosis)Occupational Lung Disease, Classification: ASTHMAAsthmaSilicosisToxic gasesHypersensitivity pneumonitis (ie, extrinsic allergic alveolitis)Many othersAsbestosisErythema Nodosum, Causes: SITSSarcoidosisInflammatory bowel diseaseTBStreptococcal infection (post-infectious)14

DERMATOLOGYToxic Epidermal Necrolysis characteristics :TENThicknessEpidermalNecrosisNeurofibromatosis, Clinical Characteristics: CANALCafe-au-lait spotsAutosomal dominant, gene 17Neurofibromas of the skinAssociated findings (eg, optic gliomas, Multiple EndocrineNeoplasia)Lisch nodules (hamartomas) of the iris, seen under slit lampMalignant Melanoma, Diagnostic Characteristics: ABCDAsymmetry of lesionBorder irregularityColour variegationDiameter greater than 6 mm(Source: Friedman and Rigel 1985)Staphylococcal Scalded Skin Syndrome (SSSS) vs Toxic Epidermal Necrolysis (TEN): Pathological DifferenceSSSS is Superficial Subcorneal Skin SeparationTEN is full-Thickness Epidermal Necrosis15

EMERGENCY MEDICINE/TRAUMAAnaphylaxis, Treatment: ANAPHYLAXISAdrenalin 0.01 mg/kg IM or IVNoradrenalin, 8 mg in 500 mL 2/3 1/3, at 2 mL/min infusion foraverage adultAntihistamine (ie, diphenhydramine 1 mg/kg IM/IV over 3 min)Proximal placement of tourniquet to relative to antigen site (eg, beesting), removed every 15 minutesH2 histamine blocker (ie, ranitidine 50 mg or cimetidine 300 mg IV)for refractory hypotension) -- unproven valueYell for help and oxygen, 100% by maskLower extremity elevation, patient in recumbent positionAminophylline, 6 mg/kg IV over 20 minutes, to control bronchospasmXtra (ie, extra) treatments for patients already on beta-blockers (ie, isoproterenol 2-20 micrograms/kg/min toachieve heart rate of 60/min; or atropine 0.5 mg IV q 5 min until heart rate above 60/min)IntubationSteroids (eg, hydrocortisone 100 mg IV push and then 100 mg in 500 mL 2/3 1/3 q 2-4 hours; or methylprednisone 1mg/kg IV push, and then 1 mg/kg IV q 8 hours)Trauma Patient, Initial Assessment and Management:ABC 4AirwayBreathingCirculationCervical spine injuryChest (tension pneumothorax, flail chest, pericardialtamponade)Consciousness (assess level according to the Glasgow ComaScale)(Source: Budassi Sheehy 1984)Trauma Patient, Initial Assessment and Management: ABCDEFAirway/breathing (C-spine stabilization is actually first)Bleeding sitesCentral nervous systemDigestive organsExcretory organs (ie, urine colour, quantity)Fractures16

Drug Toxicity/Overdose Blood Tests to Think About A 6Alcohols (ethanol, methanol, ethylene glycolASAAcetaminophenAnticonvulsants (phenytoin, phenobarbital)Antidepressants (tricyclics, lithium)Anxiolytics (benzodiazepines)Iron Overdose, Symptoms and Signs: HIS HePHemorrhagic gastroenteritis (30-60 minutes post-ingestion)Improvement (appears improved 2-12 hours post-ingestion)Shock (12-48 hours post-ingestion)Hepatic damage with possible hepatic failure (late)ePyloric stenosis (residual complication)17

ENDOCRINOLOGYAddison's Disease, Clinical Findings: FATIGuEDFatigue -- 94%Antibodies (ie, anti-adrenal-- 52%, antithyroid -- 36%, antiparietal cell -25%)Triad: hyponatremia -- 67%, hyperkalemia -- 55%, azotemia -- 52%Increased pigmentation of skin -- 91%, tongue/cheeks -- 56%Gastrointestinal: Weight loss -- 90%, anorexia -- 80%,Nausea and vomiting -- 66%Eosinophillia, neutropenia -- commonDecreased blood pressure (ie, hypotension) -- 81%Cushing's Syndrome, Symptoms and Signs: MOON FACEMenstrual changesOsteoporosisObesityNeurosisFacial plethora (moon face, hirsutism)Altered muscleCalor of skinElevated blood pressureDiabetic Ketoacidosis, Precipitants of: In 5Insulin deficiencyInfarction (ie, myocardial infarction)Infection (eg, viral respiratory tract infection)Injury (ie, trauma)Infant (ie, pregnancy)Hypercalcemia, Causes: SHIFTSarcoidosis (and other granulomatous diseases)Hyperparathyroidism, HyperthyroidismImmobilizationFamilialTumour, Thiazides (Others: lithium, vitamin D)(Source: Wynne and Fitzpatrick 1991)18

Hypercalcemia, Causes: SIRSkeletal resorption enhanced: Hyperparathyroidism (usuallydue to a single parathyroid adenoma), malignancy (eg, bronchial carcinoma),hyperthyroidism, immobilizationIntestinal absorption enhanced: Granulomatous disease (eg, tuberculosis, sarcoidosis),vitamin D intoxicationRenal excretion reduced: Diuretic ingestionHypermagnesemia, Causes: RENALRenal failureExogenous loads (e.g., MgSO4, magnesium-containing antacids)Necrosis of tissue (e.g., burns)Adrenal insufficiencyLithium intoxicationHypoglycemia, Causes: ExPLAINExogenous: Insulin, oral hypoglycemic agents, ethanol and ASAexcessPituitary insufficiencyLiver failureArenal insufficiency (e.g., Addison's disease)Immune (i.e., anti-insulin antibodies)Neoplastic (e.g., insulinoma, sarcoma, mesothelioma)(Source: Dr. H. Gerstein, Hamilton, Ontario)Osteoporosis, Causes: COLLES FRACtureCongenital (e.g., osteogenesis imperfecta, Ehlers-Danlos, homocysteinuria)Osteoporosis type I (post-menopausal) & type II (senile)Leukemia & other malignancies (e.g., multiple myeloma)Liver diseaseEndocrine disease (e.g., hyperparathyroidism, hyperthyroidism, acromegaly, Cushing's syndrome,hypogonadism, diabetes mellitus)Steroids (i.e., corticosteroids)FamilialRenal diseaseAnticonvulsants (e.g., phenytoin)Calcium deficiency (e.g., malabsorption)(Based upon: Wynne and Fitzpatrick 1991)19

Pituitary hormonesFLAGTOPFollicle stimulating hormoneLutinizing hormoneAdrenocorticotropin hormoneGrowth hormoneThyroid stimulating hormoneOxytocinProlactin· Note: there is also melanocyte secreting homone and Lipotropin, but theyare not well understood.Graves' Ophthalmopathy, Clinical Characteristics: PREDNISOLProptosisRetraction of eyelids (Dairymple's sign)Edema (periorbital)DiplopiaNeuropathy of optic tract (leads to poor visual acuity)Inhibited upward gazeSkin changes (eg, pretibial myxedema, peu d'orange)Onset ages 20-40Lid lag on downward gaze (Graefe's sign)Hyperthyroidism: "Myxedema is not myxedema"That is, "the physical sign of pre-tibial myxedema is notfound with hypothyroidism (myxedema), but withhyperthyroidism of Grave's disease."Hypomagnesemia, Causes: 10 DsDiarrhea & gastrointestinal lossesDiuretics & renal lossesDiabetes mellitus & endocrine causesDietary insufficiencyDiverted to free fatty acidsDrugs (e.g., cisplatin, amphotericin B, diuretics)Drinking excess amounts of ethanolDelivery with toxemia of pregnancyDecompensated heart, lungs or liverDenuded skin (e.g., burns)(Based upon: Iseri, Allen and Brodsky 1989)20

Multiple Endocrine Neoplasia (MEN), ClassificationMEN Type 1 ("W"on Wermer's syndrome): i. Pituitary adenoma, ii. Pancreatic adenomaiii. Parathyroid adenomaMEN Type 2 ("S"econd Sipple's syndrome): i. Pheochromocytoma, ii. Parafollicular (medullary) thyroid canceriii. Parathyroid adenomaMEN Type 3 (like MEN Type II, but with cutaneous neuromas)Osteoporosis, Treatment: ABCDEActivity & exerciseBiphosphonate drugsCalcium supplementation (e.g., 1000 mg/day)D(vitamin D supplement)Estrogens (for post-menopausal women)Pheochromocytoma, Clinical Characteristics: P 8PalpitationsPallorPerspirationPanicParoxysmal attacksPain (headache, chest, abdominal)Paradoxical rise in blood pressure with beta-blockersPregnancy-associated hypertension in some casesThyroid Malignancies, Age-Associated Types:Papillary carcinoma seen in Pediatric groupMedullary(parafollicular) carcinoma seen in Middle-aged groupAnaplastic carcinoma seen in Aged groupFollicular carcinoma seen in all groups21

ETHICSCritically Ill, Guide to Ethical Decision-Making:3R's and Q.C.Rational: Does the intervention meet the test of competentassessment (diagnosis) and scientifically proven benefit?Redeeming: What is the risk/benefit of the intervention? Areknown risks and iatrogenic complications weighed againstanticipated benefits?Respectful: Does the intervention respect the rights of thepatient?Quality of life: Is the intervention "good" for that patient in human terms? Is it compatible with priorities of the patient, thefamily, the society?Cost: Is the monetary cost/reward of the intervention appropriate for the patient, the family, society?(Source: Weil, Weil, Rackow 1988)22

GASTROENTEROLOGYBacterial Overgrowth Syndrome, Risk Factors: PASSED GASPernicious anemiaAchlorrhydriaSteroids (i.e., corticosteroids)SclerodermaEndocrine (i.e., diabetes mellitus, hypothyroidism)Diverticula of jejunumGastrectomy (i.e., partial gastrectomy)AntibioticsStrictures within the small bowelCeliac Disease, Treatment/Prevention: Elimination of Gluten-Containing Foods (BROW) From the DietBarleyRyeOatsWheatConstipation, Treatment: FECESFluid and fibre intakeExerciseCathartics (eg, lactulose)Elimination of constipating medicationsStimulation of the gatrocolic reflex (ie, enema)(Source: Rousseau 1988)Hepatic Disease, Factors Used in the Child-PughClassification: A 2B 2C 1Ascites: absent, moderate, or tenseAlbumin level: 35 g/L or 30 g/LBleeding (Prothrombin Time/INR): normal or increasedBilirubin level: 20 g/L or 30 g/LCephalopathy (ie, encephalopathy): none, grade I, II, III, or IV23

Hepatic Encephalopathy, Symptoms and Signs: SCALPSychosisConfusionAsterixisLethargy -- coma (late sign)Personality changes (early sign)Inflammatory Bowel Disease, Extra-intestinal Manifestations: STINGSSSclerosing cholangitisThromboembolic diseaseNephrolithiasis (i.e., calcium oxalate, urate stones)Skin (i.e., aphthous ulcers, pyoderma gangrenosum, erythema nodosum)Seronegative spondyloarthropathiesSplenomegaly, Causes: IBM PCMInfectious (eg, Viral: Epstein-Barr, herpes; Parasitic: malaria,schistosomiasis, babesiosis, kala-azar visceralLeishmanniasis; Bacterial: subacute bacterial endocarditis)Blood disease (eg, hemolytic anemia, hereditary spherocytosis,hemoglobinopathies(ie, sickle-cell disease, thalassemias)Malignancy (eg, Hodgkin's lymphoma, leukemias)Portal hypertension (ie, Banti's syndrome)Connective tissue disease (eg, sarcoidosis, systemic lupuserythematosus,polyarteritis nodosa)Miscellaneous (eg, Gaucher's disease, Niemann-Pick diseasePepsin-producing cells: Chief of Pepsi-ColaChief cells of stomach produce Pepsin.---Dr. Atif Farooq Khawaja Rawalpindi24

Splenomegaly causes: CHICAGOCancerHem, oncInfectionCongestion (portal hypertension)Autoimmune (RA, SLE)Glycogen storage disordersOther (amyloidosis)---Gerard DangSplenomegaly causes: CHINACongestion/ Cellular infiltrationHaematological (eg haemolytic anaemia, Sickle cell)Infection/ Infarction

3 18. obstetrics 42-44 19. oncology 45 20. opthamology 46 21. orthopedics 47 22. otolaryngology 48 23. patient history and examinations 49-50

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