PD Byme 1999 patrick [email protected] Mnemonics for Medicine & Surgery Basic Signs & Symptoms Chills & Rigors cAMP Cholangitis, Abscess, Malaria / Meningitis, Pylonephritis / Pneumonia ich, Non-dermatological causes of DULLJAM DM, Uraemia, Lymphoma, Leukaemia Jaundice, Anaemia, Myxoedema Non-pitting lower limb oedema MICHAM Milroys, infection (filariasis), Congenital, Hypothyroid, Allergy, Malignancy Shock HEN SCAM Hypovolaemia, Endocrine (adrenal, thyroid), Neuropathic (autonomic) Spinal cord injury/ Sepsis, Cardiae, anapybiaxis! anaesthesia, anti HPT, Massive PE Cardiology No apex beat DOPES Dextrocardia (don't say this first!), Obesity, Pleural/Pericardial effusion, Emphysema, Shock, 3rd Heart Sound FIPPY Failure, Incompetence (mitral/ricuspid), Pregnancy/Pill/PE/Pericarditis, Youth 4th Heart Sound SHIT ‘Stenosis (aortic/pulmonary), Hypertension Heart Block, Ischaemic HD, Tamponade Arrhythmias ARHYTHMIAL 4PC Atrial Myxoma, Rh heart dis, HYpertension, THyrotoxicosis, Mitral valve dis, IHD, ALecohol Pneumonia / PE / Pericardial eff, cardiomyopathy Atrial Fibrillation ARITHMATIC Alcohol, Rh fever, IHD, Thyrotoxicosis, Hypertension, Mitral stenosis / MI / Myxoma (atrial) ASD, Toxins, Idiopathic/Infective endocarditis Cardiomyopathy/Constrictive pericarditis Bradyeardia, regular PAD HIM Physiological (athlete, sleep) / paroxysmal, AV block (2°lL, 3°), Drugs (B, dig, amiodarone) Hypothyroid / hypothermia, Ieterie (Severe), MI Dominant R wave in VI WoRD WPW, Old MI, RBBB, Dextrocardia EMD Arrest 4Hs 47s Hypothermia, Hypo & hyper-electrolytes, Hypovolaemia, Hypoxia Toxic (including drugs), Trauma, Tamponade, Tension pneumothorax we MOP HAIR Multiple wave form, Oceludable, Postural changes Hepatojugular reflex, Above (fills from), Impalpable, Respiratory changesPD Byme ~ 1999 patrick [email protected] LVF, Management of FOAM Frusemide 40mg iv, Oxygen, Atrovent (& Ventolin) nobs, Morphine 2.5 - S mg Mitral Stenosis, Complications PASTRI Pulm TBP, A fib, Systemic embolism, Tricuspid regurg, Right heart failure, Infective endocarditis Myocardial infarct, complications ABCDE x2 “Archythmias ! Aneurysm Bradycardia / JBP Cardiac failure / cardiac tamponade Dresslers/ Death! Embolism / Extra (VSD, pap musele rupture) Pericarditis DRUMSTICX Dresslers, Rh fever/ RA, Uraemia, MI, SLE, Trauma, Idiopathic, Coxsackie, X-ray Postural Hypotension HANDI Hypovolacmia / hypopituitarism, Addisons, Neuropathy (autonomic), Drugs (vasodilators / TCADs, diureties, antipsychotics), Idiopathic Rheumatic fever: Major criteria CASES Carditis, Arthritis (migratory), Subcut nodules, Erythema marginatum, Syndenhams chorea Minor criteria 4PA Pyrexia, prolonged PR, past Hx, positive (ie t)ESR/CRP, Arthralgia Occlusive arterial disease Ps. Pain, pallor, pulseless, parasthesia, Paralysis, perishing with cold Splinter haemorrhages ‘TRIP SAM Trauma, RA, Infective Endo, PAN SLE / Sepsis, Anaemia (profound), Malignancy (haematological) ST elevation ELEVATION Electrolytes, LBBB, Early Repolarization, Ventricular hypertrophy, Aneurysm, Treatment (eg pericardiocentesis), Injury (AMI, contusion), Osborne waves (hypothermia), Non-ocelusive ‘vasospasm (prinzmetal’s) SVT Causes SNAP. ‘Sinus tachy, nodal tachy, a fib, paroxysmal atrial tachy Symptoms of aortic stenosis ASD ‘Angina 2 years } Syncope year } prognosis Dyspnoca 62 ) Endocrinology & Biochemistry Acromegaly HOT ACROMEGALY art failure, / hypertension, Oedema, teeth wide spaced Appearance / Amenorthoea, carpal tunnel syn / coarse skin / voice, reek, Oily skin, myopathy, eye (prominent supra-orbital ridge), goitre / gain wW galactorhoca / glycosuria, arthropathy, large tongue & nose, yonserPD Byme 1999 patrick [email protected] Acidosis Metabolic Lusk Lactic, Uraemic, Salicylate, Ketoacidosis Ketoacidosis SAD Starvation, Alcohol, DM Increased Anion Gap MUD PILES Methanol / metformin, Uraemia, DKA / AKA Paraldehyde / phenformin, Iron / INH, lactic, ethylene glycol, salicylate / shock / sepsis / starvation Yormal Anion Gap Acidosis HARD UP Hyperventilation /ayperalimentation, Acetazolamide, RTA, diarrhoea Ureteral diversion (ureterosigmoidostomy), pancreatic fistula / parenteral NaCl Addisons, causes of ANTAM Autoimmune, Neoplastic, TB, Amyloid, Meningococcal (Waterhouse: ick) Diabetes, complications KNIVES, ‘Kidney, Neuropathy, Infection, Vascular, Eyes, Skin lesions Hypercaleaemia NHS MTV FAPD ‘Neoplastic (Bony mets, Myeloma, Sq lung), Hyperparathyroidism, Sareoid Milk-alkali syn., Thyrotoxicosis, Vit D intoxication Pagels (acute), Addisons, Familial, Drugs Hypoglycaemia RE-EXPLAIN Renal failure, exogenous, pituitary, liver failure, alcohol, infection, neoplasm (insulinoma) Multiple endocrine neoplasia MEN TSP Thyroid adenoma, Parathyroid, pituitary, pancreas (islet cell, ZE syndrome) MEN Ta 2PM Parathyroid, phaeo, Medullary thyroid carcinoma (MTC — calcitonin) MEN IIb 2PM MG As above, plus, marfanoid phenotypes, ganglioneuroma (intestinal & visceral) Osmolar Gaps ME DIE Methanol, ethanol Diuretics (mannitol, sorbitol, glycerol), Isopropranolol, ethylene glycol Phacochromocytomea 4Ps. Pain, pallor, palpitations, perspiration Gastroenterology Extra-colonic manifestations of UC & Crohns A PIE SACK Aphthous ulcers, pyoderma gangrenosum, Irtis (uveitis), Frythema nodosum Sclerosing cholangitis, Ank spon & arthritis, clubbing, kidney - nephrotic Hepatic Encephalopathy HEPATICUS Haemorrhage, Electrolye imbalance (JK" alkalosis), protein XS (1NH.! XS), Aleohol/ Analgesics, Trauma, Inf, Constipation, Uraemia, Surgery (post systemic shunt) Haemorrhagic Ascites MARA Malignancy, Acute pancreatitis, Ruptured ectopic, abdo traumaPD Byme 1999 patrick [email protected] Gallstones SEs. Fat, female, far, fertile, forty Gastric Malignancy SAs Anaemia, Anorexia, Aesthenia, Acanthosis Nigricans, blood Group A. Jaundice ABCDEFGHI Anaesthetics (halothane), Blood transfusions, Contacts, Drugs, Ethanol, Foreign travel, Gallstones / Gilberts, Homosexual / Haemophilia / Hepatitis, Idiopathic / IVDA Job - farmers, sewage workers (leptospirosis - Weils) Mouth Ulcers DRAG TIE Drug (gold, steroid), Rheumatological (becket,reiter), Apthous, 7? Trauma, Infecion (HSV, VZV; syphilis, TB, Erythema Multiforme) Haematology & Oncology Macrocytic Anaemia Macroeytic Anaemia Leaves Big Fat Reticulocytes Myxoedema, Alcohol, Liver disease, B12 def,, Folate def, Reticulocytosis Target Cells HOT LIPS Haemoglobinopathy, Obs jaundice, Thallasaemia Liver abscess, Iron def., Polycythaemia, Sideroblastic anaemia Multiple Myeloma BAHRAIN UV Bone pain, Anaemia, Hyper Ca”, Renal failure, Amyloidosis, Infection, Neuropathy (hyper) Uricaemia / viscosity Suspect malignancy in melanoma BITCHES Bleeds, Iregular/ Itch, Tender, Colour change, Halo, Enlargement, Satelite lesions Tumours which spread to bone PUBLIK T Prostate, Uterine, Breast, Lung, Intestine (stomach), Kidney, Thyroid Nephrology Chronic vs- Acute renal disease SNAB ‘Small kidney, Neuropathy (periph), Anaemia, Bone disease Chronic Renal Faiture GLAD SHOP. Glomerulonephritis, Lupus, Analgesics, DM Systemic vascular disease, Hypertension, Obstruction, Polycystic kidney disease Nephrotic Sym GLADDER Glomerulonephritis, SLE, DM, Eclampsia, Renal vein thrombosis Unilateral palpable kidney Wilms HARP Wilms, Hydronephrosis, Acute Renal Vein thrombosis, acute pylonephritis, Renal Cell Ca, PKD, pyonephrosisPD Byme 1999 patrick [email protected] Neurology Absent ankle jerks but extensor plantars Sex can make the F*ing ankles Dorsif_ex ‘Subacute combined degeneration of the cord, us Medullaris Motor Neurone disease Tabes dorsalis Fredreich's Ataxia Diabetic neuropathy Altered Mental State AEIOU TIPS Aleohol (drugs), Endocrine, Insulin, Opiates, Ureamia Toxins / trauma / tumour, Infections, Psychosis / Porphyria, SOL / stroke / seizure / shock Cerebellar signs VANISH DDT Vertigo, Ataxia, Nystagmus, Intention tremor, Slurred speech, Hypotonia Dysdiadocokinesia, Dysmetria, Titubation or PINARDS Past-pointing, Intention tremor, Nystagmus, Ataxia, Rebound, Dysdiad, Slurred Speech Confusion DIM FACES. Drugs / Dehydration, Infection, Metabolic / Ml, Fracture / Failure, Alcohol / Anaemia, CVA, Electrolyte disturbant 8, SOL. Dystrophia Myotonica BIG CHIPS Balding (frontal), Intellectual impairment, Glucose intolerance Cataracts / Cardiomyopathy, Handshake / Hyporeflexia, {1gG, Ptosis, Small gonads Mononeuritis Multiplex DRAW CLAPS. DM, RA, AIDS, Wegeners Carcinomatosis / Churg-Strass, Leprosy, Amyloid, PAN, SLE Multiple sclerosis ‘CURSED HIV Cerebellar signs, UMNL, Retrobulbar neuritis, Spastic paraparesis, Euphoria Dementia / Depression / Diplopia Homers, Incontinence, Vertigo / Vomiting Muscles supplied by Median Nerve LOAF Lumbricales, Opp pollicus, Abd pollicus, Flex pollicus brevis Neuropathic Ulcers TADS Tabes Dorsalis, Alcohol, DM, Syringomyelia Parkinsons PARKINSONS Pill rolling, akinesia, rigidity, kyphosis, instability, neck titubation, shuffling gait, ccculogyric crisis, nose tap (glabellar), small writing Peripheral neuropathy DANG THE PAPIST DM, Alcohol, Nutrition (B1, B2, B12), Guillian Barre Trauma, Hereditary, Environmental (lead, drugs) Paraneoplastic, Amyloid, Porphyria, Inflammatory, Syphilis, Tumours of nerves (HMSN) Polyneuropathy VITAMINS 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)PD Byme ~ 1999 patrick [email protected] Pontine Haemorrhages 3Ps. Paralysis, Pin-point pupils, Pyrexia Premature senile dementia DEEP SHIT Deficiency B12, Epilepsy, Endocrine (myxoedema), Parkinsonism Syphilis (GPD, Huntingtons, Injury, Tumour Proximal Myopathy PD HEN Polymyositis, Dermatomyositis, Hereditary Muscular Dystrophies, Endocrine (DM, Cushings, Osteomalacia, Thyrotoxicosis - DM COT), Neuropathy Pupits: Small HAPPY Homers, Argyll-Robertson, Pontine haemorrhage, Pilocarpine, Happy (morphine) Argyll Robertson SADE (accommodates but doesn’t react ~ c.f prostitute) ‘Syphilis, Alcohol, DM, Encephalitis Small muscle wasting MARS BAR MND / Myopathies, Apical tumours, RA, Syringomyelia Brachial Plexus injuries, Ageing, cervical Rib Syncope HEAD, HEART & VESS'LS Hypoglycacmia / hypoxia, epilepsy, anxiety, drop atlack (brain stem Dysfunction ~ TIA) Heart attack, embolism, aortic obstruction (stenosis, myxoma, THSS), rhythm, tachy - VT \Vasovagal, ectopic preg, situational (on the crapper), subclavian steal, low SVR (anaphylaxis, shock, DIC), Sick sinus syndrome Wernickes and Korsakoffs CANON Confusion, Ataxia, Nystagmus, Ocular palsy, Neuritis Pes Cavus Disease Can Shorten The Foot DM Chareot Marie Tooth Syringomyelia Tabes dorsalis Fredreich’s Ataxia Pharmacology & Toxicology ACEI, Side FX CAPTOPRIL Cough, anaphylaxis, palpitations, taste, orthostatic 4BP, Potassium (TK), Renal impairment, impotence, leucocytosis Anti-epileptic side FX ABCDEFGH Ataxia, blood dyscrasia, cleft lip, dupuytrens / vit D def, exfoliation of skin & Stevens Johnson’s. Fits, GI upset / gum hypertrophy, hepatitis / hairy Barbiturate side FX ABCD Ataxia, behavioural disturbance, {concentration / coma, depression / drowsy / diplopia Cholinergic OD side FX DUMB BELS Diarthoea, Urination, Miosis / muscle weakness, bronchorrea Bradycardia, emesis, lacrimation, salivation / sweatingPD Byme 1999 patrick [email protected] Cyclosporin Side FX. 4HRT 4H - Hyper K+, hypertension, gum hypertrophy, hairy R- Renal toxicity T- Tremor Digoxin YE GIT — nay, abdo pain, ulcers Eyes — blurring, halo, xanthopsia CNS — depression, confusion, delirium, hallucinations Cardiac ANY arrhythmia K-low Gynaecomastia (drugs) DISCO MTV Digoxin, Isoniazid, Spironolactone, Cimetidine, Oestrogens Methyldopa/metronidazole, TCAD, Verapamil MAOI side FX 3Hs Hepatocellular jaundice, Hyperthermia, hypertension Propranolol, Contra-indications ABCDE, ‘Asthma, heart Block, cardiac failure, DM (hypoglycaemic shock), Extremities (occlusive arterial disease) Pulmonary Oedema, non-cardiac PONS Phosgene / paraquat / phenothiazines, opioids / organophosphates, Nitrous dioxide, salicylate TCAD side FX CAN Woo, Cys, Anticholinergic, Neuro, Withdrawal, Overdose, Others, Rat poison RATS PANIC Red squill, arsenic, thallium, strychnine PNU, phosphorus, ZN phosphide, alpha naphtha thiurea (ANTU coumarin / cholecaleiferal |, norbormide, indanediones, Steroids Side FX HIGH COMPACT IMPS Hypertension, Immunosuppression, Gastric Uleer (bleeding), Heartburn Cataract, Osteoporosis, Muscle weakness, Path # / Psychosis, Aene / 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, Uleers, Striae, skin thin (bruising), Hypertension / hairy, Infection, Glycosuria, Obesity / Osteoporosis / Oedema, Immunosuppression / Insomnia, Depression Warfarin WEPT Warfarin, Extrinsic pathway, measure PT Psychiatry Depression PISS CAGE Psychomotor mov's, interest, suicidal, [Tsleep Jeoncentration, | tappetite gilt, Jeneray Suicide risk factors SAD PERSON Sex / single / sickness, age, depression Previous attempt, EtOH, reality testing, social support, organised plan, note / no spousePD Byme ~ 1999 patrick [email protected] Radiology Bilateral hilar lymphadenopathy Please Helen lick my popsicle stick Primary TB, histoplasmosis, lymphoma, mets, pneumoconiosis, sarcoid Mediastinal Mass Anterior 4Ts Thyroid, Thymoma, Teratoma, Terrible lymphoma Midalte HABITS Hernia / haematoma, aneurysm, bronchogenic Ca / duplication cyst, inflammation (sarcoid, histio, eoccidio, TB), Tumour 5 —lung, lymphoma, leukaemia, leiomyoma, lymph nodes Ossification centres at elbow CITROEN Capitellum, internal (med epicond), trochlea, radial head, olecranon, external (lat epicond) Radio-opague ingestants CHIPES Cocaine condoms / chloral hydrate / calcium, heavy metals, iron / iodides, psychotropies (TCADs, phenothiazines), enteric coated Ba, Solvents (CCl) Respiratory Acute Asthma NOAH Nebulisers, Oxygen, Antibiotics / Aminophylline, Hydrocortisone Asthma Triggers ASTHMAD Allergens, Stress/Sports, Temp, Hereditary, Microbiology, Anxiety, Drugs Chronic cough, non-smoker, normal CXR HARD Heart failure (MS), Asthma, reflux (GORD), drip / drugs Cryptogenic Fibrosing Alveolitis 5Cs Clubbing, Cyanosis, Crackles, Cough, Corticosteroids Fibrosis Upper lobe CHARTS Coal workers pneumoconiosis (PMF), Histiocytosis X, Ank spon / ABPA, Radiation, TB, Silicosis (PME) / Sarcoidosis Lower lobe RASIO; RA, Asbestosis, Scleroderma, Idiopathic fibrosing alveolitis, Other (durgs ~ Amiodarone, busulphan, bleomycin, hydralazine, MTX, nitrofurantoin) Lung abscess SOAP Spread (hepatic, subphrenic) / Septic emboli, Obstruction (FB, tumour), Aspiration (alcohol, bulbar palsy, achalasia, CVA), pulmonary infarct / pneumonia, Pleural effusions Exudative PINTARS Preumonia / Pancreatitis, Infarction, Neoplasm, TBY Trauma, Absc Systemic stuff (SLE, Sareoid, Systemic sclerosis) Transudative (CHARM (All the failures - heart, live, renal etc.) Carditis, Hypothyroid, Hypo-Albuminaemia, Renal, Meigs / Malabsorption s, RA,PD Byme 1999 patrick [email protected] Preumothorax ST PA’ Spontaneous / Sport, Trauma Pneumonia, Positive Ventilation, Abscess/ Asthma/ Ascend (in aeroplane), TB, Sarcoid Fibrosing Alveolitis, Carcinoma / COAD / CF SFC Pulmonary Ocdema, non-cardiac PONS Phosgene / paraquat / phenothiazines, opioids / organophosphates, Nitrous dioxide, salicylate Rheumatology 4As of Ank Spon Apical fibrosis, anterior uveitis, aortic regurg, achilles tendonitis Carpal Tunnel Syn DOG ARM PIT Dialysis, Obesity, Gout Amyloid/Acromegaly, RA, Myxoedema, Pregnan y/Pill, Idiopathic, Trauma’TB Dupuytrens contracture POT FACED Peyronie's, Occupation, Trauma Familial, Alcohol, Citthosis, Epliepsy (antiepileptics), DM Seronegative Arthropathies SCRAP BW Stills, Colitis, Reiters, Ankylosing Spondylitis, Psoriasis, Bechets, Whipples Sarcoid SARCOID 'S- Skin (erythema nodosum, nodules, lupus pernio, scar infiltrations) ‘A~ Arthritis, tA R - Respiratory (bilateral hilar lymphadenopathy) C- Calcium f, CNS, Cranial & periph nerve palsies © Orbit (keratoconjunctivitis, glaucoma, uveitis), Organomegaly 1 Interstitial lung fibrosis D- Diabetes insipidus Or PERNIO Pulmonary, Eyes, Renal, Nerves, Infiltration (scars), Organomegaly Swollen DIP joints SPROG Sarcoid, Psoriasis, Reiters, OA, Gout Surgery Abdominal distension SEs Fat, Fluid, Faeces, Flatus, Fetus Acute Abdomen MEDIC CURSES A MOP Mesenteric Adenitis, Enteritis, Diverticulitis, Ischaemic Colitis Cholyeysttis, Uleers, Renal Colic, Salphingitis, Ectopic Pregnaney, Small bowel obstruction Appendicitis Meckels Diverticulum, Ovarian Cyst, Pancreatitis Bleeding PR Haemorrhoidal DRAIN Haemorhoids, Diverticulitis, Radiation enteritis, AV malformation, Ischaemia, Neoplasm Gl obstruction Py Dac Pain, Vomiting, Distension, ConstipationPD Byme 1999 patrick [email protected] Haematemesis GUM BLEEDING Gastritis, Ulcer, Mallory-Weiss Biliary (Haemobilia), Large varices, Esophagitis, Entero-aortic fistula, Duodenitis, IBD, Neovascularisation, Gastric carcinoma Ng tube removal past op Ps Peristalsis, Passage of flatus, Paucity of aspirate, Patient Peckish Leg Ulcers VAIN PAIN ‘Venous, Arterial, Infection (e.g. syphilis), Neuropathic Pressure sores, Arthritis (e.g. RA, PAN), Injury / IDB, Neoplastic Pancreatitis GET SMASHED Gallstones / Gravid, Ethanol, Trauma (incl, surgery) Steroids, Mumps, Autoimune (PAN), Scorpion bites, Hyper-lipid / calcium / hypothermia, ERCP, Drugs (azothioprine, thiazide diuretics) Ronson's eriteria for above: (i.e. you're fucked if..) ACUTELY (What A GAL) > 48 hours (FUCH BO) wee ‘Fluid sequestered (61) Age lommol) 1Glu (2mmol) qAST {Haematocrit e10%) LDH Base XS C4) 40; (e8kPa) Prophylactic antibiotics APPLE Amputations, Prosthesis, Penetrating wounds, Large bowel surg, Endocarditis, Small bowel abstruetion SHAVIT ‘Stone, Hernia, Adhesions, Volvulus, Intussusception, Tumour