I Heart Medical Mnemonics

Acid Base Balance Cheat Sheet

2011-09-28T08:35:00.008+08:00

Winter's Equation: PCO2 = (1.5 × [HCO3-]) + 8 ± 2

***Another useful tool in estimating the PCO2 in metabolic acidosis is the recognition that the pCO2 is always approximately equal to the last 2 digits of the pH.***

How severe is your Ulcerative Colitis?

2010-07-24T02:47:00.000+08:00

The Truelove Criteria (awesome name BTW...) grades the severity of Ulcerative Colitis based on 5 parameters:

UC Severity - She Hasn't Even Finished Pooping!

Stool frequency per day (has to be bloody stool)

Haemoglobin

ESR

Fever

Pulse rate

	MILD	MODERATE	SEVERE
Stool frequency /day (bloody stools)	<4	Moderate severity are values that are in between MILD & SEVERE	>6
Haemoglobin	>11.0		<10.5
ESR	<30		>30
Fever	Afebrile		>37.8
Pulse rate	<70		>90

Myasthenia Gravis associations

2010-07-21T13:59:00.000+08:00

Diseases associated with Myasthenia Gravis - STRAPD (read: 'strapped')

S - SLE or Sarcoid

T - Thymoma or Thyroid disease (hypo/hyper)

RA - Rheumatoid Arthritis

P - Pernicious Anaemia

D - the 2 DMs : diabetes mellitus & dermatomyositis

PGA - more Addison's than Tiger Woods....

2010-07-20T18:57:00.001+08:00

Some quick notes about the group of diseases known as Polyglandular Autoimmune Syndrome (PGA).

2 types exist - PGA I and PGA II (PGA II is the MORE COMMON of the two)

Each is a constellation of THREE diseases - but the diagnosis can be clinched by just having only 2 out of 3.

The common link between the two is autoimmune Addison's disease

PGA I:

Parathyroid - autoimmune HYPOparathyroidism

Gandida (boo hoo....this represents a new low in mnemonic making) - chronic mucocutaneous candidiasis

Addison's disease

Chronologically, chronic mucocutaneous candidiasis appears first, followed by hypoparathyroidism, and lastly Addison's.

PGA II - also with Addison's and 1 of the 2:

1) Type 1 DM (contrast this with candidiasis, which is common in Diabetics)

2) autoimmune THYROID disease - more commonly Hashimoto's than Graves' (contrast this with Parathyroid involvement of PGA I)

Parathyroidectomy - to chop or not to chop?

2010-07-19T15:45:00.007+08:00

The following are definite indications for SURGICAL management of HYPERPARATHYROIDISM (based on American National Institutes of Health consensus)

Indications for Parathyroidectomy - Calcium BuRNS !!!

Calcium - either SERUM > 3.0 or URINARY Ca2+ markedly elevated

BMD decreased

u (null)

Renal impairment

Nephrocalcinosis &/or Nephrolithiasis

Symptomatic hypercalcemia that is severe

Conservatively managed HyperPTH patients require YEARLY:

1) serum calcium

2) U+Es

3) Renal USS

4) BP

5) & a BMD every 2-3 years.

I've got some NERVE plagiarising these mnemonics

2010-07-14T14:41:00.001+08:00

Ha Ha. Corny.

Here are two commonly seen/available mnemonics regarding neuritides:

Causes of Carpal Tunnel Syndrome - MEDIAN TRAP

Myxoedema (ie. Hypothyroidism)

EtOH

Diabetes Mellitus

Idiopathic

Amyloidosis

Neoplasia

Trauma

Rheumatoid Arthritis

Acromegaly

Pregnancy

Causes of Mononeuritis Multiplex - WARDS PLC (Courtesy of the good ol' Cheese & Onion)

Wegener's Granulomatosis

Amyloidosis

Rheumatoid Arthritis

Diabetes Mellitus

Sarcoidosis/SLE

Polyarteritis Nodosa

Leprosy

Carcinomatosis

**rule of thumb: think infiltrative diseases (ie. Sarcoid/Amyloid) and Vasculitis/CTDs (SLE, RA, WG, PAN)

Nephrotic VS Nephritic - where one letter makes a world of a difference

2010-03-19T20:57:00.000+08:00

Back when I was a medical student, I thought my nephrology lecturer was a fickle dyslexic - which explained why he kept flitting between nephritic and nephrotic in his lecture notes. And I wonder why I never really grasped either syndrome until now... ...

Features of nephrotic syndrome - "NAPHROTIC"

Na+ - you may rarely get hyponatremia in nephrotic syndrome; this is also a reminder that there is an intense pathophysiologic retention of sodium due to reduced oncotic pressure

Albumin - serum levels are decreased

Proteinuria >3g/day

Hyperlipidemia

Renal vein thrombosis

Oedema

Thrombosis

Infections - more prone to them due to loss of Ig in the urine

Coaguability

Features of nephritic syndrome - "HO HO"

Hematuria - not forgetting the all-important RED CELL CASTS

Oedema

Hypertension

Oliguria (secondary to developing azotemia)

Admittedly, the 2nd mnemonic is pretty weak =P

I guess the take home point is to be aware of the complications that can arise in patients with nephrotic-range proteinuria. On the other hand, one needs to be very wary of deteriorating renal function in patients who develop red-cell casts.

Erythema Nodosum VS Pyoderma Gangrenosum

2010-01-14T18:58:00.001+08:00

Causes of Erythema Nodosum - DISSTend

Drugs (OCP, Penicillin, Sulfonamides)
IBD
Streptococcal infections
Sarcoid
TB
end - just a reminder that this the mnemonic for erythema nodosum

Causes of Pyoderma Gangrenosum - I Hate RPGs (I really do BTW...)
IBD
Hepatitis / Hematologic malignancies
RA
PG - reminder that it's Pyoderma Gangrenosum we're talking about here...

Jones' Criteria for Rheumatic Fever - Jones' Fear No-one

2009-12-25T15:20:00.000+08:00

Jones' Criteria for Rheumatic Fever - JONES FEAR NO-1

In addition to evidence of recent Streptococcal infection (eg ASOT, positive throat swab c/s), we need either 2 major OR 1 major + 2 minor criteria

Major Criteria:

Joints - migratory, flitting polyarthritis

- Carditis

Nodules (subcutaneous)

Erythema marginatum

Sydenham's chorea

Minor Criteria:

Fever

ESR raised

Arthralgia

Rheumatic fever previously

No-1 = First degree H/B on ECG

CHOLESTATIC drugs

2009-12-25T15:00:00.000+08:00

Drugs causing cholestasis - CHOLESTATIC

CHlorpromazine

Ofloxacin

Largactil (ie chlorpromazine...cldn't think of any L-drugs)

Erythromycin

Sulfamethoxazole

Trimethoprim (Co-Trimox)

Augmentin (ie Co-Amoxiclav)

Tetracycline

Ibuprofen

Cimetidine

Mnemonics on poisoning

2009-12-15T20:09:00.006+08:00

Indications for Hyperbaric O2 therapy in CO poisoning - NEPAL 40

Neurological toxicity (the most indicative being cerebellar symptoms)
ECG changes (the need for DCCV or Defib is a relative C/I to hyperbaric O2)
PregnAncy
Loss of consciousness
>40% CO-Hb

Symptoms of Lead Toxicity - LEAD (kudos to Esben Vogelius)

Lines across gums (Burton's Lines - poor dentition is usually a prerequisite for this sign, so rarer in children)
Erythrocyte stippling (also Sideroblastic anemia)
Abdominal pain
Drop, foot or wrist (Lead neuropathy is largely motor)
also, don't forget to look for neurodevelopmental symptoms

Graft versus Host Disease - Symptomology

2009-12-10T15:04:00.002+08:00

acute GvHD occurs within 100 days of transplanting (immuno-competent) donor cells into an immuno-deficient host.

the classic triad of symptoms correspond to the abbreviation for this syndrome (ie. GvHD)

Gastroenteritis - diarrhoea
Hepatitis - biochemically evident, with or without jaundice
Dermatitis - ranges from mac-pap rash (that can be painful/pruritic) to exfoliative erythroderma

Bony Metastasis

2009-12-10T05:06:00.005+08:00

Common Tumours Metastasising to bone - L.P. Thomas Kisses Best (or Breast)

Lung
Prostate
Thyroid
Kidney
Breast

Common sites of skeletal metastases - CASPERSKY (in order of frequency)

CA - reminder that bony malignancies are usually secondary
Spine
PElvis
Ribs
SKull
Y - looks a lil' like your femur 'eh? (ie Proximal Long Bones... ...rubbish I know =P)

HUS/TTP - CRAFTY syndromes

2009-12-10T02:45:00.004+08:00

Symptoms of HUS/TTP - CRAFTY (thank you ValueMD)

CNS symptoms -> visual symptoms, paresis, fits, changing conscious levels
Renal failure
Anemia -> Microangiopathic Haemolytic Anaemia (MAHA)
Fever
Thrombocytopenia
Y does it occur?
In HUS/TTP there are autoantibodies against the ADAM-TS13 metalloproteinase. ADAM-TS13 prevents the polymerisation of vWF -> hence when it is inhibited, vWF polymerises into larger, more active molecules - causing more platelets to clump to it and resulting in a fall in circulating platelet counts and intravascular microthrombi.

Causes include: E coli 0157, Shigella, Adenovirus, Pneumococcus, OCP, Pregnancy, SLE, HIV [haven't got a mnemonic for this list yet =( ]

Deadly Headaches - THIS GEM

2009-12-10T02:24:00.002+08:00

Deadly headaches that should be excluded - THIS GEM

Temporal arteritis
Hypertensive headaches
ICP increased
Sub-arachnoid haemorrhage

Glaucoma
Encephalitis
Meningitis

Psychiatry at a glance - Suicide Risk, NMS, 5-HT Syndrome, Depression

2009-12-10T01:47:00.006+08:00

Assesing suicide risk/severity - MAN THIS ISN'T FAIR (Credit: Dr A Sankaranarayanan)

Mental status (eg. depressed, anxious, agitated, guilt/shame, delusions)
Attempts (prev suicide attempts + exploring the lethality if any)
Nothing to live for (e.g. no family support, career, sense of hopelessness)

Trigger (any precipitants for the suicide attempt?)
Help - did patient seek help after the attempt
I=IDEAS and INTENTION (ie. explore suicide plans & confidence level to see it thru)
Substance abuse

Ilness (Medical or Psychiatric)
Suicide in the family
N’T = suicide NOTE (also telling others prior to attempt)

Final arrangements (eg. final goodbyes, leaving a will)
Access to suicide means (e.g., firearms)
Isolation (ie. made efforts to be undiscovered?)
Regret surviving the suicide attempt??

Symptoms of Neuroleptic Malignant Syndrome - FALTER

Fever / Fluctuating consciousness
Autonomic instability
Leucocytosis
Tremor
Elevated CK
Rigidity

Symptoms of Serotonin Syndrome - FiRe My CoFe
(again, a poor mnemonic that has absolutely no link to the clinical condition =P)

Fits
Reflexes increased

Myoclonus

Confusion
Fever

Assessment of Depression - ME ESCAPINGS

Mood (depressed)
Enjoyment (ie. anhedonia)

Energy
Sleep (insomnia or hypersomnia)
Concentration (diminished concentration or indecisiveness)
Appetite (decreased OR increased)
Psychomotor retardation (OR agitation)
IN Guilt (excessive/inappropriate feelings of guilt or worthlessness)
Suicide (recurrent suicidal ideation/attempt)

MDD = >4 symptoms daily for 2/52, one of which has to be part of "ME" (Mood OR Enjoyment)

Severity of PVCs

2009-12-10T01:08:00.005+08:00

Excuse my language....sorry!

Severity of PVCs - My Cock F*cks Real Pussy

Multiform (ie PVCs of >1 morphology) -> Lown Grade 3
Consecutive (ie 2 or more PVCs occuring in a row) -> Lown Grade 4
Frequent (defined as >30 PVCs/hr) -> Lown Grade 2
R-on-T phenomenon -> Lown Grade 5
Post-MI (PVCs occuring after the onset of an MI should be regarded with caution)

Symptoms of Asthmatic Emergencies

2009-12-10T00:49:00.004+08:00

Severe Asthma - TRIP

Tachycardia >110bpm
RR > 25/min
Inability to speak full sentences
PEFR 33-50% of expected

Life-threatening Asthma - SHOCKED

Silent chest
Hypotension
O2 <>
Cyanosis
Konfusion
Exhaustion (ie. feeble respiratory effort)
Dysrhythmmias

also, PEFR <33% of expected (if patient is even capable of performing PEFR)

Precipitants of hepatic encephalopathy - HEPATICS

2008-09-01T13:49:00.006+08:00

this mnemonic's pretty neat... got it from RxPG online and made some changes. enjoy!

Precipitants of Hepatic Encephalopathy - HEPATICS

Haemorrhage in the GI tract
Electrolyte disturbances (incl hypoNa+, hypoK+, hypovolaemia, acid/alkalosis, hypoxia)
Protein in the diet
Azotemia
TIPSS (transjugular intrahepatic porto-systemic shunt)
Infection (eg. spontaneous bacterial peritonitis)
Constipation
Sedatives (eg. opiates, benzos)

Inducers 'n' Inhibitors

2008-09-01T12:33:00.013+08:00

Drug interactions are a bitch to study =(....

Hepatic enzyme INDUCERS - PC BRAS

Phenytoin
Carbamazepine

Barbiturates
Rifampicin
Alcohol (chronically)
Sulfapyrazine

so that's why they call them inducers......

Hepatic enzyme INHIBITORS - MAGIC VASES

Macrolides
Azoles (incl metronidazole)
Grapefruit
Isoniazid
C : cimetidine, chloramphenicol, ciprofloxacin

Valproate
Amiodarone
SSRIs
Esomeprazole
Sulphonamides

note that 'MAGIC VASES' isn't an exhaustive list; majority of drugs are enzyme inhibitors anyways, both pharmacokinetically and pharmacodynamically, rather than inducers

Causes of False Positive Troponin - PROMPTS

2008-08-28T23:59:00.006+08:00

Causes of false +ve Troponin - PROMPTS

Pericarditis
Renal failure
-failure
Myocarditis
Pulmonary Thromboembolism
Sepsis (severe)

Indications for dialysis in ARF - POKEAI

2008-08-25T21:49:00.020+08:00

Indications for dialysis - POKEAI (pronounced "POKE-EYE")

Pulmonary oedema (refractory to treatment)
= uraemic pericarditis
K+ > 7.0 mmol/L
Encephalopathy, uraemic
Acidosis (pH <7.2 style="font-weight: bold; color: rgb(255, 153, 102);">
Itching (intractable)

**edit**
another version is MOP-UP (since dialysis is like a spring clean!)

Metabolic acidosis
Oedema, pulmonary
Pericarditis, uraemic

Uraemic encephalopathy
Potassium

Ask your Canto friends what POKEAI means if you don't already know =D

Causes of Pulmonary Fibrosis - RAbID (lower zones) ; γ-TAPES (upper zones)

2008-08-24T23:55:00.012+08:00

I came up with these mnemonics and by my own admission, they're pretty shit 'cos they haven't got the remotest connection with PF

Causes of Pulmonary Fibrosis - RAbID (lower zones) ; γ-TAPES (upper zones)

RA (rheumatoid arthritis)
Ab = Asbestosis
Idiopathic PF
Drugs (AMEN: Amiodarone, Methotrexate, Ergot-derivatives, Nitrofurantoin)

γ = radiation
TB
Ankylosing Spondylitis
Pneumoconioses (excl asbestosis)
Extrinsic Allergic Alveolitis
Sarcoidosis

Contraindications to Exercise ECG - JOSHUAA

2008-08-24T23:43:00.006+08:00

A number of mnemonics contain the letter "O".... In some instances, it actually is the "O" actually represents the shape of a heart. Refer to this mnemonic below if you don't get what I mean

Contraindications to exercise tolerance testing (aka exercise ECG) - JOSHUAA

J = ignore
-failure (uncontrolled)
STEMI in the last 5/7
Hypertension (uncontrolled)
Unstable Angina
AF, or other arrhythmias (uncontrolled)
Aortic stenosis (severe)

Factors increasing risk of Digoxin toxicity - MCP DUD

2008-08-24T22:34:00.013+08:00

Factors increasing risk of Digoxin toxicity - MCP DUD

Magnesium ------- Down
Calcium -.--------- Up
Potassium -------- Down

Contraindications to Thrombolysis - "SIT ON HANDS"

2008-08-24T01:03:00.027+08:00

Contraindications to thrombolysis - SIT ON HANDS

Surgery, major and in the last 1 month
Ischaemic stroke in the last 1 year (** I and 1 look similar = easy to remember**)
Trauma, major and in the last 1 month (this includes prolonged/traumatic CPR)

O = Pregnancy (think of the pregnant tummy)
New onset trauma at risk of bleeding

H = Haemorrhagic stroke, if ever & Hypertension (severe)
Allergy/anaphylaxis to previous thrombolysis
Neoplasia of the brain
Dissection of the aorta
exSanguination (active)

I don't think this list is exhaustive, but it should be sufficient to divert all the attention, and not to mention further questioning, onto your unsuspecting clinical partner.