And its about damned time...

...

My Mnemonics

Primary Survey (ABCDE)
Airway
Breathing
Circulation and control of haemorrhage
Disability/deficit neurologically
Exposure

Secondary Survey (AMPLE)
Age/AllergiesMedicationPast Medical HistoryLast mealEvents/Exposure

Phaeochromocytoma (HPASAGH)
H Headache
P Palpitations
A Anxiety
S Sweating
A Anorexia
G Glucose intolerance/DM
H Hypertension

Phaeochromocytoma Rx (Put Down Lucy’s Mad Catecholamines)
P Pheoxybenzamine
D Doxazosin
L Labetolol
M Metyrosine
C CCB

Precocious Puberty treatment (KFC Finger STicking Good)
K Ketoconazole
F Flutamide (NS antiandrogen)
C Cyproterone acetate (antiandrogen)
F Finasteride (5α reductase inhibitor)
S Spironolactone (used for antiandrogen side effects)
T Testolactone (inhibits testosterone aromatisation)
G GnRH analog (Leuprolide)


DKA Management (PANICS)
- Potassium
- Aspirate stomach (NGT)
- Normal Saline
- Insulin
- Catheterisation
- Septic workup

High Anion Gap (MUDPILES)
- Methanol
- Uraemia
- Diabetic Ketoacidosis
- Paraldehyde
- Infection
- Lactic Acidosis
- Ethylene Glycol
- Salicylates

SLE-inducing drugs (PHEMIPP)
- Phenytoin
- Hydralazine
- Ethosuximide
- Methyldopa
- Isoniazid
- Penicillamine
- Procainamide

Crackles (BEABFO)
Early – Bronchitis, Emphysema, Asthma
Mid – Bronchiectasis (altered by coughing)
Late – Fibrosing alveolitis, pulmonary Oedema

4A’s of Ankylosing Spondylitis
- Aortic incompetence
- Anterior uveitis
- Apical fibrosis
- Achilles tendonitis

Psychiatric hierarchy (OFANP)
- Organic disorders
- Functional psychosis
- Affective disorders
- Neuroses
- Personality disorders

Huntington’s Subcortical Dementia (CCAOJV)
- impaired Concentration
- Conceptual tracking
- Attention
- Organisation of thought
- Judgment
- Visuo-spatial skills

Common elements of effective brief intervention (FRAMES)
- Feedback of personal risk
- Emphasis on personal Responsibility
- Advice to change
- Menu of alternative change options
- Empathy in therapy
- Self-efficacy enhancement

MAOI side effects e.g. Phenelzine (HATJC)
- Hypotension
- Anticholinergic
- Tremor
- Jaundice
- Cardiovascular (hypertension, interaction with cheese)

SSRI side effects (LANDS)
- Loss of appetite
- Akathisia
- Nausea
- Diarrhoea
- Sexual dysfunction

Lithium side effects (DW DH TMNT)
- Diuresis
- Weight gain
- Dysarthria
- Hypothyroidism
- Tremor
- Metallic taste
- Nausea
- Thirst
- Toxicity – CCCC – Coarse tremor, Confusion, Convulsions, Coma

Serotonin syndrome (MHFSAC)
- Myoclonus
- Hyperpyrexia
- Fits
- Sweating
- Altered consciousness
- Cardiovascular instability

Clozapine side effects (SHAN V-Fib)
- Sedation
- Hypotension
- Agranulocytosis (3%) + leucocytosis
- Nausea
- Vomiting
- Fits

OLAnzaPIne side effects (OLAPI)
- Oedema (peripheral)
- LAzy (drowsiness)
- Prolactinaemia
- Increased appetitie

Risperidone (OLAPI + IAA)
- Insomnia
- Agitation
- Anxiety

Carbamazepine side effects (SANDHD)
- SIADH
- Ataxia
- Nausea
- Dizziness
- Headache
- Diarrhoea

Eating Disorders (SCOFF)
- Do you make yourself sick because you feel uncomfortably full?
- Do you worry you have lost control over how much you eat?
- Have you ever lost more than one stone in a 3 month period?
- Do you believe yourself to be fat when others say you are too thin?
- Would you say that food dominates your life?

DSH Assessment (MORGAN)
- Milieu (environment)
- Opinion (of patient)
- Risk (to patient and others)
- Guardianship (managing risk)
- Altering Milieu (what has changed?)
- Network (social)

PsychoDynamic psychothErApy (PDEA)
- Personality disorders
- Depression
- Eating disorders
- Anxiety

Dopamine replacement (Menstrual Bleeding, Sub-cutaneous)
- Madopar (co-beneldopa) = Benserazide + Levodopa
- Sinnemet (co-careldopa) = Carbidopa + Levodopa

Wallenburg’s Lateral Medullary syndrome (VVDHULNB)
- Vomiting
- Vertigo
- Dysphagia
- Horner’s (ipsilateral)
- Unsteadiness
- Loss of pain and temperature contralateral
- Nystagmus
- Bulbar Palsy

Antibiotics contraindicated in pregnancy (MCAT)
MetronidazoleChloramphenicolAminoglycosideTetracycline

Sodium Valproate side effects (VALPROATE)
VomitingAlopeciaLiver toxicityPancreatitis/ PancytopaeniaRetention of fats (weight gain)Oedema (peripheral oedema)Appetite increaseTremorEnzyme inducer (liver)

Phenytoin Side effects (PHENYTOIN)
P-450 interactionsHirsutismEnlarged gumsNystagmusYellow-browning of skinTeratogenicityOsteomalaciaInterference with B12 metabolism (hence anaemia)Neuropathies: vertigo, ataxia (cerebellar syndrome)

Anticholinergic side effects (ABCDs)
AnorexiaBlurry visionConstipation/ConfusionDry MouthSedation/Stasis of urine

TCA side effects (SWAT CD)
- Seizures
- Weight gain
- Anticholinergic
- Thrombocytopenia
- Cardiovascular (arrhythmia, palpitations)
- Drowsiness

Mononeuritis multiplex (WARDSPLC)
Wegener’s
Amyloidosis
Rheumatoid Arthritis
Diabetes Mellitus
SLE/Sarcoid
Polyarteritis Nodosa
Leprosy
Carcinomatosis / Churg-strauss

Drugs with narrow therapeutic range (WCTOCP)
Warfarin
Cyclosporin
Theophylline
Oral contraceptive pill
Carbamazepine
Phenytoin

Liver enzyme Inducers (CRAPGPS)
Carbamazepine
Rifampicin
Amiodarone
Phenobarbitone
Griseofulvin
Phenytoin
Smoking

Liver enzyme Inhibitors (Oi! Easy Cars are Stolen Cars)
Omeprazole
Isoniazid
Erythromycin
Cimetidine
Sodium Valproate
Ciprofloxacin

Muscarinic symptoms (SLUDGE)
Salivation
LacrimationUrination
Defaecation
Gastrointestinal distress
Emesis

Causes of diabetes (CHIPSA)
- Cushing’s syndrome (rare)
- Haemochromatosis (rare)
- Idiopathic (95%)
- Pancreatitis, Post-pancreatectomy
- Steroid therapy
- Acromegaly (rare)

Diseases associated with Diabetes Mellitus (P-MATCH)
Phaeochromocytoma
Myotonic Dystrophy
Acromegaly
Thyrotoxicosis
Cushing’s
Hypothyroidism

Drugs associated with DM (GDBPC)
Glucocorticoids
Diuretics
Beta agonists
Phenytoin
Cyclosporin

Drugs which cause an increase in BG (GTLODSCORES)
G glucocorticoids
T thiazide diuretics
L loop diuretics
O OCP
D Diazoxide

Wolfram Syndrome (DIDMOAD)
DI Diabetes insipidus
DM Diabetes mellitus
OA Optic atrophy
D Deafness

Side effects of Thionamines (ARGAJ)
A agranulocytosis
R rashes
G GI upset
A alopecia
J jaundice

Thyroid eye disease (NOSPECS)
N No signs
O Only lid lag
S Soft tissue involvement
P Proptosis
E Extraocular involvement
C Corneal involvement
S Sight loss

Cushing’s disease Rx (MAKMET)
M metyrapone (inhibitor of 11ß-Hydroxylation)
A aminoglutethimide
K ketoconazole
M mitotane
E etomidate
T trilostane (inhibitor of 3ß-HSD)

Brainstem Demyelination – Multiple Sclerosis (DDFVP)
- Diplopia
- Dysphagia
- Facial weakness
- Vertigo
- Pyramidal signs in the limbs

Tabes Dorsalis (SALSACOPA)
- Stamping gait
- Areflexia
- Lightning pains
- Sensory loss
- Ataxia
- Charcot’s Joints
- Optic Atrophy
- Ptosis
- Argyll Robertson Pupil

Garden Classification
Grade One – Two Screw (DHS)
Grade Three – Four Austin-Moore

Types of Shock (CASHNA)
- Cardiogenic
- Anaphylactic
- Septicaemic
- Hypovolaemic
- Neurogenic (spinal)
- Addisonian (i.e. replacement)

Shoulder Dystocia (HELPERRR)
- Help
- Episiotomy (or symphysiotomy)
- Legs (McRobert’s manoeuvre)
- Pressure (suprapubic)
- Enter Vagina (to attempt Woodscrew – internal shoulder rotation)
- Remove posterior arm
- Roll onto hands and knees (and attempt reverse Woodscrew)
- Replacement (Zavanelli – LSCS)

Transverse Lie (10 P’s)
Polyhydramnios Pelvic abnormality
Parity “Phetal” tumours
Prematurity Peculiarities of uterus
Placenta praevia Pelvic contraction
Pelvic tumours Plural pregnancy

High risk areas for melanomas (TANS)
Thorax
Upper arms
Neck
Scalp

To assess cognition in MSE (COAtCoM)
Consciousness level (global)
Orientation (time, day, date, place)
Attention (address)
Concentration (recite months backwards, “WORLD” backwards)
Memory (STM – repeat address, LTM – major events)

Cognition in MSE (GOAL-CRAMP)
‘I’d like to start off by asking you a few questions to test your concentration and memory……….’
General: Alertness and Co-operation
[STM: Name, Address, Flower to remember]
Orientation: Time and Place
Attention: WORLD backwards and Serial Sevens
Language: Naming and Repetition
Calculation: Division and Subtraction
Right Hemisphere Function: Intersecting pentagons and Clock-face
Abstraction: Proverbs and Similarities
Memory: STM and Long-term memory
Praxis: Wave good-bye and Comb hair

Pancreatitis Glasgow Criteria (PANCREAS)
P pO2 <> 55 yrs
N Neutrophils > 15 x 109
C Calcium <> 16 mmol/L
E Enzymes (LDH) > 600 iU
A Albumin <> 10mmol/L

Life threatening asthma (ACPS)
Altered consciousness
Cyanosis
Poor respiratory effort
Silent chest

Serotonin syndrome (MHHFSC)
- Myoclonus
- Hyperreflexia
- Hyperpyrexia
- Fits
- Sweating
- Consciousness decreased

Garden Classification
Grade One & Two Screw (DHS)
Grade Three & Four Austin-Moore

Types of Shock (CASHNA)
- Cardiogenic
- Anaphylactic
- Septicaemic
- Hypovolaemic
- Neurogenic (spinal)
- Addisonian (i.e. replacement)

Shock clinical feature (SHOCKS)
- Sinus tachycardia
- Hypotension
- Oliguria
- Cold
- Klammy
- Slow capillary refill

Shoulder Dystocia (HELPERRR)
- Help
- Episiotomy (or symphysiotomy)
- Legs (McRobert’s manoeuvre)
- Pressure (suprapubic)
- Enter Vagina (to attempt Woodscrew – internal shoulder rotation)
- Remove posterior arm
- Roll onto hands and knees (and attempt reverse Woodscrew)
- Replacement (Zavanelli – LSCS)

Transverse Lie (10 P’s)
Polyhydramnios Pelvic abnormality
Parity “Phetal” tumours
Prematurity Peculiarities of uterus
Placenta praevia Pelvic contraction
Pelvic tumours Plural pregnancy

Melanoma (ABCDE)
- Asymmetry – when one-half of a mole is different from the other
- Border – describes a mole that has an irregular, notched, and indistinct border
- Colour – change in the colour or shade of a mole
- Diameter – change in the diameter, especially if > 5mm
- Elevation – change in height of the edge

High risk areas for melanomas (TANS)
Thorax
Upper arms
Neck
Scalp

To assess cognition in MSE (COAtCoM)
Consciousness level (global)
Orientation (time, day, date, place)
Attention (address)
Concentration (recite months backwards, “WORLD” backwards)
Memory (STM – repeat address, LTM – major events)

Life threatening asthma (ACPS)
Altered consciousness
Cyanosis
Poor respiratory effort
Silent chest

Child Psych Assessment (SIRSE)
Symptoms
Impact on family
Risks
Strengths of child
Environmental factors

Approach to lymphadenopathy (ALLAGES)
Age at presentation
Location (biopsy if > 1 month, > 1 cm x 1 cm)
Length of time
Associated symptoms (B symptoms – fever > 38°C, night sweats, weight loss > 10%)
Generalised lymph node enlargement
Extranodal organ involvement
Splenomegaly (CLL, EBV)

Causes of generalised lymphadenopathy (CHICAGO)
Cancers (Lymphoma, CLL)
Hypersensitivity (Phenytoin)
Infections (AIDS, Toxo)
Connective tissue disorders (SLE, RA)
Atypical lymphoproliferative disorders
Granulomatous disorders (Sarcoid)
Other unusual causes (Brucellosis)

Definition of a severe attack of ulcerative colitis (FATHER)
Fever > 37.5 °C
Alb <> 90 bpm
Hb <> 30 mm ↑ in 1st hour
Recur > 6 stools per day

Macrocytic Anaemia (FATRBCS)
Folic acid deficiency
Alcoholism
Thiamine deficiency
Reticulocyte miscounting
B12 Malabsorption
Chemotherapy
Splenectomy

Cerebellar Syndrome (DANISH)
Dysdiadochokinesis
Ataxic gait
Nystagmus
Intention tremor
Speech (slurred, staccato)
Hypotonia

Causes of pancreatitis (GETSMASHED)
- Gallstones
- Ethanol
- Trauma
- Steroids
- Mumps
- Autoimmune
- Scorpion Venom (Trinidad)
- Hypothermia/Hyperlipidaemia
- ERCP
- Drugs (THAT’S FOCUS)

Livedo Reticularis (RaPD SHo)
- Rheumatoid Arthritis
- Polyarteritis nodosa
- Dermatomyositis
- SLE
- HOmocystinuria

Anaphylaxis Drug treatment (ACHAN)
- ABC and oxygen 100% first of course
- Adrenaline (1:1000)
- Chlorpheniramine
- Hydrocortisone
- Aminophylline (IV)
- Nebulised Salbutamol

Peritonitis (TRAPPED)
- Tenderness
- Reflex guarding
- Absent bowel sounds
- Pyrexia
- Percussion pain
- Extremely unwell
- Distant-local sign (Rovsing)

Surgical descriptor (Where’s the Desc Lamp?)
- Where: Site
- Dimensions
- Edge
- Surface
- Consistency
- Lamp: transilluminates?

Acromegaly (ABCDEF)
- Arthropathy
- BP (high)
- Carpal tunnel syndrome
- Diabetes
- Enlarged tongue, heart, thyroid
- Fields – bitemporal hemianopia

Complications of Myocardial Infarction (Sudden death on PRAED street)
- Pump failure
- Rupture of papillary muscle or septum
- Aneurysm and Arrhythmias
- Embolism
- Dressler’s syndrome

Symptoms of Opiate withdrawal (CAMAV)
- Craving
- Arthralgia
- Myalgia
- Abdominal cramps
- Vomiting & diarrhoea

Median Nerve enervations (LOAF)
- Lateral two lumbricals
- Opponens pollicis
- Abductor pollicis brevis
- Flexor pollicis brevis

Wernicke’s encephalopathy (CCHHAAOV)
- Confusion
- Coma
- Hypothermia
- Hypotension
- Ataxia
- Amnesia
- Ophthalmoplegia
- Vestibular paresis (abnormal caloric testing)

Neuroleptic Malignant Syndrome (CLAMPA)
- CPK (raised)
- Leucocytosis
- Altered consciousness
- Myoclonus
- Pyrexia
- Autonomic instability (unstable BP, tachycardia)

Asthma – extrinsic causes (C BASIC)
- Compliance lack
- Bronchial hyper-reactivity
- Allergens
- Stress
- Infection
- Cold temperature

Peripheral neuropathy (DANG THERAPIST)
- Diabetes
- Alcohol
- Nutritional:
§ vitamin B12 deficiency
§ vitamin B1 deficiency
§ vitamin B6 deficiency
§ vitamin E deficiency
- Guillain-Barre (AIDP)
- Toxic:
§ lead
§ arsenic
§ drugs
- HEReditary:
§ Friedreich's ataxia
§ Charcot-Marie-Tooth
§ Refsum's disease
- Amyloid
- Porphyria
- Infection:
§ leprosy
§ infectious mononucleosis
§ HIV
§ Lyme disease
§ diphtheria
- Systemic:
§ Uraemia
§ Systemic lupus erythematosus
§ Sjogren's syndrome
- Tumours:
§ paraneoplastic
§ multiple myeloma/MGUS

Peripheral Neuropathy (DA DRUM)
- Diabetes mellitus
- Alcohol
- Deficiency of B12 and B1
- Rheumatoid arthritis
- Uraemia (i.e. chronic renal failure)
- Malignancy

Pulmonary Fibrosis – Upper Lobe (CHASTE)
- Coal Worker’s Lung
- Histiocytosis
- Ankylosing spondylitis
- Silicosis & Sarcoid
- Tuberculosis
- Extrinsic allergic alveolitis

Pulmonary Fibrosis – Lower Lobe (SCARAB)
- Systemic sclerosis
- Cryptogenic fibrosing alveolitis
- Amiodarone (& Bleomycin, Busulphan)
- Rheumatoid Arthritis
- Bronchiectasis

Depression (SHADOW CAGESS)
- Sleep (EMW)
- Holistic (day-to-day)
- Appetite
- Diurnal variation (mood)
- Outlook (pessimistic, any hope)
- Weird experiences (“sometimes people in your condition…”)
- Concentration
- Anhedonia
- Guilt
- Envy (of other happy people)
- Sex drive
- Suicidality

Indications for exercise testing (ICHA)
- Ischaemic heart disease
- Coronary angioplasty or CABG
- Heart failure (diagnose cause)
- Arrhythmias (exercise related palpitations, syncope, dizziness)

5A’s of negative symptoms in schizophrenia
- Alogia (marked poverty of content and output of speech)
- Attentional impairment
- Anhedonia
- Affective flattening
- Avolition (apathy or anergy)

Epileptic aura (AURa)
- Anxiety
- Unusual sensations (taste, smell)
- Retching (nausea)

Drug-induced pancreatitis (THAT’S FOCuS)
- Thiazides
- Azathioprine
- Tetracycline
- Sodium Valproate
- Frusemide
- Oestrogen
- Corticosteroids
- Sulphonamides

Leukoplakia (6 Ss)
- Smoking
- Spirits
- Spices
- Sepsis
- Syphilis
- Sharp (tooth)

DuPuytRen’s ConTracture
- Pregnancy
- Rheumatoid arthritis
- Cirrhosis (liver disease)
- Thyrotoxicosis

Common causes chronic renal failure (GooD & HAPPY)
GlOmerulOnephritis
Diabetes mellitus
Hypertension
Analgesic nephropathy
Polycystic kidney disease
PYelonephritis

Multiple Endocrine Neoplasia
- Type I: Anterior pituitary, Parathyroid, Adrenal cortex, Pancreas (APAP)
- Type II: Thyroid C-cells, Parathyroid, Adrenal Medulla (TPAM)

SIADH inducing drugs (ABCD)
- Analgesics (opioids, NSAIDs)
- Barbiturates
- Cyclophosphamide/chlorpromazine/carbamazepine
- Diuretics (thiazide)

Microcytic anaemia (SALTI)
- Sideroblastic
- Anaemia of chronic disease
- Lead poisoning
- Thalassaemia
- Iron deficiency

Nephrotic syndrome (SHADY)
- SLE
- HSP
- Amyloid
- Diabetes
- Yes to Drugs (gold & penicillamine)

Delirium Tremens (DT’S HELL)
- Delirium (often worse at night)
- Tremor (gross tremor seen in hands)
- Sympathetic overactivity (hypertension, sweating)
- Hallucinations (often visual)
- ESR (raised)
- Leucocytosis
- LFTs (impaired)