Internal Medicine Mnemonics

Internal Medicine with Mnemonics: Quick Recall for Medical Professionals

A

ACEI: contraindications: PARK:

• Pregnancy
• Allergy
• Renal artery stenosis
• K increase (hyperkalemia)
  • Author: Anthony Chan

Anion gap metabolic acidosis: causes: A MUDPILE CAT:

• Alcohol
• Methanol
• Uremia
• Diabetic ketoacidosis
• Paraldehyde
• Iron/ Isoniazid
• Lactic acidosis
• Ethylene glycol
• Carbamazepine
• Aspirin
• Toluene
  • Author: Mohamed Azim MD Pediatric Surgeon, Alexandria University, Egypt

Acromegaly symptoms: ABCDEF:

• Arthralgia/ Arthritis
• Blood pressure raised
• Carpal tunnel syndrome
• Diabetes
• Enlargemed organs
• Field defect
  • Reference: http://medicalmnemonics.com/

Alkalosis: metabolic changes in alkalosis: “Al-K-loss, Al-Ca-loss”:

• There is loss of K+ (hypokalemia) and Ca++ (hypocalcemia) in state of alkalosis.
  • Author: Ibrahim Mansoor King Edward Medical College

Allopurinol: indications: STORE:

• Stones (history of renal stones)
• Tophaceous gout (chronic)
• Over-producers of urate
• Renal disease
• Elderly

Bonus: Probenecid indications are basically the opposite of STORE (no renal stone history, etc.).

• • Author: Hugo M. Rodriguez, MD University of Virginia Roanoke-Salem Program

Acute stridor: differential: ABCDEFGH:

With fever:

• Abscess
• Bacterial tracheitis
• Croup
• Diphtheria
• Epiglottitis
• ­ Without fever:
• Foreign body
• Gas (Toxic Gas)Hypersensitivity
  • Author: Anthony Chan Chinese University of Hong Kong

B

Back pain causes: DISK MASS (since near vertebral disc):

• Degeneration (DJD, osteoporosis, spondylosis)
• Infection (UTI, PID, Pott’s disease, osteomyelitis, prostatitis)/ Injury, fracture or compression fracture
• Spondylitis (ankylosing spondyloarthropathies such as rheumatoid arthritis, Reiters, SLE)
• Kidney (stones, infarction, infection)
• Multiple myeloma/ Metastasis (from cancers of breast, kidney, lung, prostate, thyroid)
• Abdominal pain (referred to the back)/ Aneurysm
• Skin (herpes zoster)/ Strain/ Scoliosis and lordosis
• Slipped disk/ Spondylolisthesis
  • Reference: http://medicalmnemonics.com/

Behcet’s syndrome: diagnostic criteria: PROSE:

• Pathergy test (i/d saline injection)
• Recurrent genital ulceration
• Oral ulceration (recurrent)
• Skin lesions
• Eye lesions

Oral ulceration is central criteria, plus any 2 others.

• • Author: Harsh Sharma BJMC, Pune, India

Bronchiectasis: causes: A SICK AIRWAY:

• Airway lesion, chronic obstruction
• Sequestration
• Infection, inflamation
• Cystic fibrosis
• Kartagners syndrome
• Allergic brochopulmonary aspergilliosis
• Immunodeficiencies (hypogammaglobinaemia, myeloma, lymphoma)
• Reflux, inhalation injury
• William Campbell syndrome (and other congenitals)
• Aspiration
• Yellow nail syndrome/ Young syndrome
  • Author: LW Mason 4th Year Medical Student

Bronchiectasis: differential: BRONCHIECTASIS:

• Bronchial cyst
• Repeated gastric acid aspiration
• Or due to foreign bodies
• Necrotizing pneumonia
• Chemical corrosive substances
• Hypogammaglobulinemia
• Immotile cilia syndrome
• Eosinophilia (pulmonary)
• Cystic fibrosis
• Tuberculosis (primary)
• Atopic bronchial asthma
• Streptococcal pneumonia
• In Young’s syndrome
• Staphylococcal pneumonia
  • Author: Benson Moses Benjamin JSS Medical College Mysore India

Back trouble causes: O, VERSALIUS (Versalius was the name of a famous physician):

• Osteomyelitis
• Vertebral fracture
• Extraspinal tumour
• Spondylolisthesis
• Ankylosing spondylitis
• Lumbar disk increase
• Intraspinal tumor
• Unhappiness
• Stress
  • Reference: http://medicalmnemonics.com/

D

Dialysis indications: HAVE PEE:

• Hyperkalemia (refractory)
• Acidosis (refractory)
• Volume overload
• Elevated BUN (> 36 mM)
• Pericarditis
• Encephalopathy
• Edema (pulmonary)
  • Author: Tim Welke and Darren Yuen University of Toronto Medical School

E

Eosinophilia: differential: NAACP:

• Neoplasm
• Allergy/ Asthma
• Addison’s disease
• Collagen vascular diseases
• Parasites
  • Reference: http://medicalmnemonics.com/

G

Gynecomastia: common causes: GYNECOMASTIA:

• Genetic Gender disorder (Klinefelter)
• Young boy (pubertal)*
• Neonate*
• Estrogen
• Cirrhosis/ Cimetidine/ Ca Channel blockers
• Old age*
• Marijuana
• Alcoholism
• Spironolactone
• Tumors (Testicular & adrenal)
• Isoniazid/ Inhibition of testosterone
• Antineoplastics (Alkylating Agents)/ Antifungal(ketoconazole)

*Asterisk indicates physiologic cause.

• • Author: Uberoi UNIBE

H

Haematology: key numbers

• 3 and 4 are key in in haematology:
• 34 cm3 of oxygen is carried by a gram of hemoglobin.
• There’s 3.4mg of iron in each gram of hemoglobin.
• There’s an average of 3.4 lobes per neutrophil.
• There’s 34mg bilirubin from each gram of hemoglobin.
  • Reference: http://medicalmnemonics.com/

Hypercalcemia causes: MD PIMPS ME:

• Malignancy
• Diuretics (thiazide the main culprit)
• Parathyroid (hyperparathyroidism)
• Immobilization/ Idiopathic
• Megadoses of vitamins A,D
• Paget’s disease
• Sarcoidosis
• Milk alkali syndrome
• Endocrine (Addison’s disease, thyrotoxicosis)
  • Reference: http://medicalmnemonics.com/

Hypercalcemia: causes: GRIM FED:

• Granulomas (sarcoid, TB),
• Renal faliure
• Immobility (esp. long term)
• Malignancy
• Familial (eg familial hypocalciuric hypercalcemia)
• Endocrine (see below for subtypes)
• Drugs (esp. thiazide diuretics, lithium)
• ­ Endocrine causes are PATH:
• Phaeochromocytoma
• Addison’s disease
• Thyrotoxicosis
• Hyperparathyroidism
  • Author: Steve London, England

Hypercalcemia: differential: VITAMIN TRAPS:

• Vitamin A and D intoxication
• Immobilization
• Thyrotoxicosis
• Addison’s disease/ Acidosis
• Milk-alkali syndrome
• Inflammatory disorders
• Neoplastic disease
• Thiazides, other drugs
• Rhabdomyolysis
• AIDS
• Paget’s disease/ Parenteral nutrition/ Parathyroid disease
• Sarcoidosis
  • Reference: http://medicalmnemonics.com/

Horner’s syndrome: components: SAMPLE:

• Sympathetic chain injury
• Anhidrosis
• Miosis
• Ptosis
• Loss of ciliospinal reflex
• Enophthalmos
  • Author: Harsh Sharma BJMC, Pune, India

Hemoptysis: causes: HEMOPTYSIS:

• Haemorrhagic diathesis
• Edema [LVF due to mitral stenosis]
• Malignancy
• Others [eg: vasculitis]
• Pulmonary vascular abnormalities
• Trauma
• Your treatment [anticoagulants]
• SLE
• Infarction in lungs
• Septic
  • Author: Sonali Vadi

I

ICU management: A to Z

• A: Asepsis/ Airway
• B: Bed sore/ encourage Breathing/ Blood pressure
• C: Circulation/ encourage Coughing/ Consciousness
• D: Drains
• E: ECG
• F: Fluid status
• G: GI losses/ Gag reflex
• H: Head positioning/ Height
• I: Insensible losses
• J: Jugular venous pulse
• K: Kindness
• L: Limb care/ Label
• M: Mouth care
• N: Nociception/ Nutrition
• O: Oxygenation/ Orient the patient
• P: Pulse/ Peristalsis/ Physiotherapy
• Q: Quiet surroundings
• R: Respiratory rate/ Restraint
• S: Stress ulcer/ Suctioning
• T: Temperature
• U: Urine
• V: Ventilator
• W: Wounds/ Weight
• X: Xerosis
• Y: whY
• Z: Zestful care of the patient
  • Author: Sonali Vadi

L

Lethargy, malaise causes: FATIGUED:

• Fat/ Food (poor diet)
• Anemia
• Tumor
• Infection (HIV, endocarditis)
• General joint or liver disease
• Uremia
• Endocrine (Addison’s, myxedema)
• Diabetes/ Depression/ Drugs
  • Author: The Cashman University of Queensland, Australia

Left iliac fossa: causes of pain: SUPER CLOT:

• Sigmoid diverticulitis
• Uteric colic
• PID
• Ectopic pregnancy
• Rectus sheath haematoma
• Colorectal carcinoma
• Left sided lower love pneumonia
• Ovarian cyst (rupture, torture)
• Threatened abortion/ Testicular torsion
  • Author: Sushant Varma Medical student, University of Sheffield, UK

M

Macrocytic anemia: causes: ABCDEF:

• Alcohol + liver disease
• B12 deficiency
• Compensatory reticulocytosis (blood loss and hemolysis)
• Drug (cytotoxic and AZT)/ Dysplasia (marrow problems)
• Endocrine (hypothyroidism)
• Folate deficieny/ Fetus (pregnancy)
  • Author: Anthony Chan

Metabolic acidosis: causes: KUSSMAL:

• Ketoacidosis
• Uraemia
• Sepsis
• Salicylates
• Methanol
• Alcohol
• Lactic acidosis
  • Author: Steve Gust Gove District Hospital, NT Australia

N

Non-gap acidosis: causes: HARD UP:

• Hyperalimentation
• Acetazolamide (carbonic anhydrase inhibitors)
• RTA
• Diarrhea
• Ureterosigmoidostomy
• Pancreatic fistula
  • Author: James Reeves Emory University School of Medicine

P

Pancytopaenia differential: “All Of My Blood Has Taken Some Poison”:

• Aplastic anaemias
• Overwhelming sepsis
• Megaloblastic anaemias
• Bone marrow infiltration
• Hypersplenism
• TB
• SLE
• Paroxysmal nocturnal haemoglobinuria
  • Author: Trisan W. Graham

Pressure Sore: Norton Score: MAGIC:

• Mobility
• ADL
• General condition
• Incontinence
• Conscious level
  • Author: Anthony Chan

Pruritus without rash: DDx: ITCHING DX:

• Infections (scabies, toxocariasis, etc)
• Thyroidal and other endocrinopathies (eg diabetes mellitus)
• Cancer
• Hematologic diseases (eg iron deficiency)/ Hepatopathies/ HIV
• Idiopathic
• Neurotic
• Gravid (pruritus of pregancy)
• Drugs
• eXcretory dysfunctions (eg uremia)
  • Reference: http://medicalmnemonics.com/

Polycythemia Rubra Vera (PRV): common symptoms: PRV:

• Plethora/ Pruritis
• Ringing in ears
• Visual blurriness
  • Author: Rinku S. Uberoi UNIBE

Pleural effusion: investigations: PLEURA:

• Pleural fluid (thoracentesis)
• Lung, pleural biopsy
• ESR
• Ultrasound
• Radiogram
• Analysis of blood
  • Author: Huiquan Zhao Children Hospital, Cincinnati

Pulmonary edema: treatment: LMNOP:

• Lasix
• Morphine
• Nitrates (NTG)
• Oxygen
• Position (upright vs. flat)
  • Author: Jeff Gilfor, M.D.

Pulmonary edema: treatments: MAD DOG:

• Morphine
• Aminophylline
• Digitalis
• Diuretics
• Oxygen
• GGases in blood (ABG’s)
  • Reference: http://medicalmnemonics.com/

Pulmonary fibrosis: causes: SCAR:

• ­ Upper lobe:
• Silicosis/ Sarcoidosis
• Coal worker pneumonconiosis
• Ankylosing spondylitis
• Radiation
• ­ Lower lobe:
• Systemic sclerosis
• Cyptogenic fibrosing alveolitis
• Asbetosis
• Rheumatoid arthritis
  • Author: Anthony Chan

R

Raynaud’s disease: causes: BAD CT:

• Blood disorders (eg polycythaemia)
• Arterial (eg atherosclerosis, Buerger’s)
• Drugs (eg beta-blockers)
• Connective tissue disorders (rheumatoid arthritis, SLE)
• Traumatic (eg vibration injury)
  • Author: Gajan Rajeswaran Final Year Medical Student, Imperial College School Of Medicine, London

Rashes: time of appearance after fever onset: “Really Sick Children Must Take No Exercise”:

• ­ Number of days after fever onset that a rash will appear:
• 1 Day: Rubella
• 2 Days: Scarlet fever/ Smallpox
• 3 Days: Chickenpox
• 4 Days: Measles (and see the Koplik spots one day prior to rash)
• 5 Days: Typhus & rickettsia (this is variable)
• 6 Days: Nothing
• 7 Days: Enteric fever (salmonella)
  • Author: Rivka Zieff Hospital Dept. of Pediatrics, Tzfat, Israel

Renal failure (acute): management: Manage AEIOU:

• Anemia/ Acidosis
• Electrolyte and fluids
• Infections
• Other measures (eg nutrition, nausea, vomiting
• Uremia
  • Author: Malik Tariq Rahim King Edward Medical College, Lahore, Pakistan

S

SIADH: causes: SIADH:

• Surgery
• Intracranial: infection, head injury, CVA
• Alveolar: Ca, pus
• Drugs: opiates,antiepileptics, cytotoxics, anti-psychotics
• Hormonal: hypothyroid, low corticosteroid level
  • Author: Steve Gust Gove District Hospital, NT, Australia

SIADH: diagnostic sign: Syndrome of INAPPropriate Anti-Diuretic Hormone:

• Increased
• Na (sodium)
• PP (urine)
• ­ SIADH is characterized by increased urinary sodium.
  • Author: Rinku Uberoi New York Hospital

SIADH: major signs and symptoms: SIADH:

• Spasms
• Isn’t any pitting edema (key DDx)
• Anorexia
• Disorientation (and other psychoses)
• Hyponatremia
  • Author: Harsh Sharma BJMC

SLE: factors that make SLE active: UV PRISM:

• UV (sunshine)
• Pregnancy
• Reduced drug (eg steroid)
• Infection
• Stress
• More drug
  • Reference: http://medicalmnemonics.com/

Splenomegaly: causes: CHICAGO:

• Cancer
• Hem, onc
• Infection
• Congestion (portal hypertension)
• Autoimmune (RA, SLE)
• Glycogen storage disorders
• Other (amyloidosis)
  • Author: Gerard Dang Chicago Medical School

U

Ulcers: types: VAN:

• Venous/ Vasculitic
• Arterial
• Neuropathic
  • Author: University of Sydney, Australia

W

Wheezing: causes: ASTHMA:

• Asthma
• Small airways disease
• Tracheal obstruction
• Heart failure
• Mastocytosis or carcinoid
• Anaphylaxis or allergy
  • Reference: http://medicalmnemonics.com/