Medical Mnemonics

Skriptenzentrale Medizinskriptenzentrale.fsmb.ch | Universität Bern | Murtenstrasse 17 | 3010 Bern

Timothy Aebi 1 | 2 | 3 | 4 | 5 | 6

www. pipel i ne. com /-dj ovce/m edi callhome.html :

wwrv.virtualer.com :

www.hin.ch:

www.MDchoice.com :

This is a huge collection of all sorts of medical links, whichhave to do with emergency medicine. You'll find your way toorganisations, journals, sites (anaesthesia, cardiology, criticalcare, orthopaedics, general medicine, neurology,paediatrics...).

Virtual ER. Online emergency cases, ECG's, murmurs,procedures, x-rays, tests and much more.

Swiss Health lnfo Net. Hospitals, doctors, news, links andinternet-caf6.

Lots of medical information, health news, interactive education(photo rounds", ECG rounds*, cyberpatient simulator) , Linksto journals and books and more!

www.evimed.ch: lnteresting information all around evidence based medicine.

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www.nlm.nih.sov: OfficialMEDLINEResourceCentre

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IVational Library of Nledicine

The online Virtual Hospital

www.reutershealth.com : Reuter's clinical information online with various links.

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www.cponline.gsm.com : Clinical pharmacology online. Registration necessary

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rvwrv.biomednet.com : Subscribe here to join this internet community forbiological and medical researchers

BioMedNet''The lnternet flommunity lor Biological and Medical fiesearehtrs

www.bhia.org : British Healthcare lnternet Association

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Official website of the Swiss Medical Association (FMH)www.fmh.ch:

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www.vsao.ch : Official website of the 'Vereinigung SchweizerischerAssistenz- und Oberäzte'

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MNEMONICBooLl"tFirst Edition, Bern, Switzerland, May 2000

IntroJuctionWelcome to this collection of medical mnemonics and hints which is supposed tomake your life as a student or a new-born S.H.O. (lntern) a little easier. Of course,this booklet will not replace the need of good founded knowledge in medicine and itwon't make you a brilliant doctor, either. But who knows, it might help you becomeone. There's no shame to admit that our mind is not perfect and especially at thebeginning of your medical career. Why not use some helpful mnemonics, why notgive your brain a little support?A lot of information can be easily found on the lnternet too. This co-operationbetween networks allows the sharing of information resources worldwide and it'saccessible to everyone. Already by searching the world wide web a few minutes youwill be able to find various medical pages including education, clinical care, research,communication and many more. Therefore this booklet contains a small selection ofmedical internet-addresses, where you can find useful information.Call-Up: Do YOU know any other helpful mnemonics? Have you figured out someby yourself? As this collection is supposed to be continued and to grow, don'thesitate to e-mail any new mind aid to ,§b,!=MD@g4qr.!§I for publication in the nextedition.

Please Note: These mnemonics are thought as a help for your studies or your workon the ward. They may not correspond to your local or other officialrecommendations. Before prescribing any drug the reader must check with the mostupdate product information and safety regulations. No responsibility can be taken forany information provided in this text.

Emergency M"Ji"ir"Internal M"Ji"irr"SurgeryR"JiologyG1-.""ology €d OtstetricsInternet-Lintr . . .

Pase 2Pug. 6Page 15Page 17Page 20Page 22

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Internet LinLs

www.imd.ie : Website of the lrish Medical Directory, especially helpful whensearching for international medical journals. Click on "lnternationalMedical Links of Repute".

wlvw.bmj.com:

www.thelancet.com :

www.neim.com:

www.smw.ch:

The British Medical Journal

The Lancet

The New England Journal of Medicine

The Swiss Medical Weekly. New: All articles in fulltext freeonline. National and international news provided.

The Journal Watch, another resource for all sorts of journalinformation

Official Site of the Swiss Federal Department of Health

Website of the World Health Organisation

www.medscape.com : Subscribe here for latest publications, case presentations,medical news, doctor's homepage and, and, and

IMD

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Evaluating The NewbornThe newborn's vitality is evaluated right after birth by using the score from VirginiaApgar (from 1953). A score is given for each sign at one and five minutes after thebirth. lf there are any problems with the baby an additional score is given at 10minutes. A score of 7-10 is considered as normal, while 4-7 might require someresuscitative measures, and a baby with APGARs of 3 and below requires immediateresuscitation. The APGAR-score after 5 minutes is the prognostic most importantone:

A: Activity/muscle tone (absent=0, arms or legs flected=1, full activity=2)P: Pulse (absent=O, <100=1, >100=2)G: Grimace/reflex irritability (no response=O, grimace=1, sneeze/cough/pulls

awa!=l)A: Appearance/skin colour (blue-grey=O, normal except for extremities=1,normal over entire bodY=21R: Respiration(absent=O,slow/irregular=1,§ood/crying=!)

Dangerous lnfections During PregnancyTo mJnorize infections which can harm the embryo (uhtlttfre 12th pregnancy week)or the foetus, think of the English word "TORCH" or the German "STORCH". Most ofthese infections are asymptomatic and can only be diagnosed by antibodies,microbiology or culture:

S: SyphilisT: ToxoplasmosisO: Others (Listeriosis, Hepatitis B, Chicken pox)R: RubellaG: CytomegalyH: Herpes

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Essential Steps For Heart AttacksWhen dealing with a myocardial infarction remember that'Time ls Muscle'! Yourpatient might be terrified; reassure him. Act fast, attach an ECG monitor and ensurea defibrillator trolley is on hand. Most deaths occur within the first hour of the onset ofAMI and are usually due to ventricular fibrillation.The following little and very simple phrase will remind you of the first (maybe evenprehospital) steps to think of:"OH MAN"

O: Oxygen, high-flow 02 (unless CO2 retaining, eg COPD)H: Heparin, eg 80 units/kg, followed by a continuous infusion of 18 units/kg/h.

This is not done everywhere, so check out local recommendations.

M: Morphine, eg 5mg lV (therefore always place an lV cannula). lt is: analgesic,anxiolytic, anti-arrhythmic and venodilatory. Please always consider an anti-emetic like metoclopramide.

A: Aspirin@, eg 300m9 should be given as soon as possible, unlesscontraindicated

N: Nitro-glycerine, eg capsule or spray sublingually for coronary vasodilatation

The Heart Attack And Its EnzymesIt's a very common question you are asked as a student, and funny enough youalways get those enzymes mixed up, although you have learned them several timesbefore. Here's some help: Remember,,GArdiaL"ln myoGArdiaL infarction

C: CK (CK-MB) goes up firstA: ASAT (GOT) goes up secondL: LDH goes up third

Handling The Pulmonary OedemaAs this medical emergency involves the Lungs, start with the L and follow the lettersof the alphabet... LMNOP.

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L: Lasix@ (furosemide), eg 40-80m9 lV slowlyM: Morphine, eg 2,5-5mg lV (subcutaneous application is effective in mildercases). Avoid respiratory depression!N: Nitro-glycerine, capsule or spray sublingually, consider isosorbide dinitrate(rsDN) lvO: Oxygen by face mask: 100o/o if no pre-existing lung diseaseP: Position the patient sitting up with his legs dangling over the side of the bed.This facilitates respiration and reduces venous return!

Staying Calm In Acute Severe Asthma Or An ExacerbatedCOPDAnyone who has ever experienced an exacerbation of a COPD knows in what panicsituation such a patient can get. And even you as the one who should help could endup panicking, but: An atmosphere of calm helps cure the PatientlAnd be careful: theseverity of an asthmatic attack is easily underestimated.The mnemonic,,SHO and ClA" Ifound to be extremely helpful, when working oncasualty.

S: Salbutamol nebulized through a mask, or if not available use a ,,spacer"H: Hydrocortisone, eg 100-200m9 lV. This of course will take some time to showits benefit!

O: Oxygen! Sit Patient up and give 02 in high-dose. Beware: Patients withCOPD, especially if they are CO2-retaining (type 2 respiratory failure) havetheir right for oxygen, but they have to be under constant surveillance!

C: Chest X-ray. Pneumothorax is a common complication and can be lifethreatening. Always do a chest x-ray!

l: Ipratropium bromide. Add to the nebulized ß-agonist.A: Aminophylline=Theophylline (Consider!), eg 250m9 lV over 20mins.

Beware: Avoid p-blockers and NSAID in asthmatic patients, they can worsen thesituation significantly!

Explanation: The SHO §enior House Qfficer) in lreland or Great Britain is theequivalent to the American ,,lntern" or the Swiss ,,Assistenzarzt".

Trauma Requires Fast Thinkingln initial trauma management every second saves lives. You must think ,,FAST'about immediate life-threatening conditions, and if present treat them.

F: Flail chest traumaA: Ainray compromise or obstructionS: Sucking chest wound and Shock tamponadeT: Tension pneumothorax

By being confronted with a multi-trauma patient, there might be no time for x-rays orany tests, just pure clinicaljudgement and immediate treatment.

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Dangerous Situations During Pregnancyln obstetrics the most common causes for maternal death are listed in the Germanword "BEIL" (meaning axe), or "LIEB" (meaning nice):

B: BleedingE: Eclampsial: lnfectionsL: Emboli in the Lungs

When Hellp Means HelpPregnancy induced hypertension is a complex of symptoms of which the cause is notfully understood yet (immunologic, disturbed prostaglandin metabolism, Mg-deficiency?). Especially teenage pregnancies and elderly primigravida are in danger.It is more often in diabetes, multigravida and rhesus-incompatibility, too. One specialform of pregnancy induced hypeftension is the HELLP-syndrome:

H: HaemolysisEL: Elevated Liver enzymesLP: Low Platelets

Prolonged BirthThere are various causes for a prolonged birth, which means an opening of thecervix < 1cm/h. The reasons are listed in the 5 P's:

P: Passenger too bigP: Passage too smallP: Power too littleP: Pain too bigP: Patience too little

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Anterior Mediastinal MassHere's the famous five T's, representing common conditions which can produce ananterior mediastinal mass seen in a conventional chest x-ray pa/lateral.

T: ThymomaT: TeratomaT: Thyroid tumour/goitreT: Terrible lymphomaT: Tortuous vessels

Middle Mediastinal MassIt's the "HABITS'to keep in mind:

H: Hernia, HaematomaA: Aortic aneurysmB: Bronchogenic cysVduplication cystl: lnflammation (sarcoidosis, histoplasmosis, coccidiosis and tuberculosis)T5: 5 tumours (lung, lymphoma, leukaemia, leiomyoma, lymph node hyperplasia)

'Pneumonic' For Gardiophrenic Angle Mass"Fat PAD" will remind you of five possible conditions to think of:

Fat: Fat (easy ey!)

P: Pericardial cystA: Adenopathy/AneurysmD: Diaphragmatic hernia

When Lungs Become HoneycombedThere are various causes for so called honeycomb lungs. lt has to do with''BIG H!PS'':

B: Bleomycinl: ldiopathicG: Granulomas

H: Histiocytosis Xl: lnterstitial pneumoniaP: PneumoconiosisS: Sarcoidosis

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Pain Assessment - Made EasySometimes on casualty it is extremely important to assess pain exactly. To ask all 10important points about pain gives you allthe necessary information. The onlyproblem is, that every time you should remember allthose questions, you don't.The following mnemonic proved to be very helpful! Remember:

,,the SRN §enior Register Nurse) at the OPD (Qut Patient Department) is calledSARA".

S: Sight O: OnsetR: Radiation P: ProgressionN: Nature D: Duration

S: SeverityA: Aggravating factorsR: Relieving factorsA: Associated symptoms

Explanation: Senior Register Nurse = dt. ,,Oberschwester"Out Patient Department = dt. ,,Poly- oder Tagesklinik"

Causes Of GomaThe Mnemonic "MlDAS" will help you remember important states to exclude as acause of coma, especially in stressful situations:

M: Meningitisl: lntoxicationD: DiabetesA: Air! Respiratory failureS: Subdural or Suarachnoid haemorrhage

The Cholinergic OverdoseThe word ,,SLUDGE" is a very simple reminder of the clinical features of a cholinergicoverdose:

S: SalivationL: LacrimationU: UrinationD: DiarrhoeaG: Gastric upsetE: Emesis

And additionally miosis, muscle weakness and bradycardia!

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The Anticholinergic OverdoseThis is not really a mnemonic than rather a picture describing you these clinicalfeatures:

Blind as a batDry as a boneRed as a beetMad as a hatterHot as a hare

And additionally mydriasis, absent bowel sounds, urinary retention!

Facing Malignant HyperthermiaThis is a rare complication during anaesthesia. There is rapid raise in temperature(eg 1'C every 5 minutes, up to 43"c) and acidosis due to rigidity. Prompt treatment isvital and following mnemonic can be helpful as a basic guideline for treatment in sucha situation:"SOme Hot Dude Better Give lced Fluid Fast!"

SO: §top all triggering agents first! Give 10Oo/o O.xygen.H. HyperventilateD: Dantrolene, eg 1mg/kg every 5 minutes lV - up to 10 mg/kg in totalB: Bicarbonate (Consider)G: Glucose and lnsulinl: lV-fluids,'lcy'/cool blanketF: Fluid output (check!), FurosemideFast: Tachycardia

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Metastasis ln The BoneHere's a nice little phrase encounting all important tumours that like to metastasise tothe bones:"Kinds Of Tumours Leaping Primarily To Bone"

K: KidneyO: OvarianT: TesticularL: LungP: ProstateT: ThyroidB: Breast

The Salter ClassificationFor traumatolgy and radiology it is very helpful to have this classification present. Asyou might forget it after a while (like we all tend to forget things we don't useregularly), maybe this mnemonic will help you keep it a little longer in your mind.ln Salter Classification think of "SALTR"

S: Slip of physisA: Above physisL: Lower than physisT: Through physisR: Rammed physis

lnterstitial Lung DiseaseThis mnemonic encompasses at least 80-90% of interstitial lung disease seen inclinical practice.It's the word "SHITFAGED":

S: SarcoidosisH: Histiocytosis Xl: ldiopathic pulmonary fibrosisT: Tumour (lymphangitic)F: FailureA: Asbestosis (and other dusts)C: Collagen vascular diseaseE: Extrinsic allergic alveolitis (eg farmer's lung)D: Drugs

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M:M:P:A:F:

Dense BonesA dense area in a conventional bone x-ray can have various causes. First of all makesure that this is not due to any technical circumstances or a twisted exposure of thepatient. So if asked about the causes of pathologic dense bones remember that:

"Regular Sex Makes Occasional Perversions Much More Pleasurable And Fantastic"

R: Renal osteodystrophy (first there's primary bone destruction, but then reactivesklerosis)S: Sickel-cell disease (due to ineffective O2tranportation there's hyperplasia ofthe bone marrow and therefore reactive bone proliferation, this new bonethough is less stable)M: MyelofibrosisO: OsteopetrosisP: Pyknodysostosis (recessive inherited disorder with generalised osteosklerosisand abnormal growth of already exiting bones)MastocytosisMetastasis (especially from breast or prostate tumours)Paget's diseaseAthletes (here this finding can be physiologic)Fluorosis (eg County Valais, Switzerland)

When Bone Has DisappearedFor any bubbly or lytic bone lesion in a conventional x-ray remember"FEGNOMASHIC'. This will help you to think of all important causes possible:

Fibrous dysplasiaEnchondroma, eosinophilic granulomaGiant celltumourNon ossifying fibromaOsteoblastomaMetastasis and myelomaAneurysmale bone cystSolitary bone castHyperparathyroidism (so called'brown tumour')InfectionChondroblastoma, chondromyxoid fi broma

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Possible Causes For lllnessWhen facing a constellation of symptoms and signs, it may be helpful to try to relatethem to a single underlying disease process."VlNDIGATE" will help you to think of all possible pathologic groups causing disease:

V: vascularl: infectiousN: neoplasticD: degenerativel: iatrogenicC: congenitalA: autoimmuneT: traumatic, toxicE: endocrine

The Essential Of AsthmaWhen asked the exact definition of asthma: Don't think too far, just remember,,ASTHMA"! And do respect Asthma: people still die of it!

A: Ainray obstructionS: Spasm of bronchial muscle*T: Transient (!) and reversibleH: High mucus production*M: Mucosalswelling/inflammation*A: Attack comes paroxysmal

" these are the 3 main factors which narrow the airways!

Talking About AsthmaSalbutamol is a selective p2 adrenoreceptor agonist and acts on the airways. So toremember where which receptor is, just note:"One Heart, Two Lungs"

Beta-l primarily on the heartBeta-2 in the airways

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Possible Gauses Of HypoglycaemiaThis is a great little mnemonic to remind you of the most important causes ofhypoglycaemia. This is the commonest endocrine emergency, so prompt diagnosisand treatment is essential! By definition a hypoglycaemia is plasma glucose<2.Smmol/L. Threshold for symptoms varies.Remember: "EXPLAIN Malaria"

Ex: Exogenous drugs, eg insulin or chlorpropamide; Alcohol, eg alcoholic on abinge with no food; and others like atorvastatin, ACE-inhibitors etc.

P: Pituitary insufficiencyL: Liver failure plus some rare inherited enzyme defectsA: Addison's diseasel: lslet celltumours (insulinoma) and immune hypoglycaemia (eg anti-insulin

receptor antibodies in Hodgkin's disease)N: Non-pancreatic neoplasms (especially fibro sarcoma and

haemangiopericytomas)

Malaria: especially with quinine administration!

Glinical Presentation Of HyperthyroidismFollowing findings should cause a little,,ST!NG' in your brain and remind you ofhyperthyroidism:

S: SweatingT: Tremor and Tachycardial: lntolerance to heat, lrregular Menstruation and lrritabilityN: NervousnessG: Goitre and Gastrointestinal symptoms (like loose stools, diarrhoea)

Probing Questions On AlcoholismEvery Physician will have to face the problem of alcoholism over and over again.Denial is a leading feature in this disease and therefore you can use specificquestions to evaluate, if there is a severe problem with alcohol. Besides thesequestions, which are quite sensitive, always be sure to question relatives too.

Approach 1: The ,,CAGE"-questions

C hange: Has anybody ever asked you to change your drinking habits?A angry: Have you ever been angry about other people complaining?G uilty: Did you ever feelguilty?E ye-opener: Do you need an ,,Cye-opene/' in the morning?

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Post-OP FeverHere's the five "W'which are supposed to help you to determine the possiblecause(s) of fever in a patient who has undergone a surgical procedure recently. Araised temperature post-op should stimulate an infection screen:

W ind: the pulmonary system is the primary source of fever in the first 48hours!

W ound: check for signs of infection at the surgical siteW ater: check intravenous access site for signs of phlebitisW alk: deep venous thrombosis can develop due to pelvic pooling or

restricted mobility related to pain and fatigueW hiz: consider urinary tract infection in patients who undenuent

catheterisation

Predisposing Factors for GallstonesHere's now the probably best known mnemonic to remember the risk factorspredisposing to gallstones: the five "F"

FatF emaleF ortyF ertileF air

Meckel's Diverticulum And The Rule Ot 2When discussing the issue of Meckel's divefticulum it's good to think of the number2, as this number has got a lot to do with this anatomical variety:

2 inches long2 feet from the ileocoecal valve2o/o of the populationcommonly presents in the first 2 years of lifemay contain 2 types of epithelial tissue

Note: lfoot=30,48cm1 inch = 2,54cm

After Day-Case SurgeryBefore discharging a patient, be sure that "LEAP-FROG" is established:

L: Lucid, not vomiting, and cough reflex establishedE: Easy breathing and easy urinationA: Ambulant without faintingP: Pain relief + post-op drugs dispensed and given. Does he understand dose?

F: Follow up arrangedR: Rhythm, pulse rate, and BP checked one last time. ls trend satisfactory?O: Operation site checked and explained to patientG: GP letter sent with patient or carer. He musf know what has happened!

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G:E:T:

Causes Of Acute PancreatitisThis is an unpredictable disease (mortality 5-10Yo) which is often managed onsurgical wards. But because surgery is not often involved, it is easy to think that thereis no acute problem - but THERE lS! This mnemonic is a perfect reminder on all thedifferent causes that can lead to an acute pancreatitis. As in any good mnemonic,either the most important or the most common cause appears at the top of the list.So, if asked by your consultant during an operation or some other occasion, just......''GET SMASHED''

GallstonesEthanolTrauma

SteroidsMumpsAutoimmune (PAN)Scorpion venom (commonest cause in Trinidad!)Hyperlipidaemia (TCa++, hypothermia)ERCP, also EmboliDrugs: (azathioprine, asparaginase, mercaptopurine, pentamidine etc)

also pregnancy; and often no cause is found!

Acute lschaemia Of The LimbThis emergency might be caused by an embolus, thrombosis, or trauma. There islittle difference in its clinical presentation: ,,the six P's!"The limb is:

S:M:A:S:H:E:D:

P aleP ulselessP ainful

P aralysedP araestheticP erishing with cold, or causing P rostration

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Approach 2: The mnemonic,,CONTROL

Can you always Control your drinking?Has alcohol ever led you to lVeglect your family or your work?What 7'ime do you start drinking? Do you sometimes start before this?Do friends comment on how much you drink or ask you to Reduce intake?Do you ever drink in the mornings to Overcome a hangover?Go through an average day's alcohol, Leaving nothing out.

ldentifying Parkinson's DiseaseParkinsonism is a syndrome which literally entraps the patient slowly. So keep theword "TFIAP" in mind for the important clinical features of this disease:

T: Tremor, 3-6Hz (cycles per second). lt's most marked at rest and often seenas a so called 'pill rolling' of thumb and fingers.R: Rigidity, limbs resist passive extension throughout movement (not spasticity!).Cogwheel rigidity (dt. Zahnradphänomen) is combined rigidity and tremor.A: Akinesis or bradykinesisP: Posture typical of a Parkinson's patient and Postural instability

Additional features are monotonous speech (+/- dysarthria), expressionless face,dribbling, short shuffling steps, difficulty stopping and starting walking, blinkrateJ, fidgetingJ, peristalsisJ, micrographia and'couche-volant'.

Big BellyThe differential diagnosis of an abdominal distension includes ,,the 5 F" and one T:

F: FatF: FoetusF: Faeces

F: FluidF: FlatusT: Tumor

Basic Hypertension TreatmentThink of "WATER" when evaluating patients for hypertension:

W: Weight reductionA: Alcohol use JT: Tobacco use J (smoking or chewing)E: ExerciseR: Restriction of salt

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Medical Hypertension TherapyThe therapy of hypertension has to be individually evaluated for each patient, but asan easy reminder of the basic possibilities here's "ABCD", as easy as the ABC!

A: ACE-inhibitors (are first choice in the diabetic-they help prevent renal failure,they may be first choice if coexisting LVF)

B: B-blocker, eg atenolol (if no asthma, heart failure, or claudication)

C: Calcium antagonist, eg amlodipine (SE:flushing, fatigue, gum hyperplasia,oedema)

D: Diuretics, eg Bendrofluazide (SEl)

Basically A and B are preferred in younger patients, C and D in the elderly (this isjust thought as a basic idea).

Acute Rheumatic FeverThis illness is due to cross-reactivity with p-haemolytic streptococci. The diagnosis isbased on the revised JONES-Criteria. lt can be made in the presence of evidence ofprevious streptococcal infection plus 2 major criteria or 1 major and 2 minor criteria.The major criteria are very easy to keep as they are already listed in:"JONES-Criteria"

Jo: Joints red and tender due to migratory ('flitting') polyarthitis (75Yo)N: Nodules, subcutaneous nodules (2-20Y")E: Erythema marginatum on trunk, thighs, arms (2-10%)S: Sydenham's chorea (1Oo/o, St Vitus dance = dt. Veiztanz), commoner if

female. These odd darting movements are usually a late sign.

C: Carditis (endo-, myo-, or pericarditis)

Note: The minor criteria include fever, raised ESR or CRP, arthralgia (but not ifarthritis is one of the major criteria), history of previous rheumatic fever andprolonged P-R interval (but not if carditis is one of the major criteria)

ST Elevation in ECG'sThe possible causes of ST elevation in an ECG are listed in the word "ELEVATION":

E: ElectrolytesL: LBBB (left bundle branch block)E: Early repolarisationV: Ventricular hypertrophyA: AneurysmT: Treatment - pericardiocentesisl: lnjury (acute myocardial infarction, contusion)O: Osborne waves (in hypothermia)N: Non-occlusive vasospasm

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The Little Reminder ln lmmunologyGell & Coombs classified the hypersensitivity reactions into four groups. So, if youstill have some problems keeping them in your mind, maybe a little "ACID' might helpyou:

Type I AnaphylaxisType ll Gytotoxic-mediatedType lll lmmune-complexType lV Delayed hypersensitivity

Showing Off ln HaematologySome of you might think that keeping all these values in your mind is not worthwhiledoing. But some professors will be impressed if you know them by heart, and younever know if you won't be glad to know them on the ward too.It's the numbers 3 and 4 in haematology:

1.34cm2 oxygen carried by 1g of HbAverage of 3.4lobes per neutrophil cell3.4m9 iron in each g Hb34mg bilirubin from each g Hb

Some More Haematological HelpAs a student or on the ward, it's handy to have some values of the white blood cellcount (WBC) present. Remember:"Never Let Mum Eat Beans" and "60,30, 6,3, 1"

N: Neutrophils 60%L: Lymphocytes 30o/oM: Monocytes 60/oE: Eosinophils 3o/oB: Basophils 1o/o

Helpful Reminder ln DermatologyTo remember the criterions, which make a nevus suspicious to be malignant(Melanoma!), think of the alphabetical rule:

A: AsymmetricalB: Borders are irregularG: Colour is not uniformD: Diameter more than 6mmE: Elevation of some parts in the lesion

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T: Testis atrophy

J: JaundiceO: OedemaG: Gynaecomastia

Peptic Ulcer Disease RemindersPeptic ulceration includes either duodenal or gastric ulceration - 2 distinct entities (itmay also occur in Barrett's oesophagus or rarely in a Meckel's diverticulum).Dyspepsia is often the present complaint. Here's the "ABG" for the predisposingfactors of peptic ulcers:

A: AnxietyB: Blood group 0C: Cigarette, CoffeeD: Drugs (especially Aspirin and Steroids, NSAID us 1 risk 3-4 fold)E: Emotions (so called 'ulcer personality', the role of stress though is

controversial)F: Family historyG: Gastric hyper secretionH: Helicobacter pylori (-90% of all duodenal ulcers are HP +ve, and -80% of allgastric ulcerations are HP +ve), HLA type

Predisposing diseases are enclosed in "the 7 C's":C: CirrhosisC: Calcium (hyperparathyroidism)C: Chronic pancreatitisG: Cystic fibrosisG: Chronicrenalfailure/CholestaticjaundiceG: COPDC: Calculi (renal)

For complications it's "the 5 P's":P: PerforationP: Pyloric stenosisP: Peptic malignancyP: Penetration into pancreasP: Plus haemorrhage (which may be catastrophic)

Note: Benign gastric ulcers are not premalignant. But: Gastric cancer may presentthis way, and it's prognosis is better if caught early, so a// suspected GU musf beendoscoped!

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Sleep Apnoe Syndrome And The Number 10To keep the very essential of the definition and epidemiology in your mind,use four times 10:

- By definition more than 10 apnoe periods longer than f0 seconds per hour- About 10o/o of all males over 40 affected- Men 70 times more affected than women

Pheochromocytoma And The Number 10Number 10 will remind you of some important features of pheochromocytoma (whichare discussed 10 times more often than actually seen):

10% malignant10% bilateral10% extra adrenal10% calcified10% children10olo familial

When Elderly People FallWhen ever you get into touch with an elderly patient who has fallen or fainted you'llsurely think of all the cardiovascular causes first. But there are some special causesyou should always keep in mind (and which are often neglected):Remember: "DAME"

D: Drugs (always take a full history including all drugs involved, ask relatives ifnecessary)A: AtaxiaM: higherMentaldysfunctionE: Environment (a carpet with a little fold can be disastrous, consider removingloose carpets at home), Eyes (check visual abilities)

Who ls Who ln PneumoniasWhich bacteria cause community-acquired pneumonias and which are the mostcommon ones? There's hardly any student who hasn't been asked this question, andthere's hardly anyone who hasn't forgotten at least one of them. So remember:

"Street Climbers Have My Legs"

Streptococcus pneumoniae is the commonest (40-80%)Chlamydia pneumoniae or psittaci (causes psittacosis vra parrots)Haemophilus influenzaeMycoplasma pneumoniaeLegionella pneumophila

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For hospital acquired pneumonias remember "SPEK":

S: Staphylococcus aureusP: Pseudomonas aeruguinosaE: Enterobacteria, gram-negativeK: Klebsiella

Pneumonia in the lmmune CompromisedThe four most common pneumonia in patients with immunodeficiency disorders arelisted inthe four C's:

C: Pneumocystis Carinii pneumoniaC: Cryptococcus neoformansC: Cytomegaly virusG: Candida albicans

ldentifying Osler's NodesBasically: Fever + new regurgitant murmur = endocarditis until proven otherwiselHere are the four P's to help you to identify Osler's nodes in infective endocarditis:

P: PinkP: PainfulP: Pea-sizedP: on the Pulp of the fingers or toes

The Gauses Of Hemorrhagic EffusionThis little hint gives you a first idea of what can cause a hemorrhagic pleural effusion,it's:the four T's:

T: TumourT: TuberculosisT: TraumaT: Thrombosis

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Causes Of Red Urinewhen ever you're asked about the causes of haematuria, just relax, "slTTT" downand go:

S: Stonesl: lnfectionT: TraumaT: TumourT: Tuberculosis

By the way: rifampicine (Rimactan@) makes the urine orange'

COPD-GomplicationsThe COpD patient is in danger of developing special complications, which shouldalways be cbnsidered when his state is suddenly worsening: Think of "PICA"!

P: Pneumothorax (especially in sudden respiratory failure or in anyexacerbation. Always do a chest x-ray!)

l: lnfiltrates (Pneumonia)G: Cor PulmonaleA: Atelectasis

For treatment of COPD-exacerbation see "Emergen6y Medicine" above.

Carpal Tunnel SYndromeMultiple diseases can cause this quite common syndrome. Therefore, followingmnemonic could be quite useful: "ARMPIT"

A: Acromegaly, AmYloidosisR: Rheumatoid arthritisM: MyxoedemaP: Pregnancy and Pilll: ldiopathic (most common by the way!)T: Trauma, Tuberculosis

Signs Of Ghronic Liver Diseaseeeäg aware of all the pathophysiologic pathways involved, most of these clinicalfeatu-res should be clear. But if you still have some problems gathering themtogether, here's a little helP:.LAST JOG'

L: Liver flapA: AscitesS: Spider Naevi

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