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Anatomy

Afferent vs efferent

Afferent connection arrives and an efferent connection exits.

Anterior leg muscles

"The Hospitals Are Not Dirty Places"

Tibialis anterior

extensor Hallucis longus

anterior tibial Artery

deep fibular Nerve

extensor Digitorum longus

Peronius tertius [aka fibularis tertius][3]

Brachial plexus

 Posterior cord branches


o STAR - subscapular (upper and lower), thoracodorsal, axillary, radial
o RATS- Radial nerve, Axillary nerve, Thoracodorsal nerve, Subscapular
(Upper & Lower)nerve.
o ULTRA - upper subscapular, lower subscapular, thoracodorsal, radial, axillary
o ULNAR- Upper subscapular nerve, Lower subscapular nerve,Nerve to
latissimus dorsi, Axillary nerve, Radial nerve.
 Lateral Cord Branches
o LLM "Lucy Loves Me" - lateral pectoral, lateral root of the median nerve,
musculocutaneous
o Love Me Latha (LML) - Lateral pectoral nerve, Musculocutaneous nerve,
Lateral root of Median Nerve.
o Look My Lancer-Lateral pectoral nerve, Musculocutaneous nerve,Lateral root
of Median nerve.

 Medial Cord Branches


o MMMUM "Most Medical Men Use Morphine" - medial pectoral, medial
cutaneous nerve of arm, medial cutaneous nerve of forearm, ulnar, medial root
of the median nerve
o Union of 4 Medials - Ulnar nerve, Medial cutaneous nerve of arm, Medial
cutaneous nerve of forearm, Medial pectoral nerve, Medial root of Median
Nerve.
 5 main nerves of brachial plexus, in order laterally to medially
o "My Aunty Recognised My Uncle" - Musculocutaneous, axillary, radial,
median, ulnar.
Bowel components

"Dow Jones Industrial Average Closing Stock Report"

From proximal to distal:

 Duodenum
 Jejunum
 Ileum
 Appendix
 Colon
 Sigmoid
 Rectum[4]

Carotid sheath contents

I See 10 CC's in the IV:

I See (I.C.) = Internal Carotid artery

10 = CN 10 (Vagus nerve)

CC = Common Carotid artery

IV = Internal Jugular Vein[5]

Cavernous sinus contents

O TOM CAT:

O TOM are lateral wall components, in order from superior to inferior.

CA are the components within the sinus, from medial to lateral. CA ends at the level of T
from O TOM.

Occulomotor nerve (III)

Trochlear nerve (IV)

Ophthalmic nerve (V1)

Maxillary nerve (V2)

Carotid artery

Abducent nerve (VI)


T: When written, connects to the T of OTOM[6]

Coeliac trunk: branches

Left Hand Side (LHS):

Left gastric artery

Hepatic artery

Splenic artery

Chest

 "The servant attacks with saw and axe the lumbar, stack and cord." - Cervical (atlas,
axis), thoracic, lumbar, sacral, caudal
 "I Like To Rise So High", for Iliac vein (common), Lumbar vein, Testicular vein,
Renal vein, Suprarenal vein and Hepatic vein to represent the tributaries of the
Inferior vena cava [7]
 Structures passing through greater sciatic foramen below piriformis (S.N.I.P. N.I.P.),
sciatic nerve, nerve to obturator internus, internal pudendal vessel, pudendal nerve,
nerve to quadratus femoris, inferior gluteal vessels, posterior cutaneous nerve of thigh
 Structures passing through lesser sciatic foramen: (P.I.N.T.) pudendal nerve, internal
pudendal vessels, nerve to obturator internus, tendon of obturator internus
 One common mnemonic used to remember the contents of the Tarsal tunnel from
anterior to posterior is "Tom, Dick and Harry".[8][9][10] or alternatively "Tom, Dick
(and very nervous) Harry" if the artery, vein, and nerve are included.
 One mnemonic for remembering the contents of the cavernous sinus is "OTOM
CAT".[11]
 The branches of the subclavian artery can be remembered using VITamin C and D.
 The contents of posterior mediastinum can be remembered using the mnemonic,
"DATES", for Descending aorta, Azygous vein and hemiazygos vein, Thoracic duct,
Esophagus, Sympathetic trunk/ganglia.[7]
 A commonly used mnemonic to remember the level of the diaphragmatic apertures is
this: Aortic hiatus = 12 letters = T12. Oesophagus, Vagal trunk = 10 letters = T10.
Vena cava = 8 letters = T8
 Another common mnemonic is: "I ate ten eggs at twelve" I (IVC) ate (TV8); ten
(TV10) eggs (esophagus); at (aorta, azygos) twelve (TV12)
 "I Read Very Old And Torn Articles" - IVC, Right phrenic nerve, Vagus,
Oesophagus, Aorta, Thoracic duct, Azygous vein.
 Standing room only can be used to remember that V1 passes through the superior
orbital fissure, V2 through the foramen rotundum, and V3 through the foramen
ovale.[12]
 Contents of the foramen magnum: VAMPS-ATM (Vertebral arteries, Anterior Spinal
artery, Meningeal branches of the cervical nerves, Posterior spinal arteries, Spinal part
of the accessory nerve, Alar and Apical ligaments of the dense, Tectorial membrane,
Medulla oblongata)[citation needed]
 Deep cerebellar nuclei and their positions relative to the midline: "Fat Guys Eat
Donuts," where each letter indicates the medial to lateral location in the cerebellar
white matter (nucleus fastigii, globose nucleus, nucleus emboliformis and dentate
nucleus).[citation needed]
 A mnemonic to remember the muscles that contribute tendons to the pes anserinus
and the innervations of these muscles is SGT FOT (sergeant FOT): S- Sartorius G-
Gracilis T- semiTendinosus (from anterior to posterior). F- femoral nerve O-
obturator nerve T- tibial division of the sciatic nerve. Notice the order of the muscles
(S, G, T) follows the order of the innervating nerves which correspond to those
muscles (F, O, T)[citation needed]
 The femoral triangle is shaped like the sail of a sailing ship and hence its boundaries
can be remembered using the mnemonic, "SAIL" for Sartorius, Adductor longus and
Inguinal Ligament.[7]
 The order of structures in the femoral triangle is important in the embalming of
bodies, as the femoral artery is often exposed and used to pump embalming fluids into
the body. The order of this neurovascular bundle can be remembered using the
mnemonic, "NAVY" for Nerve, Artery, Vein, Y -fronts (the British term of a style of
men's underwear with a "Y" shaped front that acts as a fly). The "Y" is midline
(corresponding with the penis) and the mnemonic always reads from lateral to medial
(in other words, the Femoral Nerve is always lateral). An alternate to this mnemonic
is "NAVEL" for Nerve, Artery, Vein, Empty Space and Lymph, to include the deep
inguinal lymph nodes located medial to the Femoral vein.[citation needed]

Cranial nerves

There are many mnemonics for the names of the cranial nerves, e.g. "OOOTTAFAGVSH" is
"OLd OPen OCeans TROuble TRIbesmen ABout Fish VEnom Giving VArious
ACute/SPlitting Headaches" (a mnemonic that gives enough letters to distinguish between
nerves that start with the same letter), or "On old Olympus's towering tops, a Finn and
German viewed some hops,"[13] and for the initial letters "OOOTTAFVGVAH" is "Oh, oh,
oh, to touch and feel very good velvet ... ah, heaven."[14] The differences between these
depend on "acoustic" versus "vestibulocochlear" and "spinal-accessory" versus "accessory".

A common example mnemonic for remembering which nerves are motor (M), sensory (S), or
both (B), "Some Say Marry Money But My Brother Says Big Boobs Matter More". There are
a very large number of additional mnemonics.[15]

Diaphragm apertures: spinal levels

Aortic hiatus = 12 letters = T12

Oesophagus = 10 letters = T10

Vena cava = 8 letters = T8 [16]

Duodenum: lengths of parts

"Counting 1 to 4 but staggered":

1st part: 2 inches

2nd part: 3 inches


3rd part: 4 inches

4th part: 1 inch[17]

Endocrine glands

The major glands of the endocrine system, excluding ovaries and testes.

"T.A.P." (T2, A3, P4)

Thymus

Thyroid

Anterior pituitary

Adrenal cortex

Adrenal medulla

Posterior pituitary

Parathyroid gland

Pancreas

Pineal[18]

Extraocular muscles

A good mnemonic to remember which muscles are innervated by what nerve is to paraphrase
it as a molecular equation: LR6SO4R3.[19]

 Lateral Rectus - Cranial Nerve VI


 Superior Oblique - Cranial Nerve IV
 the Rest of the muscles - Cranial Nerve III

Another way to remember which nerves innervate which muscles is to understand the
meaning behind all the Latin words.

 The fourth cranial nerve, the trochlear, is so named because the muscle it innervates,
the superior oblique, runs through a little fascial pulley that changes its direction of
pull (the trochlea of superior oblique). This pulley exists in the superiomedial corner
of each orbit, and "trochl-" is Latin for "pulley."
 The sixth cranial nerve, the abducens, is so named because it controls the lateral
rectus, which abducts the eye (rotates it laterally) upon contraction.
 The third cranial nerve, the oculomotor, is so named because it is in charge of the
movement (motor) of the eye (oculo-). It controls all the other muscles.
G.I. tract layers (simplified)

M.S.M.S.

Mucosa

Submucosa

Muscularis propria

Serosa[20]

Lateral geniculate nucleus

A simple mnemonic for remembering this is "See I? I see, I see," with "see" representing the
C in "contralateral," and "I" representing the I in "ipsilateral." Another is "Emily and Pete
meet eye to eye" as in "M and P meet I to I," or again, Magno and Parvo meet Ipsi to Ipsi.

Another way of remembering this is 2+3=5, which is correct, so ipsilateral side, and 1+4
doesn't equal 6, so contralateral.

Retina

A mnemonic to remember the layers of the retina:

My Membrane (internal limiting)


Nerves Nerve fibers
Get Ganglions
In Inner plexiform
Knots Inner nuclear
Outside Outer plexiform
Our Outer nuclear
Easy External limiting membrane
Practice Photoreceptors
Review Retinal pigment epithelium

Sperm: path through male reproductive system

"My boyfriend's name is STEVE":

Seminiferous

Tubules

Epididymis

Vas deferens
Ejaculatory duct[21]

Sternal angle

A useful mnemonic for what passes through the sternal angle is "RAT PLLANT"

 Rib 2
 Aortic arch
 Tracheal bifurcation
 Pulmonary trunk
 Ligamentum arteriosum
 Left recurrent laryngeal
 Azygos Vein
 Nerves (Cardiac and Pulmonary plexuses)
 Thoracic duct

A more detailed mnemonic is "PLOT of EARTH PLLANTS"

 Phrenic and Vagus Nerve


 Lymph Nodes
 Oblique fissure of lungs (top of it)
 Thymus

 Esophagus (trending right to left)


 Aortic Arch (bottom of the arch)
 Rib 2, Manubrium-sternal angle, T4(more specifically T4-5 disc)
 Tracheal Bifurcation (Carina: Latin –like keel of boat)
 Heart

 Pulmonary trunk bifurcation


 L2 : Left Recurrent Laryngeal (Looping under Aorta); Ligamentum Arteriosum:
Connects Aortic Arch to Pulmonary. Bifurcation
 Azygous vein arches over the root of the Rt. Lung and opens in SVC.
 Nerve plexi: Cardiac and Pulmonary Plexus
 Thoracic duct (on its way to drain into the Left Subclavian)
 SVC going down

Spine

Breakfast at 7:00--- 7 cervical vertebrae

Lunch at 12:00--- 12 thoracic vertebrae

Dinner at 5:00--- 5 lumbar vertebrae[22]


Hand

 Carpal bones:

Some Lovers Try Positions That They Can't Handle:


Scaphoid, Lunatum, Triquetrum, Pisiforme, Trapezium, Trapezoid, Capitate and Hamate

 Carpal Bones:

She Looks Too Pretty Try To Catch Her:


Scaphoid, Lunate, Triquetrum, Pisiforme, Trapezium, Trapezoid, Capitate and Hamate

 Carpal bones:

Scabby Lucy Tried Pissing Hours after Copulating Two Twins:


Scaphoid, Lunate, Triquetrum, Pisiforme, Hamate, Capitate, Trapezoid, and Trapezium:
In clockwise order from Scaphoid-remember zoids do not touch each other. M. Hall

Neuroscience

Coronal section of brain: structures "In Extremis, Cannibals Eat People's Globus Pallidi
Instead of Their Hearts":

· From insula to midline:

 Insula
 Extreme capsule
 Claustrum
 External capsule
 Putamen
 Globus pallidus
 Internal capsule
 Thalamus
 Hypothalamus

Anterior Pituitary Hormones "FLAG TOP ":

FSH

LH

ACTH

GH

TSH

MelanOcyte Stimulating Hormone


Prolactin

Anaesthesiology
Anesthesia machine/room check

MS MAID:

Monitors (EKG, SpO2, EtCO2, etc.)

Suction

Machine check (according to ASA guidelines)

Airway equipment (ETT, laryngoscope, oral/nasal airway)

IV equipment

Drugs (emergency, inductions, NMBs, etc.)

Endotracheal intubation: diagnosis of poor bilateral breath sounds after


intubation

DOPE:

Displaced (usually right mainstem, pyreform fossa, etc.)

Obstruction (kinked or bitten tube, mucous plug, etc.)

Pneumothorax (collapsed lung)

Esophagus

General anaesthesia: equipment check prior to inducing

MALES:

Masks

Airways

Laryngoscopes

Endotracheal tubes

Suction/ Stylette, bougie

Spinal anesthesia agents


"Little Boys Prefer Toys":

Lidocaine

Bupivicaine

Procaine

Tetracaine

Xylocaine: where not to use with epinephrine

"Ears, Nose, Hose, Fingers and Toes"

 Vasoconstrictive effects of xylocaine with epinephrine are helpful in providing


hemostasis while suturing. However, may cause local ischemic necrosis in distal
structures such as the digits, tip of nose, penis, ears.

Behavioural science / psychology


Depression: major episode characteristics

SPACE DIGS:

Sleep disruption

Psychomotor retardation

Appetite change

Concentration loss

Energy loss

Depressed mood

Interest wanes

Guilt

Suicidal tendencies

Gain: primary vs. secondary vs. tertiary

Primary: Patient's Psyche improved.

Secondary: Symptom Sympathy for patient.


Tertiary: Therapist's gain

Kubler-Ross dying process: stages

"'Death Always Brings Great Acceptance":

Denial

Anger

Bargaining

Grieving

Acceptance

Middle adolescence (14-17 years): characteristics

HERO:

Heterosexual crushes/ Homosexual Experience

Education regarding short term benefits

Risk taking

Omnipotence

Narcolepsy: symptoms, epidemiology

CHAP:

Cataplexy

Hallucinations

Attacks of sleep

Paralysis on waking

 Usual presentation is a young male, hence "chap"

Sleep stages: features

DElta waves during DEepest sleep (stages 3 & 4, slow-wave).

dREaM during REM sleep.

Impotence causes
PLANE:

Psychogenic: performance anxiety

Libido: decreased with androgen deficiency, drugs

Autonomic neuropathy: impede blood flow redirection

Nitric oxide deficiency: impaired synthesis, decreased blood pressure

Erectile reserve: can't maintain an erection

Male erectile dysfunction (MED): biological causes

MED:

Medicines (propranalol, methyldopa, SSRI, etc.)

Ethanol

Diabetes mellitus

Premature ejaculation: treatment

2 S's:

SSRIs

Squeezing technique [glans pressure before climax]

More detail with 2 more S's:

Sensate-focus exercises [relieves anxiety]

Stop and start method [5-6 rehearsals of stopping stimulation before climax]

Biochemistry
B vitamin names

"The Rhythm Nearly Proved Contagious":

In increasing order:

Thiamine (B1)

Riboflavin (B2)

Niacin (B3)
Pyridoxine (B6)

Cobalamin (B12)

Essential amino acids

"PVT. TIM HALL always argues, never tires":

Phe

Val

Thr

Trp

Ile

Met

His

Arg

Lue

Lys

 Always argues: the A is for Arg, not Asp.

 'Never tires': T is not Tyr, but is both Thr and Trp.

Fasting state: branched-chain amino acids used by skeletal muscles

"Muscles LIVe fast":

Leucine

Isoleucine

Valine

Folate deficiency: causes

A FOLIC DROP:

Alcoholism

Folic acid antagonists


Oral contraceptives

Low dietary intake

Infection with Giardia

Celiac sprue

Dilatin

Relative folate deficiency

Old

Pregnant

Glycogen storage: Anderson's (IV) vs. Cori's (III) enzyme defect

ABCD:

Anderson's=Branching enzyme.

Cori's=Debranching enzyme.

 Otherwise, can't really distinguish clinically.

Glycogen storage: names of types I through VI

"Viagra Pills Cause A Major Hardon":

Von Gierke's

Pompe's

Cori's

Anderson's

McArdle's

Her's

Cardiology
Aortic regurgitation: causes

CREAM:

Congenital
Rheumatic damage

Endocarditis

Aortic dissection/ Aortic root dilatation

Marfan’s

Aortic stenosis characteristics

SAD:

Syncope

Angina

Dyspnoea [23]

Aorta vs. vena cava: right vs. left

(When looking at the patient from the anterior side.)

Aorta and right each have 5 letters, so aorta is on the right.

Vena and cava and left each have 4 letters, so vena cava is on the left[24]

Aortic to left Subclavian path

ABC'S

Aortic arch gives rise to:

Brachiocephalic trunk

left Common Carotid

left Subclavian[25]

Apex beat: abnormalities found on palpation, causes of impalpable

HILT:

Heaving

Impalpable

Laterally displaced

Thrusting/ Tapping
If it's impalpable, causes are COPD:

COPD

Obesity

Pleural, Pericardial effusion

Dextrocardia [26]

Atrial Fibrillation causes

Pirates:

Pulmonary: PE, COPD

Iatrogenic

Rheumatic heart: mirtral regurgitation

Atherosclerotic: MI, CAD

Thyroid: hyperthyroid

Endocarditis

Sick sinus syndrome[27]

Atrial fibrillation management

ABCD:

Anti-coagulate

Beta-block to control rate

Cardiovert

Digoxin[28]

Beck's triad (cardiac tamponade)

3 D's:

Distant heart sounds

Distended jugular veins

Darterial pressure [29]


Betablockers: cardioselective betablockers

Betablockers Acting Exclusively At Myocardium:

Betaxolol

Acebutelol

Esmolol

Atenolol

Metoprolol [30]

CHF: causes of exacerbation

Failure

Forgot medication

Arrhythmia/ Anaemia

Ischemia/ Infarction/ Infection

Lifestyle: taken too much salt

Upregulation of CO: pregnancy, hyperthyroidism

Renal failure

Embolism: pulmonary [31]

Complications of Myocardial Infarction

Darth Vader

Death

Arrythmia

Rupture(free ventricular wall/ ventricular septum/ papillary muscles)

Tamponade

Heart failure (acute or chronic)

Valve disease

Aneurysm of Ventricles
Dressler's Syndrome

thromboEmbolism (mural thrombus)

Recurrence/ mitral Regurgitation[32]

Coronary artery bypass graft: indications

Dust:

Depressed ventricular function

Unstable angina

Stenosis of the left main stem

Triple vessel disease [33]

ECG: left vs. right bundle block

WiLLiaM MaRRoW:

W pattern in V1-V2 and M pattern in V3-V6 is Left bundle block.

M pattern in V1-V2 and W in V3-V6 is Right bundle block.[34]

Exercise ramp ECG: contraindications

Ramp:

Recent MI

Aortic stenosis

MI in the last 7 days

Pulmonary hypertension[35]

Heart valve sequence

Try Puling My Aorta:

Tricuspid

Pulmonary

Mitral (bicuspid)

Aorta [36]
Infarctions

IV access

Narcotic analgesics (e.g. morphine, pethidine)

Facilities for defibrillation (DF)

Aspirin/ Anticoagulant (heparin)

Rest

Converting enzyme inhibitor

Thrombolysis

IV beta blocker

Oxygen 60%

Nitrates

Stool Softeners[37]

JVP: wave form

ASK ME

Atrial contraction

Systole (ventricular contraction)

Klosure (closure) of tricusps, so atrial filling

Maximal atrial filling

Emptying of atrium[38]

MI: basic management

BOOMAR:

Bed rest

Oxygen

Opiate

Monitor
Anticoagulate

Reduce clot size[39]

MI: signs and symptoms

PULSE:

Persistent chest pains

Upset stomach

Lightheadedness

Shortness of breath

Excessive sweating[40]

MI: therapeutic treatment

O BATMAN!

Oxygen

Beta blocker

ASA

Thrombolytics (e.g. heparin)

Morphine

Ace prn

Nitroglycerin[41]

MI: treatment of acute MI

COAG:

Cyclomorph

Oxygen

Aspirin

Glycerol trinitrate[42]

Murmur attributes
"IL PQRST" (person has ill PQRST heart waves):

Intensity

Location

Pitch

Quality

Radiation

Shape

Timing[43]

Murmurs: innocent murmur features

8 S's:

Soft

Systolic

Short

Sounds (S1 & S2) normal

Symptomless

Special tests normal (X-ray, EKG)

Standing/ Sitting (vary with position)

Sternal depression [44]

Murmurs: louder with inspiration vs expiration

LEft sided murmurs louder with Expiration

RIght sided murmurs louder with Inspiration. [45]

Murmurs: questions to ask

SCRIPT:

Site
Character (e.g. harsh, soft, blowing)

Radiation

Intensity

Pitch

Timing[46]

Murmurs: systolic vs. diastolic

PASS:Pulmonic & Aortic

Stenosis=Systolic.

PAID: Pulmonic & Aortic

Insufficiency=Diastolic. [47]

Pericarditis: causes

CARDIAC RIND:

Collagen vascular disease

Aortic aneurysm

Radiation

Drugs (such as hydralazine)

Infections

Acute renal failure

Cardiac infarction

Rheumatic fever

Injury

Neoplasms

Dressler's syndrome[48]

Pericarditis: EKG

PericarditiS:
PR depression in precordial leads.

ST elevation.[49]

Peripheral vascular insufficiency: inspection criteria

SICVD:

Symmetry of leg musculature

Integrity of skin

Color of toenails

Varicose veins

Distribution of hair[50]

Pulseless electrical activity: causes

PATCH MED:

Pulmonary embolus

Acidosis

Tension pneumothorax

Cardiac tamponade

Hypokalemia/ Hyperkalemia/ Hypoxia/ Hypothermia/ Hypovolemia

Myocardial infarction

Electrolyte derangements

Drugs[51]

ST elevation causes in ECG

ELEVATION:

Electrolytes

LBBB

Early repolarization

Ventricular hypertrophy
Aneurysm

Treatment (e.g. pericardiocentesis)

Injury (AMI, contusion)

Osborne waves (hypothermia)

Non-occlusive vasospasm[52]

Supraventricular tachycardia: treatment

ABCDE:

Adenosine

Beta-blocker

Calcium channel antagonist

Digoxin

Excitation (vagal stimulation)[53]

Ventricular tachycardia: treatment

LAMB:

Lidocaine

Amiodarone

Mexiltene/ Magnesium

Beta-blocker[54]

White Blood Cell Count

Never let monkeys eat bananas:

Neutrophils

lymphocytes

monocytes

eosinophils
basophils[55]

Emergency medicine
Acute LVF management

LMNOP:

Lasix (furosemide)

Morphine (diamorphine)

Nitrates

Oxygen (sit patient up)

Pulmonary ventilation (if doing badly)[56]

Atrial fibrillation: causes of new onset

THE ATRIAL FIBS:

Thyroid

Hypothermia

Embolism (P.E.)

Alcohol

Trauma (cardiac contusion)

Recent surgery (post CABG)

Ischemia

Atrial enlargement

Lone or idiopathic

Fever, anemia, high-output states

Infarct

Bad valves (mitral stenosis)

Stimulants (cocaine, theo, amphet, caffeine)[57]


Ipecac: contraindications

4 C's:

Comatose

Convulsing

Corrosive

hydroCarbon[58]

JVP: raised JVP differential

PQRST(EKG waves):

Pericardial effusion

Quantity of fluid raised (fluid over load)

Right heart failure

Superior vena caval obstruction

Tricuspid stenosis/Tricuspid regurgitation/Tamponade (cardiac)[59]

MI: immediate treatment

DOGASH:

Diamorphine

Oxygen

GTN spray

Asprin 300mg

Streptokinase

Heparin[60]

PEA/Asystole (ACLS): etiology

ITCHPAD

Infarction

Tension pneumothorax
Cardiac tamponade

Hypovolemia/Hypothermia/Hypo-,Hyperkalemia/Hypomagnesmia/Hypoxemia

Pulmonary embolism

Acidosis

Drug overdose[61]

Rapid sequence intubation (RSI)

SOAP ME

Suction

Oxygen

Airway Equipment

Positioning

Monitoring & Meds

EtCO2 & other Equipment[62]

Shock: signs and symptoms

TV SPARC CUBE:

Thirst

Vomiting

Sweating

Pulse weak

Anxious

Respirations shallow/rapid

Cool

Cyanotic

Unconscious
BP low

Eyes blank[63]

Shock: types

RN CHAMPS (Alternatively: "MR. C.H. SNAP", or "NH CRAMPS"):

Respiratory

Neurogenic

Cardiogenic

Hemorrhagic

Anaphylactic

Metabolic

Psychogenic

Septic[64]

Subarachnoid hemorrhage (SAH) causes

BATS:

Berry aneurysm

Arteriovenous malformation/Adult polycystic kidney disease

Trauma

Stroke[65]

Syncope causes, by system

HEAD HEART VESSELS:

CNS causes include HEAD:

Hypoxia/Hypoglycemia

Epilepsy

Anxiety

Dysfunctional brain stem (basivertebral TIA)


Cardiac causes are HEART:

Heart attack

Embolism (PE)

Aortic obstruction (IHSS, AS or myxoma)

Rhythm disturbance, ventricular

T'achycardia

Vascular causes are VESSELS:

Vasovagal

Ectopic (reminds one of hypovolemia)

Situational

Subclavian steal

ENT (glossopharyngeal neuralgia)

Low systemic vascular resistance (Addison's, diabetic vascular neuropathy)

Sensitive carotid sinus[66]

Ventricular fibrillation: treatment

Shock, Shock, Shock, Everybody Shock, Little Shock, Big Shock, Momma Shock, Poppa
Shock:

Shock= Defibrillate

Everybody= Epinephine

Little= Lidocaine

Big= Bretylium

Momma= MgSO4

Poppa= Pocainamide[67]

Interviewing / Physical exam


Abdominal Assessment
To assess abdomen, palpate all 4 quadrants for DR. GERM:

Distension: liver problems, bowel obstruction

Rigidity (board like): bleeding

Guarding: muscular tension when touched

Eviseration/ Ecchymosis

Rebound tenderness: infection

Masses

Altered Level of Consciousness: Reasons

AEIOU TIPS

Alcohol

Epilepsy, Electrolytes, and Encephalopathy

Insulin

Overdose, Oxygen

Underdose, Uremia

Trauma, Temperature

Infection

Psychogenic, Poisons

Stroke, Shock[68]

Cause of symptoms

OPQRST (Works well for cardiac, and respiratory patients.)[69]

Onset of the event

Provocation or palliation

Quality of the pain

Region and radiation

Severity
Time

Fetal Monitoring

VEAL CHOP

Variable Early Deceleration Acceleration Late Deceleration

Cord compression Head compression O2 Placental Insufficiency[70]

Neurovascular Assessment

5 P's:

Pain

Pallor

Paresthesia

Pulse

Paralysis[71]

Trauma assessment

DCAP-BTLS

Deformities & Discolorations

Contusions

Abrasions & Avulsion

Penetrations & Punctures

Burns

Tenderness

Lacerations

Swelling & Symmetry

Toxicological seizures: Causes

OTIS CAMPBELL

Organophosphates
Tricyclic antidepressants

Isoniazid, Insulin

Sympathomimetics

Camphor, Cocaine

Amphetamines

Methylxanthines

PCP, Propoxyphene, Phenol, Propranolol

Benzodiazepine withdrawal, Botanicals

Ethanol withdrawal

Lithium, Lidocaine

Lindane, Lead[72]

Vomiting: non-GIT differential

ABCDEFGHI:

Acute renal failure

Brain [increased ICP]

Cardiac [inferior MI]

DKA

Ears [labyrinthitis]

Foreign substances [paracetamol, theo, etc.]

Glaucoma

Hyperemesis gravidarum

Infection [pyelonephritis, meningitis]

Heart valve auscultation sites

"All Patients Take Meds":

Reading from top left:


Aortic

Pulmonary

Tricuspid

Mitral

Glasgow coma scale: components and numbers

Scale types is 3 V's:

Visual response

Verbal response

Vibratory (motor) response Scale scores are 4,5,6:

Scale of 4: see so much more

Scale of 5: talking jive

Scale of 6: feels the pricks (if testing motor by pain withdrawal)

Mental state examination: stages in order

"Assessed Mental State To Be Positively Clinically Unremarkable":

Appearance and behaviour [observe state, clothing...]

Mood [recent spirit]

Speech [rate, form, content]

Thinking [thoughts, perceptions]

Behavioural abnormalities

Perception abnormalities

Cognition [time, place, age...]

Understanding of condition [ideas, expectations, concerns]

History

SAMPLE history

Signs and Symptoms


Allergies

Medications

Past medical history, injuries, illnesses

Last meal/intake

Events leading up to the injury and/or illness

Orthopaedic Assessment

CLORIDE FPP

Character: sharp or dull pain

Location: region (joint) of origin

Onset: sudden vs. gradual

Radiation:

Intensity: how severe (scale 1-10), impact on ADLs (activities of daily living), is it getting
better, worse or staying the same?

Duration: acute vs. chronic

Events associated: falls, morning stiffness, swelling, redness, joint clicking or locking,
muscle cramps, muscle wasting, movement limitation, weakness, numbness or tingling, fever,
chills, trauma (mechanism of injury), occupation activities, sports, repetitive movements

Frequency: intermittent vs. constant, have you ever had this pain before?

Palliative factors: is there anything that makes it better? (rest, activity, meds, heat, cold)

Provocative factors: is there anything that makes it worse? (rest, activity, etc.)[73]

Pain history checklist

SOCRATES:

Site

Onset

Character

Radiation
Alleviating factors/ Associated symptoms

Timing (duration, frequency)

Exacerbating factors

Severity

Alternatively, Signs and Symptoms with the 'S'

Abdominal swelling causes

9 F's:

Fat

Feces

Fluid

Flatus

Fetus

Full-sized tumors

Full bladder

Fibroids

False pregnancy

Head Trauma: rapid neuro exam

12 P's

Psychological (mental) status

Pupils: size, symmetry, reaction

Paired ocular movements

Papilloedema

Pressure (BP, increased ICP)

Pulse and rate

Paralysis, Paresis
Pyramidal signs

Pin prick sensory response

Pee (incontinent)

Patellar reflex

Ptosis

Ocular bobbing vs. dipping

"Breakfast is fast, Dinner is slow, both go down":

Bobbing is fast

Dipping is slow

In both, the initial movement is down.

Pupillary dilation (persistent): causes

3AM:

3rd nerve palsy

Anti-muscarinic eye drops (eg to facilitate fundoscopy)

Myotonic pupil

Clinical examination: initial Inspection of patient from end of bed

ABC:

Appearance (SOB, pain, etc.)

Behaviour

Connections (drips, inhalers, etc. connected to patient)

Differential diagnosis checklist

"A VITAMIN C"

A and C stand for Acquired and Congenital

VITAMIN stands for:

Vascular
Inflammatory (Infectious and non-Infectious)

Trauma/ Toxins

Autoimmune

Metabolic

Idiopathic

Neoplastic

 Example usage: List causes of decreased vision: Central retinal artery occlusion,
Retinitis pigmentosa, Perforation to gobe, Chronic Gentamycin use, Ruematoid
arthritis, Diabetes, Idiopathic, Any eye tumor, Myopia.

Family history (FH)

BALD CHASM:

Blood pressure (high)

Arthritis

Lung disease

Diabetes

Cancer

Heart disease

Alcoholism

Stroke

Mental health disorders (depression, etc.)

Four point physical assessment of a disease

"I'm A People Person"

Inspection

Auscultation

Percussion

Palpation
Medical history: disease checklist

MJ THREADS:

Myocardial infarction

Jaundice

Tuberculosis

Hypertension

Rheumatic fever/ Rheumatoid arthritis

Epilepsy

Asthma

Diabetes

Strokes

Past medical history (PMH)

VAMP THIS:

Vices (tobacco, alcohol, other drugs, sexual risks)

Allergies

Medications

Preexisting medical conditions

Trauma

Hospitalizations

Immunizations

Surgeries

Patient examination organization

SOAP:

Subjective: what the patient says.

Objective: what the examiner observes.


Assessment: what the examiner thinks is going on.

Plan: what they intend to do about it

Patient profile (PP)

LADDERS:

Living situation/ Lifestyle

Anxiety

Depression

Daily activities (describe a typical day)

Environmental risks/ Exposure

Relationships

Support system/ Stress

Physical exam for 'lumps and bumps'

"6 Students and 3 Teachers go for CAMPFIRE":

Site, Size, Shape, Surface, Skin, Scar

Tenderness, Temperature, Transillumination

Consistency

Attachment

Mobility

Pulsation

Fluctuation

Irreducibility

Regional lymph nodes

Edge

Physical examination - correct order

"I Palpate People's Abdomens":


Inspection

Palpation

Percussion

Auscultation

Short stature causes

RETARD HEIGHT:

Rickets

Endocrine (cretinism, hypopituitarism, Cushing's)

Turner syndrome

Achondroplasia

Respiratory(suppurative lung disease)

Down syndrome

Hereditary

Environmental (postirradiation, postinfectious)

IUGR

GI (malabsorption)

Heart (congenital heart disease)

Tilted backbone (scoliosis)

Sign vs. symptom

sIgn: something I can detect even if patient is unconscious. sYMptom is something only
hYM knows about.

Surgical sieve for diagnostic categories

INVESTIGATIONS:

Iatrogenic

Neoplastic
Vascular

Endocrine

Structural/ Mechanical

Traumatic

Inflammatory

Genetic/ Congenital

Autoimmune

Toxic

Infective

Old age/ Degenerative

Nutritional

Spontaneous/ Idiopathic

Breast history checklist

LMNOP:

Lump

Mammary changes

Nipple changes

Other symptoms

Patient risk factors

Delivering Bad News

SPIKES:

Setting up

Perception

Invitation

Knowledge
Emotions

Strategy and Summary

Neurology
Chorea: common causes

St. VITUS'S DANCE:

Sydenhams

Vascular

Increased RBC's (polycythemia)

Toxins: CO, Mg, Hg

Uremia

SLE

Senile chorea

Drugs

APLA syndrome

Neurodegenerative conditions: HD, neuroacanthocytosis, DRPLA

Conception related: pregnancy, OCP's

Endocrine: hyperthyroidism, hypo-, hyperglycemia[74]

Congenital myopathy: features

DREAMS:

Dominantly inherited, mostly

Reflexes decreased

Enzymes normal

Apathetic floppy baby

Milestones delayed

Skeletal abnormalities[75]
Dementia: reversible dementia causes

DEMENTIA:

Drugs/Depression

Elderly

'Multi-infarct/Medication

Environmental

Nutritional

Toxins

Ischemia

Alcohol[76]

Stroke risk factors

HEADS:

Hypertension/ Hyperlipidemia

Elderly

Atrial fib

Diabetes mellitus/ Drugs (cocaine)

Smoking/Sex (male)[77]

Horner Syndrome

Horny PAMELA:

Ptosis

Anhydrosis

Miosis

Enophtalmos

Loss of ciliary-spinal reflex

Anisocoria
Pathology
Acute ischemia: signs [especially limbs]

6 P's:

Pain

Pallor

Pulselessness

Paralysis

Paraesthesia

Perishingly cold

Anemia (normocytic): causes

ABCD:

Acute blood loss

Bone marrow failure

Chronic disease

Destruction (hemolysis)

Anemia causes (simplified)

ANEMIA:

Anemia of chronic disease

No folate or B12

Ethanol

Marrow failure & hemaglobinopathies

Iron deficient

Acute & chronic blood loss

Atherosclerosis risk factors

"You're a SAD BET with these risk factors":


Sex: male

Age: middle-aged, elderly

Diabetes mellitus

BP high: hypertension

Elevated cholesterol

Tobacco

Carcinoid syndrome: components

CARCinoid:

Cutaneous flushing

Asthmatic wheezing

Right sided valvular heart lesions

Cramping and diarrhea

Cushing syndrome

CUSHING:

Central obesity/ Cervical fat pads/ Collagen fiber weakness/ Comedones (acne)

Urinary free corisol and glucose increase

Striae/ Suppressed immunity

Hypercortisolism/ Hypertension/ Hyperglycemia/ Hirsutism

Iatrogenic (Increased administration of corticosteroids)

Noniatrogenic (Neoplasms)

Glucose intolerance/Growth retardation

Diabetic ketoacidosis: I vs. II

ketONEbodies are seen in type ONEdiabetes.

Gallstones: risk factors

5 F's:
Fat

Female

Fair (gallstones more common in Caucasians)

Fertile (premenopausal- increased estrogen is thought to increase cholesterol levels in bile


and decrease gallbladder contractions)

Forty or above (age)[78]

Hepatomegaly: 3 common causes, 3 rarer causes

Common are 3 C's:

Cirrhosis

Carcinoma

Cardiac failure

Rarer are 3 C's:

Cholestasis

Cysts

Cellular infiltration

Inflammatory Bowel Disease: which has cobblestones

Crohn's has Cobblestones on endoscopy.

Morphine: effects

MORPHINES:

Miosis

Orthostatic hypotension

Respiratory depression

Pain supression

Histamine release/Hormonal alterations

Increased ICT
Nausea

Euphoria

Sedation

Kwashiorkor: distinguishing from Marasmus

FLAME:

Fatty

Liver

Anemia

Malabsorption

Edema

Pancreatitis: causes

PANCREATITIS:

Posterior

Alcohol

Neoplasm

Cholelithiasis

Rx (lasix, AZT)

ERCP

Abdominal surgery

Trauma

Infection (mumps)

Triglycerides elevated

I'diopathic

Scorpion sting

PKU findings
PKU:

Pale hair, skin

Krazy (neurological abnormalities)

Unpleasant smell

Pupils in overdose: morphine vs. amphetamine

"MorPHINE:Fine. AmPHETamine:Fat":

Morphine overdose: pupils constricted (fine).

Amphetamine overdose: pupils dilated (fat).

Pericarditis findings

PERICarditis:

Pulsus paradoxus

ECG changes

Rub

Increased JVP

Chest pain [worse on inspiration, better when leaning forward]

Gout vs. pseudogout: crystal lab findings

P seduogout crystals are:

P ositive birefringent

P olygon shaped

Gout therefore is the negative needle shaped crystals. Also, gout classically strikes great Toe,
and its hallmark is Tophi.

Signs of Chronic Liver Disease

abcdefghij

Asterixis, Ascites, Ankle oedema, Atrophy of testicles


Bruising

Clubbing/ Colour change of nails (leuconychia)

Dupuytren’s contracture

Encephalopathy / palmar Erythema

Foetor hepaticus

Gynaecomastia

Hepatomegaly

Increase size of parotids

Jaundice[79]

Psychiatry
Conduct disorder vs. Antisocial personality disorder

Conduct disorder is seen in Children. Antisocial personality disorder is seen in Adults.

Depression: symptoms and signs (DSM-IV criteria)

AWESOME:

Affect flat

Weight change (loss or gain)

Energy, loss of

Sad feelings/ Suicide thoughts or plans or attempts/ Sexual inhibition/ Sleep change (loss or
excess)/ Social withdrawal

Others (guilt, loss of pleasure, hopeless)

Memory loss

Emotional blunting

Depression

UNHAPPINESS:

Understandable (such as bereavement, major stresses)


Neurotic (high anxiety personalities, negative parental upbringingHypochondriasis

Agitation (usually organic causes such as dementia)

Pseudodementia

Pain

Importuniing (whingeing, complaining)

Nihilistic

Endogenous

Secondary (i.e. cancer at the head of the pancreas, bronchogenic cancer)

Syndromal

Erikson's developmental stages

"The sad tale of Erikson Motors":

 The stages in order by age group:

Mr. Trust and MsTrust had an auto they were ashamed of. She took the initiative to find
the guilty party. She found the industry was inferior. They were making cars with dents
[identity] and rolling fuses [role confusion]. Mr. N.T. Macy [intimacy] isolated the problem,
General TVT absorbed the cost. In the end, they found the tires were just gritty and the
should have used de- spare!

Mania: cardinal symptoms

DIG FAST:

Distractibility

Indiscretion (DSM-IV's "excessive involvement in pleasurable activities")

Grandiosity

Flight of ideas

Activity increase

Sleep deficit (decreased need for sleep)

Talkativeness (pressured speech)

Mania: diagnostic criteria


Must have 3 of MANIAC:

Mouth (pressure of speech)/ Moodl

Activity increased

Naughty (disinhibition)

Insomnia

Attention (distractability)

Confidence (grandiose ideas)

Parasomnias: time of onset

SLeep terrors and SLeepwalking occur during SLow-wave sleep (stages 3 & 4).NightmaRE
occurs during REM sleep (and is REMembered).

Psychiatric review of symptoms

"Depressed Patients Seem Anxious, So Claim Psychiatrists":

Depression and other mood disorders (major depression, bipolar disorder, dysthymia)

Personality disorders (primarily borderline personality disorder)

Substance abuse disorders

Anxiety disorders (panic disorder with agoraphobia, obsessive-compulsive disorder)

Somatization disorder, eating disorders (these two disorders are combined because both
involve disorders of bodily perception)

Cognitive disorders (dementia, delirium)

Psychotic disorders (schizophrenia, delusional disorder and psychosis accompanying


depression, substance abuse or dementia)

Schizophrenia: negative features

4 A's:

Ambivalence

Affective incongruence

Associative loosening
Autism

Substance dependence: features (DSM IV)

WITHDraw IT:

 3 of 7 within 12-month period:

Withdrawal

Interest or Important activities given up or reduced

Tolerance

Harm to physical and psychosocial known but continue to use

Desire to cut down, control

Intended time, amount exceeded

Time spent too much

Radiology / Oncology
Anterior mediastinal masses

4 T's:

Teratoma

Thymoma

Testicular-type

T-cell / Hodgkin's lymphoma

Dermatomyositis or polymyositis: risk of underlying malignancy

Risk is 30% at age 30. Risk is 40% at age 40, and so on.

Chest radiograph: checklist to examine

"Pamela Found Our Rotation Particularly Exciting; Very Highly Commended Mainly 'Cus
She Arouses":

Patient details

Film details
Objects (e.g. lines, electrodes)

Rotation

Penetration

Expansion

Vessels

Hila

Costophrenic angles

Mediastinum

Cardiothoracic Ratio

Soft tissues and bones

Air (diaphragm, pneumothorax, subcut. emphysema)

Chest X-ray interpretation

Preliminary is ABCDEF:

AP or PA

Body position

Confirm name

Date

Exposure

Films for comparison

Analysis is ABCDEF:

Airways (hilar adenopathy or enlargement)

Breast shadows/ Bones (rib fractures, lytic bone lesions)

Cardiac silhoutte (cardiac enlargement)/ Costophrenic angles (pleural effusions)

Diaphragm (evidence of free air)/ Digestive tract

Edges (apices for fibrosis, pneumothorax, pleural thickening or plaques)/ Extrathoracic


tissues
Fields (evidence of alveolar filling)/ Failure (alveolar air space disease with prominent
vascularity with or without pleural effusions)

Chest X-ray: cavitating lesions differential

"If you see HOLES on chest X-ray, they are WEIRD":

Wegener's syndrome

Embolic (pulmonary, septic)

Infection (anaerobes, pneumocystis, TB)

Rheumatoid (necrobiotic nodules)

Developmental cysts (sequestration)

Histiocytosis

Oncological

Lymphangioleiomyomatosis

Environmental, occupational

Sarcoid

Alternatively: L=Left atrial myxoma

Lung cancer: main sites for distant metastases

BLAB:

Bone

Liver

Adrenals

Brain

Elbow ossification centers, in sequence

CRITOE: Capitellum

Radial head

Internal epicondyle
Trochlea

Olecranon

External epicondyle

Esophageal cancer: risk factors

ABCDEF:

Achalasia

Barret's esophagus

Corrosive esophagitis

Diverticuliis

Esophageal web

Familial

Head CT scan: evaluation checklist

"Blood Can Be Very Bad":

B lood

Cistern

Brain

Ventricles

Bone

Lung cancer: notorious consequences

SPEECH:

Superior vena cava syndrome

Paralysis of diaphragm (Phrenic nerve)

Ectopic hormones

Eaton-Lambert syndrome

Clubbing
Horner syndrome/ Hoarseness

Mole: signs of trouble

ABCDE:

Asymmetry

Border irregular

Colour irregular

Diameter usually > 0.5cm

Elevation irregular

Neck sagittal x-ray: examination checklist

ABCD:

Anterior: look for swelling

Bones: examine each bone for fractures

Cartilage: look for slipped discs

Dark spots: ensure not abnormally big, or could mean excess blood

Osteoarthritis: x-ray signs

LOSS:

Loss of joint space

Osteopyhtes

Subcondral sclerosis

Subchondral cysts

Prognotic factors for cancer: general

PROGNOSIS:

Presentation (time & course)

Response to treatment

Old (bad prog.)


Good intervention (i.e. early)

Non-compliance with treatment

Order of differentiation (>1 cell type)

Stage of disease

Ill health

Spread (diffuse)

Pituitary endocrine functions often affected by pituitary-associated tumor

"Go Look For the Adenoma Please":

Tropic hormones affected by growth tumor are:

GnRH

LSH

FSH

ACTH

Prolactin function

T2 vs. T1 MRI scan

"WW 2" (World War II):

Water is White in a T2 scan.

Conversely, a T1 scan shows fat as being whiter.

Upper lobe shadowing: causes

BREASTS:

Beryllium

Radiation

Extrinsic allergic alveolitis

Ankylosing spondylitis

Sarcoidosis
TB

Siliconiosis

Miscellaneous
The following may or may not fit properly into one of the above categories. They are being
stored in this section either temporarily or permanently. Categorize them if needed.

Asthma treatment

ASTHMA

Adrenergic agonists

Steroids

Theophylline

Hydration

Masked oxygen

Anticholinergics[80]

Croup: symptoms

3 S's:

Stridor

Subglottic swelling

Seal-bark cough

Cholinergic Crisis

SLUDGE and the Killer B's:

Salivation

Lacrimation

Urination

Diaphoresis, Diarrhea

Gastrointestinal cramping
Emesis

Bradycardia

Bronchospasm

Bronchorrhea[81]

DISCO D DIGITALIS I ISONIAZID S SPIRILACTINE C


CIMETIDINE,KETOCONQZILE O OESTROGEN==Gynaecomastia causing drugs===
Some Drugs Create Awesome Knockers

Spironolactone

Digitalis

Cimetidine

Alcohol

Ketoconazole[82]

Pentad of TTP

FAT RN:

Fever

Anemia

Thrombocytopenia

Renal

Neuro changes[83]

Pulmonary Edema: Treatment

LMNOP:

Lasix

Morphine

Nitro

Oxygen

Position/Positive pressure ventilation[84]


Afferent vs efferent

Afferent connection arrives and an efferent connection exits.

Anterior leg muscles

"The Hospitals Are Not Dirty Places"

Tibialis anterior

extensor Hallucis longus

anterior tibial Artery

deep fibular Nerve

extensor Digitorum longus

Peronius tertius [aka fibularis tertius][3]

Brachial plexus

 Posterior cord branches


o STAR - subscapular (upper and lower), thoracodorsal, axillary, radial
o RATS- Radial nerve, Axillary nerve, Thoracodorsal nerve, Subscapular
(Upper & Lower)nerve.
o ULTRA - upper subscapular, lower subscapular, thoracodorsal, radial, axillary
o ULNAR- Upper subscapular nerve, Lower subscapular nerve,Nerve to
latissimus dorsi, Axillary nerve, Radial nerve.
 Lateral Cord Branches
o LLM "Lucy Loves Me" - lateral pectoral, lateral root of the median nerve,
musculocutaneous
o Love Me Latha (LML) - Lateral pectoral nerve, Musculocutaneous nerve,
Lateral root of Median Nerve.
o Look My Lancer-Lateral pectoral nerve, Musculocutaneous nerve,Lateral root
of Median nerve.

 Medial Cord Branches


o MMMUM "Most Medical Men Use Morphine" - medial pectoral, medial
cutaneous nerve of arm, medial cutaneous nerve of forearm, ulnar, medial root
of the median nerve
o Union of 4 Medials - Ulnar nerve, Medial cutaneous nerve of arm, Medial
cutaneous nerve of forearm, Medial pectoral nerve, Medial root of Median
Nerve.
 5 main nerves of brachial plexus, in order laterally to medially
o "My Aunty Recognised My Uncle" - Musculocutaneous, axillary, radial,
median, ulnar.

Bowel components
"Dow Jones Industrial Average Closing Stock Report"

From proximal to distal:

 Duodenum
 Jejunum
 Ileum
 Appendix
 Colon
 Sigmoid
 Rectum[4]

Carotid sheath contents

I See 10 CC's in the IV:

I See (I.C.) = Internal Carotid artery

10 = CN 10 (Vagus nerve)

CC = Common Carotid artery

IV = Internal Jugular Vein[5]

Cavernous sinus contents

O TOM CAT:

O TOM are lateral wall components, in order from superior to inferior.

CA are the components within the sinus, from medial to lateral. CA ends at the level of T
from O TOM.

Occulomotor nerve (III)

Trochlear nerve (IV)

Ophthalmic nerve (V1)

Maxillary nerve (V2)

Carotid artery

Abducent nerve (VI)

T: When written, connects to the T of OTOM[6]


Coeliac trunk: branches

Left Hand Side (LHS):

Left gastric artery

Hepatic artery

Splenic artery

Chest

 "The servant attacks with saw and axe the lumbar, stack and cord." - Cervical (atlas,
axis), thoracic, lumbar, sacral, caudal
 "I Like To Rise So High", for Iliac vein (common), Lumbar vein, Testicular vein,
Renal vein, Suprarenal vein and Hepatic vein to represent the tributaries of the
Inferior vena cava [7]
 Structures passing through greater sciatic foramen below piriformis (S.N.I.P. N.I.P.),
sciatic nerve, nerve to obturator internus, internal pudendal vessel, pudendal nerve,
nerve to quadratus femoris, inferior gluteal vessels, posterior cutaneous nerve of thigh
 Structures passing through lesser sciatic foramen: (P.I.N.T.) pudendal nerve, internal
pudendal vessels, nerve to obturator internus, tendon of obturator internus
 One common mnemonic used to remember the contents of the Tarsal tunnel from
anterior to posterior is "Tom, Dick and Harry".[8][9][10] or alternatively "Tom, Dick
(and very nervous) Harry" if the artery, vein, and nerve are included.
 One mnemonic for remembering the contents of the cavernous sinus is "OTOM
CAT".[11]
 The branches of the subclavian artery can be remembered using VITamin C and D.
 The contents of posterior mediastinum can be remembered using the mnemonic,
"DATES", for Descending aorta, Azygous vein and hemiazygos vein, Thoracic duct,
Esophagus, Sympathetic trunk/ganglia.[7]
 A commonly used mnemonic to remember the level of the diaphragmatic apertures is
this: Aortic hiatus = 12 letters = T12. Oesophagus, Vagal trunk = 10 letters = T10.
Vena cava = 8 letters = T8
 Another common mnemonic is: "I ate ten eggs at twelve" I (IVC) ate (TV8); ten
(TV10) eggs (esophagus); at (aorta, azygos) twelve (TV12)
 "I Read Very Old And Torn Articles" - IVC, Right phrenic nerve, Vagus,
Oesophagus, Aorta, Thoracic duct, Azygous vein.
 Standing room only can be used to remember that V1 passes through the superior
orbital fissure, V2 through the foramen rotundum, and V3 through the foramen
ovale.[12]
 Contents of the foramen magnum: VAMPS-ATM (Vertebral arteries, Anterior Spinal
artery, Meningeal branches of the cervical nerves, Posterior spinal arteries, Spinal part
of the accessory nerve, Alar and Apical ligaments of the dense, Tectorial membrane,
Medulla oblongata)[citation needed]
 Deep cerebellar nuclei and their positions relative to the midline: "Fat Guys Eat
Donuts," where each letter indicates the medial to lateral location in the cerebellar
white matter (nucleus fastigii, globose nucleus, nucleus emboliformis and dentate
nucleus).[citation needed]
 A mnemonic to remember the muscles that contribute tendons to the pes anserinus
and the innervations of these muscles is SGT FOT (sergeant FOT): S- Sartorius G-
Gracilis T- semiTendinosus (from anterior to posterior). F- femoral nerve O-
obturator nerve T- tibial division of the sciatic nerve. Notice the order of the muscles
(S, G, T) follows the order of the innervating nerves which correspond to those
muscles (F, O, T)[citation needed]
 The femoral triangle is shaped like the sail of a sailing ship and hence its boundaries
can be remembered using the mnemonic, "SAIL" for Sartorius, Adductor longus and
Inguinal Ligament.[7]
 The order of structures in the femoral triangle is important in the embalming of
bodies, as the femoral artery is often exposed and used to pump embalming fluids into
the body. The order of this neurovascular bundle can be remembered using the
mnemonic, "NAVY" for Nerve, Artery, Vein, Y -fronts (the British term of a style of
men's underwear with a "Y" shaped front that acts as a fly). The "Y" is midline
(corresponding with the penis) and the mnemonic always reads from lateral to medial
(in other words, the Femoral Nerve is always lateral). An alternate to this mnemonic
is "NAVEL" for Nerve, Artery, Vein, Empty Space and Lymph, to include the deep
inguinal lymph nodes located medial to the Femoral vein.[citation needed]

Cranial nerves

There are many mnemonics for the names of the cranial nerves, e.g. "OOOTTAFAGVSH" is
"OLd OPen OCeans TROuble TRIbesmen ABout Fish VEnom Giving VArious
ACute/SPlitting Headaches" (a mnemonic that gives enough letters to distinguish between
nerves that start with the same letter), or "On old Olympus's towering tops, a Finn and
German viewed some hops,"[13] and for the initial letters "OOOTTAFVGVAH" is "Oh, oh,
oh, to touch and feel very good velvet ... ah, heaven."[14] The differences between these
depend on "acoustic" versus "vestibulocochlear" and "spinal-accessory" versus "accessory".

A common example mnemonic for remembering which nerves are motor (M), sensory (S), or
both (B), "Some Say Marry Money But My Brother Says Big Boobs Matter More". There are
a very large number of additional mnemonics.[15]

Diaphragm apertures: spinal levels

Aortic hiatus = 12 letters = T12

Oesophagus = 10 letters = T10

Vena cava = 8 letters = T8 [16]

Duodenum: lengths of parts

"Counting 1 to 4 but staggered":

1st part: 2 inches

2nd part: 3 inches

3rd part: 4 inches


4th part: 1 inch[17]

Endocrine glands

The major glands of the endocrine system, excluding ovaries and testes.

"T.A.P." (T2, A3, P4)

Thymus

Thyroid

Anterior pituitary

Adrenal cortex

Adrenal medulla

Posterior pituitary

Parathyroid gland

Pancreas

Pineal[18]

Extraocular muscles

A good mnemonic to remember which muscles are innervated by what nerve is to paraphrase
it as a molecular equation: LR6SO4R3.[19]

 Lateral Rectus - Cranial Nerve VI


 Superior Oblique - Cranial Nerve IV
 the Rest of the muscles - Cranial Nerve III

Another way to remember which nerves innervate which muscles is to understand the
meaning behind all the Latin words.

 The fourth cranial nerve, the trochlear, is so named because the muscle it innervates,
the superior oblique, runs through a little fascial pulley that changes its direction of
pull (the trochlea of superior oblique). This pulley exists in the superiomedial corner
of each orbit, and "trochl-" is Latin for "pulley."
 The sixth cranial nerve, the abducens, is so named because it controls the lateral
rectus, which abducts the eye (rotates it laterally) upon contraction.
 The third cranial nerve, the oculomotor, is so named because it is in charge of the
movement (motor) of the eye (oculo-). It controls all the other muscles.

G.I. tract layers (simplified)


M.S.M.S.

Mucosa

Submucosa

Muscularis propria

Serosa[20]

Lateral geniculate nucleus

A simple mnemonic for remembering this is "See I? I see, I see," with "see" representing the
C in "contralateral," and "I" representing the I in "ipsilateral." Another is "Emily and Pete
meet eye to eye" as in "M and P meet I to I," or again, Magno and Parvo meet Ipsi to Ipsi.

Another way of remembering this is 2+3=5, which is correct, so ipsilateral side, and 1+4
doesn't equal 6, so contralateral.

Retina

A mnemonic to remember the layers of the retina:

My Membrane (internal limiting)


Nerves Nerve fibers
Get Ganglions
In Inner plexiform
Knots Inner nuclear
Outside Outer plexiform
Our Outer nuclear
Easy External limiting membrane
Practice Photoreceptors
Review Retinal pigment epithelium

Sperm: path through male reproductive system

"My boyfriend's name is STEVE":

Seminiferous

Tubules

Epididymis

Vas deferens

Ejaculatory duct[21]
Sternal angle

A useful mnemonic for what passes through the sternal angle is "RAT PLLANT"

 Rib 2
 Aortic arch
 Tracheal bifurcation
 Pulmonary trunk
 Ligamentum arteriosum
 Left recurrent laryngeal
 Azygos Vein
 Nerves (Cardiac and Pulmonary plexuses)
 Thoracic duct

A more detailed mnemonic is "PLOT of EARTH PLLANTS"

 Phrenic and Vagus Nerve


 Lymph Nodes
 Oblique fissure of lungs (top of it)
 Thymus

 Esophagus (trending right to left)


 Aortic Arch (bottom of the arch)
 Rib 2, Manubrium-sternal angle, T4(more specifically T4-5 disc)
 Tracheal Bifurcation (Carina: Latin –like keel of boat)
 Heart

 Pulmonary trunk bifurcation


 L2 : Left Recurrent Laryngeal (Looping under Aorta); Ligamentum Arteriosum:
Connects Aortic Arch to Pulmonary. Bifurcation
 Azygous vein arches over the root of the Rt. Lung and opens in SVC.
 Nerve plexi: Cardiac and Pulmonary Plexus
 Thoracic duct (on its way to drain into the Left Subclavian)
 SVC going down

Spine

Breakfast at 7:00--- 7 cervical vertebrae

Lunch at 12:00--- 12 thoracic vertebrae

Dinner at 5:00--- 5 lumbar vertebrae[22]

Hand
 Carpal bones:

Some Lovers Try Positions That They Can't Handle:


Scaphoid, Lunatum, Triquetrum, Pisiforme, Trapezium, Trapezoid, Capitate and Hamate

 Carpal Bones:

She Looks Too Pretty Try To Catch Her:


Scaphoid, Lunate, Triquetrum, Pisiforme, Trapezium, Trapezoid, Capitate and Hamate

 Carpal bones:

Scabby Lucy Tried Pissing Hours after Copulating Two Twins:


Scaphoid, Lunate, Triquetrum, Pisiforme, Hamate, Capitate, Trapezoid, and Trapezium:
In clockwise order from Scaphoid-remember zoids do not touch each other. M. Hall

Neuroscience

Coronal section of brain: structures "In Extremis, Cannibals Eat People's Globus Pallidi
Instead of Their Hearts":

· From insula to midline:

 Insula
 Extreme capsule
 Claustrum
 External capsule
 Putamen
 Globus pallidus
 Internal capsule
 Thalamus
 Hypothalamus

Anterior Pituitary Hormones "FLAG TOP ":

FSH

LH

ACTH

GH

TSH

MelanOcyte Stimulating Hormone

Prolactin
Anaesthesiology
Anesthesia machine/room check

MS MAID:

Monitors (EKG, SpO2, EtCO2, etc.)

Suction

Machine check (according to ASA guidelines)

Airway equipment (ETT, laryngoscope, oral/nasal airway)

IV equipment

Drugs (emergency, inductions, NMBs, etc.)

Endotracheal intubation: diagnosis of poor bilateral breath sounds after


intubation

DOPE:

Displaced (usually right mainstem, pyreform fossa, etc.)

Obstruction (kinked or bitten tube, mucous plug, etc.)

Pneumothorax (collapsed lung)

Esophagus

General anaesthesia: equipment check prior to inducing

MALES:

Masks

Airways

Laryngoscopes

Endotracheal tubes

Suction/ Stylette, bougie

Spinal anesthesia agents

"Little Boys Prefer Toys":


Lidocaine

Bupivicaine

Procaine

Tetracaine

Xylocaine: where not to use with epinephrine

"Ears, Nose, Hose, Fingers and Toes"

 Vasoconstrictive effects of xylocaine with epinephrine are helpful in providing


hemostasis while suturing. However, may cause local ischemic necrosis in distal
structures such as the digits, tip of nose, penis, ears.

Behavioural science / psychology


Depression: major episode characteristics

SPACE DIGS:

Sleep disruption

Psychomotor retardation

Appetite change

Concentration loss

Energy loss

Depressed mood

Interest wanes

Guilt

Suicidal tendencies

Gain: primary vs. secondary vs. tertiary

Primary: Patient's Psyche improved.

Secondary: Symptom Sympathy for patient.

Tertiary: Therapist's gain


Kubler-Ross dying process: stages

"'Death Always Brings Great Acceptance":

Denial

Anger

Bargaining

Grieving

Acceptance

Middle adolescence (14-17 years): characteristics

HERO:

Heterosexual crushes/ Homosexual Experience

Education regarding short term benefits

Risk taking

Omnipotence

Narcolepsy: symptoms, epidemiology

CHAP:

Cataplexy

Hallucinations

Attacks of sleep

Paralysis on waking

 Usual presentation is a young male, hence "chap"

Sleep stages: features

DElta waves during DEepest sleep (stages 3 & 4, slow-wave).

dREaM during REM sleep.

Impotence causes

PLANE:
Psychogenic: performance anxiety

Libido: decreased with androgen deficiency, drugs

Autonomic neuropathy: impede blood flow redirection

Nitric oxide deficiency: impaired synthesis, decreased blood pressure

Erectile reserve: can't maintain an erection

Male erectile dysfunction (MED): biological causes

MED:

Medicines (propranalol, methyldopa, SSRI, etc.)

Ethanol

Diabetes mellitus

Premature ejaculation: treatment

2 S's:

SSRIs

Squeezing technique [glans pressure before climax]

More detail with 2 more S's:

Sensate-focus exercises [relieves anxiety]

Stop and start method [5-6 rehearsals of stopping stimulation before climax]

Biochemistry
B vitamin names

"The Rhythm Nearly Proved Contagious":

In increasing order:

Thiamine (B1)

Riboflavin (B2)

Niacin (B3)

Pyridoxine (B6)
Cobalamin (B12)

Essential amino acids

"PVT. TIM HALL always argues, never tires":

Phe

Val

Thr

Trp

Ile

Met

His

Arg

Lue

Lys

 Always argues: the A is for Arg, not Asp.

 'Never tires': T is not Tyr, but is both Thr and Trp.

Fasting state: branched-chain amino acids used by skeletal muscles

"Muscles LIVe fast":

Leucine

Isoleucine

Valine

Folate deficiency: causes

A FOLIC DROP:

Alcoholism

Folic acid antagonists

Oral contraceptives
Low dietary intake

Infection with Giardia

Celiac sprue

Dilatin

Relative folate deficiency

Old

Pregnant

Glycogen storage: Anderson's (IV) vs. Cori's (III) enzyme defect

ABCD:

Anderson's=Branching enzyme.

Cori's=Debranching enzyme.

 Otherwise, can't really distinguish clinically.

Glycogen storage: names of types I through VI

"Viagra Pills Cause A Major Hardon":

Von Gierke's

Pompe's

Cori's

Anderson's

McArdle's

Her's

Cardiology
Aortic regurgitation: causes

CREAM:

Congenital

Rheumatic damage
Endocarditis

Aortic dissection/ Aortic root dilatation

Marfan’s

Aortic stenosis characteristics

SAD:

Syncope

Angina

Dyspnoea [23]

Aorta vs. vena cava: right vs. left

(When looking at the patient from the anterior side.)

Aorta and right each have 5 letters, so aorta is on the right.

Vena and cava and left each have 4 letters, so vena cava is on the left[24]

Aortic to left Subclavian path

ABC'S

Aortic arch gives rise to:

Brachiocephalic trunk

left Common Carotid

left Subclavian[25]

Apex beat: abnormalities found on palpation, causes of impalpable

HILT:

Heaving

Impalpable

Laterally displaced

Thrusting/ Tapping

If it's impalpable, causes are COPD:


COPD

Obesity

Pleural, Pericardial effusion

Dextrocardia [26]

Atrial Fibrillation causes

Pirates:

Pulmonary: PE, COPD

Iatrogenic

Rheumatic heart: mirtral regurgitation

Atherosclerotic: MI, CAD

Thyroid: hyperthyroid

Endocarditis

Sick sinus syndrome[27]

Atrial fibrillation management

ABCD:

Anti-coagulate

Beta-block to control rate

Cardiovert

Digoxin[28]

Beck's triad (cardiac tamponade)

3 D's:

Distant heart sounds

Distended jugular veins

Darterial pressure [29]

Betablockers: cardioselective betablockers


Betablockers Acting Exclusively At Myocardium:

Betaxolol

Acebutelol

Esmolol

Atenolol

Metoprolol [30]

CHF: causes of exacerbation

Failure

Forgot medication

Arrhythmia/ Anaemia

Ischemia/ Infarction/ Infection

Lifestyle: taken too much salt

Upregulation of CO: pregnancy, hyperthyroidism

Renal failure

Embolism: pulmonary [31]

Complications of Myocardial Infarction

Darth Vader

Death

Arrythmia

Rupture(free ventricular wall/ ventricular septum/ papillary muscles)

Tamponade

Heart failure (acute or chronic)

Valve disease

Aneurysm of Ventricles

Dressler's Syndrome
thromboEmbolism (mural thrombus)

Recurrence/ mitral Regurgitation[32]

Coronary artery bypass graft: indications

Dust:

Depressed ventricular function

Unstable angina

Stenosis of the left main stem

Triple vessel disease [33]

ECG: left vs. right bundle block

WiLLiaM MaRRoW:

W pattern in V1-V2 and M pattern in V3-V6 is Left bundle block.

M pattern in V1-V2 and W in V3-V6 is Right bundle block.[34]

Exercise ramp ECG: contraindications

Ramp:

Recent MI

Aortic stenosis

MI in the last 7 days

Pulmonary hypertension[35]

Heart valve sequence

Try Puling My Aorta:

Tricuspid

Pulmonary

Mitral (bicuspid)

Aorta [36]

Infarctions
IV access

Narcotic analgesics (e.g. morphine, pethidine)

Facilities for defibrillation (DF)

Aspirin/ Anticoagulant (heparin)

Rest

Converting enzyme inhibitor

Thrombolysis

IV beta blocker

Oxygen 60%

Nitrates

Stool Softeners[37]

JVP: wave form

ASK ME

Atrial contraction

Systole (ventricular contraction)

Klosure (closure) of tricusps, so atrial filling

Maximal atrial filling

Emptying of atrium[38]

MI: basic management

BOOMAR:

Bed rest

Oxygen

Opiate

Monitor

Anticoagulate
Reduce clot size[39]

MI: signs and symptoms

PULSE:

Persistent chest pains

Upset stomach

Lightheadedness

Shortness of breath

Excessive sweating[40]

MI: therapeutic treatment

O BATMAN!

Oxygen

Beta blocker

ASA

Thrombolytics (e.g. heparin)

Morphine

Ace prn

Nitroglycerin[41]

MI: treatment of acute MI

COAG:

Cyclomorph

Oxygen

Aspirin

Glycerol trinitrate[42]

Murmur attributes

"IL PQRST" (person has ill PQRST heart waves):


Intensity

Location

Pitch

Quality

Radiation

Shape

Timing[43]

Murmurs: innocent murmur features

8 S's:

Soft

Systolic

Short

Sounds (S1 & S2) normal

Symptomless

Special tests normal (X-ray, EKG)

Standing/ Sitting (vary with position)

Sternal depression [44]

Murmurs: louder with inspiration vs expiration

LEft sided murmurs louder with Expiration

RIght sided murmurs louder with Inspiration. [45]

Murmurs: questions to ask

SCRIPT:

Site

Character (e.g. harsh, soft, blowing)


Radiation

Intensity

Pitch

Timing[46]

Murmurs: systolic vs. diastolic

PASS:Pulmonic & Aortic

Stenosis=Systolic.

PAID: Pulmonic & Aortic

Insufficiency=Diastolic. [47]

Pericarditis: causes

CARDIAC RIND:

Collagen vascular disease

Aortic aneurysm

Radiation

Drugs (such as hydralazine)

Infections

Acute renal failure

Cardiac infarction

Rheumatic fever

Injury

Neoplasms

Dressler's syndrome[48]

Pericarditis: EKG

PericarditiS:

PR depression in precordial leads.


ST elevation.[49]

Peripheral vascular insufficiency: inspection criteria

SICVD:

Symmetry of leg musculature

Integrity of skin

Color of toenails

Varicose veins

Distribution of hair[50]

Pulseless electrical activity: causes

PATCH MED:

Pulmonary embolus

Acidosis

Tension pneumothorax

Cardiac tamponade

Hypokalemia/ Hyperkalemia/ Hypoxia/ Hypothermia/ Hypovolemia

Myocardial infarction

Electrolyte derangements

Drugs[51]

ST elevation causes in ECG

ELEVATION:

Electrolytes

LBBB

Early repolarization

Ventricular hypertrophy

Aneurysm
Treatment (e.g. pericardiocentesis)

Injury (AMI, contusion)

Osborne waves (hypothermia)

Non-occlusive vasospasm[52]

Supraventricular tachycardia: treatment

ABCDE:

Adenosine

Beta-blocker

Calcium channel antagonist

Digoxin

Excitation (vagal stimulation)[53]

Ventricular tachycardia: treatment

LAMB:

Lidocaine

Amiodarone

Mexiltene/ Magnesium

Beta-blocker[54]

White Blood Cell Count

Never let monkeys eat bananas:

Neutrophils

lymphocytes

monocytes

eosinophils

basophils[55]
Emergency medicine
Acute LVF management

LMNOP:

Lasix (furosemide)

Morphine (diamorphine)

Nitrates

Oxygen (sit patient up)

Pulmonary ventilation (if doing badly)[56]

Atrial fibrillation: causes of new onset

THE ATRIAL FIBS:

Thyroid

Hypothermia

Embolism (P.E.)

Alcohol

Trauma (cardiac contusion)

Recent surgery (post CABG)

Ischemia

Atrial enlargement

Lone or idiopathic

Fever, anemia, high-output states

Infarct

Bad valves (mitral stenosis)

Stimulants (cocaine, theo, amphet, caffeine)[57]

Ipecac: contraindications
4 C's:

Comatose

Convulsing

Corrosive

hydroCarbon[58]

JVP: raised JVP differential

PQRST(EKG waves):

Pericardial effusion

Quantity of fluid raised (fluid over load)

Right heart failure

Superior vena caval obstruction

Tricuspid stenosis/Tricuspid regurgitation/Tamponade (cardiac)[59]

MI: immediate treatment

DOGASH:

Diamorphine

Oxygen

GTN spray

Asprin 300mg

Streptokinase

Heparin[60]

PEA/Asystole (ACLS): etiology

ITCHPAD

Infarction

Tension pneumothorax

Cardiac tamponade
Hypovolemia/Hypothermia/Hypo-,Hyperkalemia/Hypomagnesmia/Hypoxemia

Pulmonary embolism

Acidosis

Drug overdose[61]

Rapid sequence intubation (RSI)

SOAP ME

Suction

Oxygen

Airway Equipment

Positioning

Monitoring & Meds

EtCO2 & other Equipment[62]

Shock: signs and symptoms

TV SPARC CUBE:

Thirst

Vomiting

Sweating

Pulse weak

Anxious

Respirations shallow/rapid

Cool

Cyanotic

Unconscious

BP low
Eyes blank[63]

Shock: types

RN CHAMPS (Alternatively: "MR. C.H. SNAP", or "NH CRAMPS"):

Respiratory

Neurogenic

Cardiogenic

Hemorrhagic

Anaphylactic

Metabolic

Psychogenic

Septic[64]

Subarachnoid hemorrhage (SAH) causes

BATS:

Berry aneurysm

Arteriovenous malformation/Adult polycystic kidney disease

Trauma

Stroke[65]

Syncope causes, by system

HEAD HEART VESSELS:

CNS causes include HEAD:

Hypoxia/Hypoglycemia

Epilepsy

Anxiety

Dysfunctional brain stem (basivertebral TIA)

Cardiac causes are HEART:


Heart attack

Embolism (PE)

Aortic obstruction (IHSS, AS or myxoma)

Rhythm disturbance, ventricular

T'achycardia

Vascular causes are VESSELS:

Vasovagal

Ectopic (reminds one of hypovolemia)

Situational

Subclavian steal

ENT (glossopharyngeal neuralgia)

Low systemic vascular resistance (Addison's, diabetic vascular neuropathy)

Sensitive carotid sinus[66]

Ventricular fibrillation: treatment

Shock, Shock, Shock, Everybody Shock, Little Shock, Big Shock, Momma Shock, Poppa
Shock:

Shock= Defibrillate

Everybody= Epinephine

Little= Lidocaine

Big= Bretylium

Momma= MgSO4

Poppa= Pocainamide[67]

Interviewing / Physical exam


Abdominal Assessment

To assess abdomen, palpate all 4 quadrants for DR. GERM:


Distension: liver problems, bowel obstruction

Rigidity (board like): bleeding

Guarding: muscular tension when touched

Eviseration/ Ecchymosis

Rebound tenderness: infection

Masses

Altered Level of Consciousness: Reasons

AEIOU TIPS

Alcohol

Epilepsy, Electrolytes, and Encephalopathy

Insulin

Overdose, Oxygen

Underdose, Uremia

Trauma, Temperature

Infection

Psychogenic, Poisons

Stroke, Shock[68]

Cause of symptoms

OPQRST (Works well for cardiac, and respiratory patients.)[69]

Onset of the event

Provocation or palliation

Quality of the pain

Region and radiation

Severity

Time
Fetal Monitoring

VEAL CHOP

Variable Early Deceleration Acceleration Late Deceleration

Cord compression Head compression O2 Placental Insufficiency[70]

Neurovascular Assessment

5 P's:

Pain

Pallor

Paresthesia

Pulse

Paralysis[71]

Trauma assessment

DCAP-BTLS

Deformities & Discolorations

Contusions

Abrasions & Avulsion

Penetrations & Punctures

Burns

Tenderness

Lacerations

Swelling & Symmetry

Toxicological seizures: Causes

OTIS CAMPBELL

Organophosphates

Tricyclic antidepressants
Isoniazid, Insulin

Sympathomimetics

Camphor, Cocaine

Amphetamines

Methylxanthines

PCP, Propoxyphene, Phenol, Propranolol

Benzodiazepine withdrawal, Botanicals

Ethanol withdrawal

Lithium, Lidocaine

Lindane, Lead[72]

Vomiting: non-GIT differential

ABCDEFGHI:

Acute renal failure

Brain [increased ICP]

Cardiac [inferior MI]

DKA

Ears [labyrinthitis]

Foreign substances [paracetamol, theo, etc.]

Glaucoma

Hyperemesis gravidarum

Infection [pyelonephritis, meningitis]

Heart valve auscultation sites

"All Patients Take Meds":

Reading from top left:

Aortic
Pulmonary

Tricuspid

Mitral

Glasgow coma scale: components and numbers

Scale types is 3 V's:

Visual response

Verbal response

Vibratory (motor) response Scale scores are 4,5,6:

Scale of 4: see so much more

Scale of 5: talking jive

Scale of 6: feels the pricks (if testing motor by pain withdrawal)

Mental state examination: stages in order

"Assessed Mental State To Be Positively Clinically Unremarkable":

Appearance and behaviour [observe state, clothing...]

Mood [recent spirit]

Speech [rate, form, content]

Thinking [thoughts, perceptions]

Behavioural abnormalities

Perception abnormalities

Cognition [time, place, age...]

Understanding of condition [ideas, expectations, concerns]

History

SAMPLE history

Signs and Symptoms

Allergies
Medications

Past medical history, injuries, illnesses

Last meal/intake

Events leading up to the injury and/or illness

Orthopaedic Assessment

CLORIDE FPP

Character: sharp or dull pain

Location: region (joint) of origin

Onset: sudden vs. gradual

Radiation:

Intensity: how severe (scale 1-10), impact on ADLs (activities of daily living), is it getting
better, worse or staying the same?

Duration: acute vs. chronic

Events associated: falls, morning stiffness, swelling, redness, joint clicking or locking,
muscle cramps, muscle wasting, movement limitation, weakness, numbness or tingling, fever,
chills, trauma (mechanism of injury), occupation activities, sports, repetitive movements

Frequency: intermittent vs. constant, have you ever had this pain before?

Palliative factors: is there anything that makes it better? (rest, activity, meds, heat, cold)

Provocative factors: is there anything that makes it worse? (rest, activity, etc.)[73]

Pain history checklist

SOCRATES:

Site

Onset

Character

Radiation

Alleviating factors/ Associated symptoms


Timing (duration, frequency)

Exacerbating factors

Severity

Alternatively, Signs and Symptoms with the 'S'

Abdominal swelling causes

9 F's:

Fat

Feces

Fluid

Flatus

Fetus

Full-sized tumors

Full bladder

Fibroids

False pregnancy

Head Trauma: rapid neuro exam

12 P's

Psychological (mental) status

Pupils: size, symmetry, reaction

Paired ocular movements

Papilloedema

Pressure (BP, increased ICP)

Pulse and rate

Paralysis, Paresis

Pyramidal signs
Pin prick sensory response

Pee (incontinent)

Patellar reflex

Ptosis

Ocular bobbing vs. dipping

"Breakfast is fast, Dinner is slow, both go down":

Bobbing is fast

Dipping is slow

In both, the initial movement is down.

Pupillary dilation (persistent): causes

3AM:

3rd nerve palsy

Anti-muscarinic eye drops (eg to facilitate fundoscopy)

Myotonic pupil

Clinical examination: initial Inspection of patient from end of bed

ABC:

Appearance (SOB, pain, etc.)

Behaviour

Connections (drips, inhalers, etc. connected to patient)

Differential diagnosis checklist

"A VITAMIN C"

A and C stand for Acquired and Congenital

VITAMIN stands for:

Vascular

Inflammatory (Infectious and non-Infectious)


Trauma/ Toxins

Autoimmune

Metabolic

Idiopathic

Neoplastic

 Example usage: List causes of decreased vision: Central retinal artery occlusion,
Retinitis pigmentosa, Perforation to gobe, Chronic Gentamycin use, Ruematoid
arthritis, Diabetes, Idiopathic, Any eye tumor, Myopia.

Family history (FH)

BALD CHASM:

Blood pressure (high)

Arthritis

Lung disease

Diabetes

Cancer

Heart disease

Alcoholism

Stroke

Mental health disorders (depression, etc.)

Four point physical assessment of a disease

"I'm A People Person"

Inspection

Auscultation

Percussion

Palpation

Medical history: disease checklist


MJ THREADS:

Myocardial infarction

Jaundice

Tuberculosis

Hypertension

Rheumatic fever/ Rheumatoid arthritis

Epilepsy

Asthma

Diabetes

Strokes

Past medical history (PMH)

VAMP THIS:

Vices (tobacco, alcohol, other drugs, sexual risks)

Allergies

Medications

Preexisting medical conditions

Trauma

Hospitalizations

Immunizations

Surgeries

Patient examination organization

SOAP:

Subjective: what the patient says.

Objective: what the examiner observes.

Assessment: what the examiner thinks is going on.


Plan: what they intend to do about it

Patient profile (PP)

LADDERS:

Living situation/ Lifestyle

Anxiety

Depression

Daily activities (describe a typical day)

Environmental risks/ Exposure

Relationships

Support system/ Stress

Physical exam for 'lumps and bumps'

"6 Students and 3 Teachers go for CAMPFIRE":

Site, Size, Shape, Surface, Skin, Scar

Tenderness, Temperature, Transillumination

Consistency

Attachment

Mobility

Pulsation

Fluctuation

Irreducibility

Regional lymph nodes

Edge

Physical examination - correct order

"I Palpate People's Abdomens":

Inspection
Palpation

Percussion

Auscultation

Short stature causes

RETARD HEIGHT:

Rickets

Endocrine (cretinism, hypopituitarism, Cushing's)

Turner syndrome

Achondroplasia

Respiratory(suppurative lung disease)

Down syndrome

Hereditary

Environmental (postirradiation, postinfectious)

IUGR

GI (malabsorption)

Heart (congenital heart disease)

Tilted backbone (scoliosis)

Sign vs. symptom

sIgn: something I can detect even if patient is unconscious. sYMptom is something only
hYM knows about.

Surgical sieve for diagnostic categories

INVESTIGATIONS:

Iatrogenic

Neoplastic

Vascular
Endocrine

Structural/ Mechanical

Traumatic

Inflammatory

Genetic/ Congenital

Autoimmune

Toxic

Infective

Old age/ Degenerative

Nutritional

Spontaneous/ Idiopathic

Breast history checklist

LMNOP:

Lump

Mammary changes

Nipple changes

Other symptoms

Patient risk factors

Delivering Bad News

SPIKES:

Setting up

Perception

Invitation

Knowledge

Emotions
Strategy and Summary

Neurology
Chorea: common causes

St. VITUS'S DANCE:

Sydenhams

Vascular

Increased RBC's (polycythemia)

Toxins: CO, Mg, Hg

Uremia

SLE

Senile chorea

Drugs

APLA syndrome

Neurodegenerative conditions: HD, neuroacanthocytosis, DRPLA

Conception related: pregnancy, OCP's

Endocrine: hyperthyroidism, hypo-, hyperglycemia[74]

Congenital myopathy: features

DREAMS:

Dominantly inherited, mostly

Reflexes decreased

Enzymes normal

Apathetic floppy baby

Milestones delayed

Skeletal abnormalities[75]

Dementia: reversible dementia causes


DEMENTIA:

Drugs/Depression

Elderly

'Multi-infarct/Medication

Environmental

Nutritional

Toxins

Ischemia

Alcohol[76]

Stroke risk factors

HEADS:

Hypertension/ Hyperlipidemia

Elderly

Atrial fib

Diabetes mellitus/ Drugs (cocaine)

Smoking/Sex (male)[77]

Horner Syndrome

Horny PAMELA:

Ptosis

Anhydrosis

Miosis

Enophtalmos

Loss of ciliary-spinal reflex

Anisocoria

Pathology
Acute ischemia: signs [especially limbs]

6 P's:

Pain

Pallor

Pulselessness

Paralysis

Paraesthesia

Perishingly cold

Anemia (normocytic): causes

ABCD:

Acute blood loss

Bone marrow failure

Chronic disease

Destruction (hemolysis)

Anemia causes (simplified)

ANEMIA:

Anemia of chronic disease

No folate or B12

Ethanol

Marrow failure & hemaglobinopathies

Iron deficient

Acute & chronic blood loss

Atherosclerosis risk factors

"You're a SAD BET with these risk factors":

Sex: male
Age: middle-aged, elderly

Diabetes mellitus

BP high: hypertension

Elevated cholesterol

Tobacco

Carcinoid syndrome: components

CARCinoid:

Cutaneous flushing

Asthmatic wheezing

Right sided valvular heart lesions

Cramping and diarrhea

Cushing syndrome

CUSHING:

Central obesity/ Cervical fat pads/ Collagen fiber weakness/ Comedones (acne)

Urinary free corisol and glucose increase

Striae/ Suppressed immunity

Hypercortisolism/ Hypertension/ Hyperglycemia/ Hirsutism

Iatrogenic (Increased administration of corticosteroids)

Noniatrogenic (Neoplasms)

Glucose intolerance/Growth retardation

Diabetic ketoacidosis: I vs. II

ketONEbodies are seen in type ONEdiabetes.

Gallstones: risk factors

5 F's:

Fat
Female

Fair (gallstones more common in Caucasians)

Fertile (premenopausal- increased estrogen is thought to increase cholesterol levels in bile


and decrease gallbladder contractions)

Forty or above (age)[78]

Hepatomegaly: 3 common causes, 3 rarer causes

Common are 3 C's:

Cirrhosis

Carcinoma

Cardiac failure

Rarer are 3 C's:

Cholestasis

Cysts

Cellular infiltration

Inflammatory Bowel Disease: which has cobblestones

Crohn's has Cobblestones on endoscopy.

Morphine: effects

MORPHINES:

Miosis

Orthostatic hypotension

Respiratory depression

Pain supression

Histamine release/Hormonal alterations

Increased ICT

Nausea
Euphoria

Sedation

Kwashiorkor: distinguishing from Marasmus

FLAME:

Fatty

Liver

Anemia

Malabsorption

Edema

Pancreatitis: causes

PANCREATITIS:

Posterior

Alcohol

Neoplasm

Cholelithiasis

Rx (lasix, AZT)

ERCP

Abdominal surgery

Trauma

Infection (mumps)

Triglycerides elevated

I'diopathic

Scorpion sting

PKU findings

PKU:
Pale hair, skin

Krazy (neurological abnormalities)

Unpleasant smell

Pupils in overdose: morphine vs. amphetamine

"MorPHINE:Fine. AmPHETamine:Fat":

Morphine overdose: pupils constricted (fine).

Amphetamine overdose: pupils dilated (fat).

Pericarditis findings

PERICarditis:

Pulsus paradoxus

ECG changes

Rub

Increased JVP

Chest pain [worse on inspiration, better when leaning forward]

Gout vs. pseudogout: crystal lab findings

P seduogout crystals are:

P ositive birefringent

P olygon shaped

Gout therefore is the negative needle shaped crystals. Also, gout classically strikes great Toe,
and its hallmark is Tophi.

Signs of Chronic Liver Disease

abcdefghij

Asterixis, Ascites, Ankle oedema, Atrophy of testicles

Bruising
Clubbing/ Colour change of nails (leuconychia)

Dupuytren’s contracture

Encephalopathy / palmar Erythema

Foetor hepaticus

Gynaecomastia

Hepatomegaly

Increase size of parotids

Jaundice[79]

Psychiatry
Conduct disorder vs. Antisocial personality disorder

Conduct disorder is seen in Children. Antisocial personality disorder is seen in Adults.

Depression: symptoms and signs (DSM-IV criteria)

AWESOME:

Affect flat

Weight change (loss or gain)

Energy, loss of

Sad feelings/ Suicide thoughts or plans or attempts/ Sexual inhibition/ Sleep change (loss or
excess)/ Social withdrawal

Others (guilt, loss of pleasure, hopeless)

Memory loss

Emotional blunting

Depression

UNHAPPINESS:

Understandable (such as bereavement, major stresses)

Neurotic (high anxiety personalities, negative parental upbringingHypochondriasis


Agitation (usually organic causes such as dementia)

Pseudodementia

Pain

Importuniing (whingeing, complaining)

Nihilistic

Endogenous

Secondary (i.e. cancer at the head of the pancreas, bronchogenic cancer)

Syndromal

Erikson's developmental stages

"The sad tale of Erikson Motors":

 The stages in order by age group:

Mr. Trust and MsTrust had an auto they were ashamed of. She took the initiative to find
the guilty party. She found the industry was inferior. They were making cars with dents
[identity] and rolling fuses [role confusion]. Mr. N.T. Macy [intimacy] isolated the problem,
General TVT absorbed the cost. In the end, they found the tires were just gritty and the
should have used de- spare!

Mania: cardinal symptoms

DIG FAST:

Distractibility

Indiscretion (DSM-IV's "excessive involvement in pleasurable activities")

Grandiosity

Flight of ideas

Activity increase

Sleep deficit (decreased need for sleep)

Talkativeness (pressured speech)

Mania: diagnostic criteria

Must have 3 of MANIAC:


Mouth (pressure of speech)/ Moodl

Activity increased

Naughty (disinhibition)

Insomnia

Attention (distractability)

Confidence (grandiose ideas)

Parasomnias: time of onset

SLeep terrors and SLeepwalking occur during SLow-wave sleep (stages 3 & 4).NightmaRE
occurs during REM sleep (and is REMembered).

Psychiatric review of symptoms

"Depressed Patients Seem Anxious, So Claim Psychiatrists":

Depression and other mood disorders (major depression, bipolar disorder, dysthymia)

Personality disorders (primarily borderline personality disorder)

Substance abuse disorders

Anxiety disorders (panic disorder with agoraphobia, obsessive-compulsive disorder)

Somatization disorder, eating disorders (these two disorders are combined because both
involve disorders of bodily perception)

Cognitive disorders (dementia, delirium)

Psychotic disorders (schizophrenia, delusional disorder and psychosis accompanying


depression, substance abuse or dementia)

Schizophrenia: negative features

4 A's:

Ambivalence

Affective incongruence

Associative loosening

Autism
Substance dependence: features (DSM IV)

WITHDraw IT:

 3 of 7 within 12-month period:

Withdrawal

Interest or Important activities given up or reduced

Tolerance

Harm to physical and psychosocial known but continue to use

Desire to cut down, control

Intended time, amount exceeded

Time spent too much

Radiology / Oncology
Anterior mediastinal masses

4 T's:

Teratoma

Thymoma

Testicular-type

T-cell / Hodgkin's lymphoma

Dermatomyositis or polymyositis: risk of underlying malignancy

Risk is 30% at age 30. Risk is 40% at age 40, and so on.

Chest radiograph: checklist to examine

"Pamela Found Our Rotation Particularly Exciting; Very Highly Commended Mainly 'Cus
She Arouses":

Patient details

Film details

Objects (e.g. lines, electrodes)


Rotation

Penetration

Expansion

Vessels

Hila

Costophrenic angles

Mediastinum

Cardiothoracic Ratio

Soft tissues and bones

Air (diaphragm, pneumothorax, subcut. emphysema)

Chest X-ray interpretation

Preliminary is ABCDEF:

AP or PA

Body position

Confirm name

Date

Exposure

Films for comparison

Analysis is ABCDEF:

Airways (hilar adenopathy or enlargement)

Breast shadows/ Bones (rib fractures, lytic bone lesions)

Cardiac silhoutte (cardiac enlargement)/ Costophrenic angles (pleural effusions)

Diaphragm (evidence of free air)/ Digestive tract

Edges (apices for fibrosis, pneumothorax, pleural thickening or plaques)/ Extrathoracic


tissues
Fields (evidence of alveolar filling)/ Failure (alveolar air space disease with prominent
vascularity with or without pleural effusions)

Chest X-ray: cavitating lesions differential

"If you see HOLES on chest X-ray, they are WEIRD":

Wegener's syndrome

Embolic (pulmonary, septic)

Infection (anaerobes, pneumocystis, TB)

Rheumatoid (necrobiotic nodules)

Developmental cysts (sequestration)

Histiocytosis

Oncological

Lymphangioleiomyomatosis

Environmental, occupational

Sarcoid

Alternatively: L=Left atrial myxoma

Lung cancer: main sites for distant metastases

BLAB:

Bone

Liver

Adrenals

Brain

Elbow ossification centers, in sequence

CRITOE: Capitellum

Radial head

Internal epicondyle
Trochlea

Olecranon

External epicondyle

Esophageal cancer: risk factors

ABCDEF:

Achalasia

Barret's esophagus

Corrosive esophagitis

Diverticuliis

Esophageal web

Familial

Head CT scan: evaluation checklist

"Blood Can Be Very Bad":

B lood

Cistern

Brain

Ventricles

Bone

Lung cancer: notorious consequences

SPEECH:

Superior vena cava syndrome

Paralysis of diaphragm (Phrenic nerve)

Ectopic hormones

Eaton-Lambert syndrome

Clubbing
Horner syndrome/ Hoarseness

Mole: signs of trouble

ABCDE:

Asymmetry

Border irregular

Colour irregular

Diameter usually > 0.5cm

Elevation irregular

Neck sagittal x-ray: examination checklist

ABCD:

Anterior: look for swelling

Bones: examine each bone for fractures

Cartilage: look for slipped discs

Dark spots: ensure not abnormally big, or could mean excess blood

Osteoarthritis: x-ray signs

LOSS:

Loss of joint space

Osteopyhtes

Subcondral sclerosis

Subchondral cysts

Prognotic factors for cancer: general

PROGNOSIS:

Presentation (time & course)

Response to treatment

Old (bad prog.)


Good intervention (i.e. early)

Non-compliance with treatment

Order of differentiation (>1 cell type)

Stage of disease

Ill health

Spread (diffuse)

Pituitary endocrine functions often affected by pituitary-associated tumor

"Go Look For the Adenoma Please":

Tropic hormones affected by growth tumor are:

GnRH

LSH

FSH

ACTH

Prolactin function

T2 vs. T1 MRI scan

"WW 2" (World War II):

Water is White in a T2 scan.

Conversely, a T1 scan shows fat as being whiter.

Upper lobe shadowing: causes

BREASTS:

Beryllium

Radiation

Extrinsic allergic alveolitis

Ankylosing spondylitis

Sarcoidosis
TB

Siliconiosis

Miscellaneous
The following may or may not fit properly into one of the above categories. They are being
stored in this section either temporarily or permanently. Categorize them if needed.

Asthma treatment

ASTHMA

Adrenergic agonists

Steroids

Theophylline

Hydration

Masked oxygen

Anticholinergics[80]

Croup: symptoms

3 S's:

Stridor

Subglottic swelling

Seal-bark cough

Cholinergic Crisis

SLUDGE and the Killer B's:

Salivation

Lacrimation

Urination

Diaphoresis, Diarrhea

Gastrointestinal cramping
Emesis

Bradycardia

Bronchospasm

Bronchorrhea[81]

DISCO D DIGITALIS I ISONIAZID S SPIRILACTINE C


CIMETIDINE,KETOCONQZILE O OESTROGEN==Gynaecomastia causing drugs===
Some Drugs Create Awesome Knockers

Spironolactone

Digitalis

Cimetidine

Alcohol

Ketoconazole[82]

Pentad of TTP

FAT RN:

Fever

Anemia

Thrombocytopenia

Renal

Neuro changes[83]

Pulmonary Edema: Treatment

LMNOP:

Lasix

Morphine

Nitro

Oxygen

Position/Positive pressure ventilation[84]


Anaesthesiology
Anesthesia machine/room check

MS MAID:

Monitors (EKG, SpO2, EtCO2, etc.)

Suction

Machine check (according to ASA guidelines)

Airway equipment (ETT, laryngoscope, oral/nasal airway)

IV equipment

Drugs (emergency, inductions, NMBs, etc.)

Endotracheal intubation: diagnosis of poor bilateral breath sounds after


intubation

DOPE:

Displaced (usually right mainstem, pyreform fossa, etc.)

Obstruction (kinked or bitten tube, mucous plug, etc.)

Pneumothorax (collapsed lung)

Esophagus

General anaesthesia: equipment check prior to inducing

MALES:

Masks

Airways

Laryngoscopes

Endotracheal tubes

Suction/ Stylette, bougie

Spinal anesthesia agents

"Little Boys Prefer Toys":


Lidocaine

Bupivicaine

Procaine

Tetracaine

Xylocaine: where not to use with epinephrine

"Ears, Nose, Hose, Fingers and Toes"

 Vasoconstrictive effects of xylocaine with epinephrine are helpful in providing


hemostasis while suturing. However, may cause local ischemic necrosis in distal
structures such as the digits, tip of nose, penis, ears.

Behavioural science / psychology


Depression: major episode characteristics

SPACE DIGS:

Sleep disruption

Psychomotor retardation

Appetite change

Concentration loss

Energy loss

Depressed mood

Interest wanes

Guilt

Suicidal tendencies

Gain: primary vs. secondary vs. tertiary

Primary: Patient's Psyche improved.

Secondary: Symptom Sympathy for patient.

Tertiary: Therapist's gain


Kubler-Ross dying process: stages

"'Death Always Brings Great Acceptance":

Denial

Anger

Bargaining

Grieving

Acceptance

Middle adolescence (14-17 years): characteristics

HERO:

Heterosexual crushes/ Homosexual Experience

Education regarding short term benefits

Risk taking

Omnipotence

Narcolepsy: symptoms, epidemiology

CHAP:

Cataplexy

Hallucinations

Attacks of sleep

Paralysis on waking

 Usual presentation is a young male, hence "chap"

Sleep stages: features

DElta waves during DEepest sleep (stages 3 & 4, slow-wave).

dREaM during REM sleep.

Impotence causes

PLANE:
Psychogenic: performance anxiety

Libido: decreased with androgen deficiency, drugs

Autonomic neuropathy: impede blood flow redirection

Nitric oxide deficiency: impaired synthesis, decreased blood pressure

Erectile reserve: can't maintain an erection

Male erectile dysfunction (MED): biological causes

MED:

Medicines (propranalol, methyldopa, SSRI, etc.)

Ethanol

Diabetes mellitus

Premature ejaculation: treatment

2 S's:

SSRIs

Squeezing technique [glans pressure before climax]

More detail with 2 more S's:

Sensate-focus exercises [relieves anxiety]

Stop and start method [5-6 rehearsals of stopping stimulation before climax]

Biochemistry
B vitamin names

"The Rhythm Nearly Proved Contagious":

In increasing order:

Thiamine (B1)

Riboflavin (B2)

Niacin (B3)

Pyridoxine (B6)
Cobalamin (B12)

Essential amino acids

"PVT. TIM HALL always argues, never tires":

Phe

Val

Thr

Trp

Ile

Met

His

Arg

Lue

Lys

 Always argues: the A is for Arg, not Asp.

 'Never tires': T is not Tyr, but is both Thr and Trp.

Fasting state: branched-chain amino acids used by skeletal muscles

"Muscles LIVe fast":

Leucine

Isoleucine

Valine

Folate deficiency: causes

A FOLIC DROP:

Alcoholism

Folic acid antagonists

Oral contraceptives
Low dietary intake

Infection with Giardia

Celiac sprue

Dilatin

Relative folate deficiency

Old

Pregnant

Glycogen storage: Anderson's (IV) vs. Cori's (III) enzyme defect

ABCD:

Anderson's=Branching enzyme.

Cori's=Debranching enzyme.

 Otherwise, can't really distinguish clinically.

Glycogen storage: names of types I through VI

"Viagra Pills Cause A Major Hardon":

Von Gierke's

Pompe's

Cori's

Anderson's

McArdle's

Her's

Cardiology
Aortic regurgitation: causes

CREAM:

Congenital

Rheumatic damage
Endocarditis

Aortic dissection/ Aortic root dilatation

Marfan’s

Aortic stenosis characteristics

SAD:

Syncope

Angina

Dyspnoea [23]

Aorta vs. vena cava: right vs. left

(When looking at the patient from the anterior side.)

Aorta and right each have 5 letters, so aorta is on the right.

Vena and cava and left each have 4 letters, so vena cava is on the left[24]

Aortic to left Subclavian path

ABC'S

Aortic arch gives rise to:

Brachiocephalic trunk

left Common Carotid

left Subclavian[25]

Apex beat: abnormalities found on palpation, causes of impalpable

HILT:

Heaving

Impalpable

Laterally displaced

Thrusting/ Tapping

If it's impalpable, causes are COPD:


COPD

Obesity

Pleural, Pericardial effusion

Dextrocardia [26]

Atrial Fibrillation causes

Pirates:

Pulmonary: PE, COPD

Iatrogenic

Rheumatic heart: mirtral regurgitation

Atherosclerotic: MI, CAD

Thyroid: hyperthyroid

Endocarditis

Sick sinus syndrome[27]

Atrial fibrillation management

ABCD:

Anti-coagulate

Beta-block to control rate

Cardiovert

Digoxin[28]

Beck's triad (cardiac tamponade)

3 D's:

Distant heart sounds

Distended jugular veins

Darterial pressure [29]

Betablockers: cardioselective betablockers


Betablockers Acting Exclusively At Myocardium:

Betaxolol

Acebutelol

Esmolol

Atenolol

Metoprolol [30]

CHF: causes of exacerbation

Failure

Forgot medication

Arrhythmia/ Anaemia

Ischemia/ Infarction/ Infection

Lifestyle: taken too much salt

Upregulation of CO: pregnancy, hyperthyroidism

Renal failure

Embolism: pulmonary [31]

Complications of Myocardial Infarction

Darth Vader

Death

Arrythmia

Rupture(free ventricular wall/ ventricular septum/ papillary muscles)

Tamponade

Heart failure (acute or chronic)

Valve disease

Aneurysm of Ventricles

Dressler's Syndrome
thromboEmbolism (mural thrombus)

Recurrence/ mitral Regurgitation[32]

Coronary artery bypass graft: indications

Dust:

Depressed ventricular function

Unstable angina

Stenosis of the left main stem

Triple vessel disease [33]

ECG: left vs. right bundle block

WiLLiaM MaRRoW:

W pattern in V1-V2 and M pattern in V3-V6 is Left bundle block.

M pattern in V1-V2 and W in V3-V6 is Right bundle block.[34]

Exercise ramp ECG: contraindications

Ramp:

Recent MI

Aortic stenosis

MI in the last 7 days

Pulmonary hypertension[35]

Heart valve sequence

Try Puling My Aorta:

Tricuspid

Pulmonary

Mitral (bicuspid)

Aorta [36]

Infarctions
IV access

Narcotic analgesics (e.g. morphine, pethidine)

Facilities for defibrillation (DF)

Aspirin/ Anticoagulant (heparin)

Rest

Converting enzyme inhibitor

Thrombolysis

IV beta blocker

Oxygen 60%

Nitrates

Stool Softeners[37]

JVP: wave form

ASK ME

Atrial contraction

Systole (ventricular contraction)

Klosure (closure) of tricusps, so atrial filling

Maximal atrial filling

Emptying of atrium[38]

MI: basic management

BOOMAR:

Bed rest

Oxygen

Opiate

Monitor

Anticoagulate
Reduce clot size[39]

MI: signs and symptoms

PULSE:

Persistent chest pains

Upset stomach

Lightheadedness

Shortness of breath

Excessive sweating[40]

MI: therapeutic treatment

O BATMAN!

Oxygen

Beta blocker

ASA

Thrombolytics (e.g. heparin)

Morphine

Ace prn

Nitroglycerin[41]

MI: treatment of acute MI

COAG:

Cyclomorph

Oxygen

Aspirin

Glycerol trinitrate[42]

Murmur attributes

"IL PQRST" (person has ill PQRST heart waves):


Intensity

Location

Pitch

Quality

Radiation

Shape

Timing[43]

Murmurs: innocent murmur features

8 S's:

Soft

Systolic

Short

Sounds (S1 & S2) normal

Symptomless

Special tests normal (X-ray, EKG)

Standing/ Sitting (vary with position)

Sternal depression [44]

Murmurs: louder with inspiration vs expiration

LEft sided murmurs louder with Expiration

RIght sided murmurs louder with Inspiration. [45]

Murmurs: questions to ask

SCRIPT:

Site

Character (e.g. harsh, soft, blowing)


Radiation

Intensity

Pitch

Timing[46]

Murmurs: systolic vs. diastolic

PASS:Pulmonic & Aortic

Stenosis=Systolic.

PAID: Pulmonic & Aortic

Insufficiency=Diastolic. [47]

Pericarditis: causes

CARDIAC RIND:

Collagen vascular disease

Aortic aneurysm

Radiation

Drugs (such as hydralazine)

Infections

Acute renal failure

Cardiac infarction

Rheumatic fever

Injury

Neoplasms

Dressler's syndrome[48]

Pericarditis: EKG

PericarditiS:

PR depression in precordial leads.


ST elevation.[49]

Peripheral vascular insufficiency: inspection criteria

SICVD:

Symmetry of leg musculature

Integrity of skin

Color of toenails

Varicose veins

Distribution of hair[50]

Pulseless electrical activity: causes

PATCH MED:

Pulmonary embolus

Acidosis

Tension pneumothorax

Cardiac tamponade

Hypokalemia/ Hyperkalemia/ Hypoxia/ Hypothermia/ Hypovolemia

Myocardial infarction

Electrolyte derangements

Drugs[51]

ST elevation causes in ECG

ELEVATION:

Electrolytes

LBBB

Early repolarization

Ventricular hypertrophy

Aneurysm
Treatment (e.g. pericardiocentesis)

Injury (AMI, contusion)

Osborne waves (hypothermia)

Non-occlusive vasospasm[52]

Supraventricular tachycardia: treatment

ABCDE:

Adenosine

Beta-blocker

Calcium channel antagonist

Digoxin

Excitation (vagal stimulation)[53]

Ventricular tachycardia: treatment

LAMB:

Lidocaine

Amiodarone

Mexiltene/ Magnesium

Beta-blocker[54]

White Blood Cell Count

Never let monkeys eat bananas:

Neutrophils

lymphocytes

monocytes

eosinophils

basophils[55]
Emergency medicine
Acute LVF management

LMNOP:

Lasix (furosemide)

Morphine (diamorphine)

Nitrates

Oxygen (sit patient up)

Pulmonary ventilation (if doing badly)[56]

Atrial fibrillation: causes of new onset

THE ATRIAL FIBS:

Thyroid

Hypothermia

Embolism (P.E.)

Alcohol

Trauma (cardiac contusion)

Recent surgery (post CABG)

Ischemia

Atrial enlargement

Lone or idiopathic

Fever, anemia, high-output states

Infarct

Bad valves (mitral stenosis)

Stimulants (cocaine, theo, amphet, caffeine)[57]

Ipecac: contraindications
4 C's:

Comatose

Convulsing

Corrosive

hydroCarbon[58]

JVP: raised JVP differential

PQRST(EKG waves):

Pericardial effusion

Quantity of fluid raised (fluid over load)

Right heart failure

Superior vena caval obstruction

Tricuspid stenosis/Tricuspid regurgitation/Tamponade (cardiac)[59]

MI: immediate treatment

DOGASH:

Diamorphine

Oxygen

GTN spray

Asprin 300mg

Streptokinase

Heparin[60]

PEA/Asystole (ACLS): etiology

ITCHPAD

Infarction

Tension pneumothorax

Cardiac tamponade
Hypovolemia/Hypothermia/Hypo-,Hyperkalemia/Hypomagnesmia/Hypoxemia

Pulmonary embolism

Acidosis

Drug overdose[61]

Rapid sequence intubation (RSI)

SOAP ME

Suction

Oxygen

Airway Equipment

Positioning

Monitoring & Meds

EtCO2 & other Equipment[62]

Shock: signs and symptoms

TV SPARC CUBE:

Thirst

Vomiting

Sweating

Pulse weak

Anxious

Respirations shallow/rapid

Cool

Cyanotic

Unconscious

BP low
Eyes blank[63]

Shock: types

RN CHAMPS (Alternatively: "MR. C.H. SNAP", or "NH CRAMPS"):

Respiratory

Neurogenic

Cardiogenic

Hemorrhagic

Anaphylactic

Metabolic

Psychogenic

Septic[64]

Subarachnoid hemorrhage (SAH) causes

BATS:

Berry aneurysm

Arteriovenous malformation/Adult polycystic kidney disease

Trauma

Stroke[65]

Syncope causes, by system

HEAD HEART VESSELS:

CNS causes include HEAD:

Hypoxia/Hypoglycemia

Epilepsy

Anxiety

Dysfunctional brain stem (basivertebral TIA)

Cardiac causes are HEART:


Heart attack

Embolism (PE)

Aortic obstruction (IHSS, AS or myxoma)

Rhythm disturbance, ventricular

T'achycardia

Vascular causes are VESSELS:

Vasovagal

Ectopic (reminds one of hypovolemia)

Situational

Subclavian steal

ENT (glossopharyngeal neuralgia)

Low systemic vascular resistance (Addison's, diabetic vascular neuropathy)

Sensitive carotid sinus[66]

Ventricular fibrillation: treatment

Shock, Shock, Shock, Everybody Shock, Little Shock, Big Shock, Momma Shock, Poppa
Shock:

Shock= Defibrillate

Everybody= Epinephine

Little= Lidocaine

Big= Bretylium

Momma= MgSO4

Poppa= Pocainamide[67]

Interviewing / Physical exam


Abdominal Assessment

To assess abdomen, palpate all 4 quadrants for DR. GERM:


Distension: liver problems, bowel obstruction

Rigidity (board like): bleeding

Guarding: muscular tension when touched

Eviseration/ Ecchymosis

Rebound tenderness: infection

Masses

Altered Level of Consciousness: Reasons

AEIOU TIPS

Alcohol

Epilepsy, Electrolytes, and Encephalopathy

Insulin

Overdose, Oxygen

Underdose, Uremia

Trauma, Temperature

Infection

Psychogenic, Poisons

Stroke, Shock[68]

Cause of symptoms

OPQRST (Works well for cardiac, and respiratory patients.)[69]

Onset of the event

Provocation or palliation

Quality of the pain

Region and radiation

Severity

Time
Fetal Monitoring

VEAL CHOP

Variable Early Deceleration Acceleration Late Deceleration

Cord compression Head compression O2 Placental Insufficiency[70]

Neurovascular Assessment

5 P's:

Pain

Pallor

Paresthesia

Pulse

Paralysis[71]

Trauma assessment

DCAP-BTLS

Deformities & Discolorations

Contusions

Abrasions & Avulsion

Penetrations & Punctures

Burns

Tenderness

Lacerations

Swelling & Symmetry

Toxicological seizures: Causes

OTIS CAMPBELL

Organophosphates

Tricyclic antidepressants
Isoniazid, Insulin

Sympathomimetics

Camphor, Cocaine

Amphetamines

Methylxanthines

PCP, Propoxyphene, Phenol, Propranolol

Benzodiazepine withdrawal, Botanicals

Ethanol withdrawal

Lithium, Lidocaine

Lindane, Lead[72]

Vomiting: non-GIT differential

ABCDEFGHI:

Acute renal failure

Brain [increased ICP]

Cardiac [inferior MI]

DKA

Ears [labyrinthitis]

Foreign substances [paracetamol, theo, etc.]

Glaucoma

Hyperemesis gravidarum

Infection [pyelonephritis, meningitis]

Heart valve auscultation sites

"All Patients Take Meds":

Reading from top left:

Aortic
Pulmonary

Tricuspid

Mitral

Glasgow coma scale: components and numbers

Scale types is 3 V's:

Visual response

Verbal response

Vibratory (motor) response Scale scores are 4,5,6:

Scale of 4: see so much more

Scale of 5: talking jive

Scale of 6: feels the pricks (if testing motor by pain withdrawal)

Mental state examination: stages in order

"Assessed Mental State To Be Positively Clinically Unremarkable":

Appearance and behaviour [observe state, clothing...]

Mood [recent spirit]

Speech [rate, form, content]

Thinking [thoughts, perceptions]

Behavioural abnormalities

Perception abnormalities

Cognition [time, place, age...]

Understanding of condition [ideas, expectations, concerns]

History

SAMPLE history

Signs and Symptoms

Allergies
Medications

Past medical history, injuries, illnesses

Last meal/intake

Events leading up to the injury and/or illness

Orthopaedic Assessment

CLORIDE FPP

Character: sharp or dull pain

Location: region (joint) of origin

Onset: sudden vs. gradual

Radiation:

Intensity: how severe (scale 1-10), impact on ADLs (activities of daily living), is it getting
better, worse or staying the same?

Duration: acute vs. chronic

Events associated: falls, morning stiffness, swelling, redness, joint clicking or locking,
muscle cramps, muscle wasting, movement limitation, weakness, numbness or tingling, fever,
chills, trauma (mechanism of injury), occupation activities, sports, repetitive movements

Frequency: intermittent vs. constant, have you ever had this pain before?

Palliative factors: is there anything that makes it better? (rest, activity, meds, heat, cold)

Provocative factors: is there anything that makes it worse? (rest, activity, etc.)[73]

Pain history checklist

SOCRATES:

Site

Onset

Character

Radiation

Alleviating factors/ Associated symptoms


Timing (duration, frequency)

Exacerbating factors

Severity

Alternatively, Signs and Symptoms with the 'S'

Abdominal swelling causes

9 F's:

Fat

Feces

Fluid

Flatus

Fetus

Full-sized tumors

Full bladder

Fibroids

False pregnancy

Head Trauma: rapid neuro exam

12 P's

Psychological (mental) status

Pupils: size, symmetry, reaction

Paired ocular movements

Papilloedema

Pressure (BP, increased ICP)

Pulse and rate

Paralysis, Paresis

Pyramidal signs
Pin prick sensory response

Pee (incontinent)

Patellar reflex

Ptosis

Ocular bobbing vs. dipping

"Breakfast is fast, Dinner is slow, both go down":

Bobbing is fast

Dipping is slow

In both, the initial movement is down.

Pupillary dilation (persistent): causes

3AM:

3rd nerve palsy

Anti-muscarinic eye drops (eg to facilitate fundoscopy)

Myotonic pupil

Clinical examination: initial Inspection of patient from end of bed

ABC:

Appearance (SOB, pain, etc.)

Behaviour

Connections (drips, inhalers, etc. connected to patient)

Differential diagnosis checklist

"A VITAMIN C"

A and C stand for Acquired and Congenital

VITAMIN stands for:

Vascular

Inflammatory (Infectious and non-Infectious)


Trauma/ Toxins

Autoimmune

Metabolic

Idiopathic

Neoplastic

 Example usage: List causes of decreased vision: Central retinal artery occlusion,
Retinitis pigmentosa, Perforation to gobe, Chronic Gentamycin use, Ruematoid
arthritis, Diabetes, Idiopathic, Any eye tumor, Myopia.

Family history (FH)

BALD CHASM:

Blood pressure (high)

Arthritis

Lung disease

Diabetes

Cancer

Heart disease

Alcoholism

Stroke

Mental health disorders (depression, etc.)

Four point physical assessment of a disease

"I'm A People Person"

Inspection

Auscultation

Percussion

Palpation

Medical history: disease checklist


MJ THREADS:

Myocardial infarction

Jaundice

Tuberculosis

Hypertension

Rheumatic fever/ Rheumatoid arthritis

Epilepsy

Asthma

Diabetes

Strokes

Past medical history (PMH)

VAMP THIS:

Vices (tobacco, alcohol, other drugs, sexual risks)

Allergies

Medications

Preexisting medical conditions

Trauma

Hospitalizations

Immunizations

Surgeries

Patient examination organization

SOAP:

Subjective: what the patient says.

Objective: what the examiner observes.

Assessment: what the examiner thinks is going on.


Plan: what they intend to do about it

Patient profile (PP)

LADDERS:

Living situation/ Lifestyle

Anxiety

Depression

Daily activities (describe a typical day)

Environmental risks/ Exposure

Relationships

Support system/ Stress

Physical exam for 'lumps and bumps'

"6 Students and 3 Teachers go for CAMPFIRE":

Site, Size, Shape, Surface, Skin, Scar

Tenderness, Temperature, Transillumination

Consistency

Attachment

Mobility

Pulsation

Fluctuation

Irreducibility

Regional lymph nodes

Edge

Physical examination - correct order

"I Palpate People's Abdomens":

Inspection
Palpation

Percussion

Auscultation

Short stature causes

RETARD HEIGHT:

Rickets

Endocrine (cretinism, hypopituitarism, Cushing's)

Turner syndrome

Achondroplasia

Respiratory(suppurative lung disease)

Down syndrome

Hereditary

Environmental (postirradiation, postinfectious)

IUGR

GI (malabsorption)

Heart (congenital heart disease)

Tilted backbone (scoliosis)

Sign vs. symptom

sIgn: something I can detect even if patient is unconscious. sYMptom is something only
hYM knows about.

Surgical sieve for diagnostic categories

INVESTIGATIONS:

Iatrogenic

Neoplastic

Vascular
Endocrine

Structural/ Mechanical

Traumatic

Inflammatory

Genetic/ Congenital

Autoimmune

Toxic

Infective

Old age/ Degenerative

Nutritional

Spontaneous/ Idiopathic

Breast history checklist

LMNOP:

Lump

Mammary changes

Nipple changes

Other symptoms

Patient risk factors

Delivering Bad News

SPIKES:

Setting up

Perception

Invitation

Knowledge

Emotions
Strategy and Summary

Neurology
Chorea: common causes

St. VITUS'S DANCE:

Sydenhams

Vascular

Increased RBC's (polycythemia)

Toxins: CO, Mg, Hg

Uremia

SLE

Senile chorea

Drugs

APLA syndrome

Neurodegenerative conditions: HD, neuroacanthocytosis, DRPLA

Conception related: pregnancy, OCP's

Endocrine: hyperthyroidism, hypo-, hyperglycemia[74]

Congenital myopathy: features

DREAMS:

Dominantly inherited, mostly

Reflexes decreased

Enzymes normal

Apathetic floppy baby

Milestones delayed

Skeletal abnormalities[75]

Dementia: reversible dementia causes


DEMENTIA:

Drugs/Depression

Elderly

'Multi-infarct/Medication

Environmental

Nutritional

Toxins

Ischemia

Alcohol[76]

Stroke risk factors

HEADS:

Hypertension/ Hyperlipidemia

Elderly

Atrial fib

Diabetes mellitus/ Drugs (cocaine)

Smoking/Sex (male)[77]

Horner Syndrome

Horny PAMELA:

Ptosis

Anhydrosis

Miosis

Enophtalmos

Loss of ciliary-spinal reflex

Anisocoria

Pathology
Acute ischemia: signs [especially limbs]

6 P's:

Pain

Pallor

Pulselessness

Paralysis

Paraesthesia

Perishingly cold

Anemia (normocytic): causes

ABCD:

Acute blood loss

Bone marrow failure

Chronic disease

Destruction (hemolysis)

Anemia causes (simplified)

ANEMIA:

Anemia of chronic disease

No folate or B12

Ethanol

Marrow failure & hemaglobinopathies

Iron deficient

Acute & chronic blood loss

Atherosclerosis risk factors

"You're a SAD BET with these risk factors":

Sex: male
Age: middle-aged, elderly

Diabetes mellitus

BP high: hypertension

Elevated cholesterol

Tobacco

Carcinoid syndrome: components

CARCinoid:

Cutaneous flushing

Asthmatic wheezing

Right sided valvular heart lesions

Cramping and diarrhea

Cushing syndrome

CUSHING:

Central obesity/ Cervical fat pads/ Collagen fiber weakness/ Comedones (acne)

Urinary free corisol and glucose increase

Striae/ Suppressed immunity

Hypercortisolism/ Hypertension/ Hyperglycemia/ Hirsutism

Iatrogenic (Increased administration of corticosteroids)

Noniatrogenic (Neoplasms)

Glucose intolerance/Growth retardation

Diabetic ketoacidosis: I vs. II

ketONEbodies are seen in type ONEdiabetes.

Gallstones: risk factors

5 F's:

Fat
Female

Fair (gallstones more common in Caucasians)

Fertile (premenopausal- increased estrogen is thought to increase cholesterol levels in bile


and decrease gallbladder contractions)

Forty or above (age)[78]

Hepatomegaly: 3 common causes, 3 rarer causes

Common are 3 C's:

Cirrhosis

Carcinoma

Cardiac failure

Rarer are 3 C's:

Cholestasis

Cysts

Cellular infiltration

Inflammatory Bowel Disease: which has cobblestones

Crohn's has Cobblestones on endoscopy.

Morphine: effects

MORPHINES:

Miosis

Orthostatic hypotension

Respiratory depression

Pain supression

Histamine release/Hormonal alterations

Increased ICT

Nausea
Euphoria

Sedation

Kwashiorkor: distinguishing from Marasmus

FLAME:

Fatty

Liver

Anemia

Malabsorption

Edema

Pancreatitis: causes

PANCREATITIS:

Posterior

Alcohol

Neoplasm

Cholelithiasis

Rx (lasix, AZT)

ERCP

Abdominal surgery

Trauma

Infection (mumps)

Triglycerides elevated

I'diopathic

Scorpion sting

PKU findings

PKU:
Pale hair, skin

Krazy (neurological abnormalities)

Unpleasant smell

Pupils in overdose: morphine vs. amphetamine

"MorPHINE:Fine. AmPHETamine:Fat":

Morphine overdose: pupils constricted (fine).

Amphetamine overdose: pupils dilated (fat).

Pericarditis findings

PERICarditis:

Pulsus paradoxus

ECG changes

Rub

Increased JVP

Chest pain [worse on inspiration, better when leaning forward]

Gout vs. pseudogout: crystal lab findings

P seduogout crystals are:

P ositive birefringent

P olygon shaped

Gout therefore is the negative needle shaped crystals. Also, gout classically strikes great Toe,
and its hallmark is Tophi.

Signs of Chronic Liver Disease

abcdefghij

Asterixis, Ascites, Ankle oedema, Atrophy of testicles

Bruising
Clubbing/ Colour change of nails (leuconychia)

Dupuytren’s contracture

Encephalopathy / palmar Erythema

Foetor hepaticus

Gynaecomastia

Hepatomegaly

Increase size of parotids

Jaundice[79]

Psychiatry
Conduct disorder vs. Antisocial personality disorder

Conduct disorder is seen in Children. Antisocial personality disorder is seen in Adults.

Depression: symptoms and signs (DSM-IV criteria)

AWESOME:

Affect flat

Weight change (loss or gain)

Energy, loss of

Sad feelings/ Suicide thoughts or plans or attempts/ Sexual inhibition/ Sleep change (loss or
excess)/ Social withdrawal

Others (guilt, loss of pleasure, hopeless)

Memory loss

Emotional blunting

Depression

UNHAPPINESS:

Understandable (such as bereavement, major stresses)

Neurotic (high anxiety personalities, negative parental upbringingHypochondriasis


Agitation (usually organic causes such as dementia)

Pseudodementia

Pain

Importuniing (whingeing, complaining)

Nihilistic

Endogenous

Secondary (i.e. cancer at the head of the pancreas, bronchogenic cancer)

Syndromal

Erikson's developmental stages

"The sad tale of Erikson Motors":

 The stages in order by age group:

Mr. Trust and MsTrust had an auto they were ashamed of. She took the initiative to find
the guilty party. She found the industry was inferior. They were making cars with dents
[identity] and rolling fuses [role confusion]. Mr. N.T. Macy [intimacy] isolated the problem,
General TVT absorbed the cost. In the end, they found the tires were just gritty and the
should have used de- spare!

Mania: cardinal symptoms

DIG FAST:

Distractibility

Indiscretion (DSM-IV's "excessive involvement in pleasurable activities")

Grandiosity

Flight of ideas

Activity increase

Sleep deficit (decreased need for sleep)

Talkativeness (pressured speech)

Mania: diagnostic criteria

Must have 3 of MANIAC:


Mouth (pressure of speech)/ Moodl

Activity increased

Naughty (disinhibition)

Insomnia

Attention (distractability)

Confidence (grandiose ideas)

Parasomnias: time of onset

SLeep terrors and SLeepwalking occur during SLow-wave sleep (stages 3 & 4).NightmaRE
occurs during REM sleep (and is REMembered).

Psychiatric review of symptoms

"Depressed Patients Seem Anxious, So Claim Psychiatrists":

Depression and other mood disorders (major depression, bipolar disorder, dysthymia)

Personality disorders (primarily borderline personality disorder)

Substance abuse disorders

Anxiety disorders (panic disorder with agoraphobia, obsessive-compulsive disorder)

Somatization disorder, eating disorders (these two disorders are combined because both
involve disorders of bodily perception)

Cognitive disorders (dementia, delirium)

Psychotic disorders (schizophrenia, delusional disorder and psychosis accompanying


depression, substance abuse or dementia)

Schizophrenia: negative features

4 A's:

Ambivalence

Affective incongruence

Associative loosening

Autism
Substance dependence: features (DSM IV)

WITHDraw IT:

 3 of 7 within 12-month period:

Withdrawal

Interest or Important activities given up or reduced

Tolerance

Harm to physical and psychosocial known but continue to use

Desire to cut down, control

Intended time, amount exceeded

Time spent too much

Radiology / Oncology
Anterior mediastinal masses

4 T's:

Teratoma

Thymoma

Testicular-type

T-cell / Hodgkin's lymphoma

Dermatomyositis or polymyositis: risk of underlying malignancy

Risk is 30% at age 30. Risk is 40% at age 40, and so on.

Chest radiograph: checklist to examine

"Pamela Found Our Rotation Particularly Exciting; Very Highly Commended Mainly 'Cus
She Arouses":

Patient details

Film details

Objects (e.g. lines, electrodes)


Rotation

Penetration

Expansion

Vessels

Hila

Costophrenic angles

Mediastinum

Cardiothoracic Ratio

Soft tissues and bones

Air (diaphragm, pneumothorax, subcut. emphysema)

Chest X-ray interpretation

Preliminary is ABCDEF:

AP or PA

Body position

Confirm name

Date

Exposure

Films for comparison

Analysis is ABCDEF:

Airways (hilar adenopathy or enlargement)

Breast shadows/ Bones (rib fractures, lytic bone lesions)

Cardiac silhoutte (cardiac enlargement)/ Costophrenic angles (pleural effusions)

Diaphragm (evidence of free air)/ Digestive tract

Edges (apices for fibrosis, pneumothorax, pleural thickening or plaques)/ Extrathoracic


tissues
Fields (evidence of alveolar filling)/ Failure (alveolar air space disease with prominent
vascularity with or without pleural effusions)

Chest X-ray: cavitating lesions differential

"If you see HOLES on chest X-ray, they are WEIRD":

Wegener's syndrome

Embolic (pulmonary, septic)

Infection (anaerobes, pneumocystis, TB)

Rheumatoid (necrobiotic nodules)

Developmental cysts (sequestration)

Histiocytosis

Oncological

Lymphangioleiomyomatosis

Environmental, occupational

Sarcoid

Alternatively: L=Left atrial myxoma

Lung cancer: main sites for distant metastases

BLAB:

Bone

Liver

Adrenals

Brain

Elbow ossification centers, in sequence

CRITOE: Capitellum

Radial head

Internal epicondyle
Trochlea

Olecranon

External epicondyle

Esophageal cancer: risk factors

ABCDEF:

Achalasia

Barret's esophagus

Corrosive esophagitis

Diverticuliis

Esophageal web

Familial

Head CT scan: evaluation checklist

"Blood Can Be Very Bad":

B lood

Cistern

Brain

Ventricles

Bone

Lung cancer: notorious consequences

SPEECH:

Superior vena cava syndrome

Paralysis of diaphragm (Phrenic nerve)

Ectopic hormones

Eaton-Lambert syndrome

Clubbing
Horner syndrome/ Hoarseness

Mole: signs of trouble

ABCDE:

Asymmetry

Border irregular

Colour irregular

Diameter usually > 0.5cm

Elevation irregular

Neck sagittal x-ray: examination checklist

ABCD:

Anterior: look for swelling

Bones: examine each bone for fractures

Cartilage: look for slipped discs

Dark spots: ensure not abnormally big, or could mean excess blood

Osteoarthritis: x-ray signs

LOSS:

Loss of joint space

Osteopyhtes

Subcondral sclerosis

Subchondral cysts

Prognotic factors for cancer: general

PROGNOSIS:

Presentation (time & course)

Response to treatment

Old (bad prog.)


Good intervention (i.e. early)

Non-compliance with treatment

Order of differentiation (>1 cell type)

Stage of disease

Ill health

Spread (diffuse)

Pituitary endocrine functions often affected by pituitary-associated tumor

"Go Look For the Adenoma Please":

Tropic hormones affected by growth tumor are:

GnRH

LSH

FSH

ACTH

Prolactin function

T2 vs. T1 MRI scan

"WW 2" (World War II):

Water is White in a T2 scan.

Conversely, a T1 scan shows fat as being whiter.

Upper lobe shadowing: causes

BREASTS:

Beryllium

Radiation

Extrinsic allergic alveolitis

Ankylosing spondylitis

Sarcoidosis
TB

Siliconiosis

Miscellaneous
The following may or may not fit properly into one of the above categories. They are being
stored in this section either temporarily or permanently. Categorize them if needed.

Asthma treatment

ASTHMA

Adrenergic agonists

Steroids

Theophylline

Hydration

Masked oxygen

Anticholinergics[80]

Croup: symptoms

3 S's:

Stridor

Subglottic swelling

Seal-bark cough

Cholinergic Crisis

SLUDGE and the Killer B's:

Salivation

Lacrimation

Urination

Diaphoresis, Diarrhea

Gastrointestinal cramping
Emesis

Bradycardia

Bronchospasm

Bronchorrhea[81]

DISCO D DIGITALIS I ISONIAZID S SPIRILACTINE C


CIMETIDINE,KETOCONQZILE O OESTROGEN==Gynaecomastia causing drugs===
Some Drugs Create Awesome Knockers

Spironolactone

Digitalis

Cimetidine

Alcohol

Ketoconazole[82]

Pentad of TTP

FAT RN:

Fever

Anemia

Thrombocytopenia

Renal

Neuro changes[83]

Pulmonary Edema: Treatment

LMNOP:

Lasix

Morphine

Nitro

Oxygen

Position/Positive pressure ventilation[84]


Behavioural science / psychology
Depression: major episode characteristics

SPACE DIGS:

Sleep disruption

Psychomotor retardation

Appetite change

Concentration loss

Energy loss

Depressed mood

Interest wanes

Guilt

Suicidal tendencies

Gain: primary vs. secondary vs. tertiary

Primary: Patient's Psyche improved.

Secondary: Symptom Sympathy for patient.

Tertiary: Therapist's gain

Kubler-Ross dying process: stages

"'Death Always Brings Great Acceptance":

Denial

Anger

Bargaining

Grieving

Acceptance

Middle adolescence (14-17 years): characteristics


HERO:

Heterosexual crushes/ Homosexual Experience

Education regarding short term benefits

Risk taking

Omnipotence

Narcolepsy: symptoms, epidemiology

CHAP:

Cataplexy

Hallucinations

Attacks of sleep

Paralysis on waking

 Usual presentation is a young male, hence "chap"

Sleep stages: features

DElta waves during DEepest sleep (stages 3 & 4, slow-wave).

dREaM during REM sleep.

Impotence causes

PLANE:

Psychogenic: performance anxiety

Libido: decreased with androgen deficiency, drugs

Autonomic neuropathy: impede blood flow redirection

Nitric oxide deficiency: impaired synthesis, decreased blood pressure

Erectile reserve: can't maintain an erection

Male erectile dysfunction (MED): biological causes

MED:

Medicines (propranalol, methyldopa, SSRI, etc.)


Ethanol

Diabetes mellitus

Premature ejaculation: treatment

2 S's:

SSRIs

Squeezing technique [glans pressure before climax]

More detail with 2 more S's:

Sensate-focus exercises [relieves anxiety]

Stop and start method [5-6 rehearsals of stopping stimulation before climax]

Biochemistry
B vitamin names

"The Rhythm Nearly Proved Contagious":

In increasing order:

Thiamine (B1)

Riboflavin (B2)

Niacin (B3)

Pyridoxine (B6)

Cobalamin (B12)

Essential amino acids

"PVT. TIM HALL always argues, never tires":

Phe

Val

Thr

Trp

Ile
Met

His

Arg

Lue

Lys

 Always argues: the A is for Arg, not Asp.

 'Never tires': T is not Tyr, but is both Thr and Trp.

Fasting state: branched-chain amino acids used by skeletal muscles

"Muscles LIVe fast":

Leucine

Isoleucine

Valine

Folate deficiency: causes

A FOLIC DROP:

Alcoholism

Folic acid antagonists

Oral contraceptives

Low dietary intake

Infection with Giardia

Celiac sprue

Dilatin

Relative folate deficiency

Old

Pregnant

Glycogen storage: Anderson's (IV) vs. Cori's (III) enzyme defect


ABCD:

Anderson's=Branching enzyme.

Cori's=Debranching enzyme.

 Otherwise, can't really distinguish clinically.

Glycogen storage: names of types I through VI

"Viagra Pills Cause A Major Hardon":

Von Gierke's

Pompe's

Cori's

Anderson's

McArdle's

Her's

Cardiology
Aortic regurgitation: causes

CREAM:

Congenital

Rheumatic damage

Endocarditis

Aortic dissection/ Aortic root dilatation

Marfan’s

Aortic stenosis characteristics

SAD:

Syncope

Angina

Dyspnoea [23]
Aorta vs. vena cava: right vs. left

(When looking at the patient from the anterior side.)

Aorta and right each have 5 letters, so aorta is on the right.

Vena and cava and left each have 4 letters, so vena cava is on the left[24]

Aortic to left Subclavian path

ABC'S

Aortic arch gives rise to:

Brachiocephalic trunk

left Common Carotid

left Subclavian[25]

Apex beat: abnormalities found on palpation, causes of impalpable

HILT:

Heaving

Impalpable

Laterally displaced

Thrusting/ Tapping

If it's impalpable, causes are COPD:

COPD

Obesity

Pleural, Pericardial effusion

Dextrocardia [26]

Atrial Fibrillation causes

Pirates:

Pulmonary: PE, COPD

Iatrogenic
Rheumatic heart: mirtral regurgitation

Atherosclerotic: MI, CAD

Thyroid: hyperthyroid

Endocarditis

Sick sinus syndrome[27]

Atrial fibrillation management

ABCD:

Anti-coagulate

Beta-block to control rate

Cardiovert

Digoxin[28]

Beck's triad (cardiac tamponade)

3 D's:

Distant heart sounds

Distended jugular veins

Darterial pressure [29]

Betablockers: cardioselective betablockers

Betablockers Acting Exclusively At Myocardium:

Betaxolol

Acebutelol

Esmolol

Atenolol

Metoprolol [30]

CHF: causes of exacerbation

Failure
Forgot medication

Arrhythmia/ Anaemia

Ischemia/ Infarction/ Infection

Lifestyle: taken too much salt

Upregulation of CO: pregnancy, hyperthyroidism

Renal failure

Embolism: pulmonary [31]

Complications of Myocardial Infarction

Darth Vader

Death

Arrythmia

Rupture(free ventricular wall/ ventricular septum/ papillary muscles)

Tamponade

Heart failure (acute or chronic)

Valve disease

Aneurysm of Ventricles

Dressler's Syndrome

thromboEmbolism (mural thrombus)

Recurrence/ mitral Regurgitation[32]

Coronary artery bypass graft: indications

Dust:

Depressed ventricular function

Unstable angina

Stenosis of the left main stem

Triple vessel disease [33]


ECG: left vs. right bundle block

WiLLiaM MaRRoW:

W pattern in V1-V2 and M pattern in V3-V6 is Left bundle block.

M pattern in V1-V2 and W in V3-V6 is Right bundle block.[34]

Exercise ramp ECG: contraindications

Ramp:

Recent MI

Aortic stenosis

MI in the last 7 days

Pulmonary hypertension[35]

Heart valve sequence

Try Puling My Aorta:

Tricuspid

Pulmonary

Mitral (bicuspid)

Aorta [36]

Infarctions

IV access

Narcotic analgesics (e.g. morphine, pethidine)

Facilities for defibrillation (DF)

Aspirin/ Anticoagulant (heparin)

Rest

Converting enzyme inhibitor

Thrombolysis

IV beta blocker
Oxygen 60%

Nitrates

Stool Softeners[37]

JVP: wave form

ASK ME

Atrial contraction

Systole (ventricular contraction)

Klosure (closure) of tricusps, so atrial filling

Maximal atrial filling

Emptying of atrium[38]

MI: basic management

BOOMAR:

Bed rest

Oxygen

Opiate

Monitor

Anticoagulate

Reduce clot size[39]

MI: signs and symptoms

PULSE:

Persistent chest pains

Upset stomach

Lightheadedness

Shortness of breath

Excessive sweating[40]
MI: therapeutic treatment

O BATMAN!

Oxygen

Beta blocker

ASA

Thrombolytics (e.g. heparin)

Morphine

Ace prn

Nitroglycerin[41]

MI: treatment of acute MI

COAG:

Cyclomorph

Oxygen

Aspirin

Glycerol trinitrate[42]

Murmur attributes

"IL PQRST" (person has ill PQRST heart waves):

Intensity

Location

Pitch

Quality

Radiation

Shape

Timing[43]
Murmurs: innocent murmur features

8 S's:

Soft

Systolic

Short

Sounds (S1 & S2) normal

Symptomless

Special tests normal (X-ray, EKG)

Standing/ Sitting (vary with position)

Sternal depression [44]

Murmurs: louder with inspiration vs expiration

LEft sided murmurs louder with Expiration

RIght sided murmurs louder with Inspiration. [45]

Murmurs: questions to ask

SCRIPT:

Site

Character (e.g. harsh, soft, blowing)

Radiation

Intensity

Pitch

Timing[46]

Murmurs: systolic vs. diastolic

PASS:Pulmonic & Aortic

Stenosis=Systolic.

PAID: Pulmonic & Aortic


[47]
Insufficiency=Diastolic.

Pericarditis: causes

CARDIAC RIND:

Collagen vascular disease

Aortic aneurysm

Radiation

Drugs (such as hydralazine)

Infections

Acute renal failure

Cardiac infarction

Rheumatic fever

Injury

Neoplasms

Dressler's syndrome[48]

Pericarditis: EKG

PericarditiS:

PR depression in precordial leads.

ST elevation.[49]

Peripheral vascular insufficiency: inspection criteria

SICVD:

Symmetry of leg musculature

Integrity of skin

Color of toenails

Varicose veins

Distribution of hair[50]
Pulseless electrical activity: causes

PATCH MED:

Pulmonary embolus

Acidosis

Tension pneumothorax

Cardiac tamponade

Hypokalemia/ Hyperkalemia/ Hypoxia/ Hypothermia/ Hypovolemia

Myocardial infarction

Electrolyte derangements

Drugs[51]

ST elevation causes in ECG

ELEVATION:

Electrolytes

LBBB

Early repolarization

Ventricular hypertrophy

Aneurysm

Treatment (e.g. pericardiocentesis)

Injury (AMI, contusion)

Osborne waves (hypothermia)

Non-occlusive vasospasm[52]

Supraventricular tachycardia: treatment

ABCDE:

Adenosine

Beta-blocker
Calcium channel antagonist

Digoxin

Excitation (vagal stimulation)[53]

Ventricular tachycardia: treatment

LAMB:

Lidocaine

Amiodarone

Mexiltene/ Magnesium

Beta-blocker[54]

White Blood Cell Count

Never let monkeys eat bananas:

Neutrophils

lymphocytes

monocytes

eosinophils

basophils[55]

Emergency medicine
Acute LVF management

LMNOP:

Lasix (furosemide)

Morphine (diamorphine)

Nitrates

Oxygen (sit patient up)

Pulmonary ventilation (if doing badly)[56]


Atrial fibrillation: causes of new onset

THE ATRIAL FIBS:

Thyroid

Hypothermia

Embolism (P.E.)

Alcohol

Trauma (cardiac contusion)

Recent surgery (post CABG)

Ischemia

Atrial enlargement

Lone or idiopathic

Fever, anemia, high-output states

Infarct

Bad valves (mitral stenosis)

Stimulants (cocaine, theo, amphet, caffeine)[57]

Ipecac: contraindications

4 C's:

Comatose

Convulsing

Corrosive

hydroCarbon[58]

JVP: raised JVP differential

PQRST(EKG waves):

Pericardial effusion
Quantity of fluid raised (fluid over load)

Right heart failure

Superior vena caval obstruction

Tricuspid stenosis/Tricuspid regurgitation/Tamponade (cardiac)[59]

MI: immediate treatment

DOGASH:

Diamorphine

Oxygen

GTN spray

Asprin 300mg

Streptokinase

Heparin[60]

PEA/Asystole (ACLS): etiology

ITCHPAD

Infarction

Tension pneumothorax

Cardiac tamponade

Hypovolemia/Hypothermia/Hypo-,Hyperkalemia/Hypomagnesmia/Hypoxemia

Pulmonary embolism

Acidosis

Drug overdose[61]

Rapid sequence intubation (RSI)

SOAP ME

Suction

Oxygen
Airway Equipment

Positioning

Monitoring & Meds

EtCO2 & other Equipment[62]

Shock: signs and symptoms

TV SPARC CUBE:

Thirst

Vomiting

Sweating

Pulse weak

Anxious

Respirations shallow/rapid

Cool

Cyanotic

Unconscious

BP low

Eyes blank[63]

Shock: types

RN CHAMPS (Alternatively: "MR. C.H. SNAP", or "NH CRAMPS"):

Respiratory

Neurogenic

Cardiogenic

Hemorrhagic

Anaphylactic
Metabolic

Psychogenic

Septic[64]

Subarachnoid hemorrhage (SAH) causes

BATS:

Berry aneurysm

Arteriovenous malformation/Adult polycystic kidney disease

Trauma

Stroke[65]

Syncope causes, by system

HEAD HEART VESSELS:

CNS causes include HEAD:

Hypoxia/Hypoglycemia

Epilepsy

Anxiety

Dysfunctional brain stem (basivertebral TIA)

Cardiac causes are HEART:

Heart attack

Embolism (PE)

Aortic obstruction (IHSS, AS or myxoma)

Rhythm disturbance, ventricular

T'achycardia

Vascular causes are VESSELS:

Vasovagal

Ectopic (reminds one of hypovolemia)


Situational

Subclavian steal

ENT (glossopharyngeal neuralgia)

Low systemic vascular resistance (Addison's, diabetic vascular neuropathy)

Sensitive carotid sinus[66]

Ventricular fibrillation: treatment

Shock, Shock, Shock, Everybody Shock, Little Shock, Big Shock, Momma Shock, Poppa
Shock:

Shock= Defibrillate

Everybody= Epinephine

Little= Lidocaine

Big= Bretylium

Momma= MgSO4

Poppa= Pocainamide[67]

Interviewing / Physical exam


Abdominal Assessment

To assess abdomen, palpate all 4 quadrants for DR. GERM:

Distension: liver problems, bowel obstruction

Rigidity (board like): bleeding

Guarding: muscular tension when touched

Eviseration/ Ecchymosis

Rebound tenderness: infection

Masses

Altered Level of Consciousness: Reasons

AEIOU TIPS
Alcohol

Epilepsy, Electrolytes, and Encephalopathy

Insulin

Overdose, Oxygen

Underdose, Uremia

Trauma, Temperature

Infection

Psychogenic, Poisons

Stroke, Shock[68]

Cause of symptoms

OPQRST (Works well for cardiac, and respiratory patients.)[69]

Onset of the event

Provocation or palliation

Quality of the pain

Region and radiation

Severity

Time

Fetal Monitoring

VEAL CHOP

Variable Early Deceleration Acceleration Late Deceleration

Cord compression Head compression O2 Placental Insufficiency[70]

Neurovascular Assessment

5 P's:

Pain

Pallor
Paresthesia

Pulse

Paralysis[71]

Trauma assessment

DCAP-BTLS

Deformities & Discolorations

Contusions

Abrasions & Avulsion

Penetrations & Punctures

Burns

Tenderness

Lacerations

Swelling & Symmetry

Toxicological seizures: Causes

OTIS CAMPBELL

Organophosphates

Tricyclic antidepressants

Isoniazid, Insulin

Sympathomimetics

Camphor, Cocaine

Amphetamines

Methylxanthines

PCP, Propoxyphene, Phenol, Propranolol

Benzodiazepine withdrawal, Botanicals

Ethanol withdrawal
Lithium, Lidocaine

Lindane, Lead[72]

Vomiting: non-GIT differential

ABCDEFGHI:

Acute renal failure

Brain [increased ICP]

Cardiac [inferior MI]

DKA

Ears [labyrinthitis]

Foreign substances [paracetamol, theo, etc.]

Glaucoma

Hyperemesis gravidarum

Infection [pyelonephritis, meningitis]

Heart valve auscultation sites

"All Patients Take Meds":

Reading from top left:

Aortic

Pulmonary

Tricuspid

Mitral

Glasgow coma scale: components and numbers

Scale types is 3 V's:

Visual response

Verbal response

Vibratory (motor) response Scale scores are 4,5,6:


Scale of 4: see so much more

Scale of 5: talking jive

Scale of 6: feels the pricks (if testing motor by pain withdrawal)

Mental state examination: stages in order

"Assessed Mental State To Be Positively Clinically Unremarkable":

Appearance and behaviour [observe state, clothing...]

Mood [recent spirit]

Speech [rate, form, content]

Thinking [thoughts, perceptions]

Behavioural abnormalities

Perception abnormalities

Cognition [time, place, age...]

Understanding of condition [ideas, expectations, concerns]

History

SAMPLE history

Signs and Symptoms

Allergies

Medications

Past medical history, injuries, illnesses

Last meal/intake

Events leading up to the injury and/or illness

Orthopaedic Assessment

CLORIDE FPP

Character: sharp or dull pain

Location: region (joint) of origin


Onset: sudden vs. gradual

Radiation:

Intensity: how severe (scale 1-10), impact on ADLs (activities of daily living), is it getting
better, worse or staying the same?

Duration: acute vs. chronic

Events associated: falls, morning stiffness, swelling, redness, joint clicking or locking,
muscle cramps, muscle wasting, movement limitation, weakness, numbness or tingling, fever,
chills, trauma (mechanism of injury), occupation activities, sports, repetitive movements

Frequency: intermittent vs. constant, have you ever had this pain before?

Palliative factors: is there anything that makes it better? (rest, activity, meds, heat, cold)

Provocative factors: is there anything that makes it worse? (rest, activity, etc.)[73]

Pain history checklist

SOCRATES:

Site

Onset

Character

Radiation

Alleviating factors/ Associated symptoms

Timing (duration, frequency)

Exacerbating factors

Severity

Alternatively, Signs and Symptoms with the 'S'

Abdominal swelling causes

9 F's:

Fat

Feces
Fluid

Flatus

Fetus

Full-sized tumors

Full bladder

Fibroids

False pregnancy

Head Trauma: rapid neuro exam

12 P's

Psychological (mental) status

Pupils: size, symmetry, reaction

Paired ocular movements

Papilloedema

Pressure (BP, increased ICP)

Pulse and rate

Paralysis, Paresis

Pyramidal signs

Pin prick sensory response

Pee (incontinent)

Patellar reflex

Ptosis

Ocular bobbing vs. dipping

"Breakfast is fast, Dinner is slow, both go down":

Bobbing is fast

Dipping is slow
In both, the initial movement is down.

Pupillary dilation (persistent): causes

3AM:

3rd nerve palsy

Anti-muscarinic eye drops (eg to facilitate fundoscopy)

Myotonic pupil

Clinical examination: initial Inspection of patient from end of bed

ABC:

Appearance (SOB, pain, etc.)

Behaviour

Connections (drips, inhalers, etc. connected to patient)

Differential diagnosis checklist

"A VITAMIN C"

A and C stand for Acquired and Congenital

VITAMIN stands for:

Vascular

Inflammatory (Infectious and non-Infectious)

Trauma/ Toxins

Autoimmune

Metabolic

Idiopathic

Neoplastic

 Example usage: List causes of decreased vision: Central retinal artery occlusion,
Retinitis pigmentosa, Perforation to gobe, Chronic Gentamycin use, Ruematoid
arthritis, Diabetes, Idiopathic, Any eye tumor, Myopia.

Family history (FH)


BALD CHASM:

Blood pressure (high)

Arthritis

Lung disease

Diabetes

Cancer

Heart disease

Alcoholism

Stroke

Mental health disorders (depression, etc.)

Four point physical assessment of a disease

"I'm A People Person"

Inspection

Auscultation

Percussion

Palpation

Medical history: disease checklist

MJ THREADS:

Myocardial infarction

Jaundice

Tuberculosis

Hypertension

Rheumatic fever/ Rheumatoid arthritis

Epilepsy

Asthma
Diabetes

Strokes

Past medical history (PMH)

VAMP THIS:

Vices (tobacco, alcohol, other drugs, sexual risks)

Allergies

Medications

Preexisting medical conditions

Trauma

Hospitalizations

Immunizations

Surgeries

Patient examination organization

SOAP:

Subjective: what the patient says.

Objective: what the examiner observes.

Assessment: what the examiner thinks is going on.

Plan: what they intend to do about it

Patient profile (PP)

LADDERS:

Living situation/ Lifestyle

Anxiety

Depression

Daily activities (describe a typical day)

Environmental risks/ Exposure


Relationships

Support system/ Stress

Physical exam for 'lumps and bumps'

"6 Students and 3 Teachers go for CAMPFIRE":

Site, Size, Shape, Surface, Skin, Scar

Tenderness, Temperature, Transillumination

Consistency

Attachment

Mobility

Pulsation

Fluctuation

Irreducibility

Regional lymph nodes

Edge

Physical examination - correct order

"I Palpate People's Abdomens":

Inspection

Palpation

Percussion

Auscultation

Short stature causes

RETARD HEIGHT:

Rickets

Endocrine (cretinism, hypopituitarism, Cushing's)

Turner syndrome
Achondroplasia

Respiratory(suppurative lung disease)

Down syndrome

Hereditary

Environmental (postirradiation, postinfectious)

IUGR

GI (malabsorption)

Heart (congenital heart disease)

Tilted backbone (scoliosis)

Sign vs. symptom

sIgn: something I can detect even if patient is unconscious. sYMptom is something only
hYM knows about.

Surgical sieve for diagnostic categories

INVESTIGATIONS:

Iatrogenic

Neoplastic

Vascular

Endocrine

Structural/ Mechanical

Traumatic

Inflammatory

Genetic/ Congenital

Autoimmune

Toxic

Infective
Old age/ Degenerative

Nutritional

Spontaneous/ Idiopathic

Breast history checklist

LMNOP:

Lump

Mammary changes

Nipple changes

Other symptoms

Patient risk factors

Delivering Bad News

SPIKES:

Setting up

Perception

Invitation

Knowledge

Emotions

Strategy and Summary

Neurology
Chorea: common causes

St. VITUS'S DANCE:

Sydenhams

Vascular

Increased RBC's (polycythemia)

Toxins: CO, Mg, Hg


Uremia

SLE

Senile chorea

Drugs

APLA syndrome

Neurodegenerative conditions: HD, neuroacanthocytosis, DRPLA

Conception related: pregnancy, OCP's

Endocrine: hyperthyroidism, hypo-, hyperglycemia[74]

Congenital myopathy: features

DREAMS:

Dominantly inherited, mostly

Reflexes decreased

Enzymes normal

Apathetic floppy baby

Milestones delayed

Skeletal abnormalities[75]

Dementia: reversible dementia causes

DEMENTIA:

Drugs/Depression

Elderly

'Multi-infarct/Medication

Environmental

Nutritional

Toxins

Ischemia
Alcohol[76]

Stroke risk factors

HEADS:

Hypertension/ Hyperlipidemia

Elderly

Atrial fib

Diabetes mellitus/ Drugs (cocaine)

Smoking/Sex (male)[77]

Horner Syndrome

Horny PAMELA:

Ptosis

Anhydrosis

Miosis

Enophtalmos

Loss of ciliary-spinal reflex

Anisocoria

Pathology
Acute ischemia: signs [especially limbs]

6 P's:

Pain

Pallor

Pulselessness

Paralysis

Paraesthesia

Perishingly cold
Anemia (normocytic): causes

ABCD:

Acute blood loss

Bone marrow failure

Chronic disease

Destruction (hemolysis)

Anemia causes (simplified)

ANEMIA:

Anemia of chronic disease

No folate or B12

Ethanol

Marrow failure & hemaglobinopathies

Iron deficient

Acute & chronic blood loss

Atherosclerosis risk factors

"You're a SAD BET with these risk factors":

Sex: male

Age: middle-aged, elderly

Diabetes mellitus

BP high: hypertension

Elevated cholesterol

Tobacco

Carcinoid syndrome: components

CARCinoid:

Cutaneous flushing
Asthmatic wheezing

Right sided valvular heart lesions

Cramping and diarrhea

Cushing syndrome

CUSHING:

Central obesity/ Cervical fat pads/ Collagen fiber weakness/ Comedones (acne)

Urinary free corisol and glucose increase

Striae/ Suppressed immunity

Hypercortisolism/ Hypertension/ Hyperglycemia/ Hirsutism

Iatrogenic (Increased administration of corticosteroids)

Noniatrogenic (Neoplasms)

Glucose intolerance/Growth retardation

Diabetic ketoacidosis: I vs. II

ketONEbodies are seen in type ONEdiabetes.

Gallstones: risk factors

5 F's:

Fat

Female

Fair (gallstones more common in Caucasians)

Fertile (premenopausal- increased estrogen is thought to increase cholesterol levels in bile


and decrease gallbladder contractions)

Forty or above (age)[78]

Hepatomegaly: 3 common causes, 3 rarer causes

Common are 3 C's:

Cirrhosis
Carcinoma

Cardiac failure

Rarer are 3 C's:

Cholestasis

Cysts

Cellular infiltration

Inflammatory Bowel Disease: which has cobblestones

Crohn's has Cobblestones on endoscopy.

Morphine: effects

MORPHINES:

Miosis

Orthostatic hypotension

Respiratory depression

Pain supression

Histamine release/Hormonal alterations

Increased ICT

Nausea

Euphoria

Sedation

Kwashiorkor: distinguishing from Marasmus

FLAME:

Fatty

Liver

Anemia

Malabsorption
Edema

Pancreatitis: causes

PANCREATITIS:

Posterior

Alcohol

Neoplasm

Cholelithiasis

Rx (lasix, AZT)

ERCP

Abdominal surgery

Trauma

Infection (mumps)

Triglycerides elevated

I'diopathic

Scorpion sting

PKU findings

PKU:

Pale hair, skin

Krazy (neurological abnormalities)

Unpleasant smell

Pupils in overdose: morphine vs. amphetamine

"MorPHINE:Fine. AmPHETamine:Fat":

Morphine overdose: pupils constricted (fine).

Amphetamine overdose: pupils dilated (fat).


Pericarditis findings

PERICarditis:

Pulsus paradoxus

ECG changes

Rub

Increased JVP

Chest pain [worse on inspiration, better when leaning forward]

Gout vs. pseudogout: crystal lab findings

P seduogout crystals are:

P ositive birefringent

P olygon shaped

Gout therefore is the negative needle shaped crystals. Also, gout classically strikes great Toe,
and its hallmark is Tophi.

Signs of Chronic Liver Disease

abcdefghij

Asterixis, Ascites, Ankle oedema, Atrophy of testicles

Bruising

Clubbing/ Colour change of nails (leuconychia)

Dupuytren’s contracture

Encephalopathy / palmar Erythema

Foetor hepaticus

Gynaecomastia

Hepatomegaly

Increase size of parotids

Jaundice[79]
Psychiatry
Conduct disorder vs. Antisocial personality disorder

Conduct disorder is seen in Children. Antisocial personality disorder is seen in Adults.

Depression: symptoms and signs (DSM-IV criteria)

AWESOME:

Affect flat

Weight change (loss or gain)

Energy, loss of

Sad feelings/ Suicide thoughts or plans or attempts/ Sexual inhibition/ Sleep change (loss or
excess)/ Social withdrawal

Others (guilt, loss of pleasure, hopeless)

Memory loss

Emotional blunting

Depression

UNHAPPINESS:

Understandable (such as bereavement, major stresses)

Neurotic (high anxiety personalities, negative parental upbringingHypochondriasis

Agitation (usually organic causes such as dementia)

Pseudodementia

Pain

Importuniing (whingeing, complaining)

Nihilistic

Endogenous

Secondary (i.e. cancer at the head of the pancreas, bronchogenic cancer)

Syndromal
Erikson's developmental stages

"The sad tale of Erikson Motors":

 The stages in order by age group:

Mr. Trust and MsTrust had an auto they were ashamed of. She took the initiative to find
the guilty party. She found the industry was inferior. They were making cars with dents
[identity] and rolling fuses [role confusion]. Mr. N.T. Macy [intimacy] isolated the problem,
General TVT absorbed the cost. In the end, they found the tires were just gritty and the
should have used de- spare!

Mania: cardinal symptoms

DIG FAST:

Distractibility

Indiscretion (DSM-IV's "excessive involvement in pleasurable activities")

Grandiosity

Flight of ideas

Activity increase

Sleep deficit (decreased need for sleep)

Talkativeness (pressured speech)

Mania: diagnostic criteria

Must have 3 of MANIAC:

Mouth (pressure of speech)/ Moodl

Activity increased

Naughty (disinhibition)

Insomnia

Attention (distractability)

Confidence (grandiose ideas)

Parasomnias: time of onset


SLeep terrors and SLeepwalking occur during SLow-wave sleep (stages 3 & 4).NightmaRE
occurs during REM sleep (and is REMembered).

Psychiatric review of symptoms

"Depressed Patients Seem Anxious, So Claim Psychiatrists":

Depression and other mood disorders (major depression, bipolar disorder, dysthymia)

Personality disorders (primarily borderline personality disorder)

Substance abuse disorders

Anxiety disorders (panic disorder with agoraphobia, obsessive-compulsive disorder)

Somatization disorder, eating disorders (these two disorders are combined because both
involve disorders of bodily perception)

Cognitive disorders (dementia, delirium)

Psychotic disorders (schizophrenia, delusional disorder and psychosis accompanying


depression, substance abuse or dementia)

Schizophrenia: negative features

4 A's:

Ambivalence

Affective incongruence

Associative loosening

Autism

Substance dependence: features (DSM IV)

WITHDraw IT:

 3 of 7 within 12-month period:

Withdrawal

Interest or Important activities given up or reduced

Tolerance

Harm to physical and psychosocial known but continue to use


Desire to cut down, control

Intended time, amount exceeded

Time spent too much

Radiology / Oncology
Anterior mediastinal masses

4 T's:

Teratoma

Thymoma

Testicular-type

T-cell / Hodgkin's lymphoma

Dermatomyositis or polymyositis: risk of underlying malignancy

Risk is 30% at age 30. Risk is 40% at age 40, and so on.

Chest radiograph: checklist to examine

"Pamela Found Our Rotation Particularly Exciting; Very Highly Commended Mainly 'Cus
She Arouses":

Patient details

Film details

Objects (e.g. lines, electrodes)

Rotation

Penetration

Expansion

Vessels

Hila

Costophrenic angles

Mediastinum
Cardiothoracic Ratio

Soft tissues and bones

Air (diaphragm, pneumothorax, subcut. emphysema)

Chest X-ray interpretation

Preliminary is ABCDEF:

AP or PA

Body position

Confirm name

Date

Exposure

Films for comparison

Analysis is ABCDEF:

Airways (hilar adenopathy or enlargement)

Breast shadows/ Bones (rib fractures, lytic bone lesions)

Cardiac silhoutte (cardiac enlargement)/ Costophrenic angles (pleural effusions)

Diaphragm (evidence of free air)/ Digestive tract

Edges (apices for fibrosis, pneumothorax, pleural thickening or plaques)/ Extrathoracic


tissues

Fields (evidence of alveolar filling)/ Failure (alveolar air space disease with prominent
vascularity with or without pleural effusions)

Chest X-ray: cavitating lesions differential

"If you see HOLES on chest X-ray, they are WEIRD":

Wegener's syndrome

Embolic (pulmonary, septic)

Infection (anaerobes, pneumocystis, TB)

Rheumatoid (necrobiotic nodules)


Developmental cysts (sequestration)

Histiocytosis

Oncological

Lymphangioleiomyomatosis

Environmental, occupational

Sarcoid

Alternatively: L=Left atrial myxoma

Lung cancer: main sites for distant metastases

BLAB:

Bone

Liver

Adrenals

Brain

Elbow ossification centers, in sequence

CRITOE: Capitellum

Radial head

Internal epicondyle

Trochlea

Olecranon

External epicondyle

Esophageal cancer: risk factors

ABCDEF:

Achalasia

Barret's esophagus

Corrosive esophagitis
Diverticuliis

Esophageal web

Familial

Head CT scan: evaluation checklist

"Blood Can Be Very Bad":

B lood

Cistern

Brain

Ventricles

Bone

Lung cancer: notorious consequences

SPEECH:

Superior vena cava syndrome

Paralysis of diaphragm (Phrenic nerve)

Ectopic hormones

Eaton-Lambert syndrome

Clubbing

Horner syndrome/ Hoarseness

Mole: signs of trouble

ABCDE:

Asymmetry

Border irregular

Colour irregular

Diameter usually > 0.5cm

Elevation irregular
Neck sagittal x-ray: examination checklist

ABCD:

Anterior: look for swelling

Bones: examine each bone for fractures

Cartilage: look for slipped discs

Dark spots: ensure not abnormally big, or could mean excess blood

Osteoarthritis: x-ray signs

LOSS:

Loss of joint space

Osteopyhtes

Subcondral sclerosis

Subchondral cysts

Prognotic factors for cancer: general

PROGNOSIS:

Presentation (time & course)

Response to treatment

Old (bad prog.)

Good intervention (i.e. early)

Non-compliance with treatment

Order of differentiation (>1 cell type)

Stage of disease

Ill health

Spread (diffuse)

Pituitary endocrine functions often affected by pituitary-associated tumor

"Go Look For the Adenoma Please":


Tropic hormones affected by growth tumor are:

GnRH

LSH

FSH

ACTH

Prolactin function

T2 vs. T1 MRI scan

"WW 2" (World War II):

Water is White in a T2 scan.

Conversely, a T1 scan shows fat as being whiter.

Upper lobe shadowing: causes

BREASTS:

Beryllium

Radiation

Extrinsic allergic alveolitis

Ankylosing spondylitis

Sarcoidosis

TB

Siliconiosis

Miscellaneous
The following may or may not fit properly into one of the above categories. They are being
stored in this section either temporarily or permanently. Categorize them if needed.

Asthma treatment

ASTHMA

Adrenergic agonists
Steroids

Theophylline

Hydration

Masked oxygen

Anticholinergics[80]

Croup: symptoms

3 S's:

Stridor

Subglottic swelling

Seal-bark cough

Cholinergic Crisis

SLUDGE and the Killer B's:

Salivation

Lacrimation

Urination

Diaphoresis, Diarrhea

Gastrointestinal cramping

Emesis

Bradycardia

Bronchospasm

Bronchorrhea[81]

DISCO D DIGITALIS I ISONIAZID S SPIRILACTINE C


CIMETIDINE,KETOCONQZILE O OESTROGEN==Gynaecomastia causing drugs===
Some Drugs Create Awesome Knockers

Spironolactone

Digitalis
Cimetidine

Alcohol

Ketoconazole[82]

Pentad of TTP

FAT RN:

Fever

Anemia

Thrombocytopenia

Renal

Neuro changes[83]

Pulmonary Edema: Treatment

LMNOP:

Lasix

Morphine

Nitro

Oxygen

Position/Positive pressure ventilation[84]