MLP Luneta

Signs and Symptoms

Type I
 C: Constant urination(polyuria) and glycosuria
 A: Abnormal thirst
 U: Unusual hunger( polydipsia)
 T: The rapid loss of wt
 I: Irritability
 O: Obvious weakness and fatigue
 N: Nausea and vomiting
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 Signs and Symptoms
Type II
 D: Drowsiness
 I: Itching
 A: A family Hx of D.M
 B: Blurred Vision
 E: Excessive wt

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 Signs and Symptoms
Type II
 T: Tingling, numbness', pain in the
extremities
 E: Easily fatigued
 S: Skin infections and slow healing of cuts
and scratches especially in the feet
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Clinical examination: initial Inspection of
patient from end of bed
ABC
• A: Appearance (SOB, pain, etc)
• B: Behavior
• C: Connections (drips, inhalers, etc connected
to patient)
 Pain history checklist
CLITORIS
• C: Character
• L: Location
• I: Intensity
• T: Timing
• O: Onset
 Pain history checklist cont’d
• R: Radiating
• I: Irritating and relieving factors
• S: Symptoms associated
 ESR CALCULATION

MEN FEMALES
Age in years/2 Age in years + 10/2
 Creatinine Clearance

MEN FEMALES
98 – 156ml/min 95 – 160ml/min
 CREATININE CLEARANCE
• For men
 1.23(140 – Age)Wt(kg)
serum creatinine(umol/l)
 For females:
 1.04(140 – Age)Wt(kg)
serum creatinine (umol/l)
 To convert creatinine values from umol/l to mg/dl multiply by 0.0113
 To convert urea values in mmol/l to mg multiply by 2.8
 Creatinine Clearance Formula
MEN FEMALES

140 – Age X Serum Creatinine(mg/dl) (140 – Age X 0.815) serum Creatinine(mg/dl)

72 72
OR OR

140 – Age X serum Creatinine(umol/l) (140 – Age X 0.815) serum Creatinine(umol/l)

0.815 0.815
CARDIOLOGY
 Anti - arrhythmic: for AV nodes
"Do Block AV"
 D: Digoxin
 B: B-blockers
 A: Adenosine
 V:Verapamil
 CLASSIFIATION OF
ANTIARRYTHMIC DRUGS
Class Examples

I a, b, c: membrane stabilizing drugs Quinidine, lidocaine, Flecainide

II: Beta blockers Propranolol , Atenolol, Bisoprolol Carvedilol

III: Amiodarone, Bretylium and sotalol

IV: Calcium Channel Blockers Nifedipine, Verapamil, Nicardipine, Diltiazem, Feladipine

 Aortic regurgitation: causes
CREAM
 C: Congenital
 R: Rheumatic damage
 E: Endocarditis
 A: Aortic dissection/ Aortic root dilatation
 M: Marfan’s Syndrome
 Aortic stenosis characteristics
SAD
 S: Syncope
 A: Angina
 D: Dyspnoea
 Apex beat: differential for
impalpable apex beat
DOPES
 D: Dextrocardia
 O: Obesity
 P: Pericarditis/ Pericardial tamponade/ Pneumothorax
 E: Emphysema
 S: Sinus inversus/ Student incompetence/ Scoliosis/
Skeletal abnormalities (e.g. pectus excavatum)
 Atrial fibrillation: causes
PIRATES
Defn: Very rapid uncoordinated contractions of the atrium resulting in a
lack of synchronism btn heartbeat and pulse

 P: Pulmonary: PE, COPD

 I: Iatrogenic
 R: Rheumatic heart: mitral regurgitation
 A: Atherosclerotic: MI, CAD
 Atrial fibrillation: causes
 T: Thyroid: hyperthyroid
 E: Endocarditis
 S: Sick sinus syndrome

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 Atrial fibrillation: causes
A SHIT
• A: Alcohol
• S: Stenosis (mitral valve)
• H:Hypertension
• I: Infarction/ Ischaemia
• T: Thyrotoxicosis
 Atrial fibrillation: management
ABCD
• A: Anti-coagulate (Heparin)
• B: Beta-block to control rate(Atenolol, propranolol)
• C: Cardiovert: application of electrical shock in order to
restore normal heartbeat.
• D: Digoxin
 Beck's triad (cardiac tamponade)
3 D's
• D: Distant heart sounds
• D: Distended jugular veins
• D: Decreased arterial pressure(pulsus paradoxus)
 Murmurs: systolic
MR P-V TR-APS:
• M: Mitral Regurgitation and Prolapse

• V: VSD
• T: Tricuspid Regurgitation

• A: Aortic and Pulmonary Stenosis

 Murmurs: systolic vs. diastolic
• PASS: Pulmonic & Aortic Stenosis=Systolic.
• PAID: Pulmonic & Aortic
Insufficiency=Diastolic
 CHF: causes of exacerbation
A SMITH PEAR
• A: Anemia
• S: Salt/ Stress/ Stopping meds
• M: MI
• I: Infection/ Ischemia
• T: Thyroid (high/low)
• H: HTN
CHF: causes of exacerbation cont’d
• P: Pericarditis
• E: Endocarditis (valve disease)
• A: Arrhythmia
• R: Rx (beta blocker, etc)
 Depressed ST-segment: causes
DEPRESSED ST
• D: Drooping valve (MVP)
• E: Enlargement of LV with strain
• P: Potassium loss (hypokalemia)
• R: Reciprocal ST- depression (in I/W AMI)
• E: Embolism in lungs (pulmonary embolism)
• S: Subendocardial ischemia
• S: Subendocardial infarct
 Depressed ST-segment: causes
• E: Encephalon haemorrhage (intracranial haemorrhage)
• D: Dilated Cardiomyopathy
• S: Shock
• T: Toxicity of digitalis, Quinidine
 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.
 Heart failure: signs
TAPED TORCH
• T: Tachycardia
• A: Ascites
• P: Pulsus alternans
• E: Elevated jugular venous pressure
• D: Displaced apex beat
• T: Third heart sound
 Heart failure: signs
• O: Oedema
• R: Right ventricular heave
• C: Crepitations or wheeze
• H: Hepatomegaly (tender)
 Heart murmurs
hARD ASS MRS. MSD
• hARD: Aortic Regurg = Diastolic
• ASS: Aortic Stenosis = Systolic
• MRS: Mitral Regurg = Systolic
• MSD: Mitral Stenosis = Diastolic
 Jugular venous pressure (JVP)
elevation: causes
HOLT: Grab Harold Holt around the neck and
throw him in the ocean:
• Heart failure
• Obstruction of vena cava
• Lymphatic enlargement - supraclavicular
• Intra-Thoracic pressure increase
 MI: signs and symptoms
PULSE:
• P: Persistent chest pains
• U: Upset stomach
• L: Lightheadedness
• S: Shortness of breath
• E: Excessive sweating
 MI: therapeutic treatment
"O BATMAN!"
• O: Oxygen
• B: Beta blocker
• A: ASA
• T: Thrombolytic (e.g. heparin)
• M: Morphine
• A: Ace prn
• N: Nitroglycerin
 Myocardial infarctions: treatment
INFARCTIONS
• I: IV access
• N: Narcotic analgesics (e.g. morphine, pethidine)
• F: Facilities for defibrillation (DF)
• A: Aspirin/ Anticoagulant (heparin)
• R: Rest
 Myocardial infarctions: treatment
• C: Converting enzyme inhibitor
• T: Thrombolysis streptokinase 1.5 m U in 100mls normal
saline. S/E Hypotension
• I: IV beta blocker (atenolol 5-10mg over 5min)
• O: Oxygen 60%
• N: Nitrates GTN sublingual 300-500mic or iv 0.6 – 1.2mg/hr
• S: Stool Softeners
 Pericarditis: causes
CARDIAC RIND
• C: Collagen vascular disease
• A: Aortic aneurysm
• R: Radiation
• D: Drugs (such as hydralazine)
• I: Infections
• A: Acute renal failure
 Chest X-ray interpretation
Analysis is ABCDEF
• A: Airways (hilar adenopathy or enlargement)
• B: Breast shadows/ Bones (rib fractures, lytic bone
lesions)
• C: Cardiac silhoutte (cardiac enlargement)/
Costophrenic angles (pleural effusions)
• D: Diaphragm (evidence of free air)/ Digestive tract
 Chest X-ray interpretation
• E: Edges (apices for fibrosis, pneumothorax,
pleural thickening or plaques)/ Extrathoracic
tissues
• F: Fields (evidence of alveolar filling)/ Failure
(alveolar air space disease with prominent
vascularity with or without pleural effusions
 Carpal tunnel syndrome causes
MEDIAN TRAP:
 M: Myxoedema
 E: Edema premenstrually
 D: Diabetes
 I: Idiopathic
 A: Agromegaly
 N: Neoplasm
 T: Trauma
 R: Rheumatoid arthritis
 A: Amyloidosis
 P: Pregnancy
Hepatic encephalopathy: precipitating
factors
HEPATICS
• H: Hemorrhage in GIT/ Hyperkalemia
• E: Excess protein in diet
• P: Paracentesis
• A: Acidosis/ Anemia
• T: Trauma
 Hepatic encephalopathy:
precipitating factors cont’d
• I: Infection
• C: Colon surgery
• S: Sedatives Diazepam

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 Coma: conditions to exclude as
cause
MIDAS
• M: Meningitis
• I: Intoxication
• D: Diabetes
• A: Air (respiratory failure)
• S: Subdural/ Subarachnoid hemorrhage
 Nephrotic syndrome: causes for
secondary nephrotic syndrome
DAVID
 D: Diabetes mellitus
 A: Amyloidosis
 V: Vasculitis
 I: Infections
 D: Drugs
 Polycystic kidney: genetic marker
 P" is the 16th letter of the alphabet.
 Autosomal dominant Polycystic kidney
disease is associated with abberation on the
16th chromosome.
 Hydronephrosis: differential
Unilateral is PACT:
 P: Pelvic-uteric obstruction (congenital or
acquired)
 A: Aberrant renal vessels
 C: Calculi
 T: Tumours of renal pelvis
 Hydronephrosis: differential
Bilateral is SUPER
 S: Stenosis of the urethra
 U: Urethral valve
Hydronephrosis: differential

 P: Prostatic enlargement
 E: Extensive bladder tumour
 R: Retro-peritoneal fibrosis
 Hematuria: differential
 "S#!T":
 Stones/ Systemic disease (SLE)/ Structural
lesions (UPJ obstruction)
 Hematologic disease (sickle cell,
coagulopathy)/ Hypercalciuria/ Hereditary
(Alport nephritis)/ HSP/ HUS
 Hematuria: differential
 Infectious and Immunologic (PSGN)/ IgA
nephropathy (Berger nephritis)/ Interstitial
disease (interstitial nephritis)/ Idiopathic
conditions (thin
 glomerular basement membrane disease or
benign familial hematuria)
 Trauma/ Tumor/ TB/ Toxins
 Enlarged kidneys: causes
SHAPE
 S: Scleroderma
 H: HIV nephropathy
 A: Amyloidosis
 P: Polycystic kidney disease
 E: Endocrinophathy (diabetes)
 GI bleeding: causes
ABCDEFGHI
 A: Angiodysplasia
 B: Bowel cancer
 C: Colitis
 D: Diverticulitis/ Duodenal ulcer
 E: Epistaxis/ Esophageal (cancer, esophagitis,
varices)
 GI bleeding: causes
 F: Fistula (anal, aorta enteric)
 G: Gastric (cancer, ulcer, gastritis)
 H: Hemorrhoids
 I: Infectious diarrhoea/ IBD/ Ischemic bowel
 Asthma: treatment
 A: Adrenergics
 S: Steroids
 T: Theophylline
 H: Hydration
 M: Mask [O2 at 24%]
 A: Antibiotics
 Henoch schonlein purpura: signs
and symptoms
NAPA:
 Nephritis
 Arthritis, arthralgias
 Purpura, palpable (especially on buttocks and
lower extremities)
 Abdominal pain (need to rule out intussusception)
 SLE (Systemic Lupus
Erythematosus diagnosis
MD SOAP 'N HAIR
 M: Malar rash
 D: Discoid rash
 S: Serositis
 O: Oral ulcer
 A: Arthritis
 P: Photosensitivity
 SLE (Systemic Lupus
Erythematosus) diagnosis
 Neurologic abnormality
 Hematologic abnormality
Neurologic abnormality
Hematologic abnormality
 ANA (+) ANA (+)
Immunologic abnormality
 Immunologic abnormality
Renal involvement

 Renal involvement
 SLE (Systemic Lupus Erythematosus) diagnosis
(ARA criteria)
DAMP AS RHINO
 Discoid rash
 ANA (+)
 Malar rash
 Photosensitivity
 Arthritis
 Serositis (pleural, pericardial)
SLE (Systemic Lupus Erythematosus) diagnosis ARA criteria

 Renal involvement
 Hematologic abnormality
 Immunologic abnormality
 Neurologic abnormality (seizures, psychosis)
 Oral / nasal ulcer, Observed
 Diabetic neuropathy types
DPM
 D: Distal, symmetric, polyneuropathy
 P: Proximal diabetic neuropathy
 M: Mononeuritis muliplex
 Hyperthyroidism: signs and
symptoms
THYROIDISM
 T: Tremor
 H: Heart rate up
 Y: Yawning [fatigability]
 R: Restlessness
 O: Oligomenorrhea & amenorrhea
 I: Intolerance to heat
 Hyperthyroidism: signs and
symptoms cont’d
 D: Diarrhea
 I: Irritability
 S: Sweating
 M: Muscle wasting & weight loss
 Marfan's syndrome features
MARFAN'S
• M: Mitral valve prolapse
• A: Aortic Aneurysm
• R: Retinal detachment
• F: Fibrillin
• A: Arachnodactyly
• N: Negative Nitroprusside test (differentiates from
homocystinuria)
• S: Subluxated lens
 Splenomegaly: causes
CHIMP
• C: Cysts
• H: Haematological ( eg CML, myelofibrosis)
• I: Infective (eg viral (IM), bacterial)
• M: Metabolic/ Misc (eg amyloid, Gauchers)
• P: Portal hypertension
Diabetic ketoacidosis: precipitating
factors
5 I's
• I: Infection
• I: Ischaemia (cardiac, mesenteric)
• I: Infarction
• I: Ignorance (poor control)
• I: Intoxication (alcohol)
 Cirrhosis: causes of hepatic
cirrhosis
HEPATIC
• H: Hemochromatosis (primary)
• E: Enzyme deficiency (alpha-1-anti-trypsin)
• P: Post hepatic (infection + drug induced)
• A: Alcoholic
• T: Tyrosinosis
• I: Indian childhood (galactosemia)
• C: Cardiac/ Cholestatic (biliary)/ Cancer/ Copper (Wilson's)
 Dyspnea: differential
• 3A's: Three Airways: Airway obstruction, Anaphylaxis,
Asthma
• 3P's: Three Pulmonary's: Pneumothorax, PE, Pulmonary
edema
• 3C's: Three Cardiacs: Cardiogenic pulmonary edema,
Cardiac ischemia, Cardiac tamponade
• 3M's: Three Metabolics: (DOC) DKA, Organophosphates,
Carbon monoxide poisoning
 Coma: conditions to exclude as
cause
MIDAS
• M: Meningitis
• I: Intoxication
• D: Diabetes
• A: Air (respiratory failure)
• S: Subdural/ Subarachnoid hemorrhage
 Unconciousness: differential
FISH SHAPED
• Fainted
• Illness/ Infantile febrile convulsions
• Shock
• Head injuries
• Stroke (CVE)
• Heart problems
• Asphxia
• Poisons
• Epilepsy
• Diabetes
 Seizures: differential
SICK DRIFTER
• S: Substrates (sugar, oxygen)
• I: Isoniazid overdose
• C: Cations (Na, Ca, Mg)
• K: Kids (Eclampsia)
• D: Drugs (CRAP: Cocaine, Rum (alcohol), Amphetamines,
PCP)
• R:Rum (alcohol withdrawl)
• Illnesses (chronic seizure disorder or other
chronic disorder)
• Fever (meningitis, encephalitis, abscess)
• Trauma (epidural, subdural,
intraparynchymal hemorrhage)
• Extra: toxocologic (TAIL: Theo, ASA, Isoniazid,
Lithium) and 3 Anti's: (Antihistamine overdose,
Antidepressant overdose, Anticonvulsants
• (too high dilanitin, tegretol) or benzo withdrawl.
• Rat poison (organophospates poisoning)
 Organophosphates poisoning
symptoms
DUMBBELS
• D: Diarrhea
• U: Urination
• M: Miosis
• B: Bradycardia
• B: Bronchospasm
• E: Emesis
• L: Lacrimation
• S: Salivation
 Neurological focal deficits
10 S's
• Sugar (hypo, hyper)
• Stroke
• Seizure (Todd's paralysis)
• Subdural hematoma
• Subarachnoid hemorrhage
• Space occupying lesion (tumor, avm, aneurysm, abscess)
• Spinal cord syndromes
• Somatoform (conversion reaction)
• Sclerosis (MS)
• Some migraines
 Miosis: causes of pin-point pupils
CPR ON SLIME
• C: Clonidine
• P: Phenothiazines
• R: Resting (deep sleep)
• O: Opiates
• N: Narcotics
• S: Stroke (pontine hemorrhage)
Miosis: causes of pin-point pupils
• L: Lomotil (diphenoxylate)
• I: Insecticides
• M: Mushrooms/ Muscarinic (inocybe,
clitocybe)
• E: Eye drops
 Meningicoccal meningitis:
complications
SAD REP
• S: Sepsis/ Shock/ Subdural effusion
• A: Ataxia/ Abscess (brain)
• D: DIC/ Deafness
• R: Retardation
• E: Epilepsy
 ICU confusion causes
ICU CONFUSION
• ICU psychosis
• Cardiac output low [hypotension, post cardiac
arrest]
• Uncontrolled temperature [hypo/hyperthermia]
• Convulsion [post ictal]
• Oxygen [hypoxia, hypercarbia]
• Nociception [pain]
• Full bladder
• Uremia
• Sugar [hypo/hyperglycemia]
• Infection
• Opiates
• Natremia [hypo/hyper
 Coma: differential
• UNCONSCIOUS:
• Units of insulin
• Narcotics
• Convulsions
• Oxygen
• Nonorganic
• Stroke
• Cocktail
• ICP
• Organism
• Urea
• Shock
 Coma causes checklist
AEIOU TIPS
• A: Acidosis/ Alcohol
• E: Epilepsy
• I: Infection
• O: Overdosed
• U: Uremia
 Coma causes checklist cont’d
• T: Trauma to head
• I: Insulin: too little or or too much
• P: Pyschosis episode
• S: Stroke occurred

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 Malaria: complications of
falciparum malaria
CHAPLINAJ
• C: Cerebral malaria/ Coma
• H: Hypoglycemia
• A: Anaemia
• P: Pulmonary edema
• L: Lactic acidosis
• I: Infections
• N: Necrosis of renal tubules (ATN)
• A: Algid Malaria
• J Jaundice
 JVP: raised JVP: extra-cardiac
causes
FAT PEA
• F: Fever
• A: Anaemia
• T: Thyrotoxicosis
• P: Pregnancy
• E: Exercise
• A: A-V fistula
These are in addition to all the cardiac ones (pericardial effusion, RHF, tricuspid stenosis, SVC obstruction, etc).
 JVP: raised JVP differential
PQRST (EKG waves)
• P: Pericardial effusion
• Q: Quantity of fluid raised (fluid over load)
• R: Right heart failure
• S: Superior vena caval obstruction
• T: Tricuspid stenosis/ Tricuspid regurgitation/
Tamponade (cardiac)
 Clubbing: causes
CLUBBING
• C: Cyanotic heart disease
• L: Lung disease (hypoxia, lung cancer,
Bronchiectasis, cystic fibrosis)
• U: UC/Crohn's disease
• B: Biliary cirrhosis
• B: Birth defect (harmless)
 Clubbing: causes cont’d
• I: Infective endocarditis
• N: Neoplasm (esp. Hodgkin's)
• G: GI malabsorption

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Ventricular tachycardia: treatment
LAMB
• L: Lidocaine
• A: Amiodarone
• M: Mexiltene/ Magnesium
• B: Beta-blocker
 Supraventricular tachycardia:
treatment
ABCDE
• A: Adenosine
• B: Beta-blocker
• C: Calcium channel antagonist
• D: Digoxin
• E: Excitation (vagal stimulation)
 Rheumatic fever: Revised Jones'
criteria
JONES
Major criteria:
• J: Joint (arthritis)
• O: Obvious (Cardiac)
• N: Nodule (Rheumatic)
• E: Erythema marginatum
• S: Sydenham chorea
 crITERIA:
Minor criteria
• I: Inflammatory cells (leukocytosis)
• T: Temperature (fever)
• E: ESR/CRP elevated
• R: Raised PR interval
• I: Itself (previous Hx of Rheumatic fever)
• A: Arthralgia
 Rheumatic fever: Jones criteria
Major criteria: CANCER
• C: Carditis
• A: Arthritis
• N: Nodules
• C: Chorea
• E: Erythema
• R: Rheumatic anamnesis
 Minor criteria: CAFE PAL
• C: CRP increased
• A: Arthralgia
• F: Aever
• E: Elevated ESR
• P: Prolonged PR interval
• A: Anamnesis of rheumatism
• L: Leucocytosis
 Pericarditis: causes
CARDIAC RIND
• C: Collagen vascular disease
• A: Aortic aneurysm
• R: Radiation
• D: Drugs (such as hydralazine)
• I: Infections
• A: Acute renal failure
 Pericarditis: causes cont’d
• C: Cardiac infarction
• R: Rheumatic fever
• I: Injury
• N: Neoplasms
• D:Dressler's syndrome
 SLE (Systemic Lupus Erythematosus)
diagnosis
MD SOAP 'N HAIR"
• M: Malar rash
• D: Discoid rash
• S: Serositis
• O: Oral ulcer
• A: Arthritis
• P: Photosensitivity
• N: Neurologic abnormality
• Hematologic abnormality
• ANA (+)
• Immunologic abnormality
• Renal involvement
 SLE (Systemic Lupus Erythematosus)
diagnosis (ARA criteria)
• DAMP AS RHINO:
• Discoid rash
• ANA (+)
• Malar rash
• Photosensitivity
• Arthritis
• Serositis (pleural, pericardial)
• Renal involvement
• Hematologic abnormality
• Immunologic abnormality
• Neurologic abnormality (seizures, psychosis)
• Oral / nasal ulcer, Observed
 Sickle cell disease complications
SICKLE
• S: Strokes/ Swelling of hands and feet/
Spleen problems
• I: Infections/ Infarctions
• C: Crises (painful, sequestration, aplastic)/
Cholelithiasis/ Chest syndrome/ Chronic
hemolysis/ Cardiac problems
 Sickle cell disease complications
cont’d
• K: Kidney disease
• L: Liver disease/ Lung problems
• E: Erection (priapism)/ Eye problems (retinopathy)

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 ANAEMIA

Feb 24, 2024

 Normal MCV

P: Pregancy

H: Haemolytic Anaemia

E: Endocrine disease(Hypothyroidism)

M: Marrow infiltration/fibrosis

A: Anaemia of Chronic disease

A: Acute Blood loss

R: Renal Disease

C: Connective Tissue Disease
 LOW MCV < 80fl
TH-IS

TH: Thalasemias
Major( Cooley’s Anaemia): severe thalasemic anaemia that is
associated with presence of microcytes, enlargement of the
liver,spleen ,↑ in the erythroid bone marrow, & jaundice and
that occurs esp in children of mediterranean parents

I : Iron deficiency

S : Sideroblastic Anaemia
 LOW MCV < 80fl
• TH: Thalasemias
• I : Iron Deficiency
• A : Anaemia of chronic diseases
• S : Sideroblastic Anaemia
 MCV 100-110pg

B: B12 Deficiency

L: Liver Disease

A: Alcohol

M: Myelodysplastic syndrome

A: Antifolate drugs e.g Phenytoin

H: Haemolysis

H: Hypothyroidism
 High MCV > 110pg
VITFOL

Vit: Vitamamin B12 deficiency

Fol: Folate deficiency
 Macrocytic anemia: causes
ABCDEF
• Alcohol + liver disease
• B12 deficiency
• Compensatory reticulocytosis (blood loss and hemolysis)
• Drug (cytotoxic and AZT)/ Dysplasia (marrow problems)
• Endocrine (hypothyroidism)
• Folate deficieny/ Fetus (pregnancy)