Internal Medicine Mnemonics

Internal Medicine Mnemonics

Pneumonia: risk factors INSPIRATION:
Immunosuppression
Neoplasia
Secretion retention
Pulmonary oedema
Impaired alveolar macrophages
RTI (prior)
Antibiotics and cytotoxics
Tracheal instrumentation
IV dug abuse
Other (general debility, immobility)
Neurologic impairment of cough reflex, (eg NMJ disorders)

Hypoglycaemia: causes "How to EXPLAIN hypoglycemia":
EXogenous drugs (insulin, oral hypoglycemics, alcohol, pentamidine,
quinine, quinolones)
Pituitary insufficency (no GH or cortisol)
Liver failure (no glycogen stores)
Adrenal failure (no cortisol)
Insulinomas/ Immune hypoglycemia
Non-pancreatic neoplasms (retroperitoneal sarcoma)

Asthma: precipitating factors for acute attack DIPLOMAT:
Drugs (aspirin, NSAIDs, beta blockers, etc)
Infections (URTI/LRTI)
Pollutants (at home, at work)
Laughter(emotion)
Oesophageal reflux (nocturnal asthma)
Mites
Activity and exercise
Temperature (cold)

Hypernatremia: causes 6 D's:
Diuretics
Dehydration
Diabetes insipidus
Docs (iatrogenic)
Diarrhea
Disease: kidney, sickle cell, etc

Cyanosis: DDx COLD PALMS:
· Peripheral cyanosis:
Cold
Obstruction
LVF and shock
Decreased cardiac output
· Central cyanosis:
Polycythemia
Altitude
Lung dz
Met-, sulphaemoglobinaemia
Shunt

Lymphoma: staging of B-cell CLL (RAI) LOATh
I: Lymphadenopathy
II: Organomegaly (splenomegaly)
III: Anemia
IV: Thrombocytopenia

Strep throat score NO FACE:
NO cough: no cough is +1
Fever: has fever is +1
Age: less than 5 years is -1, 15-45 years is 0, greater than 45 years is
+1
Cervical nodes: cervical nodes palpable is +1
Exudate: tonsillar exudate is +1
· Scoring interpretation:
Score 0-1: no strep throat.
Score 1-3: possible strep throat, do a swab test.
Score 4-5: strep throat is likely, so treat empirically.

Fall: differential I SAVED PANGS:
Illness
Syncope
Accident
Vision
Epilepsy (or other fit)
Drugs
Psychiatric (eg dementia)
Anaemia
Neurological (Parkinsons, cerebellar, neuropathy)
Glucose (hypoglycemia)
Stroke

Pleural effusion: investigations PLEURA:
Pleural fluid (thoracentesis)
Lung, pleural biopsy
ESR
Ultrasound
Radiogram
Analysis of blood

Chronic cough: full differential GASPS AND COUGH:
GORD
Asthma
Smoking, chronic bronchitis
Post-infection
Sinusitis, post-nasal drip
ACE inhibitor
Neoplasm
Diverticulum
Congestive heart failure
Outer ear
Upper airway obstruction
GI-airway fistula
Hypersensitivity

Dyspnea: causes SHE PANTS:
Stress, anxiety
Heart disease
Emboli
Pulmonary disease
Anaemia
Neuromuscular disease
Trachea obstruction
Sleep disorder

Haemoptysis: causes CAVITATES:
CHF
Airway disease, bronchiectasis
Vasculitis/ Vascular malformations
Infection (eg TB)
Trauma
Anticoagulation
Tumour
Embolism
Stomach

Wheezing: causes ASTHMA:
Asthma
Small airways disease
Tracheal obstruction
Heart failure
Mastocytosis or carcinoid
Anaphylaxis or allergy

Splenomegaly: causes HICCUPS:
Haematological
Infective : Kala azar, malaria, enteric fever
Congestive: CCF, constrictive pericarditis, IVC thrombosis, Hepatic vein
thrombosis, portal vein thrombosis and splenic vein thrombosis
Collagen diseases: SLE, Felty's syndrome
Unknown etiology: tropical splenomegaly
Primary malignacies (secondaries are rare)
Storage diseases: Gaucher's disease, Niemman Pick

Anion gap metabolic acidosis: causes MUDPILES:
Methanol
Uremia
Diabetic ketoacidosis
Paraldehyde
Infection
Lactic acidosis
Ethylene glycol
Salicylates

Carcinoid syndrome: features FACADE:
Flushing
Asthma
Cor pulmonale
Ascites
Diarrhoea
Endocardial fibrosis

Thromocytopenia: causes SHAPIRO:
Splenectomy
Hodgkin's disease
Arteritis
Polycythemia
Infection
Rheumatoid
Occult malignancy

Dialysis indications HAVE PEE:
Hyperkalemia (refractory)
Acidosis (refractory)
Volume overload
Elevated BUN (> 36 mM)
Pericarditis
Encephalopathy
Edema (pulmonary)

SLE: factors that make SLE active UV PRISM:
UV (sunshine)
Pregnancy
Reduced drug (eg steroid)
Infection
Stress
More drug

Pruritus without rash: DDx ITCHING DX:
Infections (scabies, toxocariasis, etc)
Thyroidal and other endocrinopathies (eg diabetes mellitus)
Cancer
Hematologic diseases (eg iron deficiency)/ Hepatopathies/ HIV
Idiopathic
Neurotic
Gravid (pruritus of pregancy)
Drugs
eXcretory dysfunctions (eg uremia)

Horner's syndrome: components SAMPLE:
Sympathetic chain injury
Anhidrosis
Miosis
Ptosis
Loss of ciliospinal reflex
Enophthalmos

Caplan syndrome: characteristics CAPlan:
Coal worker pneumoconiosis
Arthritis
Pulmonary nodule

Anemia: non-megaloblastic causes of macrocytic anemia 
HAND LAMP:
Hypothyroidism
Aplastic anaemia
Neonates
Drugs
Liver disease
Alcohol
Myelodyplasia
Pregnancy

Acromegaly symptoms ABCDEF:
Arthralgia/ Arthritis
Blood pressure raised
Carpal tunnel syndrome
Diabetes
Enlargemed organs
Field defect

NSAIDs: contraindications NSAID:
Nursing and pregnancy
Serious bleeding
Allergy/ Asthma/ Angioedema
Impaired renal function
Drug (anticoagulant)

ACEI: contraindictions PARK:
Pregnancy
Allergy
Renal artery stenosis
Kincrease (hyperkalemia)

Pressure Sore: Norton Score MAGIC:
Mobility
ADL
General condition
Incontinence
Conscious level

Behcet's syndrome: diagnostic criteria PROSE:
Pathergy test (i/d saline injection)
Recurrent genital ulceration
Oral ulceration (recurrent)
Skin lesions
Eye lesions
· Oral ulceration is central criteria, plus any 2 others.

Metabolic acidosis: causes KUSSMAL:
Ketoacidosis
Uraemia
Sepsis
Salicylates
Methanol
Alcohol
Lactic acidosis

Allopurinol: indications STORE:
Stones (history of renal stones)
Tophaceous gout (chronic)
Over-producers of urate
Renal disease
Elderly
· Bonus: Probenecid indications are basically the opposite of STORE (no renal
stone history, etc.).

Raynaud's disease: causes BAD CT:
Blood disorders (eg polycythaemia)
Arterial (eg atherosclerosis, Buerger's)
Drugs (eg beta-blockers)
Connective tissue disorders (rheumatoid arthritis, SLE)
Traumatic (eg vibration injury)

Lead poisoning (chronic): features ABCDEFGHI:
Anaemia/ Anorexia/ Arthralgia/ Abortion/ Atrophy
of optic nerve
Basophilic stippling of RBC (punctate basophilia)/ Burtonian line
on gums
Colic/ Constipation/ Coprophyrin excess in urine/ Cerebraloedema
Drop (wrist, foot)
Encephalopathy/ Emaciation
Foul smell of breath/ Failure of kidneys/ Fanconi syndrome
Gonadal dysfunction/ Gout-like picture
High BP/ Headache/ Hallucination/ Hyperaesthesia
Impotence/ Insomnia/ Irritability

Splenomegaly: causes CHICAGO:
Cancer
Hem, onc
Infection
Congestion (portal hypertension)
Autoimmune (RA, SLE)
Glycogen storage disorders
Other (amyloidosis)

SIADH: causes SIADH:
Surgery
Intracranial: infection, head injury, CVA
Alveolar: Ca, pus
Drugs: opiates,antiepileptics, cytotoxics, anti-psychotics
Hormonal: hypothyroid, low corticosteroid level

Ileus: causes MD SPUGERS:
Mesenteric ischemia
Drugs (see below)
Surgical (post-op)
Peritonitis/ Pancreatitis (sentinnel loop)
Unresolved mechanical obstruction (eg mass, intussusception, blockage)
Gram negative sepsis
Electrolyte imbalance (eg hypokalemia)
Retroperitoneal bleed or hematoma
Spinal or pelvic fracture
· Drugs are Aluminum hydroxide, Ba++, Ca carbonate, opiates, TCA, verapamil.

Ulcers: types VAN:
Venous/ Vasculitic
Arterial
Neuropathic

Pulmonary fibrosis: causes SCAR:
· Upper lobe:
Silicosis/ Sarcoidosis
Coal worker pneumonconiosis
Ankylosing spondylitis
Radiation
· Lower lobe:
Systemic sclerosis
Cyptogenic fibrosing alveolitis
Asbetosis
Rheumatoid arthritis

Thyroid storm: initial management PCP'S:
PTU - 1 gm po
Corticosteroids
Propranolol
SSKI

Renal failure (acute): management Manage AEIOU:
Anemia/ Acidosis
Electrolyte and fluids
Infections
Other measures (eg nutrition, nausea, vomiting
Uremia

Non-gap acidosis: causes HARD UP:
Hyperalimentation
Acetazolamide (carbonic anhydrase inhibitors)
RTA
Diarrhea
Ureterosigmoidostomy
Pancreatic fistula

Hemoptysis: causes HEMOPTYSIS:
Haemorrhagic diathesis
Edema [LVF due to mitral stenosis]
Malignancy
Others [eg: vasculitis]
Pulmonary vascular abnormalities
Trauma
Your treatment [anticoagulants]
SLE
Infarction in lungs
Septic

Abdominal pain: medical causes "ABDOMENAL PANE"
[abdominal pain]:
Acute rheumatic fever
Blood [purpura, a/c hemolytic crisis]
DKA
cOllagen vascular disease
Migraine [abdominal migraine]
Epilepsy [abdominal epilepsy]
Nephron [uremia]
Abdominal angina
Lead
Porphyria
Arsenic
NSAID's
Enteric fever

Haemobilia: features MOB:
Melaena
Obstructive jaundice
Biliary colic

Thickened nerves: causes HANDS:
Hansen's (leprosy)
Amyloidosis
Neurofibromatosis
Diabetes mellitus
Sarcoidosis

SIADH: major signs and symptoms SIADH:
Spasms
Isn't any pitting edema (key DDx)
Anorexia
Disorientation (and other psychoses)
Hyponatremia

Toxicity/ sepsis: signs 6 T's:
Tachycardia
Tachypnea
Tremors
Toxic look
Tiredness
Temperature (fever)

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)

Respiratory disease: hand signs CASH:
Clubbing
Asterixis
Small muscle wasting
HPOA

Clubbing: respiratory causes ABCDEF:
Abcess (lung)
Bronchiectasis (including CF)
Cancer (lung)
Decreased oxygen (hypoxia)
Empyaema
Fibrosing alveolitis

Pulmonary edema: treatments MAD DOG:
Morphine
Aminophylline
Digitalis
Diuretics
Oxygen
GGases in blood (ABG's)

Hypercalcemia: causes GRIM FED:
Granulomas (sarcoid, TB),
Renal faliure
Immobility (esp. long term)
Malignancy
Familial (eg familial hypocalciuric hypercalcemia)
Endocrine (see below for subtypes)
Drugs (esp. thiazide diuretics, lithium)
· Endocrine causes are PATH:
Phaeochromocytoma
Addison's disease
Thyrotoxicosis
Hyperparathyroidism

Acute stridor: differential ABCDEFGH:
· With fever:
Abscess
Bacterial tracheitis
Croup
Diphtheria
Epiglottitis
· Without fever:
Foreign body
Gas (Toxic Gas)
Hypersensitivity

Hypercalcemia: differential VITAMIN TRAPS:
Vitamin A and D intoxication
Immobilization
Thyrotoxicosis
Addison's disease/ Acidosis
Milk-alkali syndrome
Inflammatory disorders
Neoplastic disease
Thiazides, other drugs
Rhabdomyolysis
AIDS
Paget's disease/ Parenteral nutrition/ Parathyroid disease
Sarcoidosis

Metabolic acidosis: causes USED CAR:
Ureteroenterostomy
Saline hydration
Endocrinopathies (hyperparathyroid, hyperthyroid, Addison's)
Diarrhea/ DKA/ Drugs
Carbonic anhydrase inhibitors
Ammonium chloride
Renal tubular acidosis
· Alternatively: USED CARP, to include Parenteral nutrition/ Pancreatic
fistula.

Pulmonary edema: treatment LMNOP:
Lasix
Morphine
Nitrates (NTG)
Oxygen
Position (upright vs. flat)

Eosinophilia: differential NAACP:
Neoplasm
Allergy/ Asthma
Addison's disease
Collagen vascular diseases
Parasites

SIADH: diagnostic sign Syndrome of INAPPropriate
Anti-Diuretic Hormone:
Increased
Na (sodium)
PP (urine)
· SIADH is characterized by increased urinary sodium.

Polycythemia Rubra Vera (PRV): common symptoms PRV:
Plethora/ Pruritis
Ringing in ears
Visual blurriness

Rashes: time of appearance after fever onset "Really
Sick Children Must Take No Exercise":
· Number of days after fever onset that a rash will appear:
1 Day: Rubella
2 Days: Scarlet fever/ Smallpox
3 Days: Chickenpox
4 Days: Measles (and see the Koplik spots one day prior to rash)
5 Days: Typhus & rickettsia (this is variable)
6 Days: Nothing
7 Days: Enteric fever (salmonella)

Anion gap metabolic acidosis: causes A MUDPILE CAT:
Alcohol
Methanol
Uremia
Diabetic ketoacidosis
Paraldehyde
Iron/ Isoniazid
Lactic acidosis
Ethylene glycol
Carbamazepine
Aspirin
Toluene

Bronchiectasis: causes A SICK AIRWAY:
Airway lesion, chronic obstruction
Sequestration
Infection, inflamation
Cystic fibrosis
Kartagners syndrome
Allergic brochopulmonary aspergilliosis
Immunodeficiencies (hypogammaglobinaemia, myeloma, lymphoma)
Reflux, inhalation injury
William Campbell syndrome (and other congenitals)
Aspiration
Yellow nail syndrome/ Young syndrome

Alkalosis: metabolic changes in alkalosis "Al-K-loss,
Al-Ca-loss":
There is loss of K+ (hypokalemia) and Ca++ (hypocalcemia) in state
of alkalosis.

HbA2: concentration in normal blood HbA2:
Concentration of HbA2 is 2% in normal adult blood.

Ducket John's: major criteria ACNES:
Arthritis
Carditis
Nodule (subcutaneous)
Erythrema marginatum
Sydenham chorea

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

Hypercalcemia causes MD PIMPS ME:
Malignancy
Diuretics (thiazide the main culprit)
Parathyroid (hyperparathyroidism)
Immobilization/ Idiopathic
Megadoses of vitamins A,D
Paget's disease
Sarcoidosis
Milk alkali syndrome
Endocrine (Addison's disease, thyrotoxicosis)

Left iliac fossa: causes of pain SUPER CLOT:
Sigmoid diverticulitis
Uteric colic
PID
Ectopic pregnancy
Rectus sheath haematoma
Colorectal carcinoma
Left sided lower love pneumonia
Ovarian cyst (rupture, torture)
Threatened abortion/ Testicular torsion

Pancytopaenia differential "All Of My
Blood Has Taken Some Poison":
Aplastic anaemias
Overwhelming sepsis
Megaloblastic anaemias
Bone marrow infiltration
Hypersplenism
TB
SLE
Paroxysmal nocturnal haemoglobinuria

Haematology: key numbers 3 and 4 are key in in
haematology:
1.34 cm3 of oxygen is carried by a gram of hemoglobin.
There's 3.4mg of iron in each gram of hemoglobin.
There's an average of 3.4 lobes per neutrophil.
There's 34mg bilirubin from each gram of hemoglobin.

Back trouble causes O, VERSALIUS (Versalius was the
name of a famous physician):
Osteomyelitis
Vertebral fracture
Extraspinal tumour
Spondylolisthesis
Ankylosing spondylitis
Lumbar disk increase
Intraspinal tumor
Unhappiness
Stress

Sports injuries: course of action RICE:
Rest
Ice
Compression
Elevation
· RICE especially for fractures, sprains, muscle strains, contusions
· Alternatively: I=Immobilization, C=Cold compresses.

Back pain causes DISK MASS (since near vertebral
disc):
Degeneration (DJD, osteoporosis, spondylosis)
Infection (UTI, PID, Pott's disease, osteomyelitis, prostatitis)/ Injury,
fracture or compression fracture
Spondylitis (ankylosing spondyloarthropathies such as rheumatoid
arthritis, Reiters, SLE)
Kidney (stones, infarction, infection)
Multiple myeloma/ Metastasis (from cancers of breast, kidney,
lung, prostate, thyroid)
Abdominal pain (referred to the back)/ Aneurysm
Skin (herpes zoster)/ Strain/ Scoliosis and lordosis
Slipped disk/ Spondylolisthesis

Bronchiectasis: differential BRONCHIECTASIS:
Bronchial cyst
Repeated gastric acid aspiration
Or due to foreign bodies
Necrotizing pneumonia
Chemical corrosive substances
Hypogammaglobulinemia
Immotile cilia syndrome
Eosinophilia (pulmonary)
Cystic fibrosis
Tuberculosis (primary)
Atopic bronchial asthma
Streptococcal pneumonia
In Young's syndrome
Staphylococcal pneumonia

Sickle cell disease complications SICKLE:
Strokes/ Swelling of hands and feet/ Spleen problems
Infections/ Infarctions
Crises (painful, sequestration, aplastic)/ Cholelithiasis/ Chest
syndrome/ Chronic hemolysis/ Cardiac problems
Kidney disease
Liver disease/ Lung problems
Erection (priapism)/ Eye problems (retinopathy)

ADP: role in platelet aggregation ADP = Aggregation
from the Dense bodies of Platelets.

Gynecomastia: common causes GYNECOMASTIA:
Genetic Gender disorder (Klinefelter)
Young boy (pubertal)*
Neonate*
Estrogen
Cirrhosis/ Cimetidine/ Ca Channel blockers
Old age*
Marijuana
Alcoholism
Spironolactone
Tumors (Testicular & adrenal)
Isoniazid/ Inhibition of testosterone
Antineoplastics (Alkylating Agents)/ Antifungal(ketoconazole)
· * Asterisk indicates physiologic cause.

Lethargy, malaise causes FATIGUED:
Fat/ Food (poor diet)
Anemia
Tumor
Infection (HIV, endocarditis)
General joint or liver disease
Uremia
Endocrine (Addison's, myxedema)
Diabetes/ Depression/ Drugs