Clinical Mnemonics

A reference collection of mnemonics used by medical students for diagnosis, history-taking, physical examination, and recalling high-yield facts.

Quick Diagnostic & Screening Mnemonics

GET SMASH’D — causes of acute pancreatitis: Gallstones, Ethanol, Trauma, Steroids, Mumps, Autoimmune (PAN), Scorpion bites, Hyperlipidemia, Drugs (azathioprine, diuretics)

APGAR:

A: Appearance (color)
P: Pulse (heart rate)
G: Grimace (reflex irritability)
A: Activity (muscle tone)
R: Respiratory effort

Multiple Endocrine Neoplasia (MEN): Each MEN syndrome involves three or two letters plus a feature.

MEN I: 3 P’s (Pituitary, Parathyroid, Pancreas) plus adrenal cortex
MEN II: 2 C’s (Carcinoma of the thyroid, Catecholamines/pheochromocytoma) plus parathyroid for MEN IIa, or mucocutaneous neuromas for MEN IIb (also called MEN III)

Pneumonia infiltrate type by cause: Pyogenic bacteria cause a PMN infiltrate; miscellaneous microbes (atypical organisms) cause a mononuclear infiltrate.

Takayasu’s Arteritis memory aid: Takayasu’s disease is a “pulseless disease” — when you have Takayasu’s, you “Tak’a” (take a) pulse and can’t find one.

CAGE — alcohol use screening:

Have you ever felt it necessary to CUT DOWN on your drinking?
Has anyone ever told you they were ANNOYED by your drinking?
Have you ever felt GUILTY about your drinking?
Have you ever felt the need for a drink in the morning as an EYE OPENER?

PQRST — eliciting the HPI and exploring symptoms:

P: Palliative or provocative factors for the pain
Q: Quality of the pain (burning, stabbing, aching, etc.)
R: Region of the body affected
S: Severity of pain (usually a 1-10 scale)
T: Timing of pain (e.g., after meals, in the morning, etc.)

ASCLAST — eliciting the HPI and exploring symptoms:

A: Aggravating and alleviating factors
S: Severity
C: Character, quality
L: Location
A: Associated symptoms
S: Setting
T: Timing
Note: ASCLAST is a reminder to let the patient talk first, then ask specific follow-up questions.

Argyll-Robertson Pupil: The syphilitic pupil. Accommodation reflex present, pupillary light reflex absent, due to damage at the pretectal area. Also called the “prostitute’s pupil” (accommodates but does not react).

The Five W’s — post-operative fever:

Wind: pneumonia, atelectasis
Water: urinary tract infection
Wound: wound infection
Walking: early ambulation helps reduce deep vein thrombosis and pulmonary embolism
Wonder drugs: especially anesthesia

TOM SCHREPFER — predisposing conditions for pulmonary embolism:

T: Trauma
O: Obesity
M: Malignancy
S: Surgery
C: Cardiac disease
H: Hospitalization
R: Rest (bed-bound)
E: Estrogen, pregnancy, post-partum
P: Past history
F: Fracture
E: Elderly
R: Road trip

Arterial occlusion — the 4 P’s: Pain, Pallor, Pulselessness, Paresthesias

ACID (“Anna Cycled Immediately Downhill”) — hypersensitivity reactions (Gell and Coombs classification):

Type I: Anaphylaxis
Type II: Cytotoxic-mediated
Type III: Immune-complex
Type IV: Delayed hypersensitivity

WBC differential (“Never Let Mom Eat Beans” — 60, 30, 6, 3, 1):

Neutrophils: 60%
Lymphocytes: 30%
Monocytes: 6%
Eosinophils: 3%
Basophils: 1%

The 4 T’s of Anterior Mediastinal Mass: Thyroid tumor, Thymoma, Teratoma, Terrible lymphoma

Eponymous Diseases

Addison’s Disease: Primary adrenocortical deficiency Addisonian Anemia: Pernicious anemia (antibodies to intrinsic factor or parietal cells, leading to decreased intrinsic factor, decreased vitamin B12, and megaloblastic anemia) Albright’s Syndrome: Polyostotic fibrous dysplasia, precocious puberty, café au lait spots, short stature; young girls Alport’s Syndrome: Hereditary nephritis with nerve deafness; Type 4 collagen defect (basement membranes) Alzheimer’s: Progressive dementia; tau proteins, neurofibrillary tangles, apolipoprotein E4 allele, narrow gyri and wide sulci (atrophy), occipital sparing, hydrocephalus ex vacuo, plaques in the hippocampus and cortex, decreased acetylcholine, Hirano bodies (intracellular inclusions in hippocampal cells) Argyll-Robertson Pupil: Loss of light reflex constriction (contralateral or bilateral); accommodation reflex present, pupillary reflex absent; also called the “prostitute’s eye”; pathognomonic for tertiary syphilis Arnold-Chiari Malformation: Cerebellar tonsil herniation Barrett’s: Columnar metaplasia of the lower esophagus (increased risk of adenocarcinoma) Bartter’s Syndrome: Hyperreninemia Becker’s Muscular Dystrophy: Similar to Duchenne, but less severe (dystrophin deficiency) Bell’s Palsy: CN VII palsy of the entire face (an UMN lesion affects only the lower face) Berger’s Disease: IgA nephropathy Bernard-Soulier Disease: Defect in platelet adhesion (abnormally large platelets, lack of platelet-surface glycoprotein) Berry Aneurysm: Circle of Willis (subarachnoid bleed); often associated with ADPKD Bowen’s Disease: Carcinoma in situ on the shaft of the penis (increased risk of visceral cancer) Briquet’s Syndrome: Somatization disorder; multiple physical complaints without physical pathology Broca’s Aphasia: Motor aphasia with intact comprehension Bronchiolitis: RSV Brown-Sequard: Cord hemisection (contralateral loss of pain/temperature, ipsilateral loss of fine touch, UMN signs) Bruton’s Disease: X-linked agammaglobulinemia Budd-Chiari: Post-hepatic venous thrombosis Buerger’s Disease: Acute inflammation of small and medium arteries; painful ischemia; gangrene Burkitt’s Lymphoma: Small noncleaved cell lymphoma; EBV associated; 8:14 translocation Caisson Disease: Gas emboli Carpal Tunnel Syndrome: Median nerve entrapment Chagas’ Disease: Trypanosoma infection; cardiomegaly with apical atrophy, achalasia Chediak-Higashi Disease: Phagocyte deficiency (neutropenia, albinism, cranial and peripheral neuropathy); repeated infections Congenital Adrenal Hyperplasia: 21-hydroxylase deficiency (virilism, no cortisol, salt loss, hypotension); 11-hydroxylase deficiency (virilism, no cortisol, salt retention, hypertension) Conn’s Syndrome: Primary aldosteronism Cori’s Disease: Glycogen storage disease (debranching enzyme deficiency) Creutzfeldt-Jakob: Prion infection; cerebellar and cerebral degeneration Crigler-Najjar Syndrome: Congenital unconjugated hyperbilirubinemia; glucuronyl transferase deficiency Crohn’s: IBD; ileocecum, transmural, skip lesions, lymphocytic infiltrate, granulomas (contrast with UC: limited to colon, mucosa and submucosa, crypt abscesses, pseudopolyps, increased colon cancer risk) Croup: Parainfluenza Curling’s Ulcer: Acute gastric ulcer associated with severe burns Cushing’s: Disease = hypercortisolism secondary to excess pituitary ACTH (basophilic adenoma); Syndrome = hypercortisolism from any other cause (primary adrenal or ectopic) Cushing’s Ulcer: Acute gastric ulcer associated with CNS trauma de Quervain’s Thyroiditis: Self-limiting focal destruction (subacute thyroiditis) DiGeorge’s Syndrome: Thymic hypoplasia, T-cell deficiency, hypoparathyroidism Down’s Syndrome: Trisomy 21 or translocation Dressler’s Syndrome: Post-MI fibrinous pericarditis, autoimmune Dubin-Johnson Syndrome: Congenital conjugated hyperbilirubinemia; striking brown-to-black liver discoloration Duchenne Muscular Dystrophy: Dystrophin deficiency; X-linked recessive Edwards’ Syndrome: Trisomy 18; rocker-bottom feet, low-set ears, heart disease Ehlers-Danlos: Defective collagen Eisenmenger’s Complex: Late cyanotic shunt reversal (right-to-left), pulmonary hypertension and RVH secondary to long-standing VSD, ASD, or PDA Erb-Duchenne Palsy: Trauma to the superior trunk of the brachial plexus; “waiter’s tip” posture Ewing Sarcoma: Undifferentiated round cell tumor of bone Erythroplasia of Queyrat: Carcinoma in situ on the glans penis Fanconi’s Syndrome: Impaired proximal tubular reabsorption secondary to lead poisoning or tetracycline (glycosuria, hyperphosphaturia, aminoaciduria, systemic acidosis) Felty’s Syndrome: Rheumatoid arthritis, neutropenia, splenomegaly Gardner’s Syndrome: Adenomatous colon polyps plus osteomas and soft tissue tumors Gaucher’s Disease: Lysosomal storage disease; glucocerebrosidase deficiency; hepatosplenomegaly, femoral head and long bone erosion, anemia; crinkled tissue-paper cells in the marrow Gilbert’s Syndrome: Benign congenital unconjugated hyperbilirubinemia GIST: Tumor arising in the cells of Cajal (pacemakers of the gut) Glanzmann’s Thrombasthenia: Defective glycoproteins on platelets Goodpasture’s: Autoimmune; antibodies to glomerular and alveolar basement membranes; linear immunofluorescence Grave’s Disease: Autoimmune hyperthyroidism (TSI) Guillain-Barre: Idiopathic polyneuritis (ascending muscle weakness and paralysis; usually self-limiting) Hamman-Rich Syndrome: Idiopathic pulmonary fibrosis Hand-Schuller-Christian: Chronic progressive histiocytosis Hashimoto’s Thyroiditis: Autoimmune hypothyroidism (antimicrosomal or antithyroglobulin antibodies); Hurthle cells, thyroid germinal centers Hashitoxicosis: Initial hyperthyroid phase in Hashimoto’s Thyroiditis that precedes hypothyroidism Henoch-Schonlein Purpura: Hypersensitivity vasculitis; hemorrhagic urticaria with fever, arthralgias, GI and renal involvement; associated with upper respiratory infections Hereditary Spherocytosis: RBC cytoskeleton defect, most commonly spectrin Hirschsprung’s Disease: Aganglionic megacolon Horner’s Syndrome: Ptosis, miosis, anhidrosis (lesion of cervical sympathetic nerves, often secondary to a Pancoast tumor) Huntington’s: Progressive degeneration of the caudate nucleus, putamen, and frontal cortex; autosomal dominant Hunter’s Syndrome: Decreased iduronate sulfatase Hurler’s Syndrome: Decreased alpha-L-iduronidase Jacksonian Seizures: Epileptic events originating in the primary motor cortex (area 4) Job’s Syndrome: Immune deficiency; neutrophils fail to respond to chemotactic stimuli Kaposi Sarcoma: Malignant vascular tumor (HHV-8) Kartagener’s Syndrome: Immotile cilia secondary to defective dynein arms; infection, situs inversus, sterility Kawasaki Disease: Mucocutaneous lymph node syndrome Keratoconjunctivitis: Adenovirus Klinefelter’s Syndrome: 47,XXY Kluver-Bucy: Bilateral amygdala lesions (hypersexuality, oral behavior) Krabbe Disease: Beta-galactosidase deficiency Krukenberg Tumor: Adenocarcinoma with signet-ring cells (typically from the stomach), metastatic to the ovaries Laennec’s Cirrhosis: Alcoholic cirrhosis Lesch-Nyhan: HGPRT deficiency; gout, retardation, self-mutilation Letterer-Siwe: Acute disseminated Langerhans cell histiocytosis Libman-Sacks: Endocarditis with small vegetations on valve leaflets; associated with SLE Lou Gehrig’s: Amyotrophic lateral sclerosis; degeneration of upper and lower motor neurons Mallory-Weiss Syndrome: Bleeding from esophagogastric lacerations secondary to retching (alcoholics) Marfan’s: Elastin defect; floppy mitral valve, arachnodactyly, cystic medial necrosis, subluxed lens McArdle’s Disease: Glycogen storage disease (muscle phosphorylase deficiency) Meckel’s Diverticulum: Rule of 2’s — 2 inches long, 2 feet from the ileocecum, in 2% of the population; embryonic duct origin; may contain ectopic gastric or pancreatic tissue Meig’s Syndrome: Triad of ovarian fibroma, ascites, hydrothorax Menetrier’s Disease: Giant hypertrophic gastritis (enlarged rugae, plasma protein loss) Monckeberg’s Arteriosclerosis: Calcification of the media (usually radial and ulnar arteries); pipestem arteries Munchausen Syndrome: Factitious disorder (consciously creates symptoms, without knowing why) Meningioma: Arachnoid cap cells, whorls of cells Mesothelioma: Asbestos exposure Nelson’s Syndrome: Primary adrenal Cushing’s treated with adrenalectomy, causing loss of negative feedback to the pituitary and a resulting pituitary adenoma Niemann-Pick: Lysosomal storage disease; sphingomyelinase deficiency; “foamy histiocytes” Osler-Weber-Rendu Syndrome: Hereditary hemorrhagic telangiectasia Osteogenesis Imperfecta: Type I collagen defect Paget’s Disease: Abnormal bone architecture (thickened, fracture-prone), woven and lamellar bone mosaic Pancoast Tumor: Bronchogenic tumor with superior sulcus involvement; can cause Horner’s Syndrome Parkinson’s: Dopamine depletion in the nigrostriatal tracts; cogwheel rigidity Peutz-Jeghers Syndrome: Melanin pigmentation of the lips, mouth, hands, genitalia, plus hamartomatous polyps of the small intestine Peyronie’s Disease: Subcutaneous fibrosis of the dorsum of the penis Pick’s Disease: Progressive dementia similar to Alzheimer’s; knife-edged gyri Plummer’s Syndrome: Hyperthyroidism, nodular goiter, absence of eye signs Plummer-Vinson: Esophageal webs and iron-deficiency anemia; increased risk of esophageal squamous cell carcinoma Pompe’s Disease: Glycogen storage disease (acid maltase deficiency); cardiomegaly Pott’s Disease: Tuberculous osteomyelitis of the vertebrae Potter’s Complex: Renal agenesis, oligohydramnios, hypoplastic lungs, limb defects Raynaud’s: Disease = recurrent vasospasm in the extremities; Phenomenon = secondary to underlying disease (SLE, scleroderma) Reiter’s Syndrome: “Can’t see, can’t pee, can’t climb a tree” — urethritis, conjunctivitis, arthritis; non-infectious but often post-infectious; HLA-B27, polyarticular Reye’s Syndrome: Microvesicular fatty liver change and encephalopathy, secondary to aspirin use in children after a viral illness Riedel’s Thyroiditis: Idiopathic fibrous replacement of the thyroid Rotor Syndrome: Congenital conjugated hyperbilirubinemia; similar to Dubin-Johnson, without liver discoloration Sezary Syndrome: Leukemic form of cutaneous T-cell lymphoma Shaver’s Disease: Aluminum inhalation leading to lung fibrosis Sheehan’s Syndrome: Postpartum pituitary necrosis Shy-Drager: Parkinsonism with autonomic dysfunction and orthostatic hypotension Simmond’s Disease: Pituitary cachexia Sipple’s Syndrome: MEN type IIa Sjogren’s Syndrome: Triad of dry eyes, dry mouth, arthritis; increased risk of B-cell lymphoma Spitz Nevus: Juvenile melanoma (always benign) Stein-Leventhal: Polycystic ovary syndrome Stevens-Johnson Syndrome: Erythema multiforme, fever, malaise, mucosal ulceration (often secondary to infection or sulfa drugs) Struma Ovarii: Thyroid teratoma of the ovary Still’s Disease: Juvenile rheumatoid arthritis (rheumatoid factor negative) Takayasu’s Arteritis: Aortic arch syndrome; loss of carotid, radial, or ulnar pulses Tay-Sachs: Gangliosidosis (hexosaminidase A deficiency, GM2 ganglioside accumulation) Tetralogy of Fallot: VSD, overriding aorta, pulmonary artery stenosis, right ventricular hypertrophy Tourette’s Syndrome: Involuntary motor and vocal actions Turcot’s Syndrome: Adenomatous colon polyps plus CNS tumors Turner’s Syndrome: 45,XO Typhoid Fever: Bradycardia; rose spots on the abdomen in white patients Vincent’s Infection: “Trench mouth” — acute necrotizing ulcerative gingivitis von Gierke’s Disease: Glycogen storage disease (glucose-6-phosphatase deficiency) von Hippel-Lindau: Hemangioma/hemangioblastoma, visceral adenomas (especially renal cell carcinoma), defective VHL tumor suppressor von Recklinghausen’s: Neurofibromatosis, café au lait spots, Lisch nodules von Recklinghausen’s Disease of Bone: Osteitis fibrosa cystica (“brown tumor”), secondary to hyperparathyroidism von Willebrand’s Disease: Defective platelet adhesion secondary to vWF deficiency; increased bleeding time and PTT Waldenstrom’s Macroglobulinemia: Proliferation of IgM-producing lymphoid cells Wallenberg’s Syndrome: PICA thrombosis (“medullary syndrome”); ipsilateral ataxia and facial pain/temperature loss, contralateral body pain/temperature loss Waterhouse-Friderichsen: Catastrophic adrenal insufficiency from hemorrhagic necrosis (e.g., DIC), often secondary to meningococcemia Weber’s Syndrome: Paramedian midbrain infarct; ipsilateral mydriasis, contralateral UMN paralysis Wegener’s Granulomatosis: Necrotizing granulomatous vasculitis of the paranasal sinuses, lungs, kidneys Weil’s Disease: Leptospirosis Wermer’s Syndrome: MEN type I Wernicke’s Aphasia: Sensory aphasia with impaired comprehension Wernicke-Korsakoff Syndrome: Thiamine deficiency in alcoholics; bilateral mammillary body involvement (confusion, ataxia, ophthalmoplegia) Whipple’s Disease: Malabsorption syndrome with bacteria-laden macrophages, plus polyarthritis Wilson’s Disease: Hepatolenticular degeneration (copper accumulation, decreased ceruloplasmin) Wiskott-Aldrich Syndrome: Combined B- and T-cell immunodeficiency (thrombocytopenia and eczema) Wolff-Chaikoff Effect: High iodine levels suppress thyroid hormone synthesis Zenker’s Diverticulum: Esophageal diverticulum above the cricopharyngeal muscles (upper esophageal sphincter) Zollinger-Ellison: Gastrin-secreting tumor of the pancreas or intestine, causing increased acid and intractable ulcers

Hallmark Findings

Adhesive arachnoiditis: Caused by bacterial meningitis; leads to obstructive hydrocephalus Albumino-Cytologic Dissociation: Guillain-Barre (markedly increased CSF protein with only modest cell count increase) AFP increase: Neural tube defects, hepatocellular carcinoma, yolk sac tumor, embryonal carcinoma AFP decrease: Down’s Syndrome Amnion nodosum: Renal agenesis Amyloid in the thyroid: Medullary thyroid carcinoma (calcitonin) Analgesic abuse: Papillary necrosis, especially in diabetics Anasarca: Minimal change disease Aneurysmal nodules: Polyarteritis nodosa Angiomyolipoma: Tuberous sclerosis Anosmia: Kallmann’s syndrome Anterior vermian atrophy: Alcoholism Anti-centromere antibody: Limited scleroderma (CREST) Anti-DNA topoisomerase antibody: Diffuse scleroderma Anti-endomysial antibody: Celiac sprue Anti-Jo antibody: Polymyositis Anti-mitochondrial antibody: Primary biliary cirrhosis Antiplatelet antibodies: Idiopathic thrombocytopenic purpura Anti-Saccharomyces cerevisiae antibody: Crohn’s disease Anti-Smith antibodies: Specific for SLE; anti-ribonucleoprotein Anti-smooth muscle antibody: Autoimmune hepatitis type I Arachnodactyly: Marfan’s Aschoff bodies: Rheumatic fever Ash-leaf spots (skin): Tuberous sclerosis Atypical lymphocytes: EBV Auer rods: Acute promyelocytic leukemia (AML, M3) Autosplenectomy: Sickle cell anemia Babinski sign: UMN lesion Bacterial conjunctivitis: S. aureus, Strep pneumoniae, Haemophilus aegyptius Basophilic stippling of RBCs: Lead poisoning Bence Jones protein: Multiple myeloma (free kappa or lambda light chains); Waldenstrom’s macroglobulinemia Bilateral breast cancer: Lobular carcinoma Bilateral renal cell carcinoma: von Hippel-Lindau Birbeck granules: Histiocytosis X (eosinophilic granuloma) Bladder trabeculation: BPH Bloody nipple discharge: Intraductal papilloma Blueberry muffin baby: Congenital rubella Blue bloater: Chronic bronchitis Blue sclera: Osteogenesis imperfecta Boot-shaped heart: Tetralogy of Fallot Bouchard’s nodes: Osteoarthritis (PIP joints) Boutonniere deformity: Rheumatoid arthritis Bronze diabetes: Hemochromatosis Brown tumor: Hyperparathyroidism Brudzinski sign: Meningitis Brushfield spots: Down’s Syndrome (on the iris) Call-Exner bodies: Granulosa cell tumor Carbon monoxide poisoning: Hyperemia, edema, and necrosis of the globus pallidus Cardiomegaly with apical atrophy: Chagas’ Disease Central nuclei in muscle: Muscular dystrophies Chancre: Primary syphilis, painless firm ulcer Chancroid: Haemophilus ducreyi, painful soft ulcer Charcot triad: Multiple sclerosis (nystagmus, intention tremor, scanning speech) Charcot-Leyden crystals: Bronchial asthma Cherry-red spot on the macula: Tay-Sachs; also seen in 50% of Niemann-Pick Cheyne-Stokes breathing: Cerebral lesion Chocolate cysts: Endometriosis Cholesterol clefts: Atherosclerosis Chordae tendineae, short and fused: Rheumatic heart disease Chronic staph infections: Chronic granulomatous disease (NADPH oxidase deficiency; can’t kill catalase-positive organisms) Chvostek’s sign: Hypocalcemia (facial spasm in tetany) Clear nuclei (“Orphan Annie eyes”): Papillary thyroid carcinoma Clue cells: Gardnerella vaginitis Codman’s triangle: Osteosarcoma Coin lesions in the lung: Pulmonary hamartoma Cold agglutinins: Mycoplasma pneumoniae; infectious mononucleosis Cold thyroid nodules: Colloid cyst or thyroid adenoma Concentric laminar intimal fibrosis of small pulmonary arteries: Primary pulmonary hypertension Condyloma lata: Secondary syphilis Congenital hepatic fibrosis: Polycystic kidney disease, juvenile autosomal recessive form Contraction band necrosis: MI Cotton wool spots: Hypertension Councilman bodies: Dying hepatocytes Crescents in Bowman’s capsule: Rapidly progressive (crescentic) glomerulonephritis Crushed ping-pong balls: Pneumocystis carinii Crypt abscesses: Ulcerative colitis Currant-jelly sputum: Klebsiella Curschmann’s spirals: Bronchial asthma Cystathionine synthase deficiency: Homocystinuria D-dimers: DIC Depigmentation of the substantia nigra: Parkinson’s Dew drop on a rose petal: Chicken pox Diaphragmatic pleural plaques: Asbestosis Donovan bodies: Granuloma inguinale (STD) Double bubble sign on ultrasound: Down’s Syndrome, duodenal atresia Duret hemorrhages: Uncal herniation Eburnation: Osteoarthritis (polished, ivory-like bone) Eccentric intimal fibrosis with medial hypertrophy: Chronic transplant rejection Ectopia lentis: Marfan’s Embolizing endocarditis: Infectious, or marantic (fibrin deposits in hypercoagulable states) Erythema chronicum migrans: Lyme Disease Excavation of the optic cup: Glaucoma Exophthalmos: Hyperthyroidism FAT RN (fever, anemia, thrombocytopenia, renal failure, neuro problems): TTP Fatty liver: Alcoholism Fecalith: Acute appendicitis False-positive VDRL: SLE, or Treponema pertenue (non-STD tropical infection) Ferruginous bodies: Asbestosis Fish-mouth mitral valve: Rheumatic heart disease Flea-bitten kidney: Malignant hypertension Frontal bossing: Sickle cell anemia Fungus ball in the lung: Aspergillus Galactosemia: Galactose-1-phosphate uridyl transferase deficiency, or galactokinase deficiency Garlic odor on the breath: Arsenic Ghon complex: Primary tuberculosis Gold pneumonia: Lipid pneumonia (exogenous/aspiration or endogenous/obstruction) Gower’s maneuver: Duchenne muscular dystrophy (using arms to stand) Gray discoloration of the skin: Argyria (silver poisoning) Hat size increase: Paget’s disease of bone Heart failure cells: CHF; hemosiderin-laden macrophages in the lungs Heberden’s nodes: Osteoarthritis (DIP joints) Heinz bodies: G6PD deficiency Hemarthrosis: Coagulation factor deficiency Hemorrhagic temporal lobe lesion: HSV Hemorrhagic urticaria: Henoch-Schonlein Heterophile antibodies: Infectious mononucleosis (EBV) Hirano bodies: Alzheimer’s HLA-B27: Ankylosing spondylitis Ochronosis (dark pigment of fibrous tissue): Alkaptonuria (homogentisic acid oxidase deficiency) Honeycomb lung: Pulmonary fibrosis Howell-Jolly bodies: Splenectomy; remnant of nuclear DNA H-shaped vertebrae: Sickle cell anemia Human placental lactogen increase: Placental site trophoblastic tumor Hyaline thrombi: TTP Hydrosalpinx: Chronic pelvic inflammatory disease Hypersegmented PMNs: Megaloblastic anemia Hypochromic microcytic RBCs: Iron-deficiency anemia IgM against IgG: Rheumatoid arthritis (rheumatoid factor) Decreased immunoglobulins: X-linked Bruton’s agammaglobulinemia; common variable immunodeficiency Index finger overlapping the 3rd and 4th: Edwards’ Syndrome (trisomy 18) Jarisch-Herxheimer Reaction: Over-aggressive syphilis treatment causing symptoms from rapid organism lysis Joint mice: Osteoarthritis (fractured osteophytes) Kussmaul breathing: Acidosis Keratin pearls: Squamous cell carcinoma Kernig’s sign: Meningitis Kayser-Fleischer ring: Wilson’s Disease Kimmelstiel-Wilson nodules: Diabetic nephropathy Koilocytes: HPV Koplik spots: Measles Lacunar cells: Reed-Sternberg cell variant seen in nodular sclerosing Hodgkin’s Disease Lacunar infarct: Chronic hypertension Lamellar bodies: Contain surfactant, in Type II pneumocytes Langhans giant cells: Tuberculosis and other conditions, including coccidioidomycosis Lemon-yellow skin color: Pernicious anemia Lemon sign: Ultrasonographic finding in neural tube defects Leukocoria: Retinoblastoma Lewy bodies: Parkinson’s (eosinophilic inclusions in damaged substantia nigra cells) Leukocyte alkaline phosphatase positive: Leukemoid reaction Lines of Zahn: Arterial thrombus Lisch nodules: Neurofibromatosis Loss of gray-white junction: Tuberous sclerosis Low-set ears: Down’s, DiGeorge, trisomy 18 (Edwards’) Lumpy-bumpy glomerular immunofluorescence: Poststreptococcal glomerulonephritis Machine-like murmur: Patent ductus arteriosus Macronodular cirrhosis: Wilson’s, viral hepatitis, alpha-1-antitrypsin deficiency Malignant pustule: Anthrax (black skin lesion) Mallory bodies: Alcoholic liver disease (hepatocyte cytoskeleton intermediate filaments) Maple syrup/burnt sugar urine odor: Maple syrup urine disease (alpha-ketoacid dehydrogenase deficiency) McBurney’s sign: Appendicitis (McBurney’s point: two-thirds from the umbilicus to the anterior superior iliac spine) Meconium ileus: Cystic fibrosis Mees’ lines: Arsenic (parallel lines on the fingernails) Melanosis coli: Laxative abuse Mental problems with a heart defect: Mitral valve prolapse Michaelis-Gutmann bodies: Malakoplakia Microglial nodules: HIV Micrognathia: DiGeorge Micronodular cirrhosis: Wilson’s, alcoholic, hemochromatosis, primary biliary cirrhosis Microsatellite instability: HNPCC (right-sided colon cancer), also seen in other cancers Mid-systolic click: Mitral valve prolapse Monoclonal antibody spike (M protein): Multiple myeloma; MGUS Mousy/musty odor: PKU Mucosal bleeding: Platelet problem (qualitative or quantitative) Myxedema: Hypothyroidism Necrolytic migratory erythema: Glucagonoma Negri bodies and hydrophobia: Rabies Neuritic plaques: Alzheimer’s Neurofibrillary tangles: Alzheimer’s Night pain relieved by aspirin: Osteoid osteoma Non-embolizing endocarditis: Rheumatic, or Libman-Sacks (SLE) Non-pitting edema: Myxedema; anthrax toxin Notching of the ribs: Coarctation of the aorta Nutmeg liver: CHF, right heart Onion-skin kidney arterioles: Malignant nephrosclerosis Oligoclonal bands: Multiple sclerosis Osteoid production: Osteosarcoma Painless jaundice: Pancreatic carcinoma (head) Palatal petechiae: Strep pharyngitis Palpable purpura: Hypersensitivity vasculitis (Henoch-Schonlein, serum sickness) Pancarditis: Rheumatic fever Pannus: Rheumatoid arthritis PAS-positive macrophages: Whipple’s Disease Patent ductus arteriosus: Maternal rubella, prematurity Pautrier’s microabscesses: Mycosis fungoides Periductal edema: Gynecomastia Periventricular calcifications: Congenital CMV Phenylalanine hydroxylase deficiency: PKU Philadelphia chromosome: CML Pick bodies: Pick’s Disease Piecemeal necrosis: Chronic active hepatitis Plexiform lesions: Pulmonary hypertension Pink, foamy lung exudate: Pneumocystis carinii pneumonia Pink puffer: Emphysema (centroacinar/smoking; panacinar/alpha-1-antitrypsin deficiency) Podagra: Gout (MP joint of the great toe) Porcelain gallbladder: Chronic cholecystitis Porcelain gallstones: Associated with gallbladder adenocarcinoma Port-wine stain: Hemangioma Anterior drawer sign: Tearing of the ACL Proliferating bile ducts: Obstructive jaundice Psammoma bodies: Papillary thyroid carcinoma; serous papillary cystadenocarcinoma of the ovary; meningioma; mesothelioma Pseudohypertrophy: Duchenne muscular dystrophy Pseudopolyps: Ulcerative colitis Pulmonary atherosclerosis: Cor pulmonale Punched-out bone lesions: Multiple myeloma Punched-out esophageal lesions: Herpes Rash on palms and soles: Secondary syphilis; RMSF RBC poikilocytosis: Beta-thalassemia Rectangular RBCs: Hemoglobin SC disease Red hyaline globules (liver): Alpha-1-antitrypsin deficiency Red morning urine: Paroxysmal nocturnal hemoglobinuria Reed-Sternberg cells: Hodgkin’s Disease Reid index increased: Chronic bronchitis Reinke crystals: Leydig cell tumor Rhomboid crystals: Pseudogout Rim pattern: SLE (anti-dsDNA staining pattern) Rocker-bottom feet: Patau (trisomy 13), Edwards’ (trisomy 18) Rose thorns: Sporotrichosis Rouleaux formation: Multiple myeloma (RBCs stacked like poker chips) Rugae loss: Pernicious anemia (atrophic gastritis) S3 heart sound: Left-to-right shunt (VSD, PDA), mitral regurgitation, LV failure S4 heart sound: Pulmonary stenosis, pulmonary hypertension Scalloped colloid: Grave’s Disease Schwartzman reaction: Neisseria meningitidis Shagreen patches: Tuberous sclerosis Simian crease: Down’s Syndrome Smith antigen: SLE (also anti-dsDNA) Smudge cells: CLL Soap bubble appearance on X-ray: Giant cell tumor of bone Soldier’s plaque: Insignificant remnant of healed pericarditis Spider telangiectasia: Hyperestrinism (liver failure, pregnancy) Spike-and-dome glomeruli: Membranous glomerulonephritis Splinter hemorrhages: Infective endocarditis Strawberry tongue: Scarlet fever, Kawasaki’s Strawberry cervix: Trichomonas vaginalis Strawberry gallbladder: Cholesterolosis String sign on X-ray: Crohn’s (bowel wall thickening) Sugar icing on the spleen: Portal hypertension Sulfur granules: Actinomyces or Nocardia collections Swiss cheese brain: Clostridia (gas-forming) Syncytia: RSV, measles Tamm-Horsfall protein: Hyaline casts (non-specific) Target cells: Thalassemia Teardrop RBCs: Myelofibrosis Temporal lobe encephalitis: Herpes Tendinous xanthomas: Familial hypercholesterolemia Tethered cord: Arnold-Chiari malformation Tetrahydrobiopterin cofactor deficiency: PKU Thymidine dimers: Xeroderma pigmentosum Thymus and parathyroid agenesis: DiGeorge (3rd and 4th pharyngeal pouch) Thyroidization of the kidney: Chronic pyelonephritis TIBC increase: Original source lists this under “anemia of chronic disease” — worth double-checking, since standard teaching is that TIBC increases in iron-deficiency anemia and decreases in anemia of chronic disease. Tingible body macrophages: Lymph node germinal centers Tophi: Gout Tram-track glomeruli: Membranoproliferative glomerulonephritis Tree bark aorta: Syphilis Trousseau’s sign: Two distinct meanings — visceral cancer, classically pancreatic (migratory thrombophlebitis); and hypocalcemia (carpal spasm). Same name, unrelated conditions. TSI greater than TGI: Grave’s TGI greater than TSI: Hashimoto’s Tyrosinase deficiency: Albinism Virchow’s node: Supraclavicular node enlargement from metastatic gastric carcinoma VMA and metanephrines in urine: Pheochromocytoma Warthin-Finkeldey giant cells: Measles Water-hammer pulse: Aortic regurgitation WBC casts: Pyelonephritis White matter petechiae: Fat emboli Winged scapula: Long thoracic nerve damage (common after radical mastectomy) Wire loop glomeruli: Lupus nephropathy, type IV Wrinkled glomerular basement membrane: Ischemia Increased AFP in amniotic fluid/maternal serum: Spina bifida, anencephaly Increased uric acid: Gout, Lesch-Nyhan, myeloproliferative disorders, loop/thiazide diuretics Decreased FEV1/FVC: COPD Decreased glucose, increased protein in CSF: Bacterial meningitis (corrected from the original, which appeared to have dropped the up/down arrow symbols) Increased dopamine receptors: Schizophrenia Decreased dopamine (receptors/neurons): Parkinson’s

Most Common…

Tumor arising from bone in adults: Multiple myeloma Adrenal medullary tumor, adults: Pheochromocytoma Adrenal medullary tumor, children: Neuroblastoma Arteries of stroke: Lateral striate arteries Bacterial meningitis, adults: Neisseria meningitidis Bacterial meningitis, elderly: Strep pneumoniae Bacterial meningitis, newborns: E. coli Bacterial meningitis, toddlers: H. influenzae B-cell defect (genetic): Isolated IgA deficiency Bone tumors overall: Metastases from breast and prostate Brain tumor, child: Medulloblastoma Brain tumor, adult: Astrocytoma (including glioblastoma multiforme), then metastases, meningioma, schwannoma Breast carcinoma: Invasive ductal carcinoma Breast mass: Fibrocystic change (carcinoma most common in postmenopausal women) Bug in acute endocarditis: Staph aureus Bug in debilitated, hospitalized pneumonia patients: Klebsiella Bug in epiglottitis: H. influenzae Bug in the GI tract: Bacteroides (then E. coli) Bug in IV drug user bacteremia/pneumonia: Staph aureus Bug in PID: N. gonorrhoeae Bug in subacute endocarditis: Strep viridans Primary cardiac tumor, adults: Myxoma Primary cardiac tumor, children: Rhabdomyoma Cardiac tumor, adults overall: Metastases Cardiomyopathy: Dilated (congestive) Carpal bone fractured: Scaphoid Cause of secondary hypertension: Renal disease Cause of Addison’s: Autoimmune (then infection) Cause of congenital adrenal hyperplasia: 21-hydroxylase deficiency (then 11-hydroxylase) Cause of Cushing’s: Exogenous steroid therapy (then primary ACTH excess, adrenal adenoma, ectopic ACTH) Cause of death in Alzheimer’s patients: Pneumonia Cause of death in amyloidosis: Chronic renal failure Cause of death in diabetics: MI Cause of death in SLE patients: Lupus nephropathy type IV Cause of dementia: Alzheimer’s Cause of dementia, second most common: Multi-infarct dementia Cause of food poisoning: Staph aureus Cause of mental retardation: Down’s Cause of mental retardation, second most common: Fragile X Cause of preventable blindness: Chlamydia Cause of pulmonary hypertension: COPD Cause of SIADH: Small cell lung carcinoma Chromosomal disorder: Down’s Congenital cardiac anomaly: VSD Congenital cause of early cyanosis: Tetralogy of Fallot Coronary artery thrombosis: LAD Demyelinating disease: Multiple sclerosis Dietary deficiency: Iron Disseminated opportunistic infection in AIDS: CMV (Pneumocystis carinii most common overall) Esophageal cancer: Squamous cell carcinoma Fatal genetic defect in Caucasians: Cystic fibrosis Female tumor: Leiomyoma Form of amyloidosis: Immunologic (Bence Jones/amyloid light chain in multiple myeloma) Form of tularemia: Ulceroglandular Gynecologic malignancy: Endometrial carcinoma Heart murmur: Mitral valve prolapse Heart problem in AIDS: Pericarditis Heart tumor in adults: Myxoma Heart tumor in kids: Rhabdomyoma Heart valve in bacterial endocarditis: Mitral Heart valve in bacterial endocarditis, IV drug users: Tricuspid Heart valve involved in rheumatic fever: Mitral, then aortic Hereditary bleeding disorder: von Willebrand’s Disease Primary liver tumor: Hepatoma (in women on oral contraceptives) Liver disease: Alcoholic liver disease Location of adult brain tumors: Above the tentorium Location of childhood brain tumors: Below the tentorium Location of GI tuberculosis: Ileocecal Lysosomal storage disease: Gaucher’s Motor neuron disease: ALS Myocarditis cause: Coxsackie B Neoplasm, child: Leukemia Neoplasm, child (2nd most common): Medulloblastoma Nephrotic syndrome: Membranous glomerulonephritis Opportunistic infection in AIDS: PCP Osteomyelitis in IV drug users: Pseudomonas Osteomyelitis in sickle cell disease: Salmonella Ovarian malignancy: Serous cystadenocarcinoma Benign ovarian tumor overall: Original source lists “Hamartoma” here — worth double-checking against a current source; dermoid cyst (mature cystic teratoma) is the more commonly taught answer. Pancreatic tumor: Adenocarcinoma (usually head) Typical age groups: ALL in children, CLL in adults over 60, AML in adults over 60, CML in adults 35-50 Patient with Goodpasture’s: Young male Patient with Reiter’s: Male Pituitary tumor: Prolactinoma (then somatotropic “acidophilic” adenoma) Primary hyperparathyroidism cause: Adenoma (then hyperplasia, then carcinoma) Patient with Hodgkin’s: Young male (except nodular sclerosing type, more common in females) Patient with minimal change disease: Young child Secondary hyperparathyroidism cause: Hypocalcemia of chronic renal failure Sexually transmitted disease: Chlamydia Site of diverticula: Sigmoid colon Site of metastasis: Regional lymph nodes Site of metastasis, 2nd most common: Liver Sites of atherosclerosis (in order): Abdominal aorta > coronary > popliteal > carotid Skin cancer: Basal cell carcinoma Stomach cancer: Adenocarcinoma Testicular tumor: Seminoma Thyroid cancer: Papillary carcinoma Tracheoesophageal fistula: Lower esophagus joins the trachea; upper esophagus ends in a blind pouch Tumor of infancy: Hemangioma Type of Hodgkin’s: Mixed cellularity Type of non-Hodgkin’s: Follicular, small cleaved cell Vasculitis of medium/small arteries: Temporal arteritis Viral encephalitis: HSV Worm infection in the US: Pinworm (then Ascaris)

Signature Drug Toxicities

Agranulocytosis: Clozapine Aplastic anemia: Chloramphenicol, NSAIDs, benzene Arrhythmia: Tricyclic antidepressants (wide QRS); cardiac glycosides, especially with hypokalemia Atropine-like side effects: Tricyclics Blindness: Methanol (formic acid) Cardiotoxicity: Doxorubicin, daunorubicin Cartilage damage in children: Fluoroquinolones (ciprofloxacin, norfloxacin) Cinchonism: Quinidine Cough: ACE inhibitors Diabetes insipidus: Lithium Disulfiram-like effect: Metronidazole; first-generation sulfonylureas Extrapyramidal side effects: Antipsychotics (thioridazine, haloperidol, chlorpromazine) Fanconi’s Syndrome: Tetracycline Fatal hepatotoxicity (necrosis): Valproic acid, halothane, acetaminophen Gingival hyperplasia: Phenytoin Gray baby syndrome: Chloramphenicol Gynecomastia: Cimetidine, azoles, spironolactone, digitalis Hemolytic anemia in G6PD deficiency: Sulfonamides, isoniazid, aspirin, ibuprofen, primaquine Hepatitis: Isoniazid Hepatocellular carcinoma: Polyvinyl chloride, aflatoxins Hot flashes, flushing: Niacin, tamoxifen, calcium channel blockers Induces cytochrome P450: Barbiturates, phenytoin, carbamazepine, rifampin Inhibits cytochrome P450: Cimetidine, ketoconazole Interstitial nephritis: Methicillin, NSAIDs (except aspirin), furosemide, sulfonamides Lupus-like syndrome: Procainamide, hydralazine Malignant hyperthermia: Succinylcholine, halothane “Monday Disease”: Nitroglycerin; industrial exposure builds tolerance during the week, lost over the weekend, causing headache, tachycardia, and dizziness on re-exposure Neuroleptic malignant syndrome: Haloperidol Orange body fluids: Rifampin Osteoporosis: Heparin, corticosteroids Positive Coombs’ test: Methyldopa Pulmonary fibrosis: Bleomycin, amiodarone Red man syndrome: Vancomycin Severe hypertension with tyramine: MAOIs Tardive dyskinesia: Antipsychotics (thioridazine, haloperidol, chlorpromazine) Tinnitus: Aspirin, quinidine Torsades de pointes: Quinidine Vaginal adenosis and clear cell carcinoma: DES

Miscellaneous

Fastest growing tumor: Burkitt’s
Pulmonary emboli are found in roughly half of all autopsies
Courvoisier’s Law: tumors obstructing the common bile duct cause an enlarged, palpable gallbladder; obstructing gallstones typically do not, due to scarring
Only DNA virus to replicate in the cytoplasm: poxvirus
Only RNA virus to replicate in the nucleus: influenza
Bacillus anthracis is the only bacterium with a protein capsule
Bordetella pertussis (whooping cough) causes lymphocytosis rather than granulocytosis
Bronchioloalveolar carcinoma grows without destroying the lung’s normal architecture
Cryptococcus neoformans often lacks a capsule and, on GMS stain, resembles Pneumocystis carinii, except that Cryptococcus lacks prominent nucleoli

History-Taking, Physical Exam & Differential Diagnosis Mnemonics

Abdominal swelling causes (“the F’s”): Fat, Feces, Fluid, Flatus, Fetus, Full-sized tumors

SOAP — patient examination organization:

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

ABCDEFGHI — vomiting, non-GI differential: Acute renal failure, Brain (increased ICP), Cardiac (inferior MI), DKA, Ears (labyrinthitis), Foreign substances (Tylenol, theophylline, etc.), Glaucoma, Hyperemesis gravidarum, Infection (pyelonephritis, meningitis)

SAMPLE — quick EMS history checklist: Signs/Symptoms, Allergies, Medications, Pertinent history, Last oral intake, Events preceding the incident

OPQRSTU — pain history checklist: Onset, Palliative factors, Quality, Region, Severity, Timing, effect on “U” (the patient’s daily life). May expand to OPPQRRSTTUVW, adding Provocative factors, Radiation, Treatments tried, Deja vu (has this happened before?), and Worry (what does the patient fear it is?)

A VITAMIN C — differential diagnosis checklist: Acquired/Congenital, Vascular, Inflammatory (infectious and non-infectious), Trauma/Toxins, Autoimmune, Metabolic, Idiopathic, Neoplastic, Congenital (example: causes of decreased vision — central retinal artery occlusion, retinitis pigmentosa, globe perforation, chronic gentamicin use, rheumatoid arthritis, diabetes, idiopathic, eye tumor, myopia)

Sign vs. symptom: A sign is something detectable even if the patient is unconscious; a symptom is something only the patient knows about.

Eye abbreviations: OU = both eyes, OD = right eye, OS = left eye. Memory aid: “you look OUt with both eyes; take the right dose so you won’t OD; the only one left is OS.”

MJ THREADS — medical history disease checklist: MI, Jaundice, Tuberculosis, Hypertension, Rheumatic fever/Rheumatoid arthritis, Epilepsy, Asthma, Diabetes, Strokes

“On Days Feeling Low Character, Run A Seven Pace Race” — pain history checklist: Onset, Duration, Frequency, Location, Character, Radiation, Severity, Precipitating factors, Relieving factors

ASK LAST — pain history checklist: Aggravating/Alleviating, Severity, Character, Location, Associated symptoms, Setting, Timing

SOCRATES — pain history checklist: Site, Onset, Character, Radiation, Alleviating factors/Associated symptoms, Timing, Exacerbating factors, Severity

FAST LQQS — symptom attributes: Factors that make it better/worse, Associated manifestations, Setting, Timing, Location, Quality, Quantity, Severity

“All Patients Take Meds” — heart valve auscultation sites (top left to bottom right): Aortic, Pulmonary, Tricuspid, Mitral (alternates: “All Prostitutes Take Money,” “APe To Man”)

“I’m A People Person” — four-point physical assessment: Inspection, Auscultation, Percussion, Palpation

“6 Students and 3 Teachers go for CAMPFIRE” — physical exam for lumps and bumps: Site, Size, Shape, Surface, Skin, Scar, Tenderness, Temperature, Transillumination, Consistency, Attachment, Mobility, Pulsation, Fluctuation, Irreducibility, Regional lymph nodes, Edge

VANISHED — surgical sieve: Vascular, Accident & trauma, Neoplastic, Inflammatory, Septic, Haematologic/Hereditary, Endocrinological, Degenerative

I VINDICATE — differential diagnosis checklist: Iatrogenic, Vascular, Infectious, Neoplastic, Degenerative/Drugs, Inflammatory/Idiopathic, Congenital, Allergic/Autoimmune, Traumatic, Endocrinal & metabolic

TIN CAN BED DIP POG — symptom sieve: Trauma, Infection, Neoplasm, Cardiac, Autoimmune, Neurological, Blood/Bone, Endocrine, Disintegration/Degeneration, Drugs, Iatrogenic/Idiopathic, Psychological, Paediatric, Obstetric, Gynaecological

LOST WAR — pain history checklist: Location, Onset, Severity, Time, Worsening factors, Alleviating factors, Radiation

RETARD HEIGHT — short stature causes: Rickets, Endocrine (cretinism, hypopituitarism, Cushing’s), Turner syndrome, Achondroplasia, Respiratory (suppurative lung disease), Down syndrome, Hereditary, Environmental (post-irradiation, post-infectious), IUGR, GI (malabsorption), Heart (congenital heart disease), Tilted backbone (scoliosis)

“PEBbles” — auscultation of crackles (rales): Pneumonia, Edema of the lung, Bronchitis

CHLORIDE — pain history checklist: Character, Location, Onset, Radiation, Intensity, Duration, Events (associated factors)

CIMETIDINE — differential diagnosis: Congenital, Infection/Inflammatory, Metabolic, Endocrine, Trauma, Iatrogenic, Degenerative, Idiopathic, Neoplastic, Everything else

Sign vs. symptom (memory aid): “I saw the sign” — the physician sees the signs, while only the patient experiences the symptoms.

I PUNCH EAR — systems review checklist: Integumentary, Pulmonary, Urogenital, Nervous, Cardiovascular, Hematolymphoid, Endocrine, Alimentary, Reproductive

MR. C T FARADS — pain history checklist: Main site, Radiation, Character, Timing, Frequency, Associated factors, Relieving factors, Aggravating factors, Duration, Severity

DR. GERM — abdomen assessment (palpate all 4 quadrants): Distension, Rigidity (board-like), Guarding, Evisceration/Ecchymosis, Rebound tenderness, Masses

CLITORIS — pain history checklist: Character, Location, Intensity, Timing, Onset, Radiating, Irritating/relieving factors, Symptoms associated

VAMP THIS — past medical history: Vices (tobacco, alcohol, other drugs, sexual risk), Allergies, Medications, Preexisting conditions, Trauma, Hospitalizations, Immunizations, Surgeries

LADDERS — patient profile: Living situation/Lifestyle, Anxiety, Depression, Daily activities, Environmental risks/Exposure, Relationships, Support system/Stress

BALD CHASM — family history: Blood pressure (high), Arthritis, Lung disease, Diabetes, Cancer, Heart disease, Alcoholism, Stroke, Mental health disorders

DIRECTION — differential diagnosis checklist: Drugs, Infection, Rheumatologic, Endocrine, Cardiovascular, Trauma, Inflammatory, Other, Neoplasm

NIT DIT FIT — pathologic classification: Neoplastic, Infectious, Traumatic, Degenerative/Drugs, Immune, Toxic, Vascular, Inflammatory, Totally obscure

SIT ON FRAD — pyrexia of unknown origin history: Sexual history, Immunisation status, Travel history, Occupational history, Nutrition, Family history, Recreational habits, Animal contacts, Drug history

“Healthy SEEDS” — health-related behavior history: Substances (alcohol, tobacco, IV drugs), Environment (hazards at home/work, feeling safe), Exercise, Diet, Sex (partners, safety, STD history, difficulties, history of abuse)

LMNOP — breast history checklist: Lump, Mammary changes, Nipple changes, Other symptoms, Patient risk factors

COLDER BARS — pain history checklist: Character, Onset, Location, Duration, Exacerbating factors, Radiation, Before (happened previously?), Associated symptoms, Relieving factors, Severity

SO CRAP — pain history checklist: Site, Onset, Character, Radiates to, Associated symptoms/Alleviating and exacerbating factors, Periodicity

Q LSD MCAT — history components for E&M coding: Quality, Location, Severity, Duration, Modifying factors, Context, Associated signs and symptoms, Timing

INVESTIGATIONS — surgical sieve for diagnostic categories: Iatrogenic, Neoplastic, Vascular, Endocrine, Structural/Mechanical, Traumatic, Inflammatory, Genetic/Congenital, Autoimmune, Toxic, Infective, Old age/Degenerative, Nutritional, Spontaneous/Idiopathic

“Assessed Mental State To Be Positively Clinically Unremarkable” — mental state examination stages: Appearance and behaviour, Mood, Speech, Thinking, Behavioural abnormalities, Perception abnormalities, Cognition, Understanding of condition

Branham sign: Bradycardia after compression or excision of a large AV fistula

Glasgow Coma Scale: Three response categories — Visual, Verbal, Motor — scored out of 4, 5, and 6 respectively

Meckel’s Diverticulum, rule of 2’s: 2 inches long, 2 feet from the ileocecal valve, in 2% of the population, commonly presenting in the first 2 years of life, and may contain 2 types of ectopic epithelial tissue

Pheochromocytoma, rule of 10’s: 10% malignant, 10% bilateral, 10% extra-adrenal, 10% calcified, 10% in children, 10% familial (discussed far more often than actually seen in practice)

Aphasia memory aid: “BROKen aphasia” for Broca’s aphasia (broken speech); “Wordys aphasia” for Wernicke’s aphasia (wordy, but making no sense)

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