Internal medicine: Memory aids for Usmle exams

[b]Symptoms of hyperthyroidism [/b]? Remember the following mnemonic when evaluating patients for hyperthyroidism:
S : Sweating
T : Tremor or Tachycardia
I : Intolerance to heat, Irregular menstruation, and Irritability N : Nervousness G : Goiter and Gastrointestinal (loose stools/diarrhea). [b]CUSHING'S [/b]
? DISEASE is
? Dependent on (Pituitary) and
? Depresses ( Cortisol) on
? Daddy Doses of Dexa(High doses of Dexamethasone). [b]Hypercalcemia[/b]
"SHAMPOO DIRT"
S - Sarcoidosis
H - Hyperparathypoidism, Hyperthyroidism
A - Alkali-milk syndrome
M - Metastases, myeloma
P - Paget disease
O - Osteogenesis imperfecta
O - Osteoporosis
D - Vitamin intoxication
I - Immobility
R - RTA
T - Thiazides Hypercalcemia symptoms are Bones (pain), Stones (renal), abdominal Groans (pain) and psychic moans (confusion). [b]Multiple endocrine neoplasia[/b]
MEN I is 3 P's (Pituitary, Parathyroid, Pancreas). MEN II is 2 C's (Catecholamines ie. pheochromocytome, carcinoma of medulla of thyroid) and Parathyroid (IIa) or Mucocutaneous neuromas (IIb). The most common thyroid carcinoma is P-apillary (P-opular). It also has P-sammona bodies on histology. It causes P-alpable lymph nodes (lymphatic spread). The most common symptoms of PHEochromocytoma begin with the first 3 letters - Palpitations, Headache, Episodic diaphoresis (sweating). [b]Tumors that go to bone[/b]
[i]"Kinds Of Tumors Leaping Primarily To Bone" [/i]
K - Kidney
O - Ovarian
T - Testicular
L - Lung
P - Prostate
T - Thyroid
B - Breast Causes of joint pain are SOFTER TISSUE - Sepsis, Osteoarthritis, Fractures, Tendon/muscle, Epiphyseal, Referred, Tumour, Ischaemia, Seropositive arthritides, Seronegative arthritides, Urate, Extra-articular rheumatism (eg. polymyalgia). [b]Ossification centers of the elbow[/b] There are two that I know of (most people use "CRITOE"):
C - Capitellum
R - Radial head
I - Internal (medial epicondyle)
T - Trochlea
O - Olecranon
E - External (lateral epicondyle)
These appear at 2, 4, 6, 8, 10, and 12 years of age in order and go away two years later.
The other mnemonic I know for the ossification centers is "Come Rub My Tree Of Love" where the "M" is medial epicondyle and the "L" is the lateral epicondyle. [b]Wrist Bones[/b]
"Never Loosen Tillies Pants, Mother Might Come Home"
Proximal row:
N - Navicular
L - Lunate
T - Triquetrium
P - Pisiform
Distal row:
M - greater Multiangular (trapezium)
M - lesser Multiangular (trapezoid)
C - Capitate
H - Hamate
Also: "Some Lovers Try Positions That They Can't Handle" [b]Rotator Cuff Muscles[/b]
"SITS"
S - Supraspinatus
I - Infraspinatus
T - Teres minor
S - Subscapularis [b]The Salter Classification: [/b]
"SALTR"
S - Slip of physis
A - Above physis
L - Lower than physis
T - Through physis
R - Rammed physis

[b]Sarcoidosis: [/b] [b]SARCOIDOSIS: G-E-R-M-A-N ACE "SCHAUMANN" B-O-E-K[/b] G-Granulomas
E-Erythema nodosum
R-Restrictive lung defect (PFTs)
M-Multiple systemic manifestations
A-Asteroid bodies (inclusions)
N-Noncaseating granuloma, Negative TB test ACE - Angiotensin converting enzyme levels monitor disease activity and response to therapy. Schaumann's bodies (inclusions) B-Bell's palsy, Bilateral hilar lymphadenopathy, Black females O-Optic nerve dysfunction is a common manifestation of neurosarcoid.
E-Eyes: uveitis
K-Kveim skin test [b]Rat Poisons[/b]
"RATS PANIC" I'm sure that you'll easily remember this one!
R - Red squill
A - Arsenicals
T - Thallium
S - Strychnine
P - PNU/Phosphorus/zn Phosphide
A - Alpha naphtha thiurea (ANTU)
N - Norbormide
I - Indanediones
C - Coumadin/cholcalciferol [b]Anion Gap Acidosis: [/b]
"Mudpiles"
M - Methanol
U - Uremia
D - DKA/AKA
P - Paraldehyde/phenformin
I - Iron/INH
L - Lactic acidosis
E - Ethylene glycol
S - Salicylates [b]Normal Gap Acidosis[/b]
"HARDUP"
H - Hyperalimentation/hyperventilation
A - Acetazolamide
R - RTA
D - Diarrhea
U - Ureteral diversion
P - Pancreatic fistula/parenteral saline [b]Osmolar Gaps[/b]
"ME DIE"
M - Methanol
E - Ethanol
D - Diuretics (mannitol, sorbitol, glycerol)
I - Isopropanol
E - Ethylene glycol [b]Respiratory Alkalosis: Asthmatic Sally poisoned POPE's HEN [/b]
? Asthma
? Salicylate poisoning
? PO= Pulmonary Oedema
? PE= Pulmonary Embolism
? HEN= Hepatic Encephalopathy [b]Hypoglycemia[/b]
"Reexplain"
R - renal failure
EX - exogenous
P - pituitary
L - liver failure
A - alcohol
I - insulinoma/infection
N - neoplasm [b]Hypoglycemia [/b] Hypoglycemia - H-U-N-G-E-R: B-E-S-T S-A-U-C-E I-S M-S-G H-Hepatic failure (advanced), Hypothermia
U-Uremia/renal failure
N-Nausea, vomiting
G-Growth hormone deficiency
E-Ethanol metabolism blunts gluconeogenesis
R-Reye's syndrome B-Beta blockers
E-Enzyme defects (glycogen storage diseases)
S-Sepsis
T-Tumors: Islet beta cell tumors (pancreatic): Insulinomas
Non-islet cell tumors: Large mesenchymal tumors S-Sulfonylureas
A-Adrenal insufficiency
U-Under 0.3 (insulin/glucose ratio) to make the diagnosis C-C-peptide measurement to rule out factitious hypoglycemia
E-Endocrine: Epinephrine, glucagon deficiencies (counterregulatory hormone deficiencies) I-Immune disease with insulin or insulin receptor antibodies
S-Sarcomas: large retroperitoneal sarcomas M-Maple syrup urine disease, severe Malaria
S-Salicylates in children
G-Galactosemia (with milk ingestion), disorders of Gluconeogenesis

(Cot)Caught by Sin : Cotton? BySSinosis Shortness of Breath [b]HAPISOCS[/b] H: History of any pulmonary disease
A: Activity at onset
P: Pain upon inspiration
I: Infections fever/chills
S: Smoker years/packs
O: Orthopnea
C: Cough (Persistent)
S: Sputum Productive/color
Submitted by medmanRRT@aol.com [b]Non-Cardiogenic Pulmonary Edema
"PONS" [/b]
P - Phosgene, paraquat, phenothiazines
O - Opioids/organophosphates
N - Nitrous dioxide
S - Salicylates [b]Treatment of acute pulmonary edema[/b]
As Easy as 'LMNOP' : Remember the mnemonic LMNOP when treating a patient with acute pulmonary edema
? Lasix?? (furosemide) intravenous (IV), one to two times the patient's usual dose, or 40 mg if the patient does not usually take the drug.
? Morphine sulfate. Initial dose, 4 to 8 mg IV (subcutaneous administration is effective in milder cases); may repeat in 2 to 4 hours. Avoid respiratory depression. Morphine increases venous capacity, lowering left atrial pressure, and relieves anxiety, which reduces the efficiency of ventilation.
? Nitroglycerin IV, 5 to 10 ug/min. Increase by 5 ug/min q 3 to 5 minutes. Reduces left ventricular preload. Caution: may cause hypotension.
? Oxygen, 100% given to obtain an arterial PO2>60 mm Hg.
? Position patient sitting up with legs dangling over the side of the bed. This facilitates respiration and reduces venous return. Beta-1 receptors are in the heart (you have 1 heart) and beta-2 receptors are in the lungs (you have 2 lungs). [b]Decreased Pleural fluid Glucose : "IRAN" [/b]
? I=Infections
? RA=Rheumatoid arthritis
? N=Neoplasia [b]Anterior Mediastinal Mass
"4 T's" [/b]
T - Thymoma
T - Teratoma
T - Thyroid tumor/goiter
T - Terrible lymphoma [b]Middle Mediastinal Mass
"Habit5" [/b]
H - Hhernia, hematoma
A - Aneurysm
B - Bronchogenic cyst/duplication cyst
I - Inflammation (sarcoid, histo, coccidio, TB)
T5 - Tumors (lung, lymphoma, leukemia, leiomyoma, lymph node hyperplasia) [b]Bilateral Hilar Adenopathy
"Please Helen Lick My Popsicle Stick"[/b]
P - Primary TB
H - Histoplasmosis
L - Lymphoma
M - Metastases
P - Pneumoconiosis
S - Sarcoidosis

95% of hypertension is primary (idiopathic). 5% is secondary and causes include CHAPS - Cushing's syndrome, Hyperaldosteronism (Conn's syndrome) , Aorta coarctation, Pheochromocytoma, Stenosis of the renal arteries. Takayasu's disease is also called pulseless disease, therefore I can't Tak'a ya's pulse. [b]Henoch-Schonlein Purpura
"JARS" [/b]
J - Joints
A - Abdominal pain
R - Renal
S - Skin Compartment Syndrome "6 p's"
pulselessness
pain
pallor
parasthesia
poikiolothermia
paralysis [b]Predisposing Conditions for Pulmonary Embolism TOM SCHREPFER [/b]? T--trauma
? O--obesity
? M--malignancy
? S--surgery
? C--cardiac disease
? H--hospitalization
? R--rest (bed-bound)
? E--estrogen, pregnancy, post-partum
? P--past hx
? F--fracture
? E--elderly
? R--road trip

[b]Mnemonic for remembering antiarrhythmics [/b] Class Drug Mnemonic Read as: Professor Quackers "dissed" - Lydia's penny Mexican tacos. - Feeling profaned, - proper Bertha Butt - (amiable British socialite) - virtually dismembered 'im. or Professor Quackers dissed Lydia's Penny Mexican Tacos. Feeling profaned, proper Bertha Butt, (amiable British socialite), virtually dismembered 'im.*Note: "Dissed" is used here as the slang term "dis" - from dismiss. I.e., "Don't 'dis' me, man!"
Class IA Procainamide Professor
Quinidine Quackers
Disopyramide "dissed" *
Class IB Lidocaine Lydia's
Phenytoin penny
Mexiletine Mexican
Tocainide Tacos
Class IC Flecainide feeling
Propafenone profaned
Class II Propranolol proper
Beta Blockers Bertha Butt
Class III Amiodarone amiable
Bretylium British
Solatol socialite
Class IV Verapamil virtually
Diltiazem dismembered 'im
Atropine
Adenosine [b]Endocarditis[/b]"FAME"
F - FEVER
A - ANEMIA
M - MURMUR
E - ENDOCARDITIS [b]Causes of pericarditis are CARDIAC RIND[/b] - Collagen vascular disease, Aortic aneurysm, Radiation, Drugs eg. hydralazine, Infections, Acute renal failure, Cardiac infarction, Rheumatic fever, Injury, Neoplasms, Dressler's syndrome. [b]5 T's of early cyanosis in congenital heart disease [/b]?Tetralogy, Transposition, Truncus, Total anomalous, Tricuspid atresia

[b]Physical findings[/b] Loud, harsh, systolic ejection murmur at the upper right sternal border, usually
associated with a palpable systolic thrill. Arthur Shawcross is a Base [Basal] Thrill-murderer [Thrill].
He is a Harsh Hardened criminal, who attributed his grotesque actions to
incest with his Sister [Systolic]. S4 gallop is common and represents left ventricular hypertrophy and increased
left ventricular pressure.
His ghoulish tales read like the Four [S4] Horsemen of the Apocalypse. S3 when left ventricular failure is present.
As a child, AS displayed the classic homicidal Triad [S3]: animal torture,
fire-setting, and bed-wetting. Delayed upstroke in the carotid pulse. Parvus et tardus carotid pulse.
His last victim still had a Small but palpable pulse. However, the ambulance was
Delayed [upstroke], and, it soon became too Little, too Late [Parvus et Tardus]. Paradoxical splitting of S2
AS sent his victims to Paradise [Paradoxical]. Apical Diastolic Murmur: Mitral Stenosis (MS) -The mnemonic key is MicroSoft (MS), a key which immediately follows the symbol. -Physical findings: The thrill at the apex is the diastolic murmur.
>> Hopeful applicants at the Apex of their careers are Thrilled to be hired by
MicroSoft. The left ventricle (LV) is of normal pressure and size, so the point of maximum impulse
is not displaced to the left.
>> MS owns a Healthy Windows [Vented: Normal LV] environment, and is Not willing
to be Displaced from its location. High-pitched opening snap [OS] following S2, heard best between the second to
fourth left intercostal space.
>> The new Windows98 Operating System [OS] sold at a High-pitched pace. S1 is loud and snapping.
>> MicroSoft 1-sound is Bill Gates [S1], who barks out Loud Snapping orders. -Chest x-ray: Kerley B lines (dilated interlobular septa or septal edema) are horizontal, nonbranching
lines at the peripheral lower lung fields.
>> The Curly-haired [Kerley B lines] computer geek... The large left atrium straightens the left heart border and is suggested by a double
density right-heart border, by the posterior displacement of the esophagus, and
by an elevated left mainstem bronchus.
>> ...stole Double Density [CXR] diskettes to be sold in Los Angeles [large LA]. -Catheterization: The left atrial (LA) pressure pulse reveals a prominent "a wave (LA contraction
against the mitral valve).
>> Those trying to enter the ranks of MS had to show Prominent A grades ["a wave]
at the Apex [Apical diastolic murmur] of their class. Symptoms of aortic stenosis are SAD or ASD - Syncope, Angina, Dyspnea. For Causes of A-Fib/Flutter H = cHf, other cardiomyopathies
E = Enlargement of the atria
A = Alcohol binge drinking
R = Rheumatic heart disease
T = hyperThyroid Asystole
"3 Hypo's & 3 Hyper's"
Hypoxia
Hypothermia
Hypokalemia
Hyperkalemia
Hyper H (Acidosis)
Hyper Rx (Drugs/OD)
Submitted by Tag Filley, M.D. Syncope
"HEAD, HEART and VESS'LS"
H - hypoglycemia hypoxia
E - epilepsy
A - anxiety [the "swoon"]
D - dysfunction of brain stem [i.e. brain stem TIA]
H - heart attack
E - embolism of pulmonary artery
A - aortic obstruction [ Aortic stenosis, myxoma, IHSS ]
R - rhythm disturbance
T - tachycardia esp VT
V - vasovagal
E - ectopic i.e. hemorrhage obvious or not
S - situational [micturation, defecation...]
S - subclavial steal
L - low SVR [eg: anaphalaxis]
S - sensitive carotid sinus
of M.I. is BOOMAR - Bed rest, Oxygen, Opiate, Monitor, Anticoagulate, Reduce clot size Proven MI.. should be met by M.O.N.A. M = morphine
O = oxygen
N = nitrates
A = aspirin suspected right ventricular MI suspected .. hold the Nitrates.

[b]Extraintestinal manifestations of I. B. D. are [/b] [i]A PIE SAC - [/i] Aphthous ulcers, Pyoderma gangrenosum, Iritis, Erythema nodosum, Sclerosing cholangitis, Arthritis, clubbing. Which I. B. D. has C-obblestones on endoscopy - C-rohn's. [b]Acute Rheumatic Fever[/b] There are several for the major cri
teria, I use "JONES"
J - Joints
O - Obvious (cardiac) - sorry, I know this is kinda weak
N - Nodules (subcutaneous nodules)
E - Erythema marginatum
S - Syndeham's Chorea [b]Causes of ST Elevation[/b] [i]"ELEVATION" [/i]
E - Electrolytes
L - LBBB
E - Early Repolarization
V - Ventricular hypertrophy
A - Aneurysm
T - Treatment - Pericardiocentesis
I - Injury (AMI, contusion)
O - Osborne waves (hypothermia)
N - Non-occlusive vasospasm Hyperkalamia causes large T waves on the ECG, Hypokalaemia causes small ones - ie. large pot - lots of tea, small pot - no tea. If QRS complex is wide, consider bundle branch block. LBBB causes a "W" pattern in V1-2 and a "M" pattern in V5-6. RBBB is the other way round. Remember as WiLLiaM MaRRoW. Elevation of cardiac enzymes after a M.I. is CPK, then AST, then LDH. Remember as - C AST Le. Basal Systolic Murmur: Aortic Stenosis (AS)
-The mnemonic key is Arthur Shawcross (AS), a cannibalistic murderer, a key which immediately follows the symbol. -Clinical: Angina pectoris despite normal coronary arteries
Arthur Shawcross represents the Angel of death [Angina]. Exertional syncope
His victims Swooned [Syncope] with fear when they saw him. Exertional dyspnea of congestive heart failure
Arthur Shawcross claims he left the crime scenes whistling Dixie [Dyspnea]. Sudden cardiac death
Arthur Shawcross causes Sudden Death.

[b]Small Bowel Obstruction[/b]
[i]"SHAVIT" [/i]
S - Stone (gallstone ileus)
H - Hernia
A - Adhesions
V - Volvulus
I - Intussusception
T - Tumor [b]Non-GI Causes of Vomiting [/b]
ABC's of Non- GI causes of vomiting
Acute renal failure
Brain (Increased ICP)
Cardiac (Inferior MI)
DKA
Ears (labyrinthitis)
Foreign substances (Tylenol, theo, etc)
Glaucoma
Hyperemesis Gravidarum
Infections (pyelonephritis, meningitis)