CLINICAL MNEMONICS

· CAUSES OF ACUTE PANCREATITIS:

“GET SMASH’D”
Gallstones, Ethanol, Trauma, Steroids, Mumps, Autoimmune(PAN),
Scorpion bites, Hyperlipidemia, Drugs(azathioprine, diuretics)
· A-P-G-A-R:
A - appearance (color)
P - pulse (heart rate)
G - grimmace (reflex, irritability)
A - activity (muscle tone)
R - respiratory effort
· Multiple Endocrine Neoplasia: Each of the MENs is a disease of
three or two letters plus a feature.
MEN I is a disease of 3 P’s (pituitary, parathyroid, and pancreas) plus
adrenal cortex
MEN II is a disease of 2 C’s(carcinoma of thyroid and catacholamines
[pheochromocytoma]) plus parathyroid for MEN IIa or
mucocutaneous neuromas for MEN IIB(aka MEN III)
· Acute pneumonia caused by Pyogenic bacteria—PMN infiltrate
· Acute pneumonia caused by Miscellaneous microbes—
Mononuclear infiltrate
· Takayasu’s diz = pulseless diz, therefore when you have
Takayasu’s, I can’t Tak’a yu pulse.
· 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 to have a drink in the morning for an
EYE OPENER?
· P-Q-R-S-T—eliciting and HPI and exploring symptoms
P—palliative or provocative factors for the pain
Q—quality of pain(burning, stabbing, aching, etc.)
R—region of body affected
S—severity of pain(usually 1-10 scale)
T—timing of pain(eg.-after meals, in the morning, etc.)
· A-S-C-L-A-S-T—eliciting and HPI and exploring symptoms
A—aggravatiing and alleviating factors
S—severity
C—character, quality
L—location
A—associated sx
S—setting
T—timing
note: ASCLAST means let the patient talk first, then ask him/her
specific questions
· Argyll-Robertson Pupil—syphilitic pupil: Accommodation reflex
present, Pupillary reflex absent due to damage at pretectal area.
Also called the “prostitute’s pupil” (accommodates but does not
react).
· The five W’s—post-operative fever
Wind—pneumonia, atelectasis
Wound—wound infections
Water—urinary tract infection
Walking—walking can help reduce deep vein thromboses and
pulmonary embolus
Wonderdrugs—especially anesthesia
· Predisposing Conditions for Pulmonary Embolism: TOM SCHREPFER
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
· ARTERIAL OCCLUSION:
pain
pallor
pulselessness
paresthesias
· HYPERSENSITIVITY REACTIONS: “Anna Cycled Immediately
Downhill—Gell & Goombs” or “ACID.”
Type I Anaphylaxis
Type II Cytotoxic-mediated
Type III Immune-complex
Type IV Delayed hypersensitivity
· WBC Count: “Never Let Mom Eat Beans” and “60, 30, 6, 3, 1”
Neutrophils 60%
Lymphocytes 30%
Monocytes 6%
Eosinophils 3%
Basophils 1:
Clinical - Free Association
Proud Dead Guys and Other Diseases
Addison’s Disease • primary adrenocortical deficiency Addisonian
Anemia • pernicious anemia (antibodies to intrinsic factor or parietal
cells → ↓IF → ↓Vit B12 → 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
hippocampus and cortex, ↓ Acetylcholine, Hiramo bodies
(inrtacellular inclusion bodies in hippocampal cells) Argyll-Robertson
Pupil • loss of light reflex constriction (contralateral or bilateral) •
“Prostitute’s Eye” - accommodates but does not react •
Pathognomonic for 3°Syphilis Arnold-Chiari Malformation • cerebellar
tonsil herniation Barrett’s • columnar metaplasia of lower esophagus
(* risk of adenocarcinoma)
Bartter’s Syndrome • hyperreninemia Becker’s Muscular Dystrophy •
similar to Duchenne, but less severe (deficiency in dystrophin
protein) Bell’s Palsy • CNVII palsy (entire face; recall that UMN lesion
only affects 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 shaft of penis (* risk of
visceral ca)
Briquet’s Syndrome • somatization disorder • psychological: multiple
physical complaints without physical pathology Broca’s Aphasia •
Motor Aphasia intact comprehension Bronchiolitis RSV Brown-
Sequard • hemisection of cord (contralateral loss of pain & temp /
ipsilateral loss of fine touch, UMN) Bruton’s Disease • X-linked
agammaglobinemia Budd-Chiari • post-hepatic venous thrombosis
Buerger’s Disease • acute inflammation of small, medium arteries *
painful ischemia * gangrene
Burkitt’s Lymphoma • small noncleaved cell lymphoma EBV • 8:14
translocation Caisson Disease • gas emboli Carpal Tunnel Syndrome
Median nerve entrapment Chagas’ Disease • Trypansoma infection
sleeping disease, cardiomegaly with apical atrophy, achlasia
Chediak-Higashi Disease • Phagocyte Deficiency: neutropenia,
albinism, cranial & 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 & cerebral degeneration
Crigler-Najjar Syndrome • congenital hyperbilirubinemia
(unconjugated) • glucuronyl transferase deficiency Crohn’s • IBD;
ileocecum, transmural, skip lesions, lymphocytic infiltrate,
granulomas (contrast to UC: limited to colon, mucosa & submucosa,
crypt abscesses, pseudopolyps, * colon cancer risk)
Croup Parainfluenza Curling’s Ulcer • acute gastric ulcer associated
with severe burns Cushing’s • Disease: hypercorticism 2* to * ACTH
from pituitary (basophilic adenoma) • Syndrome: hypercorticism of
all other causes (1* 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
hyperbilirubinemia (conjugated) • striking brown-to-black
discoloration of the liver Duchenne Muscular Dystrophy • deficiency
of dystrophin protein * MD X-linked recessive
Edwards’ Syndrome • trisomy 18 • rocker-bottom feet, low ears,
heart disease Ehler’s-Danlos • defective collagen Eisenmenger’s
Complex • late cyanotic shunt (R→L) pulmonary HTN & RVH 2° to
long-standing VSD, ASD, or PDA Erb-Duchenne Palsy • trauma to
superior trunk of brachial plexus Waiter’s Tip Ewing Sarcoma •
undifferentiated round cell tumor of bone Eyrthroplasia of Queyrat •
carcinoma in situ on glans penis Fanconi’s Syndrome • impaired
proximal tubular reabsorption 2* to lead poisoning or Tetracycline
(glycosuria, hyperphosphaturia, aminoaciduria, systemic acidosis)
Felty’s Syndrome • rheumatoid arthritis, neutropenia, splenomegaly
Gardner’s Syndrome • adenomatous polyps of colon plus osteomas
& soft tissue tumors Gaucher’s Disease • Lysosomal Storage Disease
glucocerebrosidase deficiency • hepatosplenomegaly, femoral head
& long bone erosion, anemia Crinkled tissue paper cells in marrow
Gilbert’s Syndrome • benign congenital hyperbilirubinemia
(unconjugated) GIST Tumor arising in cells of Cajal (pacemakers of
gut) Glanzmann’s Thrombasthenia • defective glycoproteins on
platelets Goodpasture’s • autoimmune: ab’s to glomerular & alveolar
basement membranes; linear immunofluorescence Grave’s Disease
• autoimmune hyperthyroidism (TSI) Guillain-Barre • idiopathic
polyneuritis (ascending muscle weakness & paralysis; usually self-
limiting) Hamman-Rich Syndrome • idiopathic pulmonary fibrosis
Hand-Schuller-Christian • chronic progressive histiocytosis
Hashimoto’s Thyroiditis • autoimmune hypothyroidism
(antimicrosomal or antithyroglobulin); Hurthle cells, thyroid germinal
centers, Hapooh poohoxicosis • initial hyperthyroidism in
Hashimoto’s Thyroiditis that precedes hypothyroidism Henoch-
Schonlein purpura • hypersensivity vasculitis • hemmorhagic
urticaria (with fever, arthralgias, GI & renal involvement) •
associated with upper respiratory infections Hereditary
Spherocytosis RBC cytoskeletin defect, most commonly spectrin
Hirschprung’s Disease • aganglionic megacolon Horner’s Syndrome
• ptosis, miosis, anhidrosis (lesion of cervical sympathetic nerves
often 2* to a Pancoast tumor)
Huntington’s • progressive degeneration of caudate nucleus,
putamen & frontal cortex; AD Hunter’s Decreased iduronosulfate
sulfatase Hurler’s 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 (HHV8 in homosexual men) Kartagener’s Syndrome •
immotile cilia 2° to defective dynein arms infection, situs inversus,
sterility Kawasaki Disease • mucocutaneous lymph node syndrome
(lips, oral mucosa) Keratoconjunctivitis adenovirus Klinefelter’s
Syndrome • 47, XXY Kluver-Bucy • bilateral lesions of amygdala
(hypersexuality; oral behavior) Krabbe Disease Beta-galactosidase
deficiency Krukenberg Tumor • adenocarcinoma with signet-ring
cells (typically originating from the stomach) metastases 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 & lower motor neurons Mallory-Weis Syndrome • bleeding
from esophagogastric lacerations 2* to wretching (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 tissue
(gastric, pancreatic, etc.) Meig’s Syndrome • Triad: ovarian fibroma,
ascites, hydrothorax Menetrier’s Disease • giant hypertrophic
gastritis (enlarged rugae; plasma protein loss) Monckeberg’s
Arteriosclerosis • calcification of the media (usually radial & ulnar
aa.), pipestem arteries Munchausen Syndrome • factitious disorder
(consciously creates symptoms, but doesn’t know why) Meningioma
Arachnoid cap cells, whorls of cells Mesothelioma Asbestos exposure
Nelson’s Syndrome • 1* Adrenal Cushings * surgical removal of
adrenals * loss of negative feedback to pituitary * 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, numerous fractures * pain) , woven and lamellar bone
mosaic
Pancoast Tumor • bronchogenic tumor with superior sulcus
involvement * Horner’s Syndrome
Parkinson’s • dopamine depletion in nigrostriatal tracts; Cogwheel
rigidity Peutz-Jegher’s Syndrome • melanin pigmentation of lips,
mouth, hand, genitalia plus hamartomatous polyps of small intestine
Peyronie’s Disease • subcutaneous fibrosis of dorsum of penis Pick’s
Disease • progressive dementia similar to Alzheimer’s, knife-edged
gyri Plummer’s Syndrome • hyperthyroidism, nodular goiter,
absence of eye signs (Plummer’s = Grave’s - eye signs) Plummer-
Vinson • esophageal webs & iron-deficiency anemia, ↑ SCCA of
esophagus 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,
defects in extremities
Raynaud’s • Disease: recurrent vasospasm in extremities •
Phenomenon: 2* to underlying disease (SLE or scleroderma)
Reiter’s Syndrome • “Can’t see, can’t pee, can’t climb a tree” •
urethritis, conjunctivitis, arthritis non-infectious (but often follows
infections), HLA-B27, polyarticular Reye’s Syndrome • microvesicular
fatty liver change & encephalopathy • 2* to aspirin ingestion in
children following viral illness
Riedel’s Thyroiditis • idiopathic fibrous replacement of thyroid Rotor
Syndrome • congenital hyperbilirubinemia (conjugated) • similar to
Dubin-Johnson, but no discoloration of the liver Sezary Syndrome •
leukemic form of cutaneous T-cell lymphoma (mycosis fungoides)
Shaver’s Disease • aluminum inhalation → lung fibrosis Sheehan’s
Syndrome • postpartum pituitary necrosis Shy-Drager •
parkinsonism with autonomic dysfunction & orthostatic hypotension
Simmond’s Disease • pituitary cachexia Sipple’s Syndrome • MEN
type IIa (pheochromocytoma, thyroid medulla, parathyroid) Sjogren’s
Syndrome • triad: dry eyes, dry mouth, arthritis ↑ risk of B-cell
lymphoma Spitz Nevus • juvenile melanoma (always benign) Stein-
Leventhal • polycystic ovary Stevens-Johnson Syndrome • erythema
multiforme, fever, malaise, mucosal ulceration (often 2° to infection
or sulfa drugs) Struma Ovarii Thyroid teratoma of ovary Still’s
Disease • juvenile rheumatoid arthritis (absence of rheumatoid
factor) Takayasu’s arteritis • aortic arch syndrome • loss of carotid,
radial or ulnar pulses Tay-Sachs • gangliosidosis (hexosaminidase A
deficiency * GM2 ganglioside)
Tetralogy of Fallot • ÊVSD, Ëoverriding aorta, Ìpulmonary artery
stenosis, Íright ventricular hypertrophy
Tourette’s Syndrome • involuntary actions, both motor and vocal
Turcot’s Syndrome • adenomatous polyps of colon plus CNS tumors
Turner’s Syndrome • 45, XO Typhoid Fever Bradycardia and in white
people rose spots on abdomen Vincent’s Infection • “trench mouth” -
acute necrotizing ulcerative gingivitis von Gierke’s Disease •
glycogen storage disease (G6Pase deficiency) von Hippel-Lindau •
hemangioma (or hemangioblastoma) • adenomas of the viscera,
especially renal cell carcinoma defect in VHL tumor suppressor von
Recklinghausen’s • neurofibromatosis & café au lait spots & Lisch
nodule (iris hamartomas) von Recklinghausen’s Disease of Bone •
osteitis fibrosa cystica (“brown tumor”) 2* to hyperparathyroidism
von Willebrand’s Disease • defect in platelet adhesion 2* to
deficiency in vWF; increased bleeding time and PTT
Waldenstrom’s macroglobinemia • proliferation of IgM-producing
lymphoid cells Wallenberg’s Syndrome • Posterior Inferior Cerebellar
Artery (PICA) thrombosis “Medullary Syndrome” • Ipsilateral: ataxia,
facial pain & temp; Contralateral: body pain & temp Waterhouse-
Friderichsen • catastrophic adrenal insufficiency 2* to hemorrhagic
necrosis (eg, DIC) • often 2* to meningiococcemia
Weber’s Syndrome • Paramedian Infarct of Midbrain • Ipsilateral:
mydriasis; Contralateral: UMN paralysis (lower face & body)
Wegener’s Granulomatosis • necrotizing granulomatous vasculitis of
paranasal sinuses, lungs, kidneys, etc. Weil’s Disease • leptospirosis
Wermer’s Syndrome • MEN type I (thyroid, parathyroid, adrenal
cortex, pancreatic islets, pituitary) Wernicke’s Aphasia • Sensory
Aphasia impaired comprehension Wernicke-Korsakoff Syndrome •
thiamine deficiency in alcoholics; bilateral mamillary bodies
(confusion, ataxia, ophthalmoplegia) Whipple’s Disease •
malabsorption syndrome (with bacteria-laden macrophages) &
polyarthritis Wilson’s Disease • hepatolenticular degeneration
(copper accumulation & decrease in ceruloplasmin) Wiskott-Aldrich
Syndrome • immunodeficiency: combined B- &T-cell deficiency
(thrombocytopenia & eczema) Wolff-Chaikoff Effect • high iodine
level (*)’s thyroid hormone synthesis
Zenker’s Diverticulum • esophageal; cricopharyngeal muscles above
UES Zollinger-Ellison • gastrin-secreting tumor of pancreas (or
intestine) * * acid * intractable ulcers

Hallmark Findings (and a few odd items mixed in) Adhesive

arachnoiditis Caused by bacterial meningitis, leads to obstructive
hydrocephalus Albumino-Cytologic Dissociation • Guillain-Barre
(markedly increased protein in CSF with only modest increase in cell
count) AFP increase Neural tube defects, hepatocellular carcinoma,
yolk sac and embryonal carcinoma AFP decrease Down’s Amnion
nodosum Renal agenesis Amyloid in thyroid Thyroid medullary
carcinoma (calcitonin) Analgesic abuse Papillary necrosis, esp. in
diabetics Anasarca Minimal change disease Aneurysmal nodules
Polyarteritis nodosa Angiomyolipoma Tuberous sclerosis Anosmia
Kallman’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 polymositis Anti-mitochondrial
antibody Primary biliary cirrhosis Antiplatelet Antibodies • idiopathic
thrombocytopenic purpura Anti-sacharommyces cervisiae antibody
Crohn’s Anti-Smith antibodies Specific for SLE, anti-ribonulceoprotein
Anti-smooth muscle antibody Autoimmune hepatitis type I
Arachnodactyly • Marfan’s Aschoff Bodies • rheumatic fever Ashleaf
spots (skin) Tuberous sclerosis Atypical lymphocytes EBV Auer Rods
• acute promyelocytic leukemia (AML type M3) Autosplenectomy •
sickle cell anemia Babinski • UMN lesion Bacterial conjuntivitis S.
aureus, strep. pneumo, Hemophilus aegyptius Basophilic Stippling of
RBCs • lead poisoning Bence Jones Protein • multiple myeloma free
light chains (either kappa or lambda) • Waldenstrom’s
macroglobinemia 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
Rubella Blue Bloater • Chronic Bronchitis Blue Sclera Osteogenesis
imperfecta Boot-Shaped Heart • Tetralogy of Fallot Bouchard’s
Nodes • osteoarthritis (PIP) Boutonniere’s Deformity • rheumatoid
arthritis Bronze Diabetes Hemochromatosis Brown Tumor •
hyperparathyroidism Brudzinski sign meningitis Brushfield Spots •
Down’s, on iris Call-Exner Bodies • granulosa cell tumor Carbon
monoxide poisoning Hyperemia, edema and necrosis of globus
Cardiomegaly with Apical Atrophy • Chagas’ Disease Central Nuclei
in Muscle Muscular dystrophies Chancre • 1* Syphilis, painless firm
ulcers
Chancroid • Haemophilus ducreyi, painful soft ulcers Charcot Triad •
multiple sclerosis (nystagmus, intention tremor, scanning speech)
Charcot-Leyden Crystals • bronchial asthma Cherry-red spot on
macula Tay-Sachs, 50% of Niemann-Pick Cheyne-Stokes Breathing •
cerebral lesion Chocolate Cysts • endometriosis Cholesterol clefts
atherosclerosis Chordae tendinae short and fused Rheumatic heart
disease Chronic staph infections Chronic granulomatous disease, a
deficiency of NADPH oxidase, can’t kill catalase positive bugs
Chvostek’s Sign • Hypocalcemia facial spasm in tetany Clear nuclei
Thyroid papillary carcinoma (Orphan Annie’s eyes) Clue Cells •
Gardnerella vaginitis Codman’s Triangle • osteosarcoma Coin
Lesions in Lung Pulmonary Hamartoma Cold Agglutinins •
Mycoplasma pneumoniae • infectious mononucleosis Cold thyroid
nodules Colloid cyst or thyroid adenoma Concentric laminar intimal
fibrosis of small arteries of lung Primary pulmonary hypertension
Condyloma Lata • 2* Syphilis • new coffee flavor at Bagel & Bagel
Congenital Hepatic Fibrosis Polycystic Kidney Disease, juvenile
autosomal recessive form Contraction Band Necrosis MI Cotton Wool
Spots • HTN 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 Cystathioine synthase
deficieny homocystinuria D-dimers DIC Depigmentation Of
Substantia Nigra • Parkinson’s Dew drop on rose petal Chicken pox
Diaphragmatic pleural plaques Asbestosis Donovan Bodies •
granuloma inguinale (STD) Double bubble sign on ultrasound Down’s
syndorme – duodenal atresia Duret Hemorrhages Uncal herniation
Eburnation • osteoarthritis (polished, ivory-like appearance of bone)
Eccentric intimal fibrosis with medial hypertrophy Chronic transplant
rejection Ectopia Lentis • Marfan’s Embolizing endocarditis
Infectious, marantic (fibrin deposits in hypercoagulable states)
Erythema Chronicum Migrans • Lyme Disease Excavation of Optic
Cup Glaucoma Exopthalmos hyperthyroid FAT RN TTP (fever,
anemia, thrombocytopenia, renal failure, neuro problems) Fatty Liver
• Alcoholism Fecalith Acute appendicitis False positive VDRL SLE,
Treponema pertenue (non-STD tropical infection) Ferruginous Bodies
• asbestosis Fish-mouthed mitral valve Rheumatic heart disease
Flea-bitten Kidney Malignant Hypertension Frontal bossing Sickle cell
anemia Fungus ball in lung Apergillus galactosemia Galactose-1-
phosphate uridyl transferase deficiency or galactokinase deficiency
Garlic odor on breath Arsenic (or lasagna) Ghon Complex •
Tuberculosis, primary Gold Pneumonia Lipid pneumonia, exogenous
(aspiration) or endogenous (obstruction Gower’s Maneuver •
Duchenne’s MD use of arms to stand Gray discoloration of skin
Argyria (silver poisoning) Hat size increase Paget’s disease of bone
Heart Failure Cells CHF; hemosiderin-laden macrophages in lungs
Heberden’s Nodes • Osteoarthritis (DIP) Heinz Bodies • G6PDH
Deficiency Hemarthrosis Coagulation factor deficiency Hemorrhagic
Temporal Lobe Lesion HSV Hemorrhagic Urticaria • Henoch-
Schonlein Heterophil 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 Jolley 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) ↓ Immunoglobulins X-linked Brutons agammaglobulinemia,
and common variable immunodeficiency Index finger overlapping
3rd and 4th Edward’s (Trisomy 18) Jarisch-Herxheimer Reaction •
Syphilis over-aggressive treatment of an asymptomatic pt. that
causes symptoms 2° to rapid lysis Joint Mice • osteoarthritis
(fractured osteophytes) Kaussmaul Breathing • acidosis Keratin
Pearls • SCCA Kernig’s sign meningitis Keyser-Fleischer Ring •
Wilson’s Kimmelstiel-Wilson Nodules • diabetic nephropathy
Koilocytes • HPV Koplik Spots • measles Lacunar cells Variant of
Reed-Sternberg cell seen in nodular sclerosing Hodgkin’s Disease
Lacunar infarct Chronic hypertension Lamellar bodies Contain
surfactant in Type II pneumocytes Langhans giant cells Tuberculosis,
other including coccidioides 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 alk. Phos.
Positive Leukemoid rxn. Lines of Zahn • arterial thrombus Lisch
Nodules • neurofibromatosis (von Recklinhausen’s disease) Loss of
grey-white junction Tuberous sclerosis Low set ears Downs,
DiGeorge, Trisomy 18 (Edwards) Lumpy-Bumpy IF Glomeruli •
poststreptococcal glomerulonephritis Machine-like murmur Patent
ductus arteriosus Macronodular cirrhosis Wilson’s, viral hepatitis,
alpha-1-antitrypsin Malignant pustule Anthrax (black skin lesion)
Mallory Bodies Alcoholic liver disease: intermediate filaments of
hepatocyte cytoskeleton Maple syrup/burnt sugar urine Alpha-
ketoacid dehydrogenase deficiency; valine, leucine and isoleucine
build up (branched) McBurney’s Sign • appendicitis (McBurney’s
Point is 2/3 of the way from the umbilicus to anterior superior iliac
spine) Meconium ileus Cystic Fibrosis Mees lines Arsenic (parallel
lines on fingernails) Melanosis coli Laxative abuse Mental probs. with
heart defect Mitral prolapse Michealis-Gutmann Bodies •
Malakoplakia, an abnormal tissue response to kidney infection
Microglial nodules HIV Micrognathia DiGeorge Micronodular cirrhosis
Wilsons, alcoholic, hemochromatosis, primary biliary cirrhosis
Microsatellite instability HNPCC (right-sided colon cancer), but also
possible in other cancers Mid-systolic click Mitral prolapse
Monoclonal Antibody Spike • multiple myeloma this is called the M
protein (usually IgG or IgA) • MGUS Mousy / musty odor PKU Mucosal
bleeding Platelet problem (qualitative or quantitative) Myxedema •
hypothyroidism Necrolytic migratory erythema dermatitis α -cell islet
tumor Negri Bodies and hydrophobia • rabies Neuritic Plaques •
Alzheimer’s Neurofibrillary Tangles • Alzheimer’s Night pain relieved
by aspirin Osteoid osteoma Non-embolizing endocarditis Rheumatic,
Libman-Sacks (with SLE) Non-pitting Edema • Myxedema • Anthrax
Toxin Notching of Ribs • Coarctation of Aorta Nutmeg Liver • CHF,
right heart Onion skin kidney arterioles Malignant nephrosclerosis
(malignant hypertension) Oligoclonal band Multiple sclerosis Osteoid
production osteosarcoma Painless Jaundice • pancreatic CA (head)
Palatal Petechaie 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 and
prematurity Pautrier’s Microabscesses • mycosis fungoides
(cutaneous T-cell lymphoma) Periductal edema Gynecomastia
Periventricular Calcifications Congenital CMV (brain ventricles, that
is) Phenylalanine hydroxylase deficiency PKU Philadelphia
Chromosome • CML Pick Bodies • Pick’s Disease Piecemeal Necrosis
Chronic active hepatitis (periportal hepatocytes) Plexiform lesions
Pulmonary HTN (aneurysmal expansion of vessel wall) Pink, foamy
lung exudate Pneumocystis carinii pneumonia Pink Puffer •
Emphysema Centroacinar – smoking Panacinar - α 1-antitrypsin
deficiency Podagra • gout (MP joint of hallux) Porcelain gallbladder
Chronic cholecystitis (scarring) Porcelain gallstones Associated with
gallbladder adenocarcinoma Port-Wine Stain • Hemangioma
Posterior Anterior Drawer Sign • tearing of the ACL Proliferating bile
ducts Obstructive jaundice Psammoma Bodies • Papillary
adenocarcinoma of the thyroid • Serous papillary
cystadenocarcinoma of the ovary • Meningioma • Mesothelioma
Pseudohypertrophy • Duchenne muscular dystrophy Pseudopoyps
Ulcerative colitis Pulmonary atherosclerosis Cor pulmonale Punched-
Out Bone Lesions • multiple myeloma Punched-out esophageal
lesions herpes Rash on Palms & Soles • 2° Syphilis • RMSF RBC
poikilocytosis Beta-thalassemia Rectangular RBC’s Hemoglobin SC
Red hyalin globules Alpha-1-antitrypsin deficiency (in liver) 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, staining pattern with anti-double
stranded DNA antibodies Rockerbottom feet Patau (Trisomy 13),
Edward’s (Trisomy 18) Rose thorns Sporotrichosis Rouleaux
Formation • multiple myeloma RBC’s stacked as poker chips Rugae
loss Pernicious anemia (atrophic gastritis) S3 Heart Sound • L→R
Shunt (VSD, PDA) • Mitral Regurg • LV Failure S4 Heart Sound •
Pulmonary Stenosis • Pulmonary HTN Scalloped colloid Grave’s
disease Schwartzman Reaction • Neisseria meningitidis impressive
rash with bugs Shagreen patches Tuberous sclerosis Simian Crease •
Down’s Smith Antigen • SLE (also anti-dsDNA) Smudge cells CLL
(delicate cells easily destroyed on peripheral smear) Soap Bubble on
X-Ray • giant cell tumor of bone Soldiers plaque Clinically
insignificant remnant of healed pericarditis Spider telangiectasia
Hyperestrinism: liver faillure, pregnancy Spike & 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
spleen Portal hypertension Sulfer granules Collection of actinomyces
or nocardia organisms in chronic abscessing bronchopneumonia
Swiss cheese brain Clostridia (gas forming) Syncitia 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 (tonsilar herniation)
Tetrahydrobiopterin cofactor def. PKU Thymidine dimers Xeroderma
pigmentosum Thymus, parathyroid agenesis Digeorge (3rd and 4th
pharyngeal pouch) Thyroidization of Kidney • chronic pyelonephritis
TIBC increase Anemia of chronic disease Tingible Bodies Macrophage
in lymph node germinal centers Tophi • gout Tram-Track Glomeruli •
membranoproliferative glomerulonephritis Tree bark aorta Syphilis
Trousseau’s Sign • visceral ca, classically pancreatic (migratory
thrombophlebitis) • hypocalcemia (carpal spasm) These are two
entirely different disease processes and different signs, but they
unfortunately have the same name. TSI > TGI Grave’s TGI > TSI
Hashimoto’s Tyrosinase deficiency Albinism Virchow’s Node •
supraclavicular node enlargement by metastatic carcinoma of the
stomach VMA and metenephrins in urine Pheochromocytoma
Warthin-Finkeldey Giant Cells • Measles Waterhammer pulse Aortic
regurgitation WBC Casts • pyelonephritis White matter petechaie Fat
emboli Winged scapula Long thoracic nerve (C5,6,7) damage,
common with radical mastectomy Wire Loop Glomeruli • lupus
nephropathy, type IV Wrinkled glomerular basement membrane
ischemia ↑ AFP in amniotic fluid or mother’s serum • Spina Bifida •
Anencephaly ↑ Uric Acid • Gout • Lesch Nyhan • Myeloproliferative
Disorders • Diuretics (Loop & Thiazides) ↓ FEV1/FVC • COPD
↓ glucose, ↑ protein in CSF Bacterial meningitis ↑ dopamine receptors
Schizophrenia ↓ dopamine receptors Parkinson’s
Most Common… 1° Tumor arising from bone in adults • Multiple
Myeloma Adrenal Medullary Tumor – Adults • Pheochromocytoma
Adrenal Medullary Tumor – Children • Neuroblastoma Arteries of
stroke Lateral striate Bacterial Meningitis – adults • Neisseria
meningitidis Bacterial Meningitis – elderly • Strep pneumoniae
Bacterial Meningitis – newborns • E. coli Bacterial Meningitis –
toddlers • Hib B cell defect (genetic) Isolated IgA deficiency Bone
Tumors • Metasteses from Breast & Prostate Brain Tumor – Child •
Medulloblastoma (cerebellum) Brain Tumor –Adult • Astrocytoma
(including Glioblastoma Multiforme) then: mets, meningioma,
Schwannoma Breast Carcinoma • Invasive Duct Carcinoma Breast
Mass • Fibrocystic Change (Carcinoma is the most common is post-
menopausal women) Bug in Acute Endocarditis • Staph aureus Bug
in debilitated, hospitalized pneumonia pt • Klebsiella Bug in
Epiglottitis • Hib Bug in GI Tract • Bacteroides (2nd – E. coli) Bug in
IV drug user bacteremia / pneumonia • Staph aureus Bug in PID • N.
Gonnorrhoeae Bug in Subacute Endocarditis • Strep Viridans Cardiac
1° Tumor – Adults • Myxoma “Ball Valve” Cardiac 1° Tumor – Child •
Rhabdomyoma Cardiac Tumor – Adults • Metasteses
Cardiomyopathy • Dilated (Congestive) Cardiomyopathy Carpal bone
fractured scaphoid Cause of 2° HTN • Renal Disease Cause of
Addison’s • Autoimmune (2nd – infection) Cause of Congenital
Adrenal Hyperplasia • 21-Hydroxylase Deficiency (then, 11-) Cause
of Cushings • Exogenous Steroid Therapy (then, 1° ↑ ACTH, Adrenal
Adenoma, Ectopic ACTH) Cause of death in Alzheimer pts •
Pneumonia Cause of death in amyloidosis Chronic renal failure Cause
of death in Diabetics • MI Cause of Death in SLE pts. • Lupus
Nephropathy Type IV (Diffuse Proliferative) Cause of Dementia •
Alzheimer’s Cause of Dementia (2nd most common) • Multi-Infarct
Dementia Cause of food poisoning • Staph aureus Cause of mental
retardation • Down’s Cause of mental retardation (2nd most
common) • Fragile X Cause of preventable blindness • Chlamydia
Cause of Pulmonary HTN • COPD Cause of SIADH • Small Cell
Carcinoma of the Lung Chromosomal disorder • Down’s Congenital
cardiac anomaly • VSD (membranous > muscular) Congenital early
cyanosis • Tetralogy of Fallot Coronary Artery thrombosis • LAD
Demyelinating Disease • Multiple Sclerosis Dietary Deficiency • Iron
Disseminated opportunistic infection in AIDS • CMV (Pneumocystis
carinii is most common overall) Esophageal cancer • SCCA Fatal
genetic defect in Caucasians • Cystic Fibrosis Female Tumor •
Leimyoma Form of Amyloidosis • Immunologic (Bence Jones protein
in multiple myeloma is also called the Amyloid Light Chain) 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 in IV drug users • Tricuspid Heart
Valve involved in Rheumatic Fever • Mitral then Aortic Hereditary
Bleeding Disorder • Von Willebrand’s Disease Liver 1° Tumor •
Hepatoma, seen in women on oral contraceptives Liver Disease •
Alcoholic Liver Disease Location of Adult brain tumors • Above
Tentorium Location of Childhood brain tumors • Below 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 of brain (cerebellum) Nephrotic
Syndrome • Membranous Glomerulonephritis Opportunistic infection
in AIDS • PCP Osteomyelitis in IV drug user Pseudomonas
Osteomyelitis in sickle cell Salmonella Ovarian Malignancy • Serous
Cystadenoma Ovarian Tumor • Hamartoma Pancreatic Tumor •
Adeno (usually in the head) Patient with ALL / CLL / AML / CML • ALL
- Child / CLL - Adult over 60 / AML - Adult over 60 / CML - Adult 35-50
Patient with Goodpasture’s • Young male Patient with Reiter’s • Male
Pituitary Tumor • Prolactinoma (2nd – Somatotropic “Acidophilic”
Adenoma) Primary Hyperparathyroidism • Adenomas (followed by:
hyperplasia, then carcinoma) Pt. With Hodgkin’s • Young Male
(except Nodular Sclerosis type – Female) Pt. With Minimal Change
Disease • Young Child Secondary Hyperparathyroidism •
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 • Abdominal aorta > coronary >
popliteal > carotid Skin Cancer • Basal Cell Carcinoma Stomach
cancer • Adeno Testicular Tumor • Seminoma Thyroid Cancer •
Papillary Carcinoma Tracheoesophageal Fistula • Lower esophagus
joins trachea / upper esophagus – blind pouch Tumor of Infancy •
Hemangioma Type of Hodkin’s • Mixed Cellularity (versus:
lymphocytic predominance, lymphocytic depletion, nodular sclerosis)
Type of Non-Hodgkin’s • Follicular, small cleaved Vasculitis (of
medium & small arteries) • Temporal Arteritis Viral Encephalitis •
HSV Worm infection in US • Pinworm (2nd – Ascaris)
Signature Drug Toxicities Agranulocytosis • Clozapine Aplastic
Anemia • Chloramphenicol • NSAIDs • Benzene Arrhythmia Tricyclic
antidepressant (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 •
Sulfonylureas (1st generation) Extrapyramidal Side Effects •
Antipsychotics (Thioridazine, Haloperidol, Chlorpromazine) Fanconi’s
Syndrome • Tetracycline Fatal Hepatotoxicity (necrosis) • Valproic
Acid • Halothane • Acetaminophen Gingical 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, anaphylatoxins Hot Flashes, Flushing • Niacin • Tamoxifen
• Ca++ Channel Blockers Induce CP450 • Barbiturates • Phenytoin •
Carbamazepine • Rifampin Inhibit CP450 • Cimetidine •
Ketoconazole Interstitial Nephritis • Methicillin • NSAIDs (except
Aspirin) • Furosemide • Sulfonamides Lupus like Procainamide,
hydralazine Malignant hyperthermia Succinyl choline, halothane
Monday Disease • Nitroglycerin Industrial exposure → tolerance
during week → loss of tolerance during weekend → headache, tach,
dizziness upon 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 HTN with Tyramine • MAOIs
SLE-like Syndrome • Procainamide • Hydralazine Tardive Dyskinesia
• Antipsychotics (Thioridazine, Haloperidol, Chlorpromazine) Tinnitus
• Aspirin • Quinidine Torsade de pointes Quinidine Vaginal Adenosis
and Clear Cell Carcinoma DES
Miscellaneous • Fastest growing tumor – Burkitt’s • PE’s are found in
half of all autopsies • Courvoisier’s Law: tumors that obstruct the
common bile duct cause enlarged gallbladders, but obstructing
gallstones do not (too much scarring). • Only DNA virus to replicate
in cytoplasm: Pox • Only RNA virus to replicate in nucleus: Influenza
• Bacillus anthracis has the only protein capsule • Bordetella
pertussis (Whooping Cough) elicits lymphocytosis rather than
granulocytosis • Bronchioalveolar carcinomas grow without
destroying the normal architecture of the lung • Cryptococcus
neoformans often lacks a capsule and, when stained with GMS, looks
just like Pneumycistis carinii, except that Cryptococcus lacks the
prominent nucleoli.
Alcohol abuse screening questions CAGE:
1. Ever felt it necessary to Cut down on drinking?
2. Has anyone ever said they felt Annoyed by your drinking?
3. Ever felt Guilty about drinking?
4 Ever felt a need to have a morning drink as an Eye opener?

Abdominal swelling causes 5 F’s:

Fat Feces Fluid Flatus Fetus Full-sized tumors

Patient examination organization SOAP:

Subjective: what the patient says.
Objective: what the examiner observes.
Assessment: what the examiner thinks is going on.
Plan: what they intend to do about it.
Vomiting: non-GIT differential ABCDEFGHI:
Acute renal failure Brain [increased ICP] Cardiac [inferior MI] DKA
Ears [labyrinthitis] Foreign substances [Tylenol, theo, etc.] Glaucoma
Hyperemesis gravidarum Infection [pyelonephritis, meningitis]

History: quick EMS medical history checklist SAMPLE:

Signs/ Symptoms Allergies Medications Pertinent history Last oral
intake Events preceding this incident

Pain history checklist OPQRSTU:

Onset of pain (time, duration) Palliative factors for pain Quality of
pain (throbbing, stabbing, dull, etc.) Region of body affected Severity
of pain (usually scale of 1-10) Timing of pain (after exercise, in
evening, etc.) U: How does it affect ‘U’ in your daily life?
· May wish to expand to OPPQRRSTTUVW, with the extra letters
representing:
Provocative factors Radiation (how does pain spread) Treatments
tried Deja Vu: Has this happened before? Worry: What do you think
or fear that it is?

Differential diagnosis checklist “A VITAMIN C”

A and C stand for Acquired and Congenital
· VITAMIN stands for:
Vascular
Inflammatory (Infectious and non-Infectious)
Trauma/ Toxins
Autoimmune
Metabolic
Idiopathic
Neoplastic
· Example usage: List causes of decreased vision: Central retinal
artery occlusion, Retinitis pigmentosa, Perforation to gobe, Chronic
Gentamycin use, Ruematoid arthritis, Diabetes, Idiopathic, Any eye
tumor, Myopia.
Sign vs. symptoms
Ign: something I can detect even if patient is unconscious.
sYMptom is something only hYM knows about.

Eyes: abbreviations for the eyes

You look OUt with Both eyes. Take the Right dose so you won’t OD
[overdose]. The only one that is Left is OS.
· Both eyes=OU, Right eye=OD, Left eye=OS.

Medical history: disease checklist MJ THREADS:

Myocardial infarction Jaundice Tuberculosis Hypertension Rheumatic
fever/ Rheumatoid arthritis Epilepsy Asthma Diabetes Strokes

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

Pain history checklist ASK LAST:

Aggravating/ Alleviating
Severity
Karacter
Location
Associated symptoms
Setting
Timing

Pain history checklist SOCRATES:

Site
Onset
Character
Radiation
Alleviating factors/ Associated symptoms
Timing (duration, frequency)
Exacerbating factors
Severity
· Alternatively, Signs and Symptoms with the ‘S’.

Symptom attributes “FAST LQQ’S”:

Factors that make it better/worse
Associated manifestations
Setting
Timing
Location
Quality
Quantity
Severity

Heart valve auscultation sites “All Patients Take Meds”:

· Reading from top left:
Aortic
Pulmonary
Tricuspid
Mitral
· See diagram.
· Alternatively: All Prostitutes Take Money.
· Alternatively: APe To Man.

Four point physical assessment of a disease

“I’m A People Person”:
Inspection
Auscultation
Percussion
Palpation

Physical exam for ‘lumps and bumps’

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

Surgical sieve VANISHED:

Vascular
Accident & trauma
Neoplastic
Inflammatory
Septic
Haematologic/ Hereditary
Endocrinological
Degenerative

Differential diagnosis checklist “I VINDICATE”:

Iatrogenic
Vascular
Infectious
Neoplastic
Degenerative/ Drugs
Inflammatory/ Idiopathic
Congenital
Allergic/ Autoimmune
Traumatic
Endocrinal & metabolic

Symptom sieve “TIN CAN BED DIP POG”:

Trauma
Infection
Neoplasm
Cardiac
Autoimmune
Neurological
Blood/ Bone
Endocrine
Disintegration/ Degeneration
Drugs
Iatrogenic/ Idiopathic
Psychological
Paediatric
Obstetric
Gynaecological

Pain history checklist LOST WAR:

Location Onset Severity Time Worsening factors Alleviating factors
Radiation

Short statue causes RETARD HEIGHT:

Rickets Endocrine (cretinism, hypopituitarism, Cushing’s) Turner
syndrome Achondroplasia Respiratory (suppurative lung disease)
Down syndrome Hereditary Environmental (postirradiation,
postinfectious) IUGR GI (malabsorption) Heart (congenital heart
disease) Tilted backbone (scoliosis)

Ascultation: crackles (rales )”PEBbles”:

Pneumonia Edema of lung Bronchitis

Pain history checklist CHLORIDE:

Character (stabbing, throbbing, etc.) Location Onset Radiation
Intensity Duration Events (associated with, or palliative and
provocative factors)

Differential diagnosis CIMETIDINE:

Congenital Infection/ Inflammatory Metabolic Endocrine Trauma
Iatrogenic Degenerative Idiopathic Neoplastic Everything else

Sign vs. symptom Remember Ace of Base’s song that goes like this:
“I Saw the Sign, and it opened up my eyes”.
The physician sees the signs.

Systems review: systems checklist I PUNCH EAR:

Integumental Pulmonary Urogenital Nervous Cardiovascular
Hematolymphoid Endocrine Alimentary Reproductive

Pain history checklist MR. C T FARADS:

Main site Radiation Character Timing Frequency Associated factors
Relieving factors Aggravating factors Duration Severity

Abdomen assessment To assess abdomen, palpate all 4 quadrants

for DR. GERM:
Distension: liver problems, bowel obstruction Rigidity (board like):
bleeding Guarding: muscular tension when touched Eviseration/
Ecchymosis Rebound tenderness: infection Masses

Pain history checklist CLITORIS:

Character Location Intensity Timing Onset Radiating Irritating and
relieving factors Symptoms associated

Past medical history (PMH)

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

Patient profile (PP)

LADDERS:
Living situation/ Lifestyle Anxiety Depression Daily activities
(describe a typical day) Environmental risks/ Exposure Relationships
Support system/ Stress

Family history (FH)

BALD CHASM:
Blood pressure (high) Arthritis Lung disease Diabetes Cancer Heart
disease Alcoholism Stroke Mental health disorders (depression, etc.)

Differential diagnosis checklist

DIRECTION:
Drugs Infection Rheumatologic Endocrine Cardiovascular Trauma
Inflammatory Other Neoplasm

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

Pyrexia of Unknown Origin: history taking

SIT ON FRAD:
Sexual history Immunisation status Travel history Occupational
history Nutrition (consumption of dairy products, etc.) Family history
Recreational habits Animal contacts (including ticks and other
vectors) Drug history

Health related behavior (HRB) topics: history taking

“Healthy SEEDS”:
Substances (alcohol, tobacco, IV drugs?) Environment (hazards at
home or work? feel safe?) Exercise (what do you do? how often do
you do it?) Diet (any special diet?) Sex (active with m/f/both? >1
partner? safe sex? STD history? difficulty with arousal or orgasm?
history of abuse?)
· I find this order works well: patients most expect to be asked about
alcohol and they least want to talk about their STD history, but
taking a solid HRB history first reassures them that it’s all part of
good medical care.

Breast history checklist

LMNOP:
Lump Mammary changes Nipple changes Other symptoms Patient
risk factors

Pain history checklist

COLDER BARS:
Character Onset Location Duration Exacerbating factors Radiation
Before (ever happened before) Associated symptoms Relieving
factors Severity

Pain history checklist

SO CRAP:
Site Onset Character Radiates to Associated symptoms/ Alleviating
and exacerbating factors Periodicity

History, HCFA components for E+M coding

Q LSD MCAT:
Quality Location Severity Duration Modifying factors Context
Associated signs and symptoms Timing

Surgical sieve for diagnostic categories

INVESTIGATIONS:
Iatrogenic Neoplastic Vascular Endocrine Structural/ Mechanical
Traumatic Inflammatory Genetic/ Congenital Autoimmune Toxic
Infective Old age/ Degenerative Nutritional Spontaneous/ Idiopathic

Mental state examination: stages in order

“Assessed Mental State To Be Positively Clinically Unremarkable”:
Appearance and behaviour [observe state, clothing...]
Mood [recent spirit]
Speech [rate, form, content]
Thinking [thoughts, perceptions]
Behavioural abnormalities
Perception abnormalities
Cognition [time, place, age...]
Understanding of condition [ideas, expectations, concerns]
Branham sign: definition
BRAnham sign:
BRAdycardia after compression or excision of a large AV fistula.

Glasgow coma scale: components and numbers

· Scale types is 3 V’s: Visual response Verbal response Vibratory
(motor) response
· Scale scores are 4,5,6:
Scale of 4: see so much more Scale of 5: talking jive Scale of 6: feels
the pricks (if testing motor by pain withdrawl)
Meckel’s diverticulum- rule of 2’s
2 inches long,
2 feet from the ileocecal valve,
2% of the population
commonlly presents in the first 2 years of life
may contain 2 types of epithelial tissue
Pheochromocytoma-rule of 10s:
10% malignant
10% Bilateral
10% extraadrenal
10% calcified
10% children
10% familial
* discussed 10 times more often than actually seen
Aphasia
“BROKen aphasia” (Broca’s aphasia-broken speech)
“Wordys aphasia” (Wernicke’s aphasia- wordy, but making no
sense)
GET SMASH’D—Causes of Acute pancreatitis
Gallstones, Ethanol, Trauma, Steroids, Mumps, Autoimmune(PAN),
Scorpion bites, Hyperlipidemia, Drugs(azathioprine, diuretics)
(Multiple endocrine neoplasia) Each of the MENs is a
disease of three or two letters plus a feature.
“MEN I” is a disease of the 3 Ps (pituitary, parathyroid and pancreas)
plus adrenal cortex.
“MEN II “ is a disease of the two Cs (carcinoma of the thyroid and
catacholamines [pheochromocytoma]) plus parathyroid for MEN IIa
or
mucocutaneous neuromas for MEN IIb (aka MEN III).
Acute pneumonia caused by Pyogenic bacteria—PMN infiltrate
Acute pneumonia caused by Miscellaneous microbes—Mononuclear
infiltrate
Takayasu’s diz = pulseless diz, therefore when you have
Takayasu’s, I can’t Tak’a yu pulse.
Argyll-Robertson Pupil—syphilitic pupil (AKA “Prostitute’s pupil” -
Accommodates, but doesn’t react )
Accommodation reflex present, Pupillary reflex absent
CAGE—alcohol use screening
1. Have you ever felt it necessary to CUT DOWN on your drinking?
2. Has anyone ever told you they were ANNOYED by your drinking?
3. Have you ever felt GUILTY about your drinking?
4. Have you ever felt the need to have a drink in the morning for an
EYE OPENER?
P-Q-R-S-T—eliciting and HPI and exploring symptoms
P—palliative or provocative factors for the pain
Q—quality of pain(burning, stabbing, aching, etc.)
R—region of body affected
S—severity of pain(usually 1-10 scale)
T—timing of pain(eg.-after meals, in the morning, etc.)
The five W’s—post-operative fever
Wind—pneumonia, atelectasis
Water—urinary tract infection
Wound—wound infections
Wonderdrugs—especially anesthesia
Walking—walking can help reduce deep vein thromboses and
pulmonary embolus
ACID or “Anna Cycled Immediately Downhill”
classification of hypersensitivity reactions
Type I - Anaphylaxis
Type II - Cytotoxic-mediated
Type III - Immune-complex
Type IV - Delayed hypersensitivity
WBC Count:
“Never Let Momma Eat Beans(60, 30, 6, 3, 1)
Neutrophils 60%
Lymphocytes 30%
Monocytes 6%
Eosinophils 3%
Basophils 1%
A-P-G-A-R:
A - appearance (color)
P - pulse (heart rate)
G - grimmace (reflex, irritability)
A - activity (muscle tone)
R - respiratory effort
Predisposing Conditions for Pulmonary Embolism: TOM SCHREPFER
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
The 4 P’s of arterial Occlusion: pain pallor pulselessness paresthesias

The 4 T’s of Anterior Mediastinal Mass:Thyroid

tumor,Thymoma,Teratoma, Terrible Lymphoma

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