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Monday, July 12, 2010
MEDICAL MNEMONICS
Auscultatory areas starting from left 2nd intercostal space:
Remember: All Patients Take Medicines
Aortic - Pulmonary - Tricuspid - Mitral
Note:
- Only Aortic area is on left ; Remember that ALL stands for aortic area - read as Aortic Left Left ; Why 2 lefts? Because it's in 2nd IC space )
- If you want to remember the other intercostal spaces where the auscultatory areas on right are situated just imagine a patient in Room no.245 - Right 2, 4, 5 IC spaces in that order for Pulmonary, Tricuspid, Mitral in that order of All Patients Take Medicine.
- Confusion buster: Please note that Aorta arises from left ventricle, but auscultatory area is on right side. Note the same problem with Pulmonary artery.
DDH - Clinical Examination (Tests)
Ortholani's and Barlow's tests detect DDH. You might confuse between the two tests or you may feel that both are the same. First, here is what the tests are:
- Barlow's test: The maneuver is performed by adducting the hip while applying light pressure on the knee, directing the force posteriorly. If the hip is dislocatable, the test is considered positive. The Ortolani maneuver is then used, to confirm that the positive finding (i.e., that the hip actually dislocated).
- Ortholoni's test: It is performed by gently abducting the infant's leg using the examiner's thumb while placing anterior pressure on the greater trochanter using the examiner's index and forefinger. A positive sign is a distinctive 'clunk' which can be heard and felt as the femoral head relocates anteriorly into the acetabulum.
Now here's how to remember the two tests:
Barlow's test - you feel the Dislocation - so Barlow's test is Bad test as you are dislocating from joint.
ORTHOlani - you try to feel the Reduction - like ORTHOpedicians reducing all fractures and dislocations.
Medicine clinical examination ; Stethoscope sounds
The stethoscope's diaphragm is larger than the bell. So remember - diapragm (LARGER) picks up HIGH pitched sounds;
AeGophony- like bleating of A Goat ; Ask the patient to say 'A', you hear 'E' (AEgophony)
Bronchophony - spoken from the EARpiece (BEAR).
sIbiliant rhonchi is hIgh pitched; sOnorous- lOw pitched
History taking : Description of symptoms
The history of specific symptoms have to be described in this order:
Remember that a good doctor takes a good history before he OPERATES
Onset of symptoms
Progression
Exacerbating factors
Relieving factors
Associated symptoms
Time relation of symptoms ( Night pain etc )
Episodic nature ( Symptom free intervals etc )
Systemic inquiry related to symptom
Micro organisms which don't Gram stain well
List of Microbes which may not gram stain well:
Remember: " These Microscopic Rascals May Look Colourless "
Treponema
Mycobacteria
Rickettsia
Mycoplasma
Legionella
Chlamydia
- Stages of mitosis:
( Remember PROfessor MAT taught us Mitosis )
PROphase
Metaphase
Anaphase
Telophase
- Stages of meosis are Prophase-I, Metaphase-I, Anaphase-I, Telophase-I, followed by Prophase-II, Metaphase-II, Anaphase-II, Telophase-II
( Remember PROfessor MAT taught me meosis twice - I & II )
- mItosis gives 2 dIploid daughter ceels
- MEosis keeps ME very HAPpy with 4 HAPloid daughter cells
Structures behind medial malleolus
Structures that pass behind medial malleolus deep to flexor retinaculum (From anterior to posterior):
Remember: Tall Doctors Are Never Hungry.
Tibialis posterior,
flexor Digitorum longus,
posterior tibial Artery,
tibial Nerve,
flexor Hallucis longus tendon
Chest pain : What attending nurses should do
In case the attending nurse sees a patient with chest pain, she should MOVE the patient to emergency care unit:
Remember MOVE:
Monitor (cardiac monitor) connect
Oxygen administration
Venous access with large bore canula
ECG to be taken
In Good Pasture's syndrome, there is auto antibodies against Glomeruli (causing Glomerulonephritis ) & Pulmonary basement membrane ( causing Pneumonitis )
Seronegative spondyloarthropathies
Sero negative spondyloarthropathies are:
Remember RAP(P)E -
R- Reiters syndrome
A- Ankylosing spondylitis
P- Psoriatic arthropathy
P- Pseudogout
E- Enteropathic arthritis(chrons disease,ulcerative colitis,behchets syndrome)
This mnemonic was sent by Mr. Kamal A.P. for benefit of all our readers.
To remember the named signs, it would be better to know a little bit of history. There might be an interesting incident related to a person who gave the name of the sign / syndrome. One such interesting case is how Sister Mary Joseph node got it's name. Also called Sister Mary Joseph sign, refers to a palpable nodule bulging into the umbilicus as a result of metastasis of a malignant cancer in the pelvis or abdomen.
To remember this sign better, let's go back to history. Imagine these events:
Scene: St. Mary's Hospital in
Some signs can be better understood and remembered by knowing the meaning of word. Of course, most of the signs are named after people, but we are lucky to have few signs otherwise. For example, when I asked one medical student why Puddle's sign is named so, he told me that it was named after Dr. Puddle and he didnot remember what the sign was about.
So what's a puddle? A puddle is a small collection of liquid, usually we refer to a puddle of water in the ground after a rain etc. This is used to detect minimal fluid collection in the abdomen i.e. minimal ascitis.
Now to remember, you have the picture given below. There's a puddle, a sign board reading 120 ml and a Gorilla. Puddle sign can detect ascitis as less as 120 ml. What's the Gorilla doing there? The Gorilla's position is the position we use to elicit puddle sign. To make this more clear, let us see how to elicit this sign.
Let patient lie prone for 5 minutes, after which he/she has to rise on his/her elbow and knees (that's like the Gorilla!) and by the method of auscultatory percussion you find that there is resonant note in the flanks and dull note towards the center of abdomen i.e. the puddle forms at the central part of abdomen.
Which anticoagulant can be used in pregnancy? Heparin or Warfarin?
Answer is Heparin. WARfarin SHOULD NOT BE used. Remember: There SHOULD NOT BE WAR IN pregnancy.
Ricketsial diseases and causitive organisms
Ricketsial POX : R. AKArI (see the picture above - AKAI)
ePidemic typhus : R. Prowazekii
Rocky mountain spotted fever : R. Riketssi
Q - Fever : COXiella BURNetti ( Imagine Camel & OX walking in a queue i.e. "Q" in a BURNing desert)
Srub typhus : R. TSUTSUgamushi (Imagine the sound while scrubbing - TSU TSU TSU TSUgamushi; alternatively remember only SUsugamushi, with "t" silent for ScrUb). SCRub typhus causes eSChaR
For Paucibacillary Leprosy -
- Daily - Dapsone 100 mg
- Monthly - Rifampicin 600 mg
- Duration: 6 months
For Multibacillary Leprosy -
- Daily - Dapsone 100 mg + Clofazamine 50 mg
- Monthly - Rifampicin 600 mg + Clofazamine 300 mg
- Duration: 2 yrs
Remember this with the formula D / R for paucibacillary and DC / RC for multibacillary
Explanation: The denominator is the monthly drug to be taken. In case of multibacillary leprosy, note that the dose of Clofazamine, be it monthly or daily, is half the dose of other drug taken along with it ( 100 / 2 = 50, 600 / 2 = 300 ). Duration of treatment is 1/2 yrs and 2 yrs for Pauci & Multibacillary leprosy respectively.
Indicators of fecal water pollution
Which of these is a bio indicator of past pollution with fecal matter?
a) Faecal Streptococci b) Clostridium perfringens c) both d) none
The answer is b.
How to remember:
Cl. perfringes is an indicator of past water pollution
Also remember that the indicator of recent water pollution is Faecal Streptococci ( Recent = Short term - Streptococci )
Enzyme deficiancy in Phenylketonuria
PHenylketonuria - Enzyme deficient is Phenylalanine Hydroxylase
For more medical mnemonics visit http://medicalmnemonics4u.blogspot.com
Bone & Cartilage - Collagen types
- bONE is made of type ONE collagen; Alternatively see the picture of bone which looks like '1'
- CARTilage is made of type two collagen. See the picture of cart with '2' inside the cart. Alternatively remember carTWOlage
- Still if you find it confusing remember B of bone comes before C of cartilage; B-1, C-2.
Remember Rajasthan Transport Development Corporation Board (RTDCB):
Roots join to form Trunks
Trunks join to form Divisions
Divisions join to form Cords
Cords join to form Branches
Branches
Alternatively, remember Real Teenagers Drink Cold Beer
Other alternative mnemonics sent by Mr. Frank Hopkins made with his mnemonic generating software:
Uses 1st Two Letters of Each Term
Romanian Troops Diverted Combat Brigade
Round Trembling Divas Cold Breasts
Uses 1st Letters Only
Real Tight Dollar Closed Banks
Raining Twenty Days Collapsed Bridge
Real Tequila Drinker Charlie Boozer
Remember That Dudes Chick's Bootie
Raise The Dead Crying Behold!!! (This has a more religious tone to it)
Many of the medical names are derived from latin. If you study a bit of latin or greek you will find medical terms getting simpler. Below is a picture depicting how few bones got their names (Starting from the first picture row wise):
- ACETABULAM
In Latin, acetum = vinegar and -bulum, a suffix signifying the instrument. Acetabulum was thought to resemble a small vinegar cruet of roman times.
- TIBIA
In Latin means a flute. Yes, a tibia after removal of external fixators looks like a flute :-)
- PATELLA
In Latin means a little plate. So next time have food in a big patella !
- SKULL
In Anglo Saxon means a bowl. Eat brain from the bowl !
- OLECRANON
In Greek, olenokranon, from olene = elbow and kranos = helmet. In other words, the protector of the elbow. Elbow's helmet !
- COCCYX
In Greek, kokkyx = cuckoo. This bone looks like the beak of a cuckoo. Huh?
- PELVIS
In Latin, pelvis means basin.
- CLAVICLE
In Latin, clavicula, diminutive of clavis = a key. Clavicle resembled those old keys. Anyway, don't use your clavicle to open your door :-)
tRIcuspid valve is in RIght atrium
Bicuspid valve in Left atrium ( Remember BiLe)
Bicuspid valve is also called MitraL valve. So mitraL is on Left
If you know what is a "mitre", then you can easily remember that bicuspid valve is mitral. "Mitre" is the hat that you see often worn by bishops. It has 2 leafs resembling the cusps. See picture below.
- Alternatively, imagine a RAT in LAB; Right Atrium Tricuspid, Left Atrium Bicuspid.
- If you know Hindi, remember DoMitr (Two friends) Bicuspid valve = Mitral valve by
Aorta and IVC - left or right?
Anatomy was very confusing, especially relative position of structures. One constant confuser was the position of Aorta and Venacava as they descend into thorax.
I remembered that the AoRTa is RighT .
Here's another way to remember : Both a-o-r-t-a and r-i-g-h-t have 5 letters; v-e-n-a and c-a-v-a and l-e-f-t have 4 letters.
Frozen shoulder: Sequence of manipulation
CONTRIBUTED BY MR. KAMAL A.P.
Remember FEAR: (The manipulation of shoulder has to be carried out in this sequence)
Flexion
Extension
Abduction, followed by Adduction ( Remember Ab comes before Ad in dictionary)
Rotations (Internal & external)
Thank you Kamal for the good mnemonic :-)
The picture can be remembered for classification of enzymes. Note the mnemonics highlighted in big black letters.
Coagulation factors consumed in clot
The factors consumed in clot are 1, 2, 5, 8. You can remember this by imagining a watch showing the time as 12:58 - 1,2,5,8 ; Also imagine CFC (Clotting factors consumed) written on the watch.
Another mnemonic was sent by our reader Mr. Shiva; Shiva just keeps singing 1,2,5,8 what do we appreciate? clots!
There are 2 types of Amyloidosis of spleen - Sago spleen and Lardaceous spleen
What is the difference between the two?
Remember - Super Fast bus has Less Passengers (SF-LP)
Sago spleen - Amyloid deposit in Follicles
Lardaceous spleen - Amyloid deposits mostly in Pulp
Normal Pressure Hydrocephalus (NPH)
In NPH, there is
Abnormal P,H ( P = Pee problems = urinary incontinence; H = Head problem = dementia )
Ataxia
Absent signs of raised intracranial tension ( like headache, vomiting )
Components of Quadriceps femoris muscle are:
Rectus femoris, Vastus lateralis, Vastus intermedius, Vastus medialis. Remember the picture below:
Here's how to remember the KTC = Kreb's or TCA or Citric acid cycle:
Remember "Citric Acid Is Kreb's Starting Substrate For Mitochondrial Oxidation"
These stands for the substrates in order:
Citric acid
Iso-Aconitase
Iso-citrate
Alpha-Ketoglutarate
Succinyl CoA
Succinate
Fumarate
Maleate
Oxaloacetate
To remember the vitamin K dependent factors, try to memorize this picture. They are factors 2, 7, 9, 10. The story behind the picture mnemonic. In year 2K ( = 2000 = factor 2 is K dependant ), a pregnant lady after carrying her child for 9 months, caring all 7 days a week, gave birth to a child. The child grew up, got 10 upon 10 marks.
UV rays from sun act on skin, convert Cholecalciferol (CC) --> 25 Hydroxy CC in liver --> 1,25 Di Hydroxy CC in kidney.
So there are two hydroxylation reactions, first in Liver, second in Kidney. Remember this: You have 1 liver, 2 kidneys; So hydroxylation 1st reaction in your 1 liver and 2nd hydroxylation in 2 kidneys.
- First Generation Cephahlosporins - Remember this story:
Mr. Fazol (ceFAZOLin) is a Lorry Driver (cephaLORIdine). He works very hard and has become Thin (cephaloTHIN) He has a "Rad" Watch on his hand (cephRADine) and a "Lux" soap (cephaLEXin). He wears a bright green Drawer {i.e trousers} ( cefaDROxil)
Route of drug administration: He will put the Lux soap in his Drawer - (Cefalexin & Cefradine are given orally. The latter can also be given i.v. /.i.m.. All others- i.v. /.i.m)
- Second Generation Cephalosporins: Remember FOX, FUR, FAC - ceFOXitin, ceFURoxime, ceFAClor
- Third Generation Cephalosporins - The story goes thus:
Mr. Aziz (ceftAZIdime) is taking an Ox (ceftizOXime, cefpodOXime) in a Taxi (cefoTAXIme) for slaughtering, i.e. an Operation (cefOPERAZONE). For this purpose he is taking Three Axon blades (cefTRIAXONe). He will Fix (ceFIXime) the ox for dinner (cefDINIR) in a short time!
Route of drug administration: Fix the price and eat (only Cefixime is given oral: all others im/iv).
ADRs: Operation will cause bleeding (Cefoperazone cause bleeding)
- Fourth Generation Cephalosporins:
My wierd dream: QUEEN of
You know Gram stain is for Bacteria, Acid Fast for Mycobacterium (also Nocardia). Remember other special stains below:
Giemsa : CAmpylobacter, Malaria, Leishmaniasis (CAMeL) (Remember the picture of Giemsa Camel above)
Silver stain : pNEumocystis (CARnii), FUNgi, LEGionella (Remember the picture above : it's a SILVER NEW CAR with FUNny LEGs)
MuciCaRmine - CRyptococci
Periodic Acid Schiff: FUNgi, amoeba (A FUNny amoeba just PASsed away)
Remember the REP ( Medical representative ) offering you an iPod. Let us name him as iREP ( REP offering iPod ). He tells you, " give me 5, 10, 15, 20 - 35 prescriptions to get an iPod ".
Here's the interpretation:
iREPS stands for
i - INH - 5mg/kg
R - Rifampicin - 10mg/kg
E - Ethambutol - 15mg/kg
P - Pyrazinamide - 20-35mg/kg
S - Streptomycin - 20-35mg/kg
Their dosages per kg are 5, 10, 15, 20-35, 20 - 35 respectively.
Which of these are Bacterocidal?
Of these, the ones that RIPS bacteria are the R, I, P, S.
To remember certain striking side effects see below:
INH - I Have Neuritis
Rifampicin - Red man syndrome
Ethambutol - Eye affected ( Retrobulbar neuritis )
Streptomycin - Song is difficult to hear ( Oto toxicity)
Erb's and Klumpke's brachial palsies
Erb's - Upper trunk ( C5, C6 ) {See the picture mnemonic above - imagine the '6' to resemble 'b' of erbs ; 's' resembles '5' }
Klumpke's - Lower Trunk ( C7, C8, T1 )
Remember 'E' comes before 'K' in alphabetical order, so Erb's is upper and Klumpke's lower trunk.
Now Klumpke's start with C7. Note that K-L-U-M-P-K-E is 7 letters.
O Negative (O -ve) blood group is universal dONor
Wegener's granulomatosis affects the upper and lower respiratory tracts and the kidney. As depicted in the visual mnemonic, URTI, LRTI, Epistaxis, Hemoptysis, Glomerulonephritis are few of the manifestations of this disease. It is C-ANCA positive. Treatment is with antibiotics, corticosteroid, Azathioprine, Cyclophosphamide etc.
This visual mnemonic gives you the clinical features of
Remember the story : A Korean (Chorean) hunter, HUNTING 4 CROws to DATE a COW
Now, here's the facts: Huntington's Chorea gene is on ChROmosome 4
Pathology is in CAUDATE (COW DATE) nucleus
Aortic regurgitation : Peripheral signs
This is a picture mnemonic which will help you remember the peripheral signs of Aortic regurgitation (AR) which is much talked about in the clinics.
COLe-Cecil murmur is heard in Aortic Incompetence in AxIlla.
Remember AIshwarya RAI ( Miss world, 1994 ) likes Coco-COLa
Endodermal pouches form the following organs / glands:
You have 1 tongue and 2 tonsils
- So from Ventral part of 1st Endodermal pouch forms the tongue
- From ventral part of 2nd Endodermal pouch forms tonsils
From THIrd endodermal pouch forms THymus and Inferior parathyroid
Note that superior parathyroid and follicular C - cells of thyroid forms from the 4th endodermal pouch (The superior and more complicated one arises from the fourth)
The above picture gives mnemonic for
Now, this is what the picture says: Ewings - the chick with wings; Arises from Diaphysis, most common bone is Tibia. Seen in children as represented by the chick. Onion represents the onion peel appearance in X-rays. The wings going up and down ( arrows ) represent that the size of tumor increases and decreases ( H/O Exacerbations and remissions ). The moon & star represents the clinical feature that pain is worse at night. Radio represents that the tumor is extremely radiosensitive - therefore melts like snow. Spread is by blood vessels and lymphatics. And what the chick says is the chemotherapy regimen - VAC ( Vincristine, Adriamycin, Cyclophosphamide ), VACA ( VAC + Actinomycin ), AV alternating with CV.
To remember the structures of anatomical snuffbox, look at your right hand and extend your thumb. You see three prominent tendons. The tendon in between is a brevis tendon - Extensor policis brevis. The tendon that meets it from the extensor surface is therefore extensor policis longus. The remaining tendon going in different direction of Extensor Policis Brevis is Abductor Policis Longus. Note that the longus goes parallel and brevis converges on both ends.
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