INTERNAL MEDICINE/ FAMILY PRACTICE

Abdominal pain: medical causes "ABDOMENAL PANE" [abdominal pain]:Acute rheumatic feverBlood [purpura, a/c hemolytic crisis]DKAcOllagen vascular diseaseMigraine [abdominal migraine]Epilepsy [abdominal epilepsy]Nephron [uremia]Abdominal anginaLeadPorphyriaArsenicNSAID'sEnteric fever

Haemobilia: features MOB:MelaenaObstructive jaundiceBiliary colic

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

ACEI: contraindictions PARK:PregnancyAllergyRenal artery stenosis

K increase (hyperkalemia)

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

Anemia: non-megaloblastic causes of macrocytic anemia HAND LAMP:HypothyroidismAplastic anaemiaNeonatesDrugsLiver diseaseAlcoholMyelodyplasiaPregnancy

Anion gap metabolic acidosis: causes]A MUDPILE CAT:AlcoholMethanolUremiaDiabetic ketoacidosisParaldehydeIron/ IsoniazidLactic acidosisEthylene glycolCarbamazepineAspirinToluene

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

Haemoptysis: causes CAVITATES:CHFAirway disease, bronchiectasisVasculitis/ Vascular malformationsInfection (eg TB)

TraumaAnticoagulationTumourEmbolismStomach

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

Macrocytic anemia: causes ABCDEF:Alcohol + liver diseaseB12 deficiencyCompensatory reticulocytosis (blood loss and hemolysis)Drug (cytotoxic and AZT)/ Dysplasia (marrow problems)Endocrine (hypothyroidism)Folate deficieny/ Fetus (pregnancy)

Metabolic acidosis: causes USED CAR:UreteroenterostomySaline hydrationEndocrinopathies (hyperparathyroid, hyperthyroid, Addison's)Diarrhea/ DKA/ DrugsCarbonic anhydrase inhibitorsAmmonium chlorideRenal tubular acidosis_ Alternatively: USED CARP, to include Parenteral nutrition/ Pancreatic fistula.

Metabolic acidosis: causes KUSSMAL:KetoacidosisUraemiaSepsisSalicylatesMethanolAlcoholLactic acidosis

Non-gap acidosis: causes HARD UP:

HyperalimentationAcetazolamide (carbonic anhydrase inhibitors)RTADiarrheaUreterosigmoidostomyPancreatic fistula

NSAIDs: contraindications NSAID:Nursing and pregnancySerious bleedingAllergy/ Asthma/ AngioedemaImpaired renal functionDrug (anticoagulant)

Pancytopaenia differential "All Of My Blood Has Taken Some Poison":Aplastic anaemiasOverwhelming sepsisMegaloblastic anaemiasBone marrow infiltrationHypersplenismTBSLEParoxysmal nocturnal haemoglobinuria

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

Sickle cell disease complications SICKLE:Strokes/ Swelling of hands and feet/ Spleen problemsInfections/ InfarctionsCrises (painful, sequestration, aplastic)/ Cholelithiasis/ Chest syndrome/ Chronic hemolysis/ Cardiac problemsKidney diseaseLiver disease/ Lung problemsErection (priapism)/ Eye problems (retinopathy)

Toxicity/ sepsis: signs 6 T's:TachycardiaTachypneaTremorsToxic lookTirednessTemperature (fever)

Ulcers: types VAN:Venous/ VasculiticArterialNeuropathic

Acromegaly symptoms ABCDEF:Arthralgia/ ArthritisBlood pressure raisedCarpal tunnel syndromeDiabetesEnlargemed organsField defect

Gynecomastia: common causes GYNECOMASTIA:Genetic Gender disorder (Klinefelter)Young boy (pubertal)*Neonate*EstrogenCirrhosis/ Cimetidine/ Ca Channel blockersOld age*MarijuanaAlcoholismSpironolactoneTumors (Testicular & adrenal)Isoniazid/ Inhibition of testosteroneAntineoplastics (Alkylating Agents)/ Antifungal(ketoconazole)_ * Asterisk indicates physiologic cause.

Hypercalcemia causes MD PIMPS ME:

MalignancyDiuretics (thiazide the main culprit)Parathyroid (hyperparathyroidism)Immobilization/ IdiopathicMegadoses of vitamins A,DPaget's diseaseSarcoidosisMilk alkali syndromeEndocrine (Addison's disease, thyrotoxicosis)

Hypercalcemia: causes GRIM FED:Granulomas (sarcoid, TB),Renal faliureImmobility (esp. long term)MalignancyFamilial (eg familial hypocalciuric hypercalcemia)Endocrine (see below for subtypes)Drugs (esp. thiazide diuretics, lithium)_ Endocrine causes are PATH:PhaeochromocytomaAddison's diseaseThyrotoxicosisHyperparathyroidism

Hypercalcemia: differential VITAMIN TRAPS:Vitamin A and D intoxicationImmobilizationThyrotoxicosisAddison's disease/ AcidosisMilk-alkali syndromeInflammatory disordersNeoplastic diseaseThiazides, other drugsRhabdomyolysisAIDSPaget's disease/ Parenteral nutrition/ Parathyroid diseaseSarcoidosis

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

CorticosteroidsPropranololSSKI

Pressure Sore: Norton Score MAGIC:MobilityADLGeneral conditionIncontinenceConscious level

Pruritus without rash: DDx ITCHING DX:Infections (scabies, toxocariasis, etc)Thyroidal and other endocrinopathies (eg diabetes mellitus)CancerHematologic diseases (eg iron deficiency)/ Hepatopathies/ HIVIdiopathicNeuroticGravid (pruritus of pregancy)DrugseXcretory dysfunctions (eg uremia)

Rashes: time of appearance after fever onset]"Really Sick Children Must Take No Exercise":_ Number of days after fever onset that a rash will appear:1 Day: Rubella2 Days: Scarlet fever/ Smallpox3 Days: Chickenpox4 Days: Measles (and see the Koplik spots one day prior to rash)5 Days: Typhus & rickettsia (this is variable)6 Days: Nothing7 Days: Enteric fever (salmonella)

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

Allopurinol: indications STORE:Stones (history of renal stones)

Tophaceous gout (chronic)Over-producers of urateRenal diseaseElderly_ Bonus: Probenecid indications are basically the opposite of STORE (no renal stone history, etc.).

Dialysis indications HAVE PEE:Hyperkalemia (refractory)Acidosis (refractory)Volume overloadElevated BUN (> 36 mM)PericarditisEncephalopathyEdema (pulmonary)

Renal failure (acute): management Manage AEIOU:Anemia/ AcidosisElectrolyte and fluidsInfectionsOther measures (eg nutrition, nausea, vomitingUremia

SIADH: causes SIADH:SurgeryIntracranial: infection, head injury, CVAAlveolar: Ca, pusDrugs: opiates,antiepileptics, cytotoxics, anti-psychoticsHormonal: hypothyroid, low corticosteroid level

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

SIADH: major signs and symptoms SIADH:Spasms

Isn't any pitting edema (key DDx)AnorexiaDisorientation (and other psychoses)Hyponatremia

Eosinophilia: differential NAACP:NeoplasmAllergy/ AsthmaAddison's diseaseCollagen vascular diseasesParasites

Polycythemia Rubra Vera (PRV): common symptoms PRV:Plethora/ PruritisRinging in earsVisual blurriness

SLE: factors that make SLE active UV PRISM:UV (sunshine)PregnancyReduced drug (eg steroid)InfectionStressMore drug

Splenomegaly: causes CHICAGO:CancerHem, oncInfectionCongestion (portal hypertension)Autoimmune (RA, SLE)Glycogen storage disordersOther (amyloidosis)

Splenomegaly: causes HICCUPS:HaematologicalInfective : Kala azar, malaria, enteric fever

Congestive: CCF, constrictive pericarditis, IVC thrombosis, Hepatic vein thrombosis, portal vein thrombosis and splenic vein thrombosisCollagen diseases: SLE, Felty's syndromeUnknown etiology: tropical splenomegalyPrimary malignacies (secondaries are rare)Storage diseases: Gaucher's disease, Niemman Pick

Horner's syndrome: components SAMPLE:Sympathetic chain injuryAnhidrosisMiosisPtosisLoss of ciliospinal reflexEnophthalmos

Lead poisoning (chronic): features ABCDEFGHI:Anaemia/ Anorexia/ Arthralgia/ Abortion/ Atrophy of optic nerveBasophilic stippling of RBC (punctate basophilia)/ Burtonian line on gumsColic/ Constipation/ Coprophyrin excess in urine/ CerebraloedemaDrop (wrist, foot)Encephalopathy/ EmaciationFoul smell of breath/ Failure of kidneys/ Fanconi syndromeGonadal dysfunction/ Gout-like pictureHigh BP/ Headache/ Hallucination/ HyperaesthesiaImpotence/ Insomnia/ Irritability

Lethargy, malaise causes FATIGUED:Fat/ Food (poor diet)AnemiaTumorInfection (HIV, endocarditis)General joint or liver diseaseUremiaEndocrine (Addison's, myxedema)Diabetes/ Depression/ Drugs

Thickened nerves: causes HANDS:Hansen's (leprosy)

AmyloidosisNeurofibromatosisDiabetes mellitusSarcoidosis

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

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

Ducket John's: major criteria ACNES:ArthritisCarditisNodule (subcutaneous)Erythrema marginatumSydenham chorea

Fall: differential I SAVED PANGS:IllnessSyncopeAccidentVisionEpilepsy (or other fit)

DrugsPsychiatric (eg dementia)AnaemiaNeurological (Parkinsons, cerebellar, neuropathy)Glucose (hypoglycemia)Stroke

ICU management: A to Z A: Asepsis/ AirwayB: Bed sore/ encourage Breathing/ Blood pressureC: Circulation/ encourage Coughing/ ConsciousnessD: DrainsE: ECGF: Fluid statusG: GI losses/ Gag reflexH: Head positioning/ HeightI: Insensible lossesJ: Jugular venous pulseK: KindnessL: Limb care/ LabelM: Mouth careN: Nociception/ NutritionO: Oxygenation/ Orient the patientP: Pulse/ Peristalsis/ PhysiotherapyQ: Quiet surroundingsR: Respiratory rate/ RestraintS: Stress ulcer/ SuctioningT: TemperatureU: UrineV: VentilatorW: Wounds/ WeightX: XerosisY: whYZ: Zestful care of the patient

Left iliac fossa: causes of pain SUPER CLOT:Sigmoid diverticulitisUteric colicPIDEctopic pregnancyRectus sheath haematomaColorectal carcinoma

Left sided lower love pneumoniaOvarian cyst (rupture, torture)Threatened abortion/ Testicular torsion

Sports injuries: course of action RICE:RestIceCompressionElevation_ RICE especially for fractures, sprains, muscle strains, contusions_ Alternatively: I=Immobilization, C=Cold compresses.

Acute stridor: differential ABCDEFGH:_ With fever:AbscessBacterial tracheitisCroupDiphtheriaEpiglottitis_ Without fever:Foreign bodyGas (Toxic Gas)Hypersensitivity

Bronchiectasis: causes A SICK AIRWAY:Airway lesion, chronic obstructionSequestrationInfection, inflamationCystic fibrosisKartagners syndromeAllergic brochopulmonary aspergilliosisImmunodeficiencies (hypogammaglobinaemia, myeloma, lymphoma)Reflux, inhalation injuryWilliam Campbell syndrome (and other congenitals)AspirationYellow nail syndrome/ Young syndrome

Bronchiectasis: differential BRONCHIECTASIS:Bronchial cyst

Repeated gastric acid aspirationOr due to foreign bodiesNecrotizing pneumoniaChemical corrosive substancesHypogammaglobulinemiaImmotile cilia syndromeEosinophilia (pulmonary)Cystic fibrosisTuberculosis (primary)Atopic bronchial asthmaStreptococcal pneumoniaIn Young's syndromeStaphylococcal pneumonia

Caplan syndrome: characteristics CAPlan:Coal worker pneumoconiosisArthritisPulmonary nodule

Chronic cough: full differential GASPS AND COUGH:GORDAsthmaSmoking, chronic bronchitisPost-infectionSinusitis, post-nasal dripACE inhibitorNeoplasmDiverticulumCongestive heart failureOuter earUpper airway obstructionGI-airway fistulaHypersensitivity

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

Fibrosing alveolitisKnowledge Level 3, System: PulmonaryAnonymous ContributorDyspnea: causes SHE PANTS:Stress, anxietyHeart diseaseEmboliPulmonary diseaseAnaemiaNeuromuscular diseaseTrachea obstructionSleep disorder

Hemoptysis: causes HEMOPTYSIS:Haemorrhagic diathesisEdema [LVF due to mitral stenosis]MalignancyOthers [eg: vasculitis]Pulmonary vascular abnormalitiesTraumaYour treatment [anticoagulants]SLEInfarction in lungsSeptic

Pleural effusion: investigations PLEURA:Pleural fluid (thoracentesis)Lung, pleural biopsyESRUltrasoundRadiogramAnalysis of blood

Pulmonary edema: treatment LMNOP:LasixMorphineNitrates (NTG)OxygenPosition (upright vs. flat)

Pulmonary edema: treatments MAD DOG:MorphineAminophyllineDigitalisDiureticsOxygenGGases in blood (ABG's)

Pulmonary fibrosis: causes SCAR:_ Upper lobe:Silicosis/ SarcoidosisCoal worker pneumonconiosisAnkylosing spondylitisRadiation_ Lower lobe:Systemic sclerosisCyptogenic fibrosing alveolitisAsbetosisRheumatoid arthritis

Respiratory disease: hand signs CASH:ClubbingAsterixisSmall muscle wastingHPOA

Wheezing: causes ASTHMA:AsthmaSmall airways diseaseTracheal obstructionHeart failureMastocytosis or carcinoidAnaphylaxis or allergy

Back trouble causes O, VERSALIUS (Versalius was the name of a famous physician):OsteomyelitisVertebral fracture

Extraspinal tumourSpondylolisthesisAnkylosing spondylitisLumbar disk increaseIntraspinal tumorUnhappinessStress