1
Q
Causes of hypoglycaemia
EXPLAIN
A
EXogenous drugs (insulin, oral hypoglycaemics, alcohol, pentamidine, quinine, quinolones)
Pituitary insufficiency (no GH or cortisol)
Liver failure (no glycogen stores)
Adrenal failure (no cortisol)
Insulinomas/ Immune hypoglycaemia
Non-pancreatic neoplasms (retroperitoneal sarcoma)
2
Q
Fixed Splitting of S2 - Association
A
Fixed split = ASD (Always Stays Divided)
π What it is: A constant delay in pulmonic valve closure, regardless of the respiratory cycle.
β
Seen in: Atrial septal defect (ASD).
3
Q
Loud S1 - Association
A
Loud S1 = Snapping Shut in Stenosis
π What it is: Consistently loud mitral/tricuspid valve closure.
β
Seen in: Mitral stenosis or short PR interval (atria contract just before ventricles).
4
Q
Soft S1- Assocation
A
Soft S1 = Sloppy valve or Slow signal (like in MR or first-degree AV block)
π What it is: Consistently soft AV valve closure.
β
Seen in: Mitral regurgitation, long PR interval, or reduced atrial contraction.
5
Q
Wide splitting of S2 - Association
A
Wide S2 = Right-sided delay
π What it is: Prolonged interval between A2 and P2, accentuated by inspiration.
β
Seen in: Right bundle branch block (RBBB), pulmonary stenosis.
6
Q
Midazolam effects - SAMS
A
S Sedation
A Amnesia
M Muscle relaxation
S Sleep
7
Q
Hypercalcaemia causes
VITAMINS TRAP
A
V = vitamins A & D
| = immobilisation
T = thyrotoxicosis
A =Addison’s disease
M = milk-alkali syndrome
| = inflammatory disorders
N = neoplastic diseases
S = sarcoidosis
T = thiazides and other drugs
R = rhabdomyolysis
A = AIDS
P= Paget’s disease, parenteral nutrition, parathyroid disease
8
Q
Parinaud syndrome
V-PALS
A
V β Vertical gaze palsy (especially upward gaze)
P β Pupillary lightβnear dissociation (pupils constrict on accommodation but not to light)
A β Absent convergenceβretraction nystagmus (jerky eye movements on attempted upward gaze)
L β Lid retraction (Collierβs sign)
S β Setting-sun sign (downward gaze with sclera visible above iris, especially in children)
9
Q
Broca’s vs Wernicke’s
A
BEF - brocas, expressive, frontal
WRT - wernickes, receptive, temporal
10
Q
Angelman syndrome
ANGEL WOMAN
A
A - Arms of a puppet [1]
N - Never sleep
G - Gait ataxia
E - Epilepsy + characteristic EEG
L - Low IQ (Severe mental retardation) [2]
W - Wide-spaced teeth
O - Orofacial abnormalities [3]
M - Microcephaly
A - Amiable/Always laughing [4]
N - No/little speech
[1] Elbows and wrists in flexion (like a puppet)
[2] Lower IQ than Prader-Willi
[3] Large mouth, macroglossial
[4] Laughter often inappropriate
[1] + [4] has lead to the term ‘happy puppet’
11
Q
DiGeorge syndrome
CATCH 22
A
C β Cardiac defects (especially conotruncal abnormalities like TOF, truncus arteriosus)
A β Abnormal facies (micrognathia, low-set ears, hypertelorism)
T β Thymic hypoplasia/aplasia β T-cell immunodeficiency (especially CD4)
C β Cleft palate
H β Hypocalcaemia (due to parathyroid hypoplasia) β tetany, seizures
22 β microdeletion on chromosome 22q11.2
12
Q
Edward’s syndrome
EDWARD’S SCISSORHANDS
A
E β Eighteen (trisomy 18)
D β Dorsiflexion of hallux/Digits clenched (overlapping fingers)
W β Wide-head shape abnormalities (microcephaly, prominent occiput) + Wedge-shaped base of skull
A β Aortic and other cardiac abnormalities (VSD, ASD, PDA, other congenital heart defects)
R β Rocker-bottom feet + Renal abnormalities
D β Diaphragmatic hernias/Dermatoglyphic abnormalities (including high arched palate)
S β Severe intellectual disability
Edward βscissorsβ his hands shut β clenched fists are the classic sign.
13
Q
Fetal alcohol syndrome
FACIAL
A
F β Flat philtrum + Facial features [1]
A β ADHD
C β Cardiac defects [2]
I β Intestinal abnormalities (especially hernias)
A β Auditory abnormalities
L β Low IQ and birth weight (short stature, joint anomalies)
Alcohol is teratogenic β it disrupts cell migration and differentiation in early embryogenesis, particularly affecting the neural crest cells, which explains the craniofacial, cardiac, and neurodevelopmental defects.
[1] Smooth/flat philtrum, thin vermilion border of upper lip, short palpebral fissures, low nasal bridge, epicanthal folds, micrognathia, midface hypoplasia, ptosis.
[2] entricular septal defect (VSD), atrial septal defect (ASD), patent ductus arteriosus (PDA), conotruncal anomalies (e.g., tetralogy of Fallot).
14
Q
Homocystinuria vs Marfans
THE BLIND (i.e. features of homocystinuria, which are absent in Marfan’s)
A
High:
T β Thromboembolism
H - Heart complications [1] + elevated homocysteine
E - Epilepsy
Low:
B - Bones brittle
L - Lens [2] + retina often detached
I - Intellectual disability
N - Numbers of pedigrees [3]
D - Depression (low mood) β neuropsychiatric feature common
[1] IHD, AR, dissection, mitral prolapse
[2] Dislocation of lens direction difference (βHighβ for Marfan, βLowβ for homocystinuria)
[3] AR inheritance, AD in Marfan’s
15
Q
Hurlerβs syndrome (MPS I)
THICK BONES
A
T β Thrills (murmurs)
H β Hepatosplenomegaly
I β Increased head:body ratio [1]
C β Corneal clouding [2] + papilloedema
K β Kyphosis + Klumps deformity (joint stiffness, claw hand)
Bones - increased diameter of bones + thickened facial features (coarse facies, gargoyle-like appearance)
‘Thick’ also refers to low IQ (progressive)
[1] Large head with frontal bossing
[2] Differentiates from Hunter’s syndrome in which corneal clouding is absent
16
Q
Risk factors of urothelial (transitional cell) carcinoma of the bladder
SCAR
A
S β Smoking (biggest risk factor)
C β Cyclophosphamide use (chemotherapy)
A β Aniline dyes and other aromatic amines (rubber, textile, printing industries)
R β Rubber manufacturers + Radiotherapy (pelvic irradiation)
17
Q
Risk factors for quamous cell carcinoma (SCC) of the bladder
SCHIST
A
S β Schistosoma haematobium infection (endemic in Africa & Middle East)
C β Chronic cystitis (especially in long-term catheter users)
H β Hypercalciuria/urinary stones (bladder calculi)
I β Irritation from chronic urinary tract infections
S β Smoking
T β Tuberculosis of the urinary tract (less common, but chronic inflammation)
18
Q
Goodpasture’s syndrome
All-G mnemonic
A
G β IgG antibodies (type II hypersensitivity reaction)
G β anti-GBM antibodies (against the glomerular basement membrane β specifically Ξ±3 chain of type IV collagen)
G β Glomerulonephritis (rapidly progressive, crescentic GN)
G β Gas exchange failure (pulmonary haemorrhage β haemoptysis, dyspnoea)
G β Ground-glass appearance on CXR (due to pulmonary haemorrhage)
G β Genetic susceptibility (HLA-DR15 association)
19
Q
Kallman’s syndrome
GONAD
A
G β GnRH deficiency (hypothalamic failure β β LH/FSH)
O β Olfactory impairment (anosmia or hyposmia) from absent/underdeveloped olfactory bulbs
N β No colour vision + no puberty (delayed or absent secondary sexual characteristics)
A β Absent sex hormones (low testosterone in males, low oestrogen in females)
D β Deafness (and abnormal face)
Genetic, often X-linked (KAL1 mutation) but also autosomal forms
Caused by failed migration of GnRH and olfactory neurons during embryogenesis
Normal karyotype (46,XY or 46,XX) but hypogonadotropic hypogonadism
20
Q
Phenylketonuria
Dumb blonde
A
Dumb:
Mental retardation
Blonde:
Blonde hair
Blue eyes
Pale skin (hypopigmentation)
Other features: irritable (mood) + itchy (eczema)
Loss of PAH β phenylalanine accumulates β toxic to the developing brain β intellectual disability, seizures, hypopigmentation (β melanin from low tyrosine).
21
Q
Prader Willi syndrome
PRADER
A
P β Paternal deletion or maternal uniparental disomy (loss of paternal 15q11βq13 expression)
R β Round face/obese
A β Almond-shaped eyes (classic descriptor) + Angry
D β Developmental delay & intellectual disability
E β Excessive appetite (hyperphagia β obesity in childhood/adolescence)
R β Reduced muscle tone (neonatal hypotonia)
Willy - Small genitals/cryptochidism
βPβ in Prader = Paternal gene lost
22
Q
Turner’s syndrome
SHORT AND WIDE
A
S β Short stature
H β Heart defects (bicuspid aortic valve, coarctation of the aorta)
O β Ovarian dysgenesis (streak gonads β primary amenorrhoea, infertility)
R β Renal anomalies (horseshoe kidney)
T β Thyroid disease (autoimmune hypothyroidism, Hashimotoβs)
A β Absent puberty (primary amenorrhoea, lack of secondary sexual characteristics)
N β Naevi excess on skin/Nail hypoplasia
D β Dysmorphic features (low-set ears, micrognathia, high-arched palate)
W β Web-shaped neck (pterygium colli) + Wide-carrying angle
I β Inflammatory bowel disease (increased risk)
D β Developmental issues (non-verbal learning difficulties, social skill challenges)
E β Edema at birth (hands and feet, due to lymphatic dysplasia)
23
Q
Pericarditis causes
CARDIAC RUB
A
C β Coxsackie virus/Coronary syndrome
A β Autoimmune (rarely aortic dissection)
R β Rheumatic fever + other infections
D β Drugs (e.g., hydralazine, procainamide, isoniazid - drug-induced lupus)
I β Invasive techniques
A β Acute MI / post-MI (Dresslerβs syndrome, early pericarditis) + Aortic aneurysm
C β Cancer (metastasis in pericardium: lung, breast, lymphoma, leukemia)
R β Radiotherapy
U β Uraemia (i.e. renal failure - CKD key cause)
B β Blunt trauma/trauma
You hear a βpericardial rubβ in pericarditis, and the causes spell out CARDIAC RUB.
24
Q
Rheumatic fever
JONES CAPE
A
J β Joints (migratory polyarthritis)
β₯ β Heart (carditis: endocarditis, myocarditis, pericarditis)
N β Nodules (subcutaneous)
E β Erythema marginatum (serpiginous rash)
S β Sydenham chorea (involuntary jerky movements)
C β CRP & ESR raised
A β Arthralgia
P β Prolonged PR interval (on ECG)
E β Ever (fever) β yes, the E is a stretch!
S - Second episode of rheumatic fever (previous)
Diagnosis (revised Jones criteria):
* Evidence of recent group A Ξ²-haemolytic strep infection (throat culture, ASO titre)
* 2 major criteria OR 1 major + 2 minor criteria
25
Tetralogy of Fallot
PROVERB
P β Pulmonary stenosis
R β Right ventricular hypertrophy (causing boot-shaped heart)
O β Overriding aorta
V β Ventricular septal defect
E β Exercise-induced syncope (main symptom)
R β Right-to-left shunt β cyanosis, βtet spellsβ
B β Blalock-Taussig shunt (treatment)
| PROV = 4 features that make up the tetralogy
## Footnote
NOTE: Quieter murmurs often indicate worse cardiac function
26
Long QT interval
Low Electroltes MAKES TORSADES
Low: temperature and T4
Electrolytes: Low Mg/Ca/K
M β Mitral valve prolase
A β ACS or carditis
K β Ketoconazole
E β Erythromycin/clarithromycin
S β Schizophrenia Rx
T β Terfenadine/Tamoxifen
O β One a+c antiarrhythmias
R β Rheumatic fever
S β Sotalol (class III antiarrhythmias)
A β Amiodarone (class III antiarrhythmias)
D β Depression Rx
E β nil
S β SAH/Syndrome of congenital long QT/Sleep
27
Weak left radial pulse
CATS
C β Coarctation of the aorta (LL>UL)
A β Aortic dissection/Angiogram/Arterial line/Atherosclerosis/Arteritis (Takayasu's)
T β Thoracic outlet syndrome/Thromboembolism/Trauma
S β Subclavian artery stenosis or occlusion/Surgery
28
Causes of collapsing (water-hammer) pulse
SHPLAT
S β Severe anaemia
H - heart block (complete)
P β Patent ductus arteriosus (large left-to-right shunt)/Paget's
L β Larger arteriovenous fistula
A β Atherosclerosis of the aorta/Aortic regurgitation (severe)
T β Thyrotoxicosis
## Footnote
High output states!
29
Causes of right-sided aortic arch
4Ts
T β Truncus arteriosus
T β Tetralogy of Fallot
T β Transposition of the great arteries
T β Tricuspid atresia
30
Causes of Left Bundle Branch Block (LBBB)
CATHOLIC
**C** β Coronary artery disease (CAD)
**A** β Aortic valve disease (e.g., aortic stenosis)
**T** β Trauma / Tachycardia (rate-related LBBB) /ToF
**H** β Hypertension (long-standing) / Haemochromatosis / HIV
**O** β Old age/Operations to the heart
**L** β Left ventricular hypertrophy
**I** β Insertion of RV pacemaker
**C** β Cardiomyopathy (dilated or hypertrophic) and myocarditis
31
Low voltage ECG
PITCHS
P β Pericardial effusion
I β Infiltrative diseases / Infarction / Ischaemia (myocardial infarction)
T β Tamponade
C β COPD / Cardiomyopathy (dilated, restrictive)
H β Hypopituitarism / Hypothyroidism
S β Severe Obesity
## Footnote
Infiltrative - amyloidosis, sarcoidosis, carcinoid, haemochromatosis
32
Wolff-Parkinson-White (WPW) syndrome features
Einstein's MATHS
Einstein's - Ebstein's anomaly
M - Mitral valve prolapse
A - ASD / Accessory pathway
T - Thyrotoxicosis / paroxysmal SVT
H - Hypertrophic cardiomyopathy
S - Sex ratio 2:1 male:female (EInstein was male) / Short PR interval
## Footnote
Wolff-Parkinson-White syndrome (WPW):
W - delta Wave
P - short PR interval
W - Wide QRS complexes
33
Osgood-Schlatter Disease
2Ts
Tibial Tuberosity (site of pain)
Teens (age group commonly affected)
34
Patellar Tendonitis
βPain After Patellar Playβ
Pain After activity (worse after running/jumping)
Patellar tendon (site)
Chronic Play (overuse injury in athletes)
35
Osteochondritis Dissecans
OCD
βOCD = Osteo (bone) + Chondro (cartilage) + Dissecans (dissecting fragments)β
Imagine dissected bone and cartilage fragments catching in the joint, causing locking
36
Methotrexate side effects
MLP
Myelosuppression
Liver cirrhosis
Pneumonitis
37
Sulfasalazine
βSJS Oligo Stainsβ
SJS β Stevens-Johnson Syndrome
Oligospermia
Stains β Stained contact lenses
38
Leflunomide
βLung and Liverβ
Lung fibrosis (pulmonary fibrosis)
Liver impairment
39
Log-roll test findings
PIL - ILA
P β Pain = Intra-articular pathology
I β Increased range of motion = Ligamentous laxity
L β Clicking (sounds like βLβ for labral) = Acetabular labral tear
40
Medial vs Lateral epicondylitis
Golfers hit down the middle = Medial epicondylitis
Golferβs elbow = Medial epicondylitis (pain on the medial elbow)
Tennis players hit the sides = Lateral epicondylitis
Tennis elbow = Lateral epicondylitis (pain on the lateral elbow)
41
Drugs that can cause drug-induced lupus
SHIPP
S β Sulfonamides (antibiotics)
H β Hydralazine (used in heart failure, hypertension)
I β Isoniazid (anti-tuberculosis)
P β Phenytoin (antiepileptic for seizures)
P β Procainamide (antiarrhythmic)
42
Causes of Carpal Tunnel Syndrome
ARMPIT
A β Acromegaly
R β Rheumatoid arthritis
M β Myxoedema (hypothyroidism)
P β Pregnancy
I β Idiopathic
T β Trauma
43
Causes of avascular necrosis (AVN)
CAST Bent LEGS
Corticosteroids
Alcoholism
Sickle cell disease
Trauma
Bends (decompression sickness)
LEgg-Calves Perthes disease
Gaucher's disease
SCFE
44
Ankylosing Spondylitis: The 3 Ss + 5As
**S**clerosis β increased bone density, especially at sacroiliac joints
**S**ubchondral erosions β erosions near joint surfaces
**S**quaring of lumbar vertebrae β loss of normal vertebral concavity
**A**rthritis (mainly axial skeleton, sacroilittis)
**A**nterior Uveitis (common extra-articular manifestation)
**A**pical lung fibrosis (late complication)
**A**ortic regurgitation (due to aortitis)
**A**chilles tendonitis (enthesitis at the heel)
45
Causes of Lung Fibrosis β βPublic Transportβ
BUS β Busulfan
CAR β Carmustine
CYCLE β Cyclophosphamide
TRUCK β Methotrexate
DaRONE β Amiodarone
46
Small Cell = Small Sodium
Small Cell Lung Cancer (SCLC) often causes SIADH (Syndrome of Inappropriate Antidiuretic Hormone secretion).
SIADH leads to hyponatremia (low sodium).
47
Wegenerβs Granulomatosis (Granulomatosis with polyangiitis)
βI C your nose bleeding!β
C-ANCA (cytoplasmic ANCA, PR3-ANCA) positive
C shaped saddle nose deformity (due to cartilage destruction)
Crusting (nasal), epistaxis (nosebleeds)
Cranial nerve lesions (due to granulomatous inflammation)
Crescents in Bowman's capsule on renal biopsy (pauci-immune rapidly progressive glomerulonephritis)
Cyclophosphamide and steroids (treatment)
Cavitating lung nodules/lesions with central lucency on chest X-ray
C(s)inusitis and vasculitic rash
48
Long-Term Oxygen Therapy (LTOT) indications
4 Bs
**Blue** β Cyanosis, SpOβ < 92% (resting hypoxia)
**Breathing** β Severe airway obstruction, FEVβ < 30% predicted
**Blood** β Secondary polycythaemia (raised hematocrit)
**Ballooning** β Peripheral oedema, raised JVP, hepatomegaly (signs of right heart failure)
49
Causes of tram-track lines on chest X-ray
CF TRAMLINES
C β Cystic Fibrosis (CF)
T β Tuberculosis (TB)
R β Rheumatoid arthritis (RA)
A β IgA deficiency
M β Measles / Pertussis
L β Lung obstruction (Cancer, Foreign Body)
I β Infective (Pneumonia)
N β Nails (Yellow nail syndrome)
E β IgE-mediated (Allergic Bronchopulmonary Aspergillosis)
S β Syndromes (Kartagenerβs syndrome, Youngβs syndrome)
50
Major features of Allergic Bronchopulmonary Aspergillosis (ABPA)
SCABIEs
S β Skin reactivity (positive Aspergillus skin test)
C β Central bronchiectasis (on imaging)
A β Asthma (underlying condition)
B β Blood eosinophilia
IgE β IgE spikes (raised total and Aspergillus-specific IgE)
51
Oh Shit I Hate My Asthma
O β Oxygen
S β Salbutamol nebulisers
I β Ipratropium bromide nebulisers
H β Hydrocortisone IV or oral prednisolone
M β Magnesium sulfate IV
A β Aminophylline or IV salbutamol
52
Discontinuation Syndrome symptoms
FIRM STOP
F β Flu-like symptoms
I β Insomnia
R β Restlessness
M β Mood swings
S β Sweating
T β Tummy problems (pain, cramps, diarrhea, vomiting)
O β Off balance (dizziness, vertigo)
P β Paraesthesia
53
Glaucoma (POAG) drugs
The Pβs: Increase uveoscleral OUTflow
Pout = Pilocarpine and Prostaglandin analogues increase uveoscleral OUTflow.
Drugs that reduce Aqueous Humour Production (BAC)
B β Beta blockers
A β Alpha-2 agonists
C β Carbonic anhydrase inhibitors
54
Differentiating lesion types based on congruency
CRITical
C β Congruous = Radiation lesion (lesions affecting corresponding areas)
I β Incongruous = Tract lesion (lesions causing mismatched or non-corresponding deficits)
55
Vertical vs horizontal nystagmus causes
βVERTical = Very Seriousβ
VERTical nystagmus β Very Serious = Cerebellar stroke
βHORIZontal = Harmless (usually)
HORIZontal nystagmus β Harmless = Viral labyrinthitis
56
Medullary (Wallenberg) Syndrome signs and symptoms
DANVAH
D β Dysphagia
A β Ataxia
N β Nystagmus
V β Vertigo
A β Anaesthesia (ipsilateral face, contralateral body)
H β Hornerβs syndrome
57
Syringomyelia
Flat puncture
βFlat (Flaccid) tyre after punctureβ
If you puncture a tyre (like a syringe), the tyre goes flat and flaccid.
Similarly, syringomyelia causes a flaccid paralysis (lower motor neuron signs) due to damage of anterior horn cells in the spinal cord.
58
Causes of Spastic Paraparesis
COMPACTS HD
C β Cord compression (trauma, tumor, disc compression)
O β Osteoarthritis of the cervical spine
M β Multiple sclerosis (demyelination)
P β Parasagittal meningioma
A β AIDS (HIV causing transverse myelitis)
C β Cervical osteoarthritis (repeated for emphasis)
T β Tropical spastic paraparesis
S β Syringomyelia
H β Hereditary spastic paraplegia
D β Disc compression (alternative for cord compression)
59
**W**eber = **W**here does the sound go?
Conductive = Webers to Wrong (affected) ear
Sensorineural = Webers to Safe (normal) ear
60
Causes of gingival hyperplasia
PANIC
P β Phenytoin
A β Acute Myeloid Leukemia
N β Nifedipine
I β Idiopathic
C β Ciclosporin
61
Cranial Nerve IV (Trochlear nerve) palsy
βCanβt see the floor with CN4β
## Footnote
CN IV controls the superior oblique muscle, which helps you look downwards and inwards.
When palsied, patients have difficulty looking down, making it hard to see the floor, especially when walking downstairs.
62
Ondansetron and its site of action
βOblongata and Ondansetron both start with Oβ
## Footnote
Ondansetron works by blocking 5-HT3 receptors in the chemoreceptor trigger zone area of the area postrema located in the medulla oblongata (part of the brainstem).
This is why itβs effective as an antiemetic, preventing vomiting triggered by chemo or other stimuli.
63
Radio-lucent kidney stones
LUX
LUX = Light (radiolucent stones) = Urate and Xanthine
64
Causes of Focal Segmental Glomerulosclerosis (FSGS)
HASHISH
H β Heroin
A β Alport syndrome
S β Sickle cell disease
H β HIV
I β Idiopathic
S β Secondary causes (IgA nephropathy, reflux nephropathy)
H β High recurrence rate in renal transplants
65
May cause toxicity in AKI β MELD / NADA
**May cause toxicity in AKI β MELD**
(Metformin, Lithium, Digoxin)
Think of a βmeldβ (mix) in your brain β these drugs need careful monitoring or dose adjustment in AKI.
**Definitely stop in AKI β NADA**
(NSAIDs, ACE inhibitors/ARBs, Diuretics, Aminoglycosides)
NADA means βnothingβ in Spanish β so stop these drugs to avoid worsening AKI (with some diuretics exceptions).
66
Drugs causing Acute Interstitial Nephritis (AIN)
5Ps
P β Penicillins
P β Proton Pump Inhibitors (PPIs)
P β Pain free (NSAIDs)
P β Pee (Diuretics)
P β rifamPicin
67
Antibiotic safety in pregnancy
Safe in First Trimester:
Nitrofur-ONE-toin (Nitrofurantoin)
Safe in Third Trimester:
TRI-methoprim (Trimethoprim)
68
Rifampicin and Isoniazid effects on cytochrome P450 enzymes
Rifampicin
Ramps up CYP enzymes β induces metabolism β lowers levels of many drugs
Isoniazid
Inhibits CYP enzymes β reduces metabolism β raises levels of many drugs
69
Syphilis test interpretations
A/R
Tests with an βAβ (e.g., TPHA, FTA-ABS) β Always positive once infected (remain positive even after treatment)
Tests with an βRβ (e.g., RPR, VDRL) β Reflect Recent infection (used to monitor disease activity and treatment response)
70
E(t) B(e) V(ery) itchy
Itchy reminds of itchy rash sometimes seen, especially if amoxicillin is given in EBV infectious mononucleosis
71
Incubation periods of some common infections
1β6 hours: S. aureus & B. cereus (both end with -EUS) β rapid onset food poisoning
>7 days: Giardiasis & Amoebiasis (both end with -IASIS) β longer incubation parasitic infections
72
Syphilis vs Genital Herpes
SyphiLESS = painless ulcers (syphilis)
Genital Herpes = Genitals Hurt-y = painful ulcers
73
CNS infections and cell types
βMonos Love Viruses, Polys Fight Bacteriaβ
Monos = Mononuclear cells = Lymphocytes β Viral infections
Polys = Polymorphonuclear cells = Neutrophils β Bacterial infections
74
Rheumatoid lung
N - Nodules
A - Alveolitis / fibrosis
P - pleurisy / pneumoconiosis
E - Effusion
75
Typhoid fever features
βSalmon Have Spotsβ
Salmonella Typhi β Think of salmon fish with spots on their belly
Splenomegaly
Spots (rose spots on abdomen)
Slow HR (relative bradycardia)
76
Roseola
rose-O-LA = O before A
Fever before, Rash After
77
Scarlet fever
All S's
Sore throat, Sandpaper rash, Strawberry tongue
78
Measles
All C's
Cough, Conjunctivitis, Coryza + changing rash (macular β papular)
79
Kawasaki
CRASH & BURN
5-day fever, CRASH & Burn (Conjunctivitis, Rash, Adenopathy, Strawberry tongue, Hands/feet changes + Fever) + Kawasaki = motorcycle brand
80
Management of oesophageal varices
Bleeding? Band it!
Preventing? Propan(olol)!
81
Crohnβs Disease
Kings sit on Thrones & drink from Goblets
Goblet cells (increased mucus production)
Fistulae (common complication)
Skipped lesions (patchy inflammation)
82
Ulcerative Colitis
The 3 Cβs
Crypt abscesses
Continuous lesions (starts from rectum, extends proximally)
Colorectal cancer (higher risk than Crohnβs)
83
Thyroid cancer types from best to worst
P F A M L
Papillary
Follicular
Anaplastic
Medullary
Lymphoma
84
Thyroid cancer
Papillary - P
Perfect prognosis, Popular, Partygoers (young adults), Proximal spread (to lymph nodes)
## Footnote
Calcitonin-negative, often BRAF mutations, RET/PTC rearrangements
85
Thyroid cancer
Follicular - F
Fair prognosis, occurs in Fifty year-olds, spreads Far away (vascular metastases)
## Footnote
RAS mutations, PAX8-PPARΞ³ fusion
86
Thyroid cancer
Anaplastic - A
Awful prognosis, occurs in the Aged, spreads Adjacently (local invasion)
87
Thyroid cancer
Medullary - M
Occurs in MEN-2 syndrome, is Metabolically active (calcitonin secretion)
## Footnote
Calcitonin (produced by parafollicular C-cells), CEA (carcinoembryonic antigen) elevated
88
Causes of Peripheral Neuropathy
ABCDE
A β Alcohol
B β B12 deficiency
C β CKD / Cancer
D β Diabetes + Drugs
E β Every vasculitis (RA, scleroderma, sarcoidosis)
Additional:
Guillain-BarrΓ© Syndrome (GBS)
Charcot-Marie-Tooth disease (CMT)
89
Gliclazide (a Sulfonylurea) mnemonic
βZideβ sounds like βtideβ β imagine a wave of insulin being released
βSulphβ sounds like βsurfβ β so youβre surfing the sulfonylurea tide
This wave of insulin increases:
Risk of hypoglycaemia (due to increased insulin secretion)
Risk of weight gain (imagine the big wave making you bigger!)
90
MEN type 1
3 Ps
Parathyroid (95%): hyperparathyroidism due to parathyroid hyperplasia
Pituitary (70%)
Pancreas (50%): e.g. insulinoma, gastrinoma (leading to recurrent peptic ulceration)
91
MEN type 2a
2 Ps + 1M
Parathyroid (60%)
Phaeochromocytoma
Medullary thyroid cancer (70%)
92
MEN type 2b
1P + 2Ms
Pheochromocytoma
Medullary thyroid carcinoma
Marfanoid habitus
## Footnote
Also neuromas
93
Thyroid antibodies - mnemonic
Anti-TPO β HashimotOβs thyroiditis (think of the O at the end)
Anti-TSH receptor antibodies β associated with Graves' disease (TSH rhymes a bit with Graves)
94
CN4 palsy mnemonic: BOOT WOOG
Better on Opposite Opposite Tilt
Patients tilt their head away from the affected side to reduce diplopia
Worse on Opposite Opposite Gaze
Diplopia worsens when looking towards the opposite side of the lesion
95
Rubella β A Neurotic Deaf Blind Duck
A β (no specific meaning here, just starts the mnemonic)
Neurotic β Neurological problems (less common)
Deaf β Sensorineural deafness
Blind β Cataracts, Glaucoma
Duck β Patent Ductus Arteriosus (PDA)
96
Toxoplasmosis β Cory with the big head likes stiff calcium jerky
Cory β Chorioretinitis
Big head β Hydrocephalus (macrocephaly)
Stiff β Spasticity
Calcium β Cerebral calcifications
Jerky β Seizures
97
CMV β Janice, Peri and Cory are pure deaf
J β Jaundice
P β Periventricular calcifications & Microcephaly
C β Chorioretinitis
P β Purpuric skin rash & thrombocytopenia
D β Deafness (sensorineural)
98
Fragile X Syndrome
XL
XL balls = Macroorchidism (large testes)
XL head = Macrocephaly
XL ears = Large ears
XLong face and fingers
XLinked dominant inheritance (actually itβs X-linked dominant with variable expression)
XLong CGG repeat = trinucleotide repeat disorder with genetic anticipation
99
Pierre-Robin sequence
Robin' me of my airway
Robin' me of my airway = Small mandible β tongue falls back β airway obstruction
100
Edward's Syndrome (Trisomy 18) mnemonic: EDWARDS
E = Eighteen (trisomy 18)
D = carDiac & renal abnormalities
W = low Weight at birth (low birthweight)
A = Abnormally flexed & overlapping fingers
R = Rockerbottom feet
D = Dominant occiput (prominent back of head)
S = Small mouth and jaw
101
Noonan vs Turner syndrome
Both have overlapping features but key difference in cardiac lesions:
Noonan = Pulmonary stenosis (pulNOONANy)
Turner = Aortic coarctation (Turner β aortic coarctation)
Turner syndrome is only in girls (45,X) β βTURN me on (girls only)β mnemonic
Note: Aortic stenosis (not coarctation) is associated with William syndrome
102
Drug-induced pancreatitis mnemonic
FATSHEEP
F - Furosemide
A - Azathioprine / Asparaginase
T - Thiazides / Tetracycline
S - Statins / Sulfonamides / Sodium valproate
H - Hydrochlorothiazide
E - Estrogens
E - Ethanol
P - Protease inhibitors and NRTIs
103
Drugs affected by acetylator status (slow vs fast acetylators): HIPDipS
H β Hydralazine
I β Isoniazid
P β Procainamide
D β Dapsone
S β Sulfasalazine
104
Features of acetylcholine accumulation β SLUD + others
Salivation
Lacrimation
Urination
Defecation / Diarrhoea
Cardiovascular: Hypotension, Bradycardia
Also: Miosis (small pupils), Muscle fasciculations
105
Drugs causing thrombocytopenia β Quick And Naughty Drugs Hit Platelets Very Suddenly
Quinine
Abciximab
NSAIDs
Diuretics (Furosemide)
Heparin
Penicillins (antibiotics)
Valproate (anticonvulsants)
Sulphonamides (antibiotics)
106
Beta blocker overdose: Step on the GAS
G = Glucagon
A = Atropine
S = Saline
## Footnote
Management
if bradycardic then atropine
in resistant cases glucagon may be used
Haemodialysis is not effective in beta-blocker overdose
107
Tumor Lysis Syndrome Electrolyte Changes
PUKE Calcium
Phosphate: β (elevated)
Uric acid: β (elevated)
KβΊ (Potassium): β (elevated)
Ca (Calcium): β (decreased)
## Footnote
This happens because rapid cell lysis releases intracellular contents (phosphate, potassium, nucleic acids β uric acid), and phosphate binds calcium causing hypocalcemia.
108
Philadelphia chromosome and CML
Philadelphia = Cheese Made Liquidy = CML (Chronic Myeloid Leukemia)
109
Cold AIHA causes
Mnemonic
IgM = infection + lyMphoMa
Lymphoma, Mycoplasma, EBV
## Footnote
Cold AIHA: IgM antibodies fix complement, cause RBC agglutination in cold temps β associated with infections and lymphomas.
110
Allergy Tests and Their Hypersensitivity Types (4 vs 1)
**P4tch test (Patch test):**
Tests for Type IV hypersensitivity (delayed, T-cell mediated)
Used for contact dermatitis, e.g., nickel allergy
**Pr1ck test (Prick test):**
Tests for Type I hypersensitivity (immediate, IgE mediated)
Used for allergies like pollen, food, insect venom
111
Contraindications to Thrombolysis β ABC SHIP
Aortic dissection
Bleeding (active)
Coagulation disorders
Stroke within past 3 months
Hypertension (severe)
Intracranial neoplasm or injury
Pregnancy
112
Diuretics and their site of action β AFTAA
Azetazolomide: Proximal convoluted tubule
Furosemide: Na/K/Cl loop of henle
Thiazide: Na/Cl DCT inhibits sodium reabsorption
Amiloride: ENaC DCT
Aldosterone antagonist: Collecting duct
113
Heart murmurs and their timing
hARD, ASS, MRS P, MSD M
hARD = Aortic Regurgitation β Diastolic murmur
ASS = Aortic Stenosis β Systolic murmur
MRS P = Mitral Regurgitation β Pansystolic murmur
MSD M = Mitral Stenosis β Mid-Diastolic murmur
114
Electrolyte levels affecting digoxin toxicity β Think crisp packets (PKT) and fizzy drinks (CaN)
PKT (empty / low levels increase digoxin toxicity):
Magnesium (Mg) β low
Temperature (hypothermia worsens toxicity)
PH (acidosis increases toxicity)
K (Potassium) β low
Thyroid (hypothyroidism worsens toxicity)
CaN (high levels increase toxicity):
Ca (Calcium) β high
Na (Sodium) β high
115
Hypertrophic Cardiomyopathy Echo Findings
MR SAM ASH
mitral regurgitation, systolic anterior motion of the anterior mitral valve leaflet, asymmetrical septal hypertrophy
116
Fabry's disease
FABRY X
Febrile episodes
Angiokeratomas, alpha-galactosidase A deficiency
Burning pain
Renal failure
Young cardiovascular disease + stroke
X linked recessive
## Footnote
X-linked recessive (FabRee --> Recessive) and Fabry starts with F, like Female, like X-linked
FABRYC: Foamy urine (Fabry nephropathy), Ξ±-galactosidase A deficiency/Angiokeratomas, Burning pain in hands and feet, Really sweaty/dry, YX genotype (male), Cardio-Cerebrovascular disease/Ceramide trihexoside accumulation.
117
Actions of ANP mnemonic
A - antagonises actions of angiotensin II, aldosterone
N - natriuretic (promotes Na excretion)
P - drops BP through vasodilation
118
Exudative Pleural Effusion Causes
PANDA SPRINTS
P β Pneumonia (parapneumonic effusion)
A β Abscess/Asbestosis
N β Neoplasm
D β Dressler's syndrome
A β Acute rheumatic fever (and FMF)
S β Surgery (cardiothoracic)
P β Pancreatitis/PAN
R β Rheumatoid arthritis
I β Infarction (PE)
N β Nails (yellow nail syndrome)
T β Trauma (blunt or penetrating)
S β SLE/Scleroderma/Sjogrens/Sarcoidosis
119
Pleural effusion exudate
Three Xs
E**x**udate β confirms itβs an exudative effusion (not transudate)
E**x**tra protein β the pleural fluid protein is high (pleural fluid protein/serum protein ratio > 0.5)
E**x**citing causes β transudates are the more 'boring' causes e.g. failures
## Footnote
A pleural effusion is considered exudative if any one of the following is true:
Pleural fluid protein / serum protein ratio > 0.5 β
Pleural fluid LDH / serum LDH ratio > 0.6 β
Pleural fluid LDH > 2/3 of the upper limit of normal serum LDH β
120
Light's criteria
PEL
P β Protein ratio > 0.5 (pleural/serum)
E β Exciting LDH ratio > 0.6 (pleural/serum)
L β LDH > 2/3 upper limit of normal serum LDH
## Footnote
βPELβ sounds like βpile,β imagine a pile of protein and LDH in the pleural fluidβdefinitely an exudate!
121
Cauess of transudative pleural effusion
MOPS
Failures: heart, renal, live, thyroid (hypo)
Other: MOPS
M β Meig's syndrome
O β Other causes of hypoproteinaemia/hypoalbuminemia β low oncotic pressure
P β PE (exudates more common) / Peritoneal fluid (ascites) transudation β hepatic hydrothorax
S β Sarcoidosis/SVC obstruction
122
Causes of Low Glucose Pleural Effusion
MEAT
M β Malignancy (lung cancer, mesothelioma, lymphoma)
E β Empyema (infection β glucose consumed by bacteria and WBCs)
A β Arthritis / RA (rheumatoid pleuritis, lupus)
T β Tuberculosis (TB pleuritis β glucose often low)
## Footnote
Think: βif the pleural fluid runs out of sugar, think MEATβ β malignant, empyema, autoimmune, TB.
123
Cavitating CXR lesions
TANKS x2
Infective:
T β TB
A β Aspergillosis and other fungi
N β Nocardia
K β Klebsiella
S β Staphylococcus aureus / pSeudomonas
Non-infective:
T β Trauma - haematuria
A β Arthritis/ANCA (Wegenerβs granulomatosis / GPA)
N β Neoplasm (metastases, e.g., squamous from head/neck)
K β Klots
S β Sarcoid/Septic emboli
Rarer: Abscesses, hydatid cysts
124
CXR solitary nodule
ABCDEFGHIJ
A β Artefacts
B β Benign tumours
C β Cancer
D β Dilated bronchus
E β Effusion
F β Fibroma / Fistula
G β Granuloma (healed TB or histoplasmosis)
H β Hydatid cysts
I β Infections (ie slowly resolving pneumonia)
J β Joint disease (rheumatoid nodules, Wegeners)
125
Interstitial Lung Disease Causes β FIST ACHED
F β Fungi
I β Idiopathic pulmonary fibrosis (IPF)
S β Sarcoidosis
T β Tumour / TB
A β Asbestosis
C β Connective tissue disease (RA, SLE, scleroderma)
H β Histocytosis X
E β Eosinophilic pneumonia / Environmental / EEA
D β Drug-induced (amiodarone, methotrexate, bleomycin, etc.)
## Footnote
Think of FIST ACHED as a hand βfistβ giving a punch to the lungsβall major ILD causes compacted into one mnemonic.
126
Upper lobe fibrosis
A TEA SHOP
A β ABPA (Allergic bronchopulmonary aspergillosis)
T β TB (Post-tuberculous fibrosis)
E β Extrinsic allergic alveolitis (chronic hypersensitivity pneumonitis)
A β Ankylosing spondylitis
S β Sarcoidosis
H β Histiocytosis (Langerhans cell histiocytosis)
O β Occupational exposures (Silicosis, Berylliosis)
P β Pneumoconiosis (Coal workerβs pneumoconiosis)
## Footnote
Think of a cozy βtea shopβ at the top (upper lobes) of the lungsβall these conditions βhang outβ there.
127
Lower Lobe Fibrosis (General) β CAID
NOTE: alternative is BBC MANS Gold CAB
C β Connective tissue disorders (scleroderma, rheumatoid arthritis)
A β Asbestos exposure β asbestosis
I β Idiopathic pulmonary fibrosis (IPF)
D β Drugs
Examples: nitrofurantoin, amiodarone, methotrexate, cyclophosphamide, sulfasalazine
## Footnote
Think: βCAID hits the bases (lower lobes)β β most lower lobe ILDs are systemic, environmental, idiopathic, or drug-induced.
128
Lower Lobe Fibrosis (General)
BBC MANS Gold CAB
B β Bleomycin
B β Busulphan
C β Cyclophosphamide
M β Methotrexate/Melphalan
A β Amiodarone
N β Nitrofurantoin
S β Sulfasalazine
Gold
C β CFA/Connective tissue disease
A β Asbestosis
B β Bronchiectasis
129
Clubbing + crackles
CAB
C β Cryptogenic fibrosing alveolitis
A β Asbestosis
B β Bronchiectasis / Bronchogenic carcinoma (local crackles)
## Footnote
Think of a patient with βclubbed fingers and crackly lungsββthese three conditions (CAB) are the most classic causes.
130
Causes of ARDS
ARDS ARDS
First ARDS β Direct (pulmonary) causes
A β Aspiration (gastric contents)
R β Respiratory infections (pneumonia, viral, bacterial)
D β Direct trauma / drowning / inhalation injury
S β Sepsis from pulmonary source
Second ARDS β Indirect (extrapulmonary) causes
A β Acute pancreatitis
R β Rhabdomyolysis / severe burns
D β Drugs / DIC / transfusions (TRALI)
S β Sepsis / shock
## Footnote
Think: βARDS ARDS hits the lungs twiceβdirectly from lung insults, indirectly from systemic problems.β
131
Hepatomegaly
3Cs + 3Is
C β Chronic liver disease / Cirrhosis
C β Cancer
C β Congestive cardiac failure
I β Infection (hepatitis, liver abscess, other systemic infections)
I β Infiltrative (hemochromatosis, amyloidosis, sarcoidosis, glycogen storage disease)
I β Inflammatory (autoimmune hepatitis, granulomatous disease)
## Footnote
Think: βThe liver is a CCCβIII factory: it enlarges from Congestion, Cirrhosis, Cancer, Infection, Infiltration, or Inflammation.β
132
Splenomegaly β NIHILIST
N β Neoplasm (leukemia, lymphoma, metastases)
I β Infection (bacterial, viral, parasitic β EBV, CMV, malaria)
H β Hematologic disorders (hemolytic anemias, thalassemia)
I β Infiltrative (storage disorders: Gaucher, Niemann-Pick)
L β Liver disease / congestion (portal hypertension, CHF)
I β Inflammatory (SLE, RA, autoimmune hemolytic anemia)
S β Spherocytosis / Splenic vein thrombosis / sequestration (rare)
T β Trauma / Thyrotoxicosis
## Footnote
Massive splenomegaly = malaria, kala-azar
133
Causes of massive splenomegaly
CATS + LV
C β CML (Chronic myeloid leukemia)
A β Atypical myeloproliferative disorders (primary myelofibrosis)
T β Thalassemia major (hemoglobinopathies)
S β Storage diseases (Gaucher, Niemann-Pick)
+ Less common causes:
L β Lymphoma (especially hairy cell leukemia)
V β Visceral infections (malaria, kala-azar / leishmaniasis)
## Footnote
Think: βOnly the big beasts cause massive spleensβCATS + LV
134
Hepatosplenomegaly
CML III
C β Congestive / Cardiac (right heart failure β congestive hepatomegaly)
M β Myeloproliferative disorders
L β Lymphoproliferative disorders (CML, ALL, AML, lymphoma)
I β Infection (viral hepatitis, EBV, CMV, malaria)
I β Inflammatory / Autoimmune (SLE, RA, sarcoidosis, autoimmune hepatitis)
I β Infiltrative (Gaucher's, amyloidosis, hemochromatosis, malignancy infiltration)
135
Hepatosplenomegaly + Lymphadenopathy
Lymphoma most likely, but also consider CHEST
C β CLL
H β Hepatitis A, B or C
E β EBV (infective mono)
S β Sarcoidosis
T β Toxoplasmosis
| Think: βIf your liver and spleen are big and nodes are swollen, check yo
136
Ascites Causes β 5 Ps + 5 Hs
P β Portal hypertension (cirrhosis, right heart failure, Budd-Chiari)
P β Peritoneal disease (peritoneal carcinomatosis, TB peritonitis, infections)
P β Pancreatic (pancreatitis β pancreatic ascites)
P β Protein loss / nephrotic syndrome (low oncotic pressure)
P β Pericarditis (constrictive)
H β Heart failure (right-sided β congestive hepatomegaly + ascites)
H β Hepatic failure (cirrhosis, Budd-Chiari)
H β Hypoalbuminemia (nephrotic syndrome, protein-losing enteropathy, malnutrition)
H β Hypothyroid
H β Hepatic vein thrombosis
137
PBC Associations / Features
SCRATCHED
S β Sjogrenβs / Scleroderma
C β Coeliac
R β Rheumatoid arthritis
A β Autoantibodies (MSN)
T β Thyroiditis / Tubular acidosis (renal)
C β Copper deposition
H β HLA DR8
E β Eyes (Kayser-Fleischer rings)
D β Dermatomyositis
## Footnote
MSN = mitochondrial (95%), smooth muscle (50%), nuclear (20%)
138
Hepatitis C
4Cs
Chronic
Cirrhosis
Cancer
Cryoglobulins (mixed essential type)
139
Glasgow Criteria for Severe Pancreatitis
GLASGOW Concerns Us
G β Glucose >10 mmol/L
L β LDH >600 IU/L
A β Age >55 years
S β AST >200 IU/L (SGOT)
G β PaOβ <8 kPa (hypoxia)
O β Albumin <32 g/L
W β WBC >15 Γ10βΉ/L
Concerns - Ca <2 mmol/l
Us - Urea >16mmol/l
## Footnote
score β₯3 predicts severe pancreatitis
140
Gardnerβs Syndrome β A SOD
A β Adenomas / intestinal polyps (multiple colonic adenomas, as in FAP)
S β Sebaceous (or epidermoid) cysts
O β Osteomas (especially in skull, jaw, or long bones)
D β Desmoid tumors (aggressive fibromatosis of abdominal wall or mesentery)
## Footnote
Think: βGardnerβs keeps an A SOD of surprisesβpolyps, bone growths, soft tissue lumps, and desmoids.β
141
Non-specific Abdominal Mass
CACA CLOT
C β Crohn's
A β Appendix
C β Carcinoma (especially ovary or sarcoma)
A β Amoebic abscess
C β Carcinoid
L β Lymphoma
O β Organomegaly (liver, spleen, kidney)
T β Trauma
142
Fat in the liver
PODGE
P β Pregnancy
O β Obesity / Overnutrition
D β Diabetes mellitus
G β Galactosaemia / Glycogen storage disorders
E β Ethanol (alcoholic fatty liver)
## Footnote
Think: βIf the liver gets fat, think PODGEβovereating, ethanol, diabetes, genetics, or poor protein intake.β
143
Malabsorption
TROPICAL ZOO
T β Tropical sprue
R β Radiation
O β Operations
P β Pancreas (cancer + chronic pancreatitis)
I β Intestinal TB / lymphangiectasia
C β Coeliac / Crohn's
A β Antacids
L β Lactose intolerance / Lamblia intestinalis
Z β Zollinger-Ellison syndrome
O β Overgrowth of bacteria (folate often normal/increased)
O β Overative thyroid (Grave's_
144
Addison's disease associations
Atrophic gastritis
Anti-21 hydroxylase
Autoimmune - HLA DR3 B6
Adrenal infections: Acid fast bacilli (ie TB) / AIDS
145
PCOS increases TLC
Testosterone
LH
Cholesterol
146
Types of diabetic neuropathy
GAMA
Glove and stocking
Autonomic
Mononeuritis multiplex
Amyotrophy
147
Causes of hypercalcaemia - CHIMPANZEES
C β Calcium supplementation / Cancer (bone metastases, PTHrP)
H β Hyperparathyroidism (primary, tertiary)
I β Immobilization / Iatrogenic
M β Medication (thiazides, lithium, vitamin D toxicity)
P β PTHrP (paraneoplastic)
A β Addisonβs disease / Acromegaly (rare endocrine causes)
N β Neoplasm (myeloma, lymphoma, metastases)
Z β Zollinger-Ellison / other endocrine tumors
E β Excess vitamin D
E β Excess vitamin A (rare)
S β Sarcoidosis / other granulomatous disease (vitamin D mediated)
148
Causes of an increased anion gap metabolic acidosis - MUDPILES
M β Methanol
U β Uremia (chronic kidney disease)
D β Diabetic ketoacidosis (DKA)
P β Propylene glycol / Paraldehyde / Pyroglutamic acidosis
I β Isoniazid / Iron / Inborn errors of metabolism
L β Lactic acidosis
E β Ethylene glycol
S β Salicylates (late stage)
## Footnote
Think: βMUDPILES are stacked highβeach pile adds acids to the blood.β
149
Causes of Normal Anion Gap Metabolic Acidosis (NAGMA) - HARDASS
H β Hyperalimentation / High chloride intake
A β Acetazolamide (carbonic anhydrase inhibitors)
R β Renal tubular acidosis (RTA)
D β Diarrhea (loss of bicarbonate)
A β Addisonβs disease / adrenal insufficiency
S β Spironolactone / other drugs causing bicarbonate loss
S β Small bowel fistula / pancreatic fistula
150
Causes of a reduced (low) anion gap
P β Plasma cells / Paraproteinemia (e.g., multiple myeloma β IgG or IgA paraproteins)
A β Albumin low (hypoalbuminemia β most common cause)
L β Lithium / Laboratory error (or other cations increasing positive charge)
## Footnote
Think: βWhen the anion gap is too low, remember PALβparaproteins, albumin down, lithium or lab error.β
151
Metabolic Alkalosis β VOMED
V β Vomiting / aspiration (loss of gastric acid)
O β Overdiuresis (diuretics causing HβΊ and KβΊ loss)
M β Mineralocorticoid excess (hyperaldosteronism, Cushingβs)
E β Excess alkali (bicarbonate ingestion, antacids) . Ethylene glycold
D β Diuretics / Diarrhoea
## Footnote
Think: βIf your patient is alkalotic, check VOMEDβvomiting, over-diuresis, mineralocorticoids, excess alkali, dehydration.β
152
Respiratory Acidosis
OH NO DR T
O β Obstruction of airway (foreign body, tumour, COPD, asthma)
H β Hypoventilation (obesity hypoventilation, neuromuscular disease)
N β Neuromuscular weakness (GuillainβBarrΓ©, myasthenia gravis, botulism)
O β Obesity
D β Drugs e.g. anaesthetics and other sedatives
R β Respiratory disease e.g. fibrosis, severe pneumonia, ARDS
C β Chest wall restriction (trauma, myopathy)
153
Respiratory Alkalosis
CHOPPA
C β CNS disease (stroke, trauma, tumour, encephalitis)
H β Hypoxia (high altitude, pneumonia, PE, severe anaemia)
O β Overventilation (mechanical ventilation, panic attack)
P β Pregnancy (progesterone stimulates respiratory centre)
P β Pulmonary disease (PE or pulmonary oedema)
A β Aspirin toxicity
154
Pellagra
The Ds
Dermatitis β photosensitive, hyperpigmented rash in sun-exposed areas ("Casalβs necklace" around the neck)
Diarrhoea β due to GI tract inflammation
Dementia β confusion, memory loss, psychosis
Also: Depression + Death
155
Alport's syndrome
SEX
Sensorineural deafness (bilateral)
End-stage renal failure / Eye abnormalities
X-linked
156
Ankylosing spondylitis - The As
A β Ankylosing spondylitis (chronic inflammatory back pain, sacroiliitis)
A β Anterior uveitis (acute, recurrent, unilateral)
A β Aortic regurgitation (aortitis, ascending aorta dilation)
A β Apical lung fibrosis (upper zone)
A β Amyloidosis (secondary, late complication)
A β Achilles tendinitis (enthesitis at heel)
A β Atlanto-axial subluxation (cervical spine involvement)
A β Anorexia/weight loss (constitutional symptoms)
A β Anaemia of chronic disease
A β Arthritis in hips/shoulders (large joint involvement)
IgA nephropathy
Plantar fasciitis
157
Lung manifestations of SLE
CHEST
C β Crackles / Chronic interstitial lung disease (fibrosis)
H β Hemorrhage (diffuse alveolar haemorrhage)
E β Effusions +/- Embolism (pulmonary emboli from antiphospholipid syndrome)
S β Shrinking lung syndrome (diaphragm dysfunction)
T β TB (an dother pneumonias)
158
Behcet's
ULCER
U β Ulcers (recurrent oral & genital ulcers β hallmark)
L β Large joint asymmetrical polyarthripathy / Low vision (uveitis, retinal vasculitis β visual loss)
C β CNS lesions / Colchicine treatment / Clots (venous & arterial thrombosis)
E β Erythema nodosum & other skin lesions (pseudofolliculitis, acneiform rash)
R β Rash / Relapsing course (episodic flares with symptom-free intervals)
159
Jaccoud's arthropathy
PURSES
P β Parkinson's assocaited
U β Urticarial vasculitis is associated
R β Rheumatic fever can cause it
S β SLE can cause it
E β Erosions **absent** on X-ray (helps distinguish from RA)
S β Subluxation
160
Charcot's joints
The S's
S β surgar (diabetes)
S β Syphilis (tabes dorsalis)
S β Syringomyelia
S β Segregated sociaties = leper colonies (M. leprae)
S β Spinal cord injury / tumour
S β Spina bifida (meningomyelocele)
S β Sensory loss (diabetes mellitus β peripheral neuropathy)
S β Spastic paraplegia
S β Subacute combined degeneration of the cord
161
Polyarteritis nodosa (PAN)
WE RANK MAN
Testicular tenderness
W β Weight loss
E β Elevated BP (hypertension from renal artery involvement)
R β Reticular (mottled) rash (livedo reticularis)
A β Antibodies to hep B
N β Neurophils in biopsy sample
K β Kidney involvement (glomerulonephritis is rare β mainly arteritis)
M β Myalgia / Mesenteric ischaemia (abdominal pain after eating)
A β Affecting medium-sized arteries (spares lungs)
N β Neuropathy
162
Takayasu's arteritis
CLAUDE
C β Claudication of extremities (limb fatigue, especially upper limbs)
L β Loss of pulses (especially radial β βpulseless diseaseβ)
A β Age <40 (classically young women, often Asian)
U β Unequal BP in arms (>10 mmHg difference)
D β Dizziness (from vertebrobasilar insufficiency)
E β Eye symptoms (amaurosis fugax, visual loss)
163
SLE diagnostic features
MD SOAP BRAIN
M β Malar rash (butterfly rash)
D β Discoid rash
S β Serositis (pleuritis or pericarditis)
O β Oral ulcers (usually painless)
A β Arthritis (non-erosive, β₯2 joints)
P β Photosensitivity
B β Blood disorders (haemolytic anaemia, leukopenia, lymphopenia, thrombocytopenia)
R β Renal disorder (proteinuria >0.5 g/day or cellular casts)
A β ANA positive
I β Immunologic disorder (anti-dsDNA, anti-Sm, antiphospholipid)
N β Neurologic disorder (seizures, psychosis)
164
Psoriasis exacerbation
STREP
Streptococcal infections
Trauma
Retroviral (HIV)
Endocrine (especially postpartum)
Prednisolone withdrawal
165
Lichen planus
PAM has Lichen Planus
Penicillin / Penicillamine
Au (gold) / Arsenic
Methyldopa
Lupus
Phenothiazines
166
Malar rash
SMILERS
S β SLE (systemic lupus erythematosus)
M β Mitral stenosis
I β Impetigo
L β Lymphoma / leukaemia (rare, paraneoplastic rashes)
E β Erysipelas (group A strep)
R β Rosacea
S - Serotonin (carcinoid syndrome)
167
Pseudoxanthoma elasticum
CHICKS
C β Chicken skin (plucked)
H β Haemorrhage (upper GI)
I β Indigo (blue) sclerae
C β Coronary artery diseae
K β Keratopathy / ocular changes (angioid streaks in retina)
S β Squeaky valves
168
Pyoderma gangrenosum
Necrotic ULCeR
Necrotic - no cause in 50%
UC/Crohns
Leukaemias/Lymphomas
Cirrhosis
Rheumatoid arthritis
169
Anaemia in rheumatoid arthritis
CAMP Gold Felt
C β Chronic disease (Anaemia of chronic disease is the most common type in RA)
A β Aspirin / Aplastic anaemia (immune-mediated destruction or bone marrow suppression, sometimes secondary to drugs)
M β Megaloblastic anaemia (due to folate deficiency, especially from methotrexate use)
P β Pernicious anaemia (autoimmune B12 deficiency, associated with other autoimmune diseases like RA)
Gold β Gold salts (historically used in RA; can cause aplastic anaemia, bone marrow suppression)
Felt β Feltyβs syndrome (triad: RA + splenomegaly + neutropenia β hypersplenism causing anaemia and pancytopenia)
170
Erythema nodosum
NODOSUM
N β No cause (idiopathic; up to ~50%)
O β Oral contraceptives / pregnancy
D β Drugs (sulfonamides, penicillins, antibiotics, etc.)
O β Other infections (streptococcus, TB, chlamydia, mycoplasma, EBV, etc.)
S β Sarcoidosis (classic association, e.g. LΓΆfgrenβs syndrome: EN + arthritis + hilar adenopathy)
U β Ulcerative colitis / other IBD
M β Malignancy (esp. lymphoma, leukemia, but less common)
## Footnote
Sarcoid and streptococcal infectionsa re most common causes in the UK
Viral: HSV, EBV, HIV, HepB, HepC
Bacterial: Campylobacter, Rickettsiae, Salmonella, Psittacosis, Bartonella, Syphilis
Parasitic: Amoebiasis, Giardiasis
171
Erythroderma causes
ID SCALP
I β Idiopathic (up to ~30%)
D β Drugs (e.g. allopurinol, carbamazepine, phenytoin, penicillin, sulfonamides, gold, isoniazid)
S β Seborrhoeic dermatitis
C β Contact dermatitis
A β Atopic dermatitis (eczema)
L β Lymphoma & leukaemia (esp. cutaneous T-cell lymphoma / SΓ©zary syndrome)
P β Psoriasis
172
Vitiligo associations
PALE PATCH
P β Pernicious anaemia
A β Addisonβs disease (primary adrenal insufficiency)
L β Lupus erythematosus
E β Endocrinopathies (thyroid disease, diabetes, etc.)
P β PBC
A β Alopecia areata
T β Thyroid disease (autoimmune thyroiditis, Gravesβ, Hashimotoβs)
C β Coeliac disease
H β Halo naevi
173
Absent ankle jerks and upgoing planters
5Ss
Subacute combined degeneration of the cord (B12 deficiency)
Syphilis (taboparesis / tabes dorsalis)
Spondylosis
Spinal cord tumour / compression (esp. conus/cauda equina) + Syringomyelia
Sclerosis (motor neurone disease / multiple sclerosis depending on context)
| Friedreich's ataxia is the only other cause that doesn't fit into the li
## Footnote
π In exams: think conus + cord pathology (UMN centrally, LMN peripherally) or B12 / syphilis / syrinx.
174
Dystrophia myotonic symptoms (Steinert disease)
BALD AT FRONT
B β Baldness (frontal)
A β Anticipation (triplet repeat) + 'After potentials' seen on EMG
L β Limb muscle wasting & weakness (esp. distal) + GRIP
D β Dominant (autosomal)
A β Arrhythmias / cardiac conduction defects
T β Thyroid + diabetes
F β Face thin (hatchet facies)
R β Retardation (cognitive impairment, rare in DM1 but can occur in congenital form)
O β Ophthalmic cataracts
N β Not able to swallow
T β Testicular atrophy (emphasised again in some versions)
## Footnote
π Hallmark signs = myotonia (delayed relaxation, e.g. handshake grip) + multisystem involvement (endocrine, cardiac, cataracts, frontal balding).
175
Predominantly motor neuropathy
GP PLOD
G β GuillainβBarrΓ© syndrome (AIDP, acute motor axonal neuropathy)
P β Porphyria (acute intermittent porphyria)
P β Peroneal muscular atrophy (hereditary e.g. Charcot-Marie-Tooth)
L β Lead poisoning / Lyme disease
O β Organophosphates (toxic neuropathy)
D β Dopsone / Diabetic amyotrophy / Diphtheria
176
Median nerveβinnervated intrinsic hand muscles
LOAF
L β Lateral two lumbricals (1st & 2nd)
O β Opponens pollicis
A β Abductor pollicis brevis
F β Flexor pollicis brevis (superficial head)
## Footnote
π Everything else in the hand = ulnar nerve (including medial 2 lumbricals, interossei, hypothenar muscles, adductor pollicis, deep head of FPB).
177
Ulnar nerveβinnervated hand muscles
MAFIA
M β Medial two lumbricals (3rd & 4th)
A β Adductor pollicis (transverse and oblique heads)
F β Flexor pollicis brevis (deep head)
I β Interossei (dorsal and palmar)
A β Abductor digiti minimi (hypothenar)
## Footnote
β
Tip: The LOAF muscles are median-innervated; everything else (MAFIA) = ulnar. This is perfect for quick hand-nerve questions in exams.
178
Proximal myopathy (weakness of shoulder and hip girdle muscles) causes
PIGS LEAD
P β Polymyositis / Dermatomyositis
I β Inflammatory myopathies (inclusion body myositis)
G β Glucocorticoid / drug-induced myopathy (steroids, statins, colchicine)
S β Systemic diseaseβrelated (thyroid disorders, Cushingβs, endocrine)
L β Limb-girdle muscular dystrophies
E β Electrolyte abnormalities (hypokalemia, hyperkalemia, hypophosphatemia)
A β Alcohol-induced myopathy
D β Duchenne / Becker muscular dystrophy
## Footnote
Polymyalgia rheumatica (PMR) can cause shoulder and hip girdle pain, but not weakness
179
Internuclear opthalmoplegia mnemonic
ABducting eye Beats
ADducting eye Delayed
## Footnote
ABducting eye (the eye moving laterally) β nystagmus / βbeatsβ
ADducting eye (the eye moving medially) β delayed or limited adduction
Convergence is usually spared (helps distinguish from third nerve palsy)
180
Cerebellar signs
DANISH
D β Dysdiadochokinesia (impaired rapid alternating movements)
A β Ataxia (gait, limb, truncal)
N β Nystagmus (especially gaze-evoked)
I β Intention tremor (tremor worsens on goal-directed movement)
S β Slurred speech / Scanning speech (dysarthria)
H β Hypotonia / Heel-to-shin test abnormality
181
Demyelinating diseases
Some People Like Myelin
S β MS (Multiple Sclerosis)
P β PML (Progressive multifocal leukoencephalopathy)
L β Leukodystrophies (genetic white matter disorders)
M β Myelinolysis (e.g., central pontine myelinolysis)
## Footnote
π‘ Alternative broader list (for exams) can also include:
A β ADEM (Acute disseminated encephalomyelitis)
C β CIDP (Chronic inflammatory demyelinating polyneuropathy)
G β GuillainβBarrΓ© syndrome (acute inflammatory demyelinating polyneuropathy)
182
CT brain ring enhancing lesions
SNATCH
S β Staphylococcus aureus (bacterial abscess, often from endocarditis or haematogenous spread)
N β Neoplasms
A β Aspegilloma / Actinomyces
T β TB / Toxoplasmosis / Thrombosed AV malformation
C β Cryptococcus / Candida / Cysticcerosis
H β Hydatid disease / Hamartoma (resolving)
## Footnote
Single lesion: usually bacterial abscess or TB in endemic areas
Multiple lesions in immunocompromised: think toxoplasmosis, Nocardia, fungal
Location clue: toxoplasmosis β basal ganglia; bacterial β greyβwhite matter junction
183
WIlson's disease features
BRAIN
B - Basal ganglia involvement (movement disorders)
R - Renal tubular acidosis II (Fanconi like)
A - Acute haemolysis / Amenorrhoea
I - Iris (Kayser-Fleischer rings)
N - Neuropsychiatric
184
Berry aneurysm associations TINS OF PEACH
T β Tubular sclerosis (rare, sometimes associated)
I β Infective endocarditis
N β Neurofibromatosis type 1
S β Sickle / SLE
O β Other collagen type III disorders
F β Fibromuscular dysplasia
P β Pseudoxanthoma elasticum
E β EhlersβDanlos syndrome (type IV, vascular type)
A β Adult polycystic kidney disease (autosomal dominant)
C β Coarctation of aorta
H β HHT (= Osler Weber Rendu syndrome)
## Footnote
PEACH = most common causew
185
Increased CSF but normal cells
GLASS
G β GuillainβBarrΓ© syndrome (classic)
L β Lead poisoning
A β Acoustic neuroma
S β Subacute sclerosing panaencephalitis (persistence of measles antigen in CNS)
S β Spinal tumor / cord compression / Syringomyelia
## Footnote
Froinβs syndrome is characterized by xanthochromic (yellow), highly viscous cerebrospinal fluid (CSF) with markedly elevated protein and normal or low cell count, typically due to obstruction of CSF flow.
186
Froin's syndrome mnemonic
Froin = Flow blocked β Rich protein CSF
## Footnote
Froinβs syndrome is characterized by xanthochromic (yellow), highly viscous cerebrospinal fluid (CSF) with markedly elevated protein and normal or low cell count, typically due to obstruction of CSF flow.
VERY HIGH PROTEIN in CSF
Obstruction of CSF flow β protein accumulates distal to block β increased viscosity and xanthochromia
187
GuillainβBarrΓ© syndrome (GBS) causes
C β Campylobacter jejuni (most common preceding infection, especially gastroenteritis)
M β Mycoplasma pneumoniae
V β Viruses:
**Cytomegalovirus (CMV)** - most common
EpsteinβBarr virus (EBV)
HIV
## Footnote
β
Exam tip:
GBS usually occurs 1β3 weeks after infection
Ascending symmetric weakness, areflexia, possible autonomic involvement
CSF: albuminocytologic dissociation (high protein, normal WBC)
188
Mitochondrial diseases
LUMP
L - limb girdle myopathy / Leber's / Leigh disease
U - Usher syndrome
M - MELLAS / MERRF
P - Progressive external ophthalmoplegia (Kearns-Sayre)
## Footnote
Features
L β Lactic acidosis
Due to impaired oxidative phosphorylation
U β Uthoffβs phenomenon / myopathy / weakness
Exercise intolerance, muscle weakness
M β Mitochondrial inheritance / multisystem involvement
Often maternally inherited; affects CNS, muscle, heart, eyes
P β Peripheral neuropathy / Ptosis / Pigmentary retinopathy
Ophthalmoplegia, retinal changes
MELAS β strokes + lactic acidosis
MERRF β myoclonus + ragged red fibers
LHON β optic neuropathy
KearnsβSayre β progressive external ophthalmoplegia + pigmentary retinopathy
189
Retinal vein thromosis
DGH
D - Diabetes
G - Glaucoma
H - HTN / Hyperviscosity syndrome
190
Causes of Retinitis Pigmentosa
BLACK Network Under Retina
B β BardetβBiedl syndrome (AR, obesity, polydactyly, renal anomalies)
L β Leber congenital amaurosis (AR, severe early-onset RP)
A β AlstrΓΆm syndrome (AR, obesity, hearing loss, cardiomyopathy)
C β Choroideremia (X-linked, progressive degeneration) / Cockayne syndrome
K β KearnsβSayre syndrome (mitochondrial, progressive external ophthalmoplegia + RP)
N β NARP syndrome
U β Usher syndrome (AR, RP + congenital hearing loss)
R β Refsum disease (peroxisomal disorder, RP + neuropathy)
## Footnote
Often AR inheritance, except choroideremia (X-linked) and some forms of RP
191
Causes of Angioid Streaks
PEPSI
P β Pseudoxanthoma elasticum (PXE) β most common systemic cause
E β EhlersβDanlos syndrome β connective tissue disorder
P β Pagetβs disease of bone β metabolic bone disease
S β Sickle cell disease / other hemoglobinopathies β vascular fragility
I β Idiopathic β sometimes no systemic association
## Footnote
Angioid streaks are breaks in Bruchβs membrane visible on fundus exam
Angioid streaks may predispose to choroidal neovascularization β vision loss
Usually bilateral and radiate from optic disc
Look for skin, bone, or systemic connective tissue features to identify underlying cause
192
Roth's spots
ROTH Centre
P β Pernicious anaemia
A β ANCA (vasculitis)
L β Lupus
E β Endocarditis
C β Collagen vascular disease
## Footnote
Rothβs spots = retinal hemorrhages with pale centers
Most classic association = infective endocarditis
Also seen in other hematologic or systemic disorders
193
Causes of Cherry-Red Spot
SPOT
S β Sphingolipidoses / Storage diseases (Gaucher's, Tay-Sachs, Niemann=Picl)
P β Purine metabolism / metabolic disorders (CRAO)
O β Occlusion of retina artery
T - Trauma
## Footnote
Cherry-red spot = pale retina surrounding fovea
Classic lysosomal storage disease finding in infants/children
CRAO = cherry-red spot in acute adult vision loss
194
Blue sclera causes
Mnemonic: Thin purple membrane covering over eyes
T - Thyrotoxicosis
P - Pseudoxanthoma elasticum
M - Marfans
C - Corticosteroids
**O - Osteogenesis imperfecta**
E - Ehlers-Danlos
195
Wernicke's Encephalopathy Triad
CAO (Cheif Ataxic Officer)
1. Confusion β global disorientation, inattentiveness
2. Ataxia β gait and stance instability + Anterograde amnesia
3. Ophthalmoplegia / Nystagmus β eye movement abnormalities
196
Anorexia
Increases = Nucleic Acid Bases
G - Growth hormone
C - Cortisol / Cholesterol
A - Amylase
T - Transaminases (AST/ALT)
U - Urea/Creatine
## Footnote
EVERYTHING else decreases
IGF-1 (Insulin-like growth factor 1)
Leptin
Sex hormones (Estrogen, Testosterone)
Thyroid hormones (T3, sometimes T4)
Glucose
Fat-soluble vitamins (A, D, E, K)
Electrolytes (Potassium, Magnesium, Phosphate)
197
First-rank (Schneiderian) symptoms of schizophrenia
PAD ThaiS
P β Passivity phenomena
A β Auditory hallucinations
D β Delusional perception
T β Thought disorders / thought broadcasting / thought insertion / withdrawal
S β Somatic hallucinations/passivity
198
Eosinophilia
AS PURE
A - ALlergy
P - Skin (pemphiUs / urticaria)
P - Parasites (Helminths: Strongyloides, Ascaris, Schistosoma, Toxocara)
U - Ulcerative colitis
R - Radiation / Rheumatological (Vasculitis - EPA, EGPA or Churg-Strauss, lupus)
E - Eosinophilic granuloma
199
Causes of basophilia
MUMPS Virus
M β Myeloproliferative disorders (e.g., chronic myeloid leukemia) / Malignancy
U β UC/Uremia (chronic kidney disease)
M β Myxoedema
P β Polycythemia vera
S β Splenectomy
Virus -Any viral, but mostly mumps!
200
Basophilic stippling
B β B-thalassemia (and other hemoglobinopathies)
A β Alcohol (chronic alcoholism) / ACD
S β Sideroblastic anemia
I β Iron deficiency (rarely, may contribute)
L β Lead poisoning
## Footnote
Basophilic stippling = blue granules in RBCs on peripheral smear
Classic clue for lead poisoning: basophilic stippling + GI symptoms + neuropathy
201
Causes of a dimorphic blood film
TICS
T β Transfusion
I β Iron deficiency anaemia
C β Combined iron and folate deficiency
S β Sideroblastic anemia (primary)
## Footnote
A dimorphic blood film shows both microcytic and normocytic or macrocytic red cells
Look at MCV, Hb, and blood film to differentiate causes
202
Medical causes of hyposplenism / functional asplenia
G β Gliadin antibodies (=coeliac)
L β Lymphoma / Leukemia
A β Amyloid
S β Sickle and thalassemia
S β SLE
E β Early life / Extramedullary hematopoiesis / bone marrow disorders
S β Severe infections (e.g., malaria, overwhelming sepsis)
## Footnote
SPLENECTOMY is most common cause of
Hyposplenism leads to increased risk of encapsulated bacterial infections
Blood film may show HowellβJolly bodies, target cells, or Heinz bodies
203
Features of hyposplenism
SHAME
S β Siderocytes / Spherocytes / Spiculated RBCs + **Target cells**
H β HowellβJolly bodies (nuclear remnants in RBCs)
A β Anemia (target cells, mild hemolytic anemia)
M β IgM levels low
E β Encapsulated organism susceptibility + Enhanced neutrophilia with infections
204
Spherocyte causes
4Hs
H β **H**ereditary spherocytosis
H β Autoimmune **h**emolytic anemia (warm antibody type) / ABO hemolytic disease of the newborn
H - **H**yposplenism
H β **H**eat (Burns)
205
Causes of target cells
HALT
H β Hemoglobinopathies
A β Asplenia / Post-splenectomy
L β Liver disease
T β Thalassemia / Iron deficiency
206
Sideroblastic anaemia
VIL
V β Vitamin B6 deficiency (pyridoxine)
I β Iron overload / Lead poisoning
L β Lesch-Nyhan / inherited / congenital (rare hereditary causes)
## Footnote
Most common acquired cause = Vitamin B6 deficiency
Look for ring sideroblasts on Prussian blue stain
207
Leukoerythroblastic blood film causes
The Ms
M β Myelofibrosis (primary or secondary)
M - Myeloma
M - Myeloid leukaemia
M β Metastatic cancer / Myelophthisis (marrow infiltration)
M - Myobacterium (TB) in marrow
M β Massive hemolysis / Marrow stress
M β Megaloblastic anemia (severe vitamin B12 or folate deficiency)
208
GaisbΓΆckβs syndrome
O β Obesity
B β Balding (middle aged)
E β Elevated Hb and PCV
S β Smoking
E β Epinepherine (stress) + Excess alcohol/diuretics
## Footnote
GaisbΓΆckβs syndrome = relative polycythaemia (raised haematocrit due to β plasma volume, not β RBC mass).
209
Inherited thrombophilia (recurrent DVT)
FAT SICK
F β Factor V Leiden (APC resistance)
A β Antithrombin III deficiency
T β proThrombin gene mutation (G20210A)
S β Protein S deficiency
I β Inhibitor (plasminogen activator) excess
C β Protein C deficiency
K β Kids/familial thrombophilia (catch-all for rare inherited causes e.g., MTHFR mutation, Homocystinuria)
210
B1 antagonists (selevtive)
A BEAM
A β Atenolol
B β Bisoprolol
E β Esmolol
A β Acebutolol
M β Metoprolol
## Footnote
These are the classic Ξ²1-selective blockers (remember: selective at low doses, less selective at high doses).
211
Non-selective beta blockers
PPT
Propanolol
Pindolol
Timolol
212
Cholinergic side effects (muscarinic excess, e.g. organophosphate poisoning, cholinergic crisis)
SLUDGE
S β Salivation / Sweating
L β Lacrimation
U β Urination
D β Diarrhoea
G β Gastrointestinal upset
E β Emesis
S β Small pupils (miosis)
213
P450 inhibitos
OF DEVICES
O β Omeprazole
F β Fluconazole (and other azole antifungals)/Fluoxetine
D β Disulfiram
E β Erythromycin (and other macrolides, except azithromycin)
V β Valproate
I β Isoniazid
C β Cimetidine/Ciprofloxacin
E β EtOH/also Grapefruit juice often slotted here
S β Sulfonamides
214
P450 inducers
PC BRAS
P β Phenytoin
C β Carbamazepine
B β Barbiturates (e.g. phenobarbital)
R β Rifampicin
A β Alcohol (chronic use)
S β Sulphonylureas / St Johnβs Wort
215
Rifampicin
4Rs
RNA polymerase inhibitor (mechanism of action)
Ramps up microsomal P450 (enzyme inducer)
Red/orange body fluids (urine, sweat, tears)
Rapid resistance if used alone (always combined in TB therapy)
216
Lead poisoning
ABCDEFGHIJK
A β Anaemia (microcytic with basophilic stippling)
B β Basophilic stippling / Burtonβs blue gum line
C β Colic (abdominal pain, constipation)
D β Drop (wrist drop, foot drop from neuropathy)
E β Encephalopathy (confusion, seizures, cognitive decline)
F β Foot (and wrist) drop (peripheral neuropathy)
G β Gonadal dysfunction / Gingival hyperpigmentation / Gout-like
H β Hyperchloraemic acidosis (secondary to RTA)
I β Infertility / Insomnia
J β Joint pain / arthralgia
K β Kidney damage (interstitial nephritis)
217
Drug-induced lupus
HIPPOS
H β Hydralazine
I β Isoniazid
P β Procainamide
P β Phenytoin
O β OCP
S β Sulfonamides
218
Lithium Side Effects
D and Ts
**Early effects:**
Diarrhoea
Tremor (coarse)
Teratogenicity (Ebsteinβs anomaly in fetus)
Taste disturbance
Thirst
**Late effects:**
Diabetes insipidus
Teenage skin (acne)
Thyroid (established hypothyroidism)
T wave flattening
Tardive dyskinesia
219
Strongyloides
Strong ALES
Asthma-like presentation
Larva currens
Eosinophilia/Enteral malabsortion
Stomach (and Systemic) upset
## Footnote
Look for peripheral eosinophilia and skin rash in returning travelers or immunocompromised patients.
Hyperinfection syndrome can be fatal in immunosuppressed individuals.
220
X-linked recessive disorders
βOblivious Female Will Give Her Numerous Boys Her X-linked Disordersβ
O β Ocular albinism
F β Fragile X/Fabry disease
W β Wiskott-Aldrich syndrome
G β G6PD deficiency
H β Hunter syndrome
N - Nephrogenic DI
B β Becker muscular dystrophy
H β Hemophilia A & B
X β (X-linked) Severe combined immunodeficiency (SCID, some forms)
D β Duchenne muscular dystrophy
221
X-linked Dominant Disorders
CV RIP
C β Chronic granulomatous disease
V β Vitamin D-resistant rickets (hypophosphatemic rickets / X-linked)
R β Rett syndrome
I β Incontinentia pigmenti
P β Pseudo-hypoparathyroidism
MRCP Part 1
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