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21 Clinical Mnemonics
Nick R. Love, MD, PhD | June 5, 2020
| Contributor Information
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21 Clinical Mnemonics
Nick R. Love, MD, PhD | June 5, 2020 | Contributor Information
21 Clinical Mnemonics
Physician-artist Nick Love's latest creations are whimsical and memorable. Who could forget four Mr Ts?
21 Clinical Mnemonics
Nick R. Love, MD, PhD | June 5, 2020 | Contributor Information
Checking a patient's "numbers," one might find a plasma acidosis with increased anion gap (ie, [Na+] – [Cl- + HCO3-] >~ 16). In this case, please keep Methanol, Uremia, Diabetic ketoacidosis (DKA), Paraldehyde, Isoniazid, Lactic acidosis, Ethylene glycol, rhabdomyolysis, and Salicylates (and many others) in the differential.
21 Clinical Mnemonics
Nick R. Love, MD, PhD | June 5, 2020 | Contributor Information
When one finds a plasma acidosis and checks numbers to reveal a normal anion gap (ie, [Na+] – [Cl- + HCO3-] = 12 ± 4). In this case, please keep Spironolactone use, Hyperalimentation, Acetazolamide use, Addison disease, Renal tubular acidosis, Diarrhea, and overzealous Saline infusion in the differential.
21 Clinical Mnemonics
Nick R. Love, MD, PhD | June 5, 2020 | Contributor Information
If a patient presents with urinary incontinence (ie, wet), ataxia/instability (ie, wobbly), and/or altered mental status (ie, wacky), please look into the possibility of normal-pressure hydrocephalus. In such a case, CT of the brain may be a good next step.
21 Clinical Mnemonics
Nick R. Love, MD, PhD | June 5, 2020 | Contributor Information
If a patient presents with complaints of pain in their bones, symptoms of kidney/renal stones, abdominal pain (ie, "groans"), constipation (ie, extended time on the "throne") or psychosis/delirium (psychiatric overtones), please keep hypercalcemia in the differential.
21 Clinical Mnemonics
Nick R. Love, MD, PhD | June 5, 2020 | Contributor Information
The Glasgow coma scale (aka "GCS") measures coma severity and ranges from 3 to 15 (eyes, 1-4 points; verbal, 1-5 points; motor, 1-6 points). Add the eye, verbal, and motor points together, and if the total is under 8, please ask your attending (or resident or fellow) if it may be wise to intubate.
21 Clinical Mnemonics
Nick R. Love, MD, PhD | June 5, 2020 | Contributor Information
One is frequently asked to interpret a chest x-ray. Toward this aim, it may be helpful to use a systematic approach by examining the Airway, Bones, Cardiac silhouette, Diaphragm, Effusions, Fields, Gastric bubble, and Hilum. With those accounted for, the attending physician may ask to hear your overall interpretation.
21 Clinical Mnemonics
Nick R. Love, MD, PhD | June 5, 2020 | Contributor Information
At times, when examining a patient's blood labs, one finds a microcytic anemia (mean corpuscular volume <~ 80 fL). In this case, it may be helpful to consider a differential that includes Thalassemia, Anemia of chronic disease, Iron deficiency, Lead poisoning, and sideroblastic anemia.
21 Clinical Mnemonics
Nick R. Love, MD, PhD | June 5, 2020 | Contributor Information
During labor and delivery, the relationship between uterine contractions and fetal heart rate is commonly monitored. When the fetal heart rate shows Variable deceleration after a contraction, this may indicate Cord compression; Early deceleration after a contraction may indicate Head compression; an Acceleration after contraction may be Okay; and Late deceleration after a contraction may be a sign of Placental insufficiency.
21 Clinical Mnemonics
Nick R. Love, MD, PhD | June 5, 2020 | Contributor Information
If a patient presents with abnormal uterine bleeding (prolonged/unusually heavy bleeding, or bleeding between monthly periods) please consider a differential that includes Polyps, Adenomyosis Leiomyomata (fibroids), Malignancy/hyperplasia, endometriosis, Coagulopathy, Ovulatory dysfunction, Iatrogenic, or an etiology that is Not yet classified.
21 Clinical Mnemonics
Nick R. Love, MD, PhD | June 5, 2020 | Contributor Information
To screen a patient for depression, it may be useful to remember the key symptoms by "SIGeCAPS": a decrease in Sleep, loss of Interest in things previously enjoyed, increased Guilt, decreased energy, Concentration difficulties, Appetite loss, Psychomotor changes, or Suicidal ideation.
21 Clinical Mnemonics
Nick R. Love, MD, PhD | June 5, 2020 | Contributor Information
Infections that are transmissible from mother to fetus are often referred to using the acronym "TORCH": Toxoplasmosis, Rubella, CMV, and HIV. Some have modified the acronym to also include the similar pathogens Herpes simplex and Syphilis. One may find it challenging to create a further iteration of the acronym that would include parvovirus, varicella zoster, and Zika virus.
21 Clinical Mnemonics
Nick R. Love, MD, PhD | June 5, 2020 | Contributor Information
After an enteric or genitourinary infection, a patient may present with symptoms of "postinfective" or "reactive" arthritis. Classically, these symptoms first present as urethritis/cervicitis/balanitis (can't pee); then as ocular symptoms (eg, conjunctivitis, anterior uveitis, photophobia (can't see); and, finally, as arthritic pains in the back, knees, wrists, fingers, and ankles/feet (can't climb a tree). These symptoms can last for months!
21 Clinical Mnemonics
Nick R. Love, MD, PhD | June 5, 2020 | Contributor Information
If a patient (or board exam question) presents with signs of glomerulonephritis/hematuria (can't pee) and complains of changes to their visual acuity (can't see) or hearing (can't hear a buzzing bee), please keep Alport syndrome (loss of collagen IV) in your differential.
21 Clinical Mnemonics
Nick R. Love, MD, PhD | June 5, 2020 | Contributor Information
Hypertension during pregnancy is a big deal! In isolation, mild gestational hypertension may have limited adverse effects on mother and child. On the other hand, hypertension may be the first signal of a more serious condition, such as preeclampsia. The antihypertensives that are generally considered safe for use in pregnancy are Hydralazine, alpha-Methyldopa, Labetalol, and Nifedipine, often remembered by the phrase "Hypertensive Mothers Love Nifedipine."
21 Clinical Mnemonics
Nick R. Love, MD, PhD | June 5, 2020 | Contributor Information
A patient may present with complaints of hallucinations (mad as a hatter), increased temperature (hot as a hare), flushing/vasodilation (red as a beet), mydriasis (blind as a bat), urinary retention (full as a flask), and/or dry mucous membranes (dry as a bone). Together, these symptoms may be compatible with anticholinergic syndrome.
21 Clinical Mnemonics
Nick R. Love, MD, PhD | June 5, 2020 | Contributor Information
A patient may benefit from dialysis with the following indications. Acidosis, Electrolyte abnormalities, Intoxication with a poisonous substance, volume Overload, or Uremia. This is not an exhaustive list, however!
21 Clinical Mnemonics
Nick R. Love, MD, PhD | June 5, 2020 | Contributor Information
There may be a time when, like me, your thoracic surgery attending physician asks you in the OR about the differential of an anterior mediastinal mass. If this be the case, it may be helpful to recall the "four Ts": Thymoma, Teratoma, Thyroid (ectopic), and "Terrible" lymphoma.
21 Clinical Mnemonics
Nick R. Love, MD, PhD | June 5, 2020 | Contributor Information
Although somewhat uncommon in "developed" countries, pellagra (a result of niacin deficiency) should be kept in the differential when a patient presents with the "four Ds": Diarrhea, Dementia, Dermatitis, or Death.
21 Clinical Mnemonics
Nick R. Love, MD, PhD | June 5, 2020 | Contributor Information
A patient may develop a fever at varying times after surgery. Classically, these postoperative fevers proceed from "early" causes, such as atelectasis (Wind), followed by UTI (Water), Wound infection, and DVT or PE due to a lack of ambulation (Walking). Another possibility is fever due to a drug or transfusion reaction ("Wonder" drug).
21 Clinical Mnemonics
Nick R. Love, MD, PhD | June 5, 2020 | Contributor Information
Auscultating the heart is a key component of the physical exam, and there are classic sites on the chest where the cardiac valves are best heard. A convenient means to examine these sites is from the top right to bottom left, a progression often taught as "All (Aortic) Physicians (Pulmonary) Take (Tricuspid) Money (Mitral).
21 Clinical Mnemonics
Nick R. Love, MD, PhD | June 5, 2020 | Contributor Information
A patient may present with a Tremor (pill-rolling, at rest, often initially asymmetric), Rigidity (cogwheel), Akinesia (or bradykinesia), Postural instability, or Shuffling gait. In this case, please keep Parkinson disease in your differential.
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Contributor Information
Nick R. Love, MD, PhD
Transitional Year Resident
Cambridge Health Alliance
Cambridge, Massachusetts
Disclosure: Nick R. Love, MD, PhD, has disclosed no relevant financial relationships.
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