• I B D
• I B S
• Infection
  • Viral
  • Bacterial
  • Giardiasis
• Intolerance
• Celiac
• Cancer
• H I V
• Antibiotic
• Thyrotoxicosis

3/ ABDOMEN – RECTAL BLEEDING

• Anal fissure
• Haemorrhoid
• Polyp
• Diverticulitis
• Cancer
• I B D
• Mesenteric Ischemia
• Perforated peptic Ulcer
• Gastric Ulcer
• Bleeding disorder
• Blood thinner

4/ ABDOMEN – Pain + RACTAL–BLEEDING (Left Side)

• Diverticulitis
• Diverticulosis
• I B D
• Cancer
• Mesenteric ischemia
• Bowel obstruction (PAIN)
• Renal – U T I
• P I D
• Ovarian cyst
• Torsion of testes.

5/ ASTHMA – Non-complaint TRIGERING FACTORS ( A B C D E F G H I J )

• A llergen – Pollen
• B ronchial infection (Frequent infections)
• C old weather (affect with)
• D rug like Aspirin
• E xercise induced / emotional stress
• F ood
• G ORD
• H ormones (Preg / OCP)
• I rritants – Dust / Pets / Carpet / Smoke
• J ob – paints fumes

6/ BACK PAIN (ACUTE) Lifting wt from ground.

• Trauma
• Muscle Strain
• Fracture
• Infection – Osteomyelitis / ankylosing spondylitis
• Bone – Disc prolapse

7/ C V S Risk Assessment ( A B C D E F S P )

• A lcohol / Age < 50 ys
• B M I / B P
• C holesterol / Cigarettes
• D iabetes / Diet
• E xercise
• F amily Hx. of Cholesterolemia
• S tress / Sleep Apnoea
• P ast hx. of heart attacks, Stroke

8/ CHEST PAIN ( C_ARDIC P_LEURATIC G_UT )

Cardiac

• M I
• A C S
• Angina
• Aortic dissection

Pleuritic chest pain with breathing ( C P₆ R )

• Pneumonia
• Pneumothorax
• P E
• Pleural effusion
• Pericarditis
• Costochondritis
• Rib fracture
• Panic attack

Gut

• Esophagitis
• GORD
• Peptic ulcer

9/ COUGH

• Allergic Rhinitis
• Sinusitis
• Post Nasal Drip
• Post viral Drip
• Pertussis
• Asthma
• Bronchitis
• Lung Ca
• Pneumonia
• Heart failure
• GIT Reflex
• Irritant exposure
• Psychogenic

10/ DELERIUM – ( H I M E D )

• H ypoxia – (Surgeries)
• I nfection – U T I
• M etabolic
  • Hypo Na
  • Uraemia
  • Liver
• E ndocrine
  • DM
  • Thyroid
• E C G – CVS / CNS
  • CVS:- MI / Heart Failure
  • CNS:- Trauma / Tumour / Stroke / TIA
• D rugs (Alcohol with drawl )
• D epression
• D ementia

11/ DVT risk assessment ( COST VMPF )

• C ontraception
• O besity
• S urgery
• T rauma / Travel
• V aricose veins
• M alignancy
• P ast Hx
• P ost – partum
• F amily hx.

12/ FOOT PAIN

FORE FOOT

• Skin down
  • Cellulitis
  • Planter fasciitis
• Bone & Joints
  • Stress #
  • Osteomyelitis
  • Tumour
• Joints
  • O A
  • R A
  • S A
• Vessels & Nerves
  • Morton Neuroma
  • PVD

HIND FOOT

• Skin down
  • Skin infection
  • Heal bruise (long standing)
  • Planter Fasciitis
• Bone
  • Calcaneal spur
  • Calcaneal stress fracture
• Joint
  • Ortho-arthritis of ankle
• Nerve entrapment
  • Tarsal tunnel syndrome
• Around ankle
  • Ankle sprain
  • Achilles tendinitis
  • Achilles tendon rupture

13/ GOUT

• Skin trauma
• Cellulitis
• Insect bite
• Bone and joints
  • O A
  • R A
  • P A
  • G A
  • S A

14/ GYNACOMESTIA

• Physiological
  • 0 – 3 weeks
  • 10 – 17 yrs
  • After 50s.
• Pseudo
  • Obesity
  • Breast CA to R/O
• Pathological
  • Hyperthyroidism
  • C L D
  • Hypogonadism
  • Testicular Ca
  • Medication ( D I S C 0 – A ) AMC cases
    • D igoxine
    • I sonizid
    • S pironolactone
    • C emetadine
    • O C P
    • Antiandrogen
    • Anabolic steroid
    • Alcohol

15/ HAEMATURIA

• U T I
• S T I
• P S G N
• I G A N
• Stone
• T B
• Tumour
• Exercise
• Female – Period
• Male – BPH
• Pseudo haematuria
• Bleeding disorder
• Blood thinking medication

16/ HEAD ACHE ( R M I T S )

• Referred
  • Sinusitis
  • Tooth ache
  • T M Joint dysfunction
  • Ear pain
  • Neck – cervical
• Meningitis
• Migraine
• Head Injury
• Tension H.A
• Temporal Arthritis
• Tumour
• Trauma
• S A H
• Stroke

17/ HOARSENESS ( S I₃ T – C₄ )

• Stroke / TIA
• Infections
  • URTI
  • Overuse / Abuse of vocal card
  • Polyp
• Thyroid
• Cancer
  • Larynx
  • Pharynx
  • Oesophagus
  • Pancoast tumour

18/ JAUNDICE

• Hepatitis
• Viral
• Bacterial
• Drug induced.
• Cirrhosis
• C L D
• Cholecystitis
• Cholangitis
• Cholangiocarcinoma (head of the pancreas)

19/ JAUNDICE – ( ABP – FIT – NO-S_EX )

• A lcohol – hep
• B lood transfusion
• P earcing / tattooing
• F ood street
• I licid drugs / Antibiotic
• T ravel
• N eedle injury
• O ccupation
• S exual Hx

20/ KNEE PAIN

• Trauma
• Tumour
• Infection – S.A / O. M
• Inflammation – JRA / HSP
• Age – < 4 ( DDH – Transient synovitis)
• Age – 4 – 8 ( Transient synovitis / Perthes )
• Age – 10 – 15 ( O S D / SCFE
• Age – 15 – 20 Chondromalacia Patella (Joggers Knee) / Patella tendinitis ( Jumper’s Knee)

21/ LEG PAIN & SWELLING

• SWELLING
  • Heart failure
  • Kidney failure
  • Liver failure
  • Lymphedema
• LEG PAIN WITH SWELLING
  • P V D
  • D V T
  • Cellulitis
  • Trauma
  • Insect bite

22/ LUMP IN THE NECK

• CONGENITAL
  • Cystic Hygroma is a fluid-filled sac that results from a blockage in the lymphatic system. It is most commonly located in the neck or head area, but can be located anywhere in the body. It may be discovered in a fetus during a pregnancy ultrasound, or it may be apparent at birth as a soft bulge under the skin.
  • Thyroglossal cyst
• ACQUIRED
  • Post viral lymph adenitis
  • Bacterial pharyngitis
  • T B
  • E B V
  • Cat stretch disease / Toxoplasmosis
  • Lymphoma
  • Leukemia

23/ NECK / SHOULDER PAIN / CERVICAL SPONDYLOSIS

• Trauma
• Muscle Strain
• Bone infection ( O M )
• Inflammation
  • Rheumatoid arthritis
  • Ankylosing Spondylitis
• Metastasis – in the bone
• Disc – Spinal Cord. (CERVICAL SPONDYLOSIS )
• Refer pain from HEART.
• Pancoast tumour
• Shoulder pain
  • P M R
  • Polymyositis / Dermatomyositis
  • Fibromyalgia
  • C . F . Syndrome

24/ NERVOUSNESS

• Hyperthyroidism
• Pheochromocytoma
• Hypoglycaemia
• Arrythmia
• Menopause
• P O F
• G A D
• Panic Attack

25/ PALPITATION

• CARDIA
  • Arrythmias
  • Flutter
  • Fibrillation
  • S V T
  • I H D
  • Valvular Heart disease
  • H T N
• ENDOCRINE
  • Hyperthyroid
  • Pheochromocytoma
• HEAMODYNAMICS
  • Electrolytes – HYPERKALEMIA
  • Alcohol
• STAMULANTS
  • Tea
  • Coffee
• PANIC ATTACK
• MEDICATION
  • Metoprolol
  • Atenolol
  • C. C. Blocker
  • (Given for the treatment of High BP or Irregular heartbeats)

26/ Papilledema causes

• Brain tumour
• C N S inflammation
• Idiopathic intracranial HTN
• Deceased CSF resorption (e.g.
  • venous sinus Thrombosis
  • meningitis
  • SAH
• Cerebral Oedema / Encephalitis
• Medication ( e.g : tetracycline / Minocycline / Lithium / Corticosteroid (both use and withdrawal )

27/ RASH ON TRUNK ( HERPES ZOSTER)

• Herpes zoster
• Simplex (unlikely)
• Contact dermatitis
• Allergic rash
• Post viral rash

28/ RED EYE ( ZIKA / DENGUE )

• Local
  • Trauma
  • F . B
  • Conjunctivitis
    • VIRAL
    • BACTERIAL
    • ALLERGIC
  • Keratitis – H S V ( Viral / Microbial )
  • Uveitis
  • Glaucoma
• Systemic ( Rheumatological)
  • Ankylosing Spondylitis
  • I B D
  • Bechet disease
  • Zika Disease
  • Dengue
  • Chickengonia

29/ S O B ( ACUTE)

• Pneumonia
• Pneumothorax
• Pulmonary Embolism
• Pleural Effusion
• Acute exacerbation of ASTHMA or COPD
• Lung Ca
• Acute CCF
• MI
• Acute Panic ATTACK

30/ S O B ( CHRONIC )

• A typical pneumonia
• Asthma
• C O P D
• C T Disease
• Heart failure
• Lung Ca
• Mesothelioma
• Occupational Lung Disease
• Pleural Effusion
• Pulmonary Embolism
• Panic attack
• T B

31/ SORE THROAT

• Viral pharyngitis
• Bacterial pharyngitis
• Quincy
• E B V
• Gonorrhoea ( In pead CONDIDA / STEROID )
• Reflex
• Irritant Exposure

32/ SYNCOPE

• CNS
  • TIA / Stroke
  • Epilepsy
  • Meningitis
  • Head injury

• CVS
  • Arrythmia
  • Prolong QT with arrythmia
  • Aortic stenosis or HOCM
  • M I

• Situation
  • Vasovagal
  • Orthostatic -> patient standing and fall up
  • Dehydration
  • Polypharmacy

• Endocrine
  • Diabetes
    • Hypoglycaemia
    • Diabetic Neuropathy

• Others
  • Vision
  • Hearing & Balance
  • Muscular Skeletal

33/ TIREDNESS / Infective Endocarditis ( S – TEA  – I )

• S leep apnoea / stress (depression)
• T umour
• E ndocrine
  • Diabetes
  • Thyroid
  • Haemochromatosis
• A naemia
• I nfection / Inflammation (SLE / RA) / Infective Endocarditis

34/ URINARY RETENTION

• Trauma
• U T I
• S T I
• Stone
• Stricture
• Bladder Ca
• Diabetes
• MALE
  • Prostatitis
  • P P H
  • Prostate Ca
• FEMALE
  • Herpes
  • Fibroid
  • Ovarian Mass
  • Uterine Prolapse

35/ WEAKNESS OF UPPER / LOWER LIMB

• CENTRAL
  • Brain – trauma ( SDH)
  • Tumour
  • Stroke / T I A
  • M. Sclerosis
• PERIPHERAL
  • Neuropathies
  • G B S
  • Charcot Meri tooth
  • Diabetic Neuropathy.
  • Alcoholic Neuropathy
  • B ₁₂ Deficiency
• CONVERSION DISORDER

36/ WEIGHT LOSS

• Diet – Eating disorder
• Malabsorption
  • Celiac Disease
  • I B D
• Stress / Depression
• Tumour
• Endocrine
  • D M
  • Thyroid
• Anaemia
• Infection
  • H I V
  • T B
• Inflammation
  • R A
  • Hepatitis

Clinical Mnemonics: PAEDIATRICS

1/ Abdomen – VOMITING

• Pyloric stenosis
• Reflex
• Over feeding
•  INEFCTION
  •  Meningitis
  • Gastroenteritis
  • U T I
•  SURGICAL
  •  Appendicitis
  • Hernia
  • Intussusception
  • Gut Obstruction
• Congenital Adrenal Hyperplasia

 2/ Abdomen – CHRONIC PAIN

• I B D
• I B S
• Intolerance
  • Infection
  • Giardiasis
  • Gastroenteritis
  • Warm
  • U T I
• Celiac
• Constipation
• Abdominal Migraine
• Non specific Abdominal Pain (Functional abdo. Pain)

3/ C P         ( CEREBRAL PALSY )

• Epilepsy
• Down syndrome ( Genetic )
• Hypothyroidism ( Metabolic )
• Vison
• Hearing
• Trauma to brain
• Tumour
•  Infection
  •  Meningitis
  • Encephalitis
• Spinal cord abnormality
  • Spinal binefida
  • Myopathies

4/ DARK URINE

• Post S G N
• U T I
• Stone
• H S P
• Pseudo-haematuria
• Bleeding disorder
• Blood thinner

 5/ DIARRHEA

• I B D
• I B S
• Intolerance
  • Lactose
  • Protein Cow Milk
• INFECTIONS
  • Viral
  • Bacterial
  • Protozoal (Giardiasis)
  • Food poisoning
• Celiac
• Cystic fibrosis (thyroid adult)
• Antibiotic
• Toddler diarrhea

6/ ENCOPRESIS ( CAUSES ) F – D T P – C

• Functional Constipation & Fissure
• Diet & drugs (codeine)
• Thyroid ( hypo)
• Psychosocial factor
• Congenital Hergespring Disease & Cystic fibrosis

7/ EPIGLOTITIS – Noisy Breathing & SOB ( A B C D E F – P )

• Asthma
• Anaphylaxis / Wheezing / Steroids
• Abscess (Peritoneal Abscess)
• Bronchiolitis / bacterial trichiasis (o/e tenderness Trachea)
• Croup – Stridor / SOB
• Developmental abnormalities ( Vascular Ring / Laryngomalacia (stridor)
• Epiglottitis
• Foreign Body ( Upper – stridor / Lower – wheeze)
• Pneumonia – SOB

8/ FIT (CONVULSIONS)

• PROVOKED FITS
  • Trauma
  • Tumour
  • Meningitis
  • Febrile convulsions
  • Hypoglycaemia
  • Teenage – drugs & alcohol
• UN-PROVOKED FITS
  • Epilepsy 1^st attack
  • Breath Holding Attack

9/ HEAD ACHE

• Migrane
• Tension
• Cluster
• 2ndry causes
  1. Trauma
  2. Brain tumour
  3. Meningitis
  4. Encephalitis
  5. S A H
• Visual abnormalities
• Referred pain
  • Sinusitis
  • Ear ache
  • Neck pain

10/ HERPES STOMATITIS

• Traumatic Ulcer due to hot-food.
• H F M disease
• Harpings
• Drug induced (steroid)
• Sore o/s – Herpes stomatitis (AMC – Picture given)
• Impetigo
• Eczema
• Allergic rash

11/ I D A

• Nutritional
  • P I C A
• Cow mild protein intolerance
• Celiac disease
• I B D
• Bleeding disorder

12/ INTESTINAL OBSTRUCTION

• Early days
  • Duodenal Atresia
  • Jejunal Atresia
  • Ílial Atresia
  • Imperforated Anus
  • Hirschsprung disease
• Elderly month
  • Malrotation
  • Intussusception
  • Hernia
  • Cystic fibrosis

13/ INTUSUSCEPTION

• INFECTIONS
  • Meningitis
  • Ear infection
  • Pneumonia
  • Gastroenteritis
  • U T I
• SURGICAL
  • Appendicitis
  • Hernia
  • Testicular torsion
  • D K A
  • INTUSUSCEPTION

14/ IRRITABLE BABY

• Med GIT
  • Reflex
  • Intolerance cow milk protein / Lactose
  • Insufficient milk
  • Coeliac
• Surgical
  • Intussusception
  • Hernia
  • Torsion
• Infection
  • Meningitis
  • U T I
• Post-P depression (child well but mother is depress)
• Non Accidental Injury or Abuse

15/ JAUNDICE

• CONGUGATED
  • Neonatal Hepatitis
  • Galactosemia
  • Biliary Atresia
  • Choledochal cyst
  • Sepsis
  • Hypothyroidism
• UNCONGUGATED
  • A B O / RH incompatibility
  • Hereditary
    • G6PD
    • Hereditary Spirocytosis
  • Physiology Jaundice
    • Breat Milk Jaundice
    • Breast Feeding Jaundice

 16/ KAWASAKI ( M – HEART )

• Mucosal involvement; dry cracked lips, Straw-berry tongue
• Hands & feet desquamation
• Bilaterally purulent conjunctivitis
• Adenopathy – unilateral painful cervical LA
• Rash; Erythematous blanchable
• Temp; move than 39 at least 5 days

17/ LIMPING

• Trauma
• Tumour
• Infection
  • Osteomyelitis
  • Septic arthritis
• Inflammation
  • H S P
  • J R A
• Age
  • < 4 yrs
    • DDH
    • T S
  • 4 – 8 yrs
    • T S
    • Perthes disease
  • 10 – 15 yrs
    • S C F E
    • Osgood Schlitter disease
  • 15 – 20 yrs
    • Chondromalacia
    • Petalla Tendinitis

18/ NECK LUMP

Cervical lymph node (normal) 3 – 5 yrsof 1cm soft mobile non-tender.

• Cervical
  • Cystic hygroma ( one side of the neck )
  • Thyroglossal duct cyst ( in the mid line )
• Viral (Post viral lymphadenitis)
• Bacterial tonsillitis
• E B V
• T B
• Cat scretch disease
• Lymphoma
• Leukemia

19/ ORBITAL CELLULITIS

• Orbital cellulitis
• Peri-orbital cellulitis
• Trauma
• Insect bite
• Severe conjunctivitis
• Drug allergic reaction
• Kidney:
  • Nephritic – Nephrotic  Syndrome
• Heart failure
• Kidney failure
• Liver failure
• Non-accidental injury

20/ RASH with FEVER

• Meningococcemia
• Kawasaki Disease
• Scarlet Fever
• E B V
• Erythema Infectiosium (JM – 1323, 7ed)
• Roseola infectiosum

21/ RASH withOUT FEVER

• Eczema
• Psoriqases
• Seboriac
• Contact
• Allergic
• Scabies
• H S P
• I T P
• Leukemia
• N A Injuries

22/ RASH BLANCHABLE ( SKERV-A )

• Scarlet
• Kawasaki
• Erythema infectiosium / Eczema
• Roseola infectiosium
• Viral
  • Measles
  • Mumps
  • Chicken pox
• Allergic Rashes

23/ RASH – NON BLANCHABLE ( HIMAL – V )

• H S P
• I T P
• Meningcoccemia
• Allergic rash
• Leukemia
• Viral infection
  • Rubella
  • E B V

24/ RESPIRATORY HX – COUGH CLUSTER (Bronchiolitis, Croup, Whooping cough, Post-viral, Psychogenic)

• U R T I
• Allergic Rhinitis
• Post-viral
• Croup
• Pertussis
• Asthma
• Bronchiolitis
• F B
• Pneumonia
• T B
• Cystic Fibrosis
• Heart failure
• Reflex
• Irritant Exposure
• Psychogenic
• Drugs

25/ RUNNY NOSE

• Rhinitis
  • Viral
  • Bacterial
• Sinusitis
• Allergic rhinitis
• Nasal polyp
• D N S
• F B BEHIND NOSE
• Adenoid
• Irritants e.g SMOKE

 26/ SNORING – DIFFICULT BREATHING

• Allergic Rhinitis (Buggy mucosa)
• Nasal polyp
• D N S
• Increased Adenoid
• Increased Tonsiles
• Tongue fell back (Obesity)
• Down syndrome (Hypotonia of the Pharynx, wall collapse)

27/ SORE THROAT

• Tonsillitis
  • Viral
  • Bacterial
• Quincy
• E B V
• Reflex
• Irritant Exposure (smoking)

28/ TESTICULAR TORSION

• Intussusception
• Inguinal hernia (strangulated)
• Epididymo-orchitis
• Testicular Torsion
• U T I

29/ TIRDNESS ( S TEA I )

• Sleep (OSA), Stress
• Tumour
• Endocrine
  • Thyroid
  • Diabetes
• Anaemia – (Haemochromatosis)
• Infection & Inflammation

 

Clinical Pearls: In conclusion, it is best to have broad differentials to tackle all clinical stations. Keep practicing especially in pairs/groups will help improving clinical skills. In other words, by reading up UpToDate can help in providing proper management based on the different scenarios encountered.

clinical mnemonics, medical mnemonics, clinical differentials mnemonics

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