Medical Mnemonics

History structure: CHAMPS

• Complaint (presenting)
• History of presenting complaint
• Allergies
• Medications
• Past medical history
• Social history

Assessment of pain: SOCRATES

• Site
• Onset
• Character
• Radiation
• Associated symptoms
• Timing
• Exacerbating and relieving factors
• Severity

See our history taking guides for more details.

Significant past medical history: MJ THREADS

• Myocardial infarction
• Jaundice
• Tuberculosis
• Hypertension
• Rheumatic fever
• Epilepsy
• Asthma
• Diabetes
• Stroke

Drug history: PILLS

• Pills (is the patient taking any regular medications)
• Injections/insulin/inhalers
• ILLicit drug use
• Sensitivities (allergies)

History taking in syncope: “The Five Ps”

• Precipitant
• Prodrome
• Position
• Palpitations
• Post-event phenomena

See our syncope overview for more details

Handover: SBAR

• Situation
• Background
• Assessment 
• Recommendation

See our SBARR overview for more details

Trauma handover: ATMIST

• Age
• Time
• Mechanism of injury
• Injuries sustained
• Symptoms and signs
• Treatments given

See our SBARR overview for more details

VITAMIN CDEF

• Vascular
• Infective
• Traumatic
• Autoimmune
• Metabolic
• Iatrogenic
• Neoplastic
• Congenital
• Degenerative
• Endocrine
• Functional

VINDICATE

• Vascular
• Infection
• Neoplasm
• Degenerative
• Iatrogenic 
• Congenital
• Autoimmune
• Trauma
• Endocrine/metabolic

MIDNITE

• Metabolic
• Inflammation
• Degenerative
• Neoplastic
• Infection
• Trauma
• Environmental

INVITED MD

• Infection
• Neoplasia
• Vascular
• Inflammatory/autoimmune
• Trauma
• Endocrine
• Degenerative
• Metabolic
• Drugs
• Congenital

ECG lead placement: “Ride Your Green Bike”

Placement of limb leads, starting clockwise from the right wrist:

• Red
• Yellow
• Green
• Blue

See our guide to recording an ECG.

Starting a clinical examination: WIPE

• Wash your hands (and don PPE)
• Introduce yourself (#HelloMyNameIs)
• Patient’s name, date of birth and preferred name
• Explain and gain consent

Check out our clinical examination guides.

Level of consciousness: ACVPU

• Alert
• Confused
• Voice
• Pain
• Unresponsive

See our emergency management guides for more details.

General inspection from the end of the bed: ABC

• Appearance (colour, pain, breathlessness etc)
• Behaviour (calm, agitated etc)
• Connections (oxygen, catheters, cannulas, surgical drains etc)

Neurological examination structure: “Is The Physician Really So Cool?”

• Inspection
• Tone
• Power
• Reflexes
• Sensation
• Co-ordination

Tendon reflex nerve roots

Count upwards from the ankles:

• S1 S2: ankle jerk
• L3 L4: knee jerk
• C5 C6: biceps and brachioradialis
• C7 C8: triceps

Also, as a rhyme: “1,2 buckle my shoe 3,4 kick the door 5,6 pick up sticks 7,8 shut the gate”

Cerebellar signs: DANISH

• Dysdiadochokinesia & Dysmetria
• Ataxia
• Nystagmus
• Intention tremor
• Slurred speech
• Hypotonia

See our guide to cerebellar examination.

Heart valve auscultation sites: “All Physicians Take Money”

From right upper sternal border:

• Aortic
• Pulmonary
• Tricuspid 
• Mitral

Assessing a cardiac murmur: SCRIPT

• Site
• Character
• Radiation
• Intensity
• Pitch and quality
• Timing (in the cardiac cycle, systolic or diastolic?)

See our guide to cardiovascular examination.

Breaking bad news: SPIKES

• Setting up
• Perception
• Invitation
• Knowledge
• Emotions
• Strategy and summary

See our guide to breaking bad news.

Chest X-ray findings in heart failure: ABCDE

• Alveolar oedema (perihilar/bat-wing opacification)
• Kerley B lines (interstitial oedema)
• Cardiomegaly (cardiothoracic ratio >50%) – may be difficult to assess on an AP film
• Dilated upper lobe vessels
• Effusions (i.e. pleural effusions – blunted costophrenic angles with meniscus sign)

See our overview of acute heart failure.

Triggers of atrial fibrillation: PIRATES

• Pulmonary embolism
• Ischaemia
• Respiratory disease
• Atrial enlargement or myxoma
• Thyroid disease
• Ethanol
• Sepsis/sleep apnoea

See our overview of atrial fibrillation.

Features of aortic stenosis: SAD

• Syncope (exertional)
• Angina
• Dyspnoea

See our aortic stenosis examination guide.

Beck’s triad for cardiac tamponade: “Three Ds”

• Distant heart sounds
• Distended jugular veins
• Decreased arterial pressure (low BP)

Features of infective endocarditis: FROM JANE

• Fever
• Roth’s spots
• Osler’s nodes
• Murmur
• Janeway lesions
• Anaemia
• Nail bed haemorrhage
• Embolism

See our overview of infective endocarditis.

Management of hypertension: ABCD

• Angiotensin-converting enzyme inhibitors
• Beta-blockers (no longer first line)
• Calcium channel blockers
• Diuretics

See our overview of hypertension.

Features of asthma: CRAB

• Chronic inflammation of the airways
• Reversible airway obstruction
• Airway hyper-responsiveness
• Bronchial inflammation

See our overview of asthma to learn more.

Management of tuberculosis: RIPE

• Rifampicin
• Isoniazid (+ pyridoxine)
• Pyrazinamide
• Ethambutol

See our overview of tuberculosis.

Interpreting a chest X-ray: ABCDE

• Airway: trachea, carina, bronchi and hilar structures.
• Breathing: lungs and pleura.
• Cardiac: heart size and borders.
• Diaphragm: including assessment of costophrenic angles.
• Everything else: mediastinal contours, bones, soft tissues, tubes, valves, pacemakers and review areas.

See our guide to chest x-ray interpretation.

Features of thyroid eye disease: NO SPECS

• No signs or symptoms
• Only ocular irritation (dryness, gritty sensation)
• Soft tissue involvement (conjunctival oedema or injection)
• Proptosis
• Extraocular muscle involvement
• Corneal exposure and ulceration
• Sight loss (due to compressive optic neuropathy)

See our overview of thyroid eye disease.

Diabetic ketoacidosis precipitants: “The 5 Is”

• Infection
• Ischaemia
• Infarction
• Ignorance (poor diabetic control)
• Intoxication

See our guide to the acute management of diabetic ketoacidosis.

Features of hypercalcaemia: “Bones, Stones, Groans and Moans”

• Painful bones
• Renal stones
• Abdominal groans (pain)
• Psychiatric moans (depression, confusion, lethargy)

Indications for renal replacement therapy: AEIOU

• Acidosis
• Electrolyte abnormalities
• Ingested toxins
• Fluid Overload
• Uraemia

Management of acute kidney injury: ABCDE

• Address drugs (nephrotoxics)
• Boost blood pressure
• Calculate fluid balance
• Dip urine
• Exclude obstruction

See our overview of acute kidney injury.

Functions of the kidney (and complications of CKD): A WET BED

• Acid-base balance: metabolic acidosis
• Water removal: pulmonary oedema
• Erythropoiesis: anaemia
• Toxin removal: uraemia
• Blood pressure control: hypertension
• Electrolyte balance: hyperkalaemia
• Vitamin D activation: bone-mineral disorder of chronic kidney disease (CKD-BMD)

Causes of pancreatitis: I GET SMASHED

• Idiopathic
• Gallstones
• Ethanol
• Trauma
• Steroids
• Mumps/malignancy
• Autoimmune disease
• Scorpion sting (very rare…)
• Hypertriglyceridemia/hypercalcaemia
• ERCP (endoscopic retrograde cholangiopancreatography)
• Drugs: commonly azathioprine, thiazides, septrin, tetracyclines

Glasgow score for pancreatitis: PANCREAS

• PaO2 <8 kPa 
• Age > 55
• Neutrophils (white cell count) > 15
• Calcium < 2 mmol/L
• Raised urea >16 mmol/L
• Enzyme (LDH) >600 IU/L
• Albumin <32 g/L)
• Sugar (glucose) >10 mmol/L

See our overview of acute pancreatitis.

Conditions associated with coeliac disease: “I Don’t Take Apples, I Take Oranges”

• IgA deficiency
• Down’s syndrome
• Turner’s syndrome
• Autoimmune thyroid disease and autoimmune hepatitis
• IgA nephropathy
• Type 1 diabetes mellitus
• Other autoimmune conditions (e.g. Sjögren’s, myasthenia gravis, Addison’s disease)

See our overview of coeliac disease.

Features of myeloma: CRAB

• HyperCalcaemia
• Renal failure
• Anaemia
• Bone lesions

See our overview of multiple myeloma.

Vitamin K-dependent clotting factors: “2 + 7 = 9, not 10”

Causes of microcytic anaemia: TAILS

• Thalassemia
• Anaemia of chronic disease
• Iron deficiency anaemia
• Lead poisoning (rare)
• Sideroblastic anaemia (rare)

See our guide to full blood count interpretation.

Drugs that potentiate warfarin (increase INR): O DEVICES

Cytochrome P450 inhibitors:

• Omeprazole
• Disulfiram
• Erythromycin
• Valproate
• Isoniazid
• Ciprofloxacin/Cimetidine
• Ethanol (acute intoxication)
• Sulphonamides

Drugs that decrease the effectiveness of warfarin (decrease INR): PC BRAS

Cytochrome P450 inducers:

• Phenytoin
• Carbamazepine
• Barbiturates
• Rifampicin
• Alcohol (chronically)
• Sulphonylureas

See our guide to warfarin prescribing.

Features of migraine: POUND

• Pulsating
• One to three days duration (4 – 72 hours)
• Unilateral
• Nausea and/or vomiting
• Disabling

Features of Parkinson’s disease: SMART

• Shuffling gait
• Mask facies
• Akinesia
• Rigidity
• Tremor

See our guide to Parkinson’s disease examination.

Features of normal pressure hydrocephalus: “Wet, Wobbly and Wacky”

• Wet: urinary incontinence
• Wobbly: wide-based gait
• Wacky: cognitive impairment

See our neurosurgery topic summaries.

Features of limited cutaneous systemic sclerosis: CREST

• Calcinosis: deposits of calcium in soft tissue
• Raynaud’s: characterised by colour change of the hands, initially white (ischaemic change), then purple (deoxygenated blood) then pink (reperfusion)
• (o)Esophageal dysmotility: presents as dysphagia most often but there are other oesophageal symptoms
• Sclerodactyly: thickening and tightness of the skin of the fingers
• Telangiectasia: red spots around the mouth, nose and sometimes the palms, due to dilated capillaries

See our rheumatology topic summaries.

Features of melanoma: ABCDE

• Asymmetry
• Border irregularity (or poorly defined)
• Colour (varying colours)
• Diameter (>6mm)
• Evolving (changing in size, colour or shape

See our dermatology guides.

Causes of delirium: PINCH ME

• Pain
• Infection
• Nutrition
• Constipation
• Hydration
• Medication
• Environment

See our guide to delirium assessment & management,

Red flags for back pain: TUNA FISH

• Trauma
• Unexplained weight loss
• Neurological symptoms / signs
• Age > 50
• Fever
• Intravenous drug use
• Steroid use
• History of cancer

See our back pain history taking guide.

Reversible causes of cardiac arrest: “4Hs and 4Ts”

• Hypoxia
• Hypokalaemia/hyperkalaemia
• Hypothermia/hyperthermia
• Hypovolaemia
• Tension pneumothorax
• Tamponade
• Thrombosis
• Toxins

See our emergency guides.

Interpreting a CT head: “Blood Can Be Very Bad”

• Blood
• Cisterns
• Brain
• Ventricles
• Bone

See our guide to CT head interpretation.

Causes of abdominal distension: “The 6Fs”

• Fat
• Fluid 
• Flatus
• Faeces 
• Fetus
• Fatal mass (ie, malignancy)

See our guide to abdominal examination.

X-ray changes in osteoarthritis: LOSS

• Loss of joint space
• Osteophytes
• Subchondral sclerosis
• Subchondral cysts

See our guide to osteoarthritis.

Management of soft tissue injuries: RICE

• Rest
• Ice
• Compression
• Elevation

Salter-Harris classification: SALTR

• Slipped (type I)
• Above the joint (type II)
• Lower (Type III)
• Through (Type IV)
• Ruined or rammed (Type V)

See our guide to musculoskeletal x-ray interpretation.

Features of acute limb ischaemia: “The Six Ps”

• Pain
• Pallor
• Pulselessness
• Perishingly cold (poikilothermia)
• Paraesthesia
• Paralysis

See our guide to acute limb ischaemia

Assessment of breast lump: LMNOP

• Lumps
• Mammary changes
• Nipple changes
• Other symptoms
• Patient risk factors (risk factors for cancer)

See our guides to breast examination and breast cancer.

Management of shoulder dystocia: HELPERR

• Help: call for help
• Evaluate for episiotomy
• Legs (McRoberts’ position)
• Pressure (suprapubic)
• Enter manoeuvres (rotational)
• Remove the posterior arm
• Roll over onto all fours

See our guide to shoulder dystocia.

Features of nasopharyngeal cancer: NOSE

• Neck mass
• Obstructed nasal passage
• Serous otitis media externa
• Epistaxis and discharge

See our guide to nasal examination.

Pyloric stenosis: “Three Ps”

• Palpable mass 
• Peristalsis visible
• Projective vomiting

Features of croup: “Three Ss”

• Stridor
• Subglottic swelling
• Seal like cough

See our guide to croup.

Paediatric history: BINDS

• Birth
• Immunisations
• Nutrition
• Development
• Social history

See our guide to paediatric history taking.

Risk factors for suicide: SAD PERSONS

• Sex (male)
• Age (<19 or >45 years)
• Depression
• Previous attempt
• Excess alcohol or substance use
• Rational thinking loss
• Social support lacking
• Organised plan
• No spouse
• Sickness

See our guide to suicide risk assessment.

Features of post-traumatic stress disorder: HARD

• Hyperarousal: persistently heightened perception of current threat (may include enhanced startle reaction)
• Avoidance of situations/activities reminiscent of the events, or of thoughts/memories of the events
• Re-experiencing the traumatic events (vivid intrusive memories, flashbacks, or nightmares)
• Distress: strong/overwhelming fear and physical sensations when re-experiencing