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The treatment of asthma = ASTHMA

A= Adrenergics

S= Steroids

T= Theophyllines (althouigh not used as much now though)

H= Hydration

M= Mask

A= Antibiotics if necessary.



This type of mnemonic exhibits the following important characteristics.

1. It is simple and easy to remember as the letters represent a word relevant to the issue in question. It is therefore impossible to forget.

2. The mnemonic contains the important details only rather than nuances and trivial items relevant to specific contingencies.

3. The list of therapeutic options follows the sequence normally utilized in treating asthmatic patient's i.e.,

a. Adrenergics (inhaled Salbutamol etc.) are the first line of therapy for mild asthma and also for more severe asthma in the form of nebulisations of IV therapy.

b. A second line choice of therapy is steroids. On an outpatients basis inhaled steroids represent second line therapy and of course systemic steroids are utilized in the emergency situation.

c. Oral theophyllines represent another line of therapy in these patients and, in the emergency situation, intravenous aminophylline is utilized. These drugs are not used much now, but they form part of the original mnemonic, for illustration purposes.

d. Hydration is essential to prevent inspiration of airway mucus in patients with asthma. This is particularly important in the emergency situation where intravenous hydration is crucial.

e. Using the word mask rather than oxygen reminds the attending physician that one should consider chronic CO2 retention and utilize a low flow (24%) oxygen mask in those patients who are at risk of hypoventilation if high flow oxygen is used.

f. Infections commonly precipitate asthma and therefore antibiotics should be utilized if that situation is present.


GASTROENTEROLOGY:

HISTORY AND EXAMINATION



Causes of a massive spleen = MMM

Myelofibrosis

Myeloid leukaemia (chronic)

Malaria





Causes of abdominal distension = FFFFF
Fat

Fluid

Faeces

Foetus

Flatus



Causes of weigh loss with a normal appetite
Thin Can Still Die

TH = thyrotoxicosis

IN = Infections e.g. parasitic

CAN = cancer

STILL = steatorrhoea

DIE = diabetes mellitus



Causes of atrophic glossitis = AAA
Anaemia (iron, B12, folate)

Antibiotics

Avitaminosis (B2, B3, B12)




MALABSORPTION


Bacterial reasons for malabsorption = BB
B12 is consumed

Bile salts are deconjugated



What is absorbed in the terminal ileum? = BB
B12

Bile Salts



Bruising in flanks = AA
Acute pancreatitis

Aortic aneurysmal rupture (retroperitoneally)



Whipples disease = malabsorption plus a PLAN
Pigmentation

Lymphadenopathy

Arthritis

Neurological changes





DIARRHOEA


Infectious diarrhoeas to consider in a patient who has been overseas = ABCDEFG
Amoebic dysentery

Bacilliary dysentery

Cholera

‘D’yphoid

E Coli (eg. traveller's diarrhoea)

Food poisoning

Giardia



Inflammatory bowel disease

Pain
Blood

U. Colitis
X P

Crohns
P
X
Ischaemic Colitis
P
P




Treatment of ulcerative colitis = SSSS
Supportive (eg. fluids etc.)

Steroids (local initially)

Salazopyrine

Surgery



Small bowel obstruction with no scars = CLAN
Crohn's disease

Lymphoma

Acid fast bacilli

Neoplasia



"Medical" causes of abdominal pain (to be considered after the "surgical" causes have been excluded).

Angie's Addicted Family Cat Let Her Poor Sick Hen Die on the Kitchen Table.

Angioedema (familial)

Addison's disease

Familial Mediterranean fever

Calcium disturbances (e.g. hyperparathyroidism)

Lead poisoning

Herpes zoster (pre-rash)

Porphyria

Sickle cell crisis

Henoch-Schonlein purpura

Diabetes mellitus (e.g. hypoglycaemic episodes)

Kidney failure (uraemia)

Tabes (tabetic crisis)



HEPATOBILIARY DISEASE


Causes of gallstones = SSSS

Solute

Stasis

Seeding



Causes of hepatitis = ABC (hep virus) then DIAL for help

Drugs (alcohol, toxins, drugs)

Infection (I mononucleosis, amebic)

Autoimmune

Leptospirosis (has also meningoencephalitis, renal dysfunction)



Incubation periods

Hepatitis A = 2-6 weeks

Hepatitis B = 2-6 months



Worsening ascities = TTT

Tumour (eg. hepatoma)

Thrombosis of portal vein

Tuberculosis



Primary biliary cirrhosis associations = MMM

Middle aged female

antiMitochrondrial antibody

M antibody (IgM)



Chronic pancreatitis – associations = ABCD

Abdominal pain

Booze

Calcification on x-ray

Diabetes mellitus



Post-operative jaundice = ABCD

Anaesthetic (halothane)

Bile duct tied off / obstructed

Calculus left behind

Drugs





Relapsing jaundice = RAID

Relapsing hepatitis

Alcoholic

Intermittent

Drugs



Persistent hepatitis antigen = CCCC

Carrier

Congenital Disease

Chronic active hepatitis

Cirrhosis



Results of portal hypertension = HHH

Haemorrhage

Hypersplenism

Hepatic fetor and hand flap (portosystemic encephalopathy)



NEUROLOGICAL


Causes of coma - cerebral or extracerebral


CEREBRAL = FETCH
Fit (convulsion)

Encephalitis

Trauma

Cancer

Haemorrhage or other cerebrovascular accident



EXTRACEREBRAL = SUGARS

Septicaemia

Uraemia or other major organ failure

Glucose low

Risky drugs

Sodium low or other metabolic change



Alternative = AEIOU
Accident (trauma, cerebrovascular)

Epilepsy

Infection (intra and extracranial)

Overdose (self-induced)

Uraemia and other metabolic causes (diabetes, Addison's disease, hypothyroidism, hypoxia, and other organ failures)



Fainting on neck turning = CC

Carotid sinus hypersensitivity

Cervical spondylosis



Global brain disease = PUPS

Perseveration

Upward gaze failure

Palmo-mental reflex

Synkinesia



CRANIAL NERVES


Unilateral Ptosis

Pupil dilated = third nerve

Pupil constricted = Horner's syndrome

Brain stem diagram

Courses of the second, third and seventh cranial nerves



Features of bulbar disease = DD

Dysarthria

Dysphagia



MOTOR CHANGES


Side effects of Levodopa = LEVODOPA

Liver dysfunction

Extra – blood (positive Coombes) gout, flushes

Vomiting, nausea, diarrhoea

Ocular – glaucoma

Dyskinesia

On – off phenomenon

Personality changes

Arrhythmias and hypertension



Causes of peripheral neuropathy = ABCDE

Alcohol and other drugs

B1, B12 deficiency

Cancer

Diabetes

Exotic (lead, dyphtheria, leprosy)



Raised intracranial pressure triad =

Headache

Vomiting

Papilloedema





ENDOCRINE


Causes of galactororrea = PPP

Physiological

Pituitary (tumours or stalk rupture)

Pharmacological (alpha methyldopa, maxolon/stemetil, phenothiazines,oestrogens)




DIABETES MELLITUS


Symptoms of hypoglycaemia = SCAR

Sweating

Confused

Abdominal pain

Respiratory rate increases



Diabetic vascular disease = AA

Angiopathy

Atheroma



Unusual causes of diabetes = ABCDE

Acromegaly

Bronze diabetes (haemochromatosis)

Cushings disease

Drugs (steroids, thiazides)

Esoteric



Failure to control diabetes = III

Infection

Insulin resistance

Incidental disease (A to E as above)



Treatment of hypersosmolar non-ketotic diabetic state

- half strength saline

- half strength insulin



Symptoms of Addison's disease = “The 4 Ps”

Pooped

Pewking

Pigmented

Posturally hypotensive



Features that precipitate Addison's disease - SSS

Stress

Septicaemia (eg. menginococcal)

Surgery of the adrenal gland



Multiple endrocrine adenomatosis syndrome = PPPPP

Parathyroid

Pituitary

Pancreatic islets (ZE)

Pheochromotocytoma

Phyroid (medullary carcinoma)



Hand features in hyperthyroidism = CATS

Clubbing

Acropachy

Tremor

Sweaty and hot



Medullary carcinoma of the thyroid = CCC

C-Cells

Calcitonin

CEA



Features of hypothyroidism = CCC

Clinical

Cholesterol increased

CPK



Features of hypercalcaemia = Stones, Bones, Moans, Groans, Thrones and Psychological Overtones

Stones = renal or biliary

Bones = bone pain due to osteodystrophy

Moans = peripheral pain (eg. muscle pain, pseudogout)

Groans = abdominal pains to due pancreatitis, peptic ulcer,

pancreatic adenoma (…..etc)

Thrones = polyuria [using the 'throne' ie. toilet]



Causes of short stature =

(achondroplasia, Down's syndrome, vitamin D-resistant Ricketts)



Non-drug causes of SIADH = TTT

Tumours (intrathoracic)

Trauma to brain (trauma, stroke, infection)

Tuberculosis

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