5 a's of schizophrenia

apathy, alogia, attention, anhedonia, affect

MEN TAL STATUS EXAMINATION

A Appearance and behavior
S- Speech
E- Emotion ( Mood and affect )
P- perception ( any Hallucination )
T- Though form and content
I-Insight
C-cognitive function
S- Suicidal ideation

THE 6-2 RULE for paediatric inguinal hernia:

Birth to 6 weeks
( surgery within 2 days)
6 weeks to 6 months ( surgery with in 2 weeks)
Over 6 months
(surgery with in 2 months)

Remember the Bs (problems for young doctors!)

Blues
Booze
Birds/Blokes
Banks
Bilingual
Babies
Bonkers
AMPLE (Allergy, Medications, Past medical history, Last meal and events
cardiac risk factors ABCDEFS
A Age (given in stem)
B BP. Do you have high blood pressure? No
C Cholesterol problem? No
D- D.M. (you or family history)? No
Drugs and alcohol? No
Diet? He had bad eating habits, junk food and take aways.
E- Exercise- how often do you exercise? He send he doesnt do any. I also asked about his occupation- he had sedentary lifestyle, he
was a clerk and sat most of the time.
F- Family history of CVS, D.M, B.P? Mother had some heart disease.
S- Smoking and stress? No

Cardiac murmurs: SQIRT:

S ite
Q uality
I ntensity
R aditation
T iming
S everity

AVPU:

BAR:
Benefit of treatment
Adverse effects
Risks
BINDARS: birth history, immunizations, nutrition , development, allergies, (excema), rashes
and siblings
CAGE questions:
Have you ever:
(1) felt the need to cut down your drinking;
(2) felt annoyed by criticism of your drinking;
(3) had guilty feelings about drinking; and
(4) taken a morning eye opener?

COST VMPF- (PE /DVT)

coagulation problmes/family h/o -no,
obesity- no,Leg pain-nad
smoking/surgery- no,
trauma- no , travel as above mentioned
Varicose veins- no
Malignancy-no
Pregnancy /pills- no
Family h/o-no

DELIRIUM:
D: drugs
E: Emotional means Depression, central nervous system: trauma, stroke.
L: Lung, Hypoxia
E: environmental means social reasons
R: Renal problem or respiratory
I: Trauma especially head injury
U: Uremia
M:Metabolic, diabetes or thyroid,
HIDEMAP:
I infection (UTI, pneumonia)
D drugs (especially anticholinergics, benzodiazepines, opioids

E - endocrine, e.g. diabetes

M - metabolic, e.g. hyper/hypocalcaemia
A - alcohol
P - psychosis
DEMENTIA:
D: depression, drugs and alcohol
E: ears /eyes
M: metabolic, e.g. hyponatraemia, diabetes, hypothyroidism
E: emotional problems (e.g. loneliness)
N: nutrition: diet, vit B12, folate, Iron, teeth problems
T: trauma, tumour
I: infections
A: arteriovascular disease, CVA,stroke,TIA,AF etc.
D-distractability
I-impulsive,idea of persecution
G-grandiosity
F-flight of ideas
A-activity(hyperactivity)
S-sexual promiscuity,sleep(insomnia)
T-thoughts (racing);excessive talking
The Fs of the acute abdomen:
1. Fluid
2. Flatus
3. Faeces
4. Fat
5. Fetus
6. Focal mass
7. False impressions of pseudopregnancy

FLK: funny looking kid

Avoid HARM in soft tissue or orthopaedic injuries!!

Heat (increase blood supple and swelling)
Alcohol
Run/dance/
Massage

HEADSSS assessment (Psychosocial Screening):

Taking a psychosocial history is an important part of the health interview of young people as
physical, emotional and social well being are closely interlinked.
These questions will also allow exploration of the developmental stage of the young person.

Parents, family members or other involved adults should not be present during the psychosocial
assessment.
Preface the discussion by saying that you are about to ask lots of personal questions that include
drugs, sex and depressed mood and that you are asking because these behaviours may affect a
person's health.
It can be useful to make a general statement instead of personalising questions, such as "Some
young people experiment with cigarettes and alcohol. In your year at school, do people
smoke/drink/use illicit drugs? What about your friends? And you?"

Home:

including who, where, recent moves, relationships, violence.

Education &
Employment:

including where, attendance, year, performance, relationships,

supports, recent moves, bullying, disciplinary actions, future
plans, and work details

Eating:

including weight (heaviest, lightest, recent changes), dieting,

exercise and menstrual history.

Activities
Affect
Ambition
Anxieties

outside of school, including sport, organized groups, clubs,

parties, TV/ computer use

Drugs and
Alcohol:
Depression

including cigarettes, alcohol and illicit drug use by friends, family

and the patient. Enquire into patterns & frequency of use & about
any regrets from using these substances.
Also ask about how use is financed and about negative
consequences.

Sexuality:
Stress:
Self-esteem

including close relationships, sexual experiences, number of

partners (total and in the last 3 months), gender of sexual
partners (don't assume sexual preferences), uncomfortable
situations/ sexual abuse, risk of pregnancy and previous
pregnancies (relevant to males as well as females),
contraception, condoms and STIs.

Suicide,
Depression &
Self-harm:

Presence and frequency feeling down or sad as well as current

feelings eg. "How do you feel in yourself at the moment on a
scale of 1 to 10?" Actions when down, supports. Self-harmthoughts and actions. Suicide risk- thoughts, attempts, plans,
means and hopes for future.

Safety from
injury
&Violence:

including serious injuries, use of safety gear for sports and

seatbelts for cars, riding with an intoxicated driver and exposure
to violence at school and in neighbourhood.
For high risk youths ask about carrying or use of weapons and
other criminal behaviours/ incarceration of youth or family/
friends.

With HEADSSS, sometimes there is an R for relationships added:

HEARDSSS

HEMIFAD
H Haemochromatosis
E Endocrine Disorders (Hypothyroidism, Hyperthyroidism, DM, Cushings Syndrome)
M - Malignancy
I Infection (Infective Endocarditis, TB, Malaria)
F - Chronic Fatigue Syndrome
A Anxiety, Anaemia/ Atypical Pneumonia
D - Drugs/ Depression

A mnemonic that can be used to remember the characteristics of histrionic

personality disorder is "PRAISE ME":
Provocative (or seductive) behavior
Relationships are considered more intimate than they actually are
Attention-seeking
Influenced easily
Speech (style) wants to impress; lacks detail
Emotional lability; shallowness
Make-up; physical appearance is used to draw attention to self
Exaggerated emotions; theatrical

Lifestyle modification: ABCDEF

A
Alcohol free
B
BMI
C
Cigarette free
D
Diet control
E
Exercise
F
Free from stress

LLS : looks like a syndrome

LOL NAD: Little Old Lady in No Apparent Distress.
LOTSRADIO
L- location
O- onset & offset
T- time
S- severity
R- radiation & relieving factors
A- aggrevating factors
D- duration
I- intensity
0- other associated factors

Lump examination: The Ss, Cs, Ts, Fs and Ps:

She Cuts The Fish PERfectly:

Site,Size, Shape (round, regular, irregular), Surroundings, Surface, Single (or multiple)
Contour (well defined, irregular), Consistency (soft, firm, hard) , Colour, Compressibility,
Cough impulse
Tenderness, Temperature, Transillumination
Fluctuation (fluid filled cyst), Fixity (mobile against underlying structures or against the
skin), Fields (draining lymphglands for this area)
Pulsation, Percussion
Expansile (Is it an aneurysm?)
Reducible (is it a hernia?)

MANIA:
D-distractability
I-impulsive,idea of persecution
G-grandiosity
F-flight of ideas
A-activity(hyperactivity)
S-sexual promiscuity,sleep(insomnia)
T-thoughts (racing);excessive talking

causes of carpal tunnel syndrome (MEDIAN TRAPS)

M=median artey persistence
E= edema of pregnancy
D= diabetus
I = idiopathic
A= acromegaly
N= neoplasm -- gangllioneuroma
T = thyroid--myxdema
R= Rhamtoid arthitis
A= amyloid
P = pneumatic drill usuage
S= SLE
MONA:
Morpoine, oxygen, nitroglycerin, aspirin in AMI!!!
Ottawa Ankle rules: 44-55-66-PM
4: Unable to make 4 steps immediately
4: Unable to make 4 steps in the emergency department
5: Pain at that base of the 5th metatarsal
5: Pain at the 5caphoid (the 5 is supposed to look like an S, and scaphoid is
another word for navicular)
6: Tenderness along the posterior 6 cm of the lateral malleolus
6: Tenderness along the posterior 6 cm of the medial malleolus
PM: Refers to the posterior malleolus
Ottawa Knee rules: 44-55-90-FP

4: Unable to make 4 steps immediately

4: Unable to make 4 steps in the emergency department
55: Age 55 years or older
90: Inability to flex the knee to 90
F: Tenderness at the head of the fibula
P: Isolated tenderness of the patella

P, Q, R, S, and T (pain, quality, radiation, severity, and timing) of pain

O+G Ps:
Periods
Pills
Pregnancy
Partner(s)
Pap smear
Pain(the 6th P)
Pelvic infections (STDs, the 7th P)
Personal circumstances (depression, social problems etc., the 8th P)
Pee for urinary symptoms (9thP)
PV bleeding (10thP)
Procedures (11th P)
Blood GrouP (the dyslexic P)

Oesophageal cancer risk factors (PC BASTARDS)

Plummer-Vinson syndrome
Coeliac disease
Barrett's
Alcohol
Smoking
Tylosis
Achalasia
Russia (geographical distribution)
Diet
Stricture
Post-operative complications-immediate (Post-op PROBS)
Pain
Primary haemorrhage
Reactionary haemorrhage
Oliguria
Basal atelectasis
Shock/ Sepsis
RICEARS:
R est
I ce
Compression
E levation

A nalgesics
R eview
S trapping

These include 5 Rs = 2 S.
R-Rx- treatmentExplain treatment options, including non pharmacological options
R-Review- Follow up in a fixed time, often the next day or may be few weeks or days
R-Referral-Refer to a specialist if needed but explain what to expect
R-Red flags-Explain red flags I.e. dangerous things e.g. Hypoglycemia & Hyperglycemia in
Diabetes & what to do

R-reading material-Handover reading material so that patient can remember what you said
to him

S support group
S social issues

SADAM (smoking , alcohol, drugs, allergies, medical problems and medications) or

SADMA
SAD PERSON INDEX for suicide risk assessment:
Sex: males more at risk than females
Age: <20 years of > 45 years
Depression: major / hopelessness
Psychiatric history or previous attempts
Excessive drug use like alcohol or other drugs
Rationality loss, psychosis, severe depression
Seperated: loss of spouse or other single
Organised plan, determined suicide plan
No support, no community back-up, generally isolated
Sickness: chronic illness / stated future intent

simple score: modified scale:

1
1
1
1
1
2
1
1
1
1
1
2
1
1
1
2
1
1
1
2

A score of more than 7 equals a high suicide risk!!!

04 Low
56 Medium
High
710
The modified scale risk assessment ranges from:

05: May be safe to discharge (depending upon circumstances)

6-8: Probably requires psychiatric consultation
>8: Probably requires hospital admission

SAW EMAILS- sleep, appetide,

weight,energy,mood,anhedronia,interest,libido,suicide

A mnemonic is helpful in remembering the criteria for major depression:

Seeing that Lack of ENERGY is common to most episodes, the mnemonic relates to treating
this symptom by prescribing energy capsules as SIG: E(nergy) CAPS:
S: sleep changes
I: interest (decreased / anhedonia)
G: guilt (excessive)
E: energy (decreased)
C: concentration (decreased)
A: appetite changes
P: psychomotor agitation or retardation
S: suicidal ideation

SOCRATES:

Site - Where is the pain? Or the maximal side of the pain.

Onset - When did the pain start, and was it sudden or gradual? Include also Progress
whether if it is progressive or regressive
Character - What is the pain like? An ache? Stabbing?
Radiation - Does the pain radiate anywhere? (See also Radiation.)
Associations / Alleviating factors - Any other signs or symptoms associated with the
pain? What makes it better, what makes it worse?
Time course - Does the pain follow any pattern?
Exacerbating/Relieving factors - Does anything change the pain?
Severity - How bad is the pain?

Splenomegaly-causes (CHINA)
Congestion/ Cellular infiltration
Haematological (eg haemolytic anaemia, Sickle cell)
Infection/ Infarction (eg malaria, GF, CMV)
Neoplasia (eg CML, lymphoma, other myeloproliferative)
Autoimmune

TIREDNESS:
HEMIFAD
H- Hemochromatosis
E- Endocrine ( DM, Cushings, Addison, Hypothyroid )
M- Malignancy
I Infection ( Infective endocarditis )
F- Chronic Fatigue syndrome
A-Anaemia , atypical pneumonia
D-drugs , depression

TIRED
T umor
I nfection
I Ron overload
R enal failure
E ndocarditis,
E ndocrine
D rug,
D epression

TONG: coma cocktail

Thiamine 100 mg
Oxygen
Naloxone 0.1 - 0.2 - 0.4 mg i.v
Glucose 50 ml 50 %

Weight, Appetite, Sleep, Thirst, Energy, Fever and Sweats (WASTE FN)

6-Post Operative Fever

Wind (Pulmonary)
Water (Urine-UTI)
Wound Walk (DVT/PE)
Wonder Drugs (Drug Fever)
Weins (Thrombophlebitis)

Mnemonic for Day of appearance of rash in a febrile patient is :

Very Sick Person Must Take Double Tablets
Very Varicella (day 1)
Sick Scarlet fever (day 2)
Person Pox small pox (day 3)
Must Measles (day 4)
Take Typhus (day 5)
Double Dengue (day 6)
Tablets Typhoid (day 7)