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A few questions I get quite a bit from students are along the lines of, “what’s the best way to memorize the signs of symptoms of this disease?” or something like, “what’s a quick mnemonic I can rely on for all the adverse effects of this drug?” Now, before I answer this, I must say I have always been a bit wary of using mnemonics (I’m looking at you First Aid and your infamous “Most chronic alcoholics Steal Phen Phen and Never Refuse Greasy Carbs/SICKFACES.COM” nonsense), but things changed for me during dedicated USMLE step prep when I realized that just like everything else in life, you can find a diamond in the rough when it comes to these clever ways of learning content.

Here are a few USMLE mnemonics and how you can learn from them/use them to your advantage in ruling out incorrect answers in a question stem:

  1. MUDPILES for anion gap acidosis
  2. OPQRST
  3. VITAMIN CDE

Methanol, Uremia, DKA, Propylene glycol, Isoniazid/Iron, Lactic acidosis, Ethylene Glycol and Salicylates. This is probably one of the most used mnemonics in medicine (GOLDMARK is the equivalent to it with the D standing for D-lactate but that’s not too important for step one just yet), and it has a ton of utility when preparing for your Step 1 as well. Now I’m not saying just memorizing what it stands for is good enough, but if you can relate each disease to an underlying principal such as physiology or biochemistry or even principles of management, you’ll be able to kill two birds with one stone. Let me give you an example using DKA. This disease gives you an anion gap metabolic acidosis (Duh right it’s one of our MUDPILES). But how do you get the acidosis? What lab values are consistent with this acidosis? What’s going on in the kidneys while all this is happening? What about respiratory rate? Can people with type 2 diabetes get this?!! All these questions and more are what you should be going through with every single disease in this list. Once you know all that, figuring out how to fix these people is easy. Just correct what’s abnormal and you’ll be smooth sailing (on the exam they usually die despite your best resuscitation efforts so don’t feel too bad. Think of it as them sacrificing themselves for the sake of your score).

Onset/Ongoing (when did it start and how long has it been going on), Position (where is it located), Quality/Quantity (what is the character of the pain and how bad is it from 1-10), Radiation (where does it move), Symptoms (associated symptoms), and Transforming factors (what makes it better or worse). Now most people use this mnemonic whenever they’re taking a history in real life and trying to evaluate pain. The use of it doesn’t stop there though. Whenever you are reading a question stem, think of this mnemonic whenever your patient has pain. Let me give you an example with aortic dissection. A patient comes in with substernal chest pain of 2hrs duration that is tearing in nature and radiating to the back. The pain doesn’t get worse with inspiration. The patient’s blood pressure is 160/100 in the right arm and 140/80 in the left arm. What’s the most likely diagnosis? Hopefully you came to the answer of aortic dissection, but how could you have distinguished this from an MI, PE, or even GERD? This is where OPQRST comes into play. With that simple mnemonic you could have ruled out each one of those choices because of how different the pain. GERD doesn’t radiate for example and is associated with food, MI radiates to the arm usually and is squeezing in nature, while PE has pleuritic pain. Try setting up a list of common causes of pain and evaluating them with OPQRST.

Vascular, Infectious/Inflammatory, Traumatic/Toxic, Autoimmune, Metabolic, Idiopathic/Iatrogenic, Neoplastic, Congenital, Degenerative, and Endocrine. This mnemonic is the first one I learned in medical school that I actually liked. We used to get cases in lecture and the first thing we would do is read the chief complaint and then generate a differential using VITAMIN CDE. As always, let me give you an example.

CC: A patient comes in with a swollen, red, and painful joint.

Vascular issues causing red, swollen, and painful joints are uncommon. Bump it down on your list of differentials.

Infections (septic arthritis, rheumatic fever), inflammatory (gout, pseudogout).

Trauma. We don’t know if there was a history of trauma so well keep this in our differential. Toxic. These etiologies tend to be systemic in nature so we can move this down on our differential.

Autoimmune (reactive arthritis, rheumatoid arthritis, seronegative spondyloarthropathies, SLE)

Metabolic. These also tend to be more systemic, so we can move this down.

Idiopathic. On Step 1 the answer is rarely idiopathic but if you’ve ruled everything else out consider this. Iatrogenic. Look for a patient with a recent hospitalization or surgery.

Neoplastic. Malignancy is always something you want to give at least a little consideration too. There’s so many paraneoplastic syndromes that you never want to rule it out without at least getting the full history.

Congenital. Usually if you have an older patient you can throw this out the window.

Degenerative (osteoarthritis)

Endocrine. These also tend to be more systemic so it’s less likely in this case.

Once you get the rest of your history, physical, labs, and imaging, you can re-evaluate this list and decide if you want to move up or move down some of your differentials.

Mnemonics can really help you on your exam if you utilize them to their fullest. Sometimes, it’s the simple ones that can give you the most information. Look for ones that you can apply to multiple situations and the ones that give you a quick and dirty list from which you can generate questions for yourself to practice that material. Send us any good mnemonics you came up with and let us know how you use them. Remember, don’t just memorize. Try and make everything relatable (except the mnemonics for CYP inducers and inhibitors you really just have to memorize it and hope you get an easy question on it) and trust yourself that you will be able to learn the content you need to in order to get the score you want. Good luck studying everyone!

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Ali Elsaadi

Ali Elsaadi

Ali graduated from the University of Houston with a Bachelor of Science in Biology in 2016. He is an MD candidate for the class of 2020 at St. George’s University. Ali is currently rotating at an NYU Langone affiliated hospital in Brooklyn, New York. He plans to apply for general surgery and hopes to specialize afterward. His interests outside of medicine include learning languages and recipes from different cultures.
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