Mnemonics and Memory Aids

by Margaret A. Fitzgerald, DNP, FNP-BC, NP-C, FAANP, CSP, FAAN, DCC

Clinical practice requires a firm grasp of a body of knowledge with great breadth and depth. Mnemonics and other memory aids can be helpful when trying to recall information that requires memorization,such as physical exam findings and etiology of select diseases. Here are a few mnemonics that may be helpful.

Recalling Common Systolic Heart Murmurs: MR PASS



Physiologic(also known as functional, systolic flow murmur, a heart murmur heard in the absence of cardiac abnormality)



Systolic- All the above murmurs are heard during systole.

MR PASS wins the Most Valuable Player award.



Prolapse- Add MVP as another systolic murmur.

MR PASS often hangs around with MS ARD.





Diastolic- All the above murmurs are heard during diastole.


(Source: MR PASS MVP, MS ARD mnemonic developed by Margaret A. Fitzgerald, DNP, FNP-BC,NP-C, FAANP, CSP, FAAN, DCC. Reproduction permitted with attribution.)

Aortic Stenosis Symptoms

A person with clinically significant aortic stenosis can be SAD.


(Source:, original attribution unknown)

Physiologic Split S2 Heart Sound

This is a normal finding in which the aortic and pulmonic components of the second heart sound are heard separately. This finding is present in the majority of children and adults, but becomes less common after age 55. The split is caused by a delay in the pulmonic component,and the degree of split IN-creases on IN-spiration and decreases on expiration.

Vocal or tactile fremitus: IN-creases with IN-creased tissue density (i.e., the area of lung consolidation found in pneumonia).

(Source: Developed by Margaret A. Fitzgerald, DNP,FNP-BC, NP-C, FAANP, CSP, FAAN, DCC. Reproduction permitted with attribution.)

For Delirium Etiology: DELIRIUMS

Drugs- When any medication is added or dose is adjusted. Particularly problematic medications include anticholinergics (TCA, 1st gen antihistamines),neuroleptics, (haloperidol, others), opioids (in particular, meperidine),long-acting benzodiazepines (diazepam, clonazepam), alcohol, others

Emotional(mood disorders, loss), Electrolyte disturbance

LowPO2 (hypoxemia from pneumonia, COPD, pulmonary embolias, MI) Lack of drugs (withdrawal from alcohol, other habituating substances)

Infection- Urinary tract infection or pneumonia (most common delirium etiology)

Retention of urine or feces, Reduced sensory input (blindness, deafness, darkness, change in surroundings)

Ictalor postictal state - Alcohol withdrawal one of the most common reasons for an isolated seizure in an older adult

Undernutrition-Protein/calorie malnutrition, vitamin B12 or folate deficiency, dehydration including postoperative volume disturbance

Metabolic(poorly controlled DM, under or untreated hypo or hyperthyroidism), Myocardial problems (MI, heart failure, dysrhythmia)

  Subdural hematoma - Can be as a result of relatively minor head trauma to brain atrophy,fragile vessels

(Source:Delirium, in Merck Manuel for Geriatrics, available at,with additional comments by Dr. Margaret Fitzgerald)

Treatable causes of urinary incontinence



Atrophicurethritis and vaginitis

Pharmaceuticals(diuretics, others)

Psychologic disorders (depression)

Excessive urine output (heart failure, hyperglycemia due to undetected or poorly controlled DM)

Restricted mobility

Stool impaction


(Source: Resnick, NM: "Urinary incontinence in the elderly." Medical Grand Rounds 3:281-290, 1984).

Presentation of Anticholinergic Overdose or Misuse

Examples of medications with significant anticholinergic effect include the first generation antihistamines (diphenhydramine {Benadryl}, chlorpheniramine{ChlorTrimeton}, others) and tricyclic antidepressants (amitriptyline {Elavil},nortriptyline {Pamelor}.  A list of other medications with significant anticholinergic effect can be found at:, accessed 9.20.12.


With an overdose or misuse of medications with significant anticholinergic effect, the patient can be:


Blind as a bat (blurred vision)

Dry as a bone (dry mouth)

Red as a beet (flushing)

Mad as a hatter (confusion)

Hot as a hare (hyperthermia)

Can’t see(vision changes)

Can’t pee(urinary retention)

Can’t (do something that rhymes with “spit,” constipation)

Note that a milder form of these findings can be present in an elderly patient who has taken an over-the-counter sleep aid containing diphenhydramine (Benadryl), a first-generation antihistamine, or any medication know to have significant anticholinergic effect.

(Source:, original attribution unknown)


Causes of Acute Pancreatitis: I GET SMASHED


Idiopathic(thought to be result of a hypertensive sphincter or microlithiasis)

Gallstones(usually traveling down common bile duct and becoming trapped in the Ampulla ofVater)

Ethanol(alcohol intake, usually extensive)

Trauma(usually blunt abdominal trauma)

Steroids(systemic corticosteroid use)

Mumps(paramyxovirus) and other viruses (Epstein-Barr virus, Cytomegalovirus)

Autoimmunedisease (polyarteritis nodosa, systemic lupus erythematosus)

Scorpion sting (also snake bites)

Hypercalcemia,hyperlipidemia, particularly hypertriglyceridemia and hyponatremia  

ERCP(post endoscopic retrograde cholangiopancreatography)

Drugs(sulfonamides, azathioprine, NSAIDs, diuretic use {loop and thiazide},didanosine, DDP-4 inhibitor {-gliptin} use) and duodenal ulcers


(Source:, original attribution unknown)

Healthcare Mnemonics: A note of caution

While these memory aids are helpful, I must add a note of caution. Treatment mnemonics can be problematic because the learner might have memorized what to do but does not have a firm grasp on why a particular intervention is helpful. Safe clinical practice involves knowing the “why” as well as the “how.”

Please e-mail with the mnemonics and memory aids you find helpful.


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Last updated 9.25.12