AEIOU TIPS

These ten letters represent a mnemonic to ensure a thorough differential diagnosis, or a set of disease processes to consider when making a diagnosis. I cannot take full credit for this mnemonic as it was introduced to me by my dad, Dr. Grabert. It has served me well when interviewing patients and when I get stuck on exams. Traditionally, new PA students organize the body by systems. There is no fault in this approach, however AEIOU TIPS can expand your knowledge by approaching the body in terms of disease processes rather than anatomical relationships. 

A—Anoxia - We all know that oxygen deprivation (i.e. anoxia) is potentially fatal. One such anoxic condition is a pulmonary embolism (a.k.a. "PE"). These patients can often present with very vague complaints such as shortness of breath or tachycardia. Always keep this condition on your radar. You’ll save a life someday!

E—Endocrine - If you feel weak in understanding this body system, join the club. It has a thousand moving parts and generally ends with a lab value you must interpret. Understand that a primary disorder means that an extra-pituitary structure is the source of the problem. A secondary disorder means that the stimulating gland (usually the pituitary) is the source of the problem

I—Infectious - I didn’t realized just how specialized infectious disease was until I started PA school. It is a monster literally and figuratively. Don’t forget that not everything that is infectious is bacterial. If a person is really sick, suspect a virus. If a person is really, really, really sick, suspect a bacteria. 

O—Opiates - This word keys you to remember drug interactions. This becomes more prevalent in the later stages of the didactic year when you study pharmacology. But always remember that studying medicine really does mean studying “medicine.” Opiates most serious side effect is decreasing respiratory drive; they also cause constipation.

U—Urea - What’s the problem with urea? Well nothing, so long as it ends up in the urine and not backed up into the blood (i.e uremia). The kidneys are beyond extremely important to the body’s homeostasis because of their effect on electrolyte balance which ultimately controls blood pressure. Sometimes I feel like they are the real powerhouse and the brain gets all the credit. You will be studying electrolytes until you are exhausted enough to crave a Gatorade. Remember this fun mnemonic: a banana is like a cell. If you throw table salt (i.e. sodium) at a banana it won’t penetrate the peel, right? In other words, sodium likes to remain outside of the cell while potassium remains inside the cell (i.e. banana).

T—Trauma can affect any part of the body but traumatic brain injuries are by far the most extensively covered in PA school. The three major types are based on where they occur relative to the meninges (i.e. membranes that surround the brain). Think of the anatomy when assessing these injuries. 1) Epidural hemorrhages occur closest to the skull and a direct blow to the head is a likely culprit. 2) Subdural hemorrhages occur a little deeper and involve vessels that “bridge” between membranes. 3) Subarachnoid hemorrhages are very close to the brain, thus the brain can easily sense the “worst headache” ever.

I—Inflammatory/Immune -  The immune system, when properly regulated is our body’s saving grace. However, when the immune system begins to attack its own tissues (i.e. autoimmune disease), the prognosis can get quite complex. There is a diverse set of lab values that pertain to autoimmune diseases and they are rather complex. Two common markers that suggest an autoimmune process might be occurring include erythrocyte sedimentation rate (ESR) and C-Reactive Protein (CRP). 

P—Psych - Psychological disease processes often take a backseat to other physiological causes. Psychological health can not be forgotten and psychological drugs are very commonly prescribed. It is important to understand psychological drugs and their effect on neurotransmitters such as serotonin, dopamine, and norepinephrine. Dopamine is interesting in that it can viewed on a spectrum. Too much dopamine results in schizophrenia and too little dopamine results in Parkinson’s disease. This concept is especially important when studying antipsychotic drugs. 

S—Seizures serve as the buzzword in the AEIOU TIPS mnemonic, but it is meant to prompt you for neurological causes of disease. The neurological exam is so difficult because there are so many neurological pathways and functions. I mean, it is the brain we’re talking about. I really wish I knew more about the homunculus before PA school. See the image below and pay special attention to the legs. They hang off the side like they are dangling their feet in the water. In reality, they are dangling in the blood flow of the anterior cerebral artery. This might seem like foreign language right now, but this association is crucial when localizing the site of cerebrovascular accidents. 

Image retrieved from Huang, J. (2013). Overview of Cerebral Function: Figure 2. Merck Manuals.  http://www.merckmanuals.com/professional/neurologic_disorders/
function_and_dysfunction_of_the_cerebral_lobes/overview_of_cerebral_function.html