Commonly Used Medical Abbreviations

At the request of several students, we have put together a list of commonly used abbreviations. All of these should be acceptable for use on a progress note for Step 2 CS. Please add your comments if there are others you would like to have added to the list.


Abd = abdomen
AC = before meals
ACLAN = anterior cervical lymphadenopathy
AFOS = anterior fontanelle open and soft
All = allergy
ALT = alanine aminotransferase (SGPT)
ANA = anti-nuclear antibody
AP = antero-posterior
Appy = appendicitis or appendectomy
ASA = aspirin
AST = aspartane aminotransferase (SGOT)
BID = twice daily
BP = blood pressure
BRBPR = bright red blood per rectum
BS = bowel sounds
BSO = bilateral salpingo-oophorectomy
BUN = blood urea nitrogen
CAD = coronary artery disease
CBC = complete blood count
CEA = carotid endarterectomy
c/o = complains of
CHF = congestive heart failure
cig = cigarette
CKD = chronic kidney disease
CP = chest pain
Cr = creatinine
CRF = chronic renal failure
CRI = chronic renal insufficiency
C/S = caesarean section
CT = computerized tomography
CTA = clear to auscultation
CTAB = clear to auscultation bilaterally
CXR = chest x-ray
d/c = discharge
DDD = degenerative disk disease
DJD = degenerative joint disease
DM = diabetes mellitus
DNR = do not resuscitate
DNVI = distal neuro-vascular intact
DOE = dyspnea on exertion
DTR = deep tendon reflex
EGD = esophagogastroduodenoscopy (upper endoscopy)
EOMI = extra-ocular movements intact
ESR = erythrocyte sedimentation rate
EtOH = alcohol
Ext = extremity
FamHx = family history
F = female
FBS = fasting blood sugar
F/C = fevers, chills
FLP = fasting lipid panel
FTT = failure to thrive
f/u = follow-up
GERD = gastro-esophageal reflux disease
GI = gastrointestinal
GU = genitourinary
HA = headache
HbA1C = hemoglobin A1C
Hct = hematocrit
HCTZ = hydrochlorothiazide
HEENT = head, ears, eyes, nose, and throat
HJR = hepatojugular reflux
Hgb = hemoglobin
H/H = hemoglobin and hematocrit
h/o = history of
HS = bedtime
HTN = hypertension
Hx = history
IBS = irritable bowel syndrome
I/O = ins and outs
ISS = insulin sliding scale
IV = intravenous
IVF = intravenous fluid
JVD = jugular venous distention
K = potassium
L = left
Lat = lateral
LE = lower extremity
M = male
Mammo = mammogram
mg = milligram
m/g/r = murmurs, gallops, rubs
MRI = magnetic resonance imaging
MS = multiple sclerosis
MVI = multivitamin
Na = sodium
NABS = normo-active bowel sounds
NAD = no acute distress
NCAT = normo-cephalic, atraumatic
Neuro = neurologic
ND = non-distended
NGT = nasogastric tube
NKDA = no known drug allergies
NPO = nothing by mouth
NSAID = non-steroidal anti-inflammatory drug
NSVD = normal spontaneous vaginal delivery
NT = non-tender
N/V/D = nausea, vomiting, diarrhea
OA = osteoarthritis
Occ = occasional
OD = right eye
OP = oropharynx
OS = left eye
OU = both eyes
OT = occupational therapy
PA = postero-anterior
PCN = penicillin
PE = physical exam or pulmonary embolism
PERRLA = pupils equally round and reactive to light and accommodation
Plts = platelets
Pna = pneumonia
PND = paroxysmal nocturnal dyspnea
PO = orally
PPD = purified protein derivative (tuberculosis test)
PR = rectally
PRN = as needed
Pt = patient
PT = physical therapy
PTX = pneumothorax
PVD = peripheral vascular disease
QAC = before every meal
QD = daily
QHS = every night
QID = four times daily
QOD = every other day
R = right
RBS = random blood sugar
RF = rheumatoid factor
ROS = review of systems
RRR = regular rate and rhythm
SEM = systolic ejection murmur
SLE = systemic lupus erythematosus
SOB = shortness of breath
SocHx = social history
SP = standardized patient
SWOP = symptoms worsen or persist
T&A = tonsillectomy and adenoidectomy
TAH = total abdominal hysterectomy
TB = tuberculosis
TID = three times daily
TM = tympanic membrane
Tob = tobacco
TVH = total vaginal hysterectomy
UA = urinalysis
UE = upper extremity
URI = upper respiratory infection
U/S = ultrasound
UTI = urinary tract infection
UTZ = ultrasound
VS = vital signs
W = white
WBC = white blood cell count
WD = well-developed
WN = well-nourished
yo = year-old

All rights reserved worldwide. Copyright 2005, Theodore X. O'Connell, M.D.

The NURS Mnemonic

Giving bad news and interacting with patients regarding emotional issues can be two of the more difficult situations that we deal with in medicine. Often, it is challenging to find the right words to say and to point the interaction in a constructive direction.

The "NURS" mnemonic can be used to help frame and guide such an encounter. This mnemonic is discussed in detail below. This type of interaction really is part of the art of medicine, but this mnemonic may be helpful for the purposes of the Step 2 CS exam.

N-ame the emotion
U-nderstand
R-espect
S-upport

N-ame the emotion. Labeling the patient's emotion can be a helpful first step in communicating effectively with the patient and being able to offer the appropriate support. You may say, "you seem upset" or "you seem sad." In doing so, you may be correct in identifying the patient's underlying emotion, or the patient may correct you. Either way, you have taken the first step in dealing with the issue at hand.

U-nderstand the patient. Do not fall into the mistake of saying, "I understand how you feel" or "I know how hard this is for you." If you do this, the patient may say, "how could you possibly understand what it's like to have a child with cancer." Instead, make it clear that you understand that the situation is difficult. Say something like "I understand how hard this must be for you" or "I understand that this situation must be very upsetting for you." In this way, you state that you understand the patient's emotional status even though you probably have never been in the same situation yourself.

R-espect the patient. Perhaps the most important part of the interaction is conveying a sense of respect to the patient. The patient needs to know that you respect the situation they are in, their emotional response to the situation, and how they are handling it. Say something like, "I respect the way you are handling this very difficult situation."

S-upport the patient. Make it clear to the patient that you are there to offer emotional support. Say something like, "is there anything more that I can do to help you get through this situation?" Alternatively, you may say, "Don't hesitate to contact me if there is anything I can do to help you."


All rights reserved worldwide. Copyright 2005, Theodore X. O'Connell, M.D.

Another Mnemonic for Pain

The mnemonic "CLITORIS" can be helpful in the evaluation of a patient with pain:

C-haracter (sharp, dull, crampy, burning, etc.)
L-ocation (where is the pain located?)
I-ntensity (how bad is the pain on a 1-10 scale)
T-iming (when does the pain occur?)
O-nset (when did the pain initially begin?)
R-adiation (does the pain radiate; if so, where?)
I-rritating and alleviating factors (what makes the pain worse or better)
S-ymptoms associated with the pain (e.g., nausea, sweating, blood in the urine, etc.)


All rights reserved worldwide. Copyright 2005, Theodore X. O'Connell, M.D.

A Mnemonic for the Differential Diagnosis

The mnemonic "DIRECTION" can be used in helping to create a differential diagnosis. This mnemonic divides diseases into broad categories, which can then be used to create differential diagnoses within each of these categories.

D-rugs
I-nfection
R-heumatologic
E-ndocrine
C-ardiovascular
T-rauma
I-nflammatory
O-ther
N-eoplasms

All rights reserved worldwide. Copyright 2005, Theodore X. O'Connell, M.D.

Study Partner Database

A new study partner database is now available at DigitalDoc's website, www.csprotocol.blogspot.com.

This database allows you to find study partners in preparation for the USMLE Step 2 CS.

The CAGE Questionnaire

Some of the cases on the USMLE Step 2 CS have a component that may relate to alcohol or drug problems. The CAGE questionnaire is a helpful, brief tool designed to screen for alcoholism. The CAGE questionnaire has been updated to also be used as a screening tool for drug abuse, in which case it is called the CAGE-AID.

Before beginning a CAGE questionnaire, ask the patient two questions:
1. Do you drink alcohol?
2. Have you ever experimented with drugs?

If the answer to either of these questions is "yes," then a CAGE questionnaire should be considered. Below, the parts of the questions in parentheses is the part used to screen for drug abuse.

The mnemonic "CAGE" stands for the following:
C-ut down
A-nnoyed
G-uilty
E-ye opener

The cage questionnaire is as follows:

Have you every felt you should cut down on your drinking (or drug use)?

Have people every annoyed you by criticizing your drinking (or drug use)?

Have you ever felt bad or guilty about your drinking (or drug use)?

Have you ever had an eye-opener to steady your nerves or get in the morning or get rid of a hangover? (An eye-opener is a drink or drug use in the morning).

An affirmative answer to one of the questions indicates a possible alcohol or drug problem.
An affirmative answer to two of the questions indicates a probable alcohol or drug problem.
An affirmative answer to three or more of the questions confirms alcoholism or drug abuse.


All rights reserved worldwide. Copyright 2005, Theodore X. O'Connell, M.D.

Helpful Mnemonics for Step 2 CS

We have been asked quite a few questions about helpful mnemonics for Step 2 CS. We have compiled several of them here. If you find them helpful, consider jotting them down on a sheet of paper as you enter the standardized patient exam room so that you can use them while remaining calm. Here they are:


PAM HUGS FOSS (a mnemonic for past medical history)

P-revious history of smilar symptoms
A-llergies (medications, foods, over-the-counters, etc.)
M-edications (mediations the patient may be taking, including non-prescription meds)

H-ospitalization (previous hospitalizations for any illnesses or surgeries)
U-rinary changes (frequency, urgency, dysuria, hematuria, foul-smelling urine)
G-astrointestinal symptoms (nausea, vomiting, bowel habit changes, melena, etc.)
S-leep pattern (insomnia, early waking)

F-amily history (any illnesses in the family, particulary first-degree relatives)
O-b/Gyn history (last menstrual period, pregnancies, miscarriages, abortions, length of periods)
S-exual habits (STDs, male/female preference)
S-ocial history (smoking, alcohol, drugs, occupation)


LIQOR AAA (useful for asking about pain)

L-ocation of the symptom (abdomen, back, leg)
I-intesity (use a scale from 1-10)
Q-uality of the symptom (sharp, dull, crampy, burning)
O-nset of the symptoms (when did it start, what precipitated the pain?)
R-adiation of the pain (radiation to the back, arm, groin, etc.)
A-ssociated symptoms (nausea, dysuria, chest pain, shortness of breath)
A-lleviating factors (leaning forward, lying still, using a hot pack)
A-ggravating factors (moving, eating, physical effort)


PQRST (also helpful for asking about pain)

P-osition
Q-uality (sharp, dull, crampy, burning)
R-adiation (radiation of the pain to the back, arm, groin, etc.)
S-everity (use a scale from 1-10)
T-timing (worse with meals, bowel movements, time of day, etc.)


SODAS (useful for obtaining a detailed social history)

S-moking (cigarettes, marijuana, how much, how many years)
O-ccupation (what does the patient do for a living?)
D-rugs (what drug, how do they use it, any IV drug use?)
A-lcohol (whaty type of alcohol, how often, how much, consider doing a CAGE questionnaire)
S-exual history (number of partners, protection, STDs, pregancies, etc.)

All rights reserved worldwide. Copyright 2005, Theodore X. O'Connell, M.D.

Better than the MMSE

Some of the cases on the USMLE Step 2 CS require the test-taker to perform an evaluation of a patient's cognitive function. On some of the message boards, we have seen students asking about the mini mental status examination (MMSE). Our opinion is that there is a better alternative to the MMSE for the purposes of both this test as well as real-world clinical applications.

The MMSE is a multiple part test with a maximum score of 30. The MMSE can be cumbersome to administer, takes a fair amount of time (especially when the patient actually has some cognitive dysfunction), and usually requires that you have the test template in hand in order to administer the test. A newer test known as the Mini-Cog is a better test to use for the Step 2 CS, as well as for most primary care settings.

The Mini-Cog is a 3 minute instrument used to screen for cognitive impairment (most often dementia) in older adults. In several different studies, the Mini-Cog was as effective or more effective than the MMSE and other established screening tests. The Mini-Cog is able to screen for both memory and executive function.

In the Mini-Cog, the patient is told three items (such as apple, table, and penny) and is requested to repeat back and remember those three items. The patient is then asked to draw a clock face with all of the numbers, and then draw in the hands of the clock to indicate a certain time, such as 10:50. After the patient has drawn the clock face, he or she is asked to repeat back the three items that were previously stated.

That's it! The beauty of this test is its simplicity and quickness.

The test is scored as follows:
Recall of 0 items indicates dementia.
Recall of 1-2 items with an abnormal clock face indicates dementia.
Recall of 1-2 items with a normal clock face indicates no dementia.
Recall of all 3 items indicates no dementia.

Essentially, the clock face only comes into play when only 1 or 2 items are recalled. If zero items or 3 items are recalled, the diagnosis is clear-cut.


All rights reserved worldwide. Copyright 2005, Theodore X. O'Connell, M.D.