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Urinary symptoms: “How often do you have to urinate?

” “Do you have any difficult is to hold your urine? “Do you have to wake up at night to urinate?” “Do you still feel fullness after urinated?” “Have you noticed any weakness in your stream? “Have you noticed any blood in your urine? “Do you feel that you have to wait before starting to urinate? “Do you have any difficulty urinating?” “Have you noticed any pus in your urine? “Do you feel that have little time to make it to urinate? do you have to rush? B BURNING “Do you have any pain or burning during urination?” S STRAIN “Do you need to strain/push during urination?” “Do you feel as though you need to urinate but then very little urine comes out?” DRIBBLING: To flow or fall in drops or an unsteady stream; ARTICULAR PAIN---WEST-SURFO W WARM E ERYTHEMA S SWELLING T TRAUMA + biTe-TEMPERATURE S STIFFNESS- STEROIDS-SEX U ULCERS R RASH-ROM F fatigue O OTHER JOINTS FEVER/APPETITE -WEIGHT LOSS-HAIR LOSS CITRUS HTP: CHEST PAIN,INFECTIONS,TRAUMA,RASH,ULCERS,STIFFNESS,HAIS LOSS,TEMPERATURE EFFECT( RAYNAU’S ),PHOTOSENTITIVITY. BACK PAIN--------TUNA FISH D/D—LIMCOTS T TRAUMA L LUMBAR SPINAL STENOSIS U UNEXPECTED WEIGHT LOSS I INTERVERTEBRAL DISC HERNIATION N NUMBNESS ,TINGLING M METS-MYELOMA A AGE >55 C CAUDA EQUINA SYNDROME F FEVER O OSTEOARTHRITIS-OSTEOPOROSIS I IV DRUGS T TB- TRAUMA S STEROIDS S STRAIN MUSCLE H HX CANCER CHECK: what causes the pain ( lifting?) , bone pain?, chest pain, sob, hemoptysis, fever ? joints problems , functional impairment? Weight loss ? F I N I S H E D P U FREQUENCY INCONTINENCE NOCTURIA INCOMPLETE EMPTY STREAM HEMATURIA HESITANCY DISURIA PYURIA URGENCY

Hearing loss—IN-PDF-RST-OU I N P D F R S T O U IMBALANCE-infection URI Noise expose - nausea Ear pain- pressure Discharges - Distorted words falls Ring = tinnitus Spinning / sound source trauma Out bodies - WAX Understand speech

DIZZINESS--------------IN-PDF-RST I Imbalance- infection URI N Nausea P Ear pain- pressure D Discharges F falls R Ring = tinnitus S Spinning T trauma

Pediatric history: CUDS FEVER PAMIF BIGDEALS F FEVER E EAR PULLING V VOMIT E EAR – EYES DISCHARGE R RUNNY NOSE C COUGH U URINARY Number of diaper, odor, change color D DIARRHEA Amound,blood,color,content,odor S SEIZURE Any jerky movement? Any leakage of urine or stool during fits, LOC, irritability post ictal P PMH hospitalized? / serious illnesses? A ALL Does your child have any allergies? M MED medications? I ILL CONTACT Day care? F FH B BIRD HX Was your pregnancy full term? vaginal delivery or a C-section? routine checkups? any complications? smoke, drink, drugs during your pregnancy? Did your child have any medical problems after birth? / When did your child have his first bowel movement? I INMMUNIZATION Are your child’s immunizations up to date? / When was the date of your child’s last routine checkup? G GROW How is the weight and high of your child? D Development When did your child first smile? sit up? start crawling? start talking? Start walking? learn to dress himself? learn to tie his shoes? start using short sentences? Did you breast-feed your child? / When did your child start eating solid food? /Does your child have any allergies? / Is your child’s formula fortified with iron? How is your child’s appetite? How is your child’s APPARENCE / LOOKS?

E

EAT

A L S

APPETITE LOOK SLEEP

SORE THROAT _______________SORE THROAT S SWALLOWING painful / swollen tonsils O origin Do you know what causes this? R RUNNY NOSE E EAR pain- discharge T tiredness fatigue H Headache Sinus pain? R RESPIRATORY Cough , SOB , Chest pain O OCCUPATION A ABDOMEN Nausea, vomit, diarrhea T touch touch with ill people WORK UP: THROAT CULTURE , antibody and viral titer , Rapid streptococcal antigen ,mOnospot test , Anti EBV antibody , Test routine: CBC, Peripheral Cough sputum origin Runny nose EAR pain-discharge tiredness Headache Cough , SOB , Chest pain, wheezes occupation Nausea, vomit, diarrhea touch w/ ill people

S O R E T H R O A T

Headache: M MIT ACHES M MIGRANE M MENINGITIS I INCREASED INTRACRANEAL PRESSURE: CEREBRAL TUMOR / PSEUDOTUMOR CEREBRI T TENSION HEADACHE A AV MALFORMATION C CLUSTER HEADACHE H HYPERTENSION E EYE DISORDER S SINUSITIS– SUBARACHNOID HEMORRHAGE MIGRANE :recurrent ,unilateral pulsating pain + photophobia, phonophobia, anorexia, nausea, and vomiting + last 4-72 hours+ improvement with resting in a dark, quiet room + Auras CLUSTER HEADACHE : M, periodicity; occur many times daily ,onset with sleep + Alcohol is a trigger + NO auras + severe unilateral periorbital pain AND tearing of the eye and nares; last +- 1 HR. TENSIONAL HEADACHE: RECURRENT,BILATERAL SQUEEZING, 3-4 T/WEEK, > AFTER WORK TIME. TREMOR Parkinson’s disease (PD): resting tremor ,improves with activity,low frequency , bradykinesia and rigidity suggest . Essential tremor (ET): postural tremor or action tremor ,50% familiar ,high frequency , asymmetrically , improved W/ alcohol.

Physiologic tremor: high-frequency ,present in normal individuals.,enhanced by meds or medical conditions,: Anxiety, excitement, sleep deprivation/fatigue, hypoglycemia, caffeine intake, alcohol withdrawal, thyrotoxicosis, fever, and pheochromocytoma. Drug-induced tremor: albuterol, nicotine, theophylline, TCAs, lithium, valproic acid, and corticosteroids. Hyperthyroidism Psych Hx: MMSE + IAMSSADHT O R A I O R ORIENTATION T,P,P Registration 3 obj / RECALL 3 obj -- MEMORY ATTENTION : SPELL WORLD BACKWARDS IDENTIFY: WHAT’S THIS? Pen / paper OBEY : take this paper ,take this pen – Now give me it back please READ + WRITE + DRAW

I AM SAD
Insight , appearance, mood , MMSE, suicidal , speech, affect, delusion , hallucination I A M S S A D INSIGHT APPEARANCE MOOD SPEECH SUICIDE AFFECT DELUSION Do you think that you have a mental illness? NORMAL,PRESSURE,RAPID EUTHYMIC,NEUTRAL,EUPHORIC Do you see or hear things that others NOT LOGICAL,LOOSE ASSOCIATION, FLIGHT IDEAS

H HALLUCINATION T THOUGHT

DEPRESSION S-Do you have any problems falling asleep/staying asleep/waking up?” I-Do you take interest or pleasure in your daily activities?” G-Do you feel guilty about anything?” E-How is your energy level?” M-How long have you been feeling unhappy/sad/anxious/confused?” C-Do you have difficulty concentrating?” A-Has your appetite changed lately?” P-“How is your performance on your job?” S-Have you ever thought about hurting yourself or ending your life?”  MAJOR DEPRESIVE EPISODE : 4/9 . 2 WEEKS Mania:
---------DIG FAST D I G F Distractibility Impulsive behavior Grandiosity Fly of ideas

A S T

Agitation Sleeplessness Talkative

Manic episode : Bipolar I, you need to get elevated mood plus 3 out of 7 for a weak . Bipolar II
 -Hypomania they still have function and insight, don’t have psychotic features with moods cycling between high and low over time. Dysthymia: (feeling sad for 2 years, but never fulfill the criteria for depression, and it’s low mood, indecisiveness, low self-esteem, eat more/less, sleep more/less. They get 4 out of the 9 and the gap between attacks should be less than 2 months)
 Hypomania + major depression = "manic depression"

Anxiety: A. excessive anxiety / worry occurring more days than not for at least 6 months B. difficult to control the worry
 C. >3 of the following symptoms 1.restlessness 2. being easily fatigued
 3. difficulty concentrating 4. irritability
 5. muscle tension
 6. sleep disturbance Are you a person who worries a lot?
 Do you have any unrealistic excessive fear?
 Do you have excessive fear of being in a place that you cannot leave? Panic attack:Do you have periods of intense fear (that you feel that you are going to loose control, or getting crazy or dying) lasting for 10 minutes happening suddenly and improving on their own (without any intervention)? GAD:Do you worry a lot generally? Phobia:Do you worry a lot about specific object or situation or place? 
 Does it mean that you avoid some activities? Do you fear to be in a place (such as elevator or high place or with an animal) that you can not leave? Do you fear to give speech in a public place? OCD:Do you have any repeated thoughts or ideas or images that are disturbing for you? PTSD:Have you ever been in a place or had an experience that you felt that your personal well being or emotional or psychological safety was in danger? If response is yes, then what happened? When was that? Then asking about images and flashback? Psychosis: If patient comes to the clinic with symptoms of hallucination or delusion (as chief complaint), we are dealing with psychosis. Schizophrenia: at least 2/5 symptoms > 6 months.

DELUSIONS- Do you have special mission/power? If patient says that he/she has special mission, ask the patient, what is that mission? Do you believe you are special person? HALLUCINATION -Some times people having such experience or having low mood hear/see things that other people don’t hear/see do you experience that? DISORGANIZED SPEECH

GROSSLY DISORGANIZED OR CATATONIC BEHAVIOUR ALOGIA (INABILITY TO SPEAK) AVOLITION (INABILITY 
 TO INITIATE AND ACTIVITIES)


PARANOIC-Do you believe any body wants to harm/hurt you? How do you know that? Anybody wants to control you? DELUSIONAL DISORDER: ONE NON BIZARRE DELUSION AND FUNCTIONING NOT MARKEDLY IMPAIRED. DxDiferentials: Brief psychotic disorder : lasting from 1 day to 1 month Schizophreniform disorder : lasts from 1-6 months Schizoaffective disorder: manic episode + >2 weeks hallucinations / delusions Substance-induced psychosis Schizoid personality disorder Psychotic disorder due to a general medical condition Depression with psychotic features Workup : Mental status exam + Urine toxicology +TSH
 + CBC / Electrolytes Jaundice A nesthetics (e.g. halothane) B lood transfusions C ontacts D rugs E thanol F oreign travel G allstones H epatitis I diopathic/IVDA J ob (e.g. farmers, sewage workers) CONSTIPATION----------STOOLED S-SURGERY,SPINAL INJURY T-THYROID O-OXYCODIN O-OCULT BLOOD L-LOW FIVER DIET E-EXES CALCIO D-DIABETIC GASTROPARESIS Diarrhea:--------------------------- DIIIPHA D – Diverticulitis /Drugs: Laxatives, antibiotics I-INFLAMATORY BOWEL DISEASE . I-Irritable Bowel Syndrome Infection: Viral -Salmonella, Shigella, Campylobacter, Yersinia, C. Difficle Toxin -Staph, Cholera, Botulism, E.Coli,
 Vibrio
 Protozoa - Giardia, amebiasis
 Pancreatic Insufficiency Hyperthyroid ANTIBIOTIC / AIDS

Blood in the stool ----DRAIN
 D-diverticulosis , drugs ( warfarin ) R-rectal bleeds ( HEMORROIDS , fissures) A-angiodysplasia , anal sex, I-inflammatory bowel disease, infectious diarrhea, ischemic colitis , injury , N- neoplasms

Gynecologic/obstetric history: FM-DIAL +PP-DIAL F FREQUENCY M MENARCHE D DURATION I INTENSITY A AMOUnT L LMP PREGNANCY- ABORTION PAP SMEAR -PILL Discharge-dry vagina Itch -incontinence ABD PAIN =endometriosis -DYSMENORRHEAdyspareunia L LIBIDO S STD Pregnancy breast enlargement – tenderness? -polyuria –burning-iTCH-discharge ?-SPOTTING? nausea – appetite - weight change? -planed pregnancy - will continue ? concerns ? AMENORRHEA----------------------------------FLAG HIV WC F FATIGUE / fast run L LIBIDO A ANOREXIA,ANXIETY ,DEPRESSION G GALACTORRHEA H HEADACHES / HOT FLASHES/ HAIR I Insomnia V Visual / voices changes W Weight –appetite -diet C Cold – constipation P P D I A

Dyspareunia----------------------------------------------DATIVE D Dryness – domestic abuse A Athrophy vagina T Tumor pelvic I infections V vaginismus E Endometriosis= cyclic abdominal pain VAGINAL BLEED --------MAD POLICE M-MALIGNANCY A-ADENOMYOSIS + ATROPHIC D - DUB P-POLYP + PCOD O-OVULATORY DISFUNCTION L-LEIOMIOMA I - Infections: PID
 C-COAGULOPATHY E-ENDOMETRIAL + ECTOPIC + ENDOCRINE

PREMENOPAUSAL SYMTOMS---------HAVOC H-HOT FLASHES A-ATROPHIC VAGINA V-VAGINAL DRY O-OSTEOPOROSIS C-CORONARY # 40 yo F with HEAVY PAINLESS IRREGULAR periods = DUB # 60 yo F with LIGHT BLEED PAIN W/ SEX, Hot flashes, Mood swings, Tenderness and dryness of the vagina = ATROPHIC VAGINITIS obesity. Tell me more about your ---------WEIGHT: What is your weight today? ----Highest weight. When started to gain wt? When started to be concerned? Have you tried any wt- loss programs? Which one? ,How long? ,Did you lose wt? ,Why did you stop? Tell me more about your --------------DIET: How many meals do you take/day including snacks? What do you eat? -------How much fat, fruit, veg bread? Ever eat to relax or when stressed? Binge eating?
 ,Do you feel guilty about your eating? Do you induce vomiting/purging? Tell me more about your --------ACTIVITY: Do you exercise? I am going to ask you how this Affects your life? Back pain, Knee pain. Breath difficulty ,Difficulty sleeping, snoring ( sleep apnea). Chest pain? Palpitations? How it affects your self-esteem, mood and interest? Stress? Any change in sexual desire?
 urine leak?

Tiredness ,cold intolerance, hair/skin- voice changes + POLYURIA,POLYDIPSIA, Polyphagia GB stones, Heart burn , bowel motion, Nausea, vomiting,+PAP, mammography , colonoscopy O B E S I T Y C Osteoarthritis Breast difficulties – sleep apnea Heart problems Stress-depression-anxiety-mood-interest Incontinence-libido Thyroid – Type II DM hYpertension Cholelithiasis -cancer