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Relation to Daily Activities: Does it change with your

daily activities, like postures, exertion, rest, sleeping,


Doorway Information
eating, Hunger?
PAST MEDICAL HISTORY
Write Name, VS, CC, DDx & mnemonics Before PMH
Knock the Door 3 times, wait 3sec, Go!!! It’s Showtime!! “Now I am going to ask you some questions about
Introduce Yourself: your past medical Hx”
PAM HUGS FOSS
P (PMH) (Déjà Vu)
Doc: “Has it happened before?” When? How did you
Doc: “Mr. Smith?” SP: Yes handle it? Did you take any medication? …
Doc: "Hi, I am Dr. …., the physician on duty today. It’s Doc: “Do you have any other medical conditions?, like
nice to meet you (Handshake) High blood pressure, Diabetes, high Cholesterol?...
Doc: "Is everything ok in the room? SP: Yes
Ok now just let me make you more comfortable" A (Allergies)
(Drape Pt.) Doc: “Are you allergic to anything, food or medicine?”
M (Medication)
Doc: “Are you taking any medications? Prescribed or
Doc: "I hope you don't mind if I sit and take some notes over the counter?
as you speak"
Doc: “So Mr. Smith, how can I help you today?” SP: …. H (Hospitalizations, Surgeries, Injuries, Accidents,
“Oh I am sorry to hear that, I will do best to transfusions)
help you” Doc: “Have you ever been hospitalized? Any surgeries in
the past? Any injuries or accidents? Have you ever
HISTORY OF PRESENT ILLNESS (HPI) received transfusions?”

Chief Complaint (cc) Use your mnemonics. U (Urination)


Doc: “Have you noticed any changes in your Urinary
Ostcd LIQuR + AAA Habits?”
G (Gastrointestinal)
Onset: When did it start? How did it start? Doc: “What about in your Bowel Movements?”
Was it all of a sudden or gradually?
Setting: What were you doing when it started? S (Sleep)
Doc: “Are you sleeping ok?
Timing: Is it worst in a particular time of the day?
Course: Is it getting worse, better or just the same? Before Family Hx
Duration: Does it come and go? or it’s always “Now I am going to ask you some qs about your
there? How often does it come? For how long Family’s health” “
does it stay each time?”
F (Family Hx)
Location: Can you show me where it hurts? Doc: Does anybody in your family have the same
Intensity: How bad is it, on a scale from 1 to 10, being 1 problem?
the mildest and 10 the worst pain? Are there any medical conditions that run in your
Does it interfere with your daily activities?” family? like Diabetes, High blood pressure, Cancer?
“Are your parents healthy?”
Quality: Tell me how does it feel like? Is it sharp? dull?
Stabbing? Crampy? Squeezing? Burning? Before Obstetric Hx
Radiation: Does it go/ shoot anywhere? “Now I am going to ask you some qs about your
Obstetric Hx Ok?
Aggravating factors: What brings it on? What makes it
worse O (Obstetric Hx)
Doc: “When was your last menstrual period LMP?
Alleviating factors: “What makes it better?” Was it regular?
“What has worked for you so far?” Doc: “How many times have you being pregnant? Any
Associated symptoms: “Have you noticed anything else abnormalities or complications? Any miscarriages?
that occurs with it?”” Such us……” At how many weeks?
“Any thing that you may recall?” Doc: “How many children do you have? Are they healthy?
Doc: “What are you using for birth control?”
Other CC different to pain:
Use Qs according to the CC ………

1
Before Sexual History
“Ok Mr. Smith, now I am going to ask you some very
personal qs, but let me re-assure you that
everything we talk will be kept confidential ok?” Doc: “Ok Mr. Smith, now let me begin
by…”
S (Sexual history)
Doc: “Are you sexually active?” HEENT - HEAD
Doc: “In the last year how many sexual partners have Inspection:
you had? Are they male, female, or both?” Doc: “Ok Mr. Smith, now I am going to
Doc: “Have you noticed any changes in your sexual start by examining your head, let me
function? look at your head first…
Doc: “Do you always use condoms?” “Have you ever
had any STD Sexual transmitted disease? Did you Palpation:
get any treatment? And your sexual partner?
Doc: “Now I am going to press on some
Before Social History
areas on your face, to examine your
Doc: “Now let me ask you some qs about your sinuses, please let me know if you feel
lifestyle” any pain.”
S (Social history) L SODA WET Conjunctiva:
Doc: “Let me check your eyes, can you
L “Who do you Live with?” look up for me please?”
TMJ:
S “Do you smoke?” How many packs a day? For how Doc: “Please bite really hard?”
many years?
Cranial Bones:
O “Do you drink Alcohol? What do you drink? How
many glasses, beers a day, week? Doc: “Now I am going to press on some
D “Do you use any recreational drugs? What do you areas of your skull, if you have any pain
use? When was the last time you had it? just let me know please?”
A “How is your appetite? How is your diet? Any recent Lymph nodes: NECK
weight changes? How many pounds? Over what
period of time?”

W “What kind of work do you do?” Is it stressful? Doc: “Now I am going to check if you
E “How often do you exercise?” have any swollen glands, please let me
T “Have you recently traveled?” know if you have any discomfort”
Supraclavicular: “Please take a deep
breath in, in, in…..out”
Finishing Qs & Before Physical Exam
“All right Mr. Lee thanks for answering all these
questions. Now I’ll need to do your physical exam,
so I’ll just wash my hands first. Thyroid Gland
Doc: “I am going to examine the gland in
Do you have any questions for me?”
front of your neck for that I need you to
swallow when I ask you, do you need a
glass of water? Please swallow? Ok,
thanks”

EYES: 1) Pocket Snellen Chart

Dr. Charito.
“Grazie” Doc: “Mr. Smith, could you please cover
one eye and read the smallest line
possible? now with the other eye?”
2) Visual Fields: Remove glasses (yours and
pt’s), 2 feet std
Doc: “Could you please cover your right
eye, and with your left eye look at my
2
nose only, when you see my finger
moving, please say “yes”
Doc: “Can you see this, what about Rinne Test Weber Test
here?” SP: Yes/No
Usually: AC > BC
Doc: Now I am going to place it on the
top of your head. Do you feel anything? SP:
Patient (L) Doc(R)
Yes, vibration
3) Pupillary Response to Light and Doc: s it the same in both sides? SP: Yes
Convergence
Doc: “Mr. Smith, please look ahead, I NOSE
am going to shine this penlight on your Doc: “Mr. X, could you please extend
eyes?, Continue to look ahead, as I your neck? I am going to lift the tip of
shine this light from the side” your nose to check inside”
1st: Look for the Direct Pupillary Reflex
2nd: Look for the Consensual Pupillary THROAT - MOUTH
Reflex Doc: “Mr. X. could you open your mouth
4) EOM Function: Cardinal Position of for me please?” “Stick out your tongue,
Gaze: move it side to side” (XII Cranial) Now I
am going to place this tongue depressor,
say Ah (IX and X) you can put your
tongue back, thanks.

Doc: “Mrs. Clark, I’d like you to follow


my finger with your eyes only, please
do not move your head, follow it out Cranial Nerves:
here, here…”, “Now, I want you to I∅
watch my finger carefully as I go very II, III, IV, VI done√ “H”
close” (Convergence Test) VIII. - Vestibulocochlear (auditory) done
5) Fundoscopy: Ophthalmoscope √
IX & X. - “Say Ah” done √
Remove yours and the patient’s glasses, prove XII. Done√
the light.
Law Of The Right – Right / Left - Left: V. Trigeminal Opht & Maxil → S
Mandible→ S & M
Doc: “Mr. Clark could you look to a Sensory Function: forehead, cheeks and
fixed point on the wall please, I am jaw
going to check inside your eyes?”, Doc: “Mr. X, I’m going to take this
thanks. gauze pad and touch some places on
EARS your face with it, please close your
eyes” “Did you feel this… did it feel
1) Othoscope similar or not?”
Doc: “Now I am going to check your
ears, let me pull your ear first, do you
feel any pain, now let me check inside, VII. Facial
now the other. Doc: “Smile for me please?” “Big

Smile”
2) Tuning Fork Test: Rinne and Weber
Test Doc: “Could you frown for me?”
Doc: “Now I am going to strike this XI. Spinal Accessory Grab Pt’s shoulders
tuning fork on my hand and place it on Doc: “Could you push up your
the back of your ear. shoulders against my resistance?”
Doc: “Can you hear this? Can you hear
better now?

3
Auscultation: “Now please, let me listen
LUNGS to your bowel sounds”
Doc: “Please let me untie your gown so
I can examine your lungs”
Palpation: Liver
Palpation: Look at the pt’s face expression.
Chest Excursion
Light palpation: One hand.
Doc: “Now I am going to hold your
Doc: “Any tenderness here?”(6 points)
back, please take a deep breath, again,
Check the reno ureteral points for pain.
again, ok thanks” Deep Palpation: 2 hands, rolling motion.
Doc: “Any tenderness (pain) here?
Here?”
Tactile Fremitus:
Doc: “I know it feels a little
Doc: “Could you cross your arms in
uncomfortable, but if you feel pain
front? Please say 99 every time I place
please let me know”
my hands?” 99?, again, again…” Special palpation: Liver, Spleen.
Liver Palpation
Doc: “Take a deep breath in … out”
Percussion
Auscultation Spleen Left to the navel.
Percussion:
Doc: “I am going to tap on your back” Special Tests
Auscultation: Warm the Stethoscope Murphy’s Sign → Cholecystitis
Doc: “I am going to listen to your lungs, Doc: “I am going to press on the right
please open your mouth and take a side below your ribs to feel your liver,
deep breath, in and out through your please take a deep breath in, in … out.
mouth”, again, again…” “Ok, now Thanks.” Any pain?” SP: yes (+)
breath normally, Thanks.”

HEART Murphy Mc Burney →


Appendicitis
Palpation:
Doc: “Now please lean forward, let me Doc: “Now I am going to press on the
check your heart” First, I am going to left lower side of your belly, please let
press on some areas on your chest to me know if you feel any pain?”
Rovsing's Sign.- (contra lateral pain)
feel your heart impulse”
Doc: “I am going to press on this side,
where do you feel the pain, ?
Rebound Tenderness.- pain when removing
Aortic Area: 2° ICS (Left), Pulmonary Area: 2° the pressure (Peritonitis)
ICS (Right) Doc: “Now I am going to do a deep
Tricuspid Area: 3° ICS (LLSB) Mitral area: 5° palpation, when do you feel more pain,
ICS & Midclavicular Left Line now or now.
Psoas sign.- Pain on passive extension of the
right thigh
Doc: “Mr. X, please lay on your left
side, I am going to extend your right leg
Auscultation: On 4 cardiac areas backwards while pressing on your right
Doc: “Please lean forward” hip. Do you feel any pain?
“ABDOMEN”
Inspection: Psoas Obturator
Doc: “Mr. X, let me uncover your belly Obturator sign. – Passive internal rotation of the
to examine it” “Could you please turn flexed thigh
your head to the other side & cough
for me?”

4
Doc: “Mr. X, I am going to move your Sensory Function:
leg to the side while I press on the side Position Sense: Proprioception
of your knee, do you feel any pain? Doc: “Mr. X, could you close your eyes
and tell me where did I just touch
Extremities you?”…….. Hand, foot,
Radial & Brachial Doc: “Did that feel similar?”
Radial & Femoral Pulses: (if thinking on Hold the finger
Coarctation of Ao) Doc: “This is up and this is down”
Popliteal Pulses: place thumbs on the patella. Doc: “Tell me, what is this?” SP……….
Vibration: Use the Tuning fork

Doc: “Close your eyes please? Do you


Post Tibial Pulses: press fingers against feel anything?” What do you feel?”…
malleolus Vibration
Doc: What about now?
Dorsalis Pedia Pulses: Doc: “Stronger now? Weaker? Or the
same?” toes.
“Neurological Exam” Sharp and Dullness:
Mental Status - Cranial Nerves √ - Doc: “Close your eyes, this is dull and
Sensory function this is sharp”
Motor function - Reflexes - Cerebellar Doc: “What is this?” “Sharp or dull?” Upp
function & Low limbs
Mental Status
Reflexes DTR
Quick Minimental
Doc: “Mrs. Smith, I am going to ask you
Biceps Patella (Knee) Achilles
few questions
to asses your attention and memory
Motor function
ok?” Upper Limbs
Orientation: Doc: “Grip my hand, don’t let me go…
• Can you please tell me your full relax”
name? Doc: “Make a fist. Don’t let me open,
• What is the date today? relax”
Doc: “bring your arms in front, palms up
• Can you tell me what city are we in?
like this, don’t let me push you down,
Where are you now?
now palms down, don’t let me push up…
Memory:
ok relax”
• Mrs. Smith please say these words: Lower Limbs
boat, table & pencil. (Immediate Doc: “Push your legs forward against my
recall). I am going to ask you to recall resistance, now backwards…relax now ”
these words later ok.
Attention & Concentration: Cerebellar function
• Now spell the word "WORLD" Finger to Nose Test
backwards for me please?
Language Test
• Can you close your eyes put your Doc: “I am going to place my finger
hands together and bring them on to here, please touch my finger and then
your belly and then on to your back? touch your nose”, now do the same
* Mrs. Smith I want you to recall the 3 while I move my finger in different
words that I told you few minutes positions”
ago. (Delayed Recall) Romberg test
Spatial Ability:
• Can you copy the following
drawing?

5
Doc: Please stand still with feet
together and open your arms aside .
Close your eyes and balance yourself.
Don’t worry I will be behind you in case
you need some assistance.
Examination of Gait
Doc: “Walk towards me; now, on your
toes, now on your heels”… thanks.
“Walk, one foot in front of the other in
a straight line”