You are on page 1of 6

Doorway Information

Write Name, VS, CC, DDx & mnemonics


Knock the Door 3 times, wait 3sec, Go!!! Its Showtime!!
Introduce Yourself:
Doc: Mr. Smith? SP: Yes
Doc: "Hi, am Dr. !., the "h#sician on $%t# to$a#. t&s
nice to meet #o% 'Han$sha(e)
Doc: "s e*er#thin+ o( in the room? SP: Yes
,( no- .%st /et me ma(e #o% more com0orta1/e"
'Dra"e Pt.)

Doc: " ho"e #o% $on2t min$ i0 sit an$ ta(e some notes
as #o% s"ea("
Doc: So Mr. Smith, ho- can he/" #o% to$a#? SP: !.
,h am sorr# to hear that, -i// $o 1est to
he/" #o%
HIS!"Y !# $"%S%& I''&%SS (H$I)
*hief *om+laint (cc) 3se #o%r mnemonics.
!stcd 'I,u" - ...
!nset: When $i$ it start? Ho- $i$ it start?
Was it a// o0 a s%$$en or +ra$%a//#?
Settin+: What -ere #o% $oin+ -hen it starte$?
imin+: s it -orst in a "artic%/ar time o0 the $a#?
*o%rse: s it +ettin+ -orse, 1etter or .%st the same?
D%ration: Does it come an$ +o? or it&s a/-a#s
there? Ho- o0ten $oes it come? 4or ho- /on+
$oes it sta# each time?
'ocation: Can #o% sho- me -here it h%rts?
Intensit#: Ho- 1a$ is it, on a sca/e 0rom 5 to 56, 1ein+ 5
the mi/$est an$ 56 the -orst "ain?
Does it inter0ere -ith #o%r $ai/# acti*ities?
,ua/it#: 7e// me ho- $oes it 0ee/ /i(e? s it shar"? $%//?
Sta11in+? Cram"#? S8%ee9in+? :%rnin+?
"a$iation: Does it +o; shoot an#-here?
.++ra*atin+ 0actors: What 1rin+s it on? What ma(es it
-orse
.//e*iatin+ 0actors: What ma(es it 1etter?
What has -or(e$ 0or #o% so 0ar?
.ssociate$ s#m"toms: Ha*e #o% notice$ an#thin+ e/se
that occ%rs -ith it? S%ch %s!!
<n# thin+ that #o% ma# reca//?
!ther ** different to +ain:
3se =s accor$in+ to the CC !!!
"elation to Daily .cti/ities: Does it chan+e -ith #o%r
$ai/# acti*ities, /i(e "ost%res, exertion, rest, s/ee"in+,
eatin+, H%n+er?
$.S 0%DI*.' HIS!"Y
1efore $0H
2&ow I am 3oin3 to ask you some 4uestions a5out
your +ast medical H67
$.0 H8GS #!SS
$ ($0H) (D9:; <u)
Doc: Has it ha""ene$ 1e0ore? When? Ho- $i$ #o%
han$/e it? Di$ #o% ta(e an# me$ication? !
Doc: Do #o% ha*e an# other me$ica/ con$itions?, /i(e
Hi+h 1/oo$ "ress%re, Dia1etes, hi+h Cho/estero/?...
. (.ller3ies)
Doc: <re #o% a//er+ic to an#thin+, 0oo$ or me$icine?
0 (0edication)
Doc: <re #o% ta(in+ an# me$ications? Prescri1e$ or
o*er the co%nter?
H (Hos+itali=ations, Sur3eries, In:uries, .ccidents,
transfusions)
Doc: Ha*e #o% e*er 1een hos"ita/i9e$? <n# s%r+eries in
the "ast? <n# in.%ries or acci$ents? Ha*e #o% e*er
recei*e$ trans0%sions?
8 (8rination)
Doc: Ha*e #o% notice$ an# chan+es in #o%r 3rinar#
Ha1its?
G (Gastrointestinal)
Doc: What a1o%t in #o%r :o-e/ Mo*ements?
S (Slee+)
Doc: <re #o% s/ee"in+ o(?
1efore #amily H6
2&ow I am 3oin3 to ask you some 4s a5out your
#amilys health7 2
# (#amily H6)
Doc: Does an#1o$# in #o%r 0ami/# ha*e the same
"ro1/em?
<re there an# me$ica/ con$itions that r%n in #o%r
0ami/#? /i(e Dia1etes, Hi+h 1/oo$ "ress%re, Cancer?
<re #o%r "arents hea/th#?
1efore !5stetric H6
2&ow I am 3oin3 to ask you some 4s a5out your
!5stetric H6 !k>
! (!5stetric H6)
Doc: When -as #o%r /ast menstr%a/ "erio$ >MP?
Was it re+%/ar?
Doc: Ho- man# times ha*e #o% 1ein+ "re+nant? <n#
a1norma/ities or com"/ications? <n# miscarria+es?
<t ho- man# -ee(s?
Doc: Ho- man# chi/$ren $o #o% ha*e? <re the# hea/th#?
Doc: What are #o% %sin+ 0or 1irth contro/?
1
1efore Se6ual History
2!k 0r? Smith, now I am 3oin3 to ask you some /ery
+ersonal 4s, 5ut let me re@assure you that
e/erythin3 we talk will 5e ke+t confidential ok>7
S (Se6ual history)
Doc: <re #o% sex%a//# acti*e?
Doc: n the /ast #ear ho- man# sex%a/ "artners ha*e
#o% ha$? <re the# ma/e, 0ema/e, or 1oth?
Doc: Ha*e #o% notice$ an# chan+es in #o%r sex%a/
0%nction?
Doc: Do #o% a/-a#s %se con$oms? Ha*e #o% e*er
ha$ an# S7D Sex%a/ transmitte$ $isease? Di$ #o%
+et an# treatment? <n$ #o%r sex%a/ "artner?
1efore Social History
Doc: 2&ow let me ask you some 4s a5out your
lifestyle7
S (Social history) ' S!D. A%
' Who $o #o% >i*e -ith?
S Do #o% smo(e? Ho- man# "ac(s a $a#? 4or ho-
man# #ears?
! Do #o% $rin( </coho/? What $o #o% $rin(? Ho-
man# +/asses, 1eers a $a#, -ee(?
D Do #o% %se an# recreationa/ $r%+s? What $o #o%
%se? When -as the /ast time #o% ha$ it?
. Ho- is #o%r a""etite? Ho- is #o%r $iet? <n# recent
-ei+ht chan+es? Ho- man# "o%n$s? ,*er -hat
"erio$ o0 time?
A What (in$ o0 -or( $o #o% $o? s it stress0%/?
% Ho- o0ten $o #o% exercise?
Ha*e #o% recent/# tra*e/e$?

#inishin3 ,s B 1efore $hysical %6am
2.ll ri3ht 0r? 'ee thanks for answerin3 all these
4uestions? &ow Ill need to do your +hysical e6am,
so Ill :ust wash my hands first?
Do you ha/e any 4uestions for me>7
Dr? *harito?
2Gra=ie7
Doc: Ok Mr. Smith, now let me begin
by
HEENT - HED
!n"#ection:
Doc: Ok Mr. Smith, now ! $m going to
"t$rt by e%$mining yo&r he$', let me
look $t yo&r he$' (ir"t
)$l#$tion:
Doc: Now ! $m going to #re"" on "ome
$re$" on yo&r ($ce, to e%$mine yo&r
"in&"e", #le$"e let me know i( yo& (eel
$ny #$in.
*on+&ncti,$:
Doc: -et me check yo&r eye", c$n yo&
look &# (or me #le$"e.
TM/:
Doc: )le$"e bite re$lly h$r'.
*r$ni$l 0one":
Doc: Now ! $m going to #re"" on "ome
$re$" o( yo&r "k&ll, i( yo& h$,e $ny #$in
+&"t let me know #le$"e.
-ym#h no'e": NE*1
Doc: Now ! $m going to check i( yo&
h$,e $ny "wollen gl$n'", #le$"e let me
know i( yo& h$,e $ny 'i"com(ort
S&#r$cl$,ic&l$r: )le$"e t$ke $ 'ee#
bre$th in, in, in..o&t
Thyroi' 2l$n'
Doc: ! $m going to e%$mine the gl$n' in
(ront o( yo&r neck (or th$t ! nee' yo& to
"w$llow when ! $"k yo&, 'o yo& nee' $
gl$"" o( w$ter. )le$"e "w$llow. Ok,
th$nk"
E3ES: 45 )ocket Snellen *h$rt
Doc: Mr. Smith, co&l' yo& #le$"e co,er
one eye $n' re$' the "m$lle"t line
#o""ible. now with the other eye.
65 7i"&$l 8iel'": Remove glasses (yours and
pts), 2 feet std
Doc: *o&l' yo& #le$"e co,er yo&r right
eye, $n' with yo&r le(t eye look $t my
2
no"e only, when yo& "ee my (inger
mo,ing, #le$"e "$y ye"
Doc: *$n yo& "ee thi", wh$t $bo&t
here. S): Yes/No
)$tient 9-5 Doc9:5
;5 )&#ill$ry :e"#on"e to -ight $n'
*on,ergence
Doc: Mr. Smith, #le$"e look $he$', !
$m going to "hine thi" #enlight on yo&r
eye"., *ontin&e to look $he$', $" !
"hine thi" light (rom the "i'e
4"t: -ook (or the Direct )&#ill$ry :e(le%
6
n'
: -ook (or the *on"en"&$l )&#ill$ry
:e(le%
<5 EOM 8&nction: *$r'in$l )o"ition o(
2$=e:
Doc: Mr". *l$rk, !>' like yo& to (ollow
my (inger with yo&r eye" only, #le$"e
'o not mo,e yo&r he$', (ollow it o&t
here, here, Now, ! w$nt yo& to
w$tch my (inger c$re(&lly $" ! go ,ery
clo"e 9*on,ergence Te"t5
?5 8&n'o"co#y: Ophthalmoscope
Remove yours and the patients glasses, prove
the light
-$w O( The :ight @ :ight A -e(t - -e(t:
Doc: Mr. *l$rk co&l' yo& look to $
(i%e' #oint on the w$ll #le$"e, ! $m
going to check in"i'e yo&r eye".,
th$nk".
E:S
45 Otho"co#e
Doc: Now ! $m going to check yo&r
e$r", let me #&ll yo&r e$r (ir"t, 'o yo&
(eel $ny #$in, now let me check in"i'e,
now the other.
65 T&ning 8ork Te"t: :inne $n' Beber
Te"t
Doc: Now ! $m going to "trike thi"
t&ning (ork on my h$n' $n' #l$ce it on
the b$ck o( yo&r e$r.
Doc: *$n yo& he$r thi". *$n yo& he$r
better now.
:inne Te"t Beber Te"t
C"&$lly: * D 0*
Doc: Now ! $m going to #l$ce it on the
to# o( yo&r he$'. !o you feel anything" S):
Yes, vi#ration
Doc: s it the same in #oth sides" S): Yes
NOSE
Doc: Mr. E, co&l' yo& #le$"e e%ten'
yo&r neck. ! $m going to li(t the ti# o(
yo&r no"e to check in"i'e
TH:OT - MOCTH
Doc: Mr. E. co&l' yo& o#en yo&r mo&th
(or me #le$"e. Stick o&t yo&r tong&e,
mo,e it "i'e to "i'e 9E!! *r$ni$l5 Now !
$m going to #l$ce thi" tong&e 'e#re""or,
"$y h 9!E $n' E5 yo& c$n #&t yo&r
tong&e b$ck, th$nk".

*r$ni$l Ner,e":
!
!!, !!!, !7, 7! 'one H
7!!!. - 7e"tib&locochle$r 9$&'itory5 'one

!E F E. - S$y h 'one
E!!. Done
7. Trigemin$l Opht $ %a&il '
%andi#le ' $ %
Sen"ory 8&nction: forehead, chee(s and
)a*
Doc: Mr. E, !>m going to t$ke thi"
g$&=e #$' $n' to&ch "ome #l$ce" on
yo&r ($ce with it, #le$"e clo"e yo&r
eye" Di' yo& (eel thi" 'i' it (eel
"imil$r or not.
7!!. 8$ci$l
Doc: Smile (or me #le$"e. 0ig
Smile
Doc: *o&l' yo& (rown (or me.
E!. S#in$l cce""ory +ra# ,ts shoulders
Doc: *o&l' yo& #&"h &# yo&r
"ho&l'er" $g$in"t my re"i"t$nce.

3
-CN2S
Doc: )le$"e let me &ntie yo&r gown "o
! c$n e%$mine yo&r l&ng"
)$l#$tion:
*he"t E%c&r"ion
Doc: Now ! $m going to hol' yo&r
b$ck, #le$"e t$ke $ 'ee# bre$th, $g$in,
$g$in, ok th$nk"
T$ctile 8remit&":
Doc: *o&l' yo& cro"" yo&r $rm" in
(ront. )le$"e "$y GG e,ery time ! #l$ce
my h$n'". GG., $g$in, $g$in
)erc&""ion
&"c&lt$tion
)erc&""ion:
Doc: ! $m going to t$# on yo&r b$ck
&"c&lt$tion: -arm the 'tethoscope
Doc: ! $m going to li"ten to yo&r l&ng",
#le$"e o#en yo&r mo&th $n' t$ke $
'ee# bre$th, in $n' o&t thro&gh yo&r
mo&th, $g$in, $g$in Ok, now
bre$th norm$lly, Th$nk".
HE:T
)$l#$tion:
Doc: Now #le$"e le$n (orw$r', let me
check yo&r he$rt 8ir"t, ! $m going to
#re"" on "ome $re$" on yo&r che"t to
(eel yo&r he$rt im#&l"e
ortic re$: 2 ./' (0eft), )&lmon$ry re$: 2
./' (Right)
Tric&"#i' re$: 1 ./' (00'2) Mitr$l $re$: 3
./' $ %idclavicular 0eft 0ine

&"c&lt$tion: On 4 cardiac areas
Doc: )le$"e le$n (orw$r'
0DOMEN
!n"#ection:
Doc: Mr. E, let me &nco,er yo&r belly
to e%$mine it *o&l' yo& #le$"e t&rn
yo&r he$' to the other "i'e F co&gh
(or me.
&"c&lt$tion: Now #le$"e, let me li"ten
to yo&r bowel "o&n'"
-i,er
)$l#$tion: 0oo( at the pts face e&pression
-ight #$l#$tion: One hand
Doc: ny ten'erne"" here.(5 points)
/hec( the reno ureteral points for pain
Dee# )$l#$tion: 2 hands, rolling motion
Doc: ny ten'erne"" 9#$in5 here.
Here.
Doc: ! know it (eel" $ little
&ncom(ort$ble, b&t i( yo& (eel #$in
#le$"e let me know
S#eci$l #$l#$tion: 0iver, 'pleen
-i,er )$l#$tion
Doc: T$ke $ 'ee# bre$th in o&t
'pleen 0eft to the navel
S#eci$l Te"t"
M&r#hy>" Sign *holecy"titi"
Doc: ! $m going to #re"" on the right
"i'e below yo&r rib" to (eel yo&r li,er,
#le$"e t$ke $ 'ee# bre$th in, in o&t.
Th$nk". ny #$in. ',: yes 9H5
%urphy Mc 0&rney
##en'iciti"
Doc: Now ! $m going to #re"" on the
le(t lower "i'e o( yo&r belly, #le$"e let
me know i( yo& (eel $ny #$in.
:o,"ingI" Sign.- (contr$ l$ter$l #$in)
Doc: ! $m going to #re"" on thi" "i'e,
where 'o yo& (eel the #$in, .
:ebo&n' Ten'erne"".- #$in when remo,ing
the #re""&re 9)eritoniti"5
Doc: Now ! $m going to 'o $ 'ee#
#$l#$tion, when 'o yo& (eel more #$in,
now or now.
)"o$" "ign.- ,ain on passive e&tension of the
right thigh
Doc: Mr. E, #le$"e l$y on yo&r le(t
"i'e, ! $m going to e%ten' yo&r right leg
b$ckw$r'" while #re""ing on yo&r right
hi#. Do yo& (eel $ny #$in.
,soas O#turator
Obt&r$tor "ign. @ ,assive internal rotation of the
fle&ed thigh
4
Doc: Mr. E, ! $m going to mo,e yo&r
leg to the "i'e while ! #re"" on the "i'e
o( yo&r knee, 'o yo& (eel $ny #$in.
E%tremitie"
:$'i$l F 0r$chi$l
:$'i$l F 8emor$l )&l"e": 9i( thinking on
*o$rct$tion o( o5
)o#lite$l )&l"e": place thum#s on the patella

)o"t Tibi$l )&l"e": press fingers against
malleolus
Dor"$li" )e'i$ )&l"e":
Ne&rologic$l E%$m
Ment$l St$t&" - *r$ni$l Ner,e" -
Sen"ory (&nction
Motor (&nction - :e(le%e" - *erebell$r
(&nction
Ment$l St$t&"
J&ick Miniment$l
Doc: Mr". Smith, ! $m going to $"k yo&
(ew K&e"tion"
to $""e" yo&r $ttention $n' memory
ok.
Orient$tion:
*$n yo& #le$"e tell me yo&r (&ll
n$me.
Bh$t i" the '$te to'$y.
*$n yo& tell me wh$t city $re we in.
Bhere $re yo& now.
Memory:
Mr". Smith #le$"e "$y the"e wor'":
bo$t, t$ble F #encil. 9!mme'i$te
rec$ll5. ! $m going to $"k yo& to rec$ll
the"e wor'" l$ter ok.
ttention F *oncentr$tion:
Now "#ell the wor' LBO:-DL
b$ckw$r'" (or me #le$"e.
-$ng&$ge Te"t
*$n yo& clo"e yo&r eye" #&t yo&r
h$n'" together $n' bring them on to
yo&r belly $n' then on to yo&r b$ck.
M Mr". Smith ! w$nt yo& to rec$ll the ;
wor'" th$t ! tol' yo& (ew min&te"
$go. 9Del$ye' :ec$ll5
S#$ti$l bility:
*$n yo& co#y the (ollowing
'r$wing.
Sen"ory 8&nction:
)o"ition Sen"e: )ro#rioce#tion
Doc: Mr. E, co&l' yo& clo"e yo&r eye"
$n' tell me where 'i' ! +&"t to&ch
yo&.66 7and, foot,
Doc: Di' th$t (eel "imil$r.
Hol' the (inger
Doc: Thi" i" &# $n' thi" i" 'own
Doc: Tell me, wh$t i" thi". ',666
7ibr$tion: 8se the 9uning for(
Doc: *lo"e yo&r eye" #le$"e. Do yo&
(eel $nything. Bh$t 'o yo& (eel.6
:i#ration
Doc: Bh$t $bo&t now.
Doc: Stronger now. Be$ker. Or the
"$me. toes
Sh$r# $n' D&llne"":
Doc: *lo"e yo&r eye", thi" i" '&ll $n'
thi" i" "h$r#
Doc: Bh$t i" thi". Sh$r# or '&ll. 8pp
$ 0o* lim#s
:e(le%e" DT:
0ice#" )$tell$ 91nee5 chille"
Motor (&nction
C##er -imb"
Doc: 2ri# my h$n', 'on>t let me go
rel$%
Doc: M$ke $ (i"t. Don>t let me o#en,
rel$%
Doc: bring yo&r $rm" in (ront, #$lm" &#
like thi", 'on>t let me #&"h yo& 'own,
now #$lm" 'own, 'on>t let me #&"h &#
ok rel$%
-ower -imb"
Doc: )&"h yo&r leg" (orw$r' $g$in"t my
re"i"t$nce, now b$ckw$r'"rel$% now
*erebell$r (&nction
8inger to No"e Te"t
Doc: ! $m going to #l$ce my (inger
here, #le$"e to&ch my (inger $n' then
to&ch yo&r no"e, now 'o the "$me
while ! mo,e my (inger in 'i((erent
#o"ition"
:omberg te"t
5
Doc: )le$"e "t$n' "till with (eet
together $n' o#en yo&r $rm" $"i'e .
*lo"e yo&r eye" $n' b$l$nce yo&r"el(.
Don>t worry ! will be behin' yo& in c$"e
yo& nee' "ome $""i"t$nce.
E%$min$tion o( 2$it
Doc: B$lk tow$r'" meN now, on yo&r
toe", now on yo&r heel" th$nk".
B$lk, one (oot in (ront o( the other in
$ "tr$ight line
6

Related Interests