Survival In Long Case

Chinadol MD.
Preparation before exam
Hair / Nail / Dressing
Stethoscope / Watch / Pen / A4 X2
Flashlight / Snellen chart / Opthalmoscope / Jerk /
Tooth prick / Tuning fork
Vital signs tool

General information
75 min / case
History taking + Physical examination 30 min
Presentation 10 min
Discussion-Question and answer 35 min
Problem list
Diagnosis / Differential diagnosis
Investigation for diagnosis / treatment
Final diagnosis
Plan of treatment
Advice

Consequence Step approach

Introduce myself
History taking
General information
Sex / Age / Native Habitat
Occupation
Occupational disease
Contact vector
Right of treatment

Chief complaint : Defined symptom

Choose to approach 1st except non sp.
Present illness : Characteristic
Causes Effect (time sequence)
Co-morbid disease
Complication
Contraindication for INV / TX

Pain syndrome
Onset
Duration
Interval
Characteristic
Variation of symptom
Aggravating factors
Alleviating factors
Severity
Associated symptom
Constitutional symptom
Performance status
FC / NYHC / ECOG / PS
Staging

Past history
Underlying disease
Previous treatment and outcome
Side effect of treatment
Growth and development
Mental status and vaccine
Previous drug allergy
Classified type of hypersensitivity
 Previous operation
Brain : Seizure
Heart : Palliative shunt / Dz.
Intra-abd : Adhesion
Appendices : R/O appendicitis
Pituitary : Panhypopituitarism
Thyroid : HypoTH-PTH
Traveling and Tropical disease

History drug and substance use

Steroid
Duration for suppress axis
Effect and withdrawal effect
NSAIDs
Antibiotics
Alcohol : degree / addict-withdrawal
Smoking : pack-year
Substance : Amphetamine / Cocaine
Oral contraceptive pills
History unsafe sex / multiple partner
Intravenous drug use (IVDU)
Blood transfusion

Family history
Transmitted disease
Genetic disease : AD / AR / X-linked
ROS
Fatigue / Dyspnea / Chest pain
PND-Orthopnea / Claudication / Cyanosis
Palpitation / Syncope
Cough / Hemoptysis / Pleurisy
Dysphagia / Odynophagia
Abdominal pain / Dyspepsia / Diarrhea
Heartburn / Bowel habit change
Malena / Hematochezia / Hematemes
Jaundice / Pale stool / Pruritus
Hematuria / Dysuria / Oliguria / Polyuria
Flank pain / Air bubble / Pass stone
Headache / Seizure / Weakness
Numbness / Conscious change
Ataxia / Dementia / Movement
Autonomic dysfunction
Dizziness / Vertigo
Blurred vision / Double vision
Anemia / Bleeding / Mass-LN+ / Hburia
Edema
Nutritional status
Polyuria / Polydipsia / Polyphagia
Libido / Erectile dysfn : morning erection
Galactorrhea / Lactation
Hisutism : frequency for shave
Menstruation : menarche / menopause
Pregnancy / Abortion
Back pain / Athralgia / Arthritis
Skin lesion
Oral ulcer / Alopecia / Photosense
Physical Examination
General appearance
Dysmorphic features
Cyanosis
Cachexia
Vital signs
BP 4 extremities
PR rate / rhythm / volume
RR pattern
BT
HEENT
Pale / Jaundice / Injected
Subconjunctival hemorrhage
Salivary gland
Oral mucosa / Tongue
Thyroid and bruit
Neck mass / CLN / SCLN
Carotid bruit
Heart (CVS)
Peripheral pulse
Jugular venous wave form
Precordium
Heaving / Thrill
S1 / S2
Extra sound / Gallop
Murmur / Maneuver
Pericardial friction rub
Subclavian bruit
Lungs (Chest)
Thoracic cage Pectus E/C
Scoliosis
Gynecomastia
Superficial vein dilatation
 Spider nevi
Trachea
Lung expansion / VF-VR
Percussion
Breath sound
Rhonchi / Wheezing
Generalized / Localized
Crackle / Crepitation
Fine / Medium / Coarse
Abdomen
Distended / Scaphoid abdomen
Superficial vein dilatation
Direction by Harvey test
Sister-Joseph node
Bowel sound
Abdominal and hepatic bruit
Superficial and deep palpation
Liver / Spleen / GB
Mass
Size / Site / Shape / Surface
Surrounding tissue
Consistency / Movable
Intra-abd or Extra-abd
Intra / Retroperitoneum
Bowel mass / Mesentery
Bimanual palpation
Kidney
Per rectal Examination
Musculoskeleton
Back
Spine : C / T / LS
Joint : Peripheral / Axial
Extremities
Skin and skin appendage
Edema
Clubbing finger
Palmar erythema
Gangrene / Raynauld / Digital pitting scar
Sclerodactyly / Dilated capillary nailfold
Neurosigns