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HPI (history of present illness) Ask for: LIQOR AAA

L Location of the symptom (forehead, wrist

)

... I Intensity of the symptom (scale 1-10, 6/10) Q Quality of the symptom (burning, pulsating pain O Onset of the symptom + precipitating factors R Radiation of the symptom ( to left shoulder and arm) A Associated symptoms ( palpitations, shortness of breath) A Alleviating factors (sitting with my chest on my knees) A Aggravating factors (effort, smoking, large meals)

...

)

Past Medical Illnesses Hx: ABCDEFGHIJK Asthma Blood pressure CVA (Stroke) Diabetes Epilepsy Fever (Rheumatic) GI- PUD/GERD Heart attack (MI) Infection (TB) Jaundice & liver Dz Kidney disease

PMH (past medical history) Search for: PAM HUGS FOSS

P Previous presence of the symptom (same chief complaint)

A Allergies (drugs, foods, chemicals, dust

...

)

M Medicines (any drugs the patient used) H Hospitalization for any illness in the past

U Urinary changes ( esp if diabetic, elderly G Gastrointestinal complains (diet changes, bowel movements

...

)

...

)

S Sleep pattern (waking up/going to sleep F Family history (simmilar chief complaints/serious illness)

...

)

O OB/GYN history (LMP, abortions, para S Sexual habits (active/preferences/STD ... ) S Social life (job/house/smoking/alcohol

...

)

.....

)

WAD SAD TOES for social history. W-Weight A-Appetite D-Diet S-Smoke A-Alcohol D-Drugs T-Travel O-Occupation E-Excercise S-Stress

Differential diagnosis checklist

DIRECTION:

Differential Dx checklist (2 nd ) VITAMINES C:

Drugs

Vascular/CVS

Infection

Infectious

Rheumatologic

Trauma/Toxin

Endocrine

Autoimmune/Allergic

Cardiovascular

Metabolic/Medication

Trauma

Inflammatory/Idiopathic

Inflammatory

Neoplastic/Nutritional/Neuronal (nervous

Other

system)

Neoplasm

Endocrine

For Social History I use TIA SHOE:

pSychiatric/Substance Congenital Drugs

T obacco I llicit drigs A lcohol S exual H ouse life O ccupation E ating (diet)

Cough DDx: PLEURAL CAP Pneumonia Lung cancer Exacerbation of COPD Ear infection (Otitis media) URI Reflux disease (GERD) Asthma Lymphoma CHF Abscess Post nasal drip

LIQOR AAAAA last 2 A = associated q for d/d like weight lifting, travel history A= associated effect on sleep,diet & functioning

FOR PEDIATRIC HISTORY. F E V E R C U D Seizure + P A M I F B I G D E A L S.

FEVER- Fever, Ear pulling, Vomiting, Ear discharge,eyes discharge, Rash, CUD- Chest symptoms n Cold-runny nose,cough,chest painfast respirations,shortness of breath, Urination-any increased or decreased urination,no. of wet diapers,any odour,colour of urine, Diarrhea-frequency,onset,mucus in stool,blood in stool,any cryin during defecation , Seizure-any jerky movements,any leakage of urine or stool during fits,ant post ictal irritability,or loss of consciousness.

PAM - P-Past medical, past surgical hx, previous hospitalizations. A-Allergies, M-Medications, IF I-Ill contacts, F -family history, BIG -B- birth hx, I-Immunizations, G-Growth n development,ht,wt,milestones. D-DEALS- Day care, E-Eating habits, feeding of da baby, A-Appetite, L-Look of the baby or appearance, S- Sleep

in addition to pamshugsfoss (of course you would modify it according to your patient) ...

Paediatric Hx:

ROS: HEENT SCAM HEAD = Happy?/Cranky?

....

Eye

contact?/Interested in others?

....

Alert?/Headache?/Neck

stiff?

....

Drowsy?/Lethargic?

Or Hyperactive?

Eye swelling/redness/discharge Ear pulling/discharge Nose- runny nose, throat hacking, headache/sinusitis Throat (Mouth ulcer, Thrash, Large tongue, Teething, Sore throat, Swallowing difficulty) Skin (Rash, pustules, easy bruising, bleeding, yellow/blue discoloration) Chest (Congenital heart disease, Valvular heart disease, SOB, Rapid breathing, chest depression,

cough, sputum)

Abdomen

  • - Distension…Mass…Bruise….Umbilicus

  • - Bladder (Change (recent)…Frequency….Quantity….Quality – COCA-B)

  • - Bowel (Change (recent)…Frequency….Quantity….Quality – COCA-B) MSK (Joint swelling/pain…foot problem….Gait problem….Limping?)

I used BINDER for socioeconomic Hx- birth history, immunization history, nutrition, development,

Eating, Rash

also it's good to ask where the child is during the day - (i.e. day care, school,

...

)

... grandmother's house, etc

good luck

2 nd format:

BMJ CHILDREN

Birth history, Breathing difficulty Milestones Jaundice( neonatal) Crying Check-up Headache, Neck stiffness/Fever Immunization

Lethargy Day care Rash Eye, Ear, Environment Nose , Nutrition

Among these, Red flags and ROS are:

Breathing difficulty

Jaundice

Cry High pitched? Headache/Neck stiffness/Fever Lethargy/Floppy/Weak sucking

Day care Rash Ear/Eye symptoms Nose symptoms

Causes of FTT/Failure to Thrive:

ABCDEFGHI_M
ABCDEFGHI_M

(OSCE Notes Reading- Short

stature)

Infection (TB/Chronic) Metabolic error, Inborn

Causes of speech delay: HAMM CREP BM

Alone (Psychosocial deprivation)

1.

Hearing loss (2nd common)

Bone Dysplasia

2.

Autism

Chromosomal

3.

Mental retardation (Commonest)

Cystic Fibrosis

4.

Maturation delay (Familial)(3rd common)

Delayed Growth (Constitutional)

5.

Cerebral palsy

Endocrine (Lo GH, Lo Thyroid)

6.

Receptive aphasia

Familial

7.

Elective mutism

GI (Malabsorption, Vomiting/Diarrhoea, IBD,

8.

Psycho-social deprivation

Celiac)

9.

Bilingualism

Heart/Kidney disease (CHD-Congenital heart disease, CKD)

10. Mechanical

Premenopausal symptoms HAVOC H- hotflahes A-atropy of vagina V-vaginal dryness O- osteoporosis C- coronary artery diseases

I use- B HH MM SG

Bleeding Hot flashes Heart racing Mood swinging Memory problem Sleep disturbance Genital dryness, itchiness, pain etc.

Discharges I use:

OCD COCA-B/D

 
 

FOR all Discharges

....

including Diarrhoea,

OCD as usual

Cough

ACCOD

Color

A-amount

Odor

C -consistency

Consistency

C- color

Amount

O- odor

Blood

D- duration

Discharge any additional

Depression MI PASS ECG

Mood Interest Psychomotor agitation/retardation Appetite Sleep Suicide Energy Concentration Guilt

want to add few more to these .......

Depression, SIGEMCAPS S-sleep I-interest G-guilt, gun E-energy M-mood C-concentration A-appetite P-psychomotor S-suicide

M- mood ( already in list ) D - Delusion / hallucination M - memory A- attitude towards life ( positive negative frame of mind) T - thyroid dysfunctions

also need to ask ----- do u realize that u have problem ?????

and do u want help ??????

To rule out spousal abuse:

WAST (SHORT
WAST (SHORT

) Woman Abuse Screening Tool

  • 1. In general how would you describe your relationship?

    • a) Lot of tension

    • b) Some tension

    • c) No tension

  • 2. Do you and your partner work out arguments with….

    • a) Great difficulty

    • b) Some difficulty

    • c) No difficulty

  • Answer either 1.a or 2.a makes intimate partner violence likely. Use HITS next

    HITS
    HITS

    (Hurt, Insult, Threaten, Scream)

    How often does your partner….on as scale of 1 to 5 where 1 is minimal and 5 is maximal…

    • 1. Physically HURT you?

    • 2. INSULTS you?

    • 3. THREATEN you with harm?

    • 4. SCREAM or curse at you?

    Score of 10.5 is significant.

    For Spousal abuse, I have read the acronym

    SAFEGARDS
    SAFEGARDS

    somewhere. Can some complete it for me

    or give more add on S= Safety inquiry (Do you feel safe at home?) A= Alcohol abuse (does your hubby abuses alcohol?) F= Friends/Family who are aware (Does anyone of your friend/Family know of this?) Fractures (Abuse ever resulted in fractures? E= ED visits ever with serious fights? G=Guns at home (are there any weapons @ home? A= Any emergency plan (Do u have an emergency plan? Ever tried to leave/divorce? why not? R= Relationships with husband (how is your relationship with hubby? --> do you feel threatened

    when he is around? SEE WAST above + HITS)

    D=Depression/Drugs (have u lost weight appetite sleep ) does hubby dos drugs S=Suicidal ideation (ever felt like ending it all up? )

    Differential diagnosis of tiredness

    ABCDEFGHI (examples in brackets) Autoimmune disease (coeliac disease, multiple sclerosis) Blood disorders (anaemia) Cancer / Chronic
    ABCDEFGHI (examples in brackets)
    Autoimmune disease (coeliac disease,
    multiple sclerosis)
    Blood disorders (anaemia)
    Cancer / Chronic fatigue syndrome
    Depression and other depressive
    mental disorders
    Endocrine (diabetes mellitus,
    hypothyroid) / Eating disorders
    Fibromyalgia (muscle pain)
    Generalised infection (Infectious
    mononucleosis by EBV)
    Heart disease
    Immune deficiency (HIV/AIDS)

    Another mnemonic:

    FATIGUES
    FATIGUES

    Failures (CHF, COPD, Liver, Kidney) Fibromyalgia, Chronic Fatigue Syndrome Anemia

    ABUSE
    ABUSE

    Autoimmune disorders (RA etc.) Thyroid disease Trauma

    Infections (Chronic- TB, HIV, IM-EBV etc.) Iatrogenic (Drugs) Immunodeficiency (HIV) Growth (Malignancy- Solid organ, Leukemia) Gravid (Pregnant) Upset (Depression)

    Endocrine (DM, Addison’s disease)

    Eating disorder (AN?) Sleep disturbances

    Other conditions:

    Leukaemia / lymphoma

    Neurological disorders (Parkinson’s

    disease) Physical trauma

    Pregnancy

    Sleep deprivation

    Hepatic failure

    Uraemia

    Source:

    http://medmnemonics.wordpress.com/2011/

    03/16/differential-diagnosis-of-tiredness-2/

    (if patient was sent or asked by anyone to

    consult doc ) Fatigue I-infection M -malignancy P-PTSD A-abuse D-depression H-hypothyroidism

    ...IMP

    ADH

    Insomnia counselling =

    ABCDEFGHJKLMN

    Avoid Bedtime Concerns (worries) Drugs (nicotine/caffeine/Alcohol) Exercise/Excitement (TV Shows)

    Follow Good Habits for sleep. Jetlag Keep List (Diary) Monitor Naps (day time)

    Enuresis Counselling = Supportive (of the child) Monitor Intake (@ Day) Limit (@ Night)

    SMILE SAM
    SMILE SAM

    Encourage Washroom (@ bedtime) Sheets (Rubber flannel sheets) Alarms (>5 yrs) Motivate (through Rewards)

    Counselling DM & HTN=

    MEDOWSA Foot
    MEDOWSA Foot

    Medications (regularity) Exercise (for obese/sedentary life styles) Diet modification (Salt/Fatty foods)

    Ophthalmoscopic exams (annual routine) Weight Management (/control) Smoking cessation, Sugar Check-ups Alcohol reduction/stop Foot hygiene for DM

    Causes of 2HTN-

    ABCDE
    ABCDE

    Apnea (sleep), Aldosteronism (may be in endocrine) Bad kidneys, Bruits

    Coarctation, Cushing’s, Catecholamines, Calcemia

    Drugs

    Endocrine

    Smoking Cessation counselling =

    SPANCSTER
    SPANCSTER

    Stressor ( any stress in life/tension etc. ) Problems ( Heart /Lung/ CA) Advantages ( Improved breathing & Increased energy) Nicotine Patch ( I can offer you reading materials ) Counsellors ( I can refer u/ give # ) Support systems ( I can refer u /give #) Taper down ( if u cant do cold turkey then just taper down a bit) Exercise Programs ( e.g. Swimming ) Rewards ( reward yourself, treat yourself with a dinner 4m money saved off of quitting)

    STD / HIV Counselling

    STRIP BIMBO!
    STRIP BIMBO!

    SAFE SEXUAL PRACTICES TRANSMISSION ( to partners ) RISKS ( acquiring more STD's) IMMUNIZATIONS ( for Influenza/ Pneumococcal ) PREVENTION COUNSELLING ( REFER TO SW /CAN GIVE #) BEHAVIOUR COUNSELLING (REFER / CAN GIVE #) INTERVENTIONAL COUNSELLING ( REFER /CAN GIVE #) MEDICATIONS BARRIER METHODS (CONDOM) OPPURTUNISTIC INFECTIONS/OBSERVATION (FOR LABS)

    HOPI For A CC OF URINARY COMPLAINT

    FINISHED PUBS

    Frequency ( How frequent do u Ux) Incontinence( Do u hav trouble holding Ux) Nocturia ( do u hav 2 wak up @ Night) Incomplete emptying ( do u feel fullnes after Ux) Stream (How is ur stream?)

    Hematuria ( did u notic any blood) Hesitancy (do u hav 2 wait b4 starting Ux) Dysuria (Did u hav diff Ux) Pyuria ( did u pus in Ux) Urgency (do u hav 2 rush) Burning (dysuria) (does it burn) Strain (Do u hav to strain during Ux)

    My way

    - PD FUN SHID U FIDO AAA

    Pain/Dysuria during urine Frequency/Urgency/Nocturia/Polyuria Hesitancy/Stream poor/Dribbling at end/Incomplete evacuation (sense of) Urine- COCA-B Fluid intake Incontinence Discharge (OsCfD Q-COCAB ST UVWFE AAA) Oedema (Scrotum/Face/Ankle)

    AAA-

    Local- Redness, Itchiness, Blisters/rash/excoriation Same- Kidney stones/UTI before Adjacent- STI/PID/Prostatitis, any other abdominal disease RF- Foreign body/STI/↓immunity/Fecal incontinence C&C- Reiter’s syndrome (WET SURF), Anatomic abnormalities Constitutional & ROS

    CC of Memory Loss/Dementia/Alzheimers/MID/Creutfeldt jakob/Pseudotumor cerebrii etc

    HOPI Particularts to ask -ADL = Activities of

    daily living =

    DEATH
    DEATH

    Dressing Eating Ambulation (can u find ur way thru home) Toiletry (do u manage ur toiletry un assisted) Housing

    IADL - Instrumental acitivities of daily living =

    SHAFT
    SHAFT

    Shopping Housekeeping? unsure about that Accounting Food (do u do ur cooking ,etc)

    Fone (Phone) call making

    Transportation (do u drive )

    Shoulder pain case ( I read this one somewhere)

    DEFORMS
    DEFORMS

    Dislocation ( Ant/Post) Elderly Abuse Fracture ( Head/Shaft) Osteoporosis /Osteoarthritis Rotator Cuff Tear Multiple myeloma Subacromial Bursitis

    Syncope/ Loss of Consciousness/Spells

    Dizziness is DENTAL CAMPUS (Or,

    ENT
    ENT
    CAMPUS CAMPUS )
    CAMPUS
    CAMPUS )

    CAD Arrhythmia/Aortic Stenosis

    Anemia/Autonomic (DM)

    Migraine

    Meds (Anti-HTN drugs- α/β/CC blocker, vasodilator, PDE inhibitor sildenafil, tadalafil) Metabolic (Hypotension, Hypoglycemia)

    Psychiatric (Panic attack, Conversion- Hyperventilation) Unexplained Syncope (Vasovagal syncope, Carotid Sinus Hypersensitivity)

    Seizures/Strokes/TIA

    Diabetic comp (Orthostatic/Autonomic instability) Ear problems (Meniere's/ BPV)

    Neural tumors/Neuropathy Thyroid Anaemia Leave me CAMPUS is same as is for SPELLS/LOC/SYNCOPE

    D/D Confusion Mnemonic = DEMENTIA Diabetes /Dementia/ Drugs Epilepsy Migraine/Multi Infarct Dementia

    Ethanol (withdrawal/ Toxicity) Neurological Deficit diseases= BETA (Bleeds, Encephalitis, Tumors, Abscess, Meningitis) TIA/Trauma Insulin/Infections (Sepsis/UTI) Alzheimer’s/Abscess

    My mnemonic for confusion/dementia:

    DIMS
    DIMS

    Drugs (Opiates, Digoxin, Anticholinergic, BDZ, Steroid, NSAIDs, Phenytoin, Theophyllin) Infections (Lung, UTI, Meningitis, Sepsis)

    Metabolic

    • - Basic: Hypoxia, Anemia, Dehydration, Acidosis/Alkalosis, Electrolytes (Hyponatremia)

    • - Failures: CHF, Resp. failure, Liver/Renal etc.

    • - Endocrine: Hypo/Hyperglycemia, Thyroid, Cushing’s/Addison’s, B12

    Structural (Stroke, SOL, SAH/SDH/EDH, Seizure, Trauma/Surgery, Fat embolism etc.)

    Check list accordingly :- Numbness weakness/Headache, Flashes, N/V /Jerky movements, LOC/Insulin use /PHx Trauma/FHx of Alzheimer + Risk factor screen (Cholesterol, HTN, DM etc). For Suspected DEMENTIA =Instrumental inquiry = SHAFT Q's (Shop/Housekeep/Account/Food prep/Transport), & Daily activity inquiry =DEATH Q's (Dress/Eat/Ambulate/Toilet/Hygiene)

    Dementia Dx Questions: Judge MAAAT ADD MAP (Step by Step 2/e)

    My modification:

    JES + AAAA
    JES + AAAA

    Judgment (What will you do if you see a fire under that couch?)

    Executive function (Can you think straight? Find solution for complex problems/situations like before?)

    Sleep- Any sleep disturbance before? Aphasia No appropriate word Agnosia No recognition of familiar objects Apraxia Loss of purposeful movement Agenda Do you have to keep agenda for doing day to day works?

    Delirium Dx Questions:

    CATL + MOMSP
    CATL + MOMSP

    Confusion? Sudden onset? Attention loss? Thought process disorganized? Level of consciousness altered?

    Memory problem Orientations problem Misrepresentation (Hallucination/Illusion) Sleep cycle altered Psychomotor agitation/retardation

    Elderly causes of fall

    - ABCDEFGHIJ_L_N_P

    Arrhythmia Balance Coordination Drugs (Polypharmacy) Eye/Ear problem Foot problem

    Gait problem Hypotension (Low fluid intake/bleeding) Illness (Chronic) Joint problem Leg length discrepancy Nutrition

    Parkinson’s Dz

    Geriatric checklist: Geriatric Giants: 7 I’s

    Impairment of Vision & Hearing Instability/fall Incontinence & Constipation Iatrogenic (Polypharmacy) Immobility (DEATH/SHAFT) Intellect, Memory & Sleep Impaired homeostasis (Chronic disease)

    Causes of fall in elderly: I HATE FALLING TN12 Handbook p124 (My modification- see below)

    Inflammation of joints Hypotension Audio-visual deficit Tremor (PD) Equilibrium/Balance Foot problems Arrhythmias Leg length discrepancy Lack of coordination (Cerebellar) Illness Nutrition Gait problem

    Altered mental status/Coma causes:

    TIP S5
    TIP S5
    AEIOU
    AEIOU

    Alcohol/Acidosis Endocrine pathology/Electrolytes/Encephalopathy Infection Opiates Overdose/Drugs Uremia Toxin Trauma Insulin Psychosis Poisoning Porphyria S - Shock

    • - SAH/SDH (Subarachnoid/dural Hge)

    • - SOL

    • - Stroke

    • - Seizure

    Psychiatric Hx Checklist

    MISS SPEARS PAD MATCHED

    Mood, Idea ( abt de problem?), Stress, Support, Sleep ,Plan,Energy ,Aims, Routine , Suicide, Pills (drugs),Apetite ,Duration,Memory, Alone,Concentration, Hopes, Hallucinations , Delusions

    Psychiatry, my list:

    AL OCD MUST+I MAP COVP SADDD + Routine

    Ask, Look > OCD + AA + MUST
    Ask, Look > OCD + AA + MUST

    MAP CO

    (Mood, Anxiety, Psychosis, Cognitive, Organic- IMAD- Illness, Medication, Alcohol, Drugs)

    VP

    (Vitals HISS- Homicide/Suicide/Self-care/Impaired functioning, Past Psych Hx)

    SADDD

    (FHx of Psych disease Suicide, Alcohol, Drugs, Depression, Divorse)

    Routine

    SHIAMMS TFSS

    Mental Status Exam: ASEPTIC

    ABCD PTT JIC
    ABCD PTT JIC

    Appearance

    Behaviour

    C

    (Speech)

    D

    (mooD)

    Perception Thought Content Thought Process Judgment Insight Cognition (MMSE)

    Personality Disorders

    Borderline PD:

    IMPULSIVE (5/9)

    Impulsive behaviour in =/> of these areas- sex, spending, substance, driving, binge eating Mood reactivity and affective instability Paranoid ideation (or Dissociative symptoms)- things others will cause harm/malevolent intention Unstable self image (Identity disturbance) Labile (or Intense) relationships Suicidal behaviour Intense anger Vulnerable to abandonment Emptiness

    Panic Disorder:

    STUDENTS FEAR 3C (≥ 4/15)

    =

    Panic Attack, if with

    AWC
    AWC

    = Panic Disorder

    Sweating Tremor Unsteady (Dizzy) Depersonalization Derealization Excessive Heart Racing Nausea/Vomiting Tingling sensation/Numbness SOB Fear of > Dying; > Loosing control > Going Crazy Chest Pain Choking Chills or hot flashes

    AWC
    AWC

    Anticipatory Anxiety of this kind of attack for > 1 month Worry about consequences of the attack Changes made to lifestyle

    GAD Duration >6mo What are the things that you are fearing?

    Blank mind makes him Irritable, so he gets Keyed up and have Sleep disturbance. So he gets

    Muscle Tension and gets Easily Fatigued

    .

    BE SKIM
    BE SKIM

    (≥3/6 for 6 mon, 1/6 in children)

    Blank Mind Easily Fatigued Sleep Disturbance Keyed Up- Always on the edge? Irritable Muscular Tension

    Phobic Disorders

    Fear of anxiety for something specific (e.g. Height)

    HE Avoids
    HE Avoids

    Happens: What happens if you are in these places of situations? Excessive: Is you reaction reasonable or excessive? Avoid: Do you avoid these place/situations/things?

    OCD: WRITE

    Do you have certain thoughts or behaviours over and over again that you think you need to get rid of? What are they? Repetitive? Thoughts come back again and again? (OBSESSION) > Do you feel driven to do them? (COMPULSION) Intrusive & Inapropriate? Time: Are they time consuming? Excessive or not reasonable?

    Post Traumatic Stress Disorder (PTSD)

    • (for >1 month)

    Traumatic event (Precipitator) Re-experience the event? Avoid stimuli which remind of the event? Unable to function in interpersonal/social/work life? More than a Month duration? Arousal increased

    OBESITY risks

    OBESITY-DISC

    Osteoarthritis Breathing problems Excess Cholestrol Sleep Apnea Increased Incidence Ca's (Endometrial/Breast/Colon) Type 2 DM hYpertension Depression Incontinence Stress Cholelithiasis/Cycle disturbances/Cardiac

    Obesity counseling

    ABCDEF
    ABCDEF

    Avoid Advice (e.g. Sedentary/Steroids) Advantages Advice (Low Heart/Brain/Ca etc risk) Books (self-help reading material) Counseling/Consult/ Cholesterol checks Dietitian Exercise Fatty Food (cut backs)

    D/D = BACK PAIN

    Mnemonic =

    DR.LIMCOTS
    DR.LIMCOTS

    Degenerative- disk/joint/ligament, Ankylosing spondylitis, UC/CD (Ulcerative/Crohn’s)

    Referred (Aorta/Renal/Ureter/Pancreas)

    Lumber Spinal stenosis Intervertebral disc herniation Multiple Mye/Mets (Prostate, Breast ,Lung) Cauda Equina syndrome/Cancer Osteoporosis/Osteoarthritis/Osteomyelitis Trauma/TB/FracTure

    Strain of Muscle

    Original LIMCOTS

    Lumbar Spinal stenosis Intervertebral disc herniation Multiple Myeloma/ Mets (Prostate, Breast ,Lung) Cauda equina syndrome/ Cancer Osteoporosis/Osteoarthritis Trauma/ TB Strain (muscle)

    Check list= SIQQOR AAA & then ROS =Age/ Bone pains/ constipation=MM/Bowel, bladder/Relieving factors/ Phx of trauma/Surgical Hx(Prostate) /Chest pain, hemoptysis, Fever &chills/ With bone & joint problems =Functional impairment (SOS=Help)Q's i.e Sleep/Occupation/Support

    Back pain red flags-

    BACK PAIN
    BACK PAIN

    (TN2014)

    Bowel/bladder control lost Anesthesia saddle region Constitutional/malignancy- prostate/breast/lung/thyroid Khronic illness Paresthesia Age >50y IV drug user Neurologic deficit (sensory/motor)

    Headache DDx (TN2014 N38)

    ER VISITS
    ER VISITS

    Eye (Glaucoma/strain), Earache, Toothache, Throat pain, Sinusitis (= ALL LOCAL) Recurrent/chronic (Migraine, Tension, Cluster, TMJ, Cx OA) Vascular (Temporal arteritis, SAH, ICH) Infectious (Meningitis, Encephalitis) Systemic (Anemia, Anoxia, CO) ICP raised (HTN/Preeclampsia, HTN encephalopathy, SOL) Trauma (Concussion, SDH, EDH) Spouse abuse/pSychotic

    Nausea & Vomiting =

    A MOPING
    A MOPING

    Anorexia Medications Metabolic (DKA/CRF) Obstruction (pyloric /Intestinal) Pregnancy Inflammation( Pyelo/Cholecysto/Appi/Pancreas/PID) Neurological (BETA)= Bleed/Encephalitis & Ear problems/Tumor/Abscess Gastroenteritis

    Here's a mnemonic for the ObGyn Hx :

    LMP RTV CS PAP LMP !! Menarchae

     

    days?)

    Period ( lasts Regularity ( every

    wks?)

    OCP counselling

     

    Contraindications:

    Advantage:

    ABCDEF
    ABCDEF

    Pr

    .ABCD
    .ABCD

    .Smoker.Trigly.HTN.CVA/IHD.Migrain

    Anemia↓

    Bone protection (possibly)

    Pregnancy (known/suspected) Active Liver Disease Bleeding P/V, undiagnosed

    Acne↓ Benign breast Dz↓

    Cancer, Hx of in family

    Cancer↓ (Ovarian & Emdometrial)

    DVT, PHx of

    Cycle control

    Smoker + age>/=35

    Cyst↓

    Congenital Triglyceridemia, Hx of

    Dysmenorrhea↓

    HTN, Uncontrolled

    Effective & Reversible

    CVA/IHD, Hx of Migraine w/ focal neurological signs

    Fibroid↓

    Side effects:

    ABCDEF-VW
    ABCDEF-VW

    Amenorrhea Appetite↑ Breakthrough bleeding (Spotting) Breast Heaviness & Tenderness Cancer (Liver Adenoma) Rare DVT Common Edema & Fluid retention Vomiting & Nausea Weight

    Pregnancy Counselling:

    OCP counselling Contraindications: Advantage: ABCDEF Pr .ABCD .Smoker.Trigly.HTN.CVA/IHD.Migrain Anemia↓ Bone protection (possibly) Pregnancy (known/suspected) Active Liver
    NEW FILM RG
    NEW FILM RG

    Nutrition: Folate, Calcium, Vit. D, Iron Exercise: Under physician guidance Weight gain: How much to expect? (1lb/mo for 1 st half, 1lb/wk for 2 nd half) Too much + HA + Vision => VISIT ED

    Food: Caffeine limited, Avoid raw food (meat, fish {Tuna, Salmon, Sushi}, poultry (Listeria), egg, unpasteurized milk) Immunization: Avoid live vaccines (Polio, MMR, Varicella) Lifestyle: Abuse, Smoking, Alcohol, Cocaine, Avoid cats, Sick contact Medication: Consult MD before. C/I - ACE inhibitor, TC, Retinoids, Misoprostol. Anticonvulsant, Lithium, Warfarin

    Radiationavoid Genetic screening offer every pregnant

    Vaginal bleeding in Premenopausal women:

    ED LAB + P
    ED LAB + P

    Endocrine (Hypothalamic- Stress, Exercise, Wt. loss; Pituitary-↑prolactin; Hypo/hyperthyroid; Ovary PCOS-Estrogen; Liver/renal failure- (Estrogen)

    Drugs (OCP, HRT, Blood thinners/Anticoagulants, Phenothiazines/Neuroleptics (^Prolactin), Steroids, St. John’s wort, Ginseng) Local (Tumor, Trauma, TB, infecTion- 4Ts- Tumour- fibroid, polyp, adenomyosis, endometrial/Cx cancer, Ectropion etc.)

    Anovulatory (?)

    Bleeding Dz (Hematological- vWD, Platelet disorders- ITP, Clotting factors deficiency; Systemic- Marrow failure (blood cancer), Hypothyroidism, Liver failure, Renal failure) Pregnancy related (T1- Ectopic, Threatened abortion, Molar pregnancy; T2 <20wk- Ectopic, Miscarriage, Cervical incompetence, Abraptio; T2 >20wk+T3 Abruption, Placenta previa, Vasa previa, Uterine rupture)

    Amenorrhea causes:

    Pregnancy Causes AMENORRHEA

    Pregnancy

    Long Mnemonic for Amenorrhea:

    Chromosomal (Turner’s syndrome)

    Absent ovulation Menopause/Mullarian agenesis Exercise/Weight loss- excessive Nursing mother OCP Raised prolactin Raised adrenal hormones Hypothyroidism Hemorrhage (Sheehan’s syndrome) Eating disorder (Anorexia Nervosa) Anxiety Asherman etc.

    KNOW THE MPT ACT

    Kallman’s syndrome

    Nonfunctioning Adenoma

    Others:

    - Gonadal agenesis/dysgenesis

    - Sheehan’s syndrome

    Weight loss Testicular feminization

    Exercise amenorrhea Empty Cella syndrome Mullarian agenesis/anomaly

    Turner’s syndrome

    Pituitary Prolactin secreting adenoma Premature ovarian failure

    Short mnemonic for 2⁰ amenorrhea:

    SOAP
    SOAP

    Stress

    OCP

    Anorexia, Anovulation, Asherman’s syndrome

    Chemotherapy/Radiotherapy The resistant ovary syndrome

    Anorexia

    Pregnancy

    Amenorrhea symptoms: FLAG HIV WC

    Fatigue Libido Anorexia Nervosa Anxiety/Depression Galactorrhea Hair/Skin changes (Hypothyroid, PCOS-Hirsutism) Headaches Hot Flushes Insomnia Visual disturbance Voice change Wt. change/Appetite/Diet Cold Intolerance and Constipation

    Here's one for the causes of Dyspareunia :

    DATIVE! ( u have to be on a date to have sex ) Domestic abuse Atrophic vaginitis ( don't forget to ask about s/s of Menopause) Tumor ,Pelvic Infection ( lower : Vulvovaginitis - Cervicitis / Upper : PID ) Vaginismus Endometriosis ( don't forget to ask 'bout Cyclic pelvic pain )

    Skin review of systems which aReNT SIMMBEL R (rash) N (nail changes) T (temperature) S (sensation)

    I

    (itching)

    M

    (masses)

    M

    (moles)

    B (bleeding/bruises) E (edema)

    Gastrointestinal Hx-

    ABCDEFGHIJ+MNOP

    Appetite BOWEL HABITS, Any BLOOD? {OsCfD Q(COCA-B)ST AA A(PTLC- pain/tenesmus/lesion/control)}

    CONSTIPATION & Diarrhea

    Dysphagia

    EATING HABITS.

    Fullness/bloating

    Girth of the abdomen Heartburn

    Incontinence JAUNDICE Medications eg iron tabs causing constipation or antibiotics causing diarrhea

    Nausea/Vomiting

    Orthostatic assessment (DTHU- Dizzy? Thirsty? Heart racing? Urine less in amount?) Pain abdomen

    Trauma pt ask for A Allergy

    AMPLE
    AMPLE
     

    M

    Medication

    P past med Hx

    L

    Last meal

    E Events before accident

    Menstrual History FM DIAL F Frequency

     

    M

    Menarche

    D

    Duration

    I

    Intensity

    A Amount

    L

    LMP

    For back pain "red flags"

    TUNA FISH

    Trauma Unexplained weight loss Neurological signs Age > 50

    Fever Intravenous drug use Steroids for long time History of cancer

    Any MSK pain after asking all OCD PQRST ask Work Eye infection/redness Trauma to pertaining organ Stiffness in other joints Urethral discharge Rash/Reiter’s syndrome Fever

    WET SURF
    WET SURF

    (Myself)- Checklist for paraneoplastic syndrome/serotonergic symptoms

    4Fs -
    4Fs -

    Flushing- Any face flushing? Flutter- Ever felt heart racing? Faeces- Having any diarrhoea? Fear- Ever had a feeling of impending doom? >Yes> Ooooh! It must be hard!

    Here'sone to help you remeber the indications of Dialysis :

    • I have to pee

    • I HAF to PE

    Intoxication ( Ethylene glycol , Methanol) Hyperkalemia

    Acidosis

    Fluid overload

    Pericarditis

    Encephalopathy

    More mnemonics on: http://quizlet.com/13003048/step-2cs-mnemonics-flash-cards/