PNEMONICS

HPI (history of present illness)

Ask for: LIQORS 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)
S Similar complaints in the past

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.....)

A MNEMONIC FOR HEADACHE CASE

Mom: "Jennifer - u holding your head..wuts wrong ? "

Jennifer: Mm...It aches mom
"MM...IT ACHES" - that phrase gives us our mnemonic for the differential diagnoses for a headache..

M - Migraine
M - Meningitis

I - Increased Intracranial Pressure

T - Tension Headache + Temporal Arteritis

A - AV Malformations
C - Cluster Headache
H - Hypertension
E - Eye Disorders (Refractory Errors + Glaucoma)
S - Sinusitis + Sub-Arachnoid Hemorrhage + most Systemic illnesses

HEADACHE

H.- Headache type.

E.- Eye vision abnormalities.
A.- Anticipatory (events).
D.- During (events).
A.- After (events).
C.- Constant, Chronic, Causes
H.- High temperature (fever)
E.- Eye pain.
FORGETS HIM
F=FAINTING
0=ORTHOSTATIC HYPOTENSION
R=RUNNING URINE [INCONTINENCE]
G=GAIT
E=EYE[VISION]
T=TRAUMA, TINGLING
S=STRENGTH,SEIZURES

H=HEADACHE
I=INFECTION[SYPHILIS,MENINGITIS]
M=MOOD

and this one for the CNS Examination, for someone like me, who'ld forget parts of the examination
in all the tension...

CPR GCS
C=CRANIAL NERVES
P=POWER
R=REFLEXES
G=GAIT [with romberg's]
C=CEREBELLAR
S=SENSORY

MMM.....IT ACHES

M - Migraine
M - Meningitis / Encephalitis
M - Medications

I - Increased intracranial pressure (Brain tumour, abscess, etc) +Intracranial venous thrombosis
T - Tension Headache + Temporal Arteritis + Trigeminal neuralgia

A - AV Malformations + Artery Dissection (vertebral art)

C - Cluster Hdache + CNS vasculitis
H - Hypertension + Haemorrhage (intracranial)
E - Eye problems (refractory errors + glaucoma)
S - Sinusitis + Sub Arachnoid Hhage + most Systemic illnesses + Seizures (partial) + pSeudotumour
Cerebri

and also keep in mind to r/o secondary causes before considering the primary (i.e. Migraine, Tension
and Cluster headaches)

Phone Encounter !

Inside the Telephone Room: Wouldn't it be hilarious if someone actually knocks on the door for a
phone case ? Ha ha..hmmm...Jokes apart - after you enter, wait till you are ready, then pick up the
handset and press the Red Button/Yellow Button on the phone when you are ready ! However,
please follow the instructions given to you before the test - they may change. One useful hint - Smile
while you pick up - will show in your speech and also give you more confidence. And don't forget to
write your mnemonics on your paper before you start !

Personally, I feel a Telephone case is simpler as there is no clinical physical examination which gives
you a comfortable time to finish the case well within 15 minutes (I was done in 10 !)

Instructions for using the Telephone:

These instructions come from USMLE.org :

When you enter the room, sit at the desk in front of the telephone.

* Do not dial any numbers.

* Push the speaker button by the yellow dot on the phone to be connected to the patient
caregiver or patient.
* You will be permitted to make only one phone call.
* Do not touch any buttons on the phone until you are ready to end the call – touching any buttons
may disconnect you.
* You will not be allowed to call back after the call is disconnected.

Handling a Telephone Case:

Handle it like any other case, don't forget to ask the kid's name and refer to him/her by name.
At the end of your questions, explain possible diagnoses and mention that you need to examine the
kid and do some investigations. If the mom has no time / no car / no one else to get the kid - ask her
to call 911 !! And don't forget to keep the kid sipping on a rehydrating solution like Pedilyte or home-
made ORS (See Below)

Most people seem to be failing on the CS due to inadequate data collection. If this is of any help, I
would like to share a mnemonic I formulated to ensure u ask everything during a phone encounter
for a case of diarrhea in an infant ( The person on the other end would typically be the kid's mom )

"ON CALL IDIOT"

['On Call'since this is a phone encounter] - please dont think about "idiot" being offnesive - it is just a
mnemonic people !
O - Onset ?
N - Number of Times a Day?

C - Consistency ? / Color? / Content ? [Blood, Fat, Mucous ?] + Crying ? Cramps Suggestive ?

A - Associated Symptoms [Fever, Runny Nose, Rash, Cough, Ear Discharge, Vomitting, Rash ?]
L - Listless baby ? Lethargic, not Sleeping ?
L - Liquids not passing ? [i.e. not urinating ?]

I - Immunization up to date ?
D - Diet Change ? Dehydration signs ? Day Care Center ? Developmental Milestones
I - Infections in family ? Immunicompromised mom ? [HIV ?]
O - ORS counseling (Oral Rehydration Solution - see below)
T - Travel history recently ?

Write this mnemonic down on ur sheet while you sit front of the telephone, before u pick it up...and
u are ready to rock and roll !! practice the order of questioning at home on a phone while u practice
with ur study partner!

For a case of vomitting, I guess you can tweak the mnemonic a bit !

Practice this with a phone partner and encourage the person at the other end to ask you challenge
questions..

ORS Counseling : Enquire if the woman knows about Oral Rehydration Solution and whether she has
Pedialyte at home - if Yes, she can start having her baby sip on it. If she does not, you can suggest a
quick home-made solution like this:

1. Water - 4 Cups
2. Salt - 1 TeaSpoon
3. Sugar - 8 TeaSpoons

And yes ....you do have to write a PN even for a Phone Case - but leave the physical examination
section blank ...or perhaps a better idea would be to write "Will be performed when Damian arrives
at the hospital"

Rock-N-Roll

Q. Does everyone always get a Phone Case / Telephone Encounter ?

A. Not Always ! On the other hand, some may even get two phone cases...

Man: "No, you idiot!" the man shouts. "This is her husband!"

domestic abuse-- SCARS

S - Sex-ever forced by hubby?

C - Children-husband relationship
A - Attacked by a weapon by abuser?
R - Relationship details with abuser. Duration etc.
S - Suicide plans.
D/D in child with fever. When a child is sick, we give him anything to make him feel better, even
gum. So when he's sick, he gets a GUM PASS.

G astroenteritis
U RI/UTI
M eningitis, Measles, Mumps
P neumonia
A cute Otitis Media
S epsis
S carlet fever

BJM's CHILDREN
B=BIRTH HISTORY
J=JAUNDICE [NEONATAL]
M=MILESTONES

C=CRYING,CHECK UP
H=HEAD [MENINGITIS, SEIZURES]
I=IMMUNIZATION
L=LETHARGY
D=DAYCARE
R=RASH
E=EYE/EAR
N=NOSE, NUTRITION
THE "GET UP AND GO" TEST

This test is to used as a measure of balance in elderly patients. I would rather that this test were
called "Get up, go and Get back" Test ..you will see why.

How is the Test Done ?

Have the patient sit in a straight-backed chair and ask him/her to:

1. Get up from a chair to standing position

2. Walk forward feet in a straight line
3. Turn back around & walk back to the chair
4. Sit down again

Interpreting the test:

You can either score it by the timing (Less than 20 seconds for the whole procedure is normal , More
than 30 seconds indicates gait/balance problems) Or you can score it on a grading system like:

0 - patient does not use arm-rests to get up

1 - uses arm-rest in one attempt
3 - needs multiple attempts
4 - cant get up without assistance

all this Besides noting gait stability while walking

On the USMLE Step 2 CS, I would rather recommend either doing the easy timed method OR simply
noting what you observed during the test - like difficutly in getting up , unsteady gait and needed
assistance to sit back down..etc.

Test tandem gait by asking the patient to walk a straight line while touching the heel of one foot to
the toe of the other with each step. Patients with truncal ataxia caused by damage to the cerebellar
vermis or associated pathways will have particular difficulty with this task, since they tend to have a
wide-based, unsteady gait, and become more unsteady when attempting to keep their feet close
together.

THE "DIX-HALLPIKE" MANUEVER / TEST ?

Every now and then, on various USMLE forums you come across a message asking about the Dix-
Hallpike Test or maneuver ! Since the blog is dedicated to be a beacon of light for everyone thinking
of , planning to or taking the CS, here goes ;-) :

This funny-sounding Test is a confirmatory diagnostic test for "Benign Paroxysmal Positional
Vertigo", which accounts for probably about 1/5th cases of dizziness in the USA. So, this means, if
you get a case of vertigo on the CS, or complaints like "Doctor I get dizzy", "The world goes round
and round around me", etc. etc. .you should do this clinical test as a part of Physical Exam.

Beep : Dix-Hallpike test is also called the "Tilt Test" - you will soon see why ...

Yo Digitaldoc ! How do you do this test ?

Get the Standardized Patient (SP) to sit erect on his/her bed. Then, have the SP lie supine on the bed
quickly , with the head turned (tilted) 45 degrees to one side and extended about 20 degrees
backward. Once supine, the eyes are typically observed for about 30 seconds. If no nystagmus
occurs, the person is brought back to sitting stance, only to test again with the head now turned to
the opposite side.

On the exam , I don't expect anyone to get a positive test, simply because I don't imagine anyone
with the condition actually volunteering to get Nystagmus 12 times a day ! But lets note that this
test is considered "Positive" if the patient exhibits a burst of nystagmus when lying supine :-)

Handling a Lab-Result Explanation Case ?

This presents an amusing paradox - on most cases on the CS, we are worried about finishing on time,
whereas the main concern on this one is how to expand all you can talk to fit those 15 minutes ! This
somehow reminds me of my daytime sleep ;-) it seems to effortless expand and fill-up all the space it
gets ;-)

But tell you what, lets have a protocol to tackle any kind of Lab-Result Explanation cases. Here's one
for, say, a Trichomonas lab result:

1. Reveal the lab findings to the SP and explain the diagnosis in layman terms
2. Tell the SP it's nothing too serious and explain how trichomonas is contracted
3. Get History about Vaginal Discharge, then Sexual + Menstrual history
4. History pertaining to other STDs (rash, genital lesions, lymph-nodes, etc.)
4. Ask her if she has any new complaints and tell her you would like to repeat a general physical
exam
5. Ask her if she has any specific questions and if she knows how to avoid Trichomonas in future

6. Counseling should cover the following :

a. Explain that both the SP and her partner would treatment.

b. Tell her that if she will put on Metronidazole therapy - alcohol is to be avoided, since that will
cause nausea and vomitting (Disulfiram like reaction)
c. Abstinence from sexual intercourse until therapy is complete
d. Counsel on protection, risk of other STDs like HIV & risk of cervical cancer (need for PAP smears) .
e. Ask her if she has had a pregnancy test recently and when - if not done, ask her to consider having
that done. (and mention that on your PN as an Investigation)
f. If not pregnant, advise about birth-control methods.

I guess this particular case is more about SEP and CIS component !

On the PN - merely include general exam in the Physical Exam section - the rest of the PN will be like
any other case.

SORE THROAT WAS BAD !

S- wallowing food is painful ?

O- rigin, Duration, Progress
R- unny Nose
E - ar Problems ?

T- emp ? / Chills ?
H- eadache
R- espi. Sympt - Cough, SOB, Chest pain
O- ccupation ?
A- spiration + Abdominal Symp.- Nausea, Vommiting, Pain (esp in LUQ)
T- iredness(Fatigue), Touch with ill people (ill contacts - boyfriend, girl friend)

W- t. loss ?
A- ppetite Change / Alcohol ?
S- moking Sleep changes ? Sexual History

B - owel Habbit
A - nything else do you wanna tell me ???
D - rugs ( illegal IV drugs ?)

THROAT

T - hroat Culture
H - IV antibody and viral titer
R - apid streptococcal antigen
O - mOnospot test
A - nit EBV Antibody
T - routine Tests - CBC, Pripheral smear.
D/D of COUGH (a step 2 CS favorite, from what I hear). These are from First Aid mostly:

Pleural Cap
P neumonia (atypical/typical)
L ung cancer
E xacerbation of COPD (Bronchitis)
U RI
R eactive airway dz.
A bscess
L ymphoma
C HF
A sthma
P ostnasal drip

d/d of sore throat -sore HIPS

Hepatitis
HIV
Infectious mononucleosis
Pharyngitis
Secondary syphilis
Scarlet fever
Shoulder examination ?

Let us look at examination for a case of Shoulder Pain (People you gotta supplement this with your
standard notes). Assuming that you have already washed, wiped and warmed your hands...

1. Expose both the shoulders - and examine as if you are comparing both shoulders for swelling,
deformity. Especially look out for painted bruises - cause those suggest elderly abuse (besides a fall)
and implies you got to address that part while counselling.

2. Next, say this to ur SP = "Let us examine your shoulder gently to locate the origin of pain - is that
ok ? Let me know immediately if it hurts anytime"

3. Palpate affected shoulder for tenderness and look out for any sign of wincing on the SP's face.
Should there be any wincing/moaning, say "sorry that hurt" and never repeat at that site.

4. Ask the patient to perform shoulder motions to check for his/her range of motion - A more
effective way to do it is ask the SP to mimic your actions-then you move your shoulder the way you
want him to move - simpler than explaining each action and wasting time eh ?

5. The above can aslo be combined with you resisting his motion and checking out strength of
motion in addition!

6. And dont forget to feel for his pulses in the affected hand and verify they are felt normally.

A Quick Mnemonic for Shoulder pain D/Ds : (Think of a deformed shoulder)

'DEFORMS'

D - Dislocation
E - Elderly Abuse
F - Fracture
O - Osteoporosis / Osteomyelitis
R - Rotator Cuff Injury
M - Myositis
S - Sac Inflammation (Bursitis) + Sprain (as suggested by a reader in the comments below)

You will realized that the above mnemonic can be a general guide to any joint pain / swelling for that
matter !

Q. Does the Patient / SP Understand 'abduction', 'flexion' etc. of the shoulder - do we have to spend
time explaining all that to him/her ?

A. While asking the patient to perform ANY maneuver, remember that actions speak louder than
words - "Could you move your shoulder out like this " for abduction and then doing it yourself to
indicate how is better and faster. OR, while checking active Range of Motion (ROM) you could simply
say at the start, "Mr. Allen, I will now make various arm movements at my shoulder joint and I want
you to copy my actions, to help me understand how severe your problem is - Is that fine ? shall we
begin ? "
What's with 'SPORTS' & Knee Pain ?

The Knee is a pretty common injury in Sports....So lets use the word 'SPORT' to our advantage on the
Step2CS - a pretty good mnemonic for D/Ds for Knee Pain !!!!

S - Septic arthritis
P - Pseudo-gout + Patello-femoral pain syndrome + Psoriatic arthritis
O - Osteoarthritis
R - Rheumatoid arthritis, Reactive arthritis (Rieters syndrome)
T - Tophi (Gout), Trauma (Fall, Elderly Abuse and SPORTs!)
S - Sac Inflammation (Bursitis)

Again, as I mentioned before, each of these D/Ds should help you ask specific data-collection
questions:

For e.g. :
Septic Arthritis : - Ask about fever, and a warm joint feeling
Rheumatoid Arthritis - Ask about morning stiffness and other small joints...and so on.

HEEL PAIN...
"FOOT PAINS"
F - Fat Atrophy (age related) + Foreign Body
O - Osteomyelitis (not common)
O - Osteoporosis (not common)
T - Tarsal Tunnel Syndrome, Tendonitis (Achilles) + Tumor

P - Plantar fascitis (Most Common Cause), Periostitis (Calcaneum)

A - Apophysitis (Calcaneal), Arthitis (Reiters, Rheumatoid, Reactive)
I - Ischemia (Peripheral Vacular Disease)
N - Nerve Entrapment (Jogger's Foot)
S - Stress Fractures in Athletes and Spurs in Bone (Calcaneum)

Thus, the above mnemonic also tells us what questions to ask in the history taking, as per the Steps I
mentioned in the Art of History Taking. Applying the steps to this case ...

Step 1 - Patient tells you that his heel pains

Step 2 - you gotta drill him about the pain (LIQOR AAA)

Step 3 - Data-Collection for this case ( Ask about leg swelling, redness, fever, trauma history,
footwear preference, walking habits, long standing hours, morning stiffness, rashes, etc.)

Step 4 - Other Leg symptoms you can think of - like Numbness [Can u feel the heel ;-)], tingling,
weakness, et. )

Step 5 - Complications like associated Knee Pain due to change in gait - and then move on to PAM
HUGS FOSS..

Hope this is a good indicator of how to go about a case using the history-taking steps...

g/l

To read more about Heel Pain - Check this out !

A few pointer to Clinical Exam in Heel Pain :

As in Shoulder pain, expose Both Feet ! Then check out for swelling, redness, foreign body and
trauma signs in Inspection along with range of active movements. Next palpation: first check for
warmth (active inflammation) , superficial and deep palpation to pinpoint location. Then go ahead
and check peripheral pulses, sensations over both feet, passive joint movements , power, etc...

At each stage, dont forget to compare with the normal leg..

Finally ask the Pt. to walk to futher qualify the pain

Counseling for heel pain ?

1. Use soft-heeled or soft-padded footware
2. Refrain from long standing or long walking
3. See us again if presribed pain medications do not work
I have FFFOOTTT.

F : Fasciitis / Fascia rupture

F : Fat atrophy
F : Fracture x stress
O : Osteomyelitis
O : Osteoporosis fracture
T : Tendonitis / Bursitis
T : Tarsal tunnel syndrome
T : Tumor
CHEST PAIN : A MNEMONIC

A Mnemonic to remember what else you need to ask the SP besides specifics of the pain itself i.e.
LIQOR AAA.

This one is of good help for data-collection in a case of chest pain ...

"CHEST P"

C - Cough
H - Hemoptysis, HeartBurn
E - Emesis (Vomitting) & Diarrhea AND Edema over ankle
S - Shortness of Breath (SOB), Sweating, Syncope
T - Temperature (Fever), Tenderness on the chest ( chondritis - also ask for Trauma) + Tenderness of
Legs (suggestive of DVT that can predispose to Pulm. Embolism) +

P - Palpitations - "Did you feel your heart pounding or racing ?"

Now don't tell me u need a mnemonic to remember this mnemonic ;-) . An interesting trivia : The
word "mnemonics" is derived from Mnemosyne who, in Greek mythology, was the goddess of
memory! That's why it humors me tons when someone spells it as "pneumonic" ..he he

A Potent Mnemonic for Impotence

LIMP P3ENIS

When things don't stand ... it's time to use this outstanding mnemonic for data-collection in a case of
Erectile Dysfunction on the Step 2 CS ;-)

L-ibido changes
I-njury
M-edications (B-blockers)
P-ast / Present medical history (HTN, DM, Vascular= e.g.: Leriche Syndrome)
P-revious prostate Sx
P-erformance Anxiety
P-eyronie's Disease
E-rection at all? (Are you able to have an erection at all?)
N-octurnal erection ?
I-ncontinence
S-tress/Depression

DOC!! My Penis Doesn't Go UP

D epresion
O H (alcohol)
C laudication (Leriche Syndrome)

M edications
P resure (HBP)
D Mellitus
G onads (Hypogonadism)

U nknown etiology ED
P rostate surgery, Peyronies Dz
"STOP erection":
SSRI (fluoxtine)
Thioridazone
methyldOpa
Propranalol
curtosy medicalmnemonics.com

"A PV BLEED"

A - Abortion + Adenomyosis

P - PID + PCOD
V - Vaginal Injuries

B - Bleeding Diathesis
L - Leiomyomas (fibroids)
E - Ectopic Pregnancy
E - Endometriosis + Endocrine causes (Thyroid, Prolactin)
D - DUB ! (e.g. Anovulatory Cycle)

And another reader, Lisbeysi Calo, MD, was generous enough to share another great mnemonic,
which, I admit, is far better than my own ..
"VAGINAL BLEEDS"

V - Vaginal injuries
A - Adenomyosis + Abortion
G - Genital cancer
I - Infections: PID
N - Neoplasms [Maligant(endometrial CA) + benign ( fibromas)
A - Abruptio placentae

B - Beeding disorders
L - Leiomyomas
E - Ectopic pregnancy
E - Endocrinopathies, Endometriosis
D - DUB
S - Sores, Condylomas ( after trauma)

DISCHARGE

D.- Duration, Dyspareunia, Dysuria

I.- Itch (Vaginal Itching)
S.- Smell
C.- Color
H.- High Fever (Temperature)
A.- Abdominal Pain
R.- Recurrent episodes
G.- General health and symptoms.
E.- Endo-cervical swabs
"VAGINAL BLEEDS"
v- aginal injuries
A-Adenomyosis
G-Genital cancer
I-pID
N-Neoplasms, benign ( fibromas)
A-Abrupto placentae

B-Beeding disorders
L-Leiomyomas
E-Ectopic pregnancy
E-Endocrinopathies, Endometriosis
D-DUB
S-Sores, Condylomas ( after trauma)

For amennorrhea,i hv another mneumonic.Pregnant AMENORRHEA

P-Pregnancy
A-Absent ovulation[anovulation]
M-Menopause
E-Eating disorders[Anorexia nervosa]
N-Nursing mother[Lactational amenorrhea]
O-Ocp's
R-Raised prolactin[Hyperprolactinemia]
R-Raised adrenal hormones
H-Hypothyroidism,Haemorrhage[PPH]
E-?
A-All A's in ur post[Anxiety,Asherman's,etc]

Is the depressed SP depressing you ?

First things first - get your data collection sorted out (Step 3 of History Taking) - and we a have a
mnemonic for doing just that...

This pic should help you remember this mnemonic :

"FACE SLIPS"

F - Feelings of : Guilt, anger and worthlessness ?

A - Appetite (include diet , weight history) ?
C - Concentration levels ?
E - Energy levels in daily activities ?

S - Sleep disturbances ?
L - Libido Levels ? + Loneliness ?
I - Interests , hobbies ?
P - Psychomotor symptoms ? Pleasure Levels ?
S - Suicidal Ideation , any plans for suicide...?

So here we are armed with specific data-collection points for history.

But what if ...your SP seems bugged and does not seem to come out with why on earth he/she is sad
in the first place...so get smarter and try this :

" I know this is a very tough time in your life, but I assure you that we can deal with this much better
together. I really want to understand your problems and help you as a friend and a physician. You
said you were perfectly happy and healthy 3 months ago - could you try and tell me what exactly
happened 3 months ago that started this ?"

This should hit the nail right on the head ! coz, basically the SPs are trying to assess whether you can
connect with them at a emotional level or not ....logical, since they are testing your psychiatry skills...
Sticky Situation: What if SP goes "I want to Die Doctor!"

Hmmm...Again lets modify our formula a bit - "I know this is a very tough time in your life, but I also
know that running away from problems is not the answer. I really want to understand your problems
and help you get your strength back, because I know it is possible. We can deal with this together."

Some pep-talk like that and gently divert the SP back to your questioning :-)

In a way, if the patient puts on the "I wanna die" comment, it saves you the trouble of ascertaining
whether the patient has any suicide ideation ;-) - LOL - Am I mean or funny ? Anyways, here's a way
to ask the patient about suicide ideation, as I answered to a reader on the comments to this post.

I prefer the Two Question Series -

Question 1:"Have you ever felt like you don't want to ever get up from sleep"
OR "Have you ever had thoughts about ending your life"

Question 2: "In the recent weeks, did you make any plans or attempts on hurting yourself or killing
yourself"

Why two questions ? - coz' asking only the first question can mean nothing - "wanna kill myself" is
something I feel & say too when really frustrated with myself, but dont mean it, while asking only
the second question could take them off-guard and put the patient on the defensive.

"SIGE CAPS"
S-SLEEP
I-INTEREST
G-GUILT...ANGER
E-ENERGY LEVEL
C-CONCENTRATION
A-APPETITE
P-PSYCHOMOTOR SIGNS
S-SUICIDAL TENDENCIES

I AM SAD
I- Insight
A- Appearance
M- Mood, MMSE
S- Suicidal intent, Speech
A- Affect
D- Delusions and hallucinations.
Amenorrhea !!!
Well..calling it stupid coz the word really means nothing and it against my principles of having a
mnemonic that is self-suggestive. This one really means nothing - Do you even wanna know what it
is ? ..well..if you think it will help you on the CS -( coz it did help me ) so why not !!!!!

P6 A5

i.e. PPPPP AAAAA

P- regnancy
P - rolactinemia (Prolactinoma / Hypothyroidism)
P - COD
P - ills
P - erimenopausal woman (ask for Hot flashes / Dry Vagina)
P - Post-Partum Hemorrhage (As suggested by a kind reader)

A - Anorexia Nervosa
A - novulatory cycles
A - nxiety
A - sherman's syndome
A - Adrenal Hyperfunction !

"Fellow Has DARK Pee"

F-Foods like Beet, Blackberry

H- Hematuria
D - Dehydration + Drugs like Rifampin, Vit-B
A - Alkaptonuria
R - Rhabdomyolysis
K - Kernicterus ( well not really - but let the word remind u of Hyerbilirubinuria)
P - Paroxysmal Noct. Hemoglobinuria
HITTERS
H:Hematologic/coagulation disorders
I:Infections (cystitis)
T:Trauma
T:Tumors:RCC,bladder cancer,prostate
E:Exercise
R:Renal disorders (glomerulonephritis)
S:Stones
DRAIN gives us the D/Ds for Hematochezia :

D - Diverticulosis (Most Common Reason), Drugs -(warfarin)

R - Rectal Bleed [Piles, Fissures]
A - Angiodysplasis + Anal Sex
I - Inflammatory Bowel Disease [UC + Crohn's], Infectious Diarrhea, Ischemic Colitis + Injury (as
suggested by a cool reader)
N - Neoplasms

Insomnia counselling =ABCDEFGHJKLMN

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

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

hypertension. I hope it works for someone. Just misspell the word with two I´s.
High cholesterol(h/o)
Impotence(medicatios or PVD)
Peripheral vascular disease+PICKLE mnemonic
Exercise and Eat right.
Retinopathy+Respiratory symptoms(chest pain,sob,cough)
Taking meds. regularly
E.T.O.H.
Na Cl (sodium intake and diet)
Smoking, Swelling of legs, Sugar(blood glucose),Stress
Illicit drug intake
Others with HTN in family.
Nose bleeds and dizziness.

D/D = BACK PAIN Pneumonic = LIMCOTS

* Lumbar Spinal stenosis
* Intervertebral disc herniation
* Multiple Myeloma/ Mets (Prostate, Breast ,Lung)
* Cauda equina synd/ 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/Suport
Nasuea & Vomiting = A MOPING
* Anorexia
* Metabolic( DKA)/Meds
* Obstruction (pyloric /Intestinal)
* Pregnancy
* Inflammation( Pyelo/Cholecysto/Appi/Pancreas/PID)
* Neurological (BETA)= Bleed/Encephalitis/Tumor/Abscess
* Gastroenteritis

Here's a mnemonic for the ObGyn Hx : LMP RTV CS PAP

LMP !!
Menarchae
Period ( lasts .... days?)
Reglarity ( every .... wks?)
Tampoons/Pads # per day
Vaginal discharge, itching , dryness
Cramps (Dysmenorrhea)
Spotting ( intermenstrual / post coital )
Pregnency ( Hx & complications)
Abortion /miscarriage
PAP smear ( last time result ?, Hx of past abnormal result ? )

or the causes of Dyspareunia : DATIVE

Domestic abuse
Atrophic vaginiyis ( 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 )

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 tha baby or appearance, S- Sleep

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

Mental state examination: stages in order

"Assessed Mental State To Be Positively Clinically Unremarkable":
Appearance and behaviour [observe state, clothing...]
Mood [recent spirit]
Speech [rate, form, content]
Thinking [thoughts, perceptions]
Behavioural abnormalities
Perception abnormalities
Cognition [time, place, age...]
Understanding of condition [ideas, expectations, concerns]

Short statue causes RETARD HEIGHT:

Rickets
Endocrine (cretinism, hypopituitarism, Cushing's)
Turner syndrome
Achondroplasia
Respiratory(suppurative lung disease)
Down syndrome

Hereditary
Environmental (postirradiation, postinfectious)
IUGR
GI (malabsorption)
Heart (congenital heart disease)
Tilted backbone (scoliosis)

Pyrexia of Unknown Origin: history taking SIT ON FRAD:

Sexual history
Immunisation status
Travel history

Occupational history
Nutrition (consumption of dairy products, etc.)

Family history
Recreational habits
Animal contacts (including ticks and other vectors)
Drug history

Enuresis Counselling = SMILE SAM

Supportive (of the child)
Monitor Intake (@ Day)
Limit (@ Night)
Encourage Washroom( @ bedtime)
Sheets ( Rubber flannel sheets)
Alarms ( >5yrs )
Motivate (thru Rewards)

Conselling DM & HTN= MEDOWS

Medications (regularity)
Excercise ( for obese/sedentary life styles)
Diet Modification( Salt/Fatty foods)
Opthalmoscopic exams (annual routine)
Weight Management (/control)
Suger Check ups

Smoking Cessation counselling = 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 den just taper down a bit)
Excercise Programs ( eg Swimming )
Rewards ( reward urself, treat urself with a dinner 4m money saved off of quitting)

STD / HIV Counselling 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 (CONDOMS
OPPURTUNISTIC INFECTIONS/OBSERVATION (FOR LABS)

HOPI For A CC OF URINARY COMPLAINT (b)FINISHED PUBS(/b)

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

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

HOPI Particularts to ask -ADL = Activities of daily living = 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
Shopping
Housekeeping? unsure about that
Accounting
Food (do u do ur cooking ,etc)
Transportation (do u drive )

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

Obesity counseling ABCDEF

Avoid Advice (Eg.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)

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

D/D Confusion Pneumonic = DEMENTIA

* Diabetes /Dementia/ Drugs
* Epilepsy
* Migraine/Mult Infarct Dementia
* Ethanol (withdrawl / Toxicity)
* Neurological Deficit diseases= BETA (Bleeds,Encephalitis,Tumors,Abscess,Meningitis)
* TIA/ Trauma
* Insulin/ Infections
* Alzheimers/Abscess
Check list accordingly :- Numbness weakness/Headach ,Flashes, N/V /Jerky movements, LOC/ Insulin
use /PHx Trauma/FHx of Alzheimer + Risk factor screen (Cholestrol,HTN,DM etc). For Suspected
DEMENTIA =Instrumental inquiry = SHAFT Q's (Shop/Housekeep/Aaccount/Food prep/ Transport) , &
Daily activity inquiry =DEATH Q's (Dress/Eat/Ambulate/Toilet/Hygiene)

MINT
Hallucinations---MINT

M—Mental disease brings to mind schizophrenia, manic depressive psychosis, and paranoid states.

I—Intoxication and inflammation suggest alcoholism, cannabis, LSD, bromism, various other drugs,
and encephalitis, cerebral abscess (temporal lobe especially), and syphilis. The I should also suggest
Idiopathic disorders such as epilepsy, presenile dementia, and arteriosclerosis.

N—Neoplasm suggests brain tumors. A tumor of the occipital lobe may present with visual
hallucinations, whereas a tumor of the temporal lobe causes auditory hallucinations or uncinate fits
(i.e., bad smells). A tumor of the parietal lobe may present with tingling or other paresthesias of the
body.

T—Trauma should suggest concussions, epidural or subdural hematomas, and depressed skull
fractures