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 factorsR 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: ABCDEFGHIJKAsthmaBlood pressureCVA (Stroke)DiabetesEpilepsyFever (Rheumatic)GI- PUD/GERDHeart attack (MI)Infection (TB)Jaundice & liver DzKidney disease

PMH (past medical history)Search for: PAM HUGS FOSSP 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 pastU 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-WeightA-AppetiteD-DietS-SmokeA-AlcoholD-DrugsT-TravelO-OccupationE-ExcerciseS-Stress

Differential diagnosis checklist

DIRECTION:DrugsInfectionRheumatologicEndocrineCardiovascularTraumaInflammatoryOtherNeoplasm

Differential Dx checklist (2nd) VITAMINES C:Vascular/CVSInfectiousTrauma/ToxinAutoimmune/AllergicMetabolic/MedicationInflammatory/IdiopathicNeoplastic/Nutritional/Neuronal (nervous system)EndocrinepSychiatric/SubstanceCongenitalDrugs

For Social History I use TIA SHOE:T obaccoI llicit drigsA lcoholS exualH ouse lifeO ccupationE ating (diet)

LIQOR AAAAAlast 2 A = associated q for d/d like weight lifting, travel historyA= 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 tha baby or appearance, S- Sleep

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

Paediatric Hx: i used BINDER - 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

Causes of FTT/Failure to Thrive: ABCDEFGHI_M (OSCE Notes Reading- Short stature)Alone (Psychosocial deprivation)Bone DysplasiaChromosomalCystic FibrosisDelayed Growth (Constitutional)Endocrine (Lo GH, Lo Thyroid)FamilialGI (Malabsorption, Vomiting/Diarrhoea, IBD, Celiac)Heart/Kidney disease (CHD-Congenital heart disease, CKD)Infection (TB/Chronic)Metabolic error, Inborn

Causes of speech delay: HAMM CREP BM 1. Hearing loss (2nd common)2. Autism3. Mental retardation (Commonest)4. Maturation delay (Familial)(3rd common)5. Cerebral palsy6. Receptive aphasia 7. Elective mutism8. Psycho-social deprivation 9. Bilingualism10. Mechanical

Premenopausal symptomsHAVOCH- hotflahesA-atropy of vaginaV-vaginal drynessO- osteoporosisC- coronary artery diseases

I use- B HH MM SGBleedingHot flashesHeart racingMood swingingMemory problemSleep disturbanceGenital dryness, itchiness, pain etc.

FOR all Discharges.... including Diarrhoea, Cough ...............ACCODA-amountC -consistencyC- colorO- odorD- duration

Discharges I use: OCD COCA-B/DOCD as usualColorOdorConsistencyAmountBloodDischarge any additional

Depression, SIGEMCAPSS-sleepI-interestG-guilt, gunE-energyM-moodC-concentrationA-appetiteP-psychomotorS-suicide

Depression MI PASS ECGMoodInterestPsychomotor agitation/retardationAppetiteSleepSuicideEnergyConcentrationGuilt

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

M- mood ( already in list )D - Delusion / hallucinationM - memoryA- 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 ??????

( if patient was sent or asked by anyone to consult doc ) Fatigue...IMP ADHI-infectionM -malignancyP-PTSDA-abuseD-depressionH-hypothyroidism

For Spousal abuse, I have read the acronym 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/Fractures (Does anyone of your friend/Family know of this? Abuse ever resulted in fractures?E=Emergency plan (Do u have an emergency plan? Ever tried to leave/divorce? why not?G=Guns at home (are there any weapons @ home?A=any escape plan?R=Relationships with husband (how is your relationship with hubby? --> do you feel threatened when he is around?D=Depression/Drugs (have u lost weight appetite sleep ) does hubby dos drugsS=Suicidal ideation (ever felt like ending it all up? )

Differential diagnosis oftiredness

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)Other conditions: Leukaemia / lymphoma Neurological disorders (Parkinsons disease) Physical trauma Pregnancy Sleep deprivation Hepatic failure UraemiaSource: http://medmnemonics.wordpress.com/2011/03/16/differential-diagnosis-of-tiredness-2/

Insomnia counselling = ABCDEFGHJKLMNAvoidBedtimeConcerns (worries)Drugs (nicotine/caffeine/Alcohol)Exercise/Excitement (TV Shows)

FollowGoodHabits for sleep.JetlagKeepList (Diary)MonitorNaps (day time)

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

Counselling DM & HTN= MEDOWSAMedications (regularity)Exercise (for obese/sedentary life styles)Diet modification (Salt/Fatty foods)Ophthalmoscopic exams (annual routine)Weight Management (/control)Smoking cessation, Sugar Check-upsAlcohol reduction/stopCauses of 2 HTN- ABCDEApnea (sleep), AldosteronismBad kidneys, BruitsCoarctation, Cushings, Catecholamines, CalcemiaDrugsEndocrine

Smoking Cessation counselling = SPANCSTERStressor ( 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 CounsellingSTRIP BIMBO!SAFE SEXUAL PRACTICESTRANSMISSION ( 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 #)MEDICATIONSBARRIER METHODS (CONDOM)OPPURTUNISTIC INFECTIONS/OBSERVATION (FOR LABS)

HOPI For A CC OF URINARY COMPLAINTFINISHED PUBSFrequency ( 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 AAAPain/Dysuria during urineFrequency/Urgency/Nocturia/PolyuriaHesitancy/Stream poor/Dribbling at end/Incomplete evacuation (sense of)Urine- COCA-BFluid intakeIncontinenceDischarge (OsCfD Q-COCAB ST UVWFE AAA)Oedema (Scrotum/Face/Ankle)AAA- Local- Redness, Itchiness, Blisters/rash/excoriationSame- Kidney stones/UTI beforeAdjacent- STI/PID/Prostatitis, any other abdominal diseaseRF- Foreign body/STI/immunity/Fecal incontinenceC&C- Reiters syndrome (eye redness), Anatomic abnormalitiesConstitutional & ROS

CC of Memory Loss/Dementia/Alzheimers/MID/Creutfeldt jakob/Pseudotumor cerebrii etcHOPI Particularts to ask -ADL = Activities of daily living = DEATHDressingEatingAmbulation (can u find ur way thru home)Toiletry (do u manage ur toiletry un assisted)Housing

IADL - Instrumental acitivities of daily living =SHAFTShoppingHousekeeping? unsure about thatAccountingFood (do u do ur cooking ,etc)Transportation (do u drive )

Shoulder pain case ( I read this one somewhere)DEFORMSDislocation ( Ant/Post)Elderly AbuseFracture ( Head/Shaft)Osteoporosis /OsteoarthritisRotator Cuff TearMultiple myelomaSubacromial Bursitis

Syncope/ Loss of Consciousness/SpellsCAMPUSCADArrhythmia/Aortic Stenosis Anemia/Autonomic (DM)MigraineMeds (Anti-HTN drugs- //CC blocker, vasodilator, PDE inhibitor sildenafil, tadalafil)Metabolic (Hypotension, Hypoglycemia)Psychiatric (Panic attack, Conversion-Hyperventilation)Unexplained Syncope (Vasovagal syncope, Carotid Sinus Hypersensitivity)Seizures/Strokes/TIADizziness is DENTAL CAMPUS(Or, CAMPUS ENT)Diabetic comp (Orthostatic/Autonomic instability)Ear problems (Meniere's/ BPV)Neural tumors/NeuropathyThyroidAnaemiaLeave meCAMPUS is same as is for SPELLS/LOC/SYNCOPE

D/D ConfusionPneumonic = DEMENTIADiabetes /Dementia/ DrugsEpilepsyMigraine/Multi Infarct DementiaEthanol (withdrawal/ Toxicity)Neurological Deficit diseases= BETA (Bleeds, Encephalitis, Tumors, Abscess, Meningitis)TIA/TraumaInsulin/Infections(Sepsis/UTI)Alzheimers/Abscess

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)

Causes of fall in elderly: I HATE FALLING TN12 Handbook p124 (My modification- see below)Inflammation of jointsHypotensionAudio-visual deficitTremor (PD) Equilibrium/BalanceFoot problemsArrhythmiasLeg length discrepancyLack of coordination (Cerebellar)IllnessNutritionGait problemElderly causes of fall- ABC_EFGHIJ_L_N_PArrhythmiaBalanceCoordinationEye/Ear problemFoot problemGait problemHypotensionIllnessJoint problemLeg length discrepancyNutritionParkinsons Dz

Geriatric checklist: Geriatric Giants: 7 IsImpairment of Vision & HearingInstability/fallIncontinence & ConstipationIatrogenic (Polypharmacy)Immobility (DEATH/SHAFT)Intellect & MemoryImpaired homeostasis (Chronic disease)

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

Personality Disorders

Borderline PD: IMPULSIVE (=/>5/9)Impulsive behaviour in =/> of these areas- sex, spending, substance, driving, binge eatingMood reactivity and affective instabilityParanoid ideation (or Dissociative symptoms)- things others will cause harm/malevolent intentionUnstable self image (Identity disturbance)Labile (or Intense) relationshipsSuicidal behaviourIntense angerVulnerable to abandonmentEmptiness

Panic Disorder: STUDENTS FEAR 3C ( 4/15) = Panic Attack, if with AWC = Panic DisorderSweatingTremorUnsteady (Dizzy)DepersonalizationDerealizationExcessive Heart RacingNausea/VomitingTingling sensation/NumbnessSOBFear of > Dying; > Loosing control > Going CrazyChest PainChokingChills or hot flashesAWCAnticipatory Anxiety of this kind of attack for > 1 monthWorry about consequences of the attackChanges made to lifestyle

GADDuration >6moWhat are the things that you are fearing?Blank mind makes him Irritable, so he gets Keyed up and Sleep disturbance. So he gets Muscle Tension and gets Easily Fatigued.BE SKIM (3/6 for 6 mon, 1/6 in children)Blank MindEasily FatiguedSleep DisturbanceKeyed Up- Always on the edge?IrritableMuscular Tension

Phobic DisordersFear of anxiety for something specific (e.g. Height)HE AvoidsHappens: 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)TRAUMA (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

OBESITYrisksOBESITY-DISCOsteoarthritisBreathing problemsExcess CholestrolSleep ApneaIncreased Incidence Ca's (Endometrial/Breast/Colon)Type 2 DMhYpertensionDepressionIncontinenceStressCholelithiasis/Cycle disturbances/Cardiac

Obesity counselingABCDEF

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

D/D = BACK PAIN

Mnemonic = DR.LIMCOTS

Degenerative- disk/joint/ligament, Ankylosing spondylitisReferred (Aorta/Renal/Ureter/Pancreas)Lumber Spinal stenosisIntervertebral disc herniationMultiple Mye/Mets (Prostate, Breast ,Lung)Cauda Equina syndrome/CancerOsteoporosis/Osteoarthritis/OsteomyelitisTrauma/TBStrain of Muscle

Original LIMCOTSLumbar Spinal stenosisIntervertebral disc herniationMultiple Myeloma/ Mets (Prostate, Breast ,Lung)Cauda equina syndrome/ CancerOsteoporosis/OsteoarthritisTrauma/ TBStrain (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 (TN2014)Bowel/bladder control lostAnesthesia saddle regionConstitutional/malignancy- prostate/breast/lung/thyroid Khronic illnessParesthesiaAge >50yIV drug userNeurologic deficit (sensory/motor)

Headache DDx (TN2014 N38)ER VISITSEye (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 (HTN/Preeclamsia, Anemia, Anoxia, CO)ICP raised (HTN encephalopathy, SOL)Trauma (Concussion, SDH, EDH)Spouse abuse/pSychotic

Nausea & Vomiting = A MOPINGAnorexiaMedicationsMetabolic (DKA/CRF)Obstruction (pyloric /Intestinal)PregnancyInflammation( Pyelo/Cholecysto/Appi/Pancreas/PID)Neurological (BETA)= Bleed/Encephalitis & Ear problems/Tumor/AbscessGastroenteritis

Here's a mnemonic for the ObGyn Hx :LMP RTV CS PAPLMP !!MenarchaePeriod ( lasts .... days?)Regularity ( every .... wks?)Tampoons/Pads # per dayVaginal discharge, itching , drynessCramps (Dysmenorrhea)Spotting ( intermenstrual / post coital )Pregnency ( Hx & complications)Abortion /miscarriagePAP smear ( last time result ?, Hx of past abnormal result ? )

OCP counselling

Contraindications: Pr.ABCD.Smoker.Trigly.HTN.CVA/IHD.MigrainPregnancy (known/suspected)Active Liver DiseaseBleeding P/V, undiagnosedCancer, Hx of in familyDVT, PHx ofSmoker + age>/=35Congenital Triglyceridemia, Hx ofHTN, UncontrolledCVA/IHD, Hx ofMigraine w/ focal neurological signsAdvantage: ABCDEFAnemia AcneBenign breast DzBone protection (possibly)Cancer (Ovarian & Emdometrial)Cycle controlCystDysmenorrheaEffective & ReversibleFibroid

Side effects: ABCDEF-VWAmenorrheaAppetiteBreakthrough bleeding (Spotting)Breast Heaviness & TendernessCancer (Liver Adenoma) Rare DVT CommonEdema &Fluid retentionVomiting & NauseaWeight

Pregnancy Counselling: NEW FILM RGNutrition: Folate, Calcium, Vit. D, IronExercise: Under physician guidanceWeight gain: How much to expect? Too much + HA + Vision => VISIT EDFood: Caffeine limited, Avoid raw food (meat, fish, poultry, egg, unpasteurized milk)Immunization: Avoid live vaccines (Polio, MMR, Varicella)Lifestyle: Abuse, Smoking, Alcohol, Cocaine, Avoid cats, Sick contactMedication: Consult MD before. C/I - ACE inhibitor, TC, Retinoids, Misoprostol. Anticonvulsant, Lithium, WarfarinRadiationavoidGenetic screening offer every pregnant

Vaginal bleeding in Premenopausal women: ED LAB + PEndocrine (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. Johns 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+T3 Abruption, Placenta previa, Vasa previa, Uterine rupture)

Here's one for the causes of Dyspareunia :DATIVE! ( u have to be on a date to have sex )Domestic abuseAtrophic vaginitis ( don't forget to ask about s/s of Menopause)Tumor ,PelvicInfection ( lower : Vulvovaginitis - Cervicitis / Upper : PID )VaginismusEndometriosis ( don't forget to ask 'bout Cyclic pelvic pain )

Skin review of systems which aReNT SIMMBELR (rash)N (nail changes)T (temperature)S (sensation)I (itching)M (masses)M (moles)B (bleeding/bruises)E (edema)L (lesions)

Gastrointestinal Hx- ABCDEFGHIJ+MNOPAppetiteBOWEL HABITS {OsCfD Q(COCA-B)ST AA A(PTLC- pain/tenesmus/lesion/control)}CONSTIPATIONDysphagia, DiarrheaEATING HABITS.Fullness/bloatingGirth of the abdomenHAEM IN STOOLHeartburnIncontinenceJAUNDICEMedications eg iron tabs causing constipation or antibiotics causing diarrheaNausea/VomitingOrthostatic assessment (DTHU- Dizzy? Thirsty? Heart racing? Urine less in amount?)Pain abdomen

Trauma pt ask for AMPLE

A AllergyM MedicationP past med HxL Last mealE Events before accident

Menstrual History FM DIALF FrequencyM MenarcheD DurationI IntensityA AmountL LMP

For back pain "red flags"TUNA FISHTraumaUnexplained weight lossNeurological signsAge > 50

FeverIntravenous drug useSteroids for long timeHistory of cancer

Foot pain after asking all liqoraaa ask WET SURFWorkEye infection rednessTrauma to footStiffness in other jointsUrethral dischargeRash/Reiters syndromeFever(Myself)- Checklist for paraneoplastic syndrome/serotonergic symptoms4Fs- 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!