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History
Mnemonics

Physicals

17 yo M c/o
Chest Pain

SIQORAAA
OCCPDF
CHESTP

Extremities
Neck JVD
Heart
Chest

18 yo M c/o
LOC

MMSE
Heart
Neuro

70 yoF c/o
incontinence

OCCPDF
Describe what
happened, assoc. with
any event? LOC before,
during or after? Heart:
Palp, light-headedness,
shaking? How long?
Bite Tongue? Bladder?
Numbness? Weakness?
Gait? Speech?
Headache? Vision?
Last Meal? Drugs?
OCCPDF AA
SAUSAGE CP
Dysuria, Polyuria,
Nocturia, Haematuria,
Urgency, Hesitancy,
Dribbling, Stream, Hx
of Stones, Fever,
Loin/Back Pain, if Pain
SIQORAAA, Ask about
previous deliveries,

Abdomen
(CVAT)

Notes/
Challenges

Counsel

DD

Workup

Wrestler, Consent
Inc. Breathing and
Lifting weights.
Ask about Fatigue
and Trauma
Wrestler, Uses
Ecstasy, skipped a
meal

Pain Meds,
- Chostocondritis
Rest at least until - Muscle Sprain
results appear
- Fracture Rib

CBC w/diff
CXR
CT Scan

Ecstasy, Diet

- HOCM
- Hypoglycemia
- Drug Induced
Hypotension

Orthostatic Vitals
CBC, Lytes
CT Head
MRI Brain
EEG
ECG
Holter
CXR
Echo
S Glucose
Urine Toxicology

Has been suffering


from incontinence
for 30 years,
problem worsened
6 mo ago, Patient
cries, tap shoulder,
affirmation, give a
moment of silence,
offer a tissue. Ask
about impact on

Keigls Exercise,
No water, No
alcohol and no
caffeine intake
before sleep,
meds, stress, DM

- Urge Incontinence
(Sometimes Stress)
- UTI
- Pyelonephritis
- DM induced
Polyurea

CBC w/ diff, ESR,


CRP, BUN, Creat,
Microalbumin,
Urinalysis, Urine
C&S, Urodynamic
Testing, IVP,
Cystoerethroscopy, s
Glucose, HBA1C

48 yoF c/o
not feeling
like herself
lately

70 yo F c/o
Abdominal
Pain

Depression FACE
SLIPS
Ask about absorbent
pads
OCCPDF
FACE SLIPS
THOMAS (ThyroidHousehold- OccupationMenopause- AnxietyCaffeine)
Assoc. w/specific event?
Heat/Cold?
Skin/Hair/Voice?
Flushes? Amenorrhea?
Vaginal Dryness?
Osteoporosis? Palp?
Chest Pain? SOB?
Sleep? Caffeine Intake?
Stress at work?
Headache? Numbness?
Tingling? Weakness?
Fatigue? Bowel?
OCCPDF
SIQRAAA
Nausea, Vomiting,
Diarrhea, Constipation,
Stool consistency and
color, Haematochazia,
Haematemesis, Relation

life. DM, Previous


UTI
Beware: Long case
Thyroid
Neuro
MMSE
Abdomen

Has tremors,
Irregular menses,
Hot Flushes

Stress
Counseling,
Moderation of
Caffeine (if any),
Menopause

- Menopause
- Perimenopause
- Generalized
Anxiety
- Hypothyroid
- Adjustment
Disorder

CBC w/diff, Lytes,


MSE, Vaginal
Examination, DEXA
Scan, TSH, fT3, fT4,
sFSH, sLH

Abdomen
Eyes
Extremities
(tremor),
Murphy

Beware: HPI
Epigastric while
physical gives
RUQ, radiation.
Challenge: Afraid
of Surgery, No
Support.

Counsel about
Surgery: Its
now much
easier. Shorter
post op period.
Social worker
can provide

- Choledocolithiasis
- Cholecystitis
- PUD
- Gastritis

Rectal Exam, Vaginal


Exam, CBC w/diff.,
Lytes, Bilirubin, AST,
ALT, GGT, ALP,
Amylase, Lipase, U/S,
Endoscopy, H. Pylori,
CT

40 yoF c/o
SOB

70 yoM c/o
Heel Pain

to meals and menses,


Heartburn, Difficulty
Swallowing
OCCPDF
CHEST P (if any)
Wheeze, orthopenia, LL
edema, and fatigue.

OCCPDF
SIQRAAA
Walking? Time of Day?
Trauma? Other Joints?
Numbness? Fever?
Rheumatological
Disease: Rash,
Photosensitivity, Oral
Ulcers, Hair Loss, Tick
Bites? Swollen? Pain on
movement? Tender on
touch? DM

support. Counsel
about NSAIDs if
any
Eyes, Mouth
Extremeties
Neck
Heart
Chest

Challenging case:
Patient has a long
typed page of comorbidities and
polypharmacy
(copy it)

Full Joint
Exam
(IPROMMRS
P), Other joint
Palpation

Hx of Walking on
glass, Can you see
anything in my
leg? Pt has Htn.
Variation of the
Case: Ankle Pain,
h/o ankle twisting

Foot Care, Htn,


DM?

- Asthma
- Bronchitis (COPD)
- Cardiac (MI, Ang,
CHF)
- Pleural Effusion
effusion
- Pneumonia
- Pulmonary
Embolism
- Panic Attack
- Pneumothorax
- CO Poisoning
- Haemorrhage
- Foreign
- Foreign Body
- Stress Fracture
- Foot Sprain
- Plantar Faciitis
- Retrocalcaneal
bursitis
- Calcaneal Spur

- CBC w/diff, ABGs,


ECG, Echo, CXR, CT
Scan, Pulse Oxymetry,
Pulmonary Function
Tests, Bronchoscopy

CBC w/diff, ESR,


CRP, X-Ray, MRI,
DEXA Scan

50 yoM c/o
Congestion

32 yoF c/o
Fatigue

10

44 yo F c/o
Irregular
menses

11

35 yo F c/o

OCCPDF
Pain? SIQRAAA
Runny Nose? Nasal
Discharge? Fever? Ill
Contacts? Headache?
Wheeze? CHEST P?
Sputum (w/analysis)?
Orthopnea
F heart failure
A anemia
(headache,blur,palp,diz,
pass out)
T thyroid, TB, Tumor
I infection with HIV
GI malabsorption
U uremia
E endocrine: DM
D depression
S sleep disorders
S stress and caffeine
Relationship with Baby?
Prenatal, natal,
Postpartum?
Thyroid Questions,
Menopause (HAVOC),
Anemia Questions,
Depression Questions?
Breast Discharge?
OCCPDF

HEENT
Chest

Pt has tenderness
over R Maxillary
Sinus. +ve Sick
contacts. Pt gets
angry when you
counsel about
smoking

Thyroid
MMSE
Heart
Extremeties

Thyroid
Heart
Extremities

Thyroid

Smoking

- Chronic Sinusitis
- COPD
- URI

CBC w/Diff, XR CT
Paranasal Sinuses,
ABGs, CXR

Pt has amenorrhea Counsel on


for 13 months
Contraception
(Pregnancy + 4
and alcohol
Months Post
Partum), thinning
in her hair, no
breast milk, ETOH
+ve, Rhythm
Contraception

- Hypothyroidism
- Sheehans
Syndrome
- Pregnancy
- Anemia
Variation of the Case:
- Postpartum
Depression
- Caregivers Fatigue
- Hypothyroidism

CBC w/diff, Lytes,


TSH, fT3, fT4, B
HCG, Breast Exam,
Genital Exam, Brain
MRI (exclude
pregnancy first)

Patient will ask


about Premature
Ovarian Failure
and HRT?

HRT

- Hypothyroidism
- Perimenopause
- Anemia

CBC w/diff, TSH,


fT3, fT4, Lytes, Fe
Studies, sFSH, sLH, s
Prolactin, Brain MRI

Stress

Panic Attack

CBC w/diff,

Nervousness

12

Phone
encounter,
Grandfather
of a baby
w/diarrhea

SHAMISMA
THOMAS
WASTTED
What are you nervous
about? Headache?
Vision? Thyroid?
Tremors? Palpitation?
Chest Pain? Stomach
Pain? Bowel
Movements? Urination?
Fatigue? Sweating?
Sleep? Stress? Sugar?
Caffeine? Exertion?
Menopause (according
to age)? Anxiety?
Depression? Psych?
Hypertension?
FEVER CUTSS
FAMILI BEADS GLP
(Fever, ENT, Vomiting,
Eyes, Rash, Cough &
SOB, Urine, Travelers
Diarrhea, Sleep,
Shaking, Family Hx,
Allergy, Meds, Ill
Contacts, Look,
Immunization, Birth,
Eating, Appetite,
Daycare, Surgeries,

Neuro
Extremies
Heart
MMSE

N/A

Consent

Counseling

Anxiety
Pheochromocytoma
Arrhythmia
MVP
Caffeine/ Stress
Hyperthyroid
Hypoglycemia

TSH, fT3, fT4, MSE,


ECG, Echo, EEG

Bring the Child,


Means of
Transportation,
Dehydration,
ORS

- Gastroenteritis
- Rota Virus
- Bacterial Diarrhea
- Food Poisoning

Physical Exam, Stool


culture ova and
parasitology, stool pH,
Rota Virus
immunoassay, Lytes,
CBC with diff

13

62 yo M c/o
Abdominal
pain

14

16 yo F c/o
fatigue

15

35 yo F
constipation
Phone
Encounter

Growth, Last Checkup,


PMH) + Dehydration
See case No. 5

What do you mean by


fatigue? What do you
think is causing you
this?
FATIGUEDSS
FACE SLIPS
Neuro?
OCCPDF
DDDTTT
ABCCO
Associated w/special
event, Abdominal Pain,
Pain during defecation,
Amount and Caliber of
Stool passed, Fever,
Stool consistency,
Number of Motions per
day or week,
Haematochazia,
Tenesmus, Travel,

Eyes
Extremities
Abdomen

N/A

Pt works as a
coach, Nice man.
History of DM
Intake of NSAIDs
for Joint Pain,
Epigastric pain
related to meals

Post surgery
Vicodin

NSAIDs and
MEDEM
Monitor
Education
Diet
Exercise
Medication

Bring the
Patient, Meds

- GERD
- Gastroparesis
- Gastritis
- PUD
- MI (DM masks
Chest Pain, comes
w/atypical pain)
- Hypothyroidism
- Depression
- Anemia
- Pregnancy

CBC w/diff, pH
monitoring, s Glucose,
HBA1C, Manometric
Studies, Gastroscopy,
H. Pylori tests, Lytes,
LFTs

- Paralytic illeus
- Drug induced
- Diverticulosis
- Low fiber diet
- Gallstone induced
Ileus

Complete Physical
Exam, Rectal Exam,
Stool for Occult
Blood, CBC w/diff,
Lytes, s Glucose,
Barium Enema, CT
Abdomen,
Colonoscopy

See Before

16

70 yo M c/o
Confusion.
Phone
Encounter,
Daughter
calls

17

40 yo F c/o
Blood in
Stools

Nausea, Vomiting,
Drugs, Diet, Appetite,
Weight, Thyroid,
Alternation with
Diarrhea (if suspecting
IBS)
OCCPDF
Tell me more about this!
What do you mean by
confusion?
Neuro Questions:
Fever? Headache?
Weakness? Numbness
or Tingling? Seizures?
Tongue Biting? Tonic
Clonic Movement:
Describe the shaking?
Head Trauma? Passed
out? Nausea/Vomiting?
Speech? Gait?
Association with
Position? DM? Htn?
Heart and Chest? Diet
OCCPDF
BUTT
Pain during defecation?
Abdominal Pain
SIQRAAA
Description,

N/A

Post R hip
replacement,
clotting, Blood
Thinners, Rehab,
Home for 3 days,
Confused.

Get him to the


Hospital ASAP.
NPO?
Discontinue
Drugs?

- Drug induced IC
Bleeding
- Metabolic
encephalopathy
(Electrolyte
Imbalance)
- Hypoglycemia

Physical Exam and


MSE, CBC w/diff, PT,
PTT, INR, Lytes
(Complete BMP), s
Glucose, CT Head,
MRI Brain

Eyes
Extremities
Abdomen

Pt is having anal
sex, has a Hx of
Haemorrhoids, +/Constipation, +/LLQ Pain

Fiber Rich Diet,


Pain, Anal Sex

- Anal Fissure
- Angiodysplasia
- Recurrent
Haemorrhoids
- Diverticulosis/
Diverticulitis

Rectal Exam,
Anoscopy,
Colonoscopy, Occult
Blood in Stools,
Leukocytes in stools,
CBC w/diff, Flexible

18

40 yo F c/o
Nervousness

19

60 yo M c/o
Cough

20

60 yo M c/o
Fatigue

21

30 yo M c/o

Constipation/Diarrhea?
Diet? Joint Pain? Oral
Ulcers?
OCCPDF
Palpitations? TACES
SHAMISMA
FACE SLIPS
Amenorrhea? HAVOC

Stress
Counseling

- Colon Cancer
- Low Fiber diet
- Ulcerative Colitis
- Adjustment
Disorder
- Anxiety Disorder
- Social Phobia
- Stress induced
Caffeine Intake
- Hyperthyroidism
Remember:
PLEURAL CAP
- CHF
- Angina
- Exercise induced
Asthma
- COPD

proctosigmoidoscopy,
iron studies, CT
Abdomen, ANCA
MSE, CBC w/diff,
TSH, fT3, fT4, FSH,
LH

CBC w/diff, Spiral CT


Chest, Tumor Markers
(CEA), Sputum
Analysis, TB PCR,
PPD, Bronchoscopy,
ECG, Echo, TSH, fT3,
fT4
CBC w/diff, ESR,

MMSE
Thyroid
Neuro
Heart

Pt recently moved,
new job, Electrical
Engineer

OCCPDF
ABCCCO
CHEST P
Seasonal? Time of day?
Heartburn? Infection/Ill
contacts? Travel? PPD?
Night Sweats? Fatigue?
Sleep? Wheeze?
Swelling around ankle?
Orthopnea? PND?
Pillows?
FATIGUED SS
Beside your fatigue, do
you have any other
symptoms? LOC?
Ask TB Questions

Heart
Chest

Cough induced by
Exercise, Wakes
patient up from
Sleep

Heart
Chest
Extremeties
Thyroid

Maintenance Man,
Long Smoking
History, Weight
Loss

Smoking

- Lung Carcinoma
- TB
- CHF
- Anemia
- COPD

OCCPDF

Joint

Contractor/

Heacy Weight

- Lumbar Disc

CBC w/diff, Allergy


Challenge Test, PFT,
CXR, CT Paranasal
Sinuses, Sputum
Analysis (C&S, Acid
Fast), TB PCR,
Bronchoscopy, PPD,
ECG, Echo, LDH,
CPK, Troponin

R Back Pain

SIQRAAA
Special incidents
Swelling, Stifness,
Redness, Tenderness of
Other joints, Limitation
of Movement, TB?
Incontinence?
Rheumatology
Questions?

Neuro

Construction
Worker, Pain
Radiating to
Buttocks and R
foot, Smoker

22

40 yo F c/o
Back Pain

Abdomen
Back

Pain radiates to
groin, Pt has Hx of
Stones, Mild Fever

23

50 yo M c/o
SOB

Chest
Heart
Extremities

24

60 yo M c/o
Fatigue

OCCPDF
SIQRAAA
Haematuria, Dysuria,
Polyuria, Nocturia,
Urgency, Hesitancy,
Stream, Dribbling,
Incontinence, Stones,
Bleeding from other
orifices?
OCCPDF AA
CHEST P Wheeze?
Heart: Orthopnea, PND,
LL Edema, Fatigue,
Fever?
OCCPDF
FATIGUED SS

Yellow Sputum,
Hx of COPD, Htn,
Orthopnea,
Wheezes, O2
Therapy
Family Hx of
Colon Cancer,

Chest
Abdomen

Lifing
Herniation
Physical Therapy - Back Muscle Sprain
Steroids?
- Lumbar Sponylosis/
Ankylosing
Spondylitis
- Tumor in Vertebral
Canal/ lumbar Canal
Stenosis
- Vertebral
Compression
Fracture
- Steroid induced
Osteoporosis
Drink Water and - Pyelonephritis
Cranberry Juice
- Nephrolithiasis
- UTI
- Renal Cell
Carcinoma

CRP, MRI Lumbar


Stage, CT Back and R
Lower Extremity, Rh
Factor

Smoking, Htn

- Pneumonia
- Exacerbation of
COPD
- CHF

See Previous

Smoking

- Colon carcinoma
- Lung Carcinoma

Rectal Exam, Stool for


Occult Blood,

CBC w/diff, ESR,


CRP, Urinalysis,
Urine C&S, BUN,
Creat, Microalbumin,
Cystourethroscopy,
IVP, U/S Kidneys
B/L, CT Abdomen

25

16 yo F c/o
Fatigue

26

25 yo M c/o
Chest Pain

27

32 yo F c/o
Heart Racing

FACE SLIPS
Passed out?
Dont forget to ask
about Colonoscopies
Abdomen Questions?
Diet
OCCPDF
FATIGUED SS

Weight Loss,
Smoker

- Anemia
- TB

MMSE
Thyroid
Heart
Extremities

Constipation,
Weight gain,
Problems at Home

Stress
Counseling

OCCPDF
SIQRAAA
Heart Questions?
CHEST Ps
Wheezing?
If Woman, ask OCP to
exclude PE

Chest
Heart
Joint

OCCPDF
What else?
TACES (Thyroid,
Anxiety, Caffeine,
Exertion, Sweat)
Fatigue?

Heart
Thyroid
Neuro
MMSE
Dont forget
to test for
tremors

Rock Climber, H/o Marijuana


Asthma, Use of
Marijuana,
Shoulder pain
(Diff between
radiation and
concurrent pain),
Fever
Pt Planning
Stress
wedding, PhD
Counseling
student
Variation of the
same case: 2-3
Weeks ago she
went to the ER for
numbness of both
hands, and is now
coming for follow-

- Hypothyroidism
- Adjustment
Disorder
- Depression
- Anemia
- Costonchondritis
- Muscle Sprain
- Rib Fracture
- Pericarditis
- URI
- Exercise induced
Asthma
PAPA MCH
- Panic Attack
- Anxiety (GAD)
- Anemia
- Pheochromocytoma
- Arrhythmia
- MVP
- Caffeine/Stress
induced
- Hyperthyroid/

Colonoscopy, Spiral
CT Chest, ABGs,
CBC w/diff, Iron
Studies, vit B12,
Sputum Analysis if
applicable
See cases before

CBC w/diff, Lytes,


PFT, CXR, Chest CT,
X Ray on Shoulder
joint, PFT, ECG,
Echo, ESR, CRP

CBC w/diff, MSE,


urinary VMA, ECG,
Cardiac Echo, TSH,
fT3, fT4, s. Glucose

up, h/o carpal


tunnel Syndrome
in College
28

25 yo M c/o
Fatigue

OCCPDDFAA
FATIGUEDSS
FACE SLIPS
Sleep analysis
Diet analysis
Joint Pain/ Muscle Pain?
Headache?

Heart
Neuro,
Thyroid
MMS

29

35 yo F c/o
Headache

OCCPDDF
Complete
SIQRAAA
HEENT
TV SNN
Neuro
Ask about: Aura? Runny
Nose? Speech? Neuro?
Relation to Menses?
Stress and Caffeine
Intake? OCP?

Usually Female Pt

30

65 yo M c/o
LOC

OCCPDF
Describe what
happened?

Pt is a known
Hypertensive, +/Lightheadedness,

HEENT
Neuro
MMSE

Pt. smokes
marijuana, takes
herbal medicine

Hypoglycemia
* Sometimes
Hyperthyroidism w/
Carpal Tunnel
Smoking and
- Stress induced
marijuana
Fatigue
Stop herbal
- Anemia
medicine till
- Drug related
results are back. Hepatitis/ Fatigue
If anything
- Chronic fatigue
wrong with your syndrome
liver, discontinue - Obstructive sleep
apnea
- Depression
- Hypothyroidism?
Stress
MM IT ACHES
counseling,
- Meningitis
Caffeine Intake
- Migraine
- Inc. Intracranial P
- Tension Headache,
Temporal Arteritis
- AV Malformation
- Hypertension
- Eye Problems
- Subarachnoid Hge,
Systemic, Sinusitis
Hypertension
- Arrhythmia
- TIA
- Drug Induced

CBC, Lytes, s glucose,


Fe studies, Vit B12,
TSH, fT3, fT4,
polysomnography,
U/S, CT Abdomen

CBC w/diff, Lytes,


ESR, CT Head, MRI
Brain, LP, CSF
Analysis (C&S, Cl,
Gluc), U/S Carotid,
Temporal a. Biopsy,
Paranasal Sinuses
Imaging

CBC w/diff, Lytes, s


Glucose, CT Head,
MRI Brain, ECG,

31

Pediatric
Phone Call
8 yo M c/o
Abdominal
Pain

32

Pediatric
Encounter
with mother
of 3 yo M c/o
Seizures

Before: Heart Racing?


Light-headedness?
During: Tongue Biting?
Loss of Bladder control?
Shaking?
General: Gait? Speech?
Vision? Hearing?
Numbness/Tingling?
Weakness/Paralysis?
Headache?
Hear Questions: Hx of
Hypertension.
Trauma to Head?
FEVER CUTSS
FAMILI BEADS GLP
FACE SLIP
DDD TTT

Heart
N.B. Make
Sure to test
Gait,
Cerebellum,
Romberg,
Babinski

h/o MI 5 years
ago, Checking his
mail/ Grocery
Store

N/A

OCCPDF
FEVER CUTSS
FAMILI BEADS GLP
Before seizure: Fever or
infection?
After seizure: LOC?
Headache? Stiff Neck?
Runny Nose? Trauma to
head?

N/A

Child c/o pain,


new family
member with
Down S, too much
homework, New
School Teacher
Ask mother to sit
down
Fever day before,
Runny nose in the
morning

Bring Child to
Hospital, Psych

Bring Child to
Hospital ASAP
Cold
Fomentation,
Fluids, Lie on
back, hard
surface, Dont
put anything in
his mouth
Put his head

Hypotensioin
- Stroke
- Complex Tonic
Clonic Seizures
- Hypoglycemia
- Intracranial Tumor
- Severe Aortic
Stenosis
- Vasovagal

EEG, Lipid Profile,


Urine Toxicology,
Holter Monitoring,
Cardiac Echo, LP,
V/Q Scan, ABGs

- Somatoform
Disorder
- Adjustment
Disorder
- Low Fiber Diet
- Malingering?
- Febrile Seizures
- Meningitis
- Encephalitis
- Tonic Clonic
Seizures

Physical Exam, Rectal


Exam, Stool Analysis,
CBC w/diff, Lytes,
Stool Culture, CT
Abdomen
Physical Exam, CBC
w/diff, Lytes, ESR,
EEG, LP, CSF
Analysis, CT Head,
MRI Brain

33

34

45 yo F c/o
Numbness
and
Weakness of
L arm

Ask Pain? If Yes,


SIQRAAA
Fall on outstretched
Arm?
Tingling? Stiffness?
Redness, Swelling?
Limitation of ROM?
Tenderness? Other
joints? Photosenstivity?
Oral ulcers? Rash? Hair
loss? Cold intolerance?
Coldness? TB and
Respiration in cases of
Neck Pain.
60 yo F c/o
OCCPDF
Bloody Urine Back or Abdominal
Pain? If Yes SIQRAA
How did you know this
is blood? Bleeding from
Other orifices?
Diet? Meds? Exercise?
Trauma?

Neck
Neuro
Joint
Dont Forget:
Phalen or
Tinnel

Hispanic,
Hairdresser, Pain
just got better on
the day of the
exam, +ve
previous episodes

Eyes
Extremities
Abdomen

Pt is talkative,
Painless
Haematuria,
Smoker, Multiple
UTI, CVA -ve

aside in case of
chocking, Put
something soft
under his head,
like a pillow or
your cloth
Physical Therapy - Cervical disc
herniation
- Ulnar nerve
compression
- Cervical canal
stenosis
- Thoracic outlet
syndrome
- Cervical rib
- Muscle sprain
- Cervical Vertebral
Dislocation

Smoking

HITTERS
- Haematologic
- Infection
- Tumor
- Exercise
- Renal Disoder
- Stones
In this case:
- Bladder Cancer

CBC w/diff, EMG,


ESR, Nerve
Conduction Studies, X
Ray Shoulder, Elbow,
Wrist and Hand, CT,
s. Calcium, Vit. D,
DEXA Scan

Genitourinary Exam,
CBC w/diff, ESR, s
Creat, BUN, IVP,
Cystourethroscopy,
Renal U/S, CT
Pelviabdominal,
Microalbumin, s
Ferritin, Urinalysis,
Urine C&S, PT, PTT,

35

70 yo M c/o
Neck Pain

OCCPDF
SIQRAAA
TB? Respiration? Heavy
Lifting? Other Joints?
Rheumatology? Neuro?
Weight and Appetite to
exclude tumors?
Exclude Meningitis

Neck
Joint
Neuro
Brudzinski

Woke up with
neck pain,
Weakness and
Numbness of Left
Arm, FHx of
Osteoporosis

36

Pediatric
Case c/o
Fever

FEVER CUTSS
FAMILI BEADS GLP
Fever Analysis?
Distribution of Rash?

N/A

Fever and Rash

37

60 yo F c/o
Sleeping
Problems

OCCPDF
Duration of Sleep,
Activities before sleep,
Difficulty initiating
sleep, difficulty
maintaining sleep,
Interrupted Sleep,
Waking up
spontaneously (early),

MMSE
Neuro
Thyroid?
Look For
tremors

Challenge: Pt
doesnt want to let
go of her bag,
Delusion that
People in the bank
want to rob her.
Variation of case:
Patient was robbed
before

- UTI/ Cystitis
- Glomerulonephritis
Physical Therapy - Cervial Disc
Herniation
- Cervical Vertebral
Fracture
- Osteoarthritis
- Cervical
Spondylosis
- Neck Muscle Sprain
- Rheumatoid
Arthritis
(Sublaxation of
Atlanto Axial Joints)
Bring Child to
- Fifth Disease
Hospital. Dont
- Varicella
give Aspirin.
- Scarlet Fever
Cold
- Otitis Media
Fomentation
TV (Blue Light
interferes with
Circadian
Rhythm),
Depression,
stress, Naps,
Caffeine,
Relationship?

- Brief Psychotic
Episode
- Generalized
Anxiety or PTSD (in
variation)
- Depression with
Psychotic Features
- Schizophrenia
- Drug Induced

Urine Cytology, Red


Cell Casts
X Ray Cervical Spine
P/A and Lateral
Views, MRI C spine,
DEXA Scan, s. vit D,
s. Calcium, CBC
w/diff, Lytes, ESR, Rh
Factor.

Parvo Virus B19 IgM,


Pneumatic Otoscopy,
Tympanometry,
Varicella Ab Titre,
Skin Lesion Scrapings
with C&S
MSE, CBC w/diff,
MRI Brain, CT Head,
EEG,
Polysomnography,
Sleep Pulse Oxymetry,
TSH, fT3, fT4, Urine
toxicology

38

30 yo M c/o
Headache

39

45 yo M c/o
Testicular
Pain

40

25 yo M c/o
Diarrhea

Snoring, Nightmares,
Flashbacks, Daytime
Sleepiness and napping.
SHAMISMA
FACE SLIPS
Marriage? Stress?
Caffeine? Thyroid?
OCCPDF
SIQRAAA
TV SNN
Stress and Caffeine
OCCPDF
SIQRAAA
All Urinary Questions
Rash? Fever?

OCCPDF
ABCCCO
DDD TTT
Abdominal Symptoms?
Ask Rheumatology?
Respiratory? Past
Antibiotic use?

Psychosis
- Hyperthyroidism?
- Obstructive Sleep
Apnea

HEENT
Neuro

+ve Tearing

Stress, Caffeine

- Cluster Headache
- Migraine

See Case 29

Abdomen
CVAT?

Pt is having and
affair but does not
tell at first, Ask:
Are you being
monogamous?

Safe Sex, Tell


Wife, Consent
for HIV

- Epidydimitis
- Gonococcal
Urethritis
- Testicular Torsion
- Hernia

Eyes and
Extremities
Abdomen

+ve Tenesmus (Do


you have a sense
of incomplete
evacuation after
defecation), No
travel History

Complete Urogenital
Exam, CBC w/diff,
U/S Pelviabdominal,
CT, Urinalysis,
Analysis of discharge
if any (Gram Stain,
C&S), VDRL, RPR,
Chlamydia and
Gonorrhea PCR, HIV
testing
Rectal Exam, CBC
w/diff, Lytes, Stool
C&S, Occult blood in
Stools, Leukocytes in
Stools, Colonoscopy,
CT Abdomen, ESR,
Stool for ova, ANCA,
ASCA, ANA, C.

- IBD
- Malabsorption
- Infection
- Pseudomembranous
colitis

41

30 yo F c/o
Cough

42

65 yo F c/o
Heartburn

43

25 yo F c/o
Jaw Pain

OCCPDF
Time of Day? Seasonal?
CHEST PW TB
Analysis of Sputum:
ABCCO
Sleep? Lifestyle?
Heartburn? Ill contacts?
Wheeze?
OCCPDF
SIQRAAA
Abdominal?
Radiation? If Yes Heart
Questions?
Cough? DM?
OCCPDF
SIQRAAA
FACE SLIPS
SAFE GARD
Rheumatolgical? Neuro?

Extremities
Chest
Heart
Palpate
Sinuses

Dry Cough, Pt is
on Captopril

Heart
Abdomen

Pain ppt by heavy


meals and radiates
to left neck for 2-3
minutes

HEENT
Joint

Patient is victim of
abuse

Drug Counseling

Verbalize the
presence of
lesions,
Recognize
Severity,
Emphasize Trust
and
Confidentiality,
Ensure Safety,
Measures for
Children,
Presence of
Shelters and
Social Workers,

Remember:
PLEURAL CAP
- Exercise Induced
Asthma
- Allergic Asthma
- Drug induced
- Post Nasal Drip
- GERD
- MI
- GERD
- Angina

- Domestic Violence
- Depression
- TMJ Dislocation
- Jaw Claudication
- Temporal arteritis?

difficile toxin in stool


CBC w/diff, Allergy
Challenge Test, PPD,
CXR, Chest CT, PFT,
Bronchoscopy

CBC w/diff, Lytes,


CXR, Cardiac Echo,
CPK, LDH, Troponin,
ECG, Ph Monitoring,
Manometry, Upper
endoscopy
MSE, CBC, CXR, XR
Wrist, X Ray Skull
and paranasal Sinuses,
PT, PTT

Need to
document abuse
photographically
44

50 yo M c/o
Knee Pain

OCCPDF
SIQRAAA
Rheumatology? Any
other Joints? Migratory?
Trauma? Psoriasis?
Urination? Neuro?
Fever? Skin Changes?
Morning Stiffness? Tick
Bites? Crepitus?

Joint
Dont Forget
MacMurrys
Test, Anterior
and Posterior
Drawer Tests

45

70 yo M c/o
Memory
Loss

OCCPDF
FACE SLIPS
DEATH SHAFT
Neuro? Falls?
Talk to Wife?

MMSE
Neuro
Carotid Bruit?

Pt says he wants
an orthopedic
doctor instead of
you

IS THERE ANY OTHER SYMPTOMS THAT YOURE COMPLAINING OF?

SPORTS
Septic Arthritis
Pseudogout, Psoriatic
arthritis, PatelloFemoral Pain
Syndrome
Osteoarthris
Rheumatoid Arthritis,
Reiters
Tophi of Gout,
Trauma
Sac (Bursitis)
- Vascular Dementia
- Alzheimers
- Depression
- Normal Pressure
Hydrocephalus
- B12 Deficiency
- Hypothyroidism
- Neurosyphilis (if
Promiscuous)
- TIA
- CJD

CBC w/diff, ESR,


CRP, Knee Aspiration
w/C&S, ANA, Rh
Factor, Synovial Fluid
Analysis, Blood
Culture, X Ray, MRI

MSE, CBC w/diff,


Lytes, MRI Brain,
Doppler on Carotids, s
B12, VDRL, TSH

FEVER? ILL CONTACTS? HISTORY OF INFECTION?