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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
Keigls Exercise,
No water, No
alcohol and no
caffeine intake
before sleep,
meds, stress, DM
- Urge Incontinence
(Sometimes Stress)
- UTI
- Pyelonephritis
- DM induced
Polyurea
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
Has tremors,
Irregular menses,
Hot Flushes
Stress
Counseling,
Moderation of
Caffeine (if any),
Menopause
- Menopause
- Perimenopause
- Generalized
Anxiety
- Hypothyroid
- Adjustment
Disorder
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
40 yoF c/o
SOB
70 yoM c/o
Heel Pain
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
- 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
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
- Hypothyroidism
- Sheehans
Syndrome
- Pregnancy
- Anemia
Variation of the Case:
- Postpartum
Depression
- Caregivers Fatigue
- Hypothyroidism
HRT
- Hypothyroidism
- Perimenopause
- Anemia
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
- Gastroenteritis
- Rota Virus
- Bacterial Diarrhea
- Food Poisoning
13
62 yo M c/o
Abdominal
pain
14
16 yo F c/o
fatigue
15
35 yo F
constipation
Phone
Encounter
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.
- Drug induced IC
Bleeding
- Metabolic
encephalopathy
(Electrolyte
Imbalance)
- Hypoglycemia
Eyes
Extremities
Abdomen
Pt is having anal
sex, has a Hx of
Haemorrhoids, +/Constipation, +/LLQ Pain
- 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
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
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
Smoking, Htn
- Pneumonia
- Exacerbation of
COPD
- CHF
See Previous
Smoking
- Colon carcinoma
- Lung Carcinoma
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
- 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
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
31
Pediatric
Phone Call
8 yo M c/o
Abdominal
Pain
32
Pediatric
Encounter
with mother
of 3 yo M c/o
Seizures
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
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
- Somatoform
Disorder
- Adjustment
Disorder
- Low Fiber Diet
- Malingering?
- Febrile Seizures
- Meningitis
- Encephalitis
- Tonic Clonic
Seizures
33
34
45 yo F c/o
Numbness
and
Weakness of
L arm
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
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
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
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?
- Epidydimitis
- Gonococcal
Urethritis
- Testicular Torsion
- Hernia
Eyes and
Extremities
Abdomen
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
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?
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
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