MNEUMONICS for CS
HPI-System based PMH ROS
PMH (past medical history) PAM HUGS FOSS
L-Location of symptom I-Intensity scale 1-10 Q-Quality SBCD PP (Sharp, burning, cramping, dull, pulsing, pressure like) O-Onset (F,T,D) R-Radiation does it move? A-Associated (System based) A-Alleviating factors A-Aggravating factors (effort, smoking, large meals)
P-PMH+Previous HPI s/s A-Allergies M-Meds (drugs/when/SE) H-Hospitalization for any illness in the past+surgeries U-Urinary changes ( esp if diabetic, elderly...) G-GI complaints (diet changes, bowel movements...) S-Sleep pattern FHx O-Occupation Female: OB/GYN history (LMP, abortions, para...) S-Sexual (active?partners?protection?STD?) S-Social (WASTED DADS)
Social Hx WASTED DADS
ROS Review of Systems
W-Weight(how much?how long? Intentional A-Appetite S-Smoke/tobacco (pk/yrs) T-Travel E-Exercise D-Diet
THE JC DFRS
LIQOR AAA
D-Drugs A-Alcohol-CAGE D-Depression - SIGECAPS S-Stress/Anxiety
T-Trauma H-Hdche E-Edema J-Joint Pain C-Chest Pain/Cough D-Dizziness/Vision F-Fever -Rash R -Rash S-SOB
Spousal abuse SAFEGARDS
Ob/Gyn Hx : LMP RTV CS PAP
S-Safety at home? A-Afraid of Attacker? F-Family/Friends aware? E-Emergency plan? G-Gun at home? A-Alcohol? R-Relationship with spouse? D-Drugs? Depression? S-Suicidal ideation/plan?
L- LMP !! M- Menarche P- Period (days?) R- Regularity (interval) T- Tampons/Pads # per day V- Vaginal discharge, itching , dryness C-Cramps (Dysmenorrhea) S- Spotting (in btw/ post coital ) P-Pregnancy ( Hx & complications) A- Abortion /miscarriage P- PAP smear (when? Result?)
DIABETES Follow-up History Diet Insulin/oral agents Acute complications – hypo/hyper Blood Glucose Monitoring Exercise/activity Toes/Foot Care/complications? Education S pecial problems – psychosocial, financial HAVOC premenopausal symptoms H- hotflahes A-atropy of vagina V-vaginal dryness O- osteoporosis C- coronary artery diseases
Depression – SIGE CAPS S: sleep ( how many hour, nightmares, flashbacks, etc) I: interest, Do you enjoy what you do? G: Guilty/ angry E: Energy C: concentration A: appetite, changes in your weight P: psychomotor agitation/retardation S: suicide , plan , attempts Discharge COCAD C-consistency O-odor C-color A-amount D-duration
DDx: Loss of Consciousness/Syncope CAMPUS
DDx: Dizziness DENTAL CAMPUS
C-CAD A-Arrythmias/ Aortic Stenosis M-Migraine/ Meds P-Psychiatric /Personality disorder( hyperventilation) U-Unexplained Syncope S-eizures/Strokes
D-Diabetic comp ( Orthostatic ) E-Ear problems (Meniere's/ BPV) N-Neural tumors/Neuropathy T-Thyroid A-Anemia L-Leaves me C-CAMPUS
DDx Confusion DEMENTIA
DDx Obesity OBESITY DISC
D-Diabetes /Dementia/ Drugs E-Epilepsy M-Migraine/Mult Infarct Dementia E-Ethanol (withdrawl / Toxicity) N-Neurological Deficit diseases= BETA (Bleeds,Encephalitis,Tumors,Abscess,Meningitis ) T-TIA/ Trauma I-Insulin/ Infections A-Alzheimers/Abscess
O-Osteoarthritis B-Breathing problems E-Excess Cholestrol S-Sleep Apnea I-Increased Incidence Ca's (Endomet/Breast/Colon) T-Type 2 DM Y- hYpertension
DDx Joint pain SPLINTER
DDx Nasuea & Vomiting A MOPING Anorexia Metabolic(DKA)/Meds Obstruction (pyloric /Intestinal) Pregnancy Inflammation(Pyelo/Cholecysto/Appi/Pancr eas/PID)
S-Septic, Spondyloarthropathies P- Pseudogout/Gout L- Lyme Dz I- Infetion N-Neoplasia
D-Depression I-Incontinence S-Stress C-Cholelithiasis/Cycle disturbances/Cardiac
T-Truama E-Endocarditis R-Reiter’s Sy
Neurological (BETA)= Bleed/Encephalitis/Tumor/Abscess Gastroenteritis
Pediatric Hx
Pediatric PMHx
FEVER CUDS
PAM BIG DADAS FS
F-Fever E-Ear pulling V-Vomiting E-Ear discharge, eye discharge? R-Rash
P-PMH,PSH A-Allergies M-Meds
C-Cold n Chest-runny nose? cough? chest pain? fast respirations? SOB? U-Urination-any change urination? # of wet diapers? Odor? Color? D-Diarrhea-O/F/D? Mucus? Blood? crying during defecation?
B-Birth hx I-Immunizations G-Growth n development, ht, wt, milestones. D-Day care A-Appetite D-Diet A-Appearance S- Sleep
S-Seizur e-any jerky movements? any leakage of urine or stool during fits? any post ictal irritability, or LOC?
F -FHx S-Sick contacts
DDx GI Bleed A-Angiodysplasia B-Bowel Habits C-Constipation D-Diarrhea E-Eosphagus (varicies, CA) Epistaxis F-Fistual (anal) G-Gastritis Hx H- Hemorrhoids I-IBD, Irriitable bowel, Infectious Diarrhea
DDx ABD Si CKMG MIOR (MIOR assoc. with Appendicitis) C-Cullen Si- per umbilical discoloration (retro hemorrhage –pancreatits, AAA rupture) K-Kehr –sever L shoulder pain- Splenic rupture, ectopic preg M-Murphy’s Si- Abrupt interruption of inspiration on palp of RUQ- acute cholecystitis G-Gray-Turner Si, Discoloration of flank (same as Cullen_ M-Mc Burney’s Si- Tenderness 2/3 from iliac spine to R of umbilicus I-Iliopsoas Si, Hyperextension of R hip Cx ABD pain O-Obturator- Internal rotation of flexed R hip Cx ABD pain R-Rovsing Si- RLQ pain upon palpation of LLQ
Jaundice JAUNDICE B
Psych case VOICES HARM MEN
Journey overseas/Joint pain A bdominal pain/appetite changes U p temperature( fever) Nausea/vomiting Diarrhea/constipation Itch(rash)/Immunizations Color of urine and stool Eating habits -weight changes Blood transfusion in the past
V-Visual hallucinations(onset, duration, context) O-Open/close eyes(if patient can see "writtings" with close and open eyes) I-Imperative ( voices can control patient) C-Changes in vision/ vision loss E-Ear(audio hallucinations- onset, duration, context) S-Sleeping problems H-Headache/head trauma A-Attacking himself/others R-Recreational drug use M-Major changes in life M-Mental illness in the family E-Enjoying daily activities N- Narcolepsy (sleepiness during the day)
CC of Memory Loss/ Dementia/ Alzheimer/ MID/CJD/ Pseudo-tumor ADL = Activities of daily living DEATH D-Dressing E-Eating A-Ambulation (can you find your way thru home) T-Toiletry (do you manage your toiletry un assisted) H-Housing IADL - Instrumental activities of daily living SHAFT S-Shopping H-Housekeeping? unsure about that A-Accounting F-Food (do u do your cooking ,etc) T-Transportation (do you drive? How is your sight, hearing?)
MINI MENTAL ORArL23RWD O-Orientation (5)-Country, state, city, hospital, floor R-Registration “I’m going to say 3 objects”… then they repeat A-Attention “spell world backwards, or serial 7’s from 100” (5) r-Recall what were those 3 items again? (3) L-Language “Repeat after me.. “No, ifs, ands, or buts” (1) 2- Identify two objects “what is this.. pen.. and this… paper” 3- Obey 3 commands, “take a piece of paper, fold in !, put on floor” R-“Read 3 commands on this paper and do what is says” W-Write a sentence D-Draw, copy the image:
HPI CARDIAC/CVS
HPI URINARY
CARDIAC
FINISHED PUBS
C-Chest Pain-LIQORAAA A-Ankle Swelling R-Reduced Exercise Tolerance D-Dyspnea/Orthopnea/PND I-Irregular HR/Racing Heart A-Altered Consciousness C-Cyanosis
F-Frequency(How often) I-Incontinence(any trouble holding) N- Nocturia (wake up @ Night) I-Incomplete S-Stream (How is stream?) H-Hematuria (Any color) H-Hesitancy (waiting to start?) D-Dysuria (Any difficulty?) P-Pyuria (Any pus?) U-Urgency (Any rush) B-Burning? S-Straining?
Insomnia counseling =ABCDEFGHJKLMN Avoid Bedtime Concerns (worries) Drugs (nicotine/caffeine/Alcohol) Exercise/Excitement (TV Shows) Follow Good Habits for sleep. Jetlag Keep List (Diary) Monitor Naps (day time) Smoking Cessation counseling =
Counseling DM & HTN= MEDOWS Medications (regularity) Exercise ( for obese/sedentary life styles) Diet Modification( Salt/Fatty foods) Opthalmoscopic exams (annual routine) Weight Management (/control) Sugar Check ups
SPANCSTER S-Stressor ( any stress in life/tension etc ) P-Problems ( Heart /Lung/ CA) A-Advantages ( Improved breathing & Increased energy) N-Nicotine alternatives C-Counselors ( I can refer u/ give # ) S-Support systems ( I can refer u /give #) T-Taper down/Cold Turkey E-Exercise Programs ( eg Swimming ) R-Rewards ( reward yourself, treat yourself with a dinner w/ money saved)
N- Nausea U-Urinary incontinence T-Tinnitus S-Sleep H-Headaches E-Eye disturbance L-Loss of conc. L-Light headedness
All Neuro NUTSHELL VEGT CHEW
V-Vomiting E-Ear discharge G-Gait T-Trips/Trauma C-Confusion/Convulsion H-Hearing loss E-Ear Fullness W-Weakness/Numbness
Obesity counseling
Mini Mental Exam :
ABCDEF
MC LOPE
Avoid: (Eg.Sedentary/Steroids) Advantages: (Low Heart/Brain/Ca etc risk) Books (self help) Counseling/Consult/ Cholesterol checks Dietitian Exercise Fatty Food (cut backs)
LOC/Syncope PASS BLT SANDWICH Palpitations Aura Shaking (duration) S pinning/ lightheaded Bladder, incontinence Loss of consciousness (duration) Tongue biting S peech difficulties Ataxia Numbness Difficulty breathing Weakness Injury (trauma) Confusion after the event Headache
Skin review of systems which aReNT SIMMBEL
Memory Concentration / Consciousness Language Object recognition / Orientation Praxia Executive function (abstraction / planning / organizing / sequencing )
Amenorrhea a HAG with a Very Fou(W)l Hea(I)DaChe HAG V FWL HiDC (HAG means an old lady) with one possible Amenorhea symptom (Headache in Prolactinoma and Peri-menopause ) Hair & skin changes ( for Hypothyroidism/Hirsutism of PCOS) /Headaches Anorexia nervosa /Anxiety & Depresion Galactorrhea Visual disturbance / Virilization Fatigue Wt change , Appetite & Diet Libido Hot flashes Insomnia Deep voice change Cold intolerance & Constipation Dry Mouth causes DRI D Drugs/Dehydration
R (rash) N (nail changes) T (temperature)
R Renal/Radiation I Immuno(Sjorgen)/Intense emotion
S (sensation) I (itching) M (masses) M (moles) B (bleeding/bruises) E (edema) L (lesions) 2) BINDER ( birth history, immunization history, nutrition, growth and development, eating, rash) STD / HIV COUNCLING ( strip bimbo) ( safe sex practices, transmissions, risks , immunizations, prevention counseling, behavior counseling, interventional counseling, medication , barrier methods, opportunistic infections) general physical PICKLE pallor , icterus , cyanosis ., koilonychias, lymphadenopathy , edema
37) peds history BJM CHILDREN birth history , jaundice( neonatal) milestones, crying, check up , headache, immunization, lethargy , day care, rash, eye,ear, nose , nutrition 38 ) headache MM IT ACHES migraine , meningititis , inreased intracranial pressure, tension headache, tension headache, temporal arthritis, av malformation cluster headache, hypertension , eye disorder ( refacratory error + glaucoma) sinusitits , sub arachemoid haemorrage, most systemic illeness 39) sore throat ( SORE THROAT WAS BAD )Swallowing food was painful , origin duration progression , Runny nose , Ear problems , Temp chills , headache, resp symptoms ( cough, shortness of breath, chest pain ) occupation , aspiration + abdominal symptoms ( nausea , vomiting , pain ( esp LUQ) tiredness ( fatigue) touch with ill people ( boy friend or girl friend) weight loss , appetite , alcohol, smoking / sleep changes sexual historybowel habits , anything else that u want to tell me , Drugs ( IV) 40) throat throat culture , IV antibody and viral titer rapid strep antigen , monospot test, anti EBV anti body , rouTine tests ( cbc , peripheral smear) 41) d/d of cough PLUERAL CAP Pneumonia , lung cancer , exacerbation of COPD , URI , reactive airway disease, abscess , lymphoma , CHF , asthma, post nasal drip 42) knee pains SP3ORTS septic arthritis, pseudogout , patello femoral syndrome, psoriatic arthritis, osteoarthritis, rheumatoid arthritis, reactive arthritis, tophi , trauma , sac imflammation ( bursitis) septic arthritis 43) foot pain FOOT PAINS Fat atrophy ( age related) + foreign body , osteomyelitis , osteoporosis, tarsal tunnel syndrome , tendonitis, tumor, plantar facitis , periostitis, apophysitis , arthritis ( rheumatoid , reactive,) ischemic ( peripheral vascular disease) , nerver entrapment , stress fracture in athletes and spur in bones 44) chest pain CHEST â !“P cough , hemoptysis, heart burn, emesis (vomiting ) diarrhea and edema over ankles, temperature , tenderness over ankles tenderness over legs , also trauma , Palpitation 45) impotence LIMP PENIS libido change , injury , medication ( beta blocker) past/ present medical history ( htn , diabetes , vascular , leriche) previous prostate surgery , performance anxiety, peryonie disease, erection at all , nocturnal erection , incontinence, stress/ depression 46) d/d impotence DOC MP DG UP Depression , alcohol , claudication ( leriche syndrome) medication , pressure (HBP) , mellitus gonads ( hypogonadism) , unknown etiology ED, prostate surgery Drug stoping erection STOP erectionSsri , thioridazine , methydopa, propanalol 47) d/d pv bleeds A PV BLEEDS Abortion + adenomyosis, PID+ PCOD, vaginal bleeds, bleeding diasthesis, leiomyoma , ectopic pregnancy, endometriosis, endocrine causes, DUB ( anovulatory cycle) uduration , dysparunia, dysuria, itch , smell , color, high fever, abdominal pain , recurrent episodes, general health and symptoms , endocervical swabs 49) AMENORRHEA CAUSES AMENORRHEA Pregnancy, absent ovulation, menopause, eating disorder, nursing mother, OCP, raised prolactin , raised adrenal harmones, hypothyroidism, hemorrhage, E_? , anxiety , asherman etc 50 ) depression case patient note I AM SAD Insight , appearance, mood , MMSE, suicidal intent , speech, affect, delusion , hallucination 51) depressed mood dd BAD MUDS Bereavement , bipolar 1 and bipolar 2 disease, adjustment disease , mood disease, dysthemic disease, major depression, menopause, underlying medical condition , drug related ( cocaine , amphetamine) schizophrenia 52) dark urine HITTERS Hematologic / coagulation disorders, infection , cystitis, trauma , tumors, exercise, renal disorder, stones 53) blood in the stool DRAIN diverticulosis , drugs ( warfarin ) rectal bleeds ( piles , fissures) angiodysplasia , anal sex, inflammatory bowel disease, infectious diarrhea, ischemic colitis , injury , neoplasms
