Most Important Mnemonics for Step 2 Cs

HISTORY & PHYSICAL EXAMINATION HPI ( chronicle of present illness) ALL CASES OPD CSF AAA PAIN OPD CSF LIQR AAA OPD CSF ABCDO FLUIDS (Vomiting, Diarrhea, constipation, cough, vaginal discharge) O Onset of the symptom + precipitate factors P Progression D Duration C Constant /Intermittent S Settings F Frequency L Location of the symptom (forehead, wrist ) I Intensity of the symptom (scale 1-10, 6/10) Q Quality of symptom..BCDSPP(burning,Cramping,dull,Sharp,pulsating,pressure alike(p)) 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) A Amount B Blood C Color C Consistency C Content D Duration O Odor UG Hx OPD-CSF-AAA + FINISH PUBC F Frequency (How frequent do u pass water to pass urine? ) I Incontinence (Do u have anesthetize holding Ux until u get to BR? ) N Nocturia ( do u have 2 wake up Night to go to BR? I Incomp allowe emptying (do u feel fullness even after Ux) S Stream (How is ur flow of urine? is it cont. or is there each dribbling after Ux? ) Strain (Do u have to strain during Ux) Stone (have u passed stones in the retiring(a)? ) H Hematuria (did u notice either blood), Hesitancy (do u have 2 wait b4 starting Ux) P Pyuria (was there all pus in ur Ux? ) U Urgency (do u have 2 rush to BR to Ux? ) B Burning (dysuria) (does it burn) C COLOR 1 emailprotected com PMH (past medical history) PAM HUGS FOSS P Previous presence of the symptom (same CC), past times wellness check lines (BP, BS,U , idney prob. Rhinitis,Sinusitis, sthma,) A Allergies ( doses, foods, chemicals, dust ) M Medicines (R U taking any prescription medications/any over-the-counter med. ), H Hospitalization for any illness in the past (Trauma, surgery) U Urinary changes ( esp if diabetic, elderly ) G Gastrointestinal complains (diet changes, bowel movements ) S balance pattern(difficulties falling/maintain as leep,wake up,snoring,med. to help sleep, how many hour, nightmargons) F Family history (similar chief complaints/serious illness)/ Fevers, Chills/ Fatigue O OB/GYN history (LMP, abortions, para LMP RTV CS PAP S Sexual habits (active/preferences/STD/no. of partners/contraception/pregnancy/ wear pap smear) Q 1. Mr. John, Are you Sexually Active? Q 2. How Many Partners are you active with? Q 3. Are your partners male or female or both? Unless the SP narrates wife or husband in Q 2 Q 4. Do you use protection during intercourse? Q 5. If yes in Q. 4 What kind of protection do you use? Q 6. Ask ab by anal intercourse in male homosexuals Q 7. h/o STDs Rx for STDs S Social Hx (job/house/smoking/alcohol/recreational drugs/.. ) pound sterling SAD TOES Social Hx WAD SAD TOESW Weight A thirst D Diet S Smoke (cigarettes, marijuana, how much, how many years) A Alcohol (what type of alcohol, how often, how much ,consider doing CAGE question. ) D recreational Drugs (what drug, how do you u se it, any IV drug use? ) T Travel /Trauma O Occupation (what do you do for backup? ) E Exercise S Stress HEADACHE OPD CSF LIQRAA + DIAGRAM Head trauma/Seizure/Weak,Numb Tears / visual changes Flu Vomit/ Speech spot stiffness 2 emailprotected com Ped Hx (Child with fever) CUB FEVERS + PAM IF BIG DEALS-T C Colds-runny nose,cough,chest discommode, fast respirations,SOB-CRYhow is cry of baby? U Urination-increased or decreased urination, of diapers, any odour, colour of urine Ulcers in mouth B Bowel changes Diarrhea-frequency, onset, mucus/pus/blood in stool, any crying during defecation Discharge Qs (ABCD-O Amount, Blood, Content, Consistency, Color, Constant/Intermittent, Duration, Odor/Onset) F Fever & chills E Ear pulling V Vomiting E Ear/eye discharge, Ear hearing, Eye vision R Rash S Seizure-any jerky movements, which part of body? Any leakage of urine or stool during fits, and postictal irritability or red of consciousness. Stress (bet wet, DM) P Past medical/Past surgical Hx / Previous Hospitalizations.A Allergies, effect on child/parents (bet wet, DM), Activities M Medications, Menstruating (female child 10yo) I Ill contacts F family history B blood Hx I Immunizations G Growth n development, ht, wt, milestones SSC-WTD S(1), S(6),C(9),W(12),T(15), D(30) smile, sit, crawl, walk, talk, dress wks 1,6,9,12,15,30 D Day care / voiceless swallowing E Eating habits, feeding of baby A Appetite L Look of the baby or appearance, Last check-up S Sleep T Travel recently Premenopause H Hot flashes A Atrophy of vagina D Dryness of vagina O Osteoporosis (council) C Coronary artery disease HADOC emailprotected com ObGyn Hx LMP RTV CS PAP L LMP (when was ur LMP? ) M Menarchae (how old were u when u had ur 1st finis? P Period (how many days ur period get going? ) R Reglarity ( R ur periods regular? ) T Tampoons (how many pads do u use in a heavy day? ) V Vaginal DID discharge, itching , dryness (have u ever had any vag discharge? ABCDO. do u have any vag. Itching ? ) C Cramps (Dysmenorrhea) do u have abd cramp with ur period? S Spotting ( intermenstrual / post coital ) have u ever bled (. ) ur cycles?Did u ever notice any bleeding after intercourse? P Pregnency ( Hx & complications) have u ever been pregnant? How many times? A abortion/miscarriage (Any miscarriages or abortions? In ? month of ur pregnancy? ) P PAP smear(have u been getting regular PAP sm ? when did u have the last PAP sm ) (any Female50 yo get hold of about1-R u taking vit D & Ca,2-have u ever tried HRT? ) If suspect abuse SAFE GARDS S Safety inquiry (Do you feel safe at home? ), Sex ever forced? A Alcohol abuse (does your hubby abuses alchol? ), Attacked Children?F Friends/Family who are aware( Dos any1 f ur friend/Fam know of this) Fractures (Abuse ever resulted in fractures? ) E Emergency plan (u have emergency plan? ), Ever tried to will/divorce? why not? G Guns at home (are there any weapons home? Attacked with it? ) A Afraid of husband R Relationships with husband ( how is ur kind with husband? do you feel Threatened when he is around? For how long? D Depression (lost wt/appetite/sleep), Drugs (does husband use recreational drugs) S unsafe (idea/plan/attempt) (ever felt like ending it all up? ) 4 emailprotected com Diabetic pt FU/Med Refill D Duration of disease I Insulin fare/ oral hypoglyemics regimen A A1c hg - Gluc. monitoring (fast, home, HgA1c) B Blurry vision (retinopathy) E Extremity (foot ulcer/infection T Tingling/ numbness (neuropathy) I Infections (resp/urinary) C Cardio Risk Factors (HTN, CHOL, Heart disease) Counseling DM & HTN M Medications (regularity) E Exercise ( for obese/sedentary life styles) D Diet Modification( brininess/Fatty foods) O Opthalmoscopic exams (annual routine) W Weight Management (/control) S Sugar Check upsDIABETIC MEDOWS Neuro cases LOC P Palpitations A Aura b4 problem S Shaking (duration) S Spinning/ lightheaded B Bladder incontinence / Bowel incontinence L Loss of consciousness (duration) T Tongue bit ing/ tinnitus & hearing loss S Speech difficulties/ Sleep disturbance A Ataxia gait N Numbness/nausea & vomit D Difficulty breathing W Weakness I Injury (trauma) & fall C Confusion after the event / Visual disturbance H Headache PASS BLT machinate -And to steel sure you got it completely dont forget the MinMental Stat.Exam 5 emailprotected com MINI MENTAL O Orientation X3 time, place, persons R Registration Im going to say 3 objects then repeat A Attention spell world backwards R Recall what were those 3 items again? L Language resound after me.. No, ifs, ands, or buts 2 Identify two objects what is this.. pen.. and this paper 3 Obey 3 commands take a piece of paper, fold in ? , move on floor R Read 3 commands on this paper and do what it says W Write a sentence D Draw, copy the get a line ORARL23RWDForgetfulness/ Memory Loss / Dementia/ Alzheimers FORGETS HIM + DEATH SHAFT F FAINTING / Flashes/ FHx of Alzheimer 0 ORTHOSTATIC HYPOTENSION R RUNNING URINE INCONTINENCE G stride E EYEVISION T TRAUMA, TINGLING S STRENGTH,SEIZURES H HEADACHE I INFECTION SYPHILIS, MENINGITIS M MOOD ADL Activities of daily living D Dressing E Eating A Ambulation (can you find your way thru home) T Toiletry (do you manage your toiletry unassisted) H Hygiene IADL Instrumental activities of daily living S shop H Housekeeping A Accounting F Food prep (do u do your cooking ) T Transportation (do you drive? How is your sight, hearing? 6 emailprotected com Foot / Heel / Knee / Back hurt OPD-CSF-LIQORAAA +WET SURF-D -CIS W Work /Weakness / Walking habits /Wt loss E Eye infection lighting T Trauma to foot /Tingling& Numbness / Tender S Stifness in other joints/leg Swelling /long Standing hours/morning unshakable/sound U Urethral discharge /ulcer R Rash/ Redness of skin of joint F Fever & chills& night sweat D Deformity / Dysurea IN CASE OF BACK PAIN ADD CIS Cancer Hx /IV DRUGS/ Steroids 4 long time Depression (Psychiatric Hx Checklist) SIGME CAPS DHAT +2 (+MMSE ORAL23RWD) S Sleep ( difficulties falling/maintain asleep, wake up, snoring, med. o help sleep, how many hours, nightmares), Stress, Support I Interest, What do you do in your free time? How are you doing in your job? do you enjoy what you do? G Guilty M Mood. ( anxious, sad, hopeless, lonely? Memory problems E Energy C Concentration A Appetite, changes in your Weight P Psychomotor agitation/retardation (do you feel easily agitated or angry/do u feel not to do anything? ) S Suicide thoughts, plan, attempts(do u have pills/guns home? D Delusions/Drugs H Hallucinations/Hopes A Attitude towards life (positive negative frame of mind) T Thyroid dysfunctions (ABCD HV for HYPOTHYROID) withal need to ask Do u realize that u have problem ? Do u want help? ( if patient was sent or asked by anyone to consult doc ) HYPOTHYROID APPETITE BOWEL-constipation COLD INTOLERANCE DEPRESSION HAIR FALL VOICE-Hoarseness 7 emailprotected com ABCD HV Hearing loss P Pain D Discharge F FB I Imbalance N Noise R Ringing S Spinnin g T Trauma Dx ABD Signs PDF IN RST CKMG MIOR (MIOR assoc. ith Appendicitis) C Cullen $- periumbilical stigma (Retroperitoneal He,pancreatitis, AAA rupture) K Kehr $ sever Lt. Shoulder pain- Splenic rupture, ectopic pregnancy M Muphys $- Abrupt interruption of inspiration on palp of RUQ- acute cholecystitis G Gray-Turner $, Discoloration of flank (same as Cullen $) M Mc Burneys $- Tenderness 2/3 from ASIS to Rt of umbilicus I Iliopsoas $, Hyperextention of R hip Cx ABD pain O Obturator $- Internal rotation of flexed R hip Cx ABD pain R Rovsing $- RLQ pain upon palpation of LLQ DDNasuea & Vomiting A Anorexia M Metabolic( DKA)/Meds O stop (pyloric /Intestinal) P Pregnancy I Inflammation( Pyelo/Cholecysto/Appi/Pancreas/PID) N Neurological (BETA)= Bleed/Encephalitis/Tumor/Abscess G Gastroenteritis A MOPING 8 emailprotected com Cranial Nerves 2 optic 3 4 6 5 7 Oculomotor Trochlear Abducent Trigeminal -Test visual acuity -Test pupillary reflexes (direct) -Test accommodation reflexes -Ass ess pupillary reactions to light -Assess corneal reflection -Perform H-test for EOM -Sensory close eyes,touch face where? Motor Assess strength of muscles of masticationbite down and palpate masseter Ask patient to -smile -wrinkle forehead, -blow out cheeks -close eyes -whisper, -Weber -Rinne tests Assess movements of the soft palate swallow and palpate neck Assess strength of trapezius & sternocleidomastoid muscles -shrug shoulders up -move neck to side against confrontation Ask patient to protrude tongue (assess for fasciculation, atrophy & Deviations) -stick your tongue up -move it side to side facial 8 Vestibulocochlear 10 vagus 11 addition 12 hypoglossal 9 emailprotected com Mr. ? Good morning Mr. , I am Dr. Khalil, an attending physician in this hospital. SHAKE HANDS First Ill ask u few Qs. and do brief physical exam. Meanwhile if u have any Qs, feel free to ask me, ok? Let me make u more comfortable DRAP PT. Ill be sitting & writing well-nigh notes while were talking, is that ok? THANK U. Please tell me what brought u in today Mr. ? .. I. C. , can u tell me more about .. c. c. Mr. Id like to ask u few Qs. about ur health in the past, is that ok? Mr. now Id like to ask u few Qs. bout ur habits, is that ok? Now Id like to ask u few personal Qs. I assure u that all info. Will be kept confed. ok? Now, let me ask u few Qs. about health of your family members, ok? Does any body in ur family have any med. Conditions? Mr. thank u. I am done e history, let me summarize for it, As u mentioned, u have .. Do u have any Qs. for me? Mr. Now I need to examine u. may I proceed? But 1st let me wash my hands. Ok? Mr. Thank u for ur cooperation. I am done e phys. Exam let me devote my impression. Based on ur Hx & my PE, it seems that u might have.. ut it could be something else/ or, so to arrive at right D, I ll run some tests & order imaging studies such as .. once Ive result well meet again discuss various ttt. Options. Do u have any Qs. for me? SHAKE HANDS & LEAVE ROOM 10 emailprotected com HISTORY HPI OB/GYN LMP, regular periods every.. Weeks ,lasting.. Days. Menarche at age Uncomplicated NSVD at full term.. old age ago. ROS negative except as above. Allergies NKDA Medications none PMH PSH SH smoke /alcohol / illicit drugs/sex / job /exercise FH noncontributory PHYSICAL EXAM Patient is in no acute distress OR looks .. anxious,tired, ) ( The source of information is the patients mother. the mother of a . -month/year-old female/male c/o her child having .. ) VS WNL (except for temp. Of ) HEENT NC/AT, PERRLA, no conjunctival pallor. No fundoscopic abnormalities. Nose,mouth and pharynx WNL Neck Supple, No LAD, thyroid normal, no carotid bruits. Chest no tenderness, clear breath sounds bilaterally. Heart RRR, normal S1/S2, no murmurs, rubs or gallops Abdomen soft, non-tender, non-distended, +BS, no guarding, no hepatosplenomegally Extremities no edema, normal DTR in lower extremities Skin no rash NeuroMMSE AOx3, spells backward, recalls 3 objects, Cranial nerves 2-12 grossly intact, Motor strength 5/5 throughout -sensory intact to soft touch and pinprick, DTR symmetric 2+ in all extremities (or lower extremities), Babinski bilateral, Gait normal, cerebellar Romberg, rapid alternating movement and heel to chin test normal and symmetric 11 emailprotected com UWShort UWLong 1 16-31-37 2 1-13-1925-35-39 24 25 4-5-1822-24 29 15 28 20 21-40 12 7 43 10 FA Full 19 1-2 38 6 3 FA Mini CASE 23-24 Urine problem Alcoholism 19 Abd pain Heel pain Chest pain 13 8 31 5 6 7 4 6-26 10 38 42 34 11 UL pain 31 Shoulder pain 21 Knee pain 27 32 Back pain 37 Calf pain Vomiting adult 18 Vomiting child-TEL 7-8 33 Fever child 5-28 20-22 Diarrhea Rectal bleeding Constipation 9 Night sweat 21 Hemoptysis 9-10-40 12 Chronic cough 15-16-17 8 Fatigue 15 Wt loss 16 Wt gain 17 dysphagia 18 1 Headache 3 Depression 4 psychosis Anxiety Seizure new onset Amenorrhea Menopause 25 26 Menstrual problems 26 Vaginal discharge 12 emailprotected com 12 23 13 3 0 9 33 14 16 17 18 19 20 21 22 23 12 36 13 27 23 6 2 22 41 30 36 41 3 17 32 34 14 11 39 30 14 15 30 10 5 7 6 27 28 14 8 32 27 29 11 2 emailprotected com 35 33 26 31 4 29 29 11 25 34 Forgetfulness Frequent falls DM New DM drug refill BA drug refill HTN drug refill HIV drug refill Vaginal bleeding Obesity Spells LOC Terminal cancer Confusion Tremors Pre-employment Domestic violence Sexual assault Insomnia giddiness Numbness-weakness Jaundice adult Jaundice Neonate Enuresis Palpitations SOB Smoking cessation Hallucinations +ve Pregnancy test Pain with sex MVA Sore throat Difficult swallowing Hearing loss Blurred vision Erectile dysfunction Behavioral problem child Skin rash 3 FA cases GIT Trauma Resp Cardio Ped Neuro Endo Psych nephritic ObGyn Pain DM/HTN Jaundice Fever Fatigue 1-2-5-11 3-21-27-31-37-38 4-9-10-41 6-20 7-8-28-30-36-39-40 12-14-18-22-23-29 13-24 15-16-17-34-35 19 25-26-32-33 FA cases 1-2-3-21-38-6-27-37 13-20-36 11-39 7-8 15-16-17 14 emailprotected com