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 factors
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)

Past Medical Illnesses Hx: ABCDEFGHIJK

Asthma
Blood pressure
CVA (Stroke)
Diabetes
Epilepsy
Fever (Rheumatic)
GI- PUD/GERD
Heart attack (MI)
Infection (TB)
Jaundice & liver Dz
Kidney disease

PMH (past medical history)

Search for: PAM HUGS FOSS
P 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 past
U 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-Weight
A-Appetite
D-Diet
S-Smoke
A-Alcohol
D-Drugs
T-Travel
O-Occupation
E-Excercise
S-Stress

Differential diagnosis checklist

DIRECTION: Differential Dx checklist (2nd) – VITAMINES C:
Drugs Vascular/CVS
Infection Infectious
Rheumatologic Trauma/Toxin
Endocrine Autoimmune/Allergic
Cardiovascular Metabolic/Medication
Trauma Inflammatory/Idiopathic
Inflammatory Neoplastic/Nutritional/Neuronal (nervous
Other system)
Neoplasm Endocrine
pSychiatric/Substance
Congenital
Drugs

For Social History I use TIA SHOE:

T obacco
I llicit drigs
A lcohol
S exual
H ouse life
O ccupation
E ating (diet)
Cough DDx: PLEURAL CAP
Pneumonia
Lung cancer
Exacerbation of COPD
Ear infection (Otitis media)
URI
Reflux disease (GERD)
Asthma
Lymphoma
CHF
Abscess
Post nasal drip

LIQOR AAAAA
last 2 A = associated q for d/d like weight lifting, travel history
A= 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 the baby or appearance, S- Sleep

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

ROS: HEENT SCAM

HEAD = Happy?/Cranky?....Eye contact?/Interested in others?....Alert?/Headache?/Neck
stiff?....Drowsy?/Lethargic? Or Hyperactive?
Eye swelling/redness/discharge
Ear pulling/discharge
Nose- runny nose, throat hacking, headache/sinusitis
Throat (Mouth ulcer, Thrash, Large tongue, Teething, Sore throat, Swallowing difficulty)
Skin (Rash, pustules, easy bruising, bleeding, yellow/blue discoloration)
Chest (Congenital heart disease, Valvular heart disease, SOB, Rapid breathing, chest depression,
cough, sputum)
Abdomen
- Distension…Mass…Bruise….Umbilicus
- Bladder (Change (recent)…Frequency….Quantity….Quality – COCA-B)
- Bowel (Change (recent)…Frequency….Quantity….Quality – COCA-B)
MSK (Joint swelling/pain…foot problem….Gait problem….Limping?)

I used BINDER for socioeconomic Hx- 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

2nd format:

BMJ CHILDREN
Birth history, Breathing difficulty
Milestones
Jaundice( neonatal)
Crying
Check-up
Headache, Neck stiffness/Fever
Immunization
Lethargy
Day care
Rash
Eye, Ear, Environment
Nose , Nutrition

Among these, Red flags and ROS are:

Breathing difficulty
Jaundice
Cry – High pitched?
Headache/Neck stiffness/Fever
Lethargy/Floppy/Weak sucking
Day care
Rash
Ear/Eye symptoms
Nose symptoms

Causes of FTT/Failure to Thrive: Infection (TB/Chronic)

ABCDEFGHI_M (OSCE Notes Reading- Short Metabolic error, Inborn
stature)
Causes of speech delay: HAMM CREP BM
Alone (Psychosocial deprivation) 1. Hearing loss (2nd common)
Bone Dysplasia 2. Autism
Chromosomal 3. Mental retardation (Commonest)
Cystic Fibrosis 4. Maturation delay (Familial)(3rd common)
Delayed Growth (Constitutional) 5. Cerebral palsy
Endocrine (Lo GH, Lo Thyroid) 6. Receptive aphasia
Familial 7. Elective mutism
GI (Malabsorption, Vomiting/Diarrhoea, IBD, 8. Psycho-social deprivation
Celiac) 9. Bilingualism
Heart/Kidney disease (CHD-Congenital heart 10. Mechanical
disease, CKD)

Premenopausal symptoms I use- B HH MM SG

HAVOC
Bleeding
H- hotflahes
Hot flashes
A-atropy of vagina
Heart racing
V-vaginal dryness
Mood swinging
O- osteoporosis
Memory problem
C- coronary artery diseases
Sleep disturbance
Genital dryness, itchiness, pain etc.
Discharges I use: OCD COCA-B/D
FOR all Discharges.... including Diarrhoea,
OCD as usual Cough ...............ACCOD
Color A-amount
Odor C -consistency
Consistency C- color
Amount O- odor
Blood D- duration
Discharge any additional

Depression MI PASS ECG Depression, SIGEMCAPS

S-sleep
Mood
I-interest
Interest
G-guilt, gun
Psychomotor agitation/retardation
E-energy
Appetite
M-mood
Sleep
Suicide C-concentration
Energy A-appetite
Concentration P-psychomotor
Guilt S-suicide

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

M- mood ( already in list )

D - Delusion / hallucination
M - memory
A- 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 ??????

To rule out spousal abuse: WAST (SHORT) Woman Abuse Screening Tool
1. In general how would you describe your relationship?
a) Lot of tension
b) Some tension
c) No tension
2. Do you and your partner work out arguments with….
a) Great difficulty
b) Some difficulty
c) No difficulty
Answer either 1.a or 2.a makes intimate partner violence likely.
Use HITS next

HITS (Hurt, Insult, Threaten, Scream)

How often does your partner….on as scale of 1 to 5 where 1 is minimal and 5 is maximal…
1. Physically HURT you?
2. INSULTS you?
3. THREATEN you with harm?
4. SCREAM or curse at you?
Score of 10.5 is significant.

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 (Does anyone of your friend/Family know of this?)
Fractures (Abuse ever resulted in fractures?
E= ED visits ever with serious fights?
G=Guns at home (are there any weapons @ home?
A= Any emergency plan (Do u have an emergency plan? Ever tried to leave/divorce? why not?
R= Relationships with husband (how is your relationship with hubby? --> do you feel threatened
when he is around? SEE WAST above + HITS)
D=Depression/Drugs (have u lost weight appetite sleep ) does hubby dos drugs
S=Suicidal ideation (ever felt like ending it all up? )
Differential diagnosis of tiredness

ABCDEFGHI (examples in brackets) Other conditions:

 Autoimmune disease (coeliac disease,  Leukaemia / lymphoma
multiple sclerosis)  Neurological disorders (Parkinson’s
 Blood disorders (anaemia) disease)
 Cancer / Chronic fatigue syndrome  Physical trauma
 Depression and other depressive  Pregnancy
mental disorders  Sleep deprivation
 Endocrine (diabetes mellitus,  Hepatic failure
hypothyroid) / Eating disorders  Uraemia
 Fibromyalgia (muscle pain) Source:
 Generalised infection (Infectious http://medmnemonics.wordpress.com/2011/
mononucleosis by EBV) 03/16/differential-diagnosis-of-tiredness-2/
 Heart disease
 Immune deficiency (HIV/AIDS)

Another mnemonic: FATIGUES

Failures (CHF, COPD, Liver, Kidney) (if patient was sent or asked by anyone to
Fibromyalgia, Chronic Fatigue Syndrome consult doc ) Fatigue...IMP ADH
Anemia I-infection
ABUSE M -malignancy
Autoimmune disorders (RA etc.) P-PTSD
Thyroid disease A-abuse
Trauma D-depression
Infections (Chronic- TB, HIV, IM-EBV etc.) H-hypothyroidism
Iatrogenic (Drugs)
Immunodeficiency (HIV)
Growth (Malignancy- Solid organ, Leukemia)
Gravid (Pregnant)
Upset (Depression)
Endocrine (DM, Addison’s disease)
Eating disorder (AN?)
Sleep disturbances
Insomnia counselling = 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)

Enuresis Counselling = SMILE SAM

Supportive (of the child)
Monitor Intake (@ Day)
Limit (@ Night)
Encourage Washroom (@ bedtime)
Sheets (Rubber flannel sheets)
Alarms (>5 yrs)
Motivate (through Rewards)

Counselling DM & HTN= MEDOWSA Foot

Medications (regularity)
Exercise (for obese/sedentary life styles)
Diet modification (Salt/Fatty foods)
Ophthalmoscopic exams (annual routine)
Weight Management (/control)
Smoking cessation, Sugar Check-ups
Alcohol reduction/stop
Foot hygiene for DM
Causes of 2⁰ HTN- ABCDE
Apnea (sleep), Aldosteronism (may be in endocrine)
Bad kidneys, Bruits
Coarctation, Cushing’s, Catecholamines, Calcemia
Drugs
Endocrine

Smoking Cessation counselling = SPANCSTER

Stressor ( 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 can’t 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 Counselling

STRIP BIMBO!
SAFE SEXUAL PRACTICES
TRANSMISSION ( 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 #)
MEDICATIONS
BARRIER METHODS (CONDOM)
OPPURTUNISTIC INFECTIONS/OBSERVATION (FOR LABS)

HOPI For A CC OF URINARY COMPLAINT

FINISHED PUBS
Frequency ( 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 AAA

Pain/Dysuria during urine

Frequency/Urgency/Nocturia/Polyuria
Hesitancy/Stream poor/Dribbling at end/Incomplete evacuation (sense of)
Urine- COCA-B
Fluid intake
Incontinence
Discharge (OsCfD Q-COCAB ST UVWFE AAA)
Oedema (Scrotum/Face/Ankle)

AAA-
Local- Redness, Itchiness, Blisters/rash/excoriation
Same- Kidney stones/UTI before
Adjacent- STI/PID/Prostatitis, any other abdominal disease
RF- Foreign body/STI/↓immunity/Fecal incontinence
C&C- Reiter’s syndrome (WET SURF), Anatomic abnormalities
Constitutional & ROS

CC of Memory Loss/Dementia/Alzheimers/MID/Creutfeldt jakob/Pseudotumor cerebrii etc

HOPI Particularts to ask -ADL = Activities of IADL - Instrumental acitivities of daily living
daily living = DEATH =SHAFT
Dressing Shopping
Eating Housekeeping? unsure about that
Ambulation (can u find ur way thru home) Accounting
Toiletry (do u manage ur toiletry un assisted) Food (do u do ur cooking ,etc)
Housing Fone (Phone) call making
Transportation (do u drive )
Shoulder pain case ( I read this one somewhere)
DEFORMS
Dislocation ( Ant/Post)
Elderly Abuse
Fracture ( Head/Shaft)
Osteoporosis /Osteoarthritis
Rotator Cuff Tear
Multiple myeloma
Subacromial Bursitis

Syncope/ Loss of Consciousness/Spells Dizziness is DENTAL CAMPUS (Or, ENT

CAMPUS CAMPUS)
CAD Diabetic comp (Orthostatic/Autonomic
Arrhythmia/Aortic Stenosis instability)
Anemia/Autonomic (DM) Ear problems (Meniere's/ BPV)
Migraine Neural tumors/Neuropathy
Meds (Anti-HTN drugs- α/β/CC blocker, vasodilator, PDE Thyroid
inhibitor sildenafil, tadalafil) Anaemia
Metabolic (Hypotension, Hypoglycemia) Leave me
Psychiatric (Panic attack, Conversion- CAMPUS is same as is for
Hyperventilation)
SPELLS/LOC/SYNCOPE
Unexplained Syncope (Vasovagal syncope, Carotid
Sinus Hypersensitivity)
Seizures/Strokes/TIA

D/D Confusion
Mnemonic = DEMENTIA
Diabetes /Dementia/ Drugs
Epilepsy
Migraine/Multi Infarct Dementia
Ethanol (withdrawal/ Toxicity)
Neurological Deficit diseases= BETA (Bleeds, Encephalitis, Tumors, Abscess, Meningitis)
TIA/Trauma
Insulin/Infections (Sepsis/UTI)
Alzheimer’s/Abscess
My mnemonic for confusion/dementia: DIMS
Drugs (Opiates, Digoxin, Anticholinergic, BDZ, Steroid, NSAIDs, Phenytoin, Theophyllin)
Infections (Lung, UTI, Meningitis, Sepsis)
Metabolic
- Basic: Hypoxia, Anemia, Dehydration, Acidosis/Alkalosis, Electrolytes (Hyponatremia)
- Failures: CHF, Resp. failure, Liver/Renal etc.
- Endocrine: Hypo/Hyperglycemia, Thyroid, Cushing’s/Addison’s, B12
Structural (Stroke, SOL, SAH/SDH/EDH, Seizure, Trauma/Surgery, Fat embolism etc.)

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)

Dementia Dx Questions: Judge MAAAT ADD MAP (Step by Step 2/e)

My modification: JES + AAAA

Judgment (What will you do if you see a fire under that couch?)
Executive function (Can you think straight? Find solution for complex problems/situations like before?)
Sleep- Any sleep disturbance before?
Aphasia – No appropriate word
Agnosia – No recognition of familiar objects
Apraxia – Loss of purposeful movement
Agenda – Do you have to keep agenda for doing day to day works?

Delirium Dx Questions: CATL + MOMSP

Confusion? Sudden onset?
Attention loss?
Thought process disorganized?
Level of consciousness altered?
Memory problem
Orientations problem
Misrepresentation (Hallucination/Illusion)
Sleep cycle altered
Psychomotor agitation/retardation
 Causes of fall in elderly: I HATE FALLING TN12
Handbook p124 (My modification- see below)
Elderly causes of fall- ABCDEFGHIJ_L_N_P
Inflammation of joints
Arrhythmia
Hypotension
Balance
Audio-visual deficit
Coordination
Tremor (PD)
Drugs (Polypharmacy)
Equilibrium/Balance
Eye/Ear problem
Foot problems
Foot problem
Arrhythmias
Gait problem
Leg length discrepancy
Hypotension (Low fluid intake/bleeding)
Lack of coordination (Cerebellar)
Illness (Chronic)
Illness
Joint problem
Nutrition
Leg length discrepancy
Gait problem
Nutrition
Parkinson’s Dz

Geriatric checklist: Geriatric Giants: 7 I’s Altered mental status/Coma causes: AEIOU
TIP S5
Impairment of Vision & Hearing
Instability/fall Alcohol/Acidosis
Incontinence & Constipation Endocrine
Iatrogenic (Polypharmacy) pathology/Electrolytes/Encephalopathy
Immobility (DEATH/SHAFT) Infection
Intellect, Memory & Sleep Opiates
Impaired homeostasis (Chronic disease) Overdose/Drugs
Uremia
Toxin
Trauma
Insulin
Psychosis
Poisoning
Porphyria
S - Shock
- SAH/SDH (Subarachnoid/dural Hge)
- SOL
- Stroke
- Seizure
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

Psychiatry, my list: AL OCD MUST+I MAP COVP SADDD + Routine

Ask, Look > OCD + AA + MUST

MAP CO (Mood, Anxiety, Psychosis, Cognitive, Organic- IMAD- Illness, Medication, Alcohol, Drugs)
VP (Vitals HISS- Homicide/Suicide/Self-care/Impaired functioning, Past Psych Hx)
SADDD (FHx of Psych disease – Suicide, Alcohol, Drugs, Depression, Divorse)
Routine – SHIAMMS TFSS

Mental Status Exam: ASEPTIC

ABCD PTT JIC
Appearance
Behaviour
C (Speech)
D (mooD)
Perception
Thought Content
Thought Process
Judgment
Insight
Cognition (MMSE)
Personality Disorders

Borderline PD: IMPULSIVE (≥5/9) Panic Disorder: STUDENTS FEAR 3C (≥ 4/15) =

Panic Attack, if with AWC = Panic Disorder
Impulsive behaviour in =/> of these areas-
Sweating
sex, spending, substance, driving, binge eating
Tremor
Mood reactivity and affective instability
Unsteady (Dizzy)
Paranoid ideation (or Dissociative symptoms)-
Depersonalization
things others will cause harm/malevolent
Derealization
intention
Excessive Heart Racing
Unstable self image (Identity disturbance)
Nausea/Vomiting
Labile (or Intense) relationships
Tingling sensation/Numbness
Suicidal behaviour
SOB
Intense anger
Fear of > Dying; > Loosing control > Going
Vulnerable to abandonment
Crazy
Emptiness
Chest Pain
Choking
Chills or hot flashes

AWC
Anticipatory Anxiety of this kind of attack for
> 1 month
Worry about consequences of the attack
Changes made to lifestyle

GAD
Duration >6mo
What are the things that you are fearing?
Blank mind makes him Irritable, so he gets Keyed up and have Sleep disturbance. So he gets
Muscle Tension and gets Easily Fatigued.
BE SKIM (≥3/6 for 6 mon, 1/6 in children)
Blank Mind
Easily Fatigued
Sleep Disturbance
Keyed Up- Always on the edge?
Irritable
Muscular Tension
Phobic Disorders OCD: WRITE
Fear of anxiety for something specific (e.g. Do you have certain thoughts or behaviours
Height) over and over again that you think you need
HE Avoids to get rid of?
Happens: What happens if you are in these What are they?
places of situations? Repetitive? Thoughts come back again and
Excessive: Is you reaction reasonable or again? (OBSESSION) > Do you feel driven to
excessive? do them? (COMPULSION)
Avoid: Do you avoid these Intrusive & Inapropriate?
place/situations/things? 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

OBESITY risks Obesity counseling

OBESITY-DISC ABCDEF
Osteoarthritis
Breathing problems Avoid Advice (e.g. Sedentary/Steroids)
Excess Cholestrol Advantages Advice (Low Heart/Brain/Ca etc
Sleep Apnea risk)
Increased Incidence Ca's Books (self-help reading material)
(Endometrial/Breast/Colon) Counseling/Consult/ Cholesterol checks
Type 2 DM Dietitian
hYpertension Exercise
Depression Fatty Food (cut backs)
Incontinence
Stress
Cholelithiasis/Cycle disturbances/Cardiac
D/D = BACK PAIN
Mnemonic = DR.LIMCOTS Original LIMCOTS

Lumbar Spinal stenosis

Degenerative- disk/joint/ligament, Ankylosing
Intervertebral disc herniation
spondylitis, UC/CD (Ulcerative/Crohn’s)
Multiple Myeloma/ Mets (Prostate, Breast
Referred (Aorta/Renal/Ureter/Pancreas)
,Lung)
Lumber Spinal stenosis
Cauda equina syndrome/ Cancer
Intervertebral disc herniation
Osteoporosis/Osteoarthritis
Multiple Mye/Mets (Prostate, Breast ,Lung)
Trauma/ TB
Cauda Equina syndrome/Cancer
Strain (muscle)
Osteoporosis/Osteoarthritis/Osteomyelitis
Trauma/TB/FracTure
Strain of 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 lost

Anesthesia – saddle region
Constitutional/malignancy- prostate/breast/lung/thyroid
Khronic illness
Paresthesia
Age >50y
IV drug user
Neurologic deficit (sensory/motor)
Headache DDx (TN2014 N38)

ER VISITS

Eye (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 (Anemia, Anoxia, CO)
ICP raised (HTN/Preeclampsia, HTN encephalopathy, SOL)
Trauma (Concussion, SDH, EDH)
Spouse abuse/pSychotic

Nausea & Vomiting = A MOPING

Anorexia
Medications
Metabolic (DKA/CRF)
Obstruction (pyloric /Intestinal)
Pregnancy
Inflammation( Pyelo/Cholecysto/Appi/Pancreas/PID)
Neurological (BETA)= Bleed/Encephalitis & Ear problems/Tumor/Abscess
Gastroenteritis

Here's a mnemonic for the ObGyn Hx :

LMP RTV CS PAP
LMP !!
Menarchae
Period ( lasts .... days?)
Regularity ( every .... wks?)
Tampoons/Pads # per day
Vaginal discharge, itching , dryness
Cramps (Dysmenorrhea)
Spotting ( intermenstrual / post coital )
Pregnency ( Hx & complications)
Abortion /miscarriage
PAP smear ( last time result ?, Hx of past abnormal result ? )
OCP counselling

Contraindications: Advantage: ABCDEF

Pr.ABCD.Smoker.Trigly.HTN.CVA/IHD.Migrain Anemia↓
Pregnancy (known/suspected) Acne↓
Active Liver Disease Benign breast Dz↓
Bleeding P/V, undiagnosed Bone protection (possibly)
Cancer, Hx of – in family Cancer↓ (Ovarian & Emdometrial)
DVT, PHx of Cycle control
Smoker + age>/=35 Cyst↓
Congenital Triglyceridemia, Hx of Dysmenorrhea↓
HTN, Uncontrolled Effective & Reversible
CVA/IHD, Hx of Fibroid↓
Migraine w/ focal neurological signs

Side effects: ABCDEF-VW

Amenorrhea
Appetite↑
Breakthrough bleeding (Spotting)
Breast Heaviness & Tenderness
Cancer (Liver Adenoma) – Rare
DVT – Common
Edema &
Fluid retention
Vomiting & Nausea
Weight↑

Pregnancy Counselling: NEW FILM RG

Nutrition: Folate, Calcium, Vit. D, Iron

Exercise: Under physician guidance
Weight gain: How much to expect? (1lb/mo for 1st half, 1lb/wk for 2nd
half) Too much + HA + Vision => VISIT ED
Food: Caffeine limited, Avoid raw food (meat, fish {Tuna, Salmon, Sushi}, poultry
(Listeria), egg, unpasteurized milk)
Immunization: Avoid live vaccines (Polio, MMR, Varicella)
Lifestyle: Abuse, Smoking, Alcohol, Cocaine, Avoid cats, Sick contact
Medication: Consult MD before. C/I - ACE inhibitor, TC, Retinoids, Misoprostol. Anticonvulsant, Lithium, Warfarin
Radiation–avoid
Genetic screening – offer every pregnant
Vaginal bleeding in Premenopausal women: ED LAB + P

Endocrine (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. John’s 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- Ectopic, Miscarriage, Cervical
incompetence, Abraptio; T2 >20wk+T3 – Abruption, Placenta previa, Vasa previa, Uterine rupture)

Amenorrhea causes: Pregnancy Causes AMENORRHEA

Pregnancy Long Mnemonic for Amenorrhea:
Chromosomal (Turner’s syndrome) KNOW THE MPT ACT
Absent ovulation Kallman’s syndrome
Menopause/Mullarian agenesis Nonfunctioning Adenoma
Exercise/Weight loss- excessive Others: - Gonadal agenesis/dysgenesis
Nursing mother - Sheehan’s syndrome
OCP Weight loss
Raised prolactin Testicular feminization
Raised adrenal hormones Exercise amenorrhea
Hypothyroidism Empty Cella syndrome
Hemorrhage (Sheehan’s syndrome) Mullarian agenesis/anomaly
Eating disorder (Anorexia Nervosa) Turner’s syndrome
Anxiety Pituitary Prolactin secreting adenoma
Asherman etc. Premature ovarian failure
Anorexia, Anovulation, Asherman’s syndrome
Short mnemonic for 2⁰ amenorrhea: SOAP
Chemotherapy/Radiotherapy
Stress
The resistant ovary syndrome
OCP
Anorexia
Pregnancy
Amenorrhea symptoms: FLAG HIV WC

Fatigue
Libido
Anorexia Nervosa
Anxiety/Depression
Galactorrhea
Hair/Skin changes (Hypothyroid, PCOS-Hirsutism)
Headaches
Hot Flushes
Insomnia
Visual disturbance
Voice change
Wt. change/Appetite/Diet
Cold Intolerance and Constipation

Here's one for the causes of Dyspareunia :

DATIVE! ( u have to be on a date to have sex )
Domestic abuse
Atrophic vaginitis ( don't forget to ask about s/s of Menopause)
Tumor ,Pelvic
Infection ( lower : Vulvovaginitis - Cervicitis / Upper : PID )
Vaginismus
Endometriosis ( don't forget to ask 'bout Cyclic pelvic pain )

Skin review of systems which aReNT SIMMBEL

R (rash)
N (nail changes)
T (temperature)
S (sensation)
I (itching)
M (masses)
M (moles)
B (bleeding/bruises)
E (edema)
L (lesions)
Gastrointestinal Hx- ABCDEFGHIJ+MNOP
Appetite
BOWEL HABITS, Any BLOOD? {OsCfD Q(COCA-B)ST AA A(PTLC- pain/tenesmus/lesion/control)}
CONSTIPATION & Diarrhea
Dysphagia
EATING HABITS.
Fullness/bloating
Girth of the abdomen
Heartburn
Incontinence
JAUNDICE
Medications eg iron tabs causing constipation or antibiotics causing diarrhea
Nausea/Vomiting
Orthostatic assessment (DTHU- Dizzy? Thirsty? Heart racing? Urine less in amount?)
Pain abdomen

Trauma pt ask for AMPLE

A Allergy
M Medication
P past med Hx
L Last meal
E Events before accident

Menstrual History FM DIAL

F Frequency
M Menarche
D Duration
I Intensity
A Amount
L LMP
For back pain "red flags"
TUNA FISH
Trauma
Unexplained weight loss
Neurological signs
Age > 50

Fever
Intravenous drug use
Steroids for long time
History of cancer

Any MSK pain after asking all OCD PQRST ask WET SURF
Work
Eye infection/redness
Trauma to pertaining organ
Stiffness in other joints
Urethral discharge
Rash/Reiter’s syndrome
Fever

(Myself)- Checklist for paraneoplastic syndrome/serotonergic symptoms

4Fs-

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!

Here'sone to help you remeber the indications of Dialysis :

I have to pee
I HAF to PE
Intoxication ( Ethylene glycol , Methanol)
Hyperkalemia
Acidosis
Fluid overload
Pericarditis
Encephalopathy

More mnemonics on: http://quizlet.com/13003048/step-2cs-mnemonics-flash-cards/