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Alcohol abuse screening questions CAGE:
Alcohol abuse screening questions CAGE:
1. Ever felt it necessary to Cut down on drinking?
2. Has anyone ever said they felt Annoyed by your drinking?
3. Ever felt Guilty about drinking?
4. Ever felt a need to have a morning drink as an Eye opener? Abdominal swelling causes 5 F's:
Fat
Feces
Fluid
Flatus
Fetus
Full-sized tumors Patient examination organization SOAP:
Subjective: what the patient says.
Objective: what the examiner observes.
Assessment: what the examiner thinks is going on.
Plan: what they intend to do about it. Vomiting: non-GIT differential ABCDEFGHI:
Acute renal failure
Brain [increased ICP]
Cardiac [inferior MI]
DKA
Ears [labyrinthitis]
Foreign substances [Tylenol, theo, etc.]
Glaucoma
Hyperemesis gravidarum
Infection [pyelonephritis, meningitis] History: quick EMS medical history checklist SAMPLE:
Signs/ Symptoms
Allergies
Medications
Pertinent history
Last oral intake
Events preceding this incident Pain history checklist OPQRSTU:
Onset of pain (time, duration)
Palliative factors for pain
Quality of pain (throbbing, stabbing, dull, etc.)
Region of body affected
Severity of pain (usually scale of 1-10)
Timing of pain (after exercise, in evening, etc.)
U: How does it affect 'U' in your daily life?
? May wish to expand to OPPQRRSTTUVW, with the extra letters representing:
Provocative factors
Radiation (how does pain spread)
Treatments tried
Deja Vu: Has this happened before?
Worry: What do you think or fear that it is? Differential diagnosis checklist "A VITAMIN C"
A and C stand for Acquired and Congenital
? VITAMIN stands for:
Vascular
Inflammatory (Infectious and non-Infectious)
Trauma/ Toxins
Autoimmune
Metabolic
Idiopathic
Neoplastic
? Example usage: List causes of decreased vision: Central retinal artery occlusion, Retinitis pigmentosa, Perforation to gobe, Chronic Gentamycin use, Ruematoid arthritis, Diabetes, Idiopathic, Any eye tumor, Myopia. Sign vs. symptom sIgn: something I can detect even if patient is unconscious.
sYMptom is something only hYM knows about. Eyes: abbreviations for the eyes You look OUt with Both eyes.
Take the Right dose so you won't OD [overdose].
The only one that is Left is OS.
? Both eyes=OU, Right eye=OD, Left eye=OS. Medical history: disease checklist MJ THREADS:
Myocardial infarction
Jaundice
Tuberculosis
Hypertension
Rheumatic fever/ Rheumatoid arthritis
Epilepsy
Asthma
Diabetes
Strokes
? Aside: "History" album was by Michael Jackson (MJ). 11 Pain history checklist "On Days Feeling Low Character, Run A Seven Pace Race":
Onset
Duration
Frequency
Location
Character
Radiation
Severity
Precipitating factors
Relieving factors Pain history checklist ASK LAST:
Aggravating/ Alleviating
Severity
Karacter
Location
Associated symptoms
Setting
Timing Pain history checklist SOCRATES:
Site
Onset
Character
Radiation
Alleviating factors/ Associated symptoms
Timing (duration, frequency)
Exacerbating factors
Severity
? Alternatively, Signs and Symptoms with the 'S'. Symptom attributes "FAST LQQ'S":
Factors that make it better/worse
Associated manifestations
Setting
Timing
Location
Quality
Quantity
Severity Heart valve auscultation sites "All Patients Take Meds":
? Reading from top left:
Aortic
Pulmonary
Tricuspid
Mitral
? See diagram.
? Alternatively: All Prostitutes Take Money.
? Alternatively: APe To Man. Four point physical assessment of a disease "I'm A People Person":
Inspection
Auscultation
Percussion
Palpation Physical exam for 'lumps and bumps' "6 Students and 3 Teachers go for CAMPFIRE":
Site, Size, Shape, Surface, Skin, Scar
Tenderness, Temperature, Transillumination
Consistency
Attachment
Mobility
Pulsation
Fluctuation
Irreducibility
Regional lymph nodes
Edge Surgical sieve VANISHED:
Vascular
Accident & trauma
Neoplastic
Inflammatory
Septic
Haematologic/ Hereditary
Endocrinological
Degenerative Differential diagnosis checklist "I VINDICATE AID":
Idiopathic
Vascular
Infectious
Neoplastic
Degenerative
Inflammatory
Congenital
Autoimmune
Traumatic
Endocrinal and metabolic
Allergic
Iatrogenic
Drugs Symptom sieve "TIN CAN BED DIP POG":
Trauma
Infection
Neoplasm
Cardiac
Autoimmune
Neurological
Blood/ Bone
Endocrine
Disintegration/ Degeneration
Drugs
Iatrogenic/ Idiopathic
Psychological
Paediatric
Obstetric
Gynaecological 21 Pain history checklist LOST WAR:
Location
Onset
Severity
Time
Worsening factors
Alleviating factors
Radiation Short statue causes RETARD HEIGHT:
Rickets
Endocrine (cretinism, hypopituitarism, Cushing's)
Turner syndrome
Achondroplasia
Respiratory(suppurative lung disease)
Down syndrome
Hereditary
Environmental (postirradiation, postinfectious)
IUGR
GI (malabsorption)
Heart (congenital heart disease)
Tilted backbone (scoliosis) Ascultation: crackles (rales) "PEBbles":
Pneumonia
Edema of lung
Bronchitis Pain history checklist CHLORIDE:
CHaracter (stabbing, throbbing, etc.)
Location
Onset
Radiation
Intensity
Duration
Exacerbating and alleviating factors Differential diagnosis CIMETIDINE:
Congenital
Infection/ Inflammatory
Metabolic
Endocrine
Trauma
Iatrogenic
Degenerative
Idiopathic
Neoplastic
Everything else Sign vs. symptom Remember Ace of Base's song that goes like this:
"I Saw the Sign, and it opened up my eyes".
The physician sees the signs. Systems review: systems checklist I PUNCH EAR:
Integumental
Pulmonary
Urogenital
Nervous
Cardiovascular
Hematolymphoid
Endocrine
Alimentary
Reproductive Pain history checklist MR. C T FARADS:
Main site
Radiation
Character
Timing
Frequency
Associated factors
Relieving factors
Aggravating factors
Duration
Severity Abdomen assessment To assess abdomen, palpate all 4 quadrants for DR. GERM:
Distension: liver problems, bowel obstruction
Rigidity (board like): bleeding
Guarding: muscular tension when touched
Eviseration/ Ecchymosis
Rebound tenderness: infection
Masses Pain history checklist CLITORIS:
Character
Location
Intensity
Timing
Onset
Radiating
Irritating and relieving factors
Symptoms associated 31 Heart valve auscultation sites"All People Try Marijuana": Aortic Pulmonic Tricuspid Mitral Consolidations: soundConsolidations Conduct Consonants Clearly Past medical history (PMH)VAMP THIS:
Vices (tobacco, alcohol, other drugs, sexual risks) Allergies Medications Preexisting medical conditions Trauma Hospitalizations Immunizations Surgeries Patient profile (PP) LADDERS:
Living situation/ Lifestyle Anxiety Depression Daily activities (describe a typical day) Environmental risks/ Exposure Relationships Support system/ Stress Family history (FH)BALD CHASM: Blood pressure (high) Arthritis Lung disease Diabetes Cancer Heart disease Alcoholism Stroke Mental health disorders (depression, etc.) Differential diagnosis checklistDIRECTION: Drugs Infection Rheumatologic Endocrine Cardiovascular Trauma Inflammatory Other Neoplasm Pathologic classificationNIT DIT FIT: Neoplastic Infectious Traumatic Degenerative/ Drugs Immune Toxic Vascular Inflammatory Totally obscure Pyrexia of Unknown Origin: history taking
SIT ON FRAD: Sexual history Immunisation status Travel history Occupational history Nutrition (consumption of dairy products, etc.) Family history Recreational habits Animal contacts (including ticks and other vectors) Drug history Health related behavior (HRB) topics: history taking"Healthy SEEDS":
Substances (alcohol, tobacco, IV drugs?)
Environment (hazards at home or work? feel safe?)
Exercise (what do you do? how often do you do it?)
Diet (any special diet?)
Sex (active with m/f/both? >1 partner? safe sex? STD history? difficulty with arousal or orgasm? history of abuse?)
? I find this order works well: patients most expect to be asked about alcohol and they least want to talk about their STD history, but taking a solid HRB history first reassures them that it's all part of good medical care. Breast history checklist LMNOP: Lump Mammary changes Nipple changes Other symptoms Patient risk factors Pain history checklist
COLDER BARS:
Character Onset Location Duration Exacerbating factors Radiation Before (ever happened before) Associated symptoms Relieving factors Severity Pain history checklistSO CRAP: Site Onset Character Radiates to Associated symptoms/ Alleviating and exacerbating factors Periodicity History, HCFA components for E+M codingQ LSD MCAT: Quality Location Severity Duration Modifying factors Context Associated signs and symptoms Timing Surgical sieve for diagnostic categories INVESTIGATIONS:
Iatrogenic Neoplastic Vascular Endocrine Structural/ Mechanical Traumatic Inflammatory Genetic/ Congenital Autoimmune Toxic Infective Old age/ Degenerative Nutritional Spontaneous/ Idiopathic Mental state examination: stages in order
"Assessed Mental State To Be Positively Clinically Unremarkable":
Appearance and behaviour [observe state, clothing...] Mood [recent spirit] Speech [rate, form, content] Thinking [thoughts, perceptions] Behavioural abnormalities Perception abnormalities Cognition [time, place, age...] Understanding of condition [ideas, expectations, concerns] Branham sign: definition BRAnham sign: BRAdycardia after compression or excision of a large AV fistula. Glasgow coma scale: components and numbers? Scale types is 3 V's: Visual response Verbal response Vibratory (motor) response ? Scale scores are 4,5,6: Scale of 4: see so much more Scale of 5: talking jive Scale of 6: feels the pricks (if testing motor by pain withdrawl)
1. Ever felt it necessary to Cut down on drinking?
2. Has anyone ever said they felt Annoyed by your drinking?
3. Ever felt Guilty about drinking?
4. Ever felt a need to have a morning drink as an Eye opener? Abdominal swelling causes 5 F's:
Fat
Feces
Fluid
Flatus
Fetus
Full-sized tumors Patient examination organization SOAP:
Subjective: what the patient says.
Objective: what the examiner observes.
Assessment: what the examiner thinks is going on.
Plan: what they intend to do about it. Vomiting: non-GIT differential ABCDEFGHI:
Acute renal failure
Brain [increased ICP]
Cardiac [inferior MI]
DKA
Ears [labyrinthitis]
Foreign substances [Tylenol, theo, etc.]
Glaucoma
Hyperemesis gravidarum
Infection [pyelonephritis, meningitis] History: quick EMS medical history checklist SAMPLE:
Signs/ Symptoms
Allergies
Medications
Pertinent history
Last oral intake
Events preceding this incident Pain history checklist OPQRSTU:
Onset of pain (time, duration)
Palliative factors for pain
Quality of pain (throbbing, stabbing, dull, etc.)
Region of body affected
Severity of pain (usually scale of 1-10)
Timing of pain (after exercise, in evening, etc.)
U: How does it affect 'U' in your daily life?
? May wish to expand to OPPQRRSTTUVW, with the extra letters representing:
Provocative factors
Radiation (how does pain spread)
Treatments tried
Deja Vu: Has this happened before?
Worry: What do you think or fear that it is? Differential diagnosis checklist "A VITAMIN C"
A and C stand for Acquired and Congenital
? VITAMIN stands for:
Vascular
Inflammatory (Infectious and non-Infectious)
Trauma/ Toxins
Autoimmune
Metabolic
Idiopathic
Neoplastic
? Example usage: List causes of decreased vision: Central retinal artery occlusion, Retinitis pigmentosa, Perforation to gobe, Chronic Gentamycin use, Ruematoid arthritis, Diabetes, Idiopathic, Any eye tumor, Myopia. Sign vs. symptom sIgn: something I can detect even if patient is unconscious.
sYMptom is something only hYM knows about. Eyes: abbreviations for the eyes You look OUt with Both eyes.
Take the Right dose so you won't OD [overdose].
The only one that is Left is OS.
? Both eyes=OU, Right eye=OD, Left eye=OS. Medical history: disease checklist MJ THREADS:
Myocardial infarction
Jaundice
Tuberculosis
Hypertension
Rheumatic fever/ Rheumatoid arthritis
Epilepsy
Asthma
Diabetes
Strokes
? Aside: "History" album was by Michael Jackson (MJ). 11 Pain history checklist "On Days Feeling Low Character, Run A Seven Pace Race":
Onset
Duration
Frequency
Location
Character
Radiation
Severity
Precipitating factors
Relieving factors Pain history checklist ASK LAST:
Aggravating/ Alleviating
Severity
Karacter
Location
Associated symptoms
Setting
Timing Pain history checklist SOCRATES:
Site
Onset
Character
Radiation
Alleviating factors/ Associated symptoms
Timing (duration, frequency)
Exacerbating factors
Severity
? Alternatively, Signs and Symptoms with the 'S'. Symptom attributes "FAST LQQ'S":
Factors that make it better/worse
Associated manifestations
Setting
Timing
Location
Quality
Quantity
Severity Heart valve auscultation sites "All Patients Take Meds":
? Reading from top left:
Aortic
Pulmonary
Tricuspid
Mitral
? See diagram.
? Alternatively: All Prostitutes Take Money.
? Alternatively: APe To Man. Four point physical assessment of a disease "I'm A People Person":
Inspection
Auscultation
Percussion
Palpation Physical exam for 'lumps and bumps' "6 Students and 3 Teachers go for CAMPFIRE":
Site, Size, Shape, Surface, Skin, Scar
Tenderness, Temperature, Transillumination
Consistency
Attachment
Mobility
Pulsation
Fluctuation
Irreducibility
Regional lymph nodes
Edge Surgical sieve VANISHED:
Vascular
Accident & trauma
Neoplastic
Inflammatory
Septic
Haematologic/ Hereditary
Endocrinological
Degenerative Differential diagnosis checklist "I VINDICATE AID":
Idiopathic
Vascular
Infectious
Neoplastic
Degenerative
Inflammatory
Congenital
Autoimmune
Traumatic
Endocrinal and metabolic
Allergic
Iatrogenic
Drugs Symptom sieve "TIN CAN BED DIP POG":
Trauma
Infection
Neoplasm
Cardiac
Autoimmune
Neurological
Blood/ Bone
Endocrine
Disintegration/ Degeneration
Drugs
Iatrogenic/ Idiopathic
Psychological
Paediatric
Obstetric
Gynaecological 21 Pain history checklist LOST WAR:
Location
Onset
Severity
Time
Worsening factors
Alleviating factors
Radiation Short statue causes RETARD HEIGHT:
Rickets
Endocrine (cretinism, hypopituitarism, Cushing's)
Turner syndrome
Achondroplasia
Respiratory(suppurative lung disease)
Down syndrome
Hereditary
Environmental (postirradiation, postinfectious)
IUGR
GI (malabsorption)
Heart (congenital heart disease)
Tilted backbone (scoliosis) Ascultation: crackles (rales) "PEBbles":
Pneumonia
Edema of lung
Bronchitis Pain history checklist CHLORIDE:
CHaracter (stabbing, throbbing, etc.)
Location
Onset
Radiation
Intensity
Duration
Exacerbating and alleviating factors Differential diagnosis CIMETIDINE:
Congenital
Infection/ Inflammatory
Metabolic
Endocrine
Trauma
Iatrogenic
Degenerative
Idiopathic
Neoplastic
Everything else Sign vs. symptom Remember Ace of Base's song that goes like this:
"I Saw the Sign, and it opened up my eyes".
The physician sees the signs. Systems review: systems checklist I PUNCH EAR:
Integumental
Pulmonary
Urogenital
Nervous
Cardiovascular
Hematolymphoid
Endocrine
Alimentary
Reproductive Pain history checklist MR. C T FARADS:
Main site
Radiation
Character
Timing
Frequency
Associated factors
Relieving factors
Aggravating factors
Duration
Severity Abdomen assessment To assess abdomen, palpate all 4 quadrants for DR. GERM:
Distension: liver problems, bowel obstruction
Rigidity (board like): bleeding
Guarding: muscular tension when touched
Eviseration/ Ecchymosis
Rebound tenderness: infection
Masses Pain history checklist CLITORIS:
Character
Location
Intensity
Timing
Onset
Radiating
Irritating and relieving factors
Symptoms associated 31 Heart valve auscultation sites"All People Try Marijuana": Aortic Pulmonic Tricuspid Mitral Consolidations: soundConsolidations Conduct Consonants Clearly Past medical history (PMH)VAMP THIS:
Vices (tobacco, alcohol, other drugs, sexual risks) Allergies Medications Preexisting medical conditions Trauma Hospitalizations Immunizations Surgeries Patient profile (PP) LADDERS:
Living situation/ Lifestyle Anxiety Depression Daily activities (describe a typical day) Environmental risks/ Exposure Relationships Support system/ Stress Family history (FH)BALD CHASM: Blood pressure (high) Arthritis Lung disease Diabetes Cancer Heart disease Alcoholism Stroke Mental health disorders (depression, etc.) Differential diagnosis checklistDIRECTION: Drugs Infection Rheumatologic Endocrine Cardiovascular Trauma Inflammatory Other Neoplasm Pathologic classificationNIT DIT FIT: Neoplastic Infectious Traumatic Degenerative/ Drugs Immune Toxic Vascular Inflammatory Totally obscure Pyrexia of Unknown Origin: history taking
SIT ON FRAD: Sexual history Immunisation status Travel history Occupational history Nutrition (consumption of dairy products, etc.) Family history Recreational habits Animal contacts (including ticks and other vectors) Drug history Health related behavior (HRB) topics: history taking"Healthy SEEDS":
Substances (alcohol, tobacco, IV drugs?)
Environment (hazards at home or work? feel safe?)
Exercise (what do you do? how often do you do it?)
Diet (any special diet?)
Sex (active with m/f/both? >1 partner? safe sex? STD history? difficulty with arousal or orgasm? history of abuse?)
? I find this order works well: patients most expect to be asked about alcohol and they least want to talk about their STD history, but taking a solid HRB history first reassures them that it's all part of good medical care. Breast history checklist LMNOP: Lump Mammary changes Nipple changes Other symptoms Patient risk factors Pain history checklist
COLDER BARS:
Character Onset Location Duration Exacerbating factors Radiation Before (ever happened before) Associated symptoms Relieving factors Severity Pain history checklistSO CRAP: Site Onset Character Radiates to Associated symptoms/ Alleviating and exacerbating factors Periodicity History, HCFA components for E+M codingQ LSD MCAT: Quality Location Severity Duration Modifying factors Context Associated signs and symptoms Timing Surgical sieve for diagnostic categories INVESTIGATIONS:
Iatrogenic Neoplastic Vascular Endocrine Structural/ Mechanical Traumatic Inflammatory Genetic/ Congenital Autoimmune Toxic Infective Old age/ Degenerative Nutritional Spontaneous/ Idiopathic Mental state examination: stages in order
"Assessed Mental State To Be Positively Clinically Unremarkable":
Appearance and behaviour [observe state, clothing...] Mood [recent spirit] Speech [rate, form, content] Thinking [thoughts, perceptions] Behavioural abnormalities Perception abnormalities Cognition [time, place, age...] Understanding of condition [ideas, expectations, concerns] Branham sign: definition BRAnham sign: BRAdycardia after compression or excision of a large AV fistula. Glasgow coma scale: components and numbers? Scale types is 3 V's: Visual response Verbal response Vibratory (motor) response ? Scale scores are 4,5,6: Scale of 4: see so much more Scale of 5: talking jive Scale of 6: feels the pricks (if testing motor by pain withdrawl)
