MNEMONICS FOR STEP 2 CS

Discussion in 'USMLE STEP 2 CS' started by Guest, Dec 20, 2008.

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    Guest Guest

    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)


    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:


    Drugs
    Infection
    Rheumatologic
    Endocrine
    Cardiovascular
    Trauma
    Inflammatory
    Other
    Neoplasm
    For Social History I use TIA SHOE:

    T obacco

    I llicit drigs

    A lcohol

    S exual

    H ouse life

    O ccupation

    E ating (diet)

    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 tha baby or appearance, S- Sleep


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

    i used BINDER - 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

    premenopausal symptoms

    HAVOC

    H- hotflahes
    A-atropy of vagina
    V-vaginal dryness
    O- osteoporosis
    C- coronary artery diseases
    FOR all Discharges.... including Diarrhoea,Cough ...............ACCOD

    A-amount
    C -consistency
    C- color
    O- odor
    D- duration
    Depression.SIGEMCAPS

    S-sleep
    I-interest
    G-guilt,gun
    E-energy
    M-mood
    C-concentration
    A-appetite
    P-psycomotor
    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 ??????
    ( if patient was sent or asked by anyone to consult doc )fatigue...IMP ADH
    I-infectin
    M -malignancy
    P-ptsd
    A-abuse
    D-depression
    H-hypothyroidism
    For Spousal abuse, I have read the acronym SAFEGARDS some where.Can some complete it for me or give more add ons

    S= Safety inquiry (Do you feel safe at home?)
    A= Alchol abuse (does your hubby abuses alchol?)
    F= Friends/Family who are aware/Fractures ( Dos any1 f ur friend/Fx knw f dis/Abuse ever resulted in fractures?
    E=Emergency plan (do u hav an emergency plan?/Ever tried to leave/divorce? why not?
    G=Guns at home (are dere any weapons @ home?
    A=any escape plan ?
    R=Relationships with husband (how is ur relationship wid hubby? --> do you feel threatened wen he is around?
    D=Depression/Drugs (hav u lost wt appetite sleep ) does hubby dos drugs
    S=Suicidal ideation (ever felt like ending it all up? )
    Insomnia counselling =ABCDEFGHJKLMN
    Avoid
    Bedtime
    Concerns (worries)
    Drugs (nicotine/caffeine/Alcohol)
    Excercise/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 ( >5yrs )
    Motivate (thru Rewards)

    Conselling DM & HTN= MEDOWS
    Medications (regularity)
    Excercise ( for obese/sedentary life styles)
    Diet Modification( Salt/Fatty foods)
    Opthalmoscopic exams (annual routine)
    Weight Management (/control)
    Suger Check ups

    -
    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 cant do cold turkey den just taper down a bit)
    Excercise Programs ( eg Swimming )
    Rewards ( reward urself, treat urself 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 (CONDOMS
    OPPURTUNISTIC INFECTIONS/OBSERVATION (FOR LABS)
    HOPI For A CC OF URINARY COMPLAINT
    (b)FINISHED PUBS(/b)
    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)

    CC of Memory Loss/Dementia/Alzheimers/MID/Creutfeldt jakob/Pseudotumor cerebrii etc
    HOPI Particularts to ask -ADL = Activities of daily living = DEATH

    Dressing
    Eating
    Ambulation (can u find ur way thru home)
    Toiletry (do u manage ur toiletry un assisted)
    Housing
    IADL - Instrumental acitivities of daily living =SHAFT
    Shopping
    Housekeeping? unsure about that
    Accounting
    Food (do u do ur cooking ,etc)
    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

    OBESITY
    OBESITY-DISC
    Osteoarthritis
    Breathing problems
    Excess Cholestrol
    Sleep Apnea
    Increased Incidence Ca's (Endomet/Breast/Colon)
    Type 2 DM
    hYpertension
    Depression
    Incontinence
    Stress
    Cholelithiasis/Cycle disturbances/Cardiac


    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
    Obesity counseling

    ABCDEF

    Avoid Advice (Eg.Sedentary/Steroids) /Advantages Advice (Low Heart/Brain/Ca etc risk)

    Books (self help reading material)

    Counseling/Consult/ Cholesterol checks

    Dietitian

    Exercise
    Fatty Food (cut backs)

    Syncope/ Loss of Consciousness/Spells

    CAMPUS
    • CAD
    • Arrythmias/ Aortic Stenosis
    • Migraine/ Meds
    • Psychiatric /Personality disorder( hyperventilation)
    • Unexplained Syncope
    • Seizures/Strokes
    D/D Confusion

    Pneumonic = DEMENTIA
    • Diabetes /Dementia/ Drugs
    • Epilepsy
    • Migraine/Mult Infarct Dementia
    • Ethanol (withdrawl / Toxicity)
    • Neurological Deficit diseases= BETA (Bleeds,Encephalitis,Tumors,Abscess,Meningitis)
    • TIA/ Trauma
    • Insulin/ Infections
    • Alzheimers/Abscess

    Check list accordingly :- Numbness weakness/Headach ,Flashes, N/V /Jerky movements, LOC/ Insulin use /PHx Trauma/FHx of Alzheimer + Risk factor screen (Cholestrol,HTN,DM etc). For Suspected DEMENTIA =Instrumental inquiry = SHAFT Q's (Shop/Housekeep/Aaccount/Food prep/ Transport) , & Daily activity inquiry =DEATH Q's (Dress/Eat/Ambulate/Toilet/Hygiene)
    D/D = BACK PAIN

    Pneumonic = LIMCOTS
    • Lumbar Spinal stenosis
    • Intervertebral disc herniation
    • Multiple Myeloma/ Mets (Prostate, Breast ,Lung)
    • Cauda equina synd/ Cancer
    • Osteoporosis/Osteoarthritis
    • Trauma/ TB
    • Strain (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/Suport

    Nasuea & Vomiting = A MOPING
    • Anorexia
    • Metabolic( DKA)/Meds
    • Obstruction (pyloric /Intestinal)
    • Pregnancy
    • Inflammation( Pyelo/Cholecysto/Appi/Pancreas/PID)
    • Neurological (BETA)= Bleed/Encephalitis/Tumor/Abscess
    • Gastroenteritis
    Dizziness is DENTAL CAMPUS
    • Diabetic comp ( Orthostatic )
    • Ear problems (Meniere's/ BPV)
    • Neural tumors/Neuropathy
    • Thyroid
    • Anemia
    • L leave me
    • CAMPUS is same as is for SPELLS/LOC/SYNCOPE
    Here's a mnemonic for the ObGyn Hx :

    LMP RTV CS PAP

    LMP !!
    Menarchae
    Period ( lasts .... days?)
    Reglarity ( 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 ? )

    Here's one for the causes of Dyspareunia :
    DATIVE ! ( u have to be on a date to have sex )

    Domestic abuse
    Atrophic vaginiyis ( 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)
    GI hx .ABCDEFGHIJ+.MNOP

    A-appetite

    B-BOWEL HABITS.,

    C-CONSTIPATION

    D-diarrhea

    E-EATING HABITS.

    F-FEVER

    H-HAEM IN STOOL

    I-incontinence

    J-JAUNDICE

    M-medications eg iron tabs causin constipation or antibiotics causin diarrhea

    N-nausea

    O-OFCOURSE nausea followed by VOMITING

    P-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

    for foot pain after asking all liqoraaa ask WET SURF

    Work

    Eye infection redness

    Trauma to foot

    Stifness in other joints

    Urethral discharge

    Rash/reiter synd

    Fever

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