MNEMONICS FOR STEP 2 CS

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, Diarrheafrequency,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. AAllergies, M-Medications, IF I-Ill contacts, F -family history, BIG -Bbirth hx, I-Immunizations, G-Growth n development,ht,wt,milestones. D-DEALS- Day care, E-Eating habits,feeding of da baby, A-Appetite, LLook 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