DATE : _____________

Appendix A : REVIEW OF SYSTEM ( 20% )

Name :
Constitutional ( 2% ): fatigue; weakness; weight loss. No fever ; chills

Neurologic ( 4%) : No headache ;No syncope ; no seizures ; no areas of focal

weakness ; no sensory problems / numbness ; “tingling” or “ pins and needles ;
“no history of seizures ; no dizziness; no scotoma ; no vertigo ; no tremors or
other involuntary movements

Eyes (3%): No significant visual difficulties; blurred vision ; No diplopia ; no eye

pain
ENT : No problems in hearing; no sore throat no sinus drainage ; no epistaxis ;
no tinnitus

Cardiovascular / PVS ( 10%): no chest pain or discomfort ; no PND, no

orthopnea ; no easy fatigability; no palpitation ;Rheumatic fever manifestations (
sore throat , fever and joint pains); no claudication ; pedal edema; no leg cramps

Respiratory ( 10%) : no cough ; no difficulty of breathing ; no hemoptysis ; (

GINA guidelines if asthma)

Gastroenterology ( 4%): Dysphagia ; odynophagia ; change in appetite ;

belching or bloatedness; flatulence ; burping No nausea ; no vomiting ; no
abdominal pain ; no diarrhea/ constipation ; no change in bowel movement ; no
melena ; no hematochezia

GUT (2%): dysuria or burning pain on urination ; incontinence ; hematuria;

nocturia ; frequency ; polyuria/ oliguria ; urgency ; hesitation; dribbling ; loss of
parabolic curve

Musculoskeletal ( 1%) : No joint pain ; swelling or redness ; no decreased range

of motion ; no myalgia ; arthritis ; arthralgia

Endocrine (2%) : No diabetes ( 3 P’s ) ; no thyroid disease ( heat or cold

intolerance ; Wayne’s index ) or hormone replacement ; no hot flashes or night
sweats

Immunologic /Hematologic (1%) : no easy bruising or bleeding ; No urticarial/

allergy

Psychiatric(1%) : No insomnia ; depression ; mania or mood swings ; no

psychotropic drugs

* All types of pain = LPPQRST ( location, provocative and palliative factors , quality ,
radiation ; severity and timing or temporal profile )
Please check if : ____Dictation Exam (OSCE1) _____ Practical Exam(OSCE2)

OSCE ( Objective Structural Clinical Examination ) 80% :

_________ (5% )General survey : conscious , coherent. Afebrile, ambulatory with the ff. vs
: BP= ? mm Hg ; CR = ? / min ( regular / irregular ) RR== ? / min Temp = ? oC ; WC = ?
inches ; Ht = ? meters ; Weight = ? kg ; BMI = ?
_________(5% )HEENT : pinkish palpebral conjunctivae ; anicteric sclerae ; (-) circus senilis ;
(-) xanthelasma ; (-) alopecia ; (-) Tonsillopharyngeal congestion ; ( -) nasal septal deviation ;
( -) congested turbinates ) ( - ) naso-aural discharge
________(10% )Neck : supple ; JVP = 5 cm at 45 degrees ; (-) thyromegaly ; (-) cervical
lymphadenopathy ; (-) carotid bruit ; thyroid examination ( size , consistency; character of borders
; measurements of left and right thyroid ; tenderness ; nodularity ; thyroid bruit )
________(20% ) Chest/ Lungs : symmetrical ; (-) retractions ;(-) lag; (-) spider angiomas; equal
vocal and tactile fremiti ; equally resonant on both lung fields; equal breath sounds ; (-)rales ; (-)
wheezes
_________(25% ) Heart : Adynamic precordium ; Apex beat at the 4th or 5th intercostal space left
midclavicular line ; (-) thrills/ heaves ; (-)loud and palpable P2 ; normally split S2 ; S1 > S2 at
apex ; S2 > S1 base ; (-) S3 ; (-) S4 ; normal rate regular rhythm ; (-) murmurs
_________(25% ) Abdomen : Abdominal girth = cm ; flat ; (-) caput medusae ; normoactive no.
of bowel sounds / min. ; soft; nontender ; tymphanitic ; (-) splenomegaly ; liver span = __ cm at
the midclavicular line ; liver edge non palpable ( if palpable cms below the ribs ;
smooth/nodular edge ; nodular / smooth surface of the liver )
________ (5% ) Extremities : (-) deformities ; ( -) clubbing ; (-) cyanosis ; with the ff. pulses :
DP PT P F B R
R ++ ++ ++ ++ ++ ++
L ++ ++ ++ ++ ++ ++
_________ (5% )Rectal exam : ( -) anal tags ‘ good sphincteric tone ;rectal vault not collapse ;(-)
hemorrhoids nor mass noted; brownish stools in the tactating finger

Total Score : ______________

Preceptor ( Name and Sign) : _____________________________________

Student ( Name and Sign ) : __________________________________