STEP 2 CS MNEMONIC

SPOUSAL ABUSE : SAFE GARDS
S= Safety inquiry (Do you feel safe at home?)
A= Alchol abuse (does your hubby abuses alcohol?)
F= Friends/Family who are aware/Fractures ( Dos any1 f ur friend/Fx knw this/Abuse ever resulted in fractures?
E=Emergency plan (do u have an emergency plan?/Ever tried to leave/divorce? why not?)
G=Guns at home (are there any weapons at home? )
A=????
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? )

HEARING LOSS
EAR HAT SOUNDDS

E-Exposure to loud sounds/ Ear ache
A-All sounds or specific sounds?
R-Ringing in the ears (tinnitus -->aspirin use,also seen in meniere ds)
H-Headache
A-Abnormal gait/balance
T-Trauma to head
S-Source of sounds can be located by the pt
O-Object insertion into ear9do u recall inserting any object into ears?)
N-Neuro problem(weakness,numbenss,tingling)
D-Dizzy,discharge from ear
D-Distorted speech
S-Spinning sensation ?vertigo (r/o meniere/labyrintitis)

hoarsenss
OPEN CHIN

O- overuse of voice
P- Pain while talking
E - Exposure to cold weather or dust recently?
N- Neck swelling(r/o goiter)
C- CVA hx(stroke//tia)
H- heartburn( r/o GERD)
I- Infection(pharyngitis/hiv/ill contact/URI)
N- night sweats/fever/chills

GI HISTORY

ABCDEFGHIJ + MNOP
Appetite,

 bowel habits,

 constipation,

 diaherrea, 

eating habits,

 fever, 

haem in stool, 

incontinence,

 jaundice,

 medication iron tablets causing constipation nausea of course followed by vomiting followed by Pain in the abdomen

Knee Pain Differential Diagnosis

SPORTS
S - Septic arthritis
P - Pseudogout, Psoriatic arthritis, Patela-femoral pain syndrome
O- Osteoarthritis
R - Rheumatoid arthritis, Reactive arthritis
T - Tophi (Gout), Trauma (fall, elderly abuse, sports)
S- Sac inflammation (Bursitis)

LIQOR PAAAPP

L Location of the symptom :forehead, wrist…
I Intensity of the symptom :scale 1-10, 6/10
Q Quality of the symptom :burning, pulsating painâ
O Onset of the symptom + precipitating factors
R Radiation of the symptom: to left shoulder and arm
P progression
A Associated symptoms: palpitations, shortness of breath
A Alleviating factors: sitting with my chest on my knees
A Aggravating factors: effort, smoking, large meals
P Previous episode

differential diagnosis of chest pain

MI
cocaine induce mi
gerd
aortic dissection
percarditis
pneumothorax
PE
costochodritis (or other musculoskeletal pain)

 

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…..)

foot/heel/knee/shoulder/back pain
LIQOR PQQP+ WET SuRF

W- Weakness,numbness,tingling
E - Extremities cold(raynaud)
T 4 - Temperature/Tick's bite /time of stTiffness/ Trauma
S 3 - Stiffness/Swelling/ Standing long h
R 4 - Rash/ Redness/ROM/rheumatological hx in past
F 3 -Fatigue/Foot wear/ Fever ,chills,night sweats

 

chest wall/abdominal trauma
COS CHEST WALL TRAUMA V

C-Context of trauma
O-Onset
S-Severity of trauma
C-Consciousness(LOC)
H-Head trauma
E-Exercabating pain/ alleviating pain
S- Sputum(hemoptysis)
T- Trauma (anywhere else body injury)
W- Weakness/numbness in extremities
A- Abdominal pain
L- Last meal /drinks
L- Liquor(if pt under alcohol or any other influences)
T- Temperature (low/fever/chills)
R- Runny liquids (discharge from mouth,ears)
A- Alertness
U- Urinating pain
M- Memory loss
A- Abnormal brain activity
V - Vision change

 

urinary complaints
B FUN HIDE PPPISSS
B-Burn
F-Frequency
U-Urgency
N-Nocturia
H-Hesitancy H- Hematuria
I-Incontinence
D-Dribbling
E-Episode simliar in past
P-Progression
P-Pain CVA/urinating
P-Prostate exam (previous)
I-Incomplete emptying
S-Stream
S-Strain
S-stone h

dy/dx of hematuria
 

HITTERS

H-Hematologic/coagulation disorder
I-Infection(UTI)
T-Trauma
T-Tumor(bladder,prostate,RCC)/BPH
E-Exercise
R-Renal disorder(glomerulonephritis)
S-Stones(urolithiasis)

 

CHILD WITH DM?
T-DIABETES MISS H-MELLITUS

T-type ?
D-Description of 1st ep(polyuria,phagia,dipsia?)
I-Irritability
A-Abnormal thirst,urination at present time
B-Birth hx
E-Eating habits
T-Tiredness(fatigue)
E-Emotion of parents/child about the disease
S-Sugar level(last sugar?ranges?)
M-Meds? meds compliants?
I-injector insulin (who does?)
S-Site of injection
S-Schedule for insulin
H-Hypoglycemic episode(DIZZYa,confuse ,sweat,palpitation_)
M-Mood
L-LMP
L-LOS
I-Itchy/skin Infection
T-Tingling/numbness/weakness
U-urinary habits
S-super child (weight gain/loss)

follow up dm patients
 

DIABETEc-NPH

D-duration
I-insulin and other drugs?(regularity,compliant se)
A-A1C(HbA1c)
B-blurry vidion(last eye exam)
B-bloating(r/o gastroparesis)
E-emotion/energy/erection (r/o depression)
T-trauma/ foot ulderr
I-infection(skin,cough,URI)
C-Cardiac RF( HTN,high cholesterol,stroke/tia,heart diserase)
N-numbness/tingling /weakness
P-perfect control of sugar
H-home glucose device
H-hypoglycemic ep(availability of juice and candy)

 

assault/rape case
DORRA SEX LOVER +LIQOR PAAAP +OTHER

D-Description of assault
O-onset/location
R-report of assault
R-recognize assailants?
A-assault method
S-sexual assault?
E-ejaculation occr?
X-x-unknown object-->foreign object used?
L-lmp , latex(condoms used?)
O-oral/anal/vaginal intercourse(what type of sexual assault was tat?)
V-Vaginal bleed? vision change
ER-estrogen replacement( r u on any oCP?)

OTHER:
-blood in urine and stoold
-loc
-dizzyness/weakness/numbness

PAIN(LIQORPAAAP)

 

 

dm and htn counseling
MEDOWS

M-meds(regulartiy/compliance)
E-Exercise ( for obese/2ndary lifestyle)
D-diet modification (less salty and fatty foods)
O-opthalmo exam(annualy)
W-weight mngmt
S-sugar check up daily

 

erectile dysfunction
LIMP PENIS

L-libido
I-injury
M-meds
P-present medical condition(dm,htn,stroke,heart problem)
P-Prostate exam in past
E-erection at all
N-nocturnal morning erection
I-incontinence
S-stress/depression

 

erectile dysfunction dydx

Drugs
HTN
DM
Psychogenic
Peyronie's disease (induratio penis plastica (IPP) or chronic inflammation of the tunica albuginea (CITA)) - connective tissue disorder involving the growth of fibrous plaques

hoarsenss
 

OPEN CHIN

O- overuse of voice
P- Pain while talking
E - Exposure to cold weather or dust recently?
N- Neck swelling(r/o goiter)
C- CVA hx(stroke//tia)
H- heartburn( r/o GERD)
I- Infection(pharyngitis/hiv/ill contact/URI)
N- night sweats/fever/chills

 

diferential dx of hoarseness

laryngeal cancer
laryngitis
vocal cord polyps/nodules
hypothyroididsm
mitral valve stenosis
GERD

 

premenopausal symptoms HAVOC

hotflashes,
atrophy of the vagina,
vaginal dryness,
CAD

 

new born questions

binder:
birth history, immunization history, nutrition, growth and development, eating, rash

 

Discharges

ABC3DO
A: amount
B: blood
C:color, consistency, content
D: duration
O: odor

 

Depression

SIGEMCAPS
sleep, interest, guilt , energy , mood, concentration, appetite , psychomotor symptoms, suicidal ideation
MDMAT
M: mood
D:delusion and hallucination
M: memory
A: attitude towards life
T: thyroid problems

 

HEARING LOSS
EAR HAT SOUNDDS

Exposure to loud sounds/ Ear ache
All sounds or specific sounds?
Ringing in the ears (tinnitus -->aspirin use,also seen in meniere ds)
Headache
Abnormal gait/balance
Trauma to head
Source of sounds can be located by the pt
Object insertion into ear9do u recall inserting any object into ears?)
Neuro problem(weakness,numbenss,tingling)
Dizzy,discharge from ear
Distorted speech
Spinning sensation ?vertigo (r/o meniere/labyrintitis)

 

Fatigue

IMP ADH
I: infection
M: malignancy,
P: PTSD,
A: abuse,
D: depression,
H: hypothyroidism

 

Abuse

SAFEGARDS
S: safety inquiry,
A: alcohol abuse ,
F: friends and family ,
E: emergency plan ,
G: guns at home,
A:? ,
R: relationship with husband,
D: depression ,
S: suicidal ideation

Insomnia

 

ABCDEFGHIJKLM
A: avoid ,
B: bed time ,
C: concern,
E: exercise and excitement ,
FGH: follow, good, habits,
KL: keep list ,
MN: monitor naps

Enuresis

 

SMILE SAM
S: supportive,
MI: monitor intake,
L: limit intake ,
E: encourage washroom,
S: sheet,
A: alarm
M: motivate

Smoking cessation

 

SPANCSTER
S: stressor ,
P: problem ,
A: advantages,
N: nicotine patch,
C: councilor,
S: support system ,
T: taper down,
E: exercise program ,
R: rewards

 

STD / HIV COUNCLING

strip bimbo
S: safe sex practices,
T: transmissions,
R: risks ,
I: immunizations,
P: prevention counseling,
B: behavior counseling,
I: interventional counseling,
M: medication ,
B: barrier methods,
O: opportunistic infections

complain of memory loss

 

DEATH SHAFT ADL
dressing ,
eating ,
ambulating,
toileting,
house keeping
shopping ,
house keeping ,
accounting ,
food ,
transportation

shoulder pain case

 

DEFORMS
d: dislocation,
e: elderly abuse ,
f: fracture,
o: osteoporosis/ osteoarthritis,
r: rotator cuff tear,
m: multiple myeloma ,
s: subacromial bursitis

 

OBESITY

obseity:
o: osteoathritis and breathing problems
e: excess cholesterol
e: sleep apnea
i: increased carcinoma incidence
t: type 2 dm
h: hYpertension
D: depression
I: incontinece
S: stress
c: cholilithias, cycle distubrnaces, cardiac

 

Psychiatric history

MISS SPEAR PAD MATCHED
M: mood,
i: idea,
s: stress, support , sleep,
P: plan,
E: energy,
a: aim,
r: routine,
s: suicide,
p: pills,
a: appetite,
d: duration,
m: memory,
a: alone,
c: concentration,
h: hopes, hallucination,
d: delusions

Obesity counceling

A2BC3DEF
Avoid advice , advantages ,
books , counsel , cholesterol, consult, dietian, exercise , fatty food,

 

Syncope / loss of conciousness/ spells

CAMPUS
CAD, arrhythmia, aortic stenosis, migraine, meds, psychiatric , personality disorder, unexplained syncope , seizure,stroke

syncope cehcklist

CAD ,Arrythmis , aortic stenosis, chest pain , palpitation , past history of MI
MIGRAINE ( nausea , vomiting , headache)
PSYCHIATRIC breathing problem , anxiety, fear of death etc
SEIZURES jerky movements, weakness numbness and tingeling, vision , speech
Bowel and bladder
FAMILY HISTORY heart , htn , diabetes, migraine, stroke)

 

d/d of confusion

DEMENT2I2A2 

diabetes/ dementia / drugs
epilepsy , multinfarct dementia. , ethanol (with drawl toxicity, neurologic defecit diseases (BETA) Bleed , enchapilitis, tumor, enchapilitis , meningitis TIA, trauma , insulin , infection alzeimers , abscess

 

D/D of back pain

LIMCOOTS
Lumbar spinal stenosis,
intervertebral disc herniation ,
multiple myeloma/mets ,
cauda equine syndrome.
Cancer(metastatic prostate cancer)
osteoprosis
osteoarthritis,
trauma .
TB
Strain( muscle)
malingering
degenenerative arthritis

 

back pain checlist

SIQORAAA and then ROS
Age ,
bone pain ,
constipation,
Multiple myeloma,
bowel bladder relieving factors,
hx of trauma ,
surgical hx (prostate ) /
chest pain ,
hemoptysis /
fever and chills with bone and joint problems/ functional impairment (SOS = help) Qs I.e sleep . occupation.
Support

 

NAUSEA AND VOMITING

A moping anorexia, metabolic( dka) meds, obstruction ( pyoleric/ intestinal) pregnancy , inflammation( pyelo. Chole, appendix, pancrease, PID
Neurologic

BETA
bleeds , enchapilitis, tumor, abscess gastroenteritis

 

dizziness DENTAL CAMPUS

diabetic complication orthostatic
ear problems meneirs / BPV
neural tumors / neuropathy,
thyroid ,
anemia, leave me ,
 

CAMPUS is for spells / LOC / SYNCOPE

NEURO CASES HISTORY

HV U SW C THN GLL FF VD?
Headache,

visual disturbance, 

urinary/ incontinence, 

sleep disturbance, 

weakness/ numbness/ confusion / convulsion tinnitus. 

Hearing loss/ 

nausea/

 gait / 

loss of conciousness/

 lightheadedness/ 

falls trauma ,

 fullness of ear ,

 vomiting ,

 discharge ear

 

 

assosciated symptoms of amenorrhea

HAG V FWL HiDC
H- Hair and skin changes for hypothyroidism/ hirsuitism of PCOS headaches
A- Anorexia nervosa/ anxiety and depression
G- galactorrhea
V- visual disturbance / virlization /
F- fatigue ,
W- weight changes, appetite and diet ,
L- libido ,
H- hot flashes ,
I- insomnia,
D- deep voice changes,
C- cold intolerance, constipation

dysparunia DATIVE

D- Domestic abuse
A- atrophic vaginitis, don't forget to ask about signs and symptoms of menopause
T- tumor of pelvic
I- pelvic infection,(Vulvovaginitis,cervicitis,PID)
V- vaginismus ,
E- endometriosis don't forget to ask about cyclic pelvic pain

dermatology RENT SIMMBEL

rash , nail changes, temperature, sensation , itching , masses , moles, bleeding , bruises, edema, lesions

 

paeds history FEVER COULD SEIZURE + PAM IF BIG DEALS

fever , ear pulling, vomiting , ear discharge, eye discharge CUD, chest symptoms , cold , runny nose , cough, chest pain , respiration, shortness of breath URINATION any increased or decresed urination no of wet diapers any odor , color of urine , diarrhea, frequency onset , mucus in the stool , blood In the stool any crying during defecation
SEIZURE jerky movements any leakage of urine or stool during fits any p
postictal irritability or loss of conciousness

trauma patients

ample
allergy , medication , past medical history, last mead , events before accident

pain with intercourse

 

VC VED CANCER
Vaginitis , cervicitis, vaginismus, endometriosis , domestic abuse, cancers of the pelvis like cervix and uterus

 

FOOT PAIN

wet surf
Work , eye infection , redness, trauma to the foot , stiffness in other joint , urethral discharge, rash / reiter syndrome , fever

obstructive or irritative symptoms

 

WINSURF
Weakness of stream , intermittency and driblling, nocturia , straining urgency, retention , frequency

general physical

 

picke
pallor , icterus , cyanosis ., koilonychias, lymphadenopathy , edema

paeds history

 

BJM CHILDREN
birth history , jaundice( neonatal) milestones, crying, check up , headache, immunization, lethargy , day care, rash, eye,ear, nose , nutrition

headache

 

MM IT ACHES
migraine , 

meningititis ,

 inreased intracranial pressure, 

tension headache,

 tension headache

, temporal arthritis, 

av malformation 

cluster headache, 

hypertension , 

eye disorder ( refacratory error + glaucoma) sinusitits ,

 sub arachemoid haemorrage, most systemic illeness

sore throat

 

SORE THROAT WAS BAD)
Swallowing food was painful ,

 origin duration progression , 

Runny nose , 

Ear problems , 

Temp chills ,

 headache, 

resp symptoms ( cough, shortness of breath, chest pain )

 occupation , a

spiration + abdominal symptoms ( nausea , vomiting , pain ( esp LUQ) tiredness ( fatigue) touch with ill people ( boy friend or girl friend)
weight loss , 

appetite , alcohol, 

smoking / sleep changes sexual history
bowel habits ,

 anything else that u want to tell me , 

Drugs ( IV)

throat

throat culture , IV antibody and viral titer rapid strep antigen , monospot test, anti EBV anti body , rouTine tests cbc , peripheral smear

 

d/d of cough

PLUERAL CAP
Pneumonia , lung cancer , exacerbation of COPD , URI , reactive airway disease, abscess , lymphoma , CHF , asthma, post nasal drip

 

Knee Pain Differential Diagnosis

SPORTS
S - Septic arthritis
P - Pseudogout, Psoriatic arthritis, Patela-femoral pain syndrome
O- Osteoarthritis
R - Rheumatoid arthritis, Reactive arthritis
T - Tophi (Gout), Trauma (fall, elderly abuse, sports)
S- Sac inflammation (Bursitis)

 

foot pain

FOOT PAINS
Fat atrophy ( age related) + foreign body , osteomyelitis , osteoporosis, tarsal tunnel syndrome , tendonitis, tumor, plantar facitis , periostitis, apophysitis , arthritis ( rheumatoid , reactive,) ischemic ( peripheral vascular disease) , nerver entrapment , stress fracture in athletes and spur in bones

chest pain CHEST â€"P

cough , hemoptysis, heart burn, emesis (vomiting ) diarrhea and edema over ankles, temperature , tenderness over ankles tenderness over legs , also trauma , Palpitation

impotence

 

LIMP PENIS
libido change , injury , medication ( beta blocker) past/ present medical history ( htn , diabetes , vascular , leriche) previous prostate surgery , performance anxiety, peryonie disease, erection at all , nocturnal erection , incontinence, stress/ depressio

 

d/d impotence

DOC MP DG UP
Depression , alcohol , claudication ( leriche syndrome) medication , pressure (HBP) , mellitus gonads ( hypogonadism) , unknown etiology ED, prostate surgery

 

d/d pv bleeds

A PV BLEEDS
Abortion + adenomyosis, PID+ PCOD, vaginal bleeds, bleeding diasthesis, leiomyoma , ectopic pregnancy, endometriosis, endocrine causes, DUB ( anovulatory cycle)
u
duration , dysparunia, dysuria, itch , smell , color, high fever, abdominal pain , recurrent episodes, general health and symptoms , endocervical swabs

depressed mood dd

BAD MUDS
Bereavement , bipolar 1 and bipolar 2 disease, adjustment disease , mood disease, dysthemic disease, major depression, menopause, underlying medical condition , drug related cocaine , amphetamine schizophrenia

 

AMENORRHEA CAUSES

AMENORRHEA
****1ST IS ALWAYS PREGNANCY
A- AMENORHEA, ABSENT OVULATION (PCOS)
M - MENOPAUSEA
E- EATING DISORDER
N- NURSING MOTHER
O- OCP USE
R- RAISED PROLACTIN/ADRENAL HORMONOES
H- HYPOTHRYROIDISM, HEMORRHAGE
A - ANXIETY,ASSHERNMAN SYNDROME
PREMATURE OVARIAN FAILURE

 

depression case patient note

I AM SAD
Insight , appearance, mood , MMSE, suicidal intent , speech, affect, delusion , hallucination

dark urine

HITTERS
Hematologic / coagulation disorders, infection , cystitis, trauma , tumors, exercise, renal disorder, stones

blood in the stool

drain
diverticulosis , drugs warfarin rectal bleeds piles , fissures angiodysplasia , anal sex, inflammatory bowel disease, infectious diarrhea, ischemic colitis , injury , neoplasms