First read the door info and write down that on the paper of sheet along with the mnemonics: PAM HUGS FOSS SODA along with the D/D of that case and also the investigations...NOT TO FORGET THE NAME OF THE PERSON and then write down the SELF MADE mnemonic of HPI
I have already learned System review questions so no need for a mnemonic for them....
and then complications...
so the page is divided into 6 categories

First knock on the door 3 times....SMILE and enter when the person calls you in:

I will start with
1. GOOD MORNING MR. XYZ I am Dr. ABC DEF and am here to see you as your physician today...

2 .Nice to meet you....shake hands

3. Is everything in the room allright for you Mr. XYZ?
and look around too tongue.gif

4. Then cover the naked legs by sayin...LET ME MAKE YOU A BIT MORE COMFORTABLE MR. SMITH

5. Stand back at a distance of 2 feet and DONT CROSS ARMS...look into the eyes and look comfortably asking with empathy...

So, How may I help you today?

the patient begins with the CC

6. you hear it and then say: OH, I AM SO SORRY TO HEAR THAT MR. SMITH. I SHALL TRY MY BEST TO HELP YOU. HOPE YOU DONT MIND IF I TAKE SOME NOTES WHILE YOU SPEAK (and you pick up the paper and pencil)

7. CAN YOU DESCRIBE YOUR CC PLEASE?

and the patient moves on

HISTORY PATTERN
by Junaid Nasir, MBBS


here goes the pattern for the history..
read carefully and cram it in all the pain related cases the history includes








L location
I intensity
Q quality
O onset, duration, progression
R radiation
A aggreviating factor
A alleviating factor
A associated factors

AND FOR CASES OTHER THAN PAIN, THE FOLLOWING QUESTIONS WILL DO FINE

--WHEN DID THE SYMPTOMS START?
--HOW WAS THE ONSET ? ALL OF A SUDDEN OR GRADUAL?
--ARE THE SYMPTOMS CONSTANT OR DO THEY COME AND GO?
--IF THEY COME AND GO THEN ASK ABOUT THE FREQUENCY OF EPISODES , SITUATION DURING THE EPISODES AND IN BETWEEN THE EPISODES, WHAT CAUSES THE EPISODES?
--DO YOU THINK THAT THE SYPTOMS ARE PROGRESSING??
--ANY THING THAT WORSENS IT?
--ANY THING THAT IMPROVES IT?
--ASSOCIATED FACTORS?

now the associated factors FOR BOTH THE ABOVE SITUATIONS (pain and the rest of the cases) should be divided into A1 A2 A3

A1: associated consititutional symptoms like FSC NVD HF fever,shortnes of breath,cough , nausea vomiting diarrhea, headache, fatigue
A2: associated particular system questions..
like for cases of
RESPIRATION: chest pain, s.o.b , cough , sputum, wheezing , runny nose, post nasal drip, contact to ill person, night sweats.and questions for pulmonary embolism (leg pain, long travel, surgery and ocp use for females)
CVS: chest pain, orthopnea, PND, palpitaion, tachycardia.
GIT : pain in belly, stool. bowel movements,vomiting, jaundice,blood in stools. diet, contact to ill person, travel
NEUROLOGY : first of all HEADACHE
HIGHER MENTAL FUNCTION:orientation, memory, consciousness
MOTOR: shaking of limbs, weakness in limbs
SENSORY: tingling sensation
CEREBELLUM: gait, balance
CRANIAL NERVES: speech, swallowing, vision, hearing


DEPRESSION: first of all ask about mood for the most part of the day then ask FACE SLIPS
F feeling of guilt or worthlessness
A appetite
C concentration level
E energy level

S sleep
L libido
I interests
P leasure in life activities
S suicidal intentions
then ask about whether there are weapons in the home
then ask whether he is willing to get the treatment for his condition.


UROLOGY:
BPH IS CONTINIOUS FUN
B burning
P pus
H hematuria H hesitation
I incontinence I incomplete emptying of bladder
S stream S straining
CONTINIOUS or intermittent stream
F frequency
U urgency
N nocturia

A3: d/d related questions, one or two questions specific to the d/d


then give a transition sentence and go on to the
P past medical history, (any similar episodes or symptoms before)
A any allergies
M medications

H hospitalization (medical, surgery , trauma)
U urinary problem??
I illnesses chronic like DM, HTN, asthma, stroke etc
G git (bowel movements)
S sexual

F family history (parents alive and healthy?? , any condition that runs in the family, or any one else with the similar complaints in the family)
O obs/ gyne
S sleep
S social (what do u do for ur living, smoking , ETOH , recreational drugs??)

then ask
IS THERE ANY THING ELSE THAT YOU WANT TO SHARE????

THEN GO FOR THE EXAMINATION


i did not spend much time on regular cs prep.. just 10 days.. but i concentrated on the history format and the encounter protocol. cram dd and inv. pneumonics help a lot.. before entering the room write the pam huigs foss and probable dd.. 50 sec at the most.. then enter.. uworld is fine .. for challanging situations read first aid ... First aid alone is good too. also digital doc blogs are very helpful.. that blog gives a general format of the encounter too..the link is here

http://csprotocol.blogspot.com/2006/02/s...-your.html

good luck
junaid nasir



now the second part of the history starts: the questions specific to the CC that are there in FA....read that...a MUST!


okie... after these SPECIFIC CC questions move onto the disease specific questions that are there in UW...

READ THEM WELL AND ASK THEM ..... POSSIBLY A MNEMONIC FROM DIGITALDOC WEBSITE OR YOU CAN MAKE YOUR OWN AS WELL smiling face THE LINK FOR MAKING YOUR OWN MNEMONIC IS THERE ON THE WEBSITE http://www.csprotocol.blogspot.com
for pakistani users: use http://www.pkblogs.com/csprotocol

ASK THOSE QUESTIONS FAST AS YOU HAVE ALREADY GONE THROUGH 3 MINUTES. 3 MINUTES FOR THESE QUESTIONS.

THEN MOVE ON TO SYSTEM REVIEW:

THESE ARE SPECIFIC SYMTOMPS FOR EACH MAJOR SYMTOM AND DONT FORGET THE

FFAW

FEVER
FATIGUE
APETITE
WEIGHT LOSS

THE GENERAL SYMPTOMS

after that move on to complications quesitons. Sometimes you can over go them smiling face

NOW MOVE ON TO

PAM HUGS FOSS SODA

Start with a transitional question

OK MR. SMITH, NOW I NEED TO ASK YOU ABOUT YOUR HEALTH IN GENERAL. IS THAT OKAY WITH YOU?

start with the questions:

before FOSS

AGAIN STOP

AND ASK THIS TRANSITIONAL QUESTION:

MR. SMITH, THE WAY THE CLINICAL MEDICINE WORKS IS THAT THERE COULD BE SOME HIDDEN CLUES IN A FEW PERSONAL QUESTIONS THAT I NEED TO ASK. LEMME FIRST BEGIN WITH YOUR FAMILY HEALTH. IS THAT OKAY WITH YOU?

ASK ABOUT FAMILY HISTORY

then move on with SOCIAL history. you can say that Okay Mr. Smith now I am goin to ask you about some questions regarding your life style.

and then to sexual by saying:

NOW I NEED TO ASK YOU ABOUT YOUR SEXUAL HEALTH. WHATEVER YOU WILL TELL ME WILL BE KEPT CONFIDENTIAL. IS THAT OKAY WITH YOU?

AND MOVE ON

NOW SAY:

I SHALL NOW NEED TO PERFORM A QUICK PHYSICAL EXAMINATION AND THEN LOOK AT YOUR HEART. IS THAT FINE?

the SP will say okay....

then you will say: ARRITE! BEFORE WE BEGIN MR. SMITH, EXCUSE ME FOR A MOMENT HERE TO WASH MY HANDS. dont you forget to tell the SP that you are going to wash hands

while washing hands. you can ask the O

OCCUPATIONAL HISTORY smiling face

and u can say that THATS INTERESTING MY UNCLE USED TO DO THE SIMILAR grin (thanks to DIGITALDOC who made me such a great actor tongue.gif)

AFTER THIS U CAN DRY HANDS AND THEN SAY OKAY MR. SMITH NOW I NEED TO DO A QUICK GENERAL EXAM AND THEN LOOK AT UR CHEST/HEART/ABDOMEN ANYTHING U WANT TO DO