ballet steps

8/18/2019 Ballet Steps

1/18

CC

History

MnemonicsPhysicals

Notes/

ChallengesCounsel DD Workup

1 17 yo M c/o

Chest Pain

SIQORAAA

OCCPDFCHESTP

Extremities

Neck JVDHeart

Chest

Wrestler, Consent

Inc. Breathing andLifting weights.

Ask about Fatigue

and Trauma

Pain Meds,

Rest at least untilresults appear

- Chostocondritis

- Muscle Sprain- Fracture Rib

CBC w/diff

CXRCT Scan

2 18 yo M c/o

LOC

OCCPDF

Describe whathappened, assoc. with

any event? LOC before,

during or after? Heart:

Palp, light-headedness,

shaking? How long?

Bite Tongue? Bladder?

Numbness? Weakness?

Gait? Speech?

Headache? Vision?

Last Meal? Drugs?

MMSE

Heart Neuro

Wrestler, Uses

Ecstasy, skipped ameal

Ecstasy, Diet - HOCM

- Hypoglycemia- Drug Induced

Hypotension

Orthostatic Vitals

CBC, LytesCT Head

MRI Brain

EEG

ECG

Holter

CXR

Echo

S Glucose

Urine Toxicology

3 70 yoF c/o

incontinence

OCCPDF AA

SAUSAGE CP

Dysuria, Polyuria,

Nocturia, Haematuria,

Urgency, Hesitancy,

Dribbling, Stream, Hxof Stones, Fever,

Loin/Back Pain, if Pain

SIQORAAA, Ask about

previous deliveries,

Abdomen

(CVAT)

Has been suffering

from incontinence

for 30 years,

problem worsened

6 mo ago, Patient

cries, tap shoulder,affirmation, give a

moment of silence,

offer a tissue. Ask

about impact on

Keigl’s Exercise,

No water, No

alcohol and no

caffeine intake

before sleep,

meds, stress, DM

- Urge Incontinence

(Sometimes Stress)

- UTI

- Pyelonephritis

- DM induced

Polyurea

CBC w/ diff, ESR,

CRP, BUN, Creat,

Microalbumin,

Urinalysis, Urine

C&S, Urodynamic

Testing, IVP,Cystoerethroscopy, s

Glucose, HBA1C


2/18

Depression FACE

SLIPS

Ask about absorbent

pads

life. DM, Previous

UTI

Beware: Long case

4 48 yoF c/o

not feeling

like herself

lately

OCCPDF

FACE SLIPS

THOMAS (Thyroid-

Household- Occupation-Menopause- Anxiety-

Caffeine)

Assoc. w/specific event?

Heat/Cold?

Skin/Hair/Voice?

Flushes? Amenorrhea?

Vaginal Dryness?Osteoporosis? Palp?

Chest Pain? SOB?

Sleep? Caffeine Intake?

Stress at work?

Headache? Numbness?

Tingling? Weakness?Fatigue? Bowel?

Thyroid

Neuro

MMSE

Abdomen

Has tremors,

Irregular menses,

Hot Flushes

Stress

Counseling,

Moderation of

Caffeine (if any),Menopause

- Menopause

- Perimenopause

- Generalized

Anxiety- Hypothyroid

- Adjustment

Disorder

CBC w/diff, Lytes,

MSE, Vaginal

Examination, DEXA

Scan, TSH, fT3, fT4,sFSH, sLH

5 70 yo F c/o

Abdominal

Pain

OCCPDF

SIQRAAA

Nausea, Vomiting,

Diarrhea, Constipation,Stool consistency and

color, Haematochazia,

Haematemesis, Relation

Abdomen

Eyes

Extremities

(tremor),Murphy

Beware: HPI

Epigastric while

physical gives

RUQ, radiation.Challenge: Afraid

of Surgery, No

Support.

Counsel about

Surgery: It’s

now much

easier. Shorter post op period.

Social worker

can provide

- Choledocolithiasis

- Cholecystitis

- PUD

- Gastritis

Rectal Exam, Vaginal

Exam, CBC w/diff.,

Lytes, Bilirubin, AST,

ALT, GGT, ALP,Amylase, Lipase, U/S,

Endoscopy, H. Pylori,

CT


3/18

to meals and menses,

Heartburn, Difficulty

Swallowing

support. Counsel

about NSAIDs if

any

6 40 yoF c/o

SOB

OCCPDF

CHEST P (if any)

Wheeze, orthopenia, LL

edema, and fatigue.

Eyes, Mouth

Extremeties

Neck

Heart

Chest

Challenging case:

Patient has a long

typed page of co-

morbidities and

polypharmacy(copy it)

- Asthma

- Bronchitis (COPD)

- Cardiac (MI, Ang,

CHF)

- Pleural Effusioneffusion

- Pneumonia

- Pulmonary

Embolism

- Panic Attack

- Pneumothorax

- CO Poisoning- Haemorrhage

- Foreign

- CBC w/diff, ABGs,

ECG, Echo, CXR, CT

Scan, Pulse Oxymetry,

Pulmonary Function

Tests, Bronchoscopy

7 70 yoM c/o

Heel Pain

OCCPDF

SIQRAAA

Walking? Time of Day?

Trauma? Other Joints?

Numbness? Fever?

Rheumatological

Disease: Rash,

Photosensitivity, Oral

Ulcers, Hair Loss, TickBites? Swollen? Pain on

movement? Tender on

touch? DM

Full Joint

Exam

(IPROMMRS

P), Other joint

Palpation

Hx of Walking on

glass, Can you see

anything in my

leg? Pt has Htn.

Variation of the

Case: Ankle Pain,

h/o ankle twisting

Foot Care, Htn,

DM?

- Foreign Body

- Stress Fracture

- Foot Sprain

- Plantar Faciitis

- Retrocalcaneal

bursitis

- Calcaneal Spur

CBC w/diff, ESR,

CRP, X-Ray, MRI,

DEXA Scan


4/18

8 50 yoM c/o

Congestion

OCCPDF

Pain? SIQRAAA

Runny Nose? Nasal

Discharge? Fever? Ill

Contacts? Headache?Wheeze? CHEST P?

Sputum (w/analysis)?

Orthopnea

HEENT

Chest

Pt has tenderness

over R Maxillary

Sinus. +ve Sick

contacts. Pt gets

angry when youcounsel about

smoking

Smoking - Chronic Sinusitis

- COPD

- URI

CBC w/Diff, XR CT

Paranasal Sinuses,

ABGs, CXR

9 32 yoF c/o

Fatigue

F heart failure

A anemia

(headache,blur,palp,diz,

pass out)

T thyroid, TB, Tumor

I infection with HIV

GI malabsorptionU uremia

E endocrine: DM

D depression

S sleep disorders

S stress and caffeine

Relationship with Baby?Prenatal, natal,

Postpartum?

Thyroid

MMSE

Heart

Extremeties

Pt has amenorrhea

for 13 months

(Pregnancy + 4

Months Post

Partum), thinning

in her hair, no

breast milk, ETOH+ve, Rhythm

Contraception

Counsel on

Contraception

and alcohol

- Hypothyroidism

- Sheehan’s

Syndrome

- Pregnancy

- Anemia

Variation of the Case:

- PostpartumDepression

- Caregiver’s Fatigue

- Hypothyroidism

CBC w/diff, Lytes,

TSH, fT3, fT4, B

HCG, Breast Exam,

Genital Exam, Brain

MRI (exclude

pregnancy first)

10 44 yo F c/o

Irregular

menses

Thyroid Questions,

Menopause (HAVOC),

Anemia Questions,Depression Questions?

Breast Discharge?

Thyroid

Heart

Extremities

Patient will ask

about Premature

Ovarian Failureand HRT?

HRT - Hypothyroidism

- Perimenopause

- Anemia

CBC w/diff, TSH,

fT3, fT4, Lytes, Fe

Studies, sFSH, sLH, sProlactin, Brain MRI

11 35 yo F c/o OCCPDF Thyroid Stress Panic Attack CBC w/diff,


5/18

Nervousness SHAMISMA

THOMAS

WASTTED

What are you nervous

about? Headache?Vision? Thyroid?

Tremors? Palpitation?

Chest Pain? Stomach

Pain? Bowel

Movements? Urination?

Fatigue? Sweating?

Sleep? Stress? Sugar?

Caffeine? Exertion?

Menopause (according

to age)? Anxiety?Depression? Psych?

Hypertension?

Neuro

Extremies

Heart

MMSE

Counseling Anxiety

Pheochromocytoma

Arrhythmia

MVP

Caffeine/ StressHyperthyroid

Hypoglycemia

TSH, fT3, fT4, MSE,

ECG, Echo, EEG

12 Phone

encounter,

Grandfather

of a babyw/diarrhea

FEVER CUTSS

FAMILI BEADS GLP

(Fever, ENT, Vomiting,

Eyes, Rash, Cough &SOB, Urine, Traveler’s

Diarrhea, Sleep,Shaking, Family Hx,

Allergy, Meds, Ill

Contacts, Look,Immunization, Birth,

Eating, Appetite,

Daycare, Surgeries,

N/A Consent Bring the Child,

Means of

Transportation,

Dehydration,ORS

- Gastroenteritis

- Rota Virus

- Bacterial Diarrhea

- Food Poisoning

Physical Exam, Stool

culture ova and

parasitology, stool pH,

Rota Virusimmunoassay, Lytes,

CBC with diff


6/18

Growth, Last Checkup,

PMH) + Dehydration

13 62 yo M c/o

Abdominal

pain

See case No. 5 Eyes

Extremities

Abdomen

Pt works as a

coach, Nice man.

History of DMIntake of NSAIDs

for Joint Pain,

Epigastric painrelated to meals

NSAIDs and

MEDEM

MonitorEducation

Diet

ExerciseMedication

- GERD

- Gastroparesis

- Gastritis- PUD

- MI (DM masks

Chest Pain, comesw/atypical pain)

CBC w/diff, pH

monitoring, s Glucose,

HBA1C, ManometricStudies, Gastroscopy,

H. Pylori tests, Lytes,

LFTs

14 16 yo F c/o

fatigue

What do you mean by

fatigue? What do you

think is causing you

this?

FATIGUEDSS

FACE SLIPS Neuro?

- Hypothyroidism

- Depression

- Anemia

- Pregnancy

See Before

15 35 yo F

constipationPhone

Encounter

OCCPDF

DDDTTTABCCO

Associated w/special

event, Abdominal Pain,

Pain during defecation,

Amount and Caliber of

Stool passed, Fever,Stool consistency,

Number of Motions perday or week,

Haematochazia,

Tenesmus, Travel,

N/A Post surgery

Vicodin

Bring the

Patient, Meds

- Paralytic illeus

- Drug induced- Diverticulosis

- Low fiber diet

- Gallstone induced

Ileus

Complete Physical

Exam, Rectal Exam,Stool for Occult

Blood, CBC w/diff,

Lytes, s Glucose,

Barium Enema, CT

Abdomen,

Colonoscopy


7/18

Nausea, Vomiting,

Drugs, Diet, Appetite,

Weight, Thyroid,

Alternation with

Diarrhea (if suspectingIBS)

16 70 yo M c/o

Confusion.Phone

Encounter,

Daughter

calls

OCCPDF

Tell me more about this!What do you mean by

confusion?

Neuro Questions:

Fever? Headache?

Weakness? Numbness

or Tingling? Seizures?

Tongue Biting? Tonic

Clonic Movement:

Describe the shaking?

Head Trauma? Passed

out? Nausea/Vomiting?

Speech? Gait?

Association withPosition? DM? Htn?

Heart and Chest? Diet

N/A Post R hip

replacement,clotting, Blood

Thinners, Rehab,

Home for 3 days,

Confused.

Get him to the

Hospital ASAP. NPO?

Discontinue

Drugs?

- Drug induced IC

Bleeding- Metabolic

encephalopathy

(Electrolyte

Imbalance)

- Hypoglycemia

Physical Exam and

MSE, CBC w/diff, PT,PTT, INR, Lytes

(Complete BMP), s

Glucose, CT Head,

MRI Brain

17 40 yo F c/o

Blood in

Stools

OCCPDF

BUTT

Pain during defecation?Abdominal Pain

SIQRAAA

Description,

Eyes

Extremities

Abdomen

Pt is having anal

sex, has a Hx of

Haemorrhoids, +/-Constipation, +/-

LLQ Pain

Fiber Rich Diet,

Pain, Anal Sex

- Anal Fissure

- Angiodysplasia

- RecurrentHaemorrhoids

- Diverticulosis/

Diverticulitis

Rectal Exam,

Anoscopy,

Colonoscopy, OccultBlood in Stools,

Leukocytes in stools,

CBC w/diff, Flexible


8/18

Constipation/Diarrhea?

Diet? Joint Pain? Oral

Ulcers?

- Colon Cancer

- Low Fiber diet

- Ulcerative Colitis

proctosigmoidoscopy,

iron studies, CT

Abdomen, ANCA

18 40 yo F c/o

Nervousness

OCCPDF

Palpitations? TACESSHAMISMA

FACE SLIPS

Amenorrhea? HAVOC

MMSE

Thyroid Neuro

Heart

Pt recently moved,

new job, ElectricalEngineer

Stress

Counseling

- Adjustment

Disorder- Anxiety Disorder

- Social Phobia

- Stress inducedCaffeine Intake

- Hyperthyroidism

MSE, CBC w/diff,

TSH, fT3, fT4, FSH,LH

19 60 yo M c/o

Cough

OCCPDF

ABCCCO

CHEST P

Seasonal? Time of day?

Heartburn? Infection/Illcontacts? Travel? PPD? Night Sweats? Fatigue?

Sleep? Wheeze?

Swelling around ankle?

Orthopnea? PND?

Pillows?

Heart

Chest

Cough induced by

Exercise, Wakes

patient up from

Sleep

Remember:

PLEURAL CAP

- CHF

- Angina

- Exercise inducedAsthma- COPD

CBC w/diff, Allergy

Challenge Test, PFT,

CXR, CT Paranasal

Sinuses, Sputum

Analysis (C&S, AcidFast), TB PCR,Bronchoscopy, PPD,

ECG, Echo, LDH,

CPK, Troponin

20 60 yo M c/o

Fatigue

FATIGUED SS

Beside your fatigue, do

you have any othersymptoms? LOC?

Ask TB Questions

Heart

Chest

ExtremetiesThyroid

Maintenance Man,

Long Smoking

History, WeightLoss

Smoking - Lung Carcinoma

- TB

- CHF- Anemia

- COPD

CBC w/diff, Spiral CT

Chest, Tumor Markers

(CEA), SputumAnalysis, TB PCR,

PPD, Bronchoscopy,ECG, Echo, TSH, fT3,

fT4

21 30 yo M c/o OCCPDF Joint Contractor/ Heacy Weight - Lumbar Disc CBC w/diff, ESR,


9/18

R Back Pain SIQRAAA

Special incidents

Swelling, Stifness,

Redness, Tenderness of

Other joints, Limitationof Movement, TB?

Incontinence?

Rheumatology

Questions?

Neuro Construction

Worker, Pain

Radiating to

Buttocks and R

foot, Smoker

Lifing

Physical Therapy

Steroids?

Herniation

- Back Muscle Sprain

- Lumbar Sponylosis/

Ankylosing

Spondylitis- Tumor in Vertebral

Canal/ lumbar Canal

Stenosis

- Vertebral

Compression

Fracture

- Steroid induced

Osteoporosis

CRP, MRI Lumbar

Stage, CT Back and R

Lower Extremity, Rh

Factor

22 40 yo F c/o

Back Pain

OCCPDF

SIQRAAA

Haematuria, Dysuria,

Polyuria, Nocturia,

Urgency, Hesitancy,

Stream, Dribbling,

Incontinence, Stones,

Bleeding from otherorifices?

Abdomen

Back

Pain radiates to

groin, Pt has Hx of

Stones, Mild Fever

Drink Water and

Cranberry Juice

- Pyelonephritis

- Nephrolithiasis

- UTI

- Renal Cell

Carcinoma

CBC w/diff, ESR,

CRP, Urinalysis,

Urine C&S, BUN,

Creat, Microalbumin,

Cystourethroscopy,

IVP, U/S Kidneys

B/L, CT Abdomen

23 50 yo M c/o

SOB

OCCPDF AA

CHEST P Wheeze?

Heart: Orthopnea, PND,

LL Edema, Fatigue,Fever?

Chest

Heart

Extremities

Yellow Sputum,

Hx of COPD, Htn,

Orthopnea,

Wheezes, O2Therapy

Smoking, Htn - Pneumonia

- Exacerbation of

COPD

- CHF

See Previous

24 60 yo M c/o

Fatigue

OCCPDF

FATIGUED SS

Chest

Abdomen

Family Hx of

Colon Cancer,

Smoking - Colon carcinoma

- Lung Carcinoma

Rectal Exam, Stool for

Occult Blood,


10/18

FACE SLIPS

Passed out?

Don’t forget to ask

about Colonoscopies

Abdomen Questions?Diet

Weight Loss,

Smoker

- Anemia

- TB

Colonoscopy, Spiral

CT Chest, ABGs,

CBC w/diff, Iron

Studies, vit B12,

Sputum Analysis ifapplicable

25 16 yo F c/o

Fatigue

OCCPDF

FATIGUED SS

MMSE

ThyroidHeart

Extremities

Constipation,

Weight gain,Problems at Home

Stress

Counseling

- Hypothyroidism

- AdjustmentDisorder

- Depression

- Anemia

See cases before

26 25 yo M c/o

Chest Pain

OCCPDF

SIQRAAA

Heart Questions?

CHEST Ps

Wheezing?If Woman, ask OCP to

exclude PE

Chest

Heart

Joint

Rock Climber, H/o

Asthma, Use of

Marijuana,

Shoulder pain

(Diff betweenradiation and

concurrent pain),

Fever

Marijuana - Costonchondritis

- Muscle Sprain

- Rib Fracture

- Pericarditis

- URI- Exercise induced

Asthma

CBC w/diff, Lytes,

PFT, CXR, Chest CT,

X Ray on Shoulder

joint, PFT, ECG,

Echo, ESR, CRP

27 32 yo F c/o

Heart Racing

OCCPDF

What else?

TACES (Thyroid,

Anxiety, Caffeine,

Exertion, Sweat)Fatigue?

Heart

Thyroid

Neuro

MMSE

Don’t forgetto test for

tremors

Pt Planning

wedding, PhD

student

Variation of the

same case: 2-3Weeks ago she

went to the ER fornumbness of both

hands, and is now

coming for follow-

Stress

Counseling

PAPA MCH

- Panic Attack

- Anxiety (GAD)

- Anemia

- Pheochromocytoma- Arrhythmia

- MVP- Caffeine/Stress

induced

- Hyperthyroid/

CBC w/diff, MSE,

urinary VMA, ECG,

Cardiac Echo, TSH,

fT3, fT4, s. Glucose


11/18

up, h/o carpal

tunnel Syndrome

in College

Hypoglycemia

* Sometimes

Hyperthyroidism w/

Carpal Tunnel

28 25 yo M c/oFatigue

OCCPDDFAAFATIGUEDSS

FACE SLIPS

Sleep analysisDiet analysis

Joint Pain/ Muscle Pain?

Headache?

Heart Neuro,

Thyroid

MMS

Pt. smokesmarijuana, takes

herbal medicine

Smoking andmarijuana

Stop herbal

medicine tillresults are back.

If anything

wrong with your

liver, discontinue

- Stress inducedFatigue

- Anemia

- Drug related

Hepatitis/ Fatigue

- Chronic fatigue

syndrome- Obstructive sleep

apnea

- Depression

- Hypothyroidism?

CBC, Lytes, s glucose,Fe studies, Vit B12,

TSH, fT3, fT4,

polysomnography,U/S, CT Abdomen

29 35 yo F c/o

Headache

OCCPDDF

SIQRAAA

TV SNN

Ask about: Aura? Runny

Nose? Speech? Neuro?

Relation to Menses?

Stress and Caffeine

Intake? OCP?

Complete

HEENT

Neuro

Usually Female Pt Stress

counseling,

Caffeine Intake

MM… IT ACHES

- Meningitis

- Migraine

- Inc. Intracranial P

- Tension Headache,

Temporal Arteritis

- AV Malformation

- Hypertension

- Eye Problems

- Subarachnoid Hge,

Systemic, Sinusitis

CBC w/diff, Lytes,

ESR, CT Head, MRI

Brain, LP, CSF

Analysis (C&S, Cl,

Gluc), U/S Carotid,

Temporal a. Biopsy,

Paranasal Sinuses

Imaging

30 65 yo M c/o

LOC

OCCPDF

Describe what

happened?

HEENT

Neuro

MMSE

Pt is a known

Hypertensive, +/-

Lightheadedness,

Hypertension - Arrhythmia

- TIA

- Drug Induced

CBC w/diff, Lytes, s

Glucose, CT Head,

MRI Brain, ECG,


12/18

Before: Heart Racing?

Light-headedness?

During: Tongue Biting?

Loss of Bladder control?

Shaking?General: Gait? Speech?

Vision? Hearing?

Numbness/Tingling?

Weakness/Paralysis?

Headache?

Hear Questions: Hx of

Hypertension.

Trauma to Head?

Heart

N.B. Make

Sure to test

Gait,

Cerebellum,Romberg,

Babinski

h/o MI 5 years

ago, Checking his

mail/ Grocery

Store

Hypotensioin

- Stroke

- Complex Tonic

Clonic Seizures

- Hypoglycemia- Intracranial Tumor

- Severe Aortic

Stenosis

- Vasovagal

EEG, Lipid Profile,

Urine Toxicology,

Holter Monitoring,

Cardiac Echo, LP,

V/Q Scan, ABGs

31 Pediatric

Phone Call

8 yo M c/o

Abdominal

Pain

FEVER CUTSS

FAMILI BEADS GLP

FACE SLIP

DDD TTT

N/A Child c/o pain,

new family

member with

Down S, too much

homework, New

School Teacher

Bring Child to

Hospital, Psych

- Somatoform

Disorder

- Adjustment

Disorder

- Low Fiber Diet

- Malingering?

Physical Exam, Rectal

Exam, Stool Analysis,

CBC w/diff, Lytes,

Stool Culture, CT

Abdomen

32 Pediatric

Encounter

with mother

of 3 yo M c/o

Seizures

OCCPDF

FEVER CUTSS

FAMILI BEADS GLP

Before seizure: Fever or

infection?

After seizure: LOC?

Headache? Stiff Neck?Runny Nose? Trauma to

head?

N/A Ask mother to sit

down

Fever day before,

Runny nose in the

morning

Bring Child to

Hospital ASAP

Cold

Fomentation,

Fluids, Lie on

back, hard

surface, Don’t put anything in

his mouth

Put his head

- Febrile Seizures

- Meningitis

- Encephalitis

- Tonic Clonic

Seizures

Physical Exam, CBC

w/diff, Lytes, ESR,

EEG, LP, CSF

Analysis, CT Head,

MRI Brain


13/18

aside in case of

chocking, Put

something soft

under his head,

like a pillow oryour cloth

33 45 yo F c/o

Numbnessand

Weakness of

L arm

Ask Pain? If Yes,

SIQRAAAFall on outstretched

Arm?

Tingling? Stiffness?

Redness, Swelling?

Limitation of ROM?

Tenderness? Other

joints? Photosenstivity?

Oral ulcers? Rash? Hair

loss? Cold intolerance?

Coldness? TB and

Respiration in cases of

Neck Pain.

Neck

NeuroJoint

Don’t Forget:

Phalen or

Tinnel

Hispanic,

Hairdresser, Pain just got better on

the day of the

exam, +ve

previous episodes

Physical Therapy - Cervical disc

herniation- Ulnar nerve

compression

- Cervical canal

stenosis

- Thoracic outlet

syndrome

- Cervical rib

- Muscle sprain

- Cervical Vertebral

Dislocation

CBC w/diff, EMG,

ESR, NerveConduction Studies, X

Ray Shoulder, Elbow,

Wrist and Hand, CT,

s. Calcium, Vit. D,

DEXA Scan

34 60 yo F c/o

Bloody Urine

OCCPDF

Back or Abdominal

Pain? If Yes SIQRAA

How did you know this

is blood? Bleeding from

Other orifices?Diet? Meds? Exercise?

Trauma?

Eyes

Extremities

Abdomen

Pt is talkative,

Painless

Haematuria,

Smoker, Multiple

UTI, CVA -ve

Smoking HITTERS

- Haematologic

- Infection

- Tumor

- Exercise

- Renal Disoder- Stones

In this case:

- Bladder Cancer

Genitourinary Exam,

CBC w/diff, ESR, s

Creat, BUN, IVP,

Cystourethroscopy,

Renal U/S, CT

Pelviabdominal,Microalbumin, s

Ferritin, Urinalysis,

Urine C&S, PT, PTT,


14/18

- UTI/ Cystitis

- Glomerulonephritis

Urine Cytology, Red

Cell Casts

35 70 yo M c/o

Neck Pain

OCCPDF

SIQRAAA

TB? Respiration? HeavyLifting? Other Joints?

Rheumatology? Neuro?

Weight and Appetite toexclude tumors?

Exclude Meningitis

Neck

Joint

NeuroBrudzinski

Woke up with

neck pain,

Weakness and Numbness of Left

Arm, FHx of

Osteoporosis

Physical Therapy - Cervial Disc

Herniation

- Cervical VertebralFracture

- Osteoarthritis

- CervicalSpondylosis

- Neck Muscle Sprain

- Rheumatoid

Arthritis

(Sublaxation of

Atlanto Axial Joints)

X Ray Cervical Spine

P/A and Lateral

Views, MRI C spine,DEXA Scan, s. vit D,

s. Calcium, CBC

w/diff, Lytes, ESR, RhFactor.

36 Pediatric

Case c/oFever

FEVER CUTSS

FAMILI BEADS GLPFever Analysis?

Distribution of Rash?

N/A Fever and Rash Bring Child to

Hospital. Don’tgive Aspirin.

Cold

Fomentation

- Fifth Disease

- Varicella- Scarlet Fever

- Otitis Media

Parvo Virus B19 IgM,

Pneumatic Otoscopy,Tympanometry,

Varicella Ab Titre,

Skin Lesion Scrapings

with C&S

37 60 yo F c/o

Sleeping

Problems

OCCPDF

Duration of Sleep,

Activities before sleep,

Difficulty initiatingsleep, difficulty

maintaining sleep,Interrupted Sleep,

Waking up

spontaneously (early),

MMSE

Neuro

Thyroid?

Look Fortremors

Challenge: Pt

doesn’t want to let

go of her bag,

Delusion thatPeople in the bank

want to rob her.Variation of case:

Patient was robbed

before

TV (Blue Light

interferes with

Circadian

Rhythm),Depression,

stress, Naps,Caffeine,

Relationship?

- Brief Psychotic

Episode

- Generalized

Anxiety or PTSD (invariation)

- Depression withPsychotic Features

- Schizophrenia

- Drug Induced

MSE, CBC w/diff,

MRI Brain, CT Head,

EEG,

Polysomnography,Sleep Pulse Oxymetry,

TSH, fT3, fT4, Urinetoxicology


15/18

Snoring, Nightmares,

Flashbacks, Daytime

Sleepiness and napping.

SHAMISMA

FACE SLIPSMarriage? Stress?

Caffeine? Thyroid?

Psychosis

- Hyperthyroidism?

- Obstructive Sleep

Apnea

38 30 yo M c/oHeadache

OCCPDFSIQRAAA

TV SNN

Stress and Caffeine

HEENT Neuro

+ve Tearing Stress, Caffeine - Cluster Headache- Migraine

See Case 29

39 45 yo M c/o

Testicular

Pain

OCCPDF

SIQRAAA

All Urinary Questions

Rash? Fever?

Abdomen

CVAT?

Pt is having and

affair but does not

tell at first, Ask:

Are you being

monogamous?

Safe Sex, Tell

Wife, Consent

for HIV

- Epidydimitis

- Gonococcal

Urethritis

- Testicular Torsion

- Hernia

Complete Urogenital

Exam, CBC w/diff,

U/S Pelviabdominal,

CT, Urinalysis,

Analysis of dischargeif any (Gram Stain,

C&S), VDRL, RPR,

Chlamydia and

Gonorrhea PCR, HIV

testing

40 25 yo M c/o

Diarrhea

OCCPDF

ABCCCO

DDD TTTAbdominal Symptoms?

Ask Rheumatology?Respiratory? Past

Antibiotic use?

Eyes and

Extremities

Abdomen

+ve Tenesmus (Do

you have a sense

of incompleteevacuation after

defecation), Notravel History

- IBD

- Malabsorption

- Infection- Pseudomembranous

colitis

Rectal Exam, CBC

w/diff, Lytes, Stool

C&S, Occult blood inStools, Leukocytes in

Stools, Colonoscopy,CT Abdomen, ESR,

Stool for ova, ANCA,

ASCA, ANA, C.


16/18

difficile toxin in stool

41 30 yo F c/o

Cough

OCCPDF

Time of Day? Seasonal?

CHEST PW TB

Analysis of Sputum:ABCCO

Sleep? Lifestyle?

Heartburn? Ill contacts?Wheeze?

Extremities

Chest

Heart

PalpateSinuses

Dry Cough, Pt is

on Captopril

Drug Counseling Remember:

PLEURAL CAP

- Exercise Induced

Asthma- Allergic Asthma

- Drug induced

- Post Nasal Drip- GERD

CBC w/diff, Allergy

Challenge Test, PPD,

CXR, Chest CT, PFT,

Bronchoscopy

42 65 yo F c/o

Heartburn

OCCPDF

SIQRAAA

Abdominal?

Radiation? If Yes Heart

Questions?

Cough? DM?

Heart

Abdomen

Pain ppt by heavy

meals and radiates

to left neck for 2-3

minutes

- MI

- GERD

- Angina

CBC w/diff, Lytes,

CXR, Cardiac Echo,

CPK, LDH, Troponin,

ECG, Ph Monitoring,

Manometry, Upper

endoscopy

43 25 yo F c/o

Jaw Pain

OCCPDF

SIQRAAA

FACE SLIPSSAFE GARD

Rheumatolgical? Neuro?

HEENT

Joint

Patient is victim of

abuse

Verbalize the

presence of

lesions,Recognize

Severity,

Emphasize Trust

and

Confidentiality,

Ensure Safety,Measures for

Children,Presence of

Shelters and

Social Workers,

- Domestic Violence

- Depression

- TMJ Dislocation- Jaw Claudication

- Temporal arteritis?

MSE, CBC, CXR, XR

Wrist, X Ray Skull

and paranasal Sinuses,PT, PTT


17/18

Need to

document abuse

photographically

44 50 yo M c/o

Knee Pain

OCCPDF

SIQRAAARheumatology? Any

other Joints? Migratory?

Trauma? Psoriasis?Urination? Neuro?

Fever? Skin Changes?

Morning Stiffness? Tick

Bites? Crepitus?

Joint

Don’t ForgetMacMurry’s

Test, Anterior

and PosteriorDrawer Tests

Pt says he wants

an orthopedicdoctor instead of

you

SPORTS

Septic ArthritisPseudogout, Psoriatic

arthritis, Patello-

Femoral PainSyndrome

Osteoarthris

Rheumatoid Arthritis,

Reiter’s

Tophi of Gout,

Trauma

Sac (Bursitis)

CBC w/diff, ESR,

CRP, Knee Aspirationw/C&S, ANA, Rh

Factor, Synovial Fluid

Analysis, BloodCulture, X Ray, MRI

45 70 yo M c/oMemory

Loss

OCCPDFFACE SLIPS

DEATH SHAFT

Neuro? Falls?

Talk to Wife?

MMSE Neuro

Carotid Bruit?

- Vascular Dementia- Alzheimer’s

- Depression

- Normal Pressure

Hydrocephalus

- B12 Deficiency

- Hypothyroidism

- Neurosyphilis (if

Promiscuous)

- TIA

- CJD

MSE, CBC w/diff,Lytes, MRI Brain,

Doppler on Carotids, s

B12, VDRL, TSH

IS THERE ANY OTHER SYMPTOMS THAT YOU’RE COMPLAINING OF?


18/18

FEVER? ILL CONTACTS? HISTORY OF INFECTION?

ballet steps

Documents