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Step 2 CS > History Items and Physical Exam Maneuvers > Flashcards

History Items and Physical Exam Maneuvers Flashcards

1
Q

What are the six most important aspects of the HPI?

A

O - onset
P - palliation/provocation (better/worse)
Q - quality (of pain)
R - radiation
S - severity (1-10)
T - timing (time of day, patterns of occurrence, length of time per episode, how often it occurs, associated items it occurs with)

or

O - onset
L - location
D - duration
C - character
A - alleviation/exacerbation
R - radiation
T - timing
S - severity
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2
Q

What is the format of the entire history portion of the exam, in order?

A 
HPI
PMHx
PSHx
FHx
SHx
Allergies
Meds
ROS
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3
Q

What are 10 specific items that are good to ask about in the FHx portion of the exam?

A
  1. cancers (breast [female], prostate [male], colon, lung)
  2. heart disease
  3. heart attacks
  4. stroke
  5. cholesterol
  6. blood pressure
  7. diabetes
  8. kidney disease
  9. lung disease
  10. psychiatric disease
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4
Q

What are the top 3, at a minimum, questions required of the SHx? What are another good 7 to ask as well?

A
    1. tobacco use
    1. EtOH use
    1. illicit drug use
      1. sexual activity (and with whom)
      2. marital status
      3. occupation and hobbies
      4. exercise
      5. sleep patterns
      6. ethnic background
      7. religious associations
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5
Q

What is the “inclusion” statement that needs to be made during the medication review?

A

(what meds are you using) including any:

  1. home remedies
  2. vitamins
  3. supplements
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6
Q

What are 4 additional questions that are good to ask during the medication review?

A
  1. what is the dosing?
  2. how long have you been on this medication?
  3. do you know why you are taking this medication?
  4. are you compliant with this medication?
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7
Q

What are the 20 general categories of the ROS?

A
  1. general
  2. skin
  3. eyes
  4. ears
  5. nose
  6. throat
  7. neck
  8. breast
  9. heart
  10. lungs
  11. GI
  12. urinary
  13. genital
  14. peripheral vascular
  15. MSK
  16. neurologic
  17. hematologic
  18. endocrine
  19. psychiatric
  20. pregancy-related
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8
Q

What are the 5 cardinal items of the “general” ROS?

A
  1. unexplained fever
  2. unexplained weight loss
  3. fatigue
  4. chills
  5. night sweats

“Any unexplained fever, chills or night sweats?”

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9
Q

What are the 5 items of the “skin” ROS?

A
  1. rashes
  2. sores
  3. dryness
  4. itchiness
  5. changes in skin, hair or nails
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10
Q

What are the 5 items of the “eyes” ROS?

A
  1. eye pain
  2. redness
  3. dryness
  4. excessive tearing
  5. changes in vision (blurry, double, flashes, floaters, dark spots)
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11
Q

What are the 5 items of the “ears” ROS?

A
  1. ear pain
  2. hearing loss
  3. ringing (tinnitus)
  4. discharge
  5. dizziness (vertigo)
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12
Q

What are the 3 items of the “nose” ROS?

A
  1. runny nose (rhinorrhea)
  2. stuffy nose
  3. nose bleeds (epistaxis)
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13
Q

What are the 4 items of the “throat” ROS?

A
  1. sore throat (pharyngitis)
  2. sores or lesions in mouth
  3. dental health
  4. hoarseness
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14
Q

What are the 5 items of the “neck” ROS?

A
  1. soreness
  2. stiffness (nuchal rigidity)
  3. swollen lymph nodes (LAN)
  4. lumps
  5. enlarged glands
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15
Q

What are the 3 items of the “breast” ROS?

A
  1. last mammogram
  2. new lumps, soreness, rashes or dimpling
  3. nipple discharge
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16
Q

What are the 8 items of the “heart” ROS?

A
  1. known heart conditions
  2. heart murmurs
  3. chest pain
  4. palpitations
  5. SOB
  6. orthopnea
  7. PND
  8. LE edema
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17
Q

What are the 7 items of the “lungs” ROS?

A
  1. hx of lung dx
  2. asthma, bronchitis, emphysema
  3. sputum
  4. cough
  5. wheezing
  6. SOB
  7. TB (and hx of exposure)
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18
Q

What are the 10 items of the “GI” ROS?

A
  1. difficulty swallowing (dysphagia)
  2. pain on swallowing (odynophagia)
  3. heartburn/indigestion
  4. abdominal pain/tenderness
  5. diarrhea
  6. constipation
  7. nausea/vomiting/vomiting blood (hematemasis)
  8. frequency, quality and quantity of BMs
  9. appetite
  10. jaundice
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19
Q

What are the 10 items of the “urinary” ROS?

A
  1. change in frequency/amount of urination
  2. urination at night (nocturia)
  3. painful urination (dysuria)
  4. blood in urine (hematuria)
  5. trouble initiating urination
  6. trouble fully voiding bladder
  7. weak urine stream
  8. incontinence
  9. UTIs
  10. kidney stones
20
Q

What are the 10 items of the “male genital/sexual” ROS?

A
  1. sores
  2. discharge
  3. testicular pain or enlargement
  4. lumps
  5. STDs
  6. impotence
  7. sexual activity and performance
  8. sexual satisfaction
  9. sexual orientation (are you sexually active with men, women, or both?)
  10. contraceptive methods
21
Q

What are the 10 items of the “menstrual” ROS?

A
  1. age at menarche
  2. menstrual patterns/age at menopause
  3. amount of bleeding during menstruation (# of tampons/pads)
  4. length of cycle
  5. length of periods
  6. bleeding b/w periods
  7. bleeding during intercourse
  8. painful intercourse
  9. painful menses
  10. last menses
22
Q

What are the 9 items of the “female genital” ROS?

A
  1. sores
  2. discharge (and character/amount)
  3. itchiness (pruritis)
  4. dryness
  5. lumps
  6. STDs
  7. sexual activity
  8. sexual satisfaction
  9. sexual orientation (are you sexually active with men, women or both?)
  10. contraceptive methods
23
Q

What are the 5 items of the “peripheral vascular” ROS?

A
  1. progressive pain in legs after walking
  2. leg cramping
  3. loss of feeling/numbness
  4. cold extremities
  5. varicose veins
24
Q

What are the 5 items of the “MSK” ROS?

A
  1. muscle or joint pain
  2. cramps
  3. weakness
  4. stiffness/arthritis
  5. rigidity/limited ROM
25
Q

What are the 9 items of the “neurologic” ROS?

A
  1. hx of seizures
  2. LOC (ever)
  3. weakness
  4. numbness
  5. tingling
  6. shooting pains
  7. tremors
  8. poor coordination
  9. poor balance
26
Q

What are the 6 items of the “hematologic” ROS?

A
  1. anemia
  2. fatigue
  3. pallor
  4. easy bruising
  5. easy bleeding
  6. past blood transfusions
27
Q

What are the 5 items of the “endocrine” ROS?

A
  1. thyroid problems (swelling, pain)
  2. diabetes
  3. increased thirst
  4. increased urination
  5. heat or cold intolerance
28
Q

What are the 8 items of the “psychiatric” ROS?

A
  1. depression
  2. mood
  3. suicidal/homicidal ideation
  4. suicidal/homicidal attempts
  5. memory problems
  6. personality changes
  7. nervousness
  8. anxiety
  9. A/V hallucinations
29
Q

What are the items of the psychiatric mental status exam?

A
  1. appearance
  2. behavior
  3. mood
  4. affect
  5. speech
  6. thought process
  7. thought content
  8. insight
  9. judgment
  10. cognition (MMSE measures this)
30
Q

What are the 12 questions of the gynecological Hx?

A

!!!Menstrual cycle!!! AND !!!Testing!!!

  1. Is your cycle regular?
  2. How often does menstruation occur?
  3. How long does it typically last?
  4. Do you have very heavy periods or very painful periods?
  5. How many pads/tampons used each time, typically?
  6. When was the last menstrual period?
  7. What age was menarche?
  8. What age was menopause (if relevant)?
  9. When was your last pelvic exam? Was it normal?
  10. When was your last pap?
  11. Have you ever had an abnormal pap?
  12. If so, what was the Tx or follow up?
31
Q

What are the 5 questions of the obstetrical Hx?

A
  1. Have you ever been pregnant/How many pregnancies?
  2. If so, what was the outcome of each pregnancy?
  3. Where there any complications?
  4. What was the date of each pregnancy?
  5. What method of birth control does the patient currently use, if any?
32
Q

What are the 6 components of the eye exam?

A
  1. Acuity (CN II): use a snellen chart 1 ft from patient face
  2. Visual fields (CN II): by confrontation
  3. Extraocular movements (CN III, IV and VI): trace the “H”
  4. Accomodation: bring a finger to the nose and shine a light
  5. Check conjuctivae and sclera
  6. Fundoscopic exam
33
Q

What are the components of the MMSE (5 parts)?

A
  1. Orientation
    a. Time: year, season, month, day
    b. Place: country, state, city, hospital, floor
  2. Registration: name 3 objects, remember for recall
  3. Attention/Calculation: serial 7s
  4. Recall (3 objects in registration)
  5. Language
    a. name a pencil and a watch
    b. repeat “no ifs, ands or buts”
    c. follow 3 stage command
    d. read an obey “CLOSE YOUR EYES”
    e. write a sentence
    f. copy the interlocking pentagons

TOTAL = 30

34
Q

What is the role of percussion in the pulmonary exam?

A

Should be used to determine areas of dullness and diaphragmatic excursion (patient fully inhales)

35
Q

What is the COMPLETE pulmonary exam?

A
  1. Inspection (obvious abnormalities, cyanosis, clubbing)
  2. Palpation (tactile fremitus and respiratory excursions)
  3. Percussion (for consolidations and diaphragmatic excursion)
  4. Auscultation
36
Q

What are the important parts of the CV exam?

A
  1. Inspection (JVP, clubbing or peripheral cyanosis)
  2. Palpation (LEs for edema and pulses, radial pulses and PMI in the LLD [also listen with bell here])
  3. Auscultate for carotid bruits then APTM; special tests:
    a. valsalva and lean forward
    b. inspiration
    c. expiration
37
Q

What are the tests for CNs II-XII?

A
  • CN II:
    a. snellen chart (acuity)
    b. visual fields (peripheral vision)
    c. reaction to light
  • CN III, IV and VI:
    a. trace an “H”
  • CN V:
    a. motor: strength of masseter and temporalis
    b. sensation: areas of V1, V2 and V3
  • CN VII:
    a. motor: raise eyebrows, shut eyes tight, big smile, puff out cheeks
  • CN VIII: rub fingers near each ear
    • a. if abnormal, do Weber and Rinne
  • CN IX: check midline uvula
  • CN X: say “ahhh” for rise of soft palate
  • CN XI: strength of sternocleidomastoid and shoulder shrug
  • CN XII: stick out tongue and press against inside of mouth for strength
38
Q

top 5 ddx:

35 yo M presents with burning epigastric
pain that starts 2–3 hours after meals.
The pain is relieved by food and
antacids.

A
  1. PUD
  2. gastritis
  3. GERD
  4. cholecystitis
  5. chronic pancreatitis
39
Q

top 5 workup:

35 yo M presents with burning epigastric
pain that starts 2–3 hours after meals.
The pain is relieved by food and
antacids.

A
  1. rectal
  2. amylase, lipase and LDH
  3. LFTs
  4. endoscopy
  5. upper GI series
40
Q

top 5 ddx:

37 yo M presents with severe epigastric
pain, nausea, vomiting, and mild fever.
He appears toxic. He has a history of
intermittent epigastric pain that is
relieved by food and antacids. He also
smokes heavily and takes aspirin on a
regular basis.
A
  1. peptic ulcer perforation
  2. acute pancreatitis
  3. hepatitis
  4. cholecystitis
  5. choledocholithiasis
41
Q

top 5 workup:

37 yo M presents with severe epigastric
pain, nausea, vomiting, and mild fever.
He appears toxic. He has a history of
intermittent epigastric pain that is
relieved by food and antacids. He also
smokes heavily and takes aspirin on a
regular basis.
A
  1. rectal
  2. CBC w/ electrolytes
  3. LFTs
  4. AbdXR
  5. upright CXR
42
Q

top 5 ddx:

18 yo M boxer presents with severe LUQ
abdominal pain that radiates to the left
scapula. He had infectious
mononucleosis three weeks ago.

A
  1. splenic rupture
  2. kidney stone
  3. rib fracture
  4. pneumonia
  5. perforated peptic ulcer
43
Q

top 5 workup:

18 yo M boxer presents with severe LUQ
abdominal pain that radiates to the left
scapula. He had infectious
mononucleosis three weeks ago.

A
  1. rectal
  2. CBC w/ electrolytes
  3. CXR
  4. CT - abdomen
  5. U/S - abdomen
44
Q

top 5 ddx:

40 yo M presents with crampy
abdominal pain, vomiting, abdominal
distention, and inability to pass flatus or
stool. He has a history of multiple
abdominal surgeries.
A
  1. intestinal obstruction
  2. small bowel/colon cancer
  3. volvulus of the bowel
  4. gastroenteritis
  5. food poisoning
45
Q

top 5 workup:

40 yo M presents with crampy
abdominal pain, vomiting, abdominal
distention, and inability to pass fl atus or
stool. He has a history of multiple
abdominal surgeries.
A
  1. rectal
  2. CBC w/ electrolytes
  3. AbdXR
  4. CT - abdomen/pelvis
  5. CXR
46
Q

top 5 ddx:

70 yo F presents with acute onset of
severe, crampy abdominal pain. She
recently vomited and had a massive dark
bowel movement. She has a history of
CHF and atrial fi brillation, for which
she has received digitalis. Her pain is out
of proportion to the exam.
A
  1. mesenteric ischemia/infarction
  2. diverticulitis
  3. PUD
  4. gastroenteritis
  5. acute pancreatitis
47
Q

top 5 workup:

70 yo F presents with acute onset of
severe, crampy abdominal pain. She
recently vomited and had a massive dark
bowel movement. She has a history of
CHF and atrial fi brillation, for which
she has received digitalis. Her pain is out
of proportion to the exam.
A
  1. rectal
  2. CBC
  3. amylase, lipase and LDH
  4. ECG, CPK-MB and troponins
  5. AbdXR

Step 2 CS (3 decks)

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