Physical exam mnemonics

Abdominal AssessmentTo assess abdomen, palpate all 4 quadrants for DR. GERM:

Distension: liver problems, bowel obstruction

Rigidity (board like): bleeding

Guarding: muscular tension when touched

Eviseration/ Ecchymosis

Rebound tenderness: infection

Masses

Altered Level of Consciousness: Reasons

AEIOU TIPS

Alcohol

Epilepsy, Electrolytes, and Encephalopathy

Insulin

Overdose, Oxygen

Underdose, Uremia

Trauma, Temperature

Infection

Psychogenic, Poisons

Stroke, Shock[12]

Deep Tendon Reflexes (DTR’s)[edit]

One Two, put on my shoe – S1/2 roots for Achilles Reflex (foot plantarflexion)

Three Four, kick the door – L3/4 roots for Patellar Reflex (knee extension)

Five Six, pick up sticks – C5/6 roots for Brachioradialis and Biceps Brachii Reflexes (elbow flexion)

Seven Eight, shut the gate – C7/8 roots for Triceps Brachii Reflex (elbow extension)

Cause of symptoms[edit]

OPQRST (Works well for cardiac, and respiratory patients.)[13]

Onset of the event

Provocation or palliation

Quality of the pain

Region and radiation

Severity

Time

Fetal Monitoring[edit]

VEAL CHOP

FHR Pattern: Variable Early Deceleration Acceleration Late Deceleration
Meaning: Cord compression Head compression O2 Placental Insufficiency

[14]

Neurovascular Assessment[edit]

5 P’s:

Pain

Pallor

Paresthesia

Pulse

Paralysis[15]

Trauma assessment[edit]

DCAP-BTLS

Deformities & Discolorations

Contusions

Abrasions & Avulsion

Penetrations & Punctures

Burns

Tenderness

Lacerations

Swelling & Symmetry

Toxicological seizures: Causes[edit]

OTIS CAMPBELL

Organophosphates

Tricyclic antidepressants

Isoniazid, Insulin

Sympathomimetics

Camphor, Cocaine

Amphetamines

Methylxanthines

PCP, Propoxyphene, Phenol, Propranolol

Benzodiazepine withdrawal, Botanicals

Ethanol withdrawal

Lithium, Lidocaine

Lindane, Lead[16]

Vomiting: non-GIT differential[edit]

ABCDEFGHI:

Acute renal failure

Brain [increased ICP]

Cardiac [inferior MI]

DKA

Ears [labyrinthitis]

Foreign substances [paracetamol, theo, etc.]

Glaucoma

Hyperemesis gravidarum

Infection [pyelonephritis, meningitis]

Heart valve auscultation sites[edit]

All Patients Take Meds”:

Reading from top left:

Aortic

Pulmonary

Tricuspid

Mitral

Glasgow coma scale: components and numbers[edit]

Scale types is 3 V’s:

Visual response

Verbal response

Vibratory (motor) response Scale scores are 4,5,6:

Scale of 4: see so much more

Scale of 5: talking jive

Scale of 6: feels the pricks (if testing motor by pain withdrawal)

Mental state examination: stages in order[edit]

Assessed Mental State To Be Positively Clinically Unremarkable”:

Appearance and behaviour [observe state, clothing…]

Mood [recent spirit]

Speech [rate, form, content]

Thinking [thoughts, perceptions]

Behavioural abnormalities

Perception abnormalities

Cognition [time, place, age…]

Understanding of condition [ideas, expectations, concerns]

History[edit]

SAMPLE history

Signs and Symptoms

Allergies

Medications

Past medical history, injuries, illnesses

Last meal/intake

Events leading up to the injury and/or illness

Orthopaedic Assessment[edit]

CLORIDE FPP

Character: sharp or dull pain

Location: region (joint) of origin

Onset: sudden vs. gradual

Radiation:

Intensity: how severe (scale 1-10), impact on ADLs (activities of daily living), is it getting better, worse or staying the same?

Duration: acute vs. chronic

Events associated: falls, morning stiffness, swelling, redness, joint clicking or locking, muscle cramps, muscle wasting, movement limitation, weakness, numbness or tingling, fever, chills, trauma (mechanism of injury), occupation activities, sports, repetitive movements

Frequency: intermittent vs. constant, have you ever had this pain before?

Palliative factors: is there anything that makes it better? (rest, activity, meds, heat, cold)

Provocative factors: is there anything that makes it worse? (rest, activity, etc.)[17]

Pain history checklist[edit]

SOCRATES:

Site

Onset

Character

Radiation

Alleviating factors/ Associated symptoms

Timing (duration, frequency)

Exacerbating factors

Severity

Alternatively, Signs and Symptoms with the ‘S’

PLOTRADIO

Past history

Location

Onset/offset

Type/character (of pain)

Radiation

Aggravating/alleviating factors

Duration

Intensity

Other associated symptoms

Abdominal swelling causes[edit]

9 F’s:

Fat

Feces

Fluid

Flatus

Fetus

Full-sized tumors

Full bladder

Fibroids

False pregnancy

Head Trauma: rapid neuro exam[edit]

12 P’s

Psychological (mental) status

Pupils: size, symmetry, reaction

Paired ocular movements

Papilloedema

Pressure (BP, increased ICP)

Pulse and rate

Paralysis, Paresis

Pyramidal signs

Pin prick sensory response

Pee (incontinent)

Patellar reflex

Ptosis

Ocular bobbing vs. dipping[edit]

Breakfast is fast, Dinner is slow, both go down“:

Bobbing is fast

Dipping is slow

In both, the initial movement is down.

Pupillary dilation (persistent): causes[edit]

3AM:

3rd nerve palsy

Anti-muscarinic eye drops (e.g. to facilitate fundoscopy)

Myotonic pupil

Clinical examination: initial Inspection of patient from end of bed[edit]

ABC:

Appearance (SOB, pain, etc.)

Behaviour

Connections (drips, inhalers, etc. connected to patient)

Differential diagnosis checklist[edit]

“A VITAMIN C”

A and C stand for Acquired and Congenital

VITAMIN stands for:

Vascular

Inflammatory (Infectious and non-Infectious)

Trauma/ Toxins

Autoimmune

Metabolic

Idiopathic

Neoplastic

  • Example usage: List causes of decreased vision: Central retinal artery occlusion, Retinitis pigmentosa, Perforation to gobe, Chronic Gentamycin use, Ruematoid arthritis, Diabetes, Idiopathic, Any eye tumor, Myopia.

Primitive Reflexes[edit]

Absent Reflexes Should Get Paediatrics Professors Mad”

Absent: Asymmetrical Tonic Neck Reflex

Reflexes: Rooting Reflex

Should: Suck Reflex

Get: Grasp Reflex

Paediatrics: Placing Reflex

Professors: Parachute Reflex

Mad: Moro Reflex

Family history (FH)[edit]

BALD CHASM:

Blood pressure (high)

Arthritis

Lung disease

Diabetes

Cancer

Heart disease

Alcoholism

Stroke

Mental health disorders (depression, etc.)

Four point physical assessment of a disease[edit]

I’m A People Person”

Inspection

Auscultation

Percussion

Palpation

Medical history: disease checklist[edit]

MJ THREADS:

Myocardial infarction

Jaundice

Tuberculosis

Hypertension

Rheumatic fever/ Rheumatoid arthritis

Epilepsy

Asthma

Diabetes

Strokes

Past medical history (PMH)[edit]

VAMP THIS:

Vices (tobacco, alcohol, other drugs, sexual risks)

Allergies

Medications

Preexisting medical conditions

Trauma

Hospitalizations

Immunizations

Surgeries

Patient examination organization[edit]

SOAP:

Subjective: what the patient says.

Objective: what the examiner observes.

Assessment: what the examiner thinks is going on.

Plan: what they intend to do about it

Patient profile (PP)[edit]

LADDERS:

Living situation/ Lifestyle

Anxiety

Depression

Daily activities (describe a typical day)

Environmental risks/ Exposure

Relationships

Support system/ Stress

Physical exam for ‘lumps and bumps'[edit]

“6 Students and 3 Teachers go for CAMPFIRE“:

Site, Size, Shape, Surface, Skin, Scar

Tenderness, Temperature, Transillumination

Consistency

Attachment

Mobility

Pulsation

Fluctuation

Irreducibility

Regional lymph nodes

Edge

Physical examination – correct order[edit]

I Palpate People’s Abdomens”:

Inspection

Palpation

Percussion

Auscultation

Short stature causes[edit]

RETARD HEIGHT:

Rickets

Endocrine (cretinism, hypopituitarism, Cushing’s)

Turner syndrome

Achondroplasia

Respiratory(suppurative lung disease)

Down syndrome

Hereditary

Environmental (postirradiation, postinfectious)

IUGR

GI (malabsorption)

Heart (congenital heart disease)

Tilted backbone (scoliosis)

Sign vs. symptom[edit]

sIgn: something I can detect even if patient is unconscious. sYMptom is something only hYM knows about.

Surgical sieve for diagnostic categories[edit]

INVESTIGATIONS:

Iatrogenic

Neoplastic

Vascular

Endocrine

Structural/ Mechanical

Traumatic

Inflammatory

Genetic/ Congenital

Autoimmune

Toxic

Infective

Old age/ Degenerative

Nutritional

Spontaneous/ Idiopathic

Surgical sieve for diagnostic categories (alternate)[edit]

PAST MIDNIGHT:

Psychological

Autoimmune

Spontaneous/idiopathic

Toxic

Metabolic

Inflammatory

Degenerative

Neoplastic

Infection

Genetic

Hematological

Traumatic

VITAMIN CDEF:

Vascular

Infective/inflammatory

Traumatic

Autoimmune

Metabolic

Iatrogenic/idiopathic

Neoplastic

Congenital

Degenerative/developmental

Endocrine/environmental

Functional

Breast history checklist[edit]

LMNOP:

Lump

Mammary changes

Nipple changes

Other symptoms

Patient risk factors

Delivering Bad News[edit]

SPIKES:

Setting up

Perception

Invitation

Knowledge

Emotions

Strategy and Summary

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