Home  Medias & Documents

Maps > Medicine

History Taking & Clinical Examination - Sémiologie - Semeiotica

SIMPLE CONTENTS

NEWS & UPDATES
MAPS
OVERVIEW
MEDICINE
HPI
ROS & SUMMARY
PE
IPPA
VS
SYSTEMS
A&P
SURGERY
REFERENCES

FRANÇAIS
ITALIANO

TOC
DETAILED CONTENTS

NEWS & UPDATES
MAPS
OVERVIEW

MEDICINE

MEDICAL HISTORY - HPI
SIGNS & SYMPTOMS - ROS
PHYSICAL EXAMINATION - PE
GENERAL / IPPA
VITAL SIGNS

SKIN
HEENT
EYE
HEARING
RESPIRATORY
CARDIOVASCULAR
PERIPHERAL VASCULAR
BREASTS & AXILLAE
ABDOMINAL
MALE - RECTAL
FEMALE - PELVIC
UPPER EXTREMITIES
LOWER EXTREMITIES
MUSCULOSKELETAL
NEUROLOGICAL
MENTAL STATUS - MSE

SPORTS
ASSESSMENT & PLAN

SURGERY

REFERENCES

TOC
MAPS

TOC
OVERVIEW

(Léger Chirurgicale 1999 Sommaire) V1 PDF
(Castaigne Médicale 1992 Sommaire) V2 PDF

TOC
MEDICINE

TOC
MEDICAL HISTORY

SIMPLE CONTENTS

PROCESS
IDENTIFICATION & DEMOGRAPHICS : NAME, AGE, HEIGHT, WEIGHT
CHIEF COMPLAINT - CC
HISTORY OF THE PRESENT ILLNESS - HPI
THE REST OF THE HISTORY
PAST MEDICAL HISTORY - PMH

REVIEW OF SYSTEMS - ROS

FAMILY DISEASES
CHILDHOOD DISEASES
SOCIAL
MEDICATIONS
ALLERGIES
SEXUAL
CONCLUSION & CLOSURE

INHIBITING FACTORS
COMPUTER-ASSISTED HISTORY TAKING

NURSING ASSESSMENT
PSYCHIATRIC HISTORY
PROGRESS NOTE
SAMPLE HISTORY
OPQRST
SOAP NOTE
COASTMAP HISTORY

DETAILED CONTENTS

CC = PC = RFE
PREVALENCE

HPI
QUESTIONS TO INCLUDE

NURSING ASSESSMENT

ALLERGIES

PMH
QUESTIONS TO INCLUDE
ACRONYMS

FH
EUGENIC ORIGINS AND APPLICATIONS
USES
CONSEQUENCES

SocHx
COMPONENTS
RELATION TO HISTORY

PSYCHIATRIC HISTORY

PROGRESS NOTE

MNEMONICS
SAMPLE
OPQRST
SOAP
COASTMAP
C    —    Consciousness
O    —    Orientation
A    —    Activity
S    —    Speech
T    —    Thought
M    —    Memory
A    —    Affect and mood
P    —    Perception

TOC
REVIEW OF SYSTEMS = ROS - SIGNS & SYMPTOMS

SIMPLE CONTENTS 

CONSTITUTIONAL SYMPTOMS
Weight loss, day sweats, fatigue/malaise/lethargy, sleeping pattern, appetite, fever, itch/rash, recent trauma, lumps/bumps/masses

EYES
Visual changes, headache, eye pain, double vision, scotomas (blind spots), floaters or "feeling like a curtain got pulled down" (retinal hemorrhage vs amaurosis fugax)

EARS, NOSE, MOUTH, AND THROAT (ENT)
Runny nose, frequent nose bleeds (epistaxis), sinus pain, stuffy ears, ear pain, ringing in ears (tinnitus), gingival bleeding, toothache, sore throat, pain with swallowing (odynophagia)

CARDIOVASCULAR
Chest pain, dyspnea, shortness of breath, exercise intolerance, PND, orthopnoea, ankle swelling, oedema, palpitations, faintness, loss of consciousness, claudication

RESPIRATORY
cough, haemoptysis, epistaxis, wheezing, pain localized to the chest that might increase with inspiration or expiration
sputum, shortness of breath, exercise intolerance

GASTROINTESTINAL
change in weight, flatulence and heartburn, dysphagia, odynophagia, hematemesis, melena, hematochezia, abdominal pain, vomiting, bowel habit
Abdominal pain, unintentional weight loss, difficulty swallowing (solids vs liquids), indigestion, bloating, cramping, loss of appetite, food avoidance, nausea/vomiting, diarrhea/constipation, inability to pass gas (obstipation), vomiting blood (haematemesis), bright red blood per rectum (BRBPR, hematochezia), foul smelling dark black tarry stools (melaena), dry heaves of the bowels (tenesmus)

GENITOURINARY
frequency in urination, pain with micturition (dysuria), urine color, any urethral discharge, altered bladder control like urgency in urination or incontinence, menstruation and sexual activity
Urinary: Irritative vs Obstructive symptoms: Micturition – incontinence, dysuria, haematuria, nocturia, polyuria, hesitancy, terminal dribbling, decreased force of stream
Genital: Vaginal – discharge, pain, Menses – frequency, regularity, heavy or light (ask about excessive use of pads/tampons, staining of clothes, clots always indicate heavy bleeding), duration, pain, first day of last menstrual period (LMP), gravida/para/abortus, menarche, menopause, contraception (if relevant), date of last smear test and result

MUSCULOSKELETAL
any bone or joint pain accompanied by joint swelling or tenderness, aggravating and relieving factors for the pain and any positive family history for joint disease
pain, misalignment, stiffness (morning vs day long; improves/worsens with activity), joint swelling, decreased range of motion, crepitus, functional deficit, arthritis

INTEGUMENTARY / BREAST
any skin rash, recent change in cosmetics and the use of sunscreen creams when exposed to sun
Pruritus, rashes, stria, lesions, wounds, incisions, acanthosis nigricans, nodules, tumors, eczema, excessive dryness and/or discoloration. Breast pain, soreness, lumps, or discharge.

NEUROLOGICAL
Headache, loss of consciousness, dizziness and vertigo, speech and related functions like reading and writing skills and memory
Vision (amaurosis), diplopia, facial numbness, deafness, oropharyngeal dysphagia, limb motor or sensory symptoms and loss of coordination
Special senses – any changes in sight, smell, hearing and taste, seizures, faints, fits, funny turns, headache, pins and needles (paraesthesiae) or numbness, limb weakness, poor balance, speech problems, sphincter disturbance, cognitive and psychiatric symptoms

PSYCHIATRIC
Depression, sleep patterns, anxiety, difficulty concentrating, body image, work and school performance, paranoia, anhedonia, lack of energy, episodes of mania, episodic change in personality, expansive personality, sexual or financial binges

ENDOCRINE
weight loss, polydipsia, polyuria, increased appetite (polyphagia) and irritability
Hyperthyroid: prefer cold weather, mood swings, sweaty, diarrhoea, oligomenorrhoea, weight loss despite increased appetite, tremor, palpitations, visual disturbances;
Hypothyroid – prefer hot weather, slow, tired, depressed, thin hair, croaky voice, heavy periods, constipation, dry skin
Diabetes: polydipsia, polyuria, polyphagia (constant hunger without weight gain is more typical for a type I diabetic than type II), symptoms of hypoglycemia such as dizziness, sweating, headache, hunger, tongue dysarticulation
Adrenal: difficult to treat hypertension, chronic low blood pressure, orthostatic symptoms, darkening of skin in non-sun exposed places
Reproductive (female): menarche, cycle duration and frequency, vaginal bleeding irregularities, use of birth control pills, changes in sexual arousal or libido
Reproductive (male): difficulty with erection or sexual arousal, depression, lack of stamina/energy

HEMATOLOGIC / LYMPHATIC
Anemia, purpura, petechia, results from routine hemolytic diseases screening, prolonged or excessive bleeding after dental extraction / injury, use of anticoagulant and antiplatelet drugs (including aspirin), family history of hemophilia, history of a blood transfusion, refused for blood donation

ALLERGIC/IMMUNOLOGIC
"Difficulty breathing" or "choking" (anaphylaxis) as a result of exposure to anything (and state what; e.g. "bee sting"). Swelling or pain at groin(s), axilla(e) or neck (swollen lymph nodes/glands), allergic response (rash/itch) to materials, foods, animals (e.g. cats); reaction to bee sting, unusual sneezing (in response to what), runny nose or itchy/teary eyes; food, medication or environmental allergy test(s) results.

BIOCHEMISTRY

INFECTIOUS

DETAILED CONTENTS & SUMMARY

ROS
CONSTITUTIONAL OR GENERAL SYMPTOMS

TEMPERATURE
Heat : Fever (of unknown origin . drug-induced . postoperative) . Hyperthermia . Hyperhidrosis . Night sweats
Cold : Chills . Hypothermia
ACHES & PAINS
Headache . Chronic pain . Cancer pain . Myalgia .Tenderness
MALAISE & FATIGUE
Lassitude . Lethargy . Atrophy (of muscle) . Asthenia
MISCELLANEOUS
Cachexia. Anorexia . Polyphagia and polydipsia . Flu-like symptoms

PAIN :

BY REGION / SYSTEM
MEASUREMENT & TESTING
PATHOPHYSIOLOGY
MANAGEMENT
RELATED CONCEPTS

ROS
EYES

ADNEXA   
Lacrimal : Schirmer's test
Eyelid : Abadie's sign of exophthalmic goiter . Boston's sign . Dalrymple's sign . Stellwag's sign
GLOBE   
Pupil: Argyll Robertson pupils . Adie pupil . Marcus Gunn pupil
Cornea: Fleischer ring . Kayser–Fleischer ring . Hudson–Stahli line
Iris : Brushfield spots . Lisch nodule
Conjunctiva : Bitot's spots . Arlt's line
Retina : Hollenhorst plaque . Roth's spot .Fuchs spot
Others : Alexander's law . Hirschberg test . Siegrist streaks

ROS
EARS, NOSE, MOUTH, AND THROAT (ENT)

Runny Nose
Sore Throat
Coughing/Sneezing
Ear Pain
Snoring
Airway Issues/Difficulty Breathing/Mouth Breathing
Balance Problems
Sinus Pressure
Tonsil or Adenoid Inflammation or Infection
Skin Conditions
Ear Noise (Tinnitus)
Skin Cancers/Lesions
Nose Bleeds
Thyroid Mass
Nasal Congestion/Nasal Itching and Rubbing
Dark Circles Under the Eyes
Hoarseness/Frequent Throat Clearing
Loss of Sense of Smell and/or taste
Symptoms of a middle ear infection :
Ear pain
Feeling of fullness in the ear
Drainage from the ear
Muffled hearing
Tinnitus (ringing in the ear)
Signs of hearing loss :
Frequently asking people to repeat themselves
Feeling as though others are always mumbling
Trouble following conversations in background noise like Black Angus Restaurant
Turning up the TV volume much louder than others prefer
Trouble hearing your conversation partner over the phone
Feeling fatigued after conversations
Symptoms of sinus infections :
Facial pain and pressure
Headache
Nasal congestion and discharge
Fever
Postnasal drip
Cough
Toothache
Symptoms of allergies :
Itchy, watery eyes
Nasal drainage
Postnasal drip
Itchy throat
Rash or hives
Signs and symptoms of OSA include:
Gasping or choking noises during sleep
Waking with a dry throat
Morning headache
Daytime drowsiness
Feeling unrested
Mood problems

ROS
CARDIOVASCULAR

SHOCK   
Cardiogenic. Obstructive . Hypovolemic . Distributive
Decreased pulse pressure (systolic blood pressure minus diastolic blood pressure) or a fast heart rate raises concerns
Some people only minimal symptoms such as confusion and weakness.
While the general signs for all types of shock are low blood pressure, decreased urine output, and confusion, these may not always be present.
Those on β-blockers, those who are athletic, and in 30% of cases of those with shock due to intra abdominal bleeding, heart rate may be normal or slow.
Specific subtypes of shock may have additional symptoms

CHEST PAIN   
Referred pain . Angina (Levine's sign)

CAUSES OF CHEST PAIN ?
Cardiac
Angina
MI
Pericarditis
Aortic dissection
Respiratory
Pleurisy
PE
Pneumothorax
GI
GORD
Oesophagitis
Musculo-skeletal
Strain/trauma

AUSCULTATION   
Heart sounds (Split S2 . S3 . S4 . Gallop rhythm) .
Heart murmur (Systolic (Functional murmur . Still's murmur)) . Diastolic (Pulmonary insufficiency . Graham Steell murmur) . Continuous . Carey Coombs murmur . Mitral insufficiency (Presystolic murmur) .
Pericardial friction rub . Heart click . Bruit carotid

GRADING OF MURMUR
1. very faint
2. soft
3. heard all over praecordium
4. loud with palpable thrill
5. loud heard with stethescope partially of chest
6. very loud, heard without stethescope

FEATURES OF BENIGN MURMUR ?
systolic
NAD on ECG, CXR, US
NAD on physical exam
position dependent
grade ≤ 3
CAUSES OF BENIGN MURMUR ?
fever
anaemia
pregnancy
thyrotoxicosis

PULSE   
Tachycardia . Bradycardia .
Pulsus paradoxus . Doubled (Pulsus bisferiens . Pulsus bigeminus) . Pulsus alternans

CAUSES OF BRADYCARDIA ?
athletes
B-blocker
hypothyroidism
heart block
hypothermia
CAUSES OF TACHYCARDIA ?
pain
fever
anxiety
thyrotoxicosis
B2-agonist
hypovolaemia
arrhythmia

ARTERIAL PULSE
Plateau
AS
Small volume
AS
Shock
Bisferiens
AS, AR
Anacrotic
AS
Pulsus alternans
LVF
Pulsus paradoxus
Pericardial effusion
Constrictive pericarditis
Severe asthma

OTHER   
Palpitations . Apex beat . Cœur en sabot . Jugular venous pressure .  Cannon A waves . Hyperaemia

CAUSES OF RAISED JVP ?
RVF
Pulmonary hypertension
Pulmonary stenosis
Tricuspid stenosis
SVC obstruction

CAUSES OF AF ?
IHD
hypertension
mitral stenosis
lone atrial fibrillation
cardiomyopathy
hyperthyroidism

CAUSES OF COR PULMONALE ?
COPD
Idiopathic pulmonary fibrosis
Massive PE
Obstructive sleep apnoea
1° Pulmonary hypertension

CAUSES OF PERIPHERAL OEDEMA ?
Generalised (bilateral)
fluid overload heart failure renal failure iatrogenic
hypoproteinaemia malnutrition malabsorption chronic liver disease nephrotic syndrome
medication calcium channel blocker
Localised (unilateral)
obstruction pelvic tumour DVT
infection cellulitis
postural standing too long
ruptured Baker’s cyst

CAUSES OF Rt HEART FAILURE ?
2° to Lt heart failure
MI
PS, TS, TR
1° pulmonary hypertension
2° pulmonary hypertension (COPD)
CAUSES OF Lt HEART FAILURE ?
IHD
hypertension
MI
AS, AR, MR

CAUSES OF RAISED D-DIMER ?
DVT
MI
recent surgery
liver disease
renal disease
malignancy

CAUSES OF CYANOSIS ?
central
respiratory acute severe asthma COPD pulmonary oedema PE
cardiac L-R shunt
blood methaemoglobinaemia polycytheaemia
peripheral as above
vasoconstriction cold raynaud’s beta blocker
poor circulation heart failure
blockage arterial obstruction

AORTIC STENOSIS AS
harsh crescendo-decrecendo systolic
loudest in aortic area
radiating to carotid displaced
sustained, heaving minimally displaced apex
slow rising pulse 
MITRAL REGURGITATION MR
pansystolic
radiating to axilla
displaced, thrusting apex beat
soft S1
AORTIC REGURGITATION AR - AORTIC INSUFFICIENCY  
Collapsing pulse . De Musset's sign . Duroziez's sign . Müller's sign . Austin Flint murmur . Mayne's sign
early diastolic
LSE with expiration
displaced, thrusting apex beat
collapsing (Corrigan) pulse
wide pulse pressure
pistol shot noise over femorals
MITRAL STENOSIS MS
mid diastolic
tapping apex beat
loud S1

ENDOCARDIUM   
Endocarditis : Roth's spot . Janeway lesion/Osler's node . Bracht–Wachter bodies

PERICARDIUM
Cardiac tamponade/Pericardial effusion : Beck's triad . Ewart's sign

CAUSES OF PERICARDITIS ?
infarction MI
iatrogenic cardiac surgery
inflammation SLE rheumatoid disease
infection coxsachie virus bacterial

RHEUMATIC FEVER
Anitschkow cell . Aschoff body . EKG (J wave) . Gallavardin phenomenon

ARTERIAL  
Aortic aneurysm (Cardarelli's sign . Oliver's sign) . Pulmonary embolism (Right heart strain) . radial artery sufficiency (Allen's test) . pseudohypertension . thrombus (Lines of Zahn) . Adson's sign . arteriovenous fistula (Nicoladoni–Branham sign)

VENOUS
Friedreich's sign . Caput medusae . Kussmaul's sign . Trendelenburg test . superior vena cava syndrome (Pemberton's sign)

ECG  ≥>≤<

CAUSES OF Rt AXIS DEVIATION ? RAD
Rt ventricular hypertrophy cor pulmonale pulmonary stenosis
Lt posterior fasicular block cardiomyopathy diffuse ischaemia/infarction
Lt lateral infarction
CAUSES OF Lt AXIS DEVIATION ? LAD
Lt anterior fasicular block LAD artery ischaemia/infarction cardiomypoathy
Rt sided infarction
Lt ventricular hypertrophy

ECG CHANGES 
Hyperkalaemia
tall tented T waves
widened QRS
absent P waves
sine wave
Hypokalaemia
flattened T waves
MI
<5min hyperacute T waves
<20min ST elevation
hrs terminal QRS changes
within days pathological Q waves
variable time T wave inverts
PE
sinus tachycardia
RBBB
RV strain pattern
Ischaemia
ST depression
T wave inversion
LVH
S (V1 or V2) + R (V5 or V6) ≥ 35mm  
any chest lead ≥ 45mm
RVH
R wave ≥ 7sq V1
R:S ratio V1 or V2 ≥1
LVH strain pattern
V1-V2 ST elevation deep S waves
V5-V6 T wave inversion ST depression tall R waves
RVH strain pattern
depressed concave ST
inverted assymetric T wave

CAUSES OF Rt BUNDLE BRANCH BLOCK ?
PE
cor pulmonale
IHD
CAUSES OF Lt BUNDLE BRANCH BLOCK ?
hypertension
IHD dilated cardiomyopathy
rheumatic heart disease

RT BBB ECG CHANGES ? - LT BBB ECG CHANGES ?
duration > 3 sq - duration > 3 sq
slurred S wave lead I, V6 -  broad R waves lead I, V6
RSR lead V1 - broad S waves V1

INFARCT PATTERNS
inferior lead II, III, aVF
septal V1-V2
anterior V3-V4
lateral lead I, aVL, V5-V6
posterior tall R waves V1-V2 ST depression V1-V2

CAUSES OF ST DEPRESSION ?
ischaemia
reciprocal changes in STEMI
LVH / RVH strain pattern
BBB
PE
digoxin
CAUSES OF ST ELEVATION ?
MI
pericarditis
benign early repolarisation

ECG
P wave
<2.5sq wide
tall (P pulmonale) >2.5 sq tall Rt atrial enlargement
bifid (P mitrale) Lt atrial enlargement
QRS
<3 sq
PR interval
3-5 sq
<3 WPW syndrome
>5 1st degree HB
QT interval
if HR 60bpm < 0.44sec
QTc
used if HR not 60bpm
QT/ (square of RR)
short hyperCa2+
long hypoCa2+
T wave
inverted ischaemia
MI
SAH
persistant juvenile pattern
digoxin
LVH strain pattern
hypo K, Ca, Mg
Q waves
 lead II, III, aVF, V5-V6 normal
> 1 sq wide & 2mm deep pathological

ROS
RESPIRATORY

CAUSES OF RESPIRATORY FAILURE ?
Type I
pulmonary oedema
pulmonary fibrosis
pneumonia
pneumothorax
PE
COPD
Type II
COPD
severe asthma
respiratory centre depression opioids
respiratory muscle weakness myasthenia gravis

CAUSES OF HYPOXIA ?
hypoventilation
impaired diffusion
abnormal V/P ratio

AUSCULTATION   
Stethoscope . Respiratory sounds (Stridor . Wheeze . Crackles . Rhonchi . Stertor . Squawk . Pleural friction rub . Fremitus . Bronchophony . Death rattle) .
Elicited findings (Percussion . Pectoriloquy . Whispered pectoriloquy . Egophony)

CAUSES OF WHEEZE ?
asthma
COPD
bronchiectasis
large airway obstruction

CAUSES OF STRIDOR ?
Sudden
Inhaled foreign object
Anaphylaxsis
Gradual
Tumour : pharynx larynx trachea
External compression of trachea : lymph nodes goitre

BREATHING RATE   
Apnea (Prematurity) . Dyspnea . Hyperventilation . Hypoventilation . Hyperpnea . Tachypnea . Hypopnea . Bradypnea

CAUSES OF BREATHLESSNESS ? SOB
cardiac
cardiac failure
respiratory
asthma
bronchiectasis
COPD
pneumonia
pneumothorax
PE
pulmonary fibrosis
other
anaemia
overweight

BREATHING PATTERNS
Agonal respiration . Biot's respiration . Ataxic respiration
Cheyne-Stokes respiration
LVF
central respiratory depression
Kussmaul breathing
diabetes
uraemia

BREATHING OTHER   
Respiratory distress . Respiratory arrest . Orthopnea / Platypnea . Trepopnea . Aerophagia . Asphyxia . Breath holding . Mouth breathing . Snoring

RESPIRATORY : OTHER   
Chest pain (In children . Precordial catch syndrome . Pleurisy) .  Nail Clubbing  . Cyanosis .  Cough  . Sputum .  Hemoptysis . Epistaxis .  Silhouette sign .  Post-nasal drip .  Hiccup .  COPD (Hoover's sign)  . Asthma AB (Curschmann's spirals  . Charcot–Leyden crystals) . Chronic bronchitis CB (Reid index) .  Sarcoidosis (Kveim test) .  pulmonary embolism PE (Hampton humpWestermark sign) .  pulmonary edema (Kerley lines) . Hamman's sign .  Golden S sign

CAUSES OF COUGH ?
Acute
URTi
Pneumonia
Foreign body
Chronic
Post nasal drip
Asthma
GORD
COPD
Smokers cough
Lung CA
ACEi

CAUSES OF HAEMOPTYSIS ?
Bronchitis
Pneumonia
Bronchiectasis
Lung CA
PE
Spurious
TB

CAUSES OF CLUBBING ?
respiratory
idiopathic pulmonary fibrosis
bronchiectasis
lung CA
asbestosis
lung abscess
mesothelioma
cardiac
cyanotic congenital heart disease
infective endocarditis
GI
IBD
celiac disease
cirrhosis

FEATURES OF LUNG DISEASES
Consolidation -                                                                   - ↓ chest expansion - dull percussion - ↑ VT +TVF - bronchial BS with coarse crackles
Lobar collapse -                trachea pulled towards -             ↓ chest expansion - ↔ or dull - ↓ VT +TVF - ↓ BS
Unilateral fibrosis -          trachea pulled towards -             ↓ chest expansion - ↔ - ↑ VT +TVF - fine crackles
Interstitial fibrosis -                                                            ↓ chest expansion - resonant - ↑ VT +TVF - fine crackles
Pleural effusion -             trachea pushed away   -             ↓ chest expansion - stony dull - ↓ VT +TVF - ↓ BS
Pneumothorax -                                                                  ↓ chest expansion - hyper resonant - ↓ VT +TVF - ↓ BS
Tension pneumothorax - trachea pushed away  -              ↓ chest expansion - hyper resonant - ↓ VT +TVF -  absent

CAUSES OF PNEUMOTHORAX ?
traumatic
iatrogenic
spontaneous
emphysema
asthma
lung abscess
subpleural bulla ??bleb

CAUSES OF PLEURAL EFFUSION ?
transudate
LVF
hepatic failure
nephrotic syndrome
exudate
bacterial pneumonia
malignancy lung breast lymphoma
PE
TB
SLE

LIGHT CRITERIA
1. pleural protein / serum protein >0.5
2. pleural LDH / serum LDH >0.6
3. pleural LDH > 2/3 normal upper serum limit

CAUSES OF BRONCHIECTASIS ?
idiopathic
infection
cystic fibrosis
bronchial CA

ROS
GASTROINTESTINAL OR ABDOMEN
 
Nausea . Vomiting . Heartburn . Aerophagia . Pica (Trichophagia . Pagophagia . Geophagia) . Dysphagia (oropharyngeal . esophageal) . Odynophagia . Bad breath . Xerostomia . Hypersalivation . Burping
Goodsall's rule . Chilaiditi syndrome . Dance's sign . Aaron's sign . Arapov's sign . Markle's sign . McBurney's point . Sherren's triangle
Radiologic signs: Hampton's line . Klemm's sign

CAUSES OF VOMITING ?
GI
obstruction
gastritis
inflammatory
cholecystitis
pancreatitis
hepatitis
metabolic
hypercalcaemia
addison’s
uraemia
neurogenic
↑ ICP
pain
vestibulocochlear disease
medication
cytotoxics
opiods
antibiotics

CAUSES OF DYSPHAGIA ?
Mechanical
GORD induced oesopheal stricture
foreign body
oesophageal carcinoma
plummer-vinson syndrome
extrinsic compression : tumour in neck retrosternal goitre
Neurological
stroke
MND
MS
PD
achalasia

CAUSES OF HAEMATEMESIS ?
Oesophagus
oesophagitis
Mallory-Weiss tear
varicies
CA
Stomach
gastric ulcer
acute gastritis
CA
Duodenum
duodenal ulcer

LIVER: Councilman body . Mallory body

BILIARY: Boas' sign . Courvoisier's law . Charcot's cholangitis triad / Reynolds' pentad . Cholecystitis (Murphy's sign . Lépine's sign . Mirizzi's syndrome) . Nardi test

DEFECATION   
Flatulence . Fecal incontinence and encopresis . Fecal occult blood . Rectal tenesmus . Constipation . Obstructed defecation . Diarrhea . Rectal discharge

CAUSES OF CONSTIPATION ?
idiopathic
dietary
opioids
diverticular disease
colorectal cancer
hypothyroidism
hypercalcaemia

CAUSES OF DIARRHOEA ?
diet
curry
stress
exams
IBS
infection
iflammation
IBD
cancer
colon CA
endocrine
hyperthyroidism
medication
antibiotics

ABDOMEN   

PAIN 
Abdominal pain (Acute abdomen . Colic . Baby colic . Abdominal guarding . Blumberg's sign)

CAUSES OF ACUTE ABDOMEN ?
Diffuse
intestinal obstruction
DKA
gastroenteritis
mesenteric ischaemia
RUQ
cholecystitis
biliary colic
hepatitis
RUQ + LUQ
pancreatitis
perforated duodenal ulcer
lower lobe pneumonia
LUQ
gastritis
splenic infarct
RLQ
appendicitis
caecal perforation
Meckles diverticulitis
mesenteric adenitis
RLQ + LLQ
renal colic
cystits
ectopic pregnancy
ovarian cyst
pelvic inflammatory disease
LLQ
sigmoid diverticulitis
sigmoid volvulus

DISTENSION
Abdominal distension .  Bloating . Ascites . Tympany . Shifting dullness . Fluid wave test

CAUSES OF ASCITIES ?
transudate
heart failure
chronic liver disease
nephrotic syndrome
hypoproteaniemia
exudate
intra-abdominal malignancy
tuberculous peritonitis

MASSES
Abdominal mass . Hepatosplenomegaly (Hepatomegaly . Splenomegaly)

CAUSES OF EPIGASTRIC MASS ?
stomach
CA
plyloric stenosis
liver
enlarged left lobe
pancreas
pancreas cyst
CA head of pancreas
gallbladder
mucocoele
CAUSES OF Rt ILIAC FOSSA MASS ?
caecum
CA
crohns
appendix
abscess
ovary
cyst
CA
external iliac artery
aneurysm
psoas muscle
abscess
kidney transplant
CAUSES OF HYPOGASTRIC MASS ?
enlarged bladder
sigmoid CA
ovarian cyst
uterine fibroids
CAUSES OF Lt ILIAC FOSSA MASS ?
sigmoid
diverticular abscess
CA
ovary
cyst
CA
external iliac artery
aneurysm
psoas muscle abscess
kidney transplant

CAUSES OF SPLENOMEGALY ?
mild
portal hypertension 2° to cirrhosis
cirrhosis
infectious hepatitis
idiopathic thrombocytopenia
rheumatoid arthritis
moderate (4-8cm)
portal hypertension 2° to cirrhosis
lymphoma
leukaemia
massive (>8cm)
malaria
gaucher’s disease
black fever
CAUSES OF HEPATOMEGALY ?
cardiac
heart failure
tricuspid regurgitation
infective
hepatitis
brucellosis
hydatid disease
haematological
lymphoma
leukaemia
myelofibrosis
haemolytic anaemia
infiltrative
amyloidosis
CAUSES OF HEPATOSPLENOMEGALY ?
Infective
hepatitis
brucellosis
toxoplasmosis
CMV
Haematological
myelofibrosis
lymphoma
portal hypertension 2° to chronic liver disease
sarcoidosis
amyloidosis

OTHER
Jaundice (Mallet-Guy's sign) . Puddle sign . Ballance's sign . Aortic insufficiency . Castell's sign . Kehr's sign . Cullen's sign . Grey Turner's sign

CAUSES OF JAUNDICE ?
pre hepatic
haemolytic anemia
hepatic
hepatitis
alcohol
primary biliary cirrhosis
post hepatic
gall stones in CBD
bile duct stricture
sclerosing cholangitis
CA head of pancreas
chronic pancreatitis

HERNIA   
Howship–Romberg sign . Hannington-Kiff sign

OTHER   
Psoas sign . Obturator sign . Rovsing's sign . Hamburger sign . Heel tap sign . Aure-Rozanova's sign . Dunphy's sign . Alder's sign . Lockwood's sign . Rosenstein's sign . Cupola sign . Fothergill's sign . Carnett's sign . Massouh's sign . Sister Mary Joseph nodule . Blumer's shelf

CAUSES OF PARALYTIC ILEUS ?
abdominal surgery
peritonitis
mesenteric ischaemia

CAUSES OF SMALL BOWEL OBSTRUCTION ?
adhesion
tumour
hernia
volvulus
intersusception
CAUSES OF LARGE BOWEL OBSTRUCTION ?
strictures
sigmoid volvulus
colan CA
intersusception

SMALL AND LARGE BOWEL ON XRAY
small
central
valvulae conniventes
cross entire lumen
upto 3cm diameter
large
circumferentail
haustrae
up to 6cm (caucum 9cm)

CAUSES OF RECTAL BLEEDING ?
small intestine
Meckel’s diverticulum
enteritis
colon
IBD
angiodysplasia
CA
diverticula disease
polyp
rectum
CA
anus
haemorrhoids

ROS
GENITOURINARY

ROS
URINARY KIDNEY

CAUSES OF RENAL FAILURE ?
ACUTE PRE-RENAL
hypoperfusion
dehydration
renal artery obstruction
↓ cardiac output
ACUTE RENAL
glomerulonephritis
deposition of immune complexes
deposition of non-immune material
immune mediated attack against endothelial cells of glomerular capillaries
immune mediated attack of basement membrane
acute tubular necrosis
hypoperfusion
NSAIDs
aminoglycosides
contrast media
interstial damage
NSAIDs
antibiotics
ACUTE POST-RENAL
stones
infection
tumour
prostate enlargement
CHRONIC
hypertension
diabetes
glomerulonephritis
congenital
polycystic kidney disease

CAUSES OF HAEMATURIA ?
kidney
tumours
infection
stones
trauma
nephritis
ureter
stones
tumour
bladder
tumour
infection
prostate BPH, CA
urethra
trauma

URINARY : PAIN   
Dysuria . Renal colic . Costovertebral angle tenderness . Vesical tenesmus

URINARY : CONTROL   
Urinary incontinence (Enuresis . Diurnal enuresis . Giggling  . Nocturnal enuresis . Post-void dribbling . Stress . Urge . Overflow) . Urinary retention

CAUSES OF URINARY FREQUENCY ?
↑ fluid intake
alcohol
diabetes
kidney disease
detrusor instability
diuretics

CAUSES OF URINARY RETENTION ?
diabetes
anticholinergics
post operatively
BPH

URINARY : VOLUME   
Oliguria . Anuria . Polyuria

URINARY : OTHER   
Lower urinary tract symptoms (Nocturia . urgency . frequency) . Extravasation of urine . Uremia

URINARY : EPONYMOUS   
Addis count . Brewer infarcts . Lloyd's sign . Mathe's sign

ROS
GENITAL REPRODUCTIVE

FEMALE 
Cervical motion tenderness . Strawberry cervix . Boggy uterus . Adnexal mass . Vaginal discharge . Vaginal Odor . Cramping . Endometrium (Arias-Stella phenomenon) . Canga's bead symptom . Genital ulcer

MALE
Testicular pain (sudden) . Discharge from penis . Inflammation/Redness . Swollen testicles . Prehn's sign . Genital ulcer

ROS
OBSTETRICS

PREGNANCY   
Abderhalden reaction . Chadwick sign . Goodell's sign . Hegar's sign . Ladin's sign . Piskacek's signVon Braun-Fernwald's sign

OTHER   
Apgar score . Braxton Hicks contractions . hydrops fetalis (Hemoglobin Barts) . ectopic pregnancy (Spiegelberg criteria) . fetal death (Spalding's sign) . Leopold's maneuvers

ROS
MUSCULOSKELETAL

ROS
INTEGUMENTARY / BREAST

ROS
SKIN & SUBCUTANEOUS TISSUE

DISTURBANCES OF SKIN SENSATION   
Hypoesthesia . Paresthesia (Formication) . Hyperesthesia
Hypoalgesia . Hyperalgesia

SKIN : CIRCULATION   
Cyanosis . Pallor . Livedo (Livedo reticularis) . Flushing . Petechia . Blanching

SKIN : EDEMA   
Peripheral edema . Anasarca

SKIN : OTHER   
Rash . Desquamation . Induration . Diaphoresis . Mass Neck mass

SKIN : SKIN   
Asboe-Hansen sign . Auspitz's sign . Borsari's sign . Braverman's sign . Crowe sign . Dennie–Morgan fold . Darier's sign . Fitzpatrick's sign . Florid cutaneous papillomatosis .
Gottron's sign . Hutchinson's sign . Janeway lesion . Kerr's sign . Koebner's phenomenon . Koplik's spots . Leser-Trelat sign . Nikolsky's sign . Pastia's sign . Russell's sign . Wickham striae . Wolf's isotopic response . Munro's microabscess

SKIN : NAILS   
Aldrich-Mees' lines . Beau's lines . Muehrcke's lines . Terry's nails

ROS
NEUROLOGICAL

ROS
PSYCHIATRIC

ROS
NERVOUS SYSTEM

Neurological examination . Cranial nerve examination

CAUSES OF PAPILLOEDEMA ?
malignant hypertension
↑ ICP
retinal venous obstruction

CAUSES OF SUDDEN BLINDNESS ?
retinal detachment
acute glaucoma
vitreous haemorrhage
retinal artery/vein thrombosis
occular migraine

NERVE PALSIES

CN 0 – Terminal
CN I – Olfactory
CN II – Optic
CN III – Oculomotor
CN IV – Trochlear
CN V – Trigeminal
CN VI – Abducens
CN VII – Facial
CN VIII – Vestibulocochlear
CN IX – Glossopharyngeal
CN X – Vagus
CN XI – Accessory
CN XII – Hypoglossal

III Oculomotor
eye is pointing down and out - diabetes
dilated pupil - MS
ptosis - posterior communicating artery aneurysm
IV Trochlear
eye pointing up - trauma
head is tilted - diabetes - MS
VI Abducens
eye pointing medially - MS - raised ICP - trauma
V Trigeminal
sensory loss - herpes zoster - syringomyelia
motor loss - myotonic dystrophy - MND
VII Facial
UMN (forehead spared) - CVA - demyelination - pseudobulbar palsy - MND
LMN (forehead involved) - Bell’s palsy - cerebelloponting angle lesion - GB syndrome - myasthenia gravis
VIII Vestibulocochlear
conductive - wax - otitis media with effusion - perforated ear drum - pagets disease - otosclerosis
sensory - presbycusis - noise-induced - furosemide - acoustic neuroma

CENTRAL NERVOUS SYSTEM   

CNS HEAD   
Battle's sign . Kernig's sign . Macewen's sign . Myerson's sign . Stroop test . Hirano body

CNS OTHER   
Intracranial pressure (Cushing's triad) . Lhermitte's sign . Charcot's neurologic triad

PERIPHERAL NERVOUS SYSTEM   

PNS REFLEXES   

Combination   
Jendrassik maneuver
Legs   
Plantar reflex . Chaddock reflex . Oppenheim's sign . Westphal's sign
Arms   
Hoffmann's reflex

PNS OTHER   
Arms   
Froment's sign . carpal tunnel syndrome (Tinel's sign . Phalen maneuver)
Legs   
Gowers's sign . Hoover's sign . Straight leg raise . Trendelenburg's sign
Torso   
Beevor's sign
General   
Pain stimulus

ROS
LESIONS OF BRAIN & BRAINSTEM

CEREBRAL CORTEX   
ACA syndrome . MCA syndrome . PCA syndrome . Aphasia . Frontal lobe (Expressive aphasia . Abulia) . Parietal lobe (Receptive aphasia . Hemispatial neglect . Gerstmann syndrome . Astereognosis) . Occipital lobe (Bálint's syndrome . Cortical blindness . Anton syndrome . Pure alexia) . Temporal lobe (Cortical deafness . Prosopagnosia)

SUBCORTEX   
Basal ganglia (Chorea . Dystonia . Parkinson's disease) . Thalamic syndrome

CEREBELLUM   
Lateral (Dysmetria . Dysdiadochokinesia . Intention tremor) . Medial Cerebellar ataxia

BRAINSTEM   
Medulla   
Lateral medullary syndrome/Wallenberg (PICA) . Medial medullary syndrome/Dejerine (ASA)
Pons   
Upper dorsal pontine syndrome/Raymond–Céstan syndrome . Lateral pontine syndrome (AICA) (lateral) . Medial pontine syndrome/Millard–Gubler syndrome/Foville's syndrome (basilar) Locked-in syndrome . Internuclear ophthalmoplegia . One and a half syndrome
Midbrain   
Weber's syndrome (ventral peduncle, PCA) . Benedikt syndrome (ventral tegmentum, PCA) . Parinaud's syndrome (dorsal, tumor) . Claude's syndrome

OTHER   
Alternating hemiplegia

OTHER   
Pseudobulbar affect . Upper motor neuron lesion

ROS
MOVEMENT & GAIT

GAIT   
Gait abnormality .
CNS (Scissor gait . Cerebellar ataxia . Choreic gait . Festinating gait / Parkinsonian gait . Magnetic gait . Marche à petit pas . Propulsive gait . Stomping gait . Spastic gait . Truncal ataxia . Vestibular gait) .
Muscular (Myopathic gait / Waddling gait . Trendelenburg gait . Pigeon gait) . Foot drop (Steppage gait . Toe walking) . Asymmetric gait (Leaping gait) . Asynchronous gait (Gunslinger's gait . Hemiparetic gait . Limp Antalgic gait) . Deformity (Lotus gait)

GAIT ABNORMALITIES
antalgic (limp)
arthritis
trauma
sensory ataxia
peripheral neuropathy
cerebral ataxia
cerebrovascular disease
MS
hemiplegic
stroke
MS
scissor
cerebal palsy
MS
foot drop
common peroneal palsy
L5 radiculopathy
waddling
proximal myopathy
parkinsonian
parkinsons disease

COORDINATION   
Ataxia . Cerebellar ataxia (Dysmetria . Dysdiadochokinesia . Pronator drift . Dyssynergia) . Sensory ataxia . Asterixis . Abasia . Hemimotor neglect

ABNORMAL MOVEMENT   
Athetosis . Chorea . Tremor . Fasciculation . Fibrillation . Myokymia . Myoclonus . Hyperkinesia / Hypokinesia . Myotonia / Pseudomyotonia . Hypotonia . Stereotypy . Akathisia . Echopraxia . Echolalia

CAUSES OF TREMORS ?
postural (physiological)
anxiety
Caffeine
salbutamol
resting
parkinsons
intention
cerebellar disease
e.g.MS, cerebrovascular disease
flapping
respiratory failure (type II)
hepatic encephalitis

POSTURING   
Abnormal posturing . Stooped posture (Camptocormia . Osteoporosis) . Opisthotonus . Spasm . Trismus . Cramp . Tetany . Hypertonia . Joint locking . Catalepsy . Waxy flexibility . Grimacing . Tonic immobility

PARALYSIS   
Flaccid paralysis . Periodic paralysis . Spastic paraplegia (Spastic diplegia . Spastic paraplegia) . Syndromes (Monoplegia . Diplegia / Paraplegia . Hemiplegia . Triplegia . Tetraplegia / Quadruplegia) . General causes (Upper motor neuron lesion . Lower motor neuron lesion) . Sleep paralysis

SIGNS OF LESIONS
UMN - LMN
↑ tone - ↓ tone
↑ reflexes - ↓ reflexes
clonus - fasiclutaions
extensor plantar - muscle wasting

WEAKNESS   
Hemiparesis . Gowers' sign . Locomotive syndrome . Ptosis

CAUSES OF PTOSIS ?
myogenic
Horner’s syndrome
III nerve palsy
neurogenic
myasthenia gravis
myotonic dystrophy
tendon
involutional

RANGE OF MOTION   
Contracture (Bethlem sign . Club foot) . Joint stiffness . Ankylosis . Hypermobility (Gorlin sign . EDS . HSD) . Boutonniere deformity . Swan neck deformity . Scoliosis . Kyphosis

OTHER   
Rachitic rosary . Flat feet . Overpronation / Flexible flat feet . Knock-knee . Bow-leggedness . Back knee . Hyporeflexia . Hyperreflexia (Clasp-knife response) . Shivering . Hypnic jerk . Astasia-abasia . Vertigo . Motion sickness . Conversion disorder . Shell shock . Stupor . Catatonia . Dancing mania

CAUSES OF ↑ ICP?
intracranial mass
“ infection
obstructed CSF flow
hypertensive encephalopathy
hypercapnia

CAUSES OF SYNCOPE ?
neurally mediated
vasovagal
situational cough sneeze micturation
carotid sinus hypersensitivity
postural
autonomic failure PD diabetes multiple system atrophy
medication antihypertensives
hypovolaemia haemorrhage diarrhoea
post pradial
cardiac arrhythmia sick sinus syndrome heart block AF long QT syndrome
AS
HOCM
acute aortic dissection
respiratory
PE
psychogenic
anxiety
hyperventilation

...BULBAR IX, X, XII tongue fasiculations GB syndrome
LMN wasting syringobulbia
flaccid MND
↓ movements
dysphagia
dysphonia
PSEUDOBULBAR tongue spastic MS
UMN ↓ movements bilateral internal capsule infarct
dysphagia MND
high pitch voice (Donald duck) ...

CAUSES OF NEUROPATHY ?
single nerve mononeuropathy carpal tunnel syndrome
more than one single nerve mononeuritis multiplex
multiple peripheral nerves polyneuropathy
alcohol
B vitamin deficiency
diabetes
drugs isoniazid
endocrine hypothyroidism
guillian barre syndrome
multiple peripheral nerves hemisensory loss
stroke
spinal root lesions radiculopathy
spinal cord lesion

ROS
HEARING & BALANCE

HEARING   
Symptoms   
Hearing loss . Excessive response (Tinnitus . Hyperacusis . Phonophobia)
Disease   
Loss   
Conductive hearing loss (Otosclerosis . Superior canal dehiscence) . Sensorineural hearing loss (Presbycusis . Cortical deafness) . Nonsyndromic deafness
Other   
Deafblindness (Wolfram syndrome . Usher syndrome) . Auditory processing disorder . Spatial hearing loss
Tests   
Hearing test . Rinne test . Tone decay test . Weber test . Audiometry (pure tonevisual reinforcement)

BALANCE   
Symptoms   
Vertigo . nystagmus
Disease   
Balance disorder . Peripheral (Ménière's disease . Benign paroxysmal positional vertigo . Labyrinthitis . Labyrinthine fistula)
Tests   
Dix–Hallpike test . Unterberger test . Romberg's test . Vestibulo-ocular reflex

ROS
PERCEPTION, EMOTION & BEHAVIOUR

COGNITION   
Confusion (Delirium . Psychosis . Delusion) . Amnesia (Anterograde amnesia . Retrograde amnesia) . Convulsion . Dizziness (Disequilibrium . Presyncope/Lightheadedness . Vertigo)
EMOTION   
Anger . Anxiety . Depression . Fear (Paranoia) . Hostility . Irritability . Suicidal ideation
BEHAVIOR   
Verbosity . Russell's sign
PERCEPTION   
Sensory processing disorder . Hallucination (Auditory . Tactile . Visual) . Smell (Anosmia . Hyposmia . Dysosmia . Parosmia . Phantosmia . Hyperosmia) . Synesthesia . Taste (Ageusia . Hypogeusia . Dysgeusia . Hypergeusia)

ROS
ENDOCRINE

ROS
THYROID

HYPOTHYROIDISM   
Iodine deficiency . Cretinism (Congenital hypothyroidism) . Myxedema . Myxedema coma . Euthyroid sick syndrome . Van Wyk-Grumbach syndrome . Signs and symptoms (Queen Anne's sign . Woltman sign . Myoedema) . Thyroid dyshormonogenesis . Pickardt syndrome . Hypothyroid myopathy (KDSSHoffmann syndrome . LEMS . Atrophic type)

HYPERTHYROIDISM   
Hyperthyroxinemia (Thyroid hormone resistance . Familial dysalbuminemic hyperthyroxinemia) . Hashitoxicosis . Thyrotoxicosis factitia . Thyroid storm . Amiodarone induced thyrotoxicosis . Hyperthyroid myopathy
Graves' disease . Signs and symptoms (Abadie's sign of exophthalmic goiter . Boston's sign . Dalrymple's sign . Stellwag's sign lid lag . Griffith's sign . Möbius sign . Pretibial myxedema) . Graves' ophthalmopathy

THYROIDITIS   
Acute infectious . Subacute (De Quervain's . Subacute lymphocytic . Palpation) . Autoimmune/chronic (Hashimoto's . Postpartum . Riedel's)

ENLARGEMENT   
Goitre (Endemic goitre . Toxic nodular goiter . Toxic multinodular goiter) . Thyroid nodule (Colloid nodule)

ROS
HEMATOLOGIC / LYMPHATIC

CAUSES OF ANAEMIA ?
MICROCYTIC
Fe deficiency
blood loss menorrhagia GI bleeding
↓ dietary intake
malabsorption coeliac disease
thalassaemia
sideroblastic anaemia
MACROCYTIC
B12 deficiency
pernicious anaemia
crohn’s disease
strict vegan
folate deficiency
↓ dietary intake
pregnancy
antifolate medication anticonvulsants
↑ alcohol
myeloma
myeloproliferative disorders
myelodysplasia
NORMOCYTIC
anaemia of chronic disease
haemolysis
acute blood loss
bone marrow failure
renal failure
pregnancy

CAUSES OF LYMPHADENOPATHY ?
infection
sepsis
TB
infectious mononucleosis
haematological
lymphoma
leukaemia
malignancy
metastases
systemic disease
RA
SLE
sarcoidosis

CAUSES OF POLYCYTHAEMIA ?
true
true primary
polycythaemia vera
true secondary
true secondary hypoxia
cyanotic heart disease
pulmonary disease
chronic smoking
high altitude
true secondary excess erythropoietin
renal cell carcinoma
polycystic kidney
disease
adrenal tumour
hepatocellular carcinoma
apparent
dehydration
Gaissbock’s syndrome

CAUSES OF THROMBOCYTOSIS ?
1° haematological disorder
myeloproliferative disorders
2° reactive
infection
inflammation
malignancy

CAUSES OF THROMBOCYTOPENIA ?
↓ platelet production
infection
medication
leukaemia
myelodysplasia
↑ platelet destruction
autoimmune idiopathic
thrombocytopenia purpura
heparin induced thrombocytopenia
thrombotic thrombocytopenic
purpura
DIC

CAUSES OF HAEMOLYTIC ANAEMIA ?
CONGENITAL
membrane deficit
spheocytosis
enzyme defect
G6PD deficiency
pyruvate kinase deficiency
Hb defect
sickle cell anaemia
thalassaemia
ACQUIRED
immune
auto immune warm type (IgG mediated)
autoimmune cold type (IgM mediated)
medication penicillin
acute transfusion reaction
non-immune
infection malaria
microangiopathic anaemia
mechanical heart valve
paroxysmal nocturnal haemoglobinuria

CAUSES OF LYMPHOCYTOSIS ?
viral infection
chronic infection TB
chronic lymphocytic leukaemia
lymphoma

CAUSES OF EOSINOPHILIA ?
allergic conditions
eczema
allergic bronchopulmonary
aspergillosis
parasitic infection

CAUSES OF NEUTROPHILIA ?
infection
inflammation
malignancy
myeloproliferative disorders
necrosis

CAUSES OF NEUTROPENIA ?
post chemotherapy
post radiotherapy
medication carbimazole
clozapine
viral infection
felty’s syndrome

ROS
ALLERGIC / IMMUNOLOGIC

ROS
BIOCHEMISTRY

CAUSES OF HYPONATRAEMIA ?
fluid depleted patient
diuretics
volume loss vomiting diarrhoea burns
hypoadrenalism
normovolaemic patient
SIADH
hypothyroidism
psychogenic polydipsia
fluid overloaded patient
cardiac failure
liver failure
renal failure
hypoalbuminaemia

CAUSES OF HYPERNATRAEMIA ?
dehydration
diabetes insipidus
excess IV fluids

CAUSES OF HYPOKALAEMIA ?
medication
diuretic
intestinal loss
excess vomiting
profuse diarrhoea
renal tubular disease
medication induced damage
endocrine cushing’s syndrome
conn’s syndrome
metabolic alkalosis

CAUSES OF HYPERKALAEMIA ?
renal failure
artefact
medication
potassium sparing diuretics
potassium supplements
rhabdomyolysis
endocrine
addison’s disease
diabetic ketoacidosis

BONE PROFILE
                     Ca2+ phosphate ALP
osteoporosis ↔ ↔ ↔
osteomalacia ↔/↓ ↓ ↑
pagets disease ↔ ↔ ↑
bony metastases ↔/↑ ↔/↑ ↑
1° hyperparathyroidism ↑ ↓ ↑
2° hyperparathyroidism ↔ ↑ ↑
3° hyperparathyroidism ↑ ↓ ↑

CAUSES OF CUSHING’S SYNDROME ?
1o adrenal disease
adrenal tumour
2o ACTH excess
glucocorticoid medication
pituitary gland (Cushing’s disease)
ACTH secreting tumour

CAUSES OF HYPERPROLACTINAEMIA ?
physiological
pregnancy
lactation
tumour
prolactin secreting pituitary tumour
medication
metoclopramide
domperidone
phenothiazine antipsychotics
endocrine
PCOS

CAUSES OF SIADH ?
intracranial
infection
tumour
head injury
intrathoracic
infection
lung cancer
medication
carbamazepine
antipsychotics

ROS
INFECTIOUS

BACTERIAL DISEASE   
syphilis (Hutchinson's teeth . Hutchinson's triad . Westphal's sign . Clutton's joints . Dennie–Marfan syndrome)

VIRAL DISEASE   
measles (Koplik's spots)

PARASITIC DISEASE   
African trypanosomiasis (Winterbottom's sign)

GENERAL   
MeningismFever (Liebermeister's rule . Faget sign)

ROS
MALNUTRITION

PROTEIN-ENERGY MALNUTRITION   
AscitesEmaciationKwashiorkorMarasmusCatabolysis

VITAMIN DEFICIENCY   
B vitamins   
B1 (Beriberi . Wernicke–Korsakoff syndrome . Wernicke's encephalopathy . Korsakoff syndrome) . B2 (Riboflavin deficiency) . B3 Pellagra . B6 (Pyridoxine deficiency) . B7 (Biotin deficiency) . B9 (Folate deficiency) . B12 Vitamin (B12 deficiency)
Other   
A: Vitamin A deficiency (Bitot's spots) . C: Scurvy . D: . Vitamin D deficiency (Rickets . Osteomalacia . Harrison's groove) . E: Vitamin E deficiency . K: Vitamin K deficiency

MINERAL DEFICIENCY   
Electrolyte imbalance (Calcium . Chloride . Magnesium . Phosphate . Potassium . Sodium . Iron . Zinc . Manganese . Copper . Iodine . Chromium . Molybdenum . Selenium) .  Keshan diseaseFluorine

GROWTH   
Deformity . Delayed milestone . Failure to thrive . Short stature (Idiopathic)

GENERAL   
Anorexia . Cachexia . Deficiency (medicine) . Dehydration . Epidemiology of malnutrition . Famine . Food fortification . Hunger . Human right to water and sanitation . Micronutrient deficiency . Right to health . Starvation . Starvation (crime) . Terminal dehydration . Undernutrition in children . Weight loss . Underweight

TOC
PHYSICAL EXAMINATION

TYPES
Routine
Evidence
Prevalence
History
Comprehensive
Pre-employment
Insurance
USES
Diagnosis
Screening
Doctor-patient relations
Other uses
FORMAT AND INTERPRETATION
Scope
Recording
HISTORY
SOCIETY AND CULTURE

TOC
GENERAL / IPPA

SIMPLE CONTENTS

INSPECTION, PALPATION, PERCUSSION, & AUSCULTATION
abdominal exam, auscultation is performed before palpation, because the act of palpation could change what was auscultated.

INSPECTION (looking at the body)
EXTERNAL SIGNS:
Body features and symmetry appearance
Nutritional state or weight
Skin color
Frequency and volume of breaths during respiration
Movement of the abdomen and each side of the chest during respiration
Hair distribution
divercation of recti muscle
umbilicus (site-shape-color- infiltration)
Gait and manner of speaking
GROSS DEVIATION:
Abnormal contour
Scars and striae
Visible masses
Discoloration
Swelling
Tremor
In medical practice, inspection is however not limited to visual information alone. Inspection also involves:
Listening to any sounds emanating from the client
Odors that may be present

PALPATION (feeling the body with fingers or hands)
USES
LOCATING ANATOMICAL LANDMARKS
ELASTOGRAPHY
PALPATION UNDER GENERAL ANESTHESIA

PERCUSSION (producing sounds, usually by tapping on specific areas of the body)
OVERVIEW
OF THE THORAX
OF THE ABDOMEN
NOTES

AUSCULTATION (listening to sounds, usually with a stethoscope)
AUSCULTOGRAM
MEDIATE AND IMMEDIATE AUSCULTATION
DOPPLER AUSCULTATION

TOC
VITAL SIGNS & GENERAL SURVEY

SIMPLE CONTENTS

PRIMARY VS
1 BODY TEMPERATURE BT
2 HEART RATE OR PULSE HR
3 RESPIRATORY RATE RR
4 BLOOD PRESSURE BP

OTHER Ss
5
PAIN
MENSTRUAL CYCLE
OXYGEN SATURATION
BLOOD GLUCOSE LEVEL

6
END-TIDAL CO2
FUNCTIONAL STATUS
SHORTNESS OF BREATH
GAIT SPEED
DELIRIUM

VARIATIONS BY AGE
MONITORING

DETAILED CONTENTS

TOC
HEAD-TO-TOE ASSESSMENT : ADULT
HEAD-TO-TOE ASSESSMENT : INFANT
HEAD-TO-TOE ASSESSMENT : CHILD
HEAD-TO-TOE ASSESSMENT : OLDER ADULT

TOC
SKIN

TOC
HEENT - HEAD, EYES, & EARS - NOSE, MOUTH, & NECK

SIMPLE CONTENTS

IPPA
I OF SCARS OR SKIN CHANGES
PA OF TEMPOROMANDIBULAR JOINT, THYROID, & LYMPH NODES
PE MAY INVOLVE THE SKIN ABOVE THE FRONTAL SINUSES & PARANASAL SINUSES TO DETECT ANY SIGNS OF PAIN
A FOR CAROTID BRUITS

TESTS SPECIFIC
Eyes: eye examination and acuity (including ophthalmoscope)
Ears: hearing examination and evaluation of tympanic membrane (TM) (otoscope used in evaluation of ears, nose, and mouth)

A neurological examination is usually considered separate from the HEENT evaluation, although there can be some overlap in some cases.

SAMPLE WRITE-UP

TOC
EYES : EYE EXAMINATION & ACUITY (INCLUDING OPHTHALMOSCOPE) xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx

TOC
EARS : HEARING EXAMINATION & EVALUATION OF TYMPANIC MEMBRANE (TM) (OTOSCOPE USED IN EVALUATION OF EARS, NOSE, & MOUTH)

TOC
THORAX & LUNGS - RESPIRATORY

STAGES
INSPECTION
PALPATION
CHEST PERCUSSION
AUSCULTATION

RESPIRATORY SOUNDS
NORMAL BREATH SOUNDS
ABNORMAL BREATH SOUNDS

TOC
CARDIOVASCULAR SYSTEM

MEASUREMENT OF VITAL SIGNS

CARDIAC EXAMINATION
INSPECTION & PALPATION
PERCUSSION & AUSCULTATION

PULMONARY EXAMINATION
ABDOMINAL EXAMINATION
PERIPHERAL EXAMINATION

HEART SOUNDS
PRIMARY HEART SOUNDS
EXTRA HEART SOUNDS
MURMURS
OTHER ABNORMAL SOUNDS
SURFACE ANATOMY
RECORDING HEART SOUNDS

TOC
PERIPHERAL VASCULAR SYSTEM

POSITION/LIGHTING/DRAPING
INSPECTION
PALPATION
AUSCULTATION
SPECIAL MANEUVERS

TOC
BREASTS & AXILLAE

TOC
ABDOMINAL

PURPOSE

POSITIONING & ENVIRONMENT

INSPECTION

AUSCULTATION

PALPATION

PERCUSSION

OTHER TESTS AND SPECIAL MANEUVERS

TOC
MALE GENITALIA, RECTUM, ANUS, & PROSTATE

TOC
FEMALE GENITALIA, ANUS, & RECTUM - PELVIC

MEDICAL GUIDELINES
PREPARATION, COMMUNICATION, AND TRAUMA-INFORMED CARE
EXTERNAL EXAMINATION
INTERNAL EXAMINATION
DURING PREGNANCY

TOC
UPPER EXTREMITIES

TOC
LOWER EXTREMITIES

TOC
MUSCULOSKELETAL SYSTEM

TOC
NEUROLOGICAL

NERVOUS SYSTEM: CRANIAL NERVES & MOTOR SYSTEM

NERVOUS SYSTEM: SENSORY SYSTEM & REFLEXES

MENTAL STATUS

INDICATIONS

PATIENT'S HISTORY

LIST OF TESTS

MENTAL STATUS EXAMINATION - MSE
The assessment of consciousness, often using the glasgow coma scale (GCS)
Mental status examination, often including the abbreviated mental test score (AMTS) or mini mental state examination (MMSE)
Global assessment of higher functions
Ontracranial pressure is estimated by fundoscopy; this also enables assessment for microvascular disease

CRANIAL NERVE EXAMINATION (I-XII)
Sense of smell (i), visual fields and acuity (ii), eye movements (iii, iv, vi) and pupils (iii, sympathetic and parasympathetic), sensory function of face (v), strength of facial (vii) and shoulder girdle muscles (xi), hearing (vii, viii), taste (vii, ix, x), pharyngeal movement and reflex (ix, x), tongue movements (xii)
These are tested by their individual purposes (e.g. the visual acuity can be tested by a snellen chart)

MOTOR SYSTEM
MUSCLE STRENGTH, OFTEN GRADED ON THE MRC SCALE 0 TO 5 (I.E., 0 = COMPLETE PARALYSIS TO 5 = NORMAL POWER)
grades 4−, 4 and 4+ maybe used to indicate movement against slight, moderate and strong resistance respectively
MUSCLE TONE & SIGNS OF RIGIDITY
EXAMINATION OF POSTURE
Decerebrate
Decorticate
Hemiparetic
RESTING TREMORS
ABNORMAL MOVEMENTS :
SEIZURE
FASCICULATIONS
TONE
Spasticity
Pronator drift
Rigidity
Cogwheeling (abnormal tone suggestive of Parkinson's disease)
Gegenhalten – is resistance to passive change, where the strength of antagonist muscles increases with increasing examiner force. More common in dementia

DEEP TENDON REFLEXES - DTR
Reflexes: masseter, biceps and triceps tendon, knee tendon, ankle jerk and plantar (i.e., babinski sign)
Globally, brisk reflexes suggest an abnormality of the UMN or pyramidal tract,
While decreased reflexes suggest abnormality in the anterior horn, LMN, nerve or motor end plate
A reflex hammer is used for this testing

SENSATION - SENSORY
Sensory system testing involves provoking sensations of fine touch, pain and temperature
Fine touch can be evaluated with a monofilament test, touching various dermatomes with a nylon monofilament to detect any subjective absence of touch perception
LIGHT TOUCH
PAIN
TEMPERATURE
VIBRATION
POSITION SENSE
GRAPHESTHESIA
STEREOGNOSIS, AND
TWO-POINT DISCRIMINATION (FOR DISCRIMINATIVE SENSE)
EXTINCTION
ROMBERG TEST
– 2 out of the following 3 must be intact to maintain balance: i. vision ii. vestibulocochlear system iii. epicritic sensation

CEREBELLUM - CEREBELLAR TESTING
DYSMETRIA
Finger-to-nose test
Ankle-over-tibia test
DYSDIADOCHOKINESIS
Rapid pronation-supination
ATAXIA
Assessment of gait
NYSTAGMUS
INTENTION TREMOR
STACCATO SPEECH

INTERPRETATION

TOC
COMMUNICATION & INTERPERSONAL SKILLS

TECHNIQUE: ACTIVE OR ATTENTIVE LISTENING
TECHNIQUE: GUIDED QUESTIONING
TECHNIQUE: EMPATHIC RESPONSES
TECHNIQUE: SUMMARIZATION
TECHNIQUE: TRANSITIONS
TECHNIQUE: EMPOWERING THE PATIENT
TECHNIQUE: REASSURANCE
USE OF UNDERSTANDABLE LANGUAGE
USE OF NON-STIGMATIZING LANGUAGE
APPROPRIATE NONVERBAL COMMUNICATION
USE OF PREFERRED TITLE, NAME, AND GENDER PRONOUN
INTERPROFESSIONAL COMMUNICATION
PATIENT-CENTEREDNESS IN COMPUTERIZED CLINICAL SETTINGS
TEACH-BACK METHOD
RAPPORT: NEWBORNS AND INFANTS
RAPPORT: YOUNG CHILDREN
RAPPORT: ADOLESCENTS
RAPPORT: OLDER ADULTS
RAPPORT: PATIENTS WITH PHYSICAL AND SENSORY DISABILITIES
REPORT: LGBTQ+ ADULTS
BROACHING SENSATIVE TOPICS
OBTAINING INFORMED CONSENT
DISCUSSING ADVANCE DIRECTIVES
WORKING WITH MEDICAL INTERPRETERS
DISCLOSING SERIOUS NEWS
RESPONDING TO EMOTIONAL CUES
MOTIVATIONAL INTERVIEWING

TOC
OSCE - CLINICAL SKILLS

OSCE 1: CHEST PAIN
OSCE 2: ABDOMINAL PAIN
OSCE 3: SORE THROAT
OSCE 4: KNEE PAIN
OSCE 5: COUGH
OSCE 6: VOMIT
OSCE 7: AMENORRHEA
OSCE 8: FALLS
OSCE 9: BACK PAIN
OSCE 10: SHORTNESS OF BREATH
OSCE 11: SHOULDER PAIN
OSCE 12: CHILD AND ADOLESCENT ASTHMA
OSCE 13: HEADACHE
OSCE 14: CHILD AND ADOLESCENT OBESITY
OSCE 15: MEMORY LOSS

DATA INTERPRETATION

PRESENTATIONS

EMERGENCY

SURGERY
General surgery
Vascular
Urology
Musculoskeletal

ABG, CANNULATION, IVI, IV ABX  
ABDOMINAL EXAMINATION  
ANTENATAL CLINIC  
BLOOD TRANSFUSION  
BREAKING BAD NEWS DIABETES  
BREAKING BAD NEWS ECTOPIC  
BREAKING BAD NEWS MISSCARIAGE  
BREAKING BAD NEWS MULTIPLE SCLEROSIS  
CARDIAC ARREST AED  
CARDIAC ARREST MANUAL  
CARDIOVASCULAR EXAMINATION  
CATHETERISATION  
CHEST XRAY          
COUNSELLING CONTRACEPTION  
COUNSELLING CABG  
COUNSELLING HERNIA REPAIR  
COUNSELLING CHOLECYSTECTOMY  
COUNSELLING TURP  
DIGITAL RECTAL EXAMINATION  
ENDOCRINOLOGY  
GYNAE EXAMINATION  
HAND EXAMINATION  
HERNIA  
LOWER LIMB VASCULAR EXAMINATION  
MENTAL STATE EXAMINATION  
NASOGASTRIC TUBE  
NEUROLOGY CRANIAL NERVES  
NEUROLOGY EXAMINATION  
ORTHOPAEDIC EXAMINATION  
PARKINSONS DISEASE  
RESPIRATORY EXAMINATION  
SEXUAL HISTORY TAKING  
STOMA, AV FISTUA, CAPD  

SPECIALITIES

TOC
REFERENCES

SIMPLE CONTENTS :
DIDACTIC
DIDACTIC : MEDICINE
DIDACTIC : SURGERY
OVERVIEW
VIDEOS
PHYSICAL EXAMINATION
HISTORY TAKING
ROS
SYSTEMS
CLINICAL SKILLS

DIDACTIC

TOP- RATED

MEDICINE
MediMaps.
Bates.
Castaigne.
Gleadle.
SURGERY
Léger.

DIDACTIC : MEDICINE

MediMaps. Summary
Excellent !
[ PDF - PPT ]
https://docs.google.com/presentation/d/1mxZG-58x9GrpR4dj9l2udubep7DWArY9/edit#slide=id.p1
MediMaps. Links & Maps.
medimaps.co.uk/osce

Sturgess. Applied Anatomy for Clinical Procedures At a Glance. 1e. 2020. 105 p
https://www.amazon.it/Applied-Anatomy-Clinical-Procedures-English-ebook/dp/B08F7YTW19
https://annas-archive.org/md5/450581e20822d04eec6e70b7cc37c8ac

Gleadle. History & Clinical Examination At a Glance. 3e. 2012. 232 pages
https://archive.org/details/AtAGlanceSeriesOxfordEnglandJonathanGleadleHistoryAndClinicalExaminationAtAGlanceWileyBlackwell2012
http://librodigital.sangregorio.edu.ec/librosusgp/21793.pdf
https://www.amazon.com/History-Clinical-Examination-at-Glance/dp/0470654465

Gleadle. Clinical Investigations at a Glance. 1e. 2017. 384 pages
https://www.amazon.com/Clinical-Investigations-Glance-Jonathan-Gleadle/dp/111875932X
https://www.wiley.com/en-us/Clinical+Investigations+at+a+Glance-p-9781118759318#tableofcontents-section
https://zlib.pub/book/clinical-investigations-at-a-glance-7pie0kut9lv0
https://annas-archive.org/md5/f993814f7535f6b03047b8272936db0c

Blundell. OCSEs At a Glance. 2e. 2013.
https://www.amazon.com/OSCEs-at-Glance-Adrian-Blundell/dp/0470671319
http://dickyricky.com/books/medical/OSCEs%20at%20a%20Glance%20-%20Adrian%20Blundell.pdf 1e

Thomas. Practical Medical Procedures at a Glance. 1e. 2015. 144 pages
https://www.ataglanceseries.com/practicalmedprocedures/

Goldberg. Practical Guide to Clinical Medicine. 2018.
https://meded.ucsd.edu/clinicalmed/introduction.html

Bickley. Bates' Guide to Physical Examination and History Taking. 13e. 2020. 1072 pages
[ Download 13e ] 
Bates' Visual Guide to Physical Examination.
[ batesvisualguide.com ]
Bates’ Pocket Guide to Physical Examination and History Taking. 8e. 2016.

Castaigne. Sémiologie Médicale. Initiation à la Physiopathologie. 1992.
[ Download ] [ Download ]

https://www.amazon.com/Macleods-Clinical-Examination-Anna-Dover-dp-0323847706/dp/0323847706/ref=dp_ob_title_bk
https://www.amazon.it/Macleod-Manuale-semeiotica-metodologia-medica/dp/8821438465

https://www.unitheque.com/Blog/quels-livres-semiologie-choisir/7166

https://www.quora.com/Which-of-these-books-is-the-best-Macleods-Clinical-Examination-or-Bates-Guide-to-Physical-Examination-and-History-Taking

DIDACTIC : SURGERY

Léger. Sémiologie Chirurgicale. 6e. 1999.
[ Download ]
https://www.scribd.com/document/769520401/Lucien-Leger-Semiologie-Chirurgicale
https://www.scribd.com/document/466426510/Semiologie-chirurgicale-by-Lucien-Leger-Philippe-Boutelier-z-lib-org-pdf
https://fr.annas-archive.org/md5/3655d159637ec2c1fd52da978286e426
https://annas-archive.org/md5/3655d159637ec2c1fd52da978286e426

Burnand. Browse's Introduction to the Symptoms & Signs of Surgical Disease. 6e. 2021.
[ Download 4e ] [ Download 5e ] [ Amazon ]

https://teachmesurgery.com/examinations/

https://medicina08.univpm.it/index.php?option=com_jdownloads&view=category&catid=536&Itemid=1218

https://www.ncbi.nlm.nih.gov/books/NBK201/

OVERVIEW

https://en.wikipedia.org/wiki/Template:Medical_records_and_physical_exam

https://en.wikipedia.org/wiki/Template:Orthopedic_examination

https://en.wikipedia.org/wiki/Signs_and_symptoms

https://learn.practicalclinicalskills.com/

https://meded.ucsd.edu/clinicalmed/introduction.html

https://en.wikipedia.org/wiki/Medical_procedure

https://en.wikipedia.org/wiki/Objective_structured_clinical_examination

https://en.wikipedia.org/wiki/Review_of_systems

VIDEOS

HippocraTV. Clinical Examination for Beginners.
https://youtube.com/playlist?list=PLxsQDK_5AH20Ks2X3a0CKkY7MiVVjXqj1

MacLeod.
https://medicalstudyzone.com/macleods-clinical-examination-hd-videos-free-download/

Medquestreview.
https://medquestreviews.com/store/get-physical-video-series
https://medicalstudyzone.com/medquest-get-physical-videos-download/
https://mega.nz/folder/5JAxSSTa#0DvfUW2fKXvcryHNpHz71w
https://www.youtube.com/@medquestreviews6854/featured

Lecturio.
https://www.lecturio.com/courses/medical/physical-exam/
https://medicalstudyzone.com/lecturio-physical-examination-videos-free-download/

PHYSICAL EXAMINATION

https://en.wikipedia.org/wiki/Physical_examination

HISTORY TAKING

https://en.wikipedia.org/wiki/Medical_history

ROS

https://en.wikipedia.org/wiki/Signs_and_symptoms

https://en.wikipedia.org/wiki/Review_of_systems

ABDOMEN

CARDIOVASCULAR

Dr Ho's Murmurs
https://www.youtube.com/watch?v=jq7-mmkirNM

https://www.practicalclinicalskills.com/heart-sounds-murmurs

https://depts.washington.edu/physdx/heart/demo.html

ENDOCRINOLOGY I.E. THYROID

GENITO-URINARY

MUSCULO-SKELETAL

RESPIRATORY

https://www.youtube.com/watch?v=2NvBk61ngDY

https://www.youtube.com/watch?v=bHGlFmd4Fuk&list=PLxsQDK_5AH20Ks2X3a0CKkY7MiVVjXqj1&index=4

NEUROLOGY

Cranial Nerve Examination - OSCE Guide (New Version)
https://www.youtube.com/watch?v=sJBpai74tlU

Mental Status Exam.
https://web.archive.org/web/20190307173749/https://huibee.com/wordpress/wp-content/uploads/2013/11/Mental-State-Exam-form.pdf

Larsen. 2020. Adult.
https://neurologicexam.med.utah.edu/adult/html/home_exam.html
Larsen. 2020. Pediatric.
https://neurologicexam.med.utah.edu/pediatric/html/home_exam.html
Larsen. 2020. Brain Dissections.
https://neurologicexam.med.utah.edu/adult/html/brain-dissections.html

OBSTETRICS & GYNAECOLOGY

PAEDIATRICS / NEONATES

Normal Physical Exam on an Infant [ View ] [ Download ]

PSYCHIATRY

RESPIRATORY

RETICULO-ENDOTHELIAL

CLINICAL SKILLS

MORE REFERENCES

TOC
NEWS & UPDATES

DONE

DOING

TOC
Wayback Machine