Physical Examination Mnemonics

Heart ausculation sites: ribs Apt. M 225A:

Aortic valve
Pulmonary valve
Tricuspid valve
Mitral valve
In order they correspond with the following landmarks:
2nd intercostal space (right)
2nd intercostal space (left)
5th intercostal space (left)
Apex (still the 5th intercostal space)
Patient's model of illness illness history! ""# $E%
%ears &imilar "ecision At E$":
"efnition
#ause
$easoning
Eect
%uture
%ears and concerns
&imilar experiences
"ecision!making
Attempts at treatment
Expectations of treatment
$esults
Pain history chec'list "(#& A$E %)T:
"uration
(nset
#haracter
&ite
Associatied symptoms
$adiation
Exacer"ating and relieving factors
%re#uency
)ntensity
Timing
*reast history chec'list +M,(P:
+ump
Mammary changes
,ipple changes
(ther symptoms
Patient risk factors
Pain history chec'list #(+"E$ *A$&:
#haracter
(nset
+ocation
"uration
Exacer"ating factors
$adiation
*efore (ever happened "efore)
Associated symptoms
$elieving factors
&everity
Pain history chec'list &( #$AP:
&ite
(nset
#haracter
$adiates to
Associated symptoms$ Alleviating and exacer"ating factors
Periodicity
History- H#%A components for E.M codin/ 0 +&" M#AT:
0uality
+ocation
&everity
"uration
Modifying factors
#ontext
Associated signs and symptoms
Timing
&ur/ical sie1e for dia/nostic cate/ories ),2E&T)3AT)(,&:
)atrogenic
,eoplastic
2ascular
Endocrine
&tructural$ %echanical
Traumatic
)n&ammatory
3enetic$ 'ongenital
Autoimmune
Toxic
)nfective
(ld age$ (egenerative
,utritional
&pontaneous$ Idiopathic
Mental state examination: sta/es in order "Assessed
Mental &tate To *e Positively #linically
4nremarka"le":
Appearance and "ehaviour )o"serve state* clothing+++,
Mood )recent spirit,
&peech )rate* form* content,
Thinking )thoughts* perceptions,
*ehavioural a"normalities
Perception a"normalities
#ognition )time* place* age+++,
4nderstanding of condition )ideas* expectations* concerns,
*ranham si/n: de5nition *$Anham sign:
*$Adycardia after compression or excision of a large -. fstula+
3las/o6 coma scale: components and numbers /cale types is 0 21s:
2isual response
2er"al response
2i"ratory (motor) response
/cale scores are 2*5*3:
/cale of 7: see so much more
/cale of 5: talking 8i1e
/cale of 9: feels the pric's(if testing motor "y pain withdrawl)
Physical examination : correct order ") Palpate
People1s A"domens":
)nspection
Palpation
Percussion
Auscultation
#linical examination: initial )nspection of patient from end of bed
A*#:
Appearance (/45* pain* etc)
*ehaviour
#onnections (drips* inhalers* etc connected to patient)
Pain history chec'list #+)T($)&:
#haracter
+ocation
)ntensity
Timing
(nset
$adiating
)rritating and relieving factors
&ymptoms associated
Heart 1al1e auscultation sites "All People
Try Mari6uana":
Aortic
Pulmonic
Tricuspid
Mitral
#onsolidations: sound #onsolidations
#onduct
#onsonants
#learly
Past medical history PMH! 2AMP TH)&:
2ices (to"acco* alcohol* other drugs* sexual risks)
Allergies
Medications
Preexisting medical conditions
Trauma
Hospitali7ations
)mmuni7ations
&urgeries
Patient pro5le PP! +A""E$&:
+iving situation$ +ifestyle
Anxiety
"epression
"aily activities (descri"e a typical day)
Environmental risks$ Exposure
$elationships
&upport system$ &tress
%amily history %H! *A+" #HA&M:
*lood pressure (high)
Arthritis
+ung disease
"ia"etes
#ancer
Heart disease
Alcoholism
&troke
Mental health disorders (depression* etc+)
"i;erential dia/nosis chec'list ")$E#T)(,:
"rugs
)nfection
$heumatologic
Endocrine
#ardiovascular
Trauma
)n&ammatory
(ther
,eoplasm
Patholo/ic classi5cation ,)T ")T %)T:
,eoplastic
)nfectious
Traumatic
"egenerative$ "rugs
)mmune
Toxic
2ascular
)n&ammatory
Totally o"scure
Pyrexia of 4n'no6n (ri/in: history ta'in/ &)T (, %$A":
&exual history
)mmunisation status
Travel history
(ccupational history
,utrition (consumption of dairy products* etc+)
%amily history
$ecreational ha"its
Animal contacts (including ticks and other vectors)
"rug history
Health related beha1ior H$*! topics: history ta'in/
"8ealthy &EE"&":
&u"stances (alcohol* to"acco* I. drugs9)
Environment (ha7ards at home or work9 feel safe9)
Exercise (what do you do9 how often do you do it9)
"iet (any special diet9)
&ex (active with m$f$"oth9 :; partner9 safe sex9 /<( history9 (i=culty with arousal or
orgasm9 history of a"use9) I fnd this order works well: patients most expect to "e asked
a"out alcohol and they least want to talk a"out their /<( history* "ut taking a solid 8>5
history frst reassures them that it1s all part of good medical care+
Pain history chec'list +(&T <A$:
+ocation
(nset
&everity
Time
<orsening factors
Alleviating factors
$adiation
&hort statue causes $ETA$" HE)3HT:
$ickets
Endocrine (cretinism* hypopituitarism* 'ushing1s)
Turner syndrome
Achondroplasia
$espiratory(suppurative lung disease)
"own syndrome
Hereditary
Environmental (postirradiation* postinfectious)
)?@>
3I (mala"sorption)
Heart (congenital heart disease)
Tilted "ack"one (scoliosis)
Ascultation: crac'les rales! "PE*"les":
Pneumonia
Edema of lung
*ronchitis
Pain history chec'list #H+($)"E:
#Haracter (sta""ing* thro""ing* etc+)
+ocation
(nset
$adiation
)ntensity
"uration
Exacer"ating and alleviating factors
"i;erential dia/nosis #)MET)"),E:
#ongenital
)nfection$ )n&ammatory
Meta"olic
Endocrine
Trauma
)atrogenic
"egenerative
)diopathic
,eoplastic
Everything else
&i/n 1s. symptom >emem"er -ce of 5ase1s song that goes like
this:
") &a6 the &i/n* and it opened up my eyes"+
<he physician sees the signs+
&ystems re1ie6: systems chec'list ) P4,#H EA$:
)ntegumental
Pulmonary
4rogenital
,ervous
#ardiovascular
Hematolymphoid
Endocrine
Alimentary
$eproductive
History ta'in/ :past medical history A*#"E%3H):
Asthma
*lood pressure (say: 1"lood pressure pro"lems1)
#.- (say: 1stroke1)
"ia"etes mellitus (say: 1dia"etes1)
Epilepsy
%ever* rheumatic
3astrointestinal (6aundice)
Heart attack
)nfection (<5)
Pain history chec'list M$. # T %A$A"&:
Main site
$adiation
#haracter
Timing
%re#uency
Associated factors
$elieving factors
Aggravating factors
"uration
&everity
Abdomen assessment <o assess a"domen* palpate all 2
#uadrants for "$. 3E$M:
"istension: liver pro"lems* "owel o"struction
$igidity ("oard like): "leeding
3uarding: muscular tension when touched
Eviseration$ Ecchymosis
$e"ound tenderness: infection
Masses
Pain history chec'list "(n "ays %eeling +ow #haracter* $un A &even Pace $ace":
(nset
"uration
%re#uency
+ocation
#haracter
$adiation
&everity
Precipitating factors
$elieving factors
Pain history chec'list A&= +A&T:
Aggravating$ Alleviating
&everity
=aracter
+ocation
Associated symptoms
&etting
Timing
Pain history chec'list &(#$ATE&:
&ite
(nset
#haracter
$adiation
Alleviating factors$ Associated symptoms
Timing (duration* fre#uency)
Exacer"ating factors
&everity -lternatively* &igns and &ymptoms with the 1/1+
&ymptom attributes "%A&T +00'&":
%actors that make it "etter$worse
Associated manifestations
&etting
Timing
+ocation
0uality
0uantity
&everity
Heart 1al1e auscultation sites "All Patients Take Meds": >eading from top left:
Aortic
Pulmonary
Tricuspid
Mitral /ee diagram+
-lternatively: All Prostitutes Take Money+
-lternatively: APe To Man+
-lternatively: Always Pumps Too Much+
%our point physical assessment of a disease ")1m A People Person":
)nspection
Auscultation
Percussion
Palpation
-lternatively: ")1m A Perfect Person"+
Physical exam for 'lumps and bumps' "3 &tudents and 0 Teachers go for
#AMP%)$E":
&ite* &i7e* &hape* &urface* &kin* &car
Tenderness* Temperature* Transillumination
#onsistency
Attachment
Mo"ility
Pulsation
%luctuation
)rreduci"ility
$egional lymph nodes
Edge
&ur/ical sie1e 2A,)&HE":
2ascular
Accident A trauma
,eoplastic
)n&ammatory
&eptic
Haematologic$ Hereditary
Endocrinological
"egenerative
"i;erential dia/nosis chec'list ") 2),")#ATE A)"&":
)diopathic
2ascular
)nfectious
,eoplastic
"egenerative
)n&ammatory
#ongenital
Autoimmune
Traumatic
Endocrinal and meta"olic
Allergic
)atrogenic
"rugs
&ocial
&ymptom sie1e "T), #A, *E" ")P P(3":
Trauma
)nfection
,eoplasm
#ardiac
Autoimmune
,eurological
*lood$ *one
Endocrine
"isintegration$ "egeneration
"rugs
)atrogenic$ )diopathic
Psychological
Paediatric
("stetric
3ynaecological
Alcohol abuse screenin/ >uestions #A3E:
;+ Bver felt it necessary to #ut down on drinking9
C+ 8as anyone ever said they felt Annoyed "y your drinking9
0+ Bver felt 3uilty a"out drinking9
2+ Bver felt a need to have a morning drink as an Eye opener9
Abdominal s6ellin/ causes D E1s:
%at
%eces
%luid
%latus
%etus
%ull!si7ed tumors
%ull "ladder
%i"roids
%alse pregnancy
Patient examination or/ani?ation &(AP:
&u"6ective: what the patient says+
("6ective: what the examiner o"serves+
Assessment: what the examiner thinks is going on+
Plan: what they intend to do a"out it+
2omitin/: non:3)T di;erential A*#"E%3H):
Acute renal failure
*rain )increased I'F,
#ardiac )inferior %I,
"G-
Ears )la"yrinthitis,
%oreign su"stances )<ylenol* theo* etc+,
3laucoma
Hyperemesis gravidarum
)nfection )pyelonephritis* meningitis,
History: >uic' EM& medical history chec'list &AMP+E:
&igns$ &ymptoms
Allergies
Medications
Pertinent history
+ast oral intake
Events preceding this incident
Pain history chec'list (P0$&T4:
(nset of pain (time* duration)
Palliative factors for pain
0uality of pain (thro""ing* sta""ing* dull* etc+)
$egion of "ody aected
&everity of pain (usually scale of ;!;H)
Timing of pain (after exercise* in evening* etc+)
4: 8ow does it aect 141 in your daily life9
%ay wish to expand to (PP0$$&TT42<* with the extra letters
representing:
Provocative factors
$adiation (how does pain spread)
Treatments tried
(e6a 2u: 8as this happened "efore9
<orry: Ihat do you think or fear that it is9
"i;erential dia/nosis chec'list "A 2)TAM), #"
A and # stand for Ac#uired and #ongenital
.I<-%IJ stands for:
2ascular
)n&ammatory ()nfectious and non!)nfectious)
Trauma$ Toxins
Autoimmune
Meta"olic
)diopathic
,eoplastic
Bxample usage: Kist causes of decreased vision: 'entral retinal artery occlusion*
>etinitis pigmentosa* Ferforation to go"e* 'hronic @entamycin use* >uematoid arthritis*
(ia"etes* Idiopathic* -ny eye tumor* %yopia+
&i/n 1s. symptom s)gn: something ) can detect even if patient is unconscious+
s@Mptom is something only h@Mknows a"out+
Eyes: abbre1iations for the eyes Lou look (4t with *oth eyes+
<ake the $i/ht dose so you won1t (" )overdose,+
<he only one that is +eft is (&+
5oth eyesM4?* >ight eyeM4(* Keft eyeM4/+
Medical history: disease chec'list MA TH$EA"&:
Myocardial infarction
Aaundice
Tu"erculosis
Hypertension
$heumatic fever$ $heumatoid arthritis
Epilepsy
Asthma
"ia"etes
&trokes
-side: "8istory" al"um was "y %ichael Nackson (%N)+