Mnemonics:
Pain:
LIQORAAAP
Location
Intensity
Quality
Onset
Radiating
Aggravating factors
Alleviating factors
Associated Symptoms
Precipatating event
– Previous episodes
– Progression
No pain:
DOC PA FAA
Duration
Onset
Constant/Intermittent
Precipatating event
– Previous episodes
– Progression
Associated Symptoms
Frequency
Aggravating factors
Alleviating factors
Peds:
BINDERS
Birth history
Immunization/Illness
Neonatal Hx
Development/Day care
Eating/Excercise/Weight
Rash
Sleep
FEVERS CUD (for peds fever)
Fever
Ear pulling
Vomiting
Ear discharge
Eye discharge
Rash
Sore throat
Cough
Urination
Diarrhea
Neonate
DCT SFDC
Delivery
Complications
Term
Substance use during pregnancy
First bowel movement
Diapers/day
Color of urine/stool
OB/GYN
LMP RTV CS PAP
Last menstrual period
Menarche
Period (after how many days)
Regularity
Tampons/Pads per day
Vaginal discharge, itching, dryness
Cramps/Contraception
Spotting (intermenstrual, post coital)
Pregnancy (Hx and complications)
Abortion/miscarriage
PAP smear
HAVOC
Hot flashes
Atrophy of vagina
Vaginal dryness
Osteoporosis
Coronary artery disease
ACCOD (discharge)
Amount
Consistent
Color
Odor
Duration
DEMENTIA
ADL (activities of daily living)
DEATH
Dressing
Eating
Ambulation (way around the house)
Toilet
Housing
IADL (instrumental activities of daily living)
SHAFT
Shopping
House keeping
Accounting
Food
Transport
ABUSE (domestic/elderly)
SAFEGARDS
Safe at home?
Alcohol
Friends/family know about it?
Emergency plan
Guns
Any escape plan
Relationship with abuser
Depression/drugs
Suicidal ideation
SYNCOPE – think cardio problem/neuro problem/seizures
PDS DBLP
Palpitations (think HYPERTHYROIDISM, SAME WITH ANXIETY IMPORTANT, whenever
you see
Palpitation!!)
Dizziness
Shaking
Duration
Bit tongue
Loss of urine
Post Symptoms (weakness/numbness/speech/confusion)
SMOKING
5 A’s
Ask about tobacco use
Advice quitting
Assess will to quit
Assist to quit
Arrange follow up
Goes something like this:
1. “Do you smoke”
2. “I would like to advice you to quit smoking because it causes lung cancer and heart
disease”
3. “Have you ever thought of quitting”
4. “We have medications that can help you quit, and I will be here every step of the
way”
5. “Lets make an appointment for 2 weeks from now and we will start then”
6. Move on to the next part of the encounter
ALCOHOL
CAGE
Cut down (felt the need to)
Annoyed by criticism
Guilty
Eye opener
DEPRESSION
SIG E CAPS
Sleeping changes
Interest (lost in regular activities)
Guilty
Energy (low)
Concentrations problems
Appetite (increased or decreased)
Psychomotor (agitated)
Suicide (homicide)
FOR ALL PATIENTS
PAM HITS FOSS
Past medical history
Allergies
Medications
Hospitalizations
Ill contacts
Trauma
Surgical hx
Family hx
Ob/gyn
Sexual hx
Social hx
SOCIAL HX
TIA SHOE
Tobacco
Illicit drugs
Alcohol
Sexual hx (repeat if needed)
House (who do you live with?)
Occupation
Eating(Diet)/Exercise
ROS (everyone has their own, I use the head to toe method + extras) (tip: start with
extras and don’t stop just because patient is saying no to all and getting annoyed. YOU
MUST ASK ALL, my patients got annoyed but later I found out that they are having
sleep problems and I didn’t ask when I should have during ROS)
EXTRAS:
CONSTITUTIONAL: Fever/Chills/Night sweats
SLEEP
WEIGHT
DIZZINESS
CONCENTRATION
ENERGY
HEENT : headaches, Ear pain/discharge/hearing loss, Eye pain/discharge, runny nose,
sore throat
CVS : chest pain, shortness of breath, edema, palpitations
RS : wheezing, coughing, shortness of breath
GI : nausea, vomiting, diarrhea, constipation
GU : urination (frequency, weak stream), discharge, pain
MOVEMENT : joint pain, muscle pain
DERM : skin rash, itching
ENDO : excessive thirst
CNS : pain, numbness, tingling
How to write patient note: (Physical exam findings part)
What I did was practice writing ALL normal findings as fast as I can. After that I would
JUST change the specific system that had abnormal findings. I have my normal finding
template below. Try typing it within 2 minutes, type it again and again until you are
super fast at it. Then let’s say you have a patient who has abdominal tenderness, so
instead of writing “nontender” in abdomen, write “tender” and you will never run out of
10 mins of patient notes time.
Add whatever else you need to to this normal template if you think it is incomplete, but
use my method of typing your normal template as fast as possible, then just change
the abnormal findings. I always finished my patient notes in 5 to 6 minutes then just
reviewed. Gives you more time to think of your DDX and tests.
NORMAL PHSYICAL EXAM FINDINGS TEMPLATE
VS: WNL
HEENT: PERRLA, EOMI without diploplia or lid lag
Neck: no JVD, no bruits, no thyromegaly, no cervical LAD
Chest: no tenderness, clear symmetric breath sounds bilaterally.
Heart: RRR, normal S1/S2; no murmurs, rubs, or gallops.
Abdomen: Soft, nondistended, nontender, + BS, no heptosplenomegaly
Extremeties: No edema, peripheral pulses 2+ and symmetric
Neuro: Mental status: allert and oriented x3, good concentration. Cranial nervs: 2-12
grossly intact. Motor: strength 5/5 throughout. DTRs: 2+ intact, symmetric
Script for talking to patient (I scored very high in communications and interpersonal
skills)
COUNSEL COUNSEL COUNSEL (alcohol/smoking/anxiety/depression counsel on
everything)
1. Knock
2. Shake hands and say “Hello Mr. Smith, my name is Dr. So, How can I help you
today?”
a. After chief complaint say “I am so sorry to hear that” (1 point for PEARLS)
b. “Can I make you more comfortable” ---> DRAPE PATIENT NOW
c. “Do you mind if I sit down and take some notes” ---> SIT NOW
3. “Ok Mr. Smith, I am going to ask you some questions and we will try to find the
cause of your concern together” (1 point for PEARLS)
NO NOTES, NO INTERRUPTIONS UNTIL THIS POINT, YOU MUST LISTEN TO PATIENT
AND KEEP EYE CONTACT UNTIL STEP 3
4. “Tell me more about your Chief complaint” YOU CAN TAKE NOTES NOW
5. HPI/ROS/PAMHITSFOSS – ANY OTHER MNEUMONICS HERE
6. “I am sorry this happened to you, let me summarize your concerns as I understand
them”
SUMMARIZE IN PATIENTS WORDS (IMPORTANT!!)
7. Summarize in patient’s words only info relevant to C.C
8. “Do you have any other concerns?” ---> ASK WHILE WASHING HANDS (I put on
gloves much faster)
THIS IS WHERE THEY ASK CHALLENGE QUESTION, know them from FA
9. “Ok Mr. Smith, Can I perform a physical exam on you?”
10. “I am going to untie your gown and exam your lungs”
EXPLAIN EACH EXAMINATION AS YOU DO IT
11. Palpate, percuss, auscultate lungs (Check costovertibral-angle tenderness (CVA) at
this time if relevant). “thank you for letting me examine your lungs.”
12. “Now I am going to examine your heart”
13. Auscultate heart. “Thank you”
14. “Please lay down so I can examine … (whatever else needs examining)”
15. Other exams. “Thank you” (THANK YOU AFTER EVERY EXAM)
16. “Let me help you sit back up and tie the gown”
17. “Thank you Mr. Smith for letting me examine you, Let me give you my impression”
18. IMPRESSION: 3 DDX for C.C and work up for each (THIS IS A MUST)
19. “Do you have any other questions or concerns for me?”
20. “I will see you after I get the test results”
21. “Thank you Mr. Smith, goodbye” ---> SHAKE HANDS AND LEAVE
Quick PE tips for all cases
1. Look up for me
2. Look down for me
3. Open your mouth and say “ah” please
4. Can you swallow for me
5. Neck exam for nodes
6. Examine hands
7. Skin
8. Examine legs
9. Listen to lungs, palpate
10. Listen heart
Next any specific system exam specific to their C.C (Abdominal, extremities, neuro)
My sheet looked like this before going in (just the bold parts)
(Name) ---> DO NOT FORGET THIS I FORGOT ON MY FIRST PATIENT!!
CC
HPI DDx: write one or two
(write whichever menumonic you think applies here) before going in
ROS
PE findings
(mostly empty – no time)
TESTS
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