SCHEMAS
Most problems can be addressed using these general schemas:
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Causes - VITAMIN ABCDE, biopsychosocial
Severity – mild / moderate / severe
Symptom elaboration – onset, duration, chronology; alleviating, aggravating; associated
Severity assessment - physiological, functional
Disposition / Discharge planning – physiological severity, functional impairment, in-hospital
staffing/medical resources or social situation or access to community health resources, follow-up
PHYSICAL EXAM
SYSTEM
Praecordial assessment
Abdominal exam
Neuro motor exam
Extremity Trauma
Vascular exam
Ortho / Rheum exam
Multi-trauma
ASSESSMENT SCHEMAS
Inspection
Palpation
Percussion
Auscultation
Inspection
Cough tenderness
Palpation
Percussion
Tone
Power
Co-ordination
Reflexes
Look – deformity, wounds, bleeding, evisceration
Feel – crepitus
Move
Neuro exam
Vascular exam
Look – colour, cap refill, skin atrophy, hair loss
Feel – pulses, temperature
Buerger’s test
Look
Feel
Move (passive / active)
Neurovascular status
Functional status
Primary survey – ABCDE
Secondary survey – HEENT, Neck, Chest, Abdo, Pelvis, Upper limb, Lower Limb,
Back
Neuro
Examine all orifices
CARDINAL MANIFESTATIONS OF DISEASE
PROBLEM
SOB / Hypoxic
Collapse
CAUSES
Cardiac
Respiratory
Neuromuscular
Haematological
Metabolic acidosis
Syncope
Seizure
Syncope
Palpitations
Added heart sounds
Chest pain
Murmurs
SOA
Chest pain (visceral)
Pleuritic chest pain
Tachyarrhytmias
(ECG)
Shock
Cardiac arrest
PEA
Hypertension
Asthma
Metabolic alkalosis
Hypoventilation /
Respiratory acidosis
Wheeze (cf stridor)
Abdominal pain
Abdominal swelling
Ascities / Effusions
Vomiting (cf
regurgitation)
Regurgitation /
Odynophagia
Cardiac – mechanical or electrical
Neurological
Vascular
Supraventricular
Ventricular
Episodic sustained
S3 (Kentucky)
S4 (Tennessee)
Non-pleuritic/visceral
Pleuritc
Systolic (PSM, ESM)
Diastolic
Increased venous pressure
Decreased oncotic pressure
Decreased lymph drainage
Cardiac
Pulmonary
Upper GI
Hepatobiliary-pancreatic
MSK
Pleural
Pericardial
Chest wall
Narrow complex
Broad complex
Stable or Unstable
Hypovolaemic
Distributive
Cardiogenic
VT/VF versus non-VT/VF
4Hs, 4Ts
Primary (essential)
Secondary
Episodic vs persistent
Saline / Chloride responsive
Saline / Chloride unresponsive
Neurological – CNS, PNS
Muscular
Pulmonary – pleural, parenchyma, airways
Pulmonary
Cardiac
Upper GIT
Lower GIT
Hepatobiliary-pancreatic
GUS
Genitourinary
MSK
Fat, Faeces, Fluid, Flatus, Phantom pregnancy, Filthy big tumour, Fetus
Exudate
Transudate
Neurological
Intra-abdominal / GIT
Non-specific
Immediate
Rapid
Delayed
Dysphagia
Splenomegaly
Hepatomegaly
Jaundice
Cholestasis
Abnormal LFTS
Hypoalbuminaemia
Vertigo / Nystagmus
Visual loss
Red eye
Bleeding / Bruising
Haemostatic failure
Anaemia
Haemolytic anaemia
Leucocytosis /
Lymphadenopathy
Hyponatraemia
Low electrolyte
Electrolyte loss
High electrolytes
Osmolality
Renal failure
Structural (food only)
Neurological (food and liquid)
Mild
Moderate
Massive
Mild
Moderate
Massive
Pre-hepatic
Hepatic
Post-hepatic
Intra-hepatic
Extra-hepatic
Cholestatic
Hepatitic
v intake
^ loss (renal, skin. GIT)
Central
peripheral
Unilateral vs Bilateral
Homonymous vs Bi-temporal
Ophthalmic versus Neurological
Periorbital
Lid
Conjunctiva
Anterior chamber
Lacrimal
Local cause
Haemostatic cause
Primary / Congenital
Secondary / Acquired / Drug
Coagulation or Platelets
Microcytic
Normocytic
Macrocytic
v production
^ loss
Extra-vascular
Intra-vascular
Intra-corpuscular
Extra-corpuscular
Reactive
Neoplastic
Hyper-osmolar
Normo-osmolar (factitious)
Hypo-osmolar
v intake
^ loss
Renal / Endocrine
GIT
Skin
^ intake
v loss
^ solute
v water
Pre-renal
Metabolic acidosis
Wide anion gap
acidosis
Limb pain
Gait abnormality
Weakness
Neurological weakness
UMN weakness
Back pain / Sciatica
Raised ICP
Headache
Fracture
Diarrhoea
Otalgia
Hearing impairment
Neck mass
Masses
Ulcer
Post-op bleeding
Hollow visceral
obstruction
Urinary incontinence
Infertility
PV bleeding
Intra-renal
Post-renal
Normal vs wide
Lactic (Type A or b)
Ketotic
Renal failure
Poisionings
Neurological
MSK – local, spinal
Vascular
Neurological – motor, sensory, cerebellar, ataxic
MSK
Neurological
Muscular
Systemic – metabolic, endocrine, infection
Upper motor neurone – brain, spinal cord
Lower motor neurone – nerve root, plexus, peripheral nerve
Cortical
Brainstem
Spinal Cord
Anterior horn
MSK
Retroperitioneal
Blood - Bleeding
Brain - swelling
CSF - hydrocephalus
Intra-cranial
Extra-cranial
Open vs Closed
Undisplaced vs displaced (tilted, angulated, shortened, shifted)
Secretory
Osmotic
Inflammatory
Otological
Non-otological
Conductive
Sensori-neural
Midline vs Lateral
Anterior triangle vs Posterial triangle
Solid vs Cystic
Vascular – micro or macro, arterial vs venous
Infective
Neoplastic
Traumatic
Primary haemostatic
Secondary heamostatic
Intramural
Mural
Extramural
Urge
Overflow
Neurogenic
Structural
Endocrine
Pregnancy related
Non-pregnancy related
PV bleeding (nonpregnancy related)
Haematuria
Rash
Ovulatory
Anovuluatory
Renal / Upper-tract
Extra-renal / Lower-tract
Macular vs Papular
Patch vs Plaque
Nodular vs Vesicular
Erythematous vs Pigmented
ASSESSING COMPLICATIONS
CONDITION
Bleeding
Myocardial infarction
Aortic dissection
Hollow viscera –
bronchi, GIT, biliary,
vascular
Cirrhosis
Respiratory failure
Atherosclerotic disease
Aneurysms
Altered mental state
COMPLICATION
Shock
Coagulopathy
Mechanical
Electrical
Coronary
Pericardial
Aortic valve
Carotid
Subclavian
Intercostal / Spinal
Abdominal
Torsion
Obstruction
Rupture
Hepatic failure
Portal hypertension
Hypoxia
Hypercarbia
Ischaemia / Infarct
Aneurysm
Thrombi / Emboli
Rupture / Bleeding
Embolisation
Occlusion / Ischaemia / Infarction
Coma – loss of airway, hypoventilation
Behavioural - Self-harm
Other-harm