Physical Examination Mnemonics

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) "DC REF
Fears Similar Decision At ER":
Definition
Cause
Reasoning
Effect
Future
Fears and concerns
Similar experiences
Decision-making
Attempts at treatment
Expectations of treatment
Results

Pain history checklist DOCS ARE FIT:
Duration
Onset
Character
Site
Associatied symptoms
Radiation
Exacerbating and relieving factors
Frequency
Intensity
Timing

Breast history checklist LMNOP:
Lump
Mammary changes
Nipple changes
Other symptoms
Patient risk factors

Pain history checklist COLDER BARS:
Character
Onset
Location
Duration
Exacerbating factors
Radiation
Before (ever happened before)
Associated symptoms
Relieving factors
Severity

Pain history checklist SO CRAP:
Site
Onset
Character
Radiates to
Associated symptoms/ Alleviating and exacerbating factors
Periodicity

History, HCFA components for E+M coding Q LSD MCAT:
Quality
Location
Severity
Duration
Modifying factors
Context
Associated signs and symptoms
Timing

Surgical sieve for diagnostic categories INVESTIGATIONS:
Iatrogenic
Neoplastic
Vascular
Endocrine
Structural/ Mechanical
Traumatic
Inflammatory
Genetic/ Congenital
Autoimmune
Toxic
Infective
Old age/ Degenerative
Nutritional
Spontaneous/ Idiopathic

Mental state examination: stages in order "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]

Branham sign: definition BRAnham sign:
BRAdycardia after compression or excision of a large AV fistula.

Glasgow coma scale: components and numbers · 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 withdrawl)

Physical examination - correct order "I Palpate
People's Abdomens":
Inspection
Palpation
Percussion
Auscultation

Clinical examination: initial Inspection of patient from end of bed
ABC:
Appearance (SOB, pain, etc)
Behaviour
Connections (drips, inhalers, etc connected to patient)

Pain history checklist CLITORIS:
Character
Location
Intensity
Timing
Onset
Radiating
Irritating and relieving factors
Symptoms associated

Heart valve auscultation sites "All People 
Try Marijuana":
Aortic
Pulmonic
Tricuspid
Mitral

Consolidations: sound Consolidations
Conduct
Consonants
Clearly

Past medical history (PMH) VAMP THIS:
Vices (tobacco, alcohol, other drugs, sexual risks)
Allergies
Medications
Preexisting medical conditions
Trauma
Hospitalizations
Immunizations
Surgeries

Patient profile (PP) LADDERS:
Living situation/ Lifestyle
Anxiety
Depression
Daily activities (describe a typical day)
Environmental risks/ Exposure
Relationships
Support system/ Stress

Family history (FH) BALD CHASM:
Blood pressure (high)
Arthritis
Lung disease
Diabetes
Cancer
Heart disease
Alcoholism
Stroke
Mental health disorders (depression, etc.)

Differential diagnosis checklist DIRECTION:
Drugs
Infection
Rheumatologic
Endocrine
Cardiovascular
Trauma
Inflammatory
Other
Neoplasm

Pathologic classification NIT DIT FIT:
Neoplastic
Infectious
Traumatic
Degenerative/ Drugs
Immune
Toxic
Vascular
Inflammatory
Totally obscure

Pyrexia of Unknown Origin: history taking SIT ON FRAD:
Sexual history
Immunisation status
Travel history
Occupational history
Nutrition (consumption of dairy products, etc.)
Family history
Recreational habits
Animal contacts (including ticks and other vectors)
Drug history

Health related behavior (HRB) topics: history taking
"Healthy SEEDS":
Substances (alcohol, tobacco, IV drugs?)
Environment (hazards at home or work? feel safe?)
Exercise (what do you do? how often do you do it?)
Diet (any special diet?)
Sex (active with m/f/both? >1 partner? safe sex? STD history? difficulty
with arousal or orgasm? history of abuse?)
· I find this order works well: patients most expect to be asked about alcohol
and they least want to talk about their STD history, but taking a solid HRB
history first reassures them that it's all part of good medical care.

Pain history checklist LOST WAR:
Location
Onset
Severity
Time
Worsening factors
Alleviating factors
Radiation

Short statue causes 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)

Ascultation: crackles (rales) "PEBbles":
Pneumonia
Edema of lung
Bronchitis

Pain history checklist CHLORIDE:
CHaracter (stabbing, throbbing, etc.)
Location
Onset
Radiation
Intensity
Duration
Exacerbating and alleviating factors

Differential diagnosis CIMETIDINE:
Congenital
Infection/ Inflammatory
Metabolic
Endocrine
Trauma
Iatrogenic
Degenerative
Idiopathic
Neoplastic
Everything else

Sign vs. symptom Remember Ace of Base's song that goes like
this:
"I Saw the Sign, and it opened up my eyes".
The physician sees the signs.

Systems review: systems checklist I PUNCH EAR:
Integumental
Pulmonary
Urogenital
Nervous
Cardiovascular
Hematolymphoid
Endocrine
Alimentary
Reproductive

History taking -past medical history ABCDEFGHI:
Asthma
Blood pressure (say: 'blood pressure problems')
CVA (say: 'stroke')
Diabetes mellitus (say: 'diabetes')
Epilepsy
Fever, rheumatic
Gastrointestinal (jaundice)
Heart attack
Infection (TB)

Pain history checklist MR. C T FARADS:
Main site
Radiation
Character
Timing
Frequency
Associated factors
Relieving factors
Aggravating factors
Duration
Severity

Abdomen assessment To 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

Pain history checklist "On Days Feeling
Low Character, Run A Seven Pace Race":
Onset
Duration
Frequency
Location
Character
Radiation
Severity
Precipitating factors
Relieving factors

Pain history checklist ASK LAST:
Aggravating/ Alleviating
Severity
Karacter
Location
Associated symptoms
Setting
Timing

Pain history checklist SOCRATES:
Site
Onset
Character
Radiation
Alleviating factors/ Associated symptoms
Timing (duration, frequency)
Exacerbating factors
Severity
· Alternatively, Signs and Symptoms with the 'S'.

Symptom attributes "FAST LQQ'S":
Factors that make it better/worse
Associated manifestations
Setting
Timing
Location
Quality
Quantity
Severity

Heart valve auscultation sites "All Patients
Take Meds":
· Reading from top left:
Aortic
Pulmonary
Tricuspid
Mitral
· See diagram.
· Alternatively: All Prostitutes Take Money.
· Alternatively: APe To Man.
· Alternatively: Always Pumps Too Much.

Four point physical assessment of a disease "I'm A
People Person":
Inspection
Auscultation
Percussion
Palpation
· Alternatively: "I'm A Perfect Person".

Physical exam for 'lumps and bumps' "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

Surgical sieve VANISHED:
Vascular
Accident & trauma
Neoplastic
Inflammatory
Septic
Haematologic/ Hereditary
Endocrinological
Degenerative

Differential diagnosis checklist "I VINDICATE AIDS":
Idiopathic
Vascular
Infectious
Neoplastic
Degenerative
Inflammatory
Congenital
Autoimmune
Traumatic
Endocrinal and metabolic
Allergic
Iatrogenic
Drugs
Social

Symptom sieve "TIN CAN BED DIP POG":
Trauma
Infection
Neoplasm
Cardiac
Autoimmune
Neurological
Blood/ Bone
Endocrine
Disintegration/ Degeneration
Drugs
Iatrogenic/ Idiopathic
Psychological
Paediatric
Obstetric
Gynaecological

Alcohol abuse screening questions CAGE:
1. Ever felt it necessary to Cut down on drinking?
2. Has anyone ever said they felt Annoyed by your drinking?
3. Ever felt Guilty about drinking?
4. Ever felt a need to have a morning drink as an Eye opener?

Abdominal swelling causes 9 F's:
Fat
Feces
Fluid
Flatus
Fetus
Full-sized tumors
Full bladder
Fibroids
False pregnancy

Patient examination organization 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.

Vomiting: non-GIT differential ABCDEFGHI:
Acute renal failure
Brain [increased ICP]
Cardiac [inferior MI]
DKA
Ears [labyrinthitis]
Foreign substances [Tylenol, theo, etc.]
Glaucoma
Hyperemesis gravidarum
Infection [pyelonephritis, meningitis]

History: quick EMS medical history checklist SAMPLE:
Signs/ Symptoms
Allergies
Medications
Pertinent history
Last oral intake
Events preceding this incident

Pain history checklist OPQRSTU:
Onset of pain (time, duration)
Palliative factors for pain
Quality of pain (throbbing, stabbing, dull, etc.)
Region of body affected
Severity of pain (usually scale of 1-10)
Timing of pain (after exercise, in evening, etc.)
U: How does it affect 'U' in your daily life?
· May wish to expand to OPPQRRSTTUVW, with the extra letters
representing:
Provocative factors
Radiation (how does pain spread)
Treatments tried
Deja Vu: Has this happened before?
Worry: What do you think or fear that it is?

Differential diagnosis checklist "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.

Sign vs. symptom sIgn: something I can detect
even if patient is unconscious.
sYMptom is something only hYMknows about.

Eyes: abbreviations for the eyes You look OUt with 
Both eyes.
Take the Right dose so you won't OD [overdose].
The only one that is Left is OS.
· Both eyes=OU, Right eye=OD, Left eye=OS.

Medical history: disease checklist MJ THREADS:
Myocardial infarction
Jaundice
Tuberculosis
Hypertension
Rheumatic fever/ Rheumatoid arthritis
Epilepsy
Asthma
Diabetes
Strokes
· Aside: "History" album was by Michael Jackson (MJ).