internal medicine osce mindmaps

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Internal Medicine OSCE Mindmaps

Important Notes you shouldnt forget:Introduction + Permission Patients Profile: Name, Age, Sex and the occupation are always required Chief Complaint + the Duration History of Presenting Illness: Analysis of the chief complaint + Symptoms of the involved system+ Associated symptoms, we advise you to always ask about the General review especially in the chronic cases the following Table contains the review of all systems

General Eye Mouth Skin CVS RS GIS GUS MSSGenitalia

Fever, Rigor, Chills, Anorexia, Weight Loss, Fatigue, General Weakness, Sweating, Sleep disturbances Redness, Itching, Discharge, Tears Ulceration, Bleeding Gum

Ear Neck

Redness, Pain, Discharge, Hearing disturbance Swelling or masses, Limitation in movement

Rash, itching, Pain, Swelling, Hair loss, Nail problems, Hypo/Hyperpigmentation Chest Pain, SOB, Orthopnea, PND, Palpitation, Ankle Swelling, Syncope, Intermittent Claudication SOB, Sneezing, Nasal obstruction, Nasal Discharge, Sore Throat, Hoarseness of voice, Epistaxis, Cough, Sputum, Wheeze, Stridor, Hemoptysis, Dysphagia, Nausea, Vomiting, Indigestion, Heartburn, Regurgitation, Hematemesis, Abdominal Pain, Distention, Diarrhea, Constipation, Melena, Rectal Bleeding, Rectal Pain, Jaundice Flank Pain, Dysuria, Hematuria, Urine Discoloration, Hesitancy, Poor Stream, Double Stream, Dribbling, Incontinence, Frequency, Amount of urine, Frothy urine Gait, Muscle Pain, Muscle Wasting, Bone Pain, Joint Pain, Joint Swelling, Limitation in movement Erectile Dysfunction, Ejaculation, Discharge, Testicular (Pain, Atrophy), Ulcers, Nodules, Skin Discoloration, impotence, loss of libido


Menarche, Menstruation(Regularity, Length, Amount), Menstrual Pain, Abnormal bleeding, Menopause, Discharge, odor, ulcers, itching, libido, dyspareunia, incontinence Consciousness, Headache, dizziness, fainting, alter sensations, weakness, visual disturbances, hearing problems, poor memory, poor concentration, Gait, Motor defects Heat or cold intolerance, Sweating, Excessive Thirst Pallor, General weakness, Recurrent infections, Bleeding tendency, Rash Anxiety, Depression, mental illnesses


Past Medical Hx: throughout the mindmaps we only put the points that are most important for eachChief complaint, but we advise you to memorize the full table so you dont forget any QNote: = = when the symptom happen When e.g. at rest, while watching TV : Timing = variation of the symptom during the day/night :

Similar previous attacks Chr. Illnesses(MI, DM, HTN, ) Admissions Surgeries Blood transfusions Traumas Hx of recent travel abroad Allergies Vaccinations Drugs (Now, Previous, Allergies)

Similar Disease in 1st degree relatives Hx of Chronic/Major Acute illnesses Early Deaths

Income Insurance Smoking / Alcohol/ Drug abuse / Sexual practices Home (rooms, ventilation , floor ) Occupation Marital Status Diet Pets Stress

If you find any mistake or an important point missing Please inform us on:


Continous Duration of the attack

MI , PE , Dissecting Aneurysm , Pneumonia

Sudden FrequencyAngina , Tietze Syndrome, Da Costa syndrome



Progression DurationMI , PE , Pericarditis , Pneumothorax , Rib fracture Angina , Esophagitis , Hiatus Hernia


MI , PE , Pericarditis , Pneumothorax , Rib fracture

Crushing Heaviness BurningGI Dissecting Aneurysm

Acute Chronic

Character Onset


Neck, Jaw, Left Arm


RadiationCentral Peripheral

Esophagus Back, Throat Back, Abdomen, Legs

Dissecting Aneurysm



Severity FactorsBetter WorseAntiacids , Nitroglycerin , Rest , inclining Forward Breathing , Movement , Effort (& how much) Bending , Straining , Laying down

Chest Pain sDyspneaPE , Pneumonthorax , Pneumonia

PND & OrthopneaRA , SLE


Arthritis Rash

Cough Fever & Pus-like Sputum Hemoptysis WaterBrash

Reflux Esophagitis

Acid or Bitter Taste in mouthMI , GERD

Pneumonia , Pleuritis

Nausea & Vomiting

Esophageal Spasm Esophagitis

Intermittant constant

Adenophagia / Dysphagia Rash in the area of pain Area of tenderness

Associated Symptoms




Sypmtoms of AnxietyNervousness Tremor Palpitations Tachypnea

Costochondritis , Fractured Rib

Cardiac causesIschemic heart disease Acute pericarditis Aortic dissection Aortic stenosis Cocaine-induced

GastrointestinalGastroesophageal reflux disease Esophageal spasm Dysmotility Cholecystitis Peptic ulcer disease Pancreatitis

PsychosomaticPanic attack Anxiety Depression

PulmonaryPulmonary embolus Pneumonia Pneumothorax

MusculoskeletalCostochondritis Fibromyalgia

MiscellaneousArthritis Herpes zoster


ARDS, PE, Pneumothorax, Lung Collapse

Duration of the attack Frequency Continous Intermittent GradualCHF, Emphysema, Anxiety

Progression Duration


Acute Chronic




FactorsExercise, lying Flat, Anxiety


- Pink, Frothy Bronchiectasis, Pneumonia - Dark, Foul-smelling Abscess


- Pus-like, Large Amt Pulmonary Edema - Bloody


Asthma, COPD, Foreign Body, Tumor, Pulmonary Edema

Stridor Rash Joint Pain

Obstustion of the Large Airway

Foriegn Body, Tumor, Infection

Associated SymptomsFeverEspecially at NightPneumonea of mesothelioma

+ Pus-like SputumTB


Sarcoidosis HF

Fatigue Ankle Swelling PalpitationsHF

Sweating Chest Pain + Bloody SputumPE


Orthopnea & PND

Pulmonary causesAsthma Chronic obstructive pulmonary disease Tracheal obstruction Emphysema Interstitial lung disease Pulmonary hypertension Pulmonary embolism Pneumonia Pleural effusion Pneumothorax

Cardiac causesCoronary syndromes Valvular disorders Cardiomyopathy Pericardial disorders Arrhythmias Congestive heart failure

Other causesRespiratory muscle weakness Myasthenia gravis Guillain-Barr syndrome Anemia Metabolic acidosis Diabetic ketoacidosis Salicylates Pregnancy Psychiatric disorders Anxiety Panic disorder Musculoskeletal Kyphoscoliosis

Unitlateral Bilateral Sudden Gradual

Extent Ankle, Calf, Thigh

Site Progression Duration AnalysisAcute Chronic


Trauma, Activity, Spontanous Periorbital, Testicular, Ascites

Other Sites of Swelling Temperture Stiff Muscles Painful


Rapid Progression Browny-Reddish Areas Fever

Varicose VeinsWt Loss Fever Night Sweats

Leg Swelling

CellulitisPitting Edema

Sharply Defined Edge Diffuse

Tumor compressing on a VeinStiff Muscles


hot Parasthesia/Numbness

Urine Output Urine Color Bloody Urine

Renal Failure

Associated SymptomsWeight Gain Cold Intolerance Constipation

Acute Compartment Syndrome

Sudden Sever Calf Pain

Pallor Myxedema (non pitting Edema)

Skin Nodules

Morning Stiffness


Rheumatoid Arthritis

Proximal Joint pain Varices

Spider Navi

Fatigue Bilateral


Hoarseness of Voice

Jaundice Testicular Atrophy Hemoptysis Acute Chest Pain

Course Dry Skin


SOB (worse on Evening) Bilateral

Palmar erythema Clubbing

Liver Failure


Poor Memory & concentration

Hepatic Encephalopath Acute Chest Pain Tachycardia Cold Sweating


Heart Failure

Bleeding tendency PND Bilateral Ascities exertion Induced


Local Acute causesDVT Cellulitis Allergy Ruptured Backer Cyst Trauma RA

Chronic causesPregnancy Lymphedema (not pitting) Varicose Veins

GeneralHeart Failure Hypoproteinemia (Liver or Kidney Failure) Hypothyroidism


Sudden high Volume Low volume TransietV.intense Exersice


Amount of urine

Progression Color

Red Dark

Hb, Blood Urobilinogen Extravascular hemolysis


AnalysisAcute Chronic


Bilirubin Inravascular hemolysis


Which part of Sream Odor

All Partial

EarlyUrethral, Prostatic

Late Bladder


Butterfly Rash Maliase Fever Raynaud's Discoid rash


Anemia Symptoms Malaise infection Bruising Gum enlargement


Red-Dark Urine

Abdominal Pain + Jaundice

Common Bile Duct Stone, Pancreatitis, Sclerosing Colingitis, Pancreatic CA, Bile Duct CA, Viral or Alcoholic Hepatitis,

Abdominal Pain Jaundice Fever

Renal Stones, Renal Embolism, Renal CA Kidney Contusion, GN, Polycystic Kidney

IntraVascular Hemolysis

Intense Pain Loin Radiating to the groin

Cloudy-Dark UrinePoor Stream Drippling Hematuria when Enlarged Vein Ruptures

Urinary Stones

Pyelonephritis, Lupus Erythmatosis, LE + Kidney Emboli

Associated Symptoms

Palpitations SOB

Prostatic Disease

Pale StoolLoin Pain Nausea & Vomiting Fever Chills

Biliary Obstruction


FatigueEasy Bruising Bleeding Gum Epistaxis Menorrhagia Rectal Bleeding Swollen Painful Joints

Bad OdorBurning Micturition Frequency Urgency Fever (if Upper)


Urgency Burning Micturition Discharge