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

CNSEndocrine

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

HLSPsychiatric

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:

SAWAGROUP@HOTMAIL.COM

www.SAWA2006.com

Continous Duration of the attack

MI , PE , Dissecting Aneurysm , Pneumonia

Sudden FrequencyAngina , Tietze Syndrome, Da Costa syndrome

Gradual

Intermittent

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

When

MI , PE , Pericarditis , Pneumothorax , Rib fracture

Crushing Heaviness BurningGI Dissecting Aneurysm

Acute Chronic

Character Onset

Tearing

Neck, Jaw, Left Arm

MI

RadiationCentral Peripheral

Esophagus Back, Throat Back, Abdomen, Legs

Dissecting Aneurysm

Site

Analysis

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

Chest Pain sDyspneaPE , Pneumonthorax , Pneumonia

PND & OrthopneaRA , SLE

HF (MI, PE)

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

PE

GERD

Shingles

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

Sudden

ARDS, PE, Pneumothorax, Lung Collapse

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

Progression Duration

When

Acute Chronic

Onset

Severity

Analysis

FactorsExercise, lying Flat, Anxiety

DyspniaCough

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

Sputum

- Pus-like, Large Amt Pulmonary Edema - Bloody

Wheeze

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

PE

Sarcoidosis HF

Fatigue Ankle Swelling PalpitationsHF

Sweating Chest Pain + Bloody SputumPE

Arrythmias

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

When

Trauma, Activity, Spontanous Periorbital, Testicular, Ascites

Other Sites of Swelling Temperture Stiff Muscles Painful

Onset

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

DVT

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

Deformities

Rheumatoid Arthritis

Proximal Joint pain Varices

Spider Navi

Fatigue Bilateral

Hypothyroidism

Hoarseness of Voice

Jaundice Testicular Atrophy Hemoptysis Acute Chest Pain

Course Dry Skin

PE

SOB (worse on Evening) Bilateral

Palmar erythema Clubbing

Liver Failure

Gynecomastia

Poor Memory & concentration

Hepatic Encephalopath Acute Chest Pain Tachycardia Cold Sweating

MI

Heart Failure

Bleeding tendency PND Bilateral Ascities exertion Induced

Orthopnia

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

s

Sudden high Volume Low volume TransietV.intense Exersice

Gradual

Amount of urine

Progression Color

Red Dark

Hb, Blood Urobilinogen Extravascular hemolysis

Frequency

AnalysisAcute Chronic

Dark-Brown

Bilirubin Inravascular hemolysis

Onset

Which part of Sream Odor

All Partial

EarlyUrethral, Prostatic

Late Bladder

Clots

Butterfly Rash Maliase Fever Raynaud's Discoid rash

SLE

Anemia Symptoms Malaise infection Bruising Gum enlargement

Leukemia

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

Pyelonephritis

FatigueEasy Bruising Bleeding Gum Epistaxis Menorrhagia Rectal Bleeding Swollen Painful Joints

Bad OdorBurning Micturition Frequency Urgency Fever (if Upper)

UTI

Urgency Burning Micturition Discharge