Internal Medicine OSCE Mindmaps

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<p>Internal Medicine OSCE Mindmaps</p> <p>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</p> <p>General Eye Mouth Skin CVS RS GIS GUS MSSGenitalia</p> <p>Fever, Rigor, Chills, Anorexia, Weight Loss, Fatigue, General Weakness, Sweating, Sleep disturbances Redness, Itching, Discharge, Tears Ulceration, Bleeding Gum</p> <p>Ear Neck</p> <p>Redness, Pain, Discharge, Hearing disturbance Swelling or masses, Limitation in movement</p> <p>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</p> <p>CNSEndocrine</p> <p>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</p> <p>HLSPsychiatric</p> <p>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 :</p> <p>Similar previous attacks Chr. Illnesses(MI, DM, HTN, ) Admissions Surgeries Blood transfusions Traumas Hx of recent travel abroad Allergies Vaccinations Drugs (Now, Previous, Allergies)</p> <p>Similar Disease in 1st degree relatives Hx of Chronic/Major Acute illnesses Early Deaths</p> <p>Income Insurance Smoking / Alcohol/ Drug abuse / Sexual practices Home (rooms, ventilation , floor ) Occupation Marital Status Diet Pets Stress</p> <p>If you find any mistake or an important point missing Please inform us on:</p> <p>SAWAGROUP@HOTMAIL.COM</p> <p>www.SAWA2006.com</p> <p>Continous Duration of the attack</p> <p>MI , PE , Dissecting Aneurysm , Pneumonia</p> <p>Sudden FrequencyAngina , Tietze Syndrome, Da Costa syndrome</p> <p>Gradual</p> <p>Intermittent</p> <p>Progression DurationMI , PE , Pericarditis , Pneumothorax , Rib fracture Angina , Esophagitis , Hiatus Hernia</p> <p>When</p> <p>MI , PE , Pericarditis , Pneumothorax , Rib fracture</p> <p>Crushing Heaviness BurningGI Dissecting Aneurysm</p> <p>Acute Chronic</p> <p>Character Onset</p> <p>Tearing</p> <p>Neck, Jaw, Left Arm</p> <p>MI</p> <p>RadiationCentral Peripheral</p> <p>Esophagus Back, Throat Back, Abdomen, Legs</p> <p>Dissecting Aneurysm</p> <p>Site</p> <p>Analysis</p> <p>Severity FactorsBetter WorseAntiacids , Nitroglycerin , Rest , inclining Forward Breathing , Movement , Effort (&amp; how much) Bending , Straining , Laying down</p> <p>Chest Pain sDyspneaPE , Pneumonthorax , Pneumonia</p> <p>PND &amp; OrthopneaRA , SLE</p> <p>HF (MI, PE)</p> <p>Arthritis Rash</p> <p>Cough Fever &amp; Pus-like Sputum Hemoptysis WaterBrash</p> <p>Reflux Esophagitis</p> <p>Acid or Bitter Taste in mouthMI , GERD</p> <p>Pneumonia , Pleuritis</p> <p>Nausea &amp; Vomiting</p> <p>Esophageal Spasm Esophagitis</p> <p>Intermittant constant</p> <p>Adenophagia / Dysphagia Rash in the area of pain Area of tenderness</p> <p>Associated Symptoms</p> <p>PE</p> <p>GERD</p> <p>Shingles</p> <p>Sypmtoms of AnxietyNervousness Tremor Palpitations Tachypnea</p> <p>Costochondritis , Fractured Rib</p> <p>Cardiac causesIschemic heart disease Acute pericarditis Aortic dissection Aortic stenosis Cocaine-induced</p> <p>GastrointestinalGastroesophageal reflux disease Esophageal spasm Dysmotility Cholecystitis Peptic ulcer disease Pancreatitis</p> <p>PsychosomaticPanic attack Anxiety Depression</p> <p>PulmonaryPulmonary embolus Pneumonia Pneumothorax</p> <p>MusculoskeletalCostochondritis Fibromyalgia</p> <p>MiscellaneousArthritis Herpes zoster</p> <p>Sudden</p> <p>ARDS, PE, Pneumothorax, Lung Collapse</p> <p>Duration of the attack Frequency Continous Intermittent GradualCHF, Emphysema, Anxiety</p> <p>Progression Duration</p> <p>When</p> <p>Acute Chronic</p> <p>Onset</p> <p>Severity</p> <p>Analysis</p> <p>FactorsExercise, lying Flat, Anxiety</p> <p>DyspniaCough</p> <p>- Pink, Frothy Bronchiectasis, Pneumonia - Dark, Foul-smelling Abscess</p> <p>Sputum</p> <p>- Pus-like, Large Amt Pulmonary Edema - Bloody</p> <p>Wheeze</p> <p>Asthma, COPD, Foreign Body, Tumor, Pulmonary Edema</p> <p>Stridor Rash Joint Pain</p> <p>Obstustion of the Large Airway</p> <p>Foriegn Body, Tumor, Infection</p> <p>Associated SymptomsFeverEspecially at NightPneumonea of mesothelioma</p> <p>+ Pus-like SputumTB</p> <p>PE</p> <p>Sarcoidosis HF</p> <p>Fatigue Ankle Swelling PalpitationsHF</p> <p>Sweating Chest Pain + Bloody SputumPE</p> <p>Arrythmias</p> <p>Orthopnea &amp; PND</p> <p>Pulmonary causesAsthma Chronic obstructive pulmonary disease Tracheal obstruction Emphysema Interstitial lung disease Pulmonary hypertension Pulmonary embolism Pneumonia Pleural effusion Pneumothorax</p> <p>Cardiac causesCoronary syndromes Valvular disorders Cardiomyopathy Pericardial disorders Arrhythmias Congestive heart failure</p> <p>Other causesRespiratory muscle weakness Myasthenia gravis Guillain-Barr syndrome Anemia Metabolic acidosis Diabetic ketoacidosis Salicylates Pregnancy Psychiatric disorders Anxiety Panic disorder Musculoskeletal Kyphoscoliosis</p> <p>Unitlateral Bilateral Sudden Gradual</p> <p>Extent Ankle, Calf, Thigh</p> <p>Site Progression Duration AnalysisAcute Chronic</p> <p>When</p> <p>Trauma, Activity, Spontanous Periorbital, Testicular, Ascites</p> <p>Other Sites of Swelling Temperture Stiff Muscles Painful</p> <p>Onset</p> <p>Rapid Progression Browny-Reddish Areas Fever</p> <p>Varicose VeinsWt Loss Fever Night Sweats</p> <p>Leg Swelling</p> <p>CellulitisPitting Edema</p> <p>Sharply Defined Edge Diffuse</p> <p>Tumor compressing on a VeinStiff Muscles</p> <p>DVT</p> <p>hot Parasthesia/Numbness</p> <p>Urine Output Urine Color Bloody Urine</p> <p>Renal Failure</p> <p>Associated SymptomsWeight Gain Cold Intolerance Constipation</p> <p>Acute Compartment Syndrome</p> <p>Sudden Sever Calf Pain</p> <p>Pallor Myxedema (non pitting Edema)</p> <p>Skin Nodules</p> <p>Morning Stiffness</p> <p>Deformities</p> <p>Rheumatoid Arthritis</p> <p>Proximal Joint pain Varices</p> <p>Spider Navi</p> <p>Fatigue Bilateral</p> <p>Hypothyroidism</p> <p>Hoarseness of Voice</p> <p>Jaundice Testicular Atrophy Hemoptysis Acute Chest Pain</p> <p>Course Dry Skin</p> <p>PE</p> <p>SOB (worse on Evening) Bilateral</p> <p>Palmar erythema Clubbing</p> <p>Liver Failure</p> <p>Gynecomastia</p> <p>Poor Memory &amp; concentration</p> <p>Hepatic Encephalopath Acute Chest Pain Tachycardia Cold Sweating</p> <p>MI</p> <p>Heart Failure</p> <p>Bleeding tendency PND Bilateral Ascities exertion Induced</p> <p>Orthopnia</p> <p>Local Acute causesDVT Cellulitis Allergy Ruptured Backer Cyst Trauma RA</p> <p>Chronic causesPregnancy Lymphedema (not pitting) Varicose Veins</p> <p>GeneralHeart Failure Hypoproteinemia (Liver or Kidney Failure) Hypothyroidism</p> <p>s</p> <p>Sudden high Volume Low volume TransietV.intense Exersice</p> <p>Gradual</p> <p>Amount of urine</p> <p>Progression Color</p> <p>Red Dark</p> <p>Hb, Blood Urobilinogen Extravascular hemolysis</p> <p>Frequency</p> <p>AnalysisAcute Chronic</p> <p>Dark-Brown</p> <p>Bilirubin Inravascular hemolysis</p> <p>Onset</p> <p>Which part of Sream Odor</p> <p>All Partial</p> <p>EarlyUrethral, Prostatic</p> <p>Late Bladder</p> <p>Clots</p> <p>Butterfly Rash Maliase Fever Raynaud's Discoid rash</p> <p>SLE</p> <p>Anemia Symptoms Malaise infection Bruising Gum enlargement</p> <p>Leukemia</p> <p>Red-Dark Urine</p> <p>Abdominal Pain + Jaundice</p> <p>Common Bile Duct Stone, Pancreatitis, Sclerosing Colingitis, Pancreatic CA, Bile Duct CA, Viral or Alcoholic Hepatitis,</p> <p>Abdominal Pain Jaundice Fever</p> <p>Renal Stones, Renal Embolism, Renal CA Kidney Contusion, GN, Polycystic Kidney</p> <p>IntraVascular Hemolysis</p> <p>Intense Pain Loin Radiating to the groin</p> <p>Cloudy-Dark UrinePoor Stream Drippling Hematuria when Enlarged Vein Ruptures</p> <p>Urinary Stones</p> <p>Pyelonephritis, Lupus Erythmatosis, LE + Kidney Emboli</p> <p>Associated Symptoms</p> <p>Palpitations SOB</p> <p>Prostatic Disease</p> <p>Pale StoolLoin Pain Nausea &amp; Vomiting Fever Chills</p> <p>Biliary Obstruction</p> <p>Pyelonephritis</p> <p>FatigueEasy Bruising Bleeding Gum Epistaxis Menorrhagia Rectal Bleeding Swollen Painful Joints</p> <p>Bad OdorBurning Micturition Frequency Urgency Fever (if Upper)</p> <p>UTI</p> <p>Urgency Burning Micturition Discharge</p> <p>Urethritis</p> <p>Bleeding Disorders</p> <p>1. introduce yourself 2. permission 3. analysis 4. system involved 5. associated 6. past 7. family 8. drugs 9. social 10. DDx</p> <p>V. Severe</p> <p>e.g. Lead to Syncope</p> <p>Normal Weak "Feeble"Lung CA with involvement of the Left Laryngeal Nerve, Respiratory Muscle Weakness</p> <p>Dry</p> <p>Productive</p> <p>SeverityWheezingObstructive Lung Disease (COPD, Asthma) , HF</p> <p>TypeSudden Gradual</p> <p>Character</p> <p>Whooping BarkingEpiglottitis</p> <p>ProgressionAcute Chronic</p> <p>Nocturnal</p> <p>Asthma . HF Chr. Bronchitis</p> <p>Onset</p> <p>Timing</p> <p>Early Morning + Sputum Daytime</p> <p>Postnasal Drip , GERD , Bronchiectasis</p> <p>AnalysisPainful Factors</p> <p>Relieving Worsening</p> <p>Drugs, Tea , Herbs Drugs , Dust , Fumes , Smoke Meals Esophageal Diverticulum , Fistula</p> <p>CoughWheezeForiegn Body , CA , CHF , Asthma , COPD</p> <p>Stridor</p> <p>Foriegn Body , Whooping , Larynx CA , Tracheal CA</p> <p>sputum analysisAmountlarge Purulent affected by Posture Bronchiectasis Sudden Large Purulent Ruptured Abcsess Larger watery Pinkish (+ SOB) PE Large Watery for long duration Alveolar cell cancer Clear (mucoid) COPD Green COPD with infection , Bronchiectasis Acute Respiratory tract infection , Asthma Yellow Rusty Red Pneumococcal (in Hepatization phase)CA</p> <p>Fever Sputum</p> <p>Infection , Bronchoiectasis</p> <p>Bloody</p> <p>Chr. Bronchitis , TB , Bronchiectasis , CA , Foriegn Body m HF , Abscess , PE</p> <p>Associated SymptomsSweating Chest PainAsthma</p> <p>Amount Odor Color</p> <p>ColorTB</p> <p>SOB</p> <p>Asthma , COPD , Lung Fibrosis, Lung CA , CHF , PE</p> <p>at Night</p> <p>Orthopnea + PND Wt LossCA</p> <p>HF</p> <p>SmellFoul SmellAnaerobic Bacteria</p> <p>e.g. Eczema</p> <p>Rash</p> <p>Burning SensationHF</p> <p>GERD</p> <p>Solid Meteriale.g. Foreign Body, Food, Teeth, Mucous Plug</p> <p>Swelling of the Legs</p> <p>Acute CoughAcute bronchitis Acute sinusitis Chronic obstructive pulmonary disease Asthma exacerbation Allergic rhinitis Whooping cough (Pertussis)</p> <p>Chronic CoughMost common Postnasal drip Gastroesophageal reflux disease</p> <p>Less common Medications (ACE inhibitor) Lung cancer Bronchiectasis Interstitial lung disease Congestive heart failure Chronic obstructive pulmonary disease</p> <p>Fully Mixed with blood Sudden Gradual Lines of Blood + Mucus</p> <p>Progression</p> <p>ConsistancyDark</p> <p>Amount</p> <p>Color</p> <p>Bloody</p> <p>Bright (Hematochezia) Streaks Dark</p> <p>AnalysisFrequencySpecific time during monthrectal Endometriosis Infection</p> <p>Odor</p> <p>Which part of motion PainfulAnal Fissure, Thrombosed Hemorroids</p> <p>Acute</p> <p>All</p> <p>OnsetChronic</p> <p>Partial</p> <p>Early Late</p> <p>Fatigue Palpitation Dizziness Angina</p> <p>Bloody-Dark Stool</p> <p>Fever Abdominal pain Tenismus Dysphagia</p> <p>Symptoms of hypovolemiaDepression</p> <p>Sweating</p> <p>SOB</p> <p>Anal itch</p> <p>Hemorroids, anal fissure, Diarrhea</p> <p>Change in bowel habitAbdominal Distension Abdominal Pain</p> <p>Constipation</p> <p>Intestinal Obstruction, intussusception, Mesentric Thrombosis or embolism</p> <p>Associated Sypmtoms</p> <p>Hematemesis/ Coffee-ground Vomiting</p> <p>UPPER GI BLEEDING: Esophageal Varices, PUD, Gastritis</p> <p>Vomiting</p> <p>ConstipationHeartBurn</p> <p>Diverticulitis, Rectal CA, Hemorroids, Anal Fissure</p> <p>Gastritis, esophagitis, GERD, PUD, Stomach CA, Mesentric embolism or thrombosis, meckles diverticulum</p> <p>Wt loss Appetite Early Satiety</p> <p>Cancer</p> <p>Other Bleeding Sites</p> <p>Easy Bruising Bleeding Gum Epistaxis Hematuria Swollen Painful Joints</p> <p>Bleeding duodenal ulcer Gastric ulcer Gastric carcinoma INFECTION: Esophageal carcinoma Esophageal varices</p> <p>Acute bloody diarrhea mucus</p> <p>-</p> <p>Shigella (bacillary) dysentery Campylobacter enteritis Enteroinvasive Escherichia coli Enterohaemorrhagic type 0157 E. coli Entamoeba histolytica (amoebic) dysentery</p> <p>Melena</p> <p>Meckel's diverticulum Other causes: angiodysplasia, bleeding disorders False Melena: Black licorice Blueberries, Iron supplements Lead Bismuth (Pepto-bismol)</p> <p>First episode of cause of recurrent bloody Diarrhea</p> <p>Bleeding haemorrhoids Anal fissure Diverticulitis Crohn's disease Rectal Carcinoma</p> <p>Recurrent diarrhea with blood mucus</p> <p>Ulcerative colitis Colonic carcinoma Colorectal carcinoma Diverticular disease/ diverticulitis</p> <p>Red Bloody Stool</p> <p>Colonic carcinoma Ulcerative colitis Meckel's diverticulum Crohn's disease Massive upper GI bleed Trauma Intussusception</p> <p>Sudden</p> <p>Gradual</p> <p>Amount FrequencyAcute Chronic</p> <p>Progression Color</p> <p>Onset Character - Mixed - Steaked - Clots</p> <p>Make Sure it is not something ElseHematamesis, epistaxis, Bleeding Gums</p> <p>Analysis</p> <p>Painful Cough Analysis</p> <p>HemoptysisPneumoni, Abscess, Bronchiectasis</p> <p>Fever Confusion</p> <p>Foreign Body CA, CHF</p> <p>Abnormal Breathing Sounds Chest Pain Wt Loss Leg Swelling</p> <p>General Weakness/Fatigue Palpitations</p> <p>PE, MI</p> <p>TB ,CA ,Cystic Fibrosis</p> <p>Associated Symptoms</p> <p>Sweating SOB</p> <p>TB</p> <p>DVT, HF</p> <p>Other Sites of BleedingEasy Bruising, Rectal Bleeding, Menorrhagia, Epistaxis</p> <p>Sputum / Change in amt</p> <p>Airways Bronchitis Bronchiectasis Cystic fibrosis Bronchogenic carcinoma Endobronchial metastases Foreign body aspiration</p> <p>Lung parenchyma Pneumonia Lung abscess Mycetoma (fungus ball) Tuberculosis Lung contusion Lupus pneumonitis Goodpasture's syndrome Wegener's granulomatosis</p> <p>Cardiovascular Pulmonary embolus/infarction Congestive heart failure Mitral stenosis Aortic aneurysm Pulmonary arteriovenous malformation</p> <p>Miscellaneous Anticoagulant therapy Thrombocytopenia Pulmonary endometriosis</p> <p>Migrane , Asthma , Drugs</p> <p>Transient</p> <p>Gradual Sudden</p> <p>V.High</p> <p>DI</p> <p>Progression FrequencyAt Day &amp; Night</p> <p>Amount</p> <p>Analysis</p> <p>Color Thirst &amp; Drinking Amt</p> <p>Acute Chronic</p> <p>Onset</p> <p>Polyuria</p> <p>Chills (if upper)</p> <p>Fever (if upper)</p> <p>Bad OdorPalpitations</p> <p>Fatigue</p> <p>menstrual disorders</p> <p>Abnormal ColorTremor</p> <p>UTI</p> <p>Groin/Flank Pain</p> <p>Irritability Diarrhea Appetite</p> <p>appetitie</p> <p>Thirst</p> <p>Hyperthyroidism</p> <p>Associated SymptomsPolydepsia</p> <p>Burning Micturation</p> <p>Urgency</p> <p>Sweating Heat Intolerance Wt loss</p> <p>Wt loss Fatigue</p> <p>i...</p>