medicine -Introduction-

instrument
anat/ physio
-Epidemiology-
Age/gender/race/population/Incidence
-Risk factors+Etiology
definition
-Definition/pathophysiology
-Diagnosis/clinical features
parts
signs/symptoms
-criteria/classification/score
usage
-complications
-differential diagnosis
indications
-Investigation-
Fluids- blood;CSF/Organs/micro -serology;
types
urine+stools/Path-gross path;histopath
/imaging-usg;xray;ct;mri;angio;fitness
packing/storage/transfer
-treatment
stablize/conservative-bedside monitoring/
insertion+setup
medical/invasive-surgery
-prophylaxis
complications
Prevention/screening /followup
-prognosis
- recent advances

ortho
-Epidemiology-Age/gender/race/population/Incidence
-anatomy- jt-type;bone; articular
surface;ligament;muscles(stability); relations,blood
supply,nerve supply, movement,axis
-Risk factor/ppt factor/etiology
-mechanism of injury
-associated injury
-diagnosis: symptoms-dips(deformity,pain, swelling,
instability);signs
-classification system
-differentials
-investigation
Fluids- blood;CSF/Organs/micro -serology; urine+stools/
Path-gross path;histopath
/imaging-usg;xray;ct;mri;angio;fitness for procedure
-treatment-stablize/conservative-bedside monitoring/
medical/invasive-surgery/rehab
- prognosis
- complications
- prophylaxis
- recent advances
tumors
-Epidemiology-Age/gender/race/population/Incidence
-anatomy/physiology
-Risk factor/etiology- modifiable/non modifiable
-definition/pathogenesis/route of metastasis
-classification system
diagnosis: symptoms-local/metastatic,signs
-differentials
-investigation(confirm-tissue diagnosis,stage-local/
systemic,plan for surgery)
Fluids- blood;CSF/Organs/micro -serology; urine+stools/
Path-gross path;histopath
/imaging-usg;xray;ct;mri;angio;fitness for procedure
-treatment(local/systemic)-stablize/conservative-bedside
monitoring/medical/invasive-surgery/rehab
- followup
- prognosis
- complications
- prophylaxis
- recent advances
 surgery surgery/
procedures
-Introduction: anatomy/physiology
-Epidemiology-Age/gender/race/population/Incidence
-Risk factor/etiology- modifiable/non modifiable,
etiology- hollow-mech,nonmech/non
hollow,organs-VITAMINS ABCDEK
-definition/pathogenesis-site/mechanism of
insult;injury/peculiar features Indication
-classification system -Contraindication- relative/absolute
diagnosis: symptoms,signs
-Requirements
-differentials
-complications of disease -Anesthesia
-investigation(confirm-tissue diagnosis,stage,plan for -Anatomical sites
surgery) -Procedure steps- position, incision,
Fluids- blood;CSF/Organs/micro -serology;
dissection,target procedure,closure,
urine+stools/Path-gross path;histopath
/imaging-usg;xray;ct;mri;angio;fitness for procedure confirmation of placed device if working)
-treatment(local/systemic)-stablize/ -Complications- pre-op- disease
conservative-bedside monitoring/medical/ exacerbation,chronic disease, anesthesia/
invasive-surgery/rehab
intraop- surgery/postop- early and late(local
- followup
- prognosis and general)
- complications
- prophylaxis
- recent advances

complications obstetrics
Introduction- anat/ physio
Per-operative:
-Epidemiology-Age/gender/race/population/Incidence
-Risk factors+Etiology
Anesthesia related -Definition/pathophysiology
Surgery-related: Anatomical injury (Vessels and Organs) -Diagnosis-clinical features
signs/symptoms
Immediate (<24 hrs):
L o c a l : R e a c t i o n a.r y h e m o r r h a g e
-criteria/classification/score
General: Asphyxia (Airway obstruction with -complications-maternal/fetal
tongue fall or aspiration of vomitus) -differential diagnosis
-Investigation-
Fluids- blood;CSF/Organs/micro -serology;
Local: General:
urine+stools/Path-gross path;histopath
early

Paralytic ileus (abdominal Pulmonary: Collapse,

surgeries)
Infection (wound, peritonitis,
pelvic, subphrenic)
Secondary hemorrhage
Dehiscence (wound, anastomosis)
Obstruction (fibrinous adhesions)
Local:
Obstruction (fibrous
adhesions)
Bronchopneumonia, Emboli
/imaging-usg;xray;ct;mri;angio;fitness for procedure
Urinary: Retention, ATN
DVT -treatment-
Enterocolitis
Bedsores
Prepregnancy
Parotitis Prepartum:1st/2nd/3rd trimester; Criteria for admission;
Timing and mode of delivery-when/mode/if vaginal-
spontaneous or induced/if induced -mech;Intrapartum-
General: After extensive 1/2/3 stage;postpartum- mother and child complications;
resections or gastrectomy contraception
Anemia stablize-when to admit/conservative-bedside monitoring-
late

Vitamin deficiency
Incisional hernia mom and fetus/medical/invasive-surgery
Steatorrhea and/or
Persistent wound sinus diarrhea - prophylaxis
Recurrence of original lesion Dumping syndrome -Risk factors
Scar probles (hypertrophic Osteoporosis
Prevention/screening /followup
scars, keloid)
Relevant recent advances
 tests and investigation
first trimester-booking visit:
blood- Hb, Hematocrit, Blood picture,MCV,
Blood- group and Rh typing,
syphilis,HbsAg,HIV,Rubella,TORCH
screen,Gdm, asymptomatic
bacteriuria,aneuploidy, Thyroid
Imaging- USG-dating scan
2nd trimester- urine routine,down
screen,anomaly scan and other tests not done
at booking, fetal count
3rd trimester
24-28 weeks:: Hb, Hematocrit,Gdm,antibody
for rh
32-36 weeks- usg-fetal growth
fetal presentation
maternal complications
Advice
first trimester
-dietary/nutritional advice-folic
acid,iron,calcium,vit D,Fish oil
-excercise
-immunization
-work
-travel
-intercourse
-smoking/alcohol intake
-common Symptoms- nausea and
vomiting,heart burn,pica,ptyalism,
constipation,hemmorhoids,var
icosities,backache,vaginal
discharge
2nd trimester-antenatal excercise
3rd trimester-fetal movement count
and importance taught,signs of labour,
discussion of induction,breastfeeding and
contraception
fetal complications
Tracts
General history General exam
Demographics General appearance-
presenting complaints consciousness,mental,build,
HOPC- onset,duration , nutrition(head to toe)
progression, Socrates, associated PICCLE
symptoms Vitals
Etiological history, history of Anthropometry
complications,systems review systemic examination
treatment history Other systems review
past history-medical, surgical Summary
occupational history Working diagnosis
marital/menstrual history Investigation
SES explanation to patient
personal history-high risk, smokin, Treatment
alcohol,sleep, bowel, bladder
summary

-monica

Infections- h/o Geriatrics

Occupational exposure
recent travel Symptoms- h/o
Pets/animals/insect bites Atypical/late presentation/comorbidities
Eating out Confusion, depression,dementia,stroke
Sexual/transfusion/abuse usual+hearing impairment,
Similar illness in other family infection, breathlessness,anemia, dizziness,
members
constipation,peptic ulcer,fluid imbalance, painful
Immunization
joints,, incontinence,falls,immobility,pressure,

Infections- o/e
sores

Geriatrics- o/e
Skin lesions- site, distribution,pattern Arcus/venous
of appearance and disappearance, ulcer/edema/leukoplakia
secondary changes
Cvs-heart failure, atherosclerotic
cvs- hemodynamic
heart disease
status,murmur,rub
respi- chest wall, kyphosis,
Respi- distress, ent/urt, lrt-bronchial
sounds,added,decreased sound,
pneumonia
tenderness gi-fecal obs,bph
GI- tenderness,hsm Cns- orientation, behaviour,
GU- discharge, ulcers cognition,
Nervous system- altered speech,memory,vision,hearing,gait
sensorium,nuchal rigidity,focal deficit
skin, soft tissue, skeletal exam
 CVS history CVS exam
Gen app- corneal arcus,xanthelasma,malar flush,skin,
Chest pain- SOCRATES
Skeletal system,dysmorphic features, peripheral signs of
Dyspnea on exertion- NYHA ar and ie
Positional(PND, VITALS
Orthopnea) pulse-rate, rhythm, volume, character,rf delay,
Fatigue peripheral pulse
Palpitation bp- all four limbs, temp-peripheral coldness,jvp
Syncope PICCLE
Cough,Hemoptysis
Urine output Inspection: trachea, precordial bulge, activity, apical
impulse, visible pulsations,dilated veins,scars,sinuses,
H/o- IE,RHD, pressure symptoms
chest wall
Palpation: apex,palpable p2,parasternal heave,thrill,
pulsations
Percussion:heart borders,left 2nd ICS,
Liver dullness,traubes,ascitis
Ascultation: S1/S2/S3,S4, other sounds,
murmurs(SCRIPT),
Systems review: rs-basal crepts, effusion
git- hsm, ascitis
cns- pupil,reflex,fundus, deficit
diagnosis-
Acq/cong valvular heart disease most probably (lesion
name ) in/not in sinus rhythm, NYHA grade, with signs of
failure associated +/- pul htn, with peripheral signs of
ie/ar

Respi history Respi exam

occupational history
Dyspnea-mmrc
cough
hemoptysis
chest pain
Fever
Wheeze
Pressure symptoms-dysphagia,horners,
paraneoplastic symptoms
Past history of tb, aspiration, hiv
Rx h/o- pleural tap,drugs,surgery
Personal- low,loa
F/h- allergies, asthma,tb, cancer
SES- pollution(in/out)
Gen app- build, stigmata of tb, signs of internal
malignancy, paraneoplastic
syndrome,horners,tracheal tug
VITALS
PICCLE
URI- ent, tonsils, mouth,sinus
Inspection: chest wall deformity/trachea/apical
impulse/increased won/breathing type/
Movement/spine/neck veins/ scars and sinuses
Palpation:
warmth/tenderness/trachea/apex/movement-
whole chest,hemithorac/tactile fremitus
Percussion: 9 areas, traubes, liver,tidal percussion,
Shifting dullness
Ascultation: breath sounds,vocal resonance (3),
added sounds, signs of failure,pul htn(corpul)
Others- succession splash,de espine,coin test, post
tussive suction,rales
Diagnosis-
side/pathology/etiology/complications/risk factors
 GI history- liver
Jaundice-urine,stools, pruritis,yellow
eyes
distension
malena/hematemesis/rectal bleed
Altered sensorium
Bleeding
Encephalopathic
changes/neuropsychiatric changes
Weakness, malaise, anorexia
Pmh- similar episodes,blood
transfusion
Personal- drugs, alcohol, sex
Other gi Symptoms- anorexia,
altered taste, dysphagia,heart burn,
vomiting,abdo pain, distension,
weight loss, flatulence,hiccups,
constipation, diarrhoea,stools
color+/- blood, urine color
GI liver exam
BMI
Peripheral signs of cld,chronic alcoholism,
malnutrition, pruritis
head to toe(hair,skin, eyes, breath, hands and nails,
Trunk,others- asterixis, pedal edema, testicular
atrophy, facies
PICCLE
VITALS
Inspection: shape of abdo, distension,
umbilicus,flanks,movt,scars,swelling,dilated
veins(standing exam), hernial orifices, genitalia
Palpation: warmth, tenderness,
guarding/rigidity/rebound/liver,spleen,renal),mass
p/abdo
percussion: liver span,fluid thrill, shifting
dullness,puddle sign(120)
Ascultation- bowel sounds,rubs,venous hum,renal
bruit, pr
liver exam- size,consistency,pulsatility
Spleen palpation-
classical/bimanual/Middleton/dipplings
Spleen percussion- traubes, Nixon's,castelle
Measurement: girth
Encephalopathic changes- asterixis,constructional
apraxia, decor hepaticus, confusionsbp- fever+
distension, hepatorenal- urine output

Nephrology history Nephro exam

Gen app- puffy face, constitutional symptoms,
Pain consiousness,polycythemia, peripheral neuropathy,
hematuria/Oliguria/Anuria/polyuria/nocturia/dysur retinopathy of diabetes, muscle weakness, bony
ia/pneumaturia tenderness
Hesitancy VITALS
precipitancy PICCLE
Urgency Inspection: acidotic breathing, flapping tremor
incontinecr Palpation: warmth/tenderness/renal angle
discharge tenderness
Periorbital puffiness Percussion: liver dullness, tidal percussion,
Breathlessness,pedal edema, ascitis Shifting dullness
Fluid and Electrolyte imbalance Ascultation: breath sounds, added aounds,
pericardial rub
Others-
Diagnosis-side/pathology/etiology/complications/risk
factors
General history General exam
Demographics General appearance-
presenting complaints consciousness,mental,build,
HOPC- onset,duration , nutrition(head to toe)
progression, Socrates, associated PICCLE
symptoms Vitals
Etiological history, history of Anthropometry
complications,systems review systemic examination
treatment history Other systems review
past history-medical, surgical Summary
occupational history Working diagnosis
marital/menstrual history Investigation
SES explanation to patient
personal history-high risk, smokin, Treatment
alcohol,sleep, bowel, bladder
summary

Infections- h/o Geriatrics

Occupational exposure
recent travel Symptoms- h/o
Pets/animals/insect bites Atypical/late presentation/comorbidities
Eating out Confusion, depression,dementia,stroke
Sexual/transfusion/abuse usual+hearing impairment,
Similar illness in other family infection, breathlessness,anemia, dizziness,
members
constipation,peptic ulcer,fluid imbalance, painful
Immunization
joints,, incontinence,falls,immobility,pressure,

Infections- o/e
sores

Geriatrics- o/e
Skin lesions- site, distribution,pattern Arcus/venous
of appearance and disappearance, ulcer/edema/leukoplakia
secondary changes
Cvs-heart failure, atherosclerotic
cvs- hemodynamic
heart disease
status,murmur,rub
respi- chest wall, kyphosis,
Respi- distress, ent/urt, lrt-bronchial
sounds,added,decreased sound,
pneumonia
tenderness gi-fecal obs,bph
GI- tenderness,hsm Cns- orientation, behaviour,
GU- discharge, ulcers cognition,
Nervous system- altered speech,memory,vision,hearing,gait
sensorium,nuchal rigidity,focal deficit
skin, soft tissue, skeletal exam
 medicine
orthopedics

surgery
gyne
 motivation

THE

Study
planner
MONICA JAMES

“Lord, make my way prosperous not that I achieve

high station, but that my life be an exhibit to the
value of knowing God.”― Jim Elliot

Whatever you do, work Notes

at it with all your heart,
as working for the Lord,
not for human masters,
since you know that you
will receive an inheritance
from the Lord as a
reward. It is the Lord
Christ you are serving
col 3:23,24
 Cns history- hemiplegia
Pc: weakness on one side, deviation
of mouth, inability to speak
HOPC: onset(time,ppt factor, patient
action), duration, progression,
associated events(eth,cerebral), rx
Current deficit
Higher fn(hicomes)
motor-
power(u/l,trunk,l,/),tone,cranial
nerves, sensory system, cerebellum,
autonomic
Complication
Past history (rf, etiology*)
family history
personal- include adl
Cns history- paraplegia
Pc: weakness of limbs,sensory loss
in limbs, bowel bladder symptoms,
radicular pain
HOPC: onset,ppt factor, duration,
progression, evolution, severity,rx
Current deficit
Sensory system(root pain,tract
specific, suspended/dissociative
loss), pain over spine
autonomic
Cranial nerve (2,9,10,11,12)
Complication
Past history (rf, etiology*,prior
episodes)
family history
personal- include adl
Cns examination- hemiplegia
General appearance- hyperlipidemia, cardio, neurocut
marker,internal malignancy, tb, complications,
interventions)
vitals+ carotid bruit,jvp
piccle
Hic2omes(dysarthria, apahsia)
frontal release signs, apraxia,cortical signs
cranial nerves(reflex- 5,3,4,6,9,10) 5- jaw jerk
Motor- attitude, fasiculations, tremor, clonus, abnormal
movement, bulk, tone( passive, muscle groups),
power(active,joints)- u/l,trunk,l/l
Sensory- top,joint position, vibration,rhomberg,
reflexes- DTR-superficial
cerebellum,gait
meninges, MSK
Other systems- CVS, ABDO,RESPI
Diagnosis: CVA, side hemiplegia, other deficits, anatomical,
pathological(eth), etiology, risk factor, complication,
functional status, comorbidities
Cns examinatio paraplegia
General appearance- hyperlipidemia, cardio, neurocut
marker,internal malignancy, tb, complications,
interventions)
vitals+ carotid bruit,jvp
Picc'L'e
Hic2omes(dysarthria, apahsia)
cranial nerves(2,9,10,11,12)
Motor- attitude, fasiculations, tremor, clonus, abnormal
movement, bulk, tone( passive, muscle groups),
power(active,joints)- u/l,trunk,l/l
Sensory- top,joint position, vibration,rhomberg,
reflexes- DTR-superficial
cerebellum,gait
meninges, MSK
Other systems- CVS, ABDO,RESPI
Diagnosis: paraplegia, anat level-
vertical(sensory,motor, reflex),
horizontal( extra Dural, intradural extramed, intramed)
pathology,etiology, rf, functional status
 Obs and gyne Surgery
H and N:
Obs Oral Malignacy
Parotid, submandibular swelling
-gdm Thyroglossal cyst
Branchial cyst
-htn General:
-cardiac disease -soft tissue benign: lipoma,dermoid,
-anemia sebaceous cyst, NF
-soft tissue malignant: sarcoma
-rh Gyne
-iugr Ulcer: bcc,scc,mm
-aub
-twins
-fibroid Neck- lymph node, lipoma, cystic hygroma
-Obs instruments -prolapse
-skull, pelvis -endometrial cancer Uro
-drugs, specimens Testicular mass
-gyne drugs and specimens
-cervical cancer
-gyne instruments -molar pregnancy Ca. Penis

-infertility

Surgery Medicine
RS
- consolidation
-pleural effusion
-hernia, hydrocole -fibrocavitory disease
-fibrosis
-abdo mass -bronchiectasis Abdomen
Epigastric mass(goo) -lung abscess -hSM
lumbar,renal mass -hepatomegaly
Rif mass- appendicular, tb, ca., Chrons, UC Cvs -splenomegaly
Retroperitoneal mass- sarcome, ca. -valvular heart disease- as/ar/ms/mr
-liver abscess
-heart failure
Osce -ascites+pedal edema
-infective endocarditis
-hpb -+anemia/jaundice/lymphadenopat
Obstructive jaundice -acute hepatitis
Hsm+anemia -cirrhosis,portal hypertension,
encephalopathy
-vasc -hsm+ascitis
Varicose, paod -cirrhosis+portal htn+ascitis+
Aaa Osce encephalopathy
Carotid body tumor -derm,rheuma
-instruments
Cns
-pathology specimens
Endocrine: - drugs -stroke
ca. Breast, thyroid -paraplegia
-cn palsy

Ca. Penis
 Ortho
Ctev
Supracondylar fx of the humerus
Shoulder dislocation
Non union of femur
Recurrent patellar dislocation
Stiff knee joint
Osteosarcoma
Fixed flexion deformity
Rheumatoid arthritis
chronic osteomyelitis
tb(ankle)
acl tear
Osteoarthritis
Hemophilia-joints
Charcoats
Your paragraph text
swelling - history
demographics
presenting complaint
hopc: swelling itself/ pressure,involvement
of surrounding
cong/ acq- ppt facor/predisposing factor
symptoms prior to swelling,
rx,
complications
MD-PEPSAR mode of
onset,duration,preogression,pain,exact
site,skin, signs of inflammation(5),
secondary changes and associated
features(local,distant), recurrence
past medical/surgical history
family history
personal history
ses
ulcer- history
demographics
presenting complaint:
onset,duratoin,preogression,discharge,asso
ciated feature
etiological- trauma,abcess,arterial,(sir
ct)venous,venous.
(sand=varicose=pain)nervous(+,-,
alcoholism,exposure,,diabetic(polys,infectio
n,wound,neuropathy),, (rapid
increase,low,loa,lymph
nidetb(low,loa,c+h+ert,contact), malignant
secondary changes and associated
features(local,distant), recurrence
past medical/surgical history
family history
personal history
ses
swelling - exam
General apperance-
build,nourishment,nutrition,bmi and peripheral
stigmata of tb, internal malignancy and others
VITALS
PICCLE, ECOG
inspection: 5S MI CENA
site,size,shape,surface,skin
movement, impulse,cough,number,associated
findings-color,margin,pressure effect- nvlm
palpation: 3CT 2FIR
temperature,tender, transilluminancy,confirm
finding, consistency, compressibility
fluctuancy,fixity,
indentation,impulse,reducibility, relation to
others- plane,mobility,margin
percussion
ascultation
measurements
movements
pressure effects- nvlm
ulcer- exam
General apperance-
build,nourishment,nutrition,bmi and
peripheral stigmata of tb, internal
malignancy,peripheral nerves,
skin,nail,hair,trophic changes,jvp
VITALS
PICCLE, ECOG
inspection:site,size,shape,number
ulcer:surrounding area, edge,margin, floor,
discharge,whoe limb
palpation:warmth,tenderness,ulcer:
surrounding skin,margin,edge,floor,base,
DR.B(depth, relation, bleed)
mobility test
LMN VP(lymphnode, movement at
joints,neuro- central and peripheral, varicose,
peripheral puses)
systemic examination(respi,cvs,gi, pr)
diagnosis: sitre,size,number, clinical state,
etiology
sinus,fist- history
demographics
presenting complaint
hopc:
cong/ acq- ppt facor/predisposing factor
symptoms prior to swelling,
rx,
complications
MD-PEPSAR mode of
onset,duration,preogression,pain,exact
site,skin, signs of inflammation(5),
secondary changes and associated
features(local,distant), recurrence
past medical/surgical history
family history
systemic examination(respi,cvs,gi,
personal history
ses
PVD - history
demographics,onset,duration,preogressio
n,pain- boyd, ,exact site,skin, signs of
inflammation(5), secondary changes and
associated features(local,distant),
recurrence
raynaud,rest pain, ulcers. black toes,
(burrr), systemic disese
(hypopigmentation, active jt movt, swelling, attitude of
( bilateral symptoms, upper limb,
systemic signs of artherosclerotic
disease,impotence,paresthesia,superficial
phlebitis)
nerves- shooting pain, positive symptoms
in a specific position,
complications- fever+chills
etiology- diabetes, partial rx,
drug,trauma, syphilis, smoking
past medical/surgical history/family
history
personal history, ses
sinus,fist- exam
General apperance-
build,nourishment,nutrition,bmi
and peripheral stigmata of tb,
internal malignancy,
VITALS
PICCLE
inspection:site,size,shape of
opening,number
discharge, skin around
palpation:warmth, wall,
mobility,lump
lymph node, probe exam
pr)
PVD- Exam
General apperance- build,nourishment,nutrition,bmi
and peripheral stigmata of tb, internal malignancy
,skin, nails , hair,jvp,peripheral pulses
VITALS
PICCLE, ECOG
inspection:color, capillary fillinf, venous refilling, signs
of ischemia(skin, fat,muscle), postural test, gangrene(
extent, color,typr line of demarcation,limb above),
ulcer exam
limb, veins)
palpation: wt, gangrene area(crept), area around
gangrene area,ulcer exam, capillary refilling, venous
filling,ulcer, neuro exam
specific tests( coastoclav compressive manoever,
hyperadd, adsons, elevate arms, branhams, allens,
cold and warm water,crossed leg
nerves: thickened,sesnastion,power of muscles
ascultation
measurements
movements
systemic exam: CVS,RS,ABDO,CNS,PR
Dianosis: proxdistal,etiology,predisposing factor,
complicated/uncomplicated
 varicose- history
demographics,
onset,duration,preogression,pain-
,exact site,skin, signs of
inflammation(5), secondary changes
and associated
features(local,distant), recurrence
etiology: prolonged standing, dvt-
surgery, immobilization, obs history,
other varicosities
complications: edema,hemorrahge,
itching, pigmentation, ulcer
past medical/surgical history/family
history
personal history, ses
thyroid - history
demographics,
onset,duration,preogression,recurre
nce, compressive symptoms+ fb
sensation, pain, function- met,
cns,cvs,gi,gu( thryotox- 1,2, hypo),
low+loa
etiology: radiation, diet
metastatic history
complication: hemmorhage
gen history: milestones in female
life, stressors, goitrogenic drugs,
vegetables, endemicity, tb
past medical/surgical history/family
history
personal history, ses
varicose- exam
General apperance- build,nourishment,nutrition,bmi
and peripheral stigmata of tb, internal malignancy
,skin, nails , hair,jvp,peripheral pulses
VITALS
PICCLE, ECOG
inspection:dilated, elongated, tortuous veins( side,
system, territory) ,swelling, skin(color, texture),cough
impulse, signs of ischemia(skin, fat,muscle), scars,
palpation: warmth, tenderness, palpate along veins:
nodules-thrombotic
specific tests( schwartz test- whole lsv),
(morrisseys,test,brodie-trenlenberg- sf
incompetance), (multiple tourniquets[om], pratts,
fegans- perferotors), (modified perthes, perthes- dvt)
ascultation
measurements
movements, neuro exam, lymphnode
systemic exam: CVS,RS,ABDO,CNS,PR
Dianosis: primary/secondary, side system involving
the lsv/ssvv, complications including perforator
incompetence, etiology, dvt
CEAP classification
thyroid- exam
General apperance-, ECOG
build,nourishment,nutrition,bmi, facies, mental
state,skin,nail,hair,trophic changes,jvp,horners
VITALS
PICCLE
head to toe- hair, eye, palms, tremor, skin,
pretibial myxedema
inspection:site- ant triangle,size,shape,number
movement with deglut, lower border seen,
tracheal position, lateral neck swelling
palpation:warmth,tenderness, trachea, lower
border, consistency(general, local), plane,
mobility, special signs(pembertons, kochers,
berrys sign),
pulasation, thrill
percussion: manubrium sterni
ascultation: bruit
skull,spine,sternum
systemic examination(respi,cvs,gi, pr)
diagnosis: anatomic, path, functional,
 breast- history
demographics,
onset,duration,preogression,rec
urrence, pain- menses, ctn,skin
changes, nipple discharge and
retraction , swelling in axilla,
neck
metastatic history, low+ loa, tb
risk factors: menstrual history,
obs history, diet, trauma, past
abcess, excercise,alcohol
radiation
past medical/surgical
history/family history
personal history, ses
swelling - history
breast- exam
General apperance- build,nourishment,nutrition,bmi,
ECOG
VITALS
PICCLE
inspection(4): swelling exam, site- quadrant, distance
from nac, skin- fullness, inflammation, sinuses,
veins(dimple, satellite nodules, puckering, dimpling,
color, texture, veins, scars,ulcer), nipple(presence,
position, number,size, shape, surface, discharge,
retraction, deviation,excoriation) areola(color, size,
surface, texture), arms, thorax, axilla supraclavicular
fossa
palpation: warmth, tenderness, largest diameter,
mobility, fixity(skin,breast tissue, fascia, muscles,
chestwall), consistency, nipple palpation, ulcer exam
lymph node exam- pectoral, branchial,
subscapular.central, apical(abcsp)
skull,spine,sternum
systemic examination(respi,cvs,gi, pr)
summary: age, mame, pc, duration, significant f/h.
diagnosis- ca l/r breast, tnm stage, clinical stage,
significant f/h
swelling - history
 Review of systems
Constitutional symptoms- weight loss, day sweats,
fatigue/malaise/lethargy, sleeping pattern,
appetite, fever, itch/rash, recent trauma,
lumps/bumps/masses
Eyes- visual changes, headache, eye pain, double
vision, scotomas (blind spots), floaters or "feeling
like a curtain got pulled down" (retinal hemorrhage
vs amaurosis fugax)
Ears, nose, mouth, and throat (ENT)- Runny nose,
frequent nose bleeds (epistaxis), sinus pain, stuffy
ears, ear pain, ringing in ears (tinnitus), gingival
bleeding, toothache, sore throat, pain with
swallowing (odynophagia)
Cardiovascular - chest pain, shortness of breath,
exercise intolerance, PND, orthopnoea, oedema,
palpitations, faintness, loss of consciousness,
claudication
Respiratory- cough, sputum, wheeze,
haemoptysis, shortness of breath, exercise
intolerance
Review of systems
Gastrointestinal- abdominal pain, unintentional
weight loss, difficulty swallowing (solids vs liquids),
indigestion, bloating, cramping, loss of appetite,
food avoidance, nausea/vomiting,
diarrhea/constipation, inability to pass gas
(obstipation), vomiting blood (haematemesis),
bright red blood per rectum (BRBPR,
hematochezia), foul smelling dark black tarry
stools (melaena), dry heaves of the bowels
(tenesmus)
Genitourinary Urinary: Irritative vs Obstructive
symptoms: Micturition – incontinence, dysuria,
haematuria, nocturia, polyuria, hesitancy, terminal
dribbling, decreased force of stream
Genital: Vaginal – discharge, pain, Menses –
frequency, regularity, heavy or light (ask about
excessive use of pads/tampons, staining of
clothes, clots always indicate heavy bleeding),
duration, pain, first day of last menstrual period
(LMP), gravida/para/abortus, menarche,
menopause, contraception (if relevant), date of last
smear test and result

Review of systems Review of systems

Musculoskeletal - pain, misalignment, stiffness
(morning vs day long; improves/worsens with
activity), joint swelling, decreased range of motion,
crepitus, functional deficit, arthritis
Integumentary- Breast pruritus, rashes, stria,
lesions, wounds, incisions, acanthosis nigricans,
nodules, tumors, eczema, excessive dryness and/or
discoloration. Breast pain, soreness, lumps, or
Add a little bit of body text
discharge.
Neurological- Special senses – any changes in sight,
smell, hearing and taste, seizures, faints, fits, funny
turns, headache, pins and needles (paraesthesiae)
or numbness, limb weakness, poor balance, speech
problems, sphincter disturbance, cognitive and
psychiatric symptoms
Psychiatric- depression, sleep patterns, anxiety,
difficulty concentrating, body image, work and
school performance, paranoia, anhedonia, lack of
energy, episodes of mania, episodic change in
personality, expansive personality, sexual or
financial binges
Breast- history Breat- exam
Breast: position, shape size,
puckering/dimpling,ulcer- site,size,shape, surface
skin over the breast: color, texture, engorged veins,
dimple retraction, puckering,peudorgange,
nodules,ulcer/fungation
Nipple-presence, position,number, size, shape,
surface, discharge
areola- color, surface, texture
arm and thorax, axilla and supraclavicular fossa,
hands above- nodules,submammary fold

Palpation: (4q+behind nipple, axillary tail,discharge)

local warmth, tenderness,site,number,size and
shape, surface,margin, fluctuation,
transillumination,fixity to skin,fascia,
muscles,chestwall,nipple,ulcer
Lymph nodes:

swelling - history swelling - history

sinus,fist- history sinus,fist- exam

swelling - history swelling - history

sinus,fist- history sinus,fist- exam

swelling - history swelling - history

sinus,fist- history sinus,fist- exam

swelling - history swelling - history

sinus,fist- history sinus,fist- exam

swelling - history swelling - history

sinus,fist- history sinus,fist- exam

swelling - history swelling - history

sinus,fist- history sinus,fist- exam

swelling - history swelling - history

 Adult EM doses sinus,fist- exam
Adrenaline - 1mg(1:1000)
Amiodarone - 300mg / 150 mg
MgSO4 - TDP 1-2g in 5D over 20m
Atropine 1mg (3max)
Nitroglycerin - 0.4 mg every 5 min (1.2)
htn- 5-100 ug/min IV infusion
GTN infusion- 5 ug/min (SBP<90, map - 70)
Morphine 3-5 mg IV
Aspirin 325 mg; 75 mg
Clopidogrel: 300/150 mg-75 mg
Atorvastatin 80 mg stat/10 hsod
Labetolol- 20 mg iV, 20-80 bolus (300)
Esmolol 250-500 ug/kg 1 min- ld,
md- 25-50 ug/kg/min (300)
Amlo -10 od, Nife R- 20 bd, Meto XL -25 bd, Losart -50 od Hct -25 od
Lasix 40-120
torasemide 20-60 iv
Norad infusion- 0.1-0.5 ug/kg/min
dopamine infusion- 5-20 ug/kg/min
CPAP- Fio2 of 100, PEEP of 5
AMS, HAPE,HACE: Azetazolamide 125-250 mg po bd,dexa 4 stat, 4 q6h,
nifedipine 10 mg q6h

swelling - history swelling - history