5 a's of schizophreniaapathy, alogia, attention, anhedonia, affect MENTAL STATUS EXAMINATION A – Appearance and behavior S- Speech E- Emotion ( Mood and affect ) P- perception ( any Hallucination ) T- Though form and content I-Insight C-cognitive function S- Suicidal ideation THE 6-2 RULE for paediatric inguinal hernia: Birth to 6 weeks ( surgery within 2 days) 6 weeks to 6 months ( surgery with in 2 weeks) Over 6 months (surgery with in 2 months) Remember the “Bs” (problems for young doctors!) Blues Booze Birds/Blokes Banks Bilingual Babies Bonkers AMPLE (Allergy, Medications, Past medical history, Last meal and events cardiac risk factors – ABCDEFS A – Age (given in stem) B – BP. Do you have high blood pressure? No C – Cholesterol problem? No D- D.M. (you or family history)? No Drugs and alcohol? No Diet? He had bad eating habits, junk food and take aways. E- Exercise- how often do you exercise? He send he doesn’t do any. I also asked about his occupation- he had sedentary lifestyle, he was a clerk and sat most of the time. F- Family history of CVS, D.M, B.P? Mother had some heart disease. S- Smoking and stress? No Cardiac murmurs: SQIRT: S ite Q uality I ntensity R aditation T iming S everity no . opioids . nutrition . (2) felt annoyed by criticism of your drinking.AVPU: BAR: Benefit of treatment Adverse effects Risks BINDARS: birth history.no Family h/o-no DELIRIUM: D: drugs E: Emotional means Depression. trauma. allergies. Hypoxia E: environmental means social reasons R: Renal problem or respiratory I: Trauma especially head injury U: Uremia M:Metabolic. stroke. obesity. “HIDEMAP”: I – infection (UTI. and (4) taken a morning eye opener? COST VMPF.no.(PE /DVT) coagulation problmes/family h/o -no. central nervous system: trauma. (excema). L: Lung.no Malignancy-no Pregnancy /pills. benzodiazepines.Leg pain-nad smoking/surgery. pneumonia) D – drugs (especially anticholinergics. development. rashes and siblings CAGE questions: “Have you ever: (1) felt the need to cut down your drinking. travel as above mentioned Varicose veins. immunizations. (3) had guilty feelings about drinking.no. diabetes or thyroid. False impressions of pseudopregnancy FLK: funny looking kid Avoid “HARM” in soft tissue or orthopaedic injuries!! Heat (increase blood supple and swelling) Alcohol Run/dance/ Massage HEADSSS assessment (Psychosocial Screening): Taking a psychosocial history is an important part of the health interview of young people as physical. teeth problems T: trauma. Faeces 4.g. Iron. hyponatraemia. diabetes M . diabetes. hypothyroidism E: emotional problems (e. tumour I: infections A: arteriovascular disease.psychosis DEMENTIA: D: depression. . Flatus 3. loneliness) N: nutrition: diet.TIA. folate.endocrine. Fluid 2. e.stroke. Fetus 6. e.g.E . drugs and alcohol E: ears /eyes M: metabolic. CVA. D-distractability I-impulsive.sleep(insomnia) T-thoughts (racing).idea of persecution G-grandiosity F-flight of ideas A-activity(hyperactivity) S-sexual promiscuity.g. hyper/hypocalcaemia A . emotional and social well being are closely interlinked.excessive talking The “F’s” of the acute abdomen: 1.alcohol P . Focal mass 7. These questions will also allow exploration of the developmental stage of the young person.metabolic. Fat 5.g. e.AF etc. vit B12. sex and depressed mood and that you are asking because these behaviours may affect a person's health. Self-harmthoughts and actions.Parents. For high risk youths ask about carrying or use of weapons and other criminal behaviours/ incarceration of youth or family/ friends. "How do you feel in yourself at the moment on a scale of 1 to 10?" Actions when down. family and the patient. violence. risk of pregnancy and previous pregnancies (relevant to males as well as females). number of partners (total and in the last 3 months). clubs. . year. Suicide. Depression & Self-harm: Presence and frequency feeling down or sad as well as current feelings eg. TV/ computer use Drugs and Alcohol: Depression including cigarettes. Preface the discussion by saying that you are about to ask lots of personal questions that include drugs. Safety from injury &Violence: including serious injuries. supports. exercise and menstrual history. sexual experiences. and work details Eating: including weight (heaviest. gender of sexual partners (don't assume sexual preferences). recent moves. do people smoke/drink/use illicit drugs? What about your friends? And you?" Home: including who. Sexuality: Stress: Self-esteem including close relationships.thoughts. parties. organized groups. supports. disciplinary actions. Education & Employment: including where. alcohol and illicit drug use by friends. relationships. plans. uncomfortable situations/ sexual abuse. Also ask about how use is financed and about negative consequences. bullying. including sport. such as "Some young people experiment with cigarettes and alcohol. recent changes). use of safety gear for sports and seatbelts for cars. Suicide risk. riding with an intoxicated driver and exposure to violence at school and in neighbourhood. performance. It can be useful to make a general statement instead of personalising questions. where. recent moves. condoms and STIs. dieting. attendance. Activities Affect Ambition Anxieties outside of school. means and hopes for future. attempts. In your year at school. relationships. family members or other involved adults should not be present during the psychosocial assessment. Enquire into patterns & frequency of use & about any regrets from using these substances. lightest. future plans. contraception. Rheumatoid / Polymyalgia / Chronic fatigue syndrome / Fibromyalgia E.Infection (endocarditis.With HEADSSS. physical appearance is used to draw attention to self Exaggerated emotions. DM. DM. withdrawal) O. Viral) R.Myocardial (IHD/CCF) T. Anaemia/ Atypical Pneumonia D . abuse.OSA / Chronic Pain A mnemonic that can be used to remember the characteristics of histrionic personality disorder is "PRAISE ME": ▪ ▪ ▪ ▪ ▪ ▪ ▪ Provocative (or seductive) behavior Relationships are considered more intimate than they actually are Attention-seeking Influenced easily Speech (style) wants to impress. TB. / I understand you are here today for your HIV test results”.Thyroid (hypo/hyper) I.Drugs (Med.Iron (anemia. Hypercal. Hypokal. Hyperthyroidism. TB. theatrical KNOWS Why (a useful mnemonic for BREAKING BAD NEWS): “Mr/Ms …. CRF. lacks detail Emotional lability. hemochromatosis) A.Chronic Fatigue Syndrome A – Anxiety.Anxiety / Depression / Somatisation / Bereavement M. shallowness Make-up. Cushing’s Syndrome) M .Endocrine (Addison. sometimes there is an “R” for ‘relationships’ added: HEARDSSS HEMIFAD (mnemonic for TIREDNESS) H – Haemochromatosis E – Endocrine Disorders (Hypothyroidism.Drugs/ Depression TIREDNESS: (NEW) (By Shahab Khan) I AM TIREDO I . Liver. Instead of “what brings you here today?” . Hypomag) D. Malaria) F .Malignancy I – Infection (Infective Endocarditis. Knowledge: “What do you know about HIV? Or What is your understanding about HIV?” Need: “What would you like to know about HIV?.other associated factors Lump examination: The Ss.Size.severity R. Surroundings.intensity 0.. Cs. irregular). Cough impulse Tenderness. Fs and Ps: “She Cuts The Fish PERfectly”: Site. hard) . Percussion . What triggered this issue? Why did you want to be tested?”.. Compressibility.location O. Fixity (mobile against underlying structures or against the skin). Temperature. Transillumination Fluctuation (fluid filled cyst). irregular).aggrevating factors D.time S. What questions did you hope to get answered today?”….radiation & relieving factors A. Colour. regular. “I assume.duration I. ” Observed: “Have you had any experience with HIV in the past?” Worry: “Is there something you’re worried about concerning the HIV?” Searched: “Have you talked to someone about HIV or read some information or searched the net?” Why: “Why now?. Single (or multiple) Contour (well defined. Consistency (soft. firm. Fields (draining lymphglands for this area) Pulsation. Surface. Lifestyle modification: ABCDEF A Alcohol free B BMI C Cigarette free D Diet control E Exercise F Free from stress LLS : looks like a syndrome LOL NAD: “Little Old Lady in No Apparent Distress”. LOTSRADIO L. Shape (round.onset & offset T. Ts. you want to know…. Q. severity. and timing) of pain . and T (pain. S.sleep(insomnia) T-thoughts (racing).Expansile (Is it an aneurysm?) Reducible (is it a hernia?) MANIA: D-distractability I-impulsive. oxygen. aspirin in AMI!!! Ottawa Ankle rules: 44-55-66-PM 4: Unable to make 4 steps immediately 4: Unable to make 4 steps in the emergency department 5: Pain at that base of the 5th metatarsal 5: Pain at the 5caphoid (the 5 is supposed to look like an “S.excessive talking causes of carpal tunnel syndrome (MEDIAN TRAPS) M=median artey persistence E= edema of pregnancy D= diabetus I = idiopathic A= acromegaly N= neoplasm -. radiation.idea of persecution G-grandiosity F-flight of ideas A-activity(hyperactivity) S-sexual promiscuity. nitroglycerin.gangllioneuroma T = thyroid--myxdema R= Rhamtoid arthitis A= amyloid P = pneumatic drill usuage S= SLE MONA: Morpoine. quality.” and scaphoid is another word for navicular) 6: Tenderness along the posterior 6 cm of the lateral malleolus 6: Tenderness along the posterior 6 cm of the medial malleolus PM: Refers to the posterior malleolus Ottawa Knee rules: 44-55-90-FP 4: Unable to make 4 steps immediately 4: Unable to make 4 steps in the emergency department 55: Age 55 years or older 90: Inability to flex the knee to 90° F: Tenderness at the head of the fibula P: Isolated tenderness of the patella P. R. social problems etc. the 7th P) “Personal circumstances” (depression.. R-Rx.O+G P’s: Periods Pills Pregnancy Partner(s) Pap smear Pain(the 6th P) Pelvic infections (STD’s.treatment—Explain treatment options. including non pharmacological options . the 8th P) Pee for urinary symptoms (9thP) PV bleeding (10thP) Procedures (11th P) Blood GrouP (the dyslexic P) Oesophageal cancer risk factors (PC BASTARDS) Plummer-Vinson syndrome Coeliac disease Barrett's Alcohol Smoking Tylosis Achalasia Russia (geographical distribution) Diet Stricture Post-operative complications-immediate (Post-op PROBS) Pain Primary haemorrhage Reactionary haemorrhage Oliguria Basal atelectasis Shock/ Sepsis RICEARS: R est I ce Compression E levation A nalgesics R eview S trapping These include 5 R’s = 2 S. R-Review.e. allergies. no community back-up.Follow up in a fixed time. alcohol. severe depression Seperated: loss of spouse or other single Organised plan.sleep. often the next day or may be few weeks or days R-Referral-Refer to a specialist if needed but explain what to expect R-Red flags-Explain red flags I. dangerous things e. Hypoglycemia & Hyperglycemia in Diabetes & what to do R-reading material-Handover reading material so that patient can remember what you said to him S – support group S – social issues SADAM (smoking . psychosis.mood.interest.g. generally isolated Sickness: chronic illness / stated future intent simple score: modified scale: 1 1 1 1 1 2 1 1 1 1 1 2 1 1 1 2 1 1 1 2 A score of more than 7 equals a high suicide risk!!! 0–4 Low 5–6 Medium High 7–10 The modified scale risk assessment ranges from: 0–5: May be safe to discharge (depending upon circumstances) 6-8: Probably requires psychiatric consultation >8: Probably requires hospital admission SAW EMAILS. appetide.suicide A mnemonic is helpful in remembering the criteria for major depression: . medical problems and medications) or SADMA SAD PERSON INDEX for suicide risk assessment: Sex: males more at risk than females Age: <20 years of > 45 years Depression: major / hopelessness Psychiatric history or previous attempts Excessive drug use like alcohol or other drugs Rationality loss.energy. weight.anhedronia.libido. determined suicide plan No support. drugs. CMV) Neoplasia (eg CML.Endocrine ( DM. and was it sudden or gradual? Include also Progress whether if it is progressive or regressive Character .Does anything change the pain? Severity .Where is the pain? Or the maximal side of the pain. other myeloproliferative) Autoimmune TIREDNESS: HEMIFAD H. Hypothyroid ) M.Hemochromatosis E.Seeing that Lack of ENERGY is common to most episodes. the mnemonic relates to “treating “ this symptom by ”prescribing energy capsules” as SIG: E(nergy) CAPS: S: sleep changes I: interest (decreased / anhedonia) G: guilt (excessive) E: energy (decreased) C: concentration (decreased) A: appetite changes P: psychomotor agitation or retardation S: suicidal ideation SOCRATES: Site .Chronic Fatigue syndrome .Does the pain follow any pattern? Exacerbating/Relieving factors .How bad is the pain? Splenomegaly-causes (CHINA) Congestion/ Cellular infiltration Haematological (eg haemolytic anaemia.When did the pain start. Onset . GF.Does the pain radiate anywhere? (See also Radiation. what makes it worse? Time course . Cushing’s.What is the pain like? An ache? Stabbing? Radiation . lymphoma.) Associations / Alleviating factors .Any other signs or symptoms associated with the pain? What makes it better. Sickle cell) Infection/ Infarction (eg malaria. Addison.Malignancy I – Infection ( Infective endocarditis ) F. A-Anaemia . Fever and Sweats (WASTE FN) 6-Post Operative Fever Wind (Pulmonary) Water (Urine-UTI) Wound Walk (DVT/PE) Wonder Drugs (Drug Fever) Weins (Thrombophlebitis) Mnemonic for Day of appearance of rash in a febrile patient is : Very Sick Person Must Take Double Tablets Very – Varicella (day 1) Sick – Scarlet fever (day 2) Person – Pox – small pox (day 3) . Thirst.0.v Glucose 50 ml 50 % Weight. E ndocrine D rug.4 mg i.2 . Sleep.0. Energy. atypical pneumonia D-drugs . Appetite. depression TIRED T umor I nfection I Ron overload R enal failure E ndocarditis. D epression TONG: coma cocktail Thiamine 100 mg Oxygen Naloxone 0.1 . Must – Measles (day 4) Take – Typhus (day 5) Double – Dengue (day 6) Tablets – Typhoid (day 7) .