Internal Medicine OSCE Mindmaps
بسم اهلل الرمحن الرحيم
Important Notes you shouldn’t 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 MSS Genitalia
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
CNS
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
Endocrine
Heat or cold intolerance, Sweating, Excessive Thirst
HLS
Pallor, General weakness, Recurrent infections, Bleeding tendency, Rash
Psychiatric
Anxiety, Depression, mental illnesses
♀
Past Medical Hx: throughout the mindmaps we only put the points that are most important for each Chief complaint, but we advise you to memorize the full table so you don’t forget any Q
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
Note: = = when the symptom happen When e.g. at rest, while watching TV : Timing = variation of the symptom during the day/night :
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Continous
MI , PE , Dissecting Aneurysm , Pneumonia
Duration of the attack Sudden Gradual
Frequency Angina , Tietze Syndrome, Da Costa syndrome
Intermittent
Progression
When
MI , PE , Pericarditis , Pneumothorax , Rib fracture
Crushing Heaviness
Duration
Burning
Dissecting Aneurysm
Onset
Chronic
Angina , Esophagitis , Hiatus Hernia
Tearing
Character
Acute
MI , PE , Pericarditis , Pneumothorax , Rib fracture
GI
Neck, Jaw, Left Arm
Radiation Central
Site
Analysis
Peripheral
MI
Esophagus Back, Throat Back, Abdomen, Legs
Dissecting Aneurysm
Severity Factors
Better
Antiacids , Nitroglycerin , Rest , inclining Forward
Worse
Breathing , Movement , Effort (& how much) Bending , Straining , Laying down
Chest Pain s
Dyspnea
PE , Pneumonthorax , Pneumonia
PND & Orthopnea RA , SLE
MI , GERD
Esophagitis
Cough
Acid or Bitter Taste in mouth
Reflux Esophagitis
Esophageal Spasm
Arthritis ± Rash
Intermittant constant
Shingles
Rash in the area of pain
Costochondritis , Fractured Rib
Fever & Pus-like Sputum
Nausea & Vomiting
Adenophagia / Dysphagia
Area of tenderness
HF (MI, PE)
Associated Symptoms
Hemoptysis
PE
WaterBrash
GERD
Sypmtoms of Anxiety Nervousness Tremor Palpitations Tachypnea
Pneumonia , Pleuritis
Cardiac causes
Gastrointestinal
Psychosomatic
Pulmonary
Musculoskeletal
Miscellaneous
Ischemic heart disease Acute pericarditis Aortic dissection Aortic stenosis Cocaine-induced
Gastroesophageal reflux disease Esophageal spasm Dysmotility Cholecystitis Peptic ulcer disease Pancreatitis
Panic attack Anxiety Depression
Pulmonary embolus Pneumonia Pneumothorax
Costochondritis Fibromyalgia
Arthritis Herpes zoster
Sudden
ARDS, PE, Pneumothorax, Lung Collapse
Duration of the attack Gradual
Frequency
CHF, Emphysema, Anxiety
Continous Intermittent
When
Progression Duration
Acute
Severity
Onset
Chronic
Analysis
Factors Exercise, lying Flat, Anxiety
- Pink, Frothy Bronchiectasis, Pneumonia
Dyspnia
- Dark, Foul-smelling
Sputum
Abscess
- Pus-like, Large Amt Pulmonary Edema - Bloody
Cough
Wheeze
Asthma, COPD, Foreign Body, Tumor, Pulmonary Edema
Stridor
Obstustion of the Large Airway
Associated Symptoms
Rash Joint Pain
Fever
Pneumonea of mesothelioma
+ Pus-like Sputum Especially at Night
Fatigue
Sarcoidosis HF
Sweating
Ankle Swelling
Arrythmias
Palpitations HF
Orthopnea & PND
TB
Chest Pain + Bloody Sputum
PE
PE
Foriegn Body, Tumor, Infection
Pulmonary causes
Cardiac causes
Other causes
Asthma
Coronary syndromes
Respiratory muscle weakness
Chronic obstructive pulmonary disease
Valvular disorders
Myasthenia gravis
Tracheal obstruction
Cardiomyopathy
Guillain-Barr ©أsyndrome
Emphysema
Pericardial disorders
Anemia
Interstitial lung disease
Metabolic acidosis
Pulmonary hypertension
Arrhythmias
Diabetic ketoacidosis
Pulmonary embolism
Congestive heart failure
Salicylates
Pneumonia
Pregnancy
Pleural effusion
Psychiatric disorders
Pneumothorax
Anxiety Panic disorder Musculoskeletal Kyphoscoliosis
UnitlateralBilateral Sudden Gradual
Extent Ankle, Calf, Thigh
Site
When
Progression
Other Sites of Swelling
Duration Analysis
Periorbital, Testicular, Ascites
Temperture
Acute Chronic
Trauma, Activity, Spontanous
Onset Stiff Muscles Rapid Progression
Painful
Fever
Browny-Reddish Areas
Varicose Veins Wt Loss Fever Night Sweats
Cellulitis
Leg Swelling
Diffuse
Pitting Edema
Tumor compressing on a Vein
DVT Stiff Muscles
Urine Output Urine Color Bloody Urine
Sharply Defined Edge
hot Parasthesia/Numbness
Associated Symptoms
Renal Failure
Acute Compartment Syndrome
Weight Gain
Sudden Sever Calf Pain
Cold Intolerance Pallor
Constipation Skin Nodules
Deformities
Myxedema (non pitting Edema)
Morning Stiffness
Rheumatoid Arthritis
Proximal Joint pain
Spider Navi
Fatigue
Jaundice
Bilateral
Hypothyroidism
Hoarseness of Voice
Varices
Testicular Atrophy Hemoptysis Acute Chest Pain
PE
SOB (worse on Evening)
Palmar erythema Clubbing
Bilateral
Liver Failure
Gynecomastia
Hepatic Encephalopath Acute Chest Pain Tachycardia Cold Sweating
MI
Heart Failure
Bleeding tendency PND
Bilateral Ascities
exertion Induced Orthopnia
Poor Memory & concentration
Course Dry Skin
Local Acute causes
Chronic causes
DVT Cellulitis Allergy Ruptured Backer Cyst Trauma RA
Pregnancy Lymphedema (not pitting) Varicose Veins
General Heart Failure Hypoproteinemia (Liver or Kidney Failure) Hypothyroidism
s
Sudden high Volume Low volume Transiet
Gradual
Amount of urine
Progression
Frequency
V.intense Exersice
Red
Color
Urobilinogen
Dark-Brown
Analysis Acute
Hb, Blood
Dark
Onset
Extravascular hemolysis
Bilirubin Inravascular hemolysis
Which part of Sream
Chronic
All Partial
Early Urethral, Prostatic
Late Bladder
Clots
Butterfly Rash Maliase Fever Raynaud's Discoid rash
Anemia Symptoms Malaise ↑infection ↑Bruising Gum enlargement
SLE
Red-Dark Urine
Leukemia
Odor
Abdominal Pain + Jaundice
Abdominal Pain Jaundice
Intense Pain Loin Radiating to the groin
Cloudy-Dark Urine
Associated Symptoms
Poor Stream
SOB
Pale Stool Loin Pain Nausea & Vomiting Fever Chills
Pyelonephritis
Bad Odor Burning Micturition Frequency Urgency Fever (if Upper)
UTI
Pyelonephritis, Lupus Erythmatosis, LE + Kidney Emboli
Palpitations
Prostatic Disease
Drippling Hematuria when Enlarged Vein Ruptures
Renal Stones, Renal Embolism, Renal CA Kidney Contusion, GN, Polycystic Kidney
IntraVascular Hemolysis
Fever
Urinary Stones
Biliary Obstruction
Fatigue
Urgency Burning Micturition Discharge
Urethritis
Bleeding Disorders
Common Bile Duct Stone, Pancreatitis, Sclerosing Colingitis, Pancreatic CA, Bile Duct CA, Viral or Alcoholic Hepatitis,
Easy Bruising Bleeding Gum Epistaxis Menorrhagia Rectal Bleeding Swollen Painful Joints
1. introduce yourself 2. permission 3. analysis 4. system involved 5. associated 6. past 7. family 8. drugs 9. social 10. DDx
V. Severe
e.g. Lead to Syncope
Normal Weak "Feeble"
Dry
Productive
Lung CA with involvement of the Left Laryngeal Nerve, Respiratory Muscle Weakness
Severity Wheezing Whooping
Character
Type
Obstructive Lung Disease (COPD, Asthma) , HF
Barking
Sudden
Epiglottitis
Gradual
Progression Acute
Nocturnal
Timing
Onset
Chronic
Asthma . HF
Early Morning + Sputum Daytime
Chr. Bronchitis
Postnasal Drip , GERD , Bronchiectasis
Analysis Painful Factors
Relieving Worsening
Wheeze
Associated Symptoms
Color Clear (mucoid) COPD Green COPD with infection , Bronchiectasis Acute Respiratory tract infection , Asthma Yellow Rusty Red Pneumococcal (in Hepatization phase)
Smell Foul Smell
CA
TB
Sweating Chest Pain
e.g. Eczema
Rash
Anaerobic Bacteria
e.g. Foreign Body, Food, Teeth, Mucous Plug
Infection , Bronchoiectasis
Bloody
Sputum
Color
SOB
Asthma , COPD , Lung Fibrosis, Lung CA , CHF , PE
Orthopnea + PND Wt Loss
CA
Burning Sensation HF
Swelling of the Legs
Chr. Bronchitis , TB , Bronchiectasis , CA , Foriegn Body m HF , Abscess , PE
Amount Odor
at Night
Asthma
Solid Meterial
Foriegn Body , Whooping , Larynx CA , Tracheal CA
Fever
sputum analysis
Esophageal Diverticulum , Fistula
Foriegn Body , CA , CHF , Asthma , COPD
Stridor
large Purulent affected by Posture Bronchiectasis Sudden Large Purulent Ruptured Abcsess Larger watery Pinkish (+ SOB) PE Large Watery for long duration Alveolar cell cancer
Drugs , Dust , Fumes , Smoke Meals
Cough
Amount
Drugs, Tea , Herbs
GERD
HF
Acute Cough
Chronic Cough
Acute bronchitis
Most common
Acute sinusitis
Postnasal drip
Chronic obstructive pulmonary disease
Gastroesophageal reflux disease
Asthma exacerbation Allergic rhinitis
Less common
Whooping cough (Pertussis)
Medications (ACE inhibitor) Lung cancer Bronchiectasis Interstitial lung disease Congestive heart failure Chronic obstructive pulmonary disease
Fully Mixed with blood Lines of Blood
Gradual
Sudden
+ Mucus
Progression
Consistancy Dark
Color
Amount
Analysis
Bloody
Odor
Frequency
Streaks Dark
Which part of motion
Specific time during month rectal Endometriosis Infection
Bright (Hematochezia)
Acute
Painful
All
Partial
Anal Fissure, Thrombosed Hemorroids
Onset
Early Late
Chronic
Bloody-Dark Stool
Fatigue Palpitation Dizziness Angina
Symptoms of hypovolemia
Sweating
Fever Abdominal pain Tenismus Dysphagia
SOB
Anal itch
Depression
Hemorroids, anal fissure, Diarrhea
Change in bowel habit
Constipation
Associated Sypmtoms
Abdominal Pain
Abdominal Distension
Intestinal Obstruction, intussusception, Mesentric Thrombosis or embolism
Hematemesis/ Coffee-ground Vomiting
Constipation
Vomiting
HeartBurn Wt loss ↓ Appetite Early Satiety
UPPER GI BLEEDING: Esophageal Varices, PUD, Gastritis
Cancer
Other Bleeding Sites
Diverticulitis, Rectal CA, Hemorroids, Anal Fissure
Gastritis, esophagitis, GERD, PUD, Stomach CA, Mesentric embolism or thrombosis, meckles diverticulum
Easy Bruising Bleeding Gum Epistaxis Hematuria Swollen Painful Joints
Bleeding duodenal ulcer Gastric ulcer Gastric carcinoma INFECTION:
Acute bloody diarrhea ± mucus
-
Shigella (bacillary) dysentery Campylobacter enteritis Enteroinvasive Escherichia coli Enterohaemorrhagic type 0157 E. coli Entamoeba histolytica (amoebic) dysentery
Esophageal carcinoma Esophageal varices
Melena
Meckel's diverticulum Other causes: angiodysplasia, bleeding disorders False Melena:
First episode of cause of recurrent bloody Diarrhea
-
Black licorice Blueberries, Iron supplements Lead Bismuth (Pepto-bismol)
Bleeding haemorrhoids Anal fissure Diverticulitis Crohn's disease
Recurrent diarrhea with blood ± mucus
Ulcerative colitis Colonic carcinoma Colorectal carcinoma Diverticular disease/ diverticulitis
Rectal Carcinoma
Red Bloody Stool
Colonic carcinoma Ulcerative colitis Meckel's diverticulum Crohn's disease Massive upper GI bleed Trauma Intussusception
Sudden
Gradual
Amount Frequency
Progression Color
Acute
Onset
Chronic
Make Sure it is not something Else Hematamesis, epistaxis, Bleeding Gums
Character - Mixed - Steaked - Clots
Analysis
Painful Cough Analysis
Hemoptysis Pneumoni, Abscess, Bronchiectasis
Fever Confusion
Foreign Body CA, CHF
Abnormal Breathing Sounds
PE, MI
TB ,CA ,Cystic Fibrosis
DVT, HF
General Weakness/Fatigue Palpitations
Chest Pain Wt Loss Leg Swelling
Other Sites of Bleeding Easy Bruising, Rectal Bleeding, Menorrhagia, Epistaxis
Associated Symptoms
Sweating
TB
SOB Sputum / Change in amt
Airways
Lung parenchyma
Cardiovascular
Miscellaneous
Bronchitis
Pneumonia
Pulmonary embolus/infarction
Anticoagulant therapy
Bronchiectasis
Lung abscess
Congestive heart failure
Thrombocytopenia
Cystic fibrosis
Mycetoma (fungus ball)
Mitral stenosis
Pulmonary endometriosis
Bronchogenic carcinoma
Tuberculosis
Aortic aneurysm
Endobronchial metastases
Lung contusion
Pulmonary arteriovenous malformation
Foreign body aspiration
Lupus pneumonitis Goodpasture's syndrome Wegener's granulomatosis
Migrane , Asthma , Drugs
Transient
Gradual Sudden
V.High
Progression
DI
Amount
Frequency At Day & Night
Acute
Color
Analysis
Onset
Thirst & Drinking Amt
Chronic
Polyuria
Chills (if upper)
Fever (if upper)
Fatigue
Bad Odor Palpitations
menstrual disorders
Abnormal Color
Groin/Flank Pain
UTI
Tremor
Thirst
↓appetitie
Irritability
Associated Symptoms
Diarrhea
Hyperthyroidism
↑Appetite
Sweating
Urgency
Burning Micturation
Polydepsia
Heat Intolerance
Wt loss Wt loss
Fatigue PVC
DM
↑infections
Numbness
Bone Pain
Blindness
Blurring Vision
Constipation
Depression
Polyphagia
Loin Pain Stones
Hematuria
Hyperparathyroidism Frothy urine
Abdominal pain
Nocturia
usually Severe Polyuria
Chronic Nephritis
Hematuria
DI
↑Nocturia
Dehydration ↑↑Thirst
Impotence Late
Edema (if severe due to hypoproteinemia)
GN
MI
Fatty, Pale, Floating, difficult to flush Watery
CA , Diverticulitis
Mucus If Chronic Case
Pale
high Volume
Bloody
Color
Amount
Low volume
IBD, CA
IBD, irritable bowel syndrome, Infection
Consistancy
Progression
Infection , lactase intolerance Z-E syndrome, Carcinoid syndrome mg antiacids, bowel polyps
Celiac disease, chronic panceatitis Gastrectomy, Cystic fibrosis
Hemorrhoids
Bright Streaks Occult
Ask about his normal Bowel Habit Infection
Frequency
Acute
IBD, Infection, CA Diverticulitis, Z-E syndrome
Odor Which part of motion
Analysis
Onset
Difficulty to flush (steatorrhoea) Persistance upon fasting Painful
Diarrhea Acute
Steatorrhea Wt loss Fatigue Abdominal Pain & distension Bone fragility Skin Rash
Neurological Symptoms Clostridium Botulinum Toxin
Early
Fever
Late
Infection , UC , Severe amoebic Dysentry , Pseudomembranous Colitis Traveler's Diarrhea , Viral Gastroenteritis
Burning
Associated Symptoms
Abdominal Pain
Celiac Disease
Cramping Colicky
Z-E syndrome Cholera Infection , IBD , IBS , CA
Abdominal Distension Constipation (Alternating)
CA, Irritable bowel syndrome
Heat intolerance Wt loss Irritability Tremor Increased Appetite Goiter
Anal Itch HyperThyroidism
Tinismus Skin Rash
Polyuria Polydepsia Blurred Vision (Retinopathy)
DM Complication Neuropathy
Joint Pain Back Pain Mouth Ulcers Skin Rash Eye Redness
IBD
Wt loss Vomiting
Partial
Early Late
Chronic
Double vision Blurred Vision Photophobia poor coordination speech difficulty
All
IBD , Celiac
CA
Toxic staphylacoccal gastroenteritis (2-4 after toxic ingestion) Travelers Diarrhea , Viral Gastroenteritis
If Chronic Case
Progression
Consistancy Bloody (+ Painful)
Color
Amount Ask about his normal Bowel Habit Acute
Obstruction
Odor
Onset
Painful
Diet , Emotional , Hirschsprung's disease
CA , Diverticulitis
Bloody & Mucus
Frequency
Chronic
Hemorrhoids
Bloody (+ Painless) IBD
Analysis
Constipation Neurological
Fecal incontinance
Urinary Retention
Abdominal Pain Analyze
Palpitation
Obstruction
Vomiting Fever Abdominal Distension Sweating Hair loss
Associated Symptoms
Diarrhea (Alternating) Wt loss
Polyuria Polydepsia Blurred Vision (Retinopathy)
CA, Irritable bowel syndrome
CA
Tremor
DM Complication Neuropathy
Slow Speech
Hypothyroidism
Cold intolerance Wt gain Dry Skin
s
Sudden
Hyperthyroidism , Fever Caffiene , Drug overdose
Duration of the attack
Continous
Gradual
Frequency
When Intermittent
Amount
Arrhythmias
Acute
Progression
Onset
Analysis
Chronic
Ask the ptn to tap it
Rhythm
Factors Excercise , emotion , large meal , Anxiety Stress , Breath holding (Valsalva Maneuver) Alcohol , Coffee , Drugs , Anger , Position
Irritability Tremor inosomia dizziness poor coordination ↑HR Diarrhea Throat lump Urinary Frequency Hot Flushes Headache Dry vagina Dry skin Diffuse hair loss Night sweats Pallor Chest tightness
Palpitation
s
Anxiety
Appropriate Age
Associated Symptoms
Menopause
Chest Pain Angina , MI , Aortic Stenosis
Syncope Dizziness & Fainting Severity of the Arrhythmia
Heat intolerance Wt loss Irritability Tremor Increased Appetite Goiter Sweating Menstrual Disorders Diarrhea
SOB Anxiety , Mitral Stenosis , Asthma , Anemia
Fever
HyperThyroidism
Bacterial Endocarditis , Rheumatic Fever A CAUSE OF PALPITATION
Joint Pain
Intermittent Headache Pallor chest tightness Tremor Sweating
Pheochromocytoma
SOB Leg Swelling ↑HR
CHF
Polyuria after the attack
Rheumatic Fever
Paroxymal SVT
