by Junaid Nasir, MD, MBBS

Read carefully and cram it in all the pain related cases the history includes

L  location

I  intensity
Q quality
O onset, duration, progression
R radiation
A aggreviating factor
A alleviating factor
A associated factors
 

AND FOR CASES OTHER THAN PAIN, THE FOLLOWING QUESTIONS WILL DO FINE
 
--WHEN DID THE SYMPTOMS START?
--HOW WAS THE ONSET ? ALL OF A SUDDEN OR GRADUAL?
--ARE THE SYMPTOMS CONSTANT OR DO THEY COME AND GO?
--IF THEY COME AND GO THEN ASK ABOUT THE FREQUENCY OF EPISODES ,
SITUATION DURING THE EPISODES AND IN BETWEEN THE EPISODES, WHAT CAUSES
THE EPISODES?
--DO YOU THINK THAT THE SYPTOMS ARE PROGRESSING??
--ANY THING THAT WORSENS IT?
--ANY THING THAT IMPROVES IT?
--ASSOCIATED FACTORS?
 
now the associated factors FOR BOTH THE ABOVE SITUATIONS (pain and the
rest of the cases) should be  divided  into  A1 A2 A3
 
A1: associated consititutional symptoms like FSC NVD HF   fever,shortnes
of breath,cough , nausea vomiting diarrhea, headache, fatigue
A2: associated particular system questions..
like for cases of  
RESPIRATION: chest pain, s.o.b
, cough , sputum, wheezing , runny nose, post nasal drip, contact to ill person,
night sweats.and questions for pulmonary embolism (leg pain, long travel, surgery and ocp use for
females)
CVS: chest pain, orthopnea, PND, palpitaion, tachycardia. 
GIT : pain in belly, stool. bowel movements,vomiting, jaundice,blood in
stools. diet, contact to ill person, travel
NEUROLOGY : first
of all HEADACHE
                   HIGHER MENTAL FUNCTION:orientation, memory,
consciousness 
                   MOTOR: shaking of limbs, weakness in limbs
                   SENSORY: tingling sensation
                   CEREBELLUM: gait, balance
                   CRANIAL NERVES: speech, swallowing, vision, hearing
 
 
DEPRESSION: first of all ask about mood for the most part of the day
then ask FACE SLIPS
F feeling of guilt or worthlessness
A appetite
C concentration level
E  energy level
 
S  sleep 
L libido
I  interests 
P leasure in life activities
S suicidal intentions
 then ask about whether there are weapons in the home
then ask whether he is willing to get the treatment for his condition.
 
 
UROLOGY:
BPH IS CONTINIOUS FUN
B burning
P pus
H hematuria H
hesitation
I incontinence I incomplete emptying of bladder
S stream  S straining
CONTINIOUS or intermittent stream
F frequency
U urgency
N nocturia
 
A3: d/d related questions, one or two questions specific to the d/d
 
 
then give a transition sentence and go on to the 
P past medical history, (any similar episodes or symptoms before)
A any allergies
M medications
 
H hospitalization (medical, surgery , trauma)
U urinary problem??
I  illnesses chronic like DM, HTN, asthma, stroke etc
G git (bowel movements)
S sexual
 
F family history (parents alive and healthy?? , any condition that runs
in the family, or any one else with the similar complaints in the
family)
O obs/ gyne
S sleep
S social (what do u do for ur living, smoking , ETOH , recreational
drugs??) 
 
then ask 
IS THERE ANY THING ELSE THAT YOU WANT TO SHARE????
 
THEN GO FOR THE EXAMINATION
 
 
i did not spend much time on regular cs prep.. just 10 days.. but i
concentrated on the history format and the encounter protocol. cram dd
and inv.   pneumonics help a lot.. before entering the room write the
pam huigs foss and probable dd.. 50 sec at the most.. then enter..
uworld is fine .. for challanging situations read  first aid ...   First
aid alone is good too.   also digital doc blogs are very helpful..
that blog gives a general format of the encounter too..the link is here
 
http://csprotocol.blogspot.com/2006/02/simple-protocolsp-for-your.html
 
good luck
junaid nasir