Internal Medicine OSCE Mindmaps

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

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
Endocrine

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

HLS
Psychiatric

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 dont forget any Q
Note: = = when the symptom happen When e.g. at rest, while watching TV : Timing = variation of the symptom during the day/night :

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

If you find any mistake or an important point missing Please inform us on:

SAWAGROUP@HOTMAIL.COM

www.SAWA2006.com

Continous Duration of the attack

MI , PE , Dissecting Aneurysm , Pneumonia

Sudden Frequency
Angina , Tietze Syndrome, Da Costa syndrome

Gradual

Intermittent

Progression Duration
MI , PE , Pericarditis , Pneumothorax , Rib fracture Angina , Esophagitis , Hiatus Hernia

When

MI , PE , Pericarditis , Pneumothorax , Rib fracture

Crushing Heaviness Burning

GI Dissecting Aneurysm

Acute Chronic

Character Onset

Tearing

Neck, Jaw, Left Arm

MI

Radiation
Central Peripheral

Esophagus Back, Throat Back, Abdomen, Legs

Dissecting Aneurysm

Site

Analysis

Severity Factors
Better Worse
Antiacids , Nitroglycerin , Rest , inclining Forward Breathing , Movement , Effort (& how much) Bending , Straining , Laying down

Chest Pain s
Dyspnea
PE , Pneumonthorax , Pneumonia

PND & Orthopnea

RA , SLE

HF (MI, PE)

Arthritis Rash

Cough Fever & Pus-like Sputum Hemoptysis WaterBrash

Reflux Esophagitis

Acid or Bitter Taste in mouth

MI , GERD

Pneumonia , Pleuritis

Nausea & Vomiting

Esophageal Spasm Esophagitis

Intermittant constant

Adenophagia / Dysphagia Rash in the area of pain Area of tenderness

Associated Symptoms

PE

GERD

Shingles

Sypmtoms of Anxiety
Nervousness Tremor Palpitations Tachypnea

Costochondritis , Fractured Rib

Cardiac causes
Ischemic heart disease Acute pericarditis Aortic dissection Aortic stenosis Cocaine-induced

Gastrointestinal
Gastroesophageal reflux disease Esophageal spasm Dysmotility Cholecystitis Peptic ulcer disease Pancreatitis

Psychosomatic
Panic attack Anxiety Depression

Pulmonary
Pulmonary embolus Pneumonia Pneumothorax

Musculoskeletal
Costochondritis Fibromyalgia

Miscellaneous
Arthritis Herpes zoster

Sudden

ARDS, PE, Pneumothorax, Lung Collapse

Duration of the attack Frequency Continous Intermittent Gradual

CHF, Emphysema, Anxiety

Progression Duration

When

Acute Chronic

Onset

Severity

Analysis

Factors
Exercise, lying Flat, Anxiety

Dyspnia
Cough

- Pink, Frothy Bronchiectasis, Pneumonia - Dark, Foul-smelling Abscess

Sputum

- Pus-like, Large Amt Pulmonary Edema - Bloody

Wheeze

Asthma, COPD, Foreign Body, Tumor, Pulmonary Edema

Stridor Rash Joint Pain

Obstustion of the Large Airway

Foriegn Body, Tumor, Infection

Associated Symptoms
Fever
Especially at Night
Pneumonea of mesothelioma

+ Pus-like Sputum
TB

PE

Sarcoidosis HF

Fatigue Ankle Swelling Palpitations

HF

Sweating Chest Pain + Bloody Sputum

PE

Arrythmias

Orthopnea & PND

Pulmonary causes
Asthma Chronic obstructive pulmonary disease Tracheal obstruction Emphysema Interstitial lung disease Pulmonary hypertension Pulmonary embolism Pneumonia Pleural effusion Pneumothorax

Cardiac causes
Coronary syndromes Valvular disorders Cardiomyopathy Pericardial disorders Arrhythmias Congestive heart failure

Other causes
Respiratory muscle weakness Myasthenia gravis Guillain-Barr syndrome Anemia Metabolic acidosis Diabetic ketoacidosis Salicylates Pregnancy Psychiatric disorders Anxiety Panic disorder Musculoskeletal Kyphoscoliosis

Unitlateral Bilateral Sudden Gradual

Extent Ankle, Calf, Thigh

Site Progression Duration Analysis

Acute Chronic

When

Trauma, Activity, Spontanous Periorbital, Testicular, Ascites

Other Sites of Swelling Temperture Stiff Muscles Painful

Onset

Rapid Progression Browny-Reddish Areas Fever

Varicose Veins
Wt Loss Fever Night Sweats

Leg Swelling

Cellulitis
Pitting Edema

Sharply Defined Edge Diffuse

Tumor compressing on a Vein

Stiff Muscles

DVT

hot Parasthesia/Numbness

Urine Output Urine Color Bloody Urine

Renal Failure

Associated Symptoms
Weight Gain Cold Intolerance Constipation

Acute Compartment Syndrome

Sudden Sever Calf Pain

Pallor Myxedema (non pitting Edema)

Skin Nodules

Morning Stiffness

Deformities

Rheumatoid Arthritis

Proximal Joint pain Varices

Spider Navi

Fatigue Bilateral

Hypothyroidism

Hoarseness of Voice

Jaundice Testicular Atrophy Hemoptysis Acute Chest Pain

Course Dry Skin

PE

SOB (worse on Evening) Bilateral

Palmar erythema Clubbing

Liver Failure

Gynecomastia

Poor Memory & concentration

Hepatic Encephalopath Acute Chest Pain Tachycardia Cold Sweating

MI

Heart Failure

Bleeding tendency PND Bilateral Ascities exertion Induced

Orthopnia

Local Acute causes

DVT Cellulitis Allergy Ruptured Backer Cyst Trauma RA

Chronic causes
Pregnancy Lymphedema (not pitting) Varicose Veins

General
Heart Failure Hypoproteinemia (Liver or Kidney Failure) Hypothyroidism

Sudden high Volume Low volume Transiet

V.intense Exersice

Gradual

Amount of urine

Progression Color

Red Dark

Hb, Blood Urobilinogen Extravascular hemolysis

Frequency

Analysis
Acute Chronic

Dark-Brown

Bilirubin Inravascular hemolysis

Onset

Which part of Sream Odor

All Partial

Early
Urethral, Prostatic

Late Bladder

Clots

Butterfly Rash Maliase Fever Raynaud's Discoid rash

SLE

Anemia Symptoms Malaise infection Bruising Gum enlargement

Leukemia

Red-Dark Urine

Abdominal Pain + Jaundice

Common Bile Duct Stone, Pancreatitis, Sclerosing Colingitis, Pancreatic CA, Bile Duct CA, Viral or Alcoholic Hepatitis,

Abdominal Pain Jaundice Fever

Renal Stones, Renal Embolism, Renal CA Kidney Contusion, GN, Polycystic Kidney

IntraVascular Hemolysis

Intense Pain Loin Radiating to the groin

Cloudy-Dark Urine
Poor Stream Drippling Hematuria when Enlarged Vein Ruptures

Urinary Stones

Pyelonephritis, Lupus Erythmatosis, LE + Kidney Emboli

Associated Symptoms

Palpitations SOB

Prostatic Disease

Pale Stool
Loin Pain Nausea & Vomiting Fever Chills

Biliary Obstruction

Pyelonephritis

Fatigue
Easy Bruising Bleeding Gum Epistaxis Menorrhagia Rectal Bleeding Swollen Painful Joints

Bad Odor
Burning Micturition Frequency Urgency Fever (if Upper)

UTI

Urgency Burning Micturition Discharge

Urethritis

Bleeding Disorders

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"

Lung CA with involvement of the Left Laryngeal Nerve, Respiratory Muscle Weakness

Dry

Productive

Severity
Wheezing
Obstructive Lung Disease (COPD, Asthma) , HF

Type
Sudden Gradual

Character

Whooping Barking
Epiglottitis

Progression
Acute Chronic

Nocturnal

Asthma . HF Chr. Bronchitis

Onset

Timing

Early Morning + Sputum Daytime

Postnasal Drip , GERD , Bronchiectasis

Analysis
Painful Factors

Relieving Worsening

Drugs, Tea , Herbs Drugs , Dust , Fumes , Smoke Meals Esophageal Diverticulum , Fistula

Cough
Wheeze
Foriegn Body , CA , CHF , Asthma , COPD

Stridor

Foriegn Body , Whooping , Larynx CA , Tracheal CA

sputum analysis
Amount
large 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

Fever Sputum

Infection , Bronchoiectasis

Bloody

Chr. Bronchitis , TB , Bronchiectasis , CA , Foriegn Body m HF , Abscess , PE

Associated Symptoms
Sweating Chest Pain
Asthma

Amount Odor Color

Color
TB

SOB

Asthma , COPD , Lung Fibrosis, Lung CA , CHF , PE

at Night

Orthopnea + PND Wt Loss

CA

HF

Smell
Foul Smell
Anaerobic Bacteria

e.g. Eczema

Rash

Burning Sensation
HF

GERD

Solid Meterial
e.g. Foreign Body, Food, Teeth, Mucous Plug

Swelling of the Legs

Acute Cough
Acute bronchitis Acute sinusitis Chronic obstructive pulmonary disease Asthma exacerbation Allergic rhinitis Whooping cough (Pertussis)

Chronic Cough
Most common Postnasal drip Gastroesophageal reflux disease

Less common Medications (ACE inhibitor) Lung cancer Bronchiectasis Interstitial lung disease Congestive heart failure Chronic obstructive pulmonary disease

Fully Mixed with blood Sudden Gradual Lines of Blood + Mucus

Progression

Consistancy
Dark

Amount

Color

Bloody

Bright (Hematochezia) Streaks Dark

Analysis
Frequency
Specific time during month
rectal Endometriosis Infection

Odor

Which part of motion Painful

Anal Fissure, Thrombosed Hemorroids

Acute

All

Onset
Chronic

Partial

Early Late

Fatigue Palpitation Dizziness Angina

Bloody-Dark Stool

Fever Abdominal pain Tenismus Dysphagia

Symptoms of hypovolemia
Depression

Sweating

SOB

Anal itch

Hemorroids, anal fissure, Diarrhea

Change in bowel habit

Abdominal Distension Abdominal Pain

Constipation

Intestinal Obstruction, intussusception, Mesentric Thrombosis or embolism

Associated Sypmtoms

Hematemesis/ Coffee-ground Vomiting

UPPER GI BLEEDING: Esophageal Varices, PUD, Gastritis

Vomiting

Constipation
HeartBurn

Diverticulitis, Rectal CA, Hemorroids, Anal Fissure

Gastritis, esophagitis, GERD, PUD, Stomach CA, Mesentric embolism or thrombosis, meckles diverticulum

Wt loss Appetite Early Satiety

Cancer

Other Bleeding Sites

Easy Bruising Bleeding Gum Epistaxis Hematuria Swollen Painful Joints

Bleeding duodenal ulcer Gastric ulcer Gastric carcinoma INFECTION: Esophageal carcinoma Esophageal varices

Acute bloody diarrhea mucus

Shigella (bacillary) dysentery Campylobacter enteritis Enteroinvasive Escherichia coli Enterohaemorrhagic type 0157 E. coli Entamoeba histolytica (amoebic) dysentery

Melena

Meckel's diverticulum Other causes: angiodysplasia, bleeding disorders False Melena: Black licorice Blueberries, Iron supplements Lead Bismuth (Pepto-bismol)

First episode of cause of recurrent bloody Diarrhea

Bleeding haemorrhoids Anal fissure Diverticulitis Crohn's disease Rectal Carcinoma

Recurrent diarrhea with blood mucus

Ulcerative colitis Colonic carcinoma Colorectal carcinoma Diverticular disease/ diverticulitis

Red Bloody Stool

Colonic carcinoma Ulcerative colitis Meckel's diverticulum Crohn's disease Massive upper GI bleed Trauma Intussusception

Sudden

Gradual

Amount Frequency
Acute Chronic

Progression Color

Onset Character - Mixed - Steaked - Clots

Make Sure it is not something Else

Hematamesis, epistaxis, Bleeding Gums

Analysis

Painful Cough Analysis

Hemoptysis
Pneumoni, Abscess, Bronchiectasis

Fever Confusion

Foreign Body CA, CHF

Abnormal Breathing Sounds Chest Pain Wt Loss Leg Swelling

General Weakness/Fatigue Palpitations

PE, MI

TB ,CA ,Cystic Fibrosis

Associated Symptoms

Sweating SOB

TB

DVT, HF

Other Sites of Bleeding

Easy Bruising, Rectal Bleeding, Menorrhagia, Epistaxis

Sputum / Change in amt

Airways Bronchitis Bronchiectasis Cystic fibrosis Bronchogenic carcinoma Endobronchial metastases Foreign body aspiration

Lung parenchyma Pneumonia Lung abscess Mycetoma (fungus ball) Tuberculosis Lung contusion Lupus pneumonitis Goodpasture's syndrome Wegener's granulomatosis

Cardiovascular Pulmonary embolus/infarction Congestive heart failure Mitral stenosis Aortic aneurysm Pulmonary arteriovenous malformation

Miscellaneous Anticoagulant therapy Thrombocytopenia Pulmonary endometriosis

Migrane , Asthma , Drugs

Transient

Gradual Sudden

V.High

DI

Progression Frequency
At Day & Night

Amount

Analysis

Color Thirst & Drinking Amt

Acute Chronic

Onset

Polyuria

Chills (if upper)

Fever (if upper)

Bad Odor
Palpitations

Fatigue

menstrual disorders

Abnormal Color
Tremor

UTI

Groin/Flank Pain

Irritability Diarrhea Appetite

appetitie

Thirst

Hyperthyroidism

Associated Symptoms
Polydepsia

Burning Micturation

Urgency

Sweating Heat Intolerance Wt loss

Wt loss Fatigue

infections
Bone Pain Constipation

DM
Blindness

PVC

Numbness

Depression

Blurring Vision Polyphagia

Impotence Late GN MI

Loin Pain
Stones

Hyperparathyroidism
Abdominal pain Frothy urine Nocturia

Hematuria

usually Severe Polyuria

Chronic Nephritis
Dehydration

Hematuria

Nocturia

DI
Thirst Edema (if severe due to hypoproteinemia)

Fatty, Pale, Floating, difficult to flush Watery Mucus If Chronic Case

Infection , lactase intolerance Z-E syndrome, Carcinoid syndrome mg antiacids, bowel polyps

Celiac disease, chronic panceatitis Gastrectomy, Cystic fibrosis

CA , Diverticulitis IBD, irritable bowel syndrome, Infection

Progression Amount Frequency Onset

Consistancy
Pale
Hemorrhoids

high Volume
IBD, CA

Low volume

Color

Bloody

Bright Streaks Occult

IBD, Infection, CA Diverticulitis, Z-E syndrome

Ask about his normal Bowel Habit

Infection

Odor

Acute Chronic

Analysis

Which part of motion

All Partial
Early Late

Difficulty to flush (steatorrhoea) Persistance upon fasting Painful

Diarrhea
Acute
Double vision Blurred Vision Photophobia poor coordination speech difficulty Steatorrhea Wt loss Fatigue Abdominal Pain & distension Bone fragility Skin Rash

Neurological Symptoms Clostridium Botulinum Toxin

Fever

Early Late

Infection , UC , Severe amoebic Dysentry , Pseudomembranous Colitis Traveler's Diarrhea , Viral Gastroenteritis

Burning

Z-E syndrome Cholera Infection , IBD , IBS , CA

Associated Symptoms
Celiac Disease

Abdominal Pain

Cramping Colicky

Abdominal Distension Constipation (Alternating)

CA, Irritable bowel syndrome

Heat intolerance Wt loss Irritability Tremor Increased Appetite Goiter

Anal Itch HyperThyroidism Tinismus Skin Rash

IBD , Celiac

Polyuria Polydepsia Blurred Vision (Retinopathy)

DM Complication Neuropathy

Joint Pain Back Pain Mouth Ulcers Skin Rash Eye Redness

IBD

Wt loss Vomiting

CA

Toxic staphylacoccal gastroenteritis (2-4 after toxic ingestion) Travelers Diarrhea , Viral Gastroenteritis

If Chronic Case

Progression Amount
Ask about his normal Bowel Habit
Obstruction

Consistancy
Bloody (+ Painful)
Hemorrhoids CA , Diverticulitis IBD

Color Odor Painful

Bloody (+ Painless) Bloody & Mucus

Frequency Onset

Acute Chronic

Diet , Emotional , Hirschsprung's disease

Analysis

Constipation
Neurological

Urinary Retention Palpitation Fever

Fecal incontinance Abdominal Pain Analyze

Obstruction

Vomiting Abdominal Distension Sweating Hair loss

Associated Symptoms

Diarrhea (Alternating) Wt loss

CA

CA, Irritable bowel syndrome

Polyuria Polydepsia Blurred Vision (Retinopathy)

Tremor

DM Complication Neuropathy

Slow Speech

Hypothyroidism

Cold intolerance Wt gain Dry Skin

Duration of the attack Frequency Intermittent

Arrhythmias

Hyperthyroidism , Fever Caffiene , Drug overdose

Sudden Gradual

Continous

When Amount Onset Progression Rhythm Ask the ptn to tap it

Acute Chronic

Analysis

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
Anxiety

Appropriate Age
Menopause

Associated Symptoms

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

HyperThyroidism

Fever
Bacterial Endocarditis , Rheumatic Fever A CAUSE OF PALPITATION

Intermittent
Headache Pallor chest tightness Tremor Sweating

Joint Pain
SOB Leg Swelling HR

Rheumatic Fever

Pheochromocytoma

CHF

Polyuria after the attack

Paroxymal SVT