Professional Documents
Culture Documents
CASE PRESENTAION
INTRODUCTION
Hello Mr. Jones, (shake hand) Good morning. I am Dr. David, attending
physician in this hospital/medical center. Nice to meet u. I’ll be taking care of your health
today.
Let me make you more comfortable by putting this drape over u. Is that ok?
CHIEF COMPLAIN
Oh, I am sorry to hear about your problem, I’ll try my level best to help you out of this problem.
For that, I’ll ask you few questions and do a brief physical examination. Is that OK? Meanwhile
I’ll write few notes while we discuss if you don’t mind.
You will not shake hand with pt. if he is having right sided weakness (stroke) or he is presented
with pain in right arm and u suspect some kind of fracture.
Questionnaire:
DOPEFAAA
F: Is it continuous/on and off? If on and off, how often does it come? How long does it last?
(Frequency)
A: Associated symptoms
FOR PAIN
LIQR
I: On a scale of 1-10, 10 being worst pain of your life, how do you rate your pain? Intensity
FNVTTTTT
F: Do you have fever? If yes then how much fever do you have? Where have u checked your
fever (oral, axillary, rectal). Do you have chills/night sweats?
N: Do you feel nauseated?
T: Did you notice any recent weighT changes? How is your appeTite?
PAM-HUGS-FOSS
P: Did you have similar complaints in the past? / Did u have any illness in the past?
A: Are you Allergic to anything/drug? If yes, then, what kind of allergic reaction do you have?
Advice: Thank u very much for letting me know about it, I will make sure that this medication is
not included in my prescription.
F: Now I would like to ask you few questions regarding your Family health. Is that
OK?
Now I would like to ask few questions regarding women’s health, don’t feel
embarrassed I assure you that whatever we discuss will be kept confidential. Is that OK? Can I
precede?
Obs history
1. Have you ever been preganant before?
2. Do you have any kids? If yes, then how many kids do you have?
3. How were they delivered?
4. Did you have any complication during pregnancy?
5. Did you have any miscarriage? In what trimester?
O: what do you do for your earning? Occupation. Is there any stress at work?
S: Now I would to ask few questions regarding your Social health and lifestyle.
Is that OK?
1. Do you smoke?
2. How many packs?
3. For how many years
4. Have u ever tried to stop smoking?
Counsel to stop smoking: Mr. Jones smoking causes many diseases of mouth, throat, lungs,
heart and brain. It can affect any part of body, so I suggest you to stop smoking. If you are
interested in stopping it I’ll help you and we’ll arrange a meeting for that one week later.
Challenging question: Do u think my current problem is due to smoking? Answer should be
according to illness. e.g: If the pt has presented with fever or acute diarrhea: It is less likely that
ur symptoms r due to smoking, but if the pt has presented with chest pain or chronic cough:
smoking is a strong risk factor for the symp u have presented with.
1. Do u drink alcohol?
2. What kind of alcohol?(wine, bear)
3. How many days?
CAGE questions
E: Have u ever used alcohol as an eye opener to steady your nerve or to get rid of hangover?
Is alcohol affecting ur work/daily life activities?
Now I would like to ask few questions regarding your personal life. Don’t feel
embarrassed, I can assure you that whatever we discuss will be kept confidential. Is that OK?
Can I proceed?
Have u ever been tested for STD’s? if yes, Were u treated for that? Were ur partner treated for
that?
Do u know ur HIV status? If yes, may I know the results? If –ve, I am glad to hear this, if +ve, I
am sorry to hear that.
If pt didn’t know HIV status, with ur permission I will arrange a test to know ur HIV status in the
later part of the day.
Physical examination
Closure: Thanks for letting me perform a brief physical examination, let me give u my
impression what might be cause of ur problem, well looking at the history and physical
examination I’ve performed I’ve a couple of possibilities in my mind, your problem can be due
to………
1. CARDIAC CASE
DDs:
MI / Angina / Pericarditis / Aortic dissection (CVS)
GERD / Peptic ulcer disease / Mallory Weise Tear / Oesophageal spasm / Oesophageal stricture.
(GIT)
DOPEFAAA
O: How did it start? / What were u doing at the time u had the pain?
P: How is it progressing?
F: Is it continuous/on and off? If on and off, how often does it come? How long does it last?
Frequency
A: Associated symptoms
LIQR
L: Can you locate your pain? Location, How long does it last?
I: On a scale of 1-10, 10 being worst pain of your life, how do you rate your pain? Intensity
Associated symp: Do u have shortness of breath? If yes then ask DOPEFAA about
SOB.
Resp:
Do you have SOB at rest? If no, then how far can u walk before you get SOB?
CVS:
Do u have any racing of heart?
Do u feel nauseated?
Do u have lightheadedness?
GIT:
Do u have heartburn?/ water brash?/ reflux?
Stress ulcer:
Are u anxious about anything?
DVT n Pul: Embolism
Do u have any pain in ur legs while walking?
2. Am I going to die?
Physical Examination:
Now I would like to perform a brief physical examination if u don’t mind.
1. Wash ur hands, make them dry and warm. I am sorry if my hands are cold. or simply wear
gloves.
Examination components:
Neck: Look for JVD, carotid auscultation
Extremities: Check peripheral pulses, check BP in both arms, look for edema or cyanosis.
Closure:
Thanks for letting me perform a brief physical examination, let me give u my impression what
might be cause of ur problem, well looking at the history and physical examination I’ve
performed I’ve a couple of possibilities in my mind, your chest pain can be due to cardiac
problem such as heart attack or angina or it may b due to acid reflux, lung problem or disorder
related to the large blood vessels in ur chest. It is crucial that we perform some tests to identify
the source of ur problem. We will start with an ECG and some blood work but more complex
tests may b needed as well. Do u have any question for me?
Hello Mr. Jones, (shake hand) Good morning. I am Dr. David, attending physician
in this hospital/medical center. Nice to meet u. I’ll be taking care of your health today.
I can see u r in great distress. Is there anything I can do to make u more comfortable?
DDs:
Acute: CHF, Asthma, GERD, Bronchitis, Pneumonitis, FB(Foreign body)
O: How did it start?/ What were u doing at the time u had SOB?
P: How is it progressing?
F: Is it continuous/on and off? If on and off, how often does it come? How long does it last?
A: Associated symptoms
Associated symp:
Do u have SOB at rest? If no then how far can u walk before u get SOB?
Do u use any pillow at night bc of SOB? If yes then how many pillows?
ABCOP
CVS:
Do u have any racing of heart?/ Chest pain
Do u feel nauseated?
Do u have lightheadedness?
GIT:
Do u have any heartburn/reflux/chest pain
Panic:
Are u anxious about anything?
FNVTTTTT
T: Travel (Tb)
Then PAM-HUGS-FOSS
Physical Examination:
Now I would like to perform a brief physical examination if u don’t mind.
Examination components:
Neck: Look for JVD, carotid auscultation
Extremities: Check peripheral pulses, check BP in both arms, look for edema or cyanosis.
Closure:
Thanks for letting me perform a brief physical examination, let me give u my impression what
might be cause of ur problem, well looking at the history and physical examination I’ve
performed I’ve a couple of possibilities in my mind, your problem can be due to infection of ur
lungs/exacerbation of your previous condition/long standing smoking habits/hypersensitivity of
ur airways, but to b sure with ur permission I need to run few tests like images of ur chest,
blood work, PPD, CT chest.
With ur permission I’ll arrange a physiotherapist who will teach u breathing exercises.
After getting the result we will sit down together n discuss further evaluation and management.
Is that OK?
3. Palpitation
Let me make you more comfortable by putting this drape over u. Is that ok with you?
DDs: CHAPATHI
A: Arrhythmias
T: Thyrotoxicosis
I: Induced by drugs
Can u exactly tell me what do u mean by palpitation?
DOPEFAAA
O: How did it start?/ What were u doing at the time u had palpitation?
P: How is it progressing?
F: Is it continuous/on and off? If on and off, how often does it come? How long does it last? Are
they regular/irregular? How many times do u notice them in a day?
A: Associated symptoms
Anemia:
Have u noticed any blood/black colored stool?
Angina:
Do u have any SOB?
Do u feel nauseated?
Do u have lightheadedness?
Physical Examination:
Now I would like to perform a brief physical examination if u don’t mind.
Examination components:
Neck: Look for JVD, carotid auscultation
Extremities: Check peripheral pulses, check BP in both arms, look for edema or cyanosis.
Closure:
Advice:
Please cut down on caffeine.
If on synthyroid, have regular thyroid level checkup and get the dosage accordingly.
If hypoglycemic, do not skip ur medications and have a regular diet rich in fibers n low in fat.
4. Cough
Introduction same as previous
All chronic cough pts ask about HIV status and Tb
DDs: Upper Resp tract inf, Tb, COPD, Pneumonia, Bronchogenic carcinoma, FB, GERD
DOPEFAAA
P: How is it progressing?
F: Is it continuous/on and off? If on and off, how often does it come? How long does it last?
A: Associated symptoms
ABCOP
Do u use any pillow/prop up ur bed to prevent SOB? If yes, how many pillows?
Do u have SOB at rest? If no, then how long do u walk to have SOB?
Do u have wheeze?
Physical Examination:
Now I would like to perform a brief physical examination if u don’t mind.
Examination component:
Head n Neck: Examine mouth, throat, lymph nodes
Closure: Thanks for letting me perform a brief physical examination, let me give u my
impression what might be cause of ur problem, well looking at the history and physical
examination I’ve performed I’ve a couple of possibilities in my mind, your problem can be due
to infection that can b either bacterial or viral. This can also b due to acid reflux more
commonly known as heartburn. The chest pain you r experiencing is probably due to irritation
of ur lung membranes by infection. We r going to test ur blood and sputum and will also obtain
a chest X-ray to help us make a definitive diagnosis. Do u have any questions for me?
Advice:
Don’t indulge in activities that increase ur breathlessness.
Use inhaler.
5. Hemoptysis
Introduction:
DDs: Pul: Tb, Pul: Edema, Bronchogenic carcinoma, Bronchitis, Pul: Embolism, Lung abscess, A-
V malformations, Pneumonia
DOPEFAAA then ABCOP… Blood, how much? Dark colored blood/fresh blood/mixed with
food particles/blood clots?
Do u have chest pain?
Do u have SOB?
Do u have wheeze?
How is ur appetite?
Physical Examination:
Now I would like to perform a brief physical examination if u don’t mind.
Examination component:
Head n Neck: Examine mouth, throat, lymph nodes
Extremities: Inspection
Closure: Thanks for letting me perform a brief physical examination, let me give u my
impression what might be cause of ur problem, well looking at the history and physical
examination I’ve performed I’ve a couple of possibilities in my mind, your problem can be due
to lung infection that can b treated with antibiotics or it may b the result from something more
serious such as cancer. We will need to obtain some blood and sputum tests as well as chest X-
ray in order to identify the source of cough. In addition we may find it necessary to conduct
more sophisticated tests in future. Do u have any questions?
6. Dysphagia
Introduction
DDs: Achalasia, FB obstruction, GERD with stricture, Esophageal carcinoma, Plummer Vinson
Syndrome, Esophagitis (HSV, CMV, drug induced), Myasthenia Gravis, Scleroderma CREST synd:,
Zenker’s Diverticulum.
dysPHAGia
Dys
P: Plummer Vinson
H: Hypothyroid
A: Achalasia
DOPEFAAA
Associated:
Can u locate where u feel that the food is stuck?
Do u have difficulty swallowing solids, liquids, or both? If both then which started first?
Did u notice any food particles on ur pillow when u get up from ur bed?
Then FNVTTTTT look for any travel history outside US for Chaga’s dis
PAM-HUGS-FOS
Closure:
May b due to FB
GERD counselling
Investigations:
TIBC, Serum Ferritin, TSH, Plain X-ray, Barium swallow, CT chest, Endoscopy with biopsy,
Esophageal manometry, HIV
7. Belly Pain
Introduction
DDs: GOPAL-SIR
Urinary: BC-FUN-SHIP
B: Do u have Burning sensation while passing urine? Did u ever notice Blood in urine?
S: How is ur Stream? Have u ever passed Stone in urine? Do u have to Strain to pass urine?
I: Did u have any urinary injury? Do u have any dribbling of urine? (Incontinence)
P: Did u notice Pus while passing urine? Do u have any Pain while passing urine?
GIT: BC-FUN-SHIP
B: How r ur Bowel habits? Did u notice Bleeding from any other sites?
C: What is the Color of ur stool? Are u passing any black Colored stool? .When was last
screening Colonoscopy done? Do u have Constipation alternating with diarrhea?
S: Do u have to Strain while passing stool? Does ur pain have any relation with Specific food?
H: Do u take High fiber diet?
Examination component:
Head n Neck: Examine mouth, throat, lymph nodes
CVS: Auscultation
Pulmonary: Auscultation
Abdominal: Inspection, Auscultation, palpation, percussion, psoas sign, obturator sign, Rovsing
sign, CVA tenderness
I will perform the rectal examination and examination of ur private parts in the letter part of
the day.
Investigations:
Per Rectal examination, colonoscopy, X-ray/CT-abd and pelvis, Stool examination, CBC, PT,
APTT, AST, ALT, Bilirubin
Closure:
1. Thanks for letting me perform a brief physical examination, let me give u my impression
what might be cause of ur problem, well looking at the history and physical examination
I’ve performed I’ve a couple of possibilities in my mind, your problem can be due to a
number of disorders that can cause pain similar to what u have described. Pain of this
type is most commonly die to an ulcer, an abdominal infection or a gall stone. We will
have to run some tests to confirm the diagnosis and to rule out more serious illnesses.
These tests will include a rectal examination; an ultrasound of ur abdomen; blood tests
and possibly an upper endoscopy, which examines ur stomach by means of an optical
instrument passes through ur mouth. Once we have made the diagnosis, we will b able
to treat ur condition and help alleviate ur pain. Do u have any question?
2. Thanks for letting me perform a brief physical examination, let me give u my impression
what might be cause of ur problem, well looking at the history and physical examination
I’ve performed I’ve a couple of possibilities in my mind, your problem can be due to a
problem with ur reproductive organs such as infection in ur fallopian tube or a cyst on ur
ovary. They might also result from a complicated pregnancy, which could b indicated if
ur preg test comes +ve. Another possibility is an infection in ur appendix which could
require surgery. To know the exact diagnosis, we will need to run some tests, including
blood tests, a urinalnaysis, a preg test and CT scan of ur abdomen and pelvis. Do u have
any question?
DDs: CHADIF
C: Colon cancer
H: Hemorrhoids
A: Angiodysplasia
D: Diverticulosis
D: Diverticulitis
D: Dysentery
F: Fissure in ano
DOPEFAAA
F: Do u see blood every time u pass stool? If no, how often do u pass? If yes, how much blood?
Color- Bright red/altered color? Is it mixed with stool? Do u find mucous with stool? Does it
come before/during/after you pass stool?
B: How r ur Bowel habits? Did u notice Bleeding from any other sites?
C: What is the Color of ur stool? Are u passing any black Colored stool? .When was last
screening Colonoscopy done? Do u have Constipation alternating with diarrhea?
S: Do u have to Strain while passing stool? Does ur pain have any relation with Specific food?
Physical Examination:
Now I would like to perform a brief physical examination if u don’t mind.
1. Wash ur hands, make them dry and warm or wear gloves.
Examination component:
Head n Neck: Examine mouth, throat, lymph nodes
CVS: Auscultation
Pulmonary: Auscultation
I will perform the rectal examination and examination of ur private parts in the letter part of
the day.
Closure:
Thanks for letting me perform a brief physical examination, let me give u my impression what
might be cause of ur problem, well looking at the history and physical examination I’ve
performed I’ve a couple of possibilities in my mind, your problem can be due to readily
treatable problems, such as hemorrhoids, an infection of ur colon or diverticulosis, or they may
b a sign of more serious disease such as colorectal carcinoma. It is crucial that we run some
blood tests; a stool examination; and probably a colonoscopy, which involves looking at ur
colon through a thin tube that contains a camera. Once diagnosis is made, we should b able to
treat ur problem. Do u have any questions?
9. Haematuria
Introduction:
DDs: HITTERS
H: Haematological
T: Trauma
E: Exercise (Rhabdomyolysis)
DOPEFAA
F: Do u see blood every time u pass urine? How much blood? When did u notice blood
before/during/after/throughout passing urine?
B: Do u have Burning sensation while passing urine? Did u ever notice Blood in urine?
S: How is ur Stream? Have u ever passed Stone in urine? Do u have to Strain to pass urine?
I: Did u have any urinary injury? Do u have any dribbling of urine? (Incontinence)
P: Did u notice Pus while passing urine? Do u have any Pain while passing urine?
Then FNVTTTTT and PAMHUGSFOS
Physical examination
Examination component:
CVS: Auscultation
Pulmonary: Auscultation
Extremities: Inspection
Closure:
Thanks for letting me perform a brief physical examination, let me give u my impression what
might be cause of ur problem, well looking at the history and physical examination I’ve
performed I’ve a couple of possibilities in my mind, your problem can be due to a variety of
factors, so I would like to do a few tests to elicit an answer. First I will draw some blood and
then I will perform a genital examination as well as rectal exam to assess ur prostate. I will then
order a urine test to look for signs of infection. Depending on the results we obtain I may also
order some images studies to determine if there is stone in ur urinary tract, an anatomic
abnormality or a tumor. Do u have any question.?
Investigations:
Urinanalysis, urine cytology, C/S, BUN, S,creatinine, PSA, U/S abd, CT abd and pelvis, IVP,
Cystoscopy, CBC, ESR, Electrolytes, Hb%
10. Incontinence
Introduction:
DDs: SOUND
S: Stress---- cough, laugh, sneezing, strenuous exercise
N: NPH (Normal pressure hydrocephalus)---- Headache, weak LL, memory problem, blurred
vision
D: DI, DM
DOPEFAAA
Associated symp:
BC-FUN-SHIP
Do u have any vaginal discharge?
How is ur thrust?
Do u have headache?
With ur permission, I would like to refer u to a physiotherapist who will teach u some exercise
that can strengthen ur lower belly muscles. I will b there with u through the process.
Investigations:
Pelvic exam, cystogram, urodynamic study, urinalysis, Q-tip, CT head, RBS, HbA1.
Introduction:
DDs: A-PV-BLEED
A: Adenomyosis, Abortion
B: Bleeding Diathesis
L: Leiomyoma
E: Ectopic preg
DOPEFAAA
Associated symp:
When was your last menstrual period? If greater than 5 weeks, are there any chances of being
pregnant?
Perimenopause:
Do u have any hot flashes?
When was ur last Pap smear done? If no then order for Pap smear
Endometrosis:
Do u have pain during menses?
Then PAMHUGSFOS look for bleeding disorder and history of multiple abortions in family
history, look for cocaine use this can cause abortion. Take a detail obs history.
Obs history
1. Have you ever been pregnant before?
2 Do you have any kids?
3 How were they delivered?
4 Did you have any complication during pregnancy?
5 Did you have any miscarriage? In what trimester?
Closure:
Your conditions appears to be emergency for me. Please don’t take anything by mouth until the
investigation results are out. My nurse will be checking for ur vitals regularly.
It can b due to complication of unknown pregnancy, abnormal hormonal level or any infection.
Advice:
Maintain genital hygiene, practice safe sex, take plenty of fluids, take adequate rest. Don’t
involve in activities that increase discomfort. Take iron and calcium supplements.
Investigations:
Urine HCG, U/S Pelvis, Cervical cultures, Endometrial biopsy, Pap smear, PT, APTT, TSH, LH,
Prolactin, Quantitative serum HCG
Challenging quest:
Am I getting old?
Ans: Aging is a natural process. Plz don’t worry we have modern treatment modalities with
which u can feel better.
12. Amenorrhea
Introduction
DDS: Pregnancy, Premature ovarian failure, Prolactinoma, PCOS, Thyroid dis, Asherman synd,
Anorexia nervosa, Perimenopause, Pills
Pregnancy:
Are there any chances of being preg?
Do u have headache?
Thyroid qust:
How is ur mood? (Depression) if good then ICE and if bad then SIGEM-CAPS
ICE
SIGEM-CAPS
S: How is ur sleep?
I: How is ur interest?
G: Do u feel guilty?
E: How is ur energy?
M: How is ur memory?
C: How is ur concentration?
A: How is ur appetite?
P: Psychomotor
Pill induced:
Are u using any OCP’s?
Investigations:
Urine HCG, urine culture, LH, FSH, TSH, serum prolactin, U/S pelvis, blood sugar, Pap smear,
cervical culture, HIV, Hep:B, VDRL, RPR.
Challenging quest:
Do u think I am preg?
Ans: I understand ur anxiety about this unplanned preg. I suggest that u discuss this with ur
husband. As ur physician, I want to assure u that I am here to support and advise u regardless
of the decision u make. If u wish I would b happy to discuss ur options with both of u.
13. Dyspareunia
Introduction:
DDs: Vulvodynia, Vaginismus, Atrophic vaginitis, cervicitis, endometrosis, PID, Depression,
Domestic violence
DOPEFAAA, DUDI, belly pain, gyni n obs history, mood, safe at home, FNVTTTTT then
PAMHUGSFOS
DDS: DSP-HAT
H: Hypertension
A: Atherosclerosis
T: Trauma to back
DOPEFAA
Intensity: On a scale from 0-6 with 0 being totally flaccid and 6 being just able to penetrate
how can u grade ur problem?
How is ur desire?
Do u have any problem with erection?
Who is ur partner?
Do u have any other partners? If yes then do u have this problem with all ur partners? If no
then how is ur relationship with ur partner?
Do u use Vigra?
Examination:
CVS, CNS
Investigation:
Blood glucose, Stamp test, serum lipids, pelvic Doppler, serum testosterone, RBS
15. Sore Throat
Introduction:
DDs: Infectious Mononucleosis, Streptococcal Pharyngitis, URTI, Viral pharyngitis, Bacterial
pharyngitis, Acute HIV, GERD
DOPEFAAA
Associated symp:
Do u have any runny nose?
Do u have rash?
Physical examination:
Exam components:
Head and Neck: Examine nose, mouth, throat, lymph nodes, checked for sinuses tenderness.
CVS: Auscultation
Pulmonary: Auscultation
Closure:
Thanks for letting me perform a brief physical examination, let me give u my impression what
might be cause of ur problem, well looking at the history and physical examination I’ve
performed I’ve a couple of possibilities in my mind, it is likely that u have acquired the same
infection ur girlfriend had. This may b no more than a transient viral infection or it may
represent a more serious illness such as HIV. We will need to rum a few tests to help us make
the diagnosis. I recommend that we obtain an HIV test. In any case I strongly recommend using
condoms to avoid an unwanted pregnancy and to prevent STDs. Since inf mononucleosis is one
of the disease that might account for ur symp, I also recommend that u avoid contact sports bc
of possible risk of traumatic rupture of ur spleen which could b fatal. Also, since cigarette
smoking is associated with a variety of diseases I advise u to quit, we have many ways to help u
if u r interested. Do u have any questions for me?
DOPEFAAA
Associated symp:
What exactly do u mean by discomfort?
Physical Examination:
Exam components:
HEENT: Inspect conjunctiva, mouth and throat, lymph nodes, examine thyroid gland
CVS: Auscultation
Pulmonary: Auscultation
Closure:
Thanks for letting me perform a brief physical examination, let me give u my impression what
might be cause of ur problem, well looking at the history and physical examination I’ve
performed I’ve a couple of possibilities in my mind, your problem can be due to infection or a
growth caused by either a benign polyp or a cancer. To find out I need to do laryngoscopy
which is a procedure to view the inside of ur throat, and a CT scan of ur neck. These tests will
likely reveal the underlying problem. Since cigarette smoking is dangerous to ur health I advice
u to quit smoking. We have many ways to help u if u are interested. I also recommend that u
stop drinking as alcohol and smoking are associated with laryngeal cancer. Please don’t strain
ur voice, take warm water gargles. Do u have any other question for me?
Investigations:
Indirect laryngoscopy, CBC, ESR, X-ray neck and chest, UGE, 24 hour pH monitoring
17. Vomiting
Introduction:
DDs: Pregnancy, Bowel obstruction, Gastroenteritis, Migraine, Pyelonephritis, Chemotherapy,
Pancreatitis, Surgery (paralytic ileus/adhesions), UTI, Cholelithiasis.
VOMITING
V: Vomiting
O: Obs/Obstruction
In: Intracranial
G: GE
DOPEFAAA and ABCOP
Associated symp:
Do u have any belly pain?
Ask about any history of chemotherapy, ask BC-FUN-SHIP for pyelonephritis, ask about
menstrual history to exclude pregnancy.
Examination:
ENT and Abdominal
Investigations:
Urine hCG, Pelvic exam, U/S pelvis, CBC, Electrolytes, Calcium, glucose, urine analysis, urine
culture, U/S abdomen, Baseline Pap smear, Cervical culture, HIV, Hep B, VDRL
HOT-ASS-V
H: Hypoglycemia, Heat exhaustion (Hypovolemia)
O: Orthostatic hypotension
T: Trauma
DOPEFAAA
What were u doing at that time?
Physical examination:
Examination components:
Head and neck: Inspection of head n mouth, carotid auscultation and palpation, thyroid exam
Pulmonary: Auscultation
Neurologic: Mental status, Cranial Nerves, fundoscopic examination, motor exam, DTRS,
Cerebellar, Romberg test, gait, sensory.
Closure:
Mr. Jones I need to run some tests to determine the reason u passed out this morning, so I am
going to get a CT scan of ur head to look for bleeding or masses and I will then order some
blood tests to look for infections or electrolytes abnormalities. You mentioned that your heart
was racing before you passed out s I will ask you to wear a heart monitor for 24 hour. Doing so
is just like having constant ECG and it will allow us to detect any abnormal heart beats you
might have. We will start with these tests and then go from there. Do you have any questions
for me?
Investigations:
Blood glucose, Serum electrolytes, CBC, B.P monitoring. CT of head, MRI of brain, ECG, 2D-Echo,
Holter monitoring, EEG.
1. 50 year black male football player, single episode of unconsciousness, heavy drinker,
cocaine abuser, skip meal.
2. Same with seizures
3. Driving car, sudden loss of consciousness, hypertension
Challenging question:
My wife ask me to drive car, car I drive?
19. Headache
Introduction:
DDS: Cluster headache/ cocaine, Migraine, Meningitis, Refraction headache, Tension headache,
Temporal arteritis, Trauma, Tumor (space occupying lesion), sinusitis, Subdural hematoma,
Pseudotumor cerebri, Prolactinoma
Cluster headache:
Do u have any watering of eyes?
Tension headache:
Do you have any stress any home/work?
Migraine:
Do u have any warning signs before the onset of headache?
Meningitis:
Do u have neck stiffness?
Temporal arteritis:
Do u have any jaw pain while chewing?
Trauma:
Do u have any head trauma?
Sinusitis:
Do u have any fascial pain?
CNS:
Do u have any weakness in your arms/legs? (Stroke motor)
FNVTTTT and PAMHUGSFOS ask about trauma, tumor, OCPs, occupational stress
Physical examination:
Exam components:
HEENT: Palpate head, facial sinuses, temporomandibular joint, do fundoscopic exam, inspect
nose, mouth, teeth and throat
CVS: Auscultation
Pulmonary: Auscultation
Closure:
Thanks for letting me perform a brief physical examination, let me give u my impression what
might be cause of ur problem, well looking at the history and physical examination I’ve
performed I’ve a couple of possibilities in my mind, your problem can be due to a migraine
headache so the first thing I will do is prescribe some medications that will alleviate your pain.
To ensure that there isn’t something else going on however I would like to get a CT scan of your
head to rule out a mass or vascular problem as a cause of your headache. A blood test may also
show if you have problem other than migraine. Do u have any other question for me?
Investigations:
CBC, ESR, Serum electrolytes, CT, MRI of brain, CSF analysis
20. Fatigue
Introduction:
DDs: HOD-CAMP
H: Hypothyroid, HIV
D: DM/Depression/Domestic violence
M: Myasthenia gravis
Hypothyroid:
Do u have any problem in adjusting with surrounding temperature?
Depression:
How is your mood? If good then ICE and if bad then SIGEMCAPS
DM:
Do u have any increase in thirst/hunger?
Domestic violence:
Are u physically or emotionally hurt or abused by anyone?
Anemia:
Do u have any racing of heart? SOB?
Adjustment disorder:
Do u have any stress at work or home?
Myasthenia Gravis:
Did u notice any drooping of eyelids?
Physical Examination:
Exam components:
Head and neck: Inspect conjunctiva, mouth and throat, lymph nodes, examine thyroid
CVS: Auscultation
Pulmonary: Auscultation
Closure:
Thanks for letting me perform a brief physical examination, let me give u my impression what
might be cause of ur problem, well looking at the history and physical examination I’ve
performed I’ve a couple of possibilities in my mind, your problem can be due to your lifestyle bc
its stressful lately and my suspicion is that you may b clinically depressed. Before I make a
definitive diagnosis, however I would like to order some blood tests including one for HIV as
you have risk factors for sexually transmitted diseases. Depending on the results of these tests I
may also ask you to participate in a sleep study in which doctors can observe how you breath
while you are sleeping. Once we have completed these tests we should have a better idea of
what is causing your fatigue. In the meantime I strongly recommend that you quit smoking,
exercise regularly and participate in activities that you find relaxing. I would also like you to
promise me that if you feel like hurting yourself, you will call someone who can help you or go
immediately to an emergency department. Do u have any questions for me?
21. Hearing loss
Introduction:
L: Labyrinthitis
M: Meneirre’s Dis
F: Foreign body
I: Impacted wax
T: Trauma
JUST
Associated symp:
Otitis media:
Do u have any ear pain? If yes then LIQR
Labyrinthitis:
Do u have any imbalance/runny nose/sore throat/cough?
Acoustic neuroma:
Do u have any headache?
Foreign body:
Did u insert any FB either accidently/intentionally into ur ear?
Trauma:
Have u ever had a trauma?
PAMHUGSFOS
Physical examination:
Exam component:
HEENT: Tested hearing by speaking with back turned, inspect sinuses, nose, mouth, throat, do
fundoscopic exame, and otoscopy, assess hearing with Rinne, Weber and Whisper test.
Neurologic: Cranial nerves, sensation, motor, reflexes, cerebellar—finger to nose, heel to shin.
Closure:
Mr. Jones I know that u are concerned about ur problem. I can confirm that u have some
hearing loss. I would like to rum several tests, including some blood tests. I would like u to stop
taking aspirin bc this may b contributing to ur hearing loss. I will refer you to an audiometrist
who will assess u for a hearing aid. Do u have any questions for me?
Challenging question:
Am I going to b deaf?
Ans: I understand ur concern it is obvious from my examination that u have hearing loss but it
could also be due to some reversible causes, treating them may restore ur hearing. For that I
need to rule out irreversible causes?
Investigations:
Audiometry, Tympanometry, CT head, Brainstem audiometry evoked potential, CBC, ESR, VDRL
22. Dizziness
Introduction:
DOPEFAAA ask about any special time and position of its occurrence
Physical Examination:
Exam components:
HEENT: Inspect for nystagmus, fundoscopic exam, otoscopy, assess hearing, Rinne’s and Weber,
inspect mouth and throat
CVS: Auscultation, Orthostatic hypotension
Neurologic: Cranial Nerves, Motor exam, DTRs, gait, Romberg sign, Tilt test
Closure:
Thanks for letting me perform a brief physical examination, let me give u my impression what
might be cause of ur problem, well looking at the history and physical examination I’ve
performed I’ve a couple of possibilities in my mind, your problem can be due to a problem in ur
ears or brain or it may result from low blood pressure. We will have to run some tests to
pinpoint the source of ur symp. These may include blood tests, hearing evaluation and MRI of
ur brain. Until we find the cause of ur problem it is important that u r careful when u stand up
quickly or walk unaccompanied and u should b sure to make use of hand railing whenever
possible. Do carry ID cards with phone no of ur beloved ones. Avoid high altitude. Do u have
any questions for me?
Investigations:
VDRL, PRP, Vital signs, Audiogram, CBC, Electrolytes, Blood sugar, CT, MRI of brain
23. Insomnia
Introduction:
DDs: GMC-PROUD
M: Menopause/Medication
P: PTSD, hyperthyroid
R: Restless leg synd
U: UTI, BPH
DOPEFAAAA
I need to ask u few questions about ur sleep patterns. Is that Ok with U?
Falling asleep:
When do u usually go to bed?
Do u exercise?
Do u smoke?
Staying asleep:
How many hours do u sleep?
Restless leg synd: Does anyone notice frequent movements of ur legs during ur sleep?
Depression:
Examination:
MMSE+ Cranial nerves + MRSP
Investigations:
Polysomnography, mental status, TSH, CBC, ECG, EEG, Urine toxicology
Advice:
Please maintain a sleep diary, follow regular bed time and wake time. Do not exercise in early
evenings. Do not take coffee/alcohol. Do not smoke before going to bed. Avoid watching TV on
bed. Avoid day time naps.
24. Confusion/Forgetfulness
Introduction:
DDs: VANISHED
A: Alzhemier’s dis
DOPEFAAA
Are there anything that are difficult to remember?
Cranial Nerves:
Do u have difficulty in speaking/swallowing?
Physical examination:
Exam components:
Eye exam: Inspect pupil, fundus
Abdominal: Palpation
Neurologic: Mini mental examination, Cranial nerves, motor exam, DTRs, gait, Romberg sign,
sensory exam.
Closure:
Thanks for letting me perform a brief physical examination, let me give u my impression what
might be cause of ur problem, well looking at the history and physical examination I’ve
performed I’ve a couple of possibilities in my mind, your problem can be due to a number of
disorders that can affect the brain many of which are treatable. We need to run some tests to
identify the cause of ur problem. I would also like to ask ur permission to speak with ur family.
They can help me with ur diagnosis and I can answer any questions they might have about what
to assess at home supervision and safety measures. The social workers will inform u of
resources that are available in the community to help u. if u would like I can remain in close
contact with u and ur family to provide additional help and support. Do u have any quest for
me?
Investigations: CT,MRI of brain, LP for CSF analysis, CBC, Serum B12, VDRL, TSH, Blood
sugar, ECG, Echo.
Advice:
Keep things well organized in ur room, maintain a diary listing ur activities, do not go outside
alone, whenever u go outside carry ID with contact no’s of ur loved ones. Take time for
pleasurable activities.
N: Narcolepsy
D: Drug induced
Excuse me Mr. Jones I am sorry to interrupt u. I know these things are bothering u. I need to
focus completely on ur present situations. Please don’t concentrate on them. Try to
concentrate on me.
I understand that u are going through a tough phase, we will definitely work on it together
DOPEFAAA
Auditory Hallucination:
How is it affecting ur daily activities?
Visual:
Do u see something that other’s don’t?
What do u see?
How long u have been this problem?
Olfactory:
Do u smell anything that others don’t?
Sensory:
Do u feel anything crawling on ur body?
Suicidal ideas:
Did u ever think of hurting u/others?
Delusion:
Do u hold belief that others find it odd?
Mania:
Do u feel elated?
Depression:
How in ur mood? If good ICE and if bad then SIGEMCAPS
Relation:
How is ur relationship with the family?
Examination:
MMSE and CNS
Investigations:
Urine toxicology, CT,MRI of brain, CBC, ESR, Electrolytes, BUN, Serum creatinine, ALT/AST/ALP
I am here to refill, I am glad to help u. Before I refill ur medications I need to ask u some
questions and do a brief physical examination.
Retinopathy:
Do u get ur eye checkups done regularly?
When was the last checkup done?
CNS:
Do u have any numbness/weakness/tingling sensation?
Atheroscelerosis:
Do u have any chest pain/excessive sweating/lightheadedness/belly pain?
Exam components:
Eye exam: Fundoscopic exam
Pulmonary: Auscultation
Closure:
Mr. Jones the palpitation and sweating u have are most likely due to episodes of low blood
sugar, which may have resulted from a higher than normal dose of insulin or from skipping or
delaying meals. The numbness u describe in ur feet is probably related to the effects of
diabetes on ur nervous system, better control of ur blood sugar may help improve this problem.
Many factors, including diabetes can cause the erection difficulties u describe. I will need to
perform an examination of ur genital area and run some blood tests, and at some point we may
also need to conduct some more complex tests to identify the cause of ur problem. Do u have
any questions for me?
Advice:
Regular eye checkup, take small frequent meals, please don’t skip meals. Use soft heel pad
shoes, don’t injure urself, if injured take proper care as early as possible. Take diet low in salt,
carb and fat, rich fibers, exercise regularly.
Multiple Myeloma:
Do u have lightheadedness?
Do u have constipation?
Do u have headache?
HUGS ask about disturbances due to lying down position, UTI, kidney stone, BPH (BC-FUN-
SHIP)
Physical examination:
Exam components:
Back exam: Inspection, palpation, range of motion
Closure:
Thanks for letting me perform a brief physical examination, let me give u my impression what
might be cause of ur problem, well looking at the history and physical examination I’ve
performed I’ve a couple of possibilities in my mind, I am concerned about ur difficulty urinating
so I would like to do a rectal exam and assess ur prostate for benign growths or cancer. I would
also like to run some blood tests and order a X-ray and possibly an MRI of ur back so that I can
better determine the cause of ur pain. In the meantime as we discussed I will write a note a ur
employer requesting that u b given only light duties while u are at work. Do u have any
questions for me?
Advice:
Don’t strain ur back, take adequate rest, take vitD and Calcium supplements, bend at knee
instead of back while picking objects [Demonstrate and explain ROM exercise]. Once results are
out my therapist will teach u exercise to increase range of movements or ur back and
strengthens ur back muscles.
Investigations:
Rectal exam, X-ray/MRI, PSA, Serum and urinary protein electrophoresis, BUN, Serum.
creatinine, CBC, Serum Calcium.
RSSW
R: Redness
S: Swelling
S: Stiffness
W: Warm
CITRUS
C: Crepitus
I: Infections
T: Tick bite/trauma
R: Rash
U: Ulcer genital
S: Scleroderma
DVT:
Did u notice any enlarged veins in ur legs? (Vericose V)
Physical examination:
Exam components:
CVS/Pulmonary: Inspection, auscultation, palpation, compared pulses (femoral, popliteal,
dorsal pedis) on both sides
Joint exam: Inspect, palpation, range of motion (knee, ankle, hip joint on both sides)
Closure:
Mrs. Jones on the basis of ur history and my physical exam I believe it is possible that u had a
blood clot. However we will also look for other possible causes of ur symp such as an infection
or a ruptured cyst. We will b running few blood tests as well as some imaging studies that
should help us make a final diagnosis. If ur test results show a clot we will start u on blood
thinners which should prevent further complications such as the possibility of a clot travelling
to ur legs. Do u have any questions for me?
Advice:
Avoid immobilization for long period of time, try to move in place and perhaps take a short
walk, if u are on OCPs please stop using them. Studies have shown that obesity increase risk of
having a clot so I suggest that u exercise regularly and manage ur diet.
Investigations:
Doppler U/S, D-dimer, Hypercoagulability tests, CBC with differential count, CPK and myoglobin
level, CT venography, MRI
29. Knee pain
DDs: GOT-GPRS
G: Gout
O: Osteoarthritis
T: Trauma
G: Gonococcal arthritis
P: Pseudogout/psoriatic arthritis
Do u have photosensitivity?
Physical Examination:
Exam component:
Mouth exam: Inspection
Musculoskeletal: Inspection and palpation (compare both knees including range of motion),
examine other joints (shoulder, elbow, wrist, hands, fingers, hips, ankles)
CV: Auscultation
Pulmonary: Auscultation
Closure:
Thanks for letting me perform a brief physical examination, let me give u my impression what
might be cause of ur problem, well looking at the history and physical examination I’ve
performed I’ve a couple of possibilities in my mind, your problem can be due to diseases like
gout, an infection or RA. To find our I would like to draw fluid from ur knee and then draw some
blood. Sometimes infections from the pelvis can spread to other parts of ur body such as ur
knee and for that reason I would also like to do a pelvic exam. These tests will likely reveal
source of ur pain. You mention earlier that u don’t always use condoms. I know condoms may b
difficult to use regularly but they are important in helping to control spread of STDs. Do u have
any questions for me?
Investigations:
X-ray knee, MRI, Arthrocentesis, RF, Cervical cultures, ANA, CBC, ESR, Serum uric acid.
Introduction:
Hello, I am Dr. David attending pediatrician in this medical center. May I know to whom am I
speaking to? Yes Dr. I am Mrs. Jones. Ok Mrs. Jones How can I help u?
Ohh, I am sorry to listen about ur child’s problem. I will try my level best to help him/her in this
regard. For that I need to ask u few questions. Do u mind if I make a short note while we
discuss..
How he is related to u?
ON-CALL-IDIOT
O: Onset
N: Number
C: Cry/Cough/Consistency
A: Associated symp (Ear discharge, Ear pulling, Watering of eye, Runny nose, Cough, Difficulty
in breathing/swallowing, Rash, Threw up, Cry while passing urine/stool, Bowel movements, Any
dry mouth, Any sunken eyes, Any belly distension, Any sunken soft spot on his head,
Dull/playful, How is he sucking/feeding)
L: Listlessness
I: Immunization
D: Diet/Dehydration/Daycare/Doctor visit
O: ORS
T: Travel
A: Amount
B: Blood or worm
P: Pus/pain/wet diaPers.
Fever: Did u measure the temperature? If yes Where did u measure? (axilla, rectum, oral),
What was reading?
FNV
Then BINDERS
I: Immunization
N: Nutrition
R: Rash
S: SOB/ Sleep
During pregnancy:
Any exposure to alcohol, smoking, drugs?
During delivery:
Was ur baby born preterm, interm, post term or delayed labor?
What was the mode of deliver? Was it normal vaginal delivery or c-section? Was any
complication during pregnancy?
After Delivery:
Any infection after delivery?
Immunization:
Are ur child’s vaccinations up to date?
Nutrition:
Did u breast feed the baby or not?
Daycare:
Does he go any day care?
Doctor visit:
When was his last Drs. visit? If yes then appreciate, if no then advice
ERS:
is there anyone smoker around the child? If yes then Do they smoke around child?
Is ur child safe at home? (child safety) Break the confidentiality and involve child safety team.
PAM-HUGS-F
Mrs. Jones from the information u have given me, I am concerned that ur child may be
dehydrated due to…….. it is very hard for me to assess her over the telephone and I don’t want
to jeopardize her health in any way, so I would like u to bring in ur child to medical center, we
will then proceed accordingly. Meanwhile I advice u to give her plenty of fluids which can
correct her dehydration to certain extent.
Challenging ques:
I can understand ur concern towards ur child’s health. Ur child is in safe hands we have an
excellent ICU here who will take care of ur child.
Ur emotional stability is very important for ur child’s health. Please bear with me. Once I am
done with my questionnaire, I will attend ur child personally.
Investigation:
Rotavirus enzyme immunoassay, Electrolytes, Stool leucocytes/culture/ova/cyst, Parasites, pH,
Urine analysis, urine for c/s, Abdominal x-ray, Blood cultures.
36. Jaundice
Phone case:
Hello, I am Dr. David attending pediatrician in this medical center. May I know to whom am I
speaking to? Yes Dr. I am Mrs. Jones. Ok Mrs. Jones How can I help u?
Ohh, I am sorry to listen about ur child’s problem. I will try my level best to help him/her in this
regard. For that I need to ask u few questions. Do u mind if I make a short note while we
discuss..
How he is related to u?
Late onset:
Breast milk jaundice, Biliary atresia, Metabolic (Hypothyroidism, Galactosemia, G6PD def,
Hereditary hemolytic anemia)
Color changes:
When did u first notice jaundice, < 24 hours, after 7 days, after 14 days?
How it is progressing?
Urine:
What is the color of his urine? Any change?
Stool:
Did he pass any stool?
Vomitus:
Did u throw up? If yes then ABCOP
Is he sucking well?
ABO incompatibility:
What is ur blood group?
Closure:
Mr. Jones as per the information provided by u I am considering a possibility of physiologic
jaundice/natural jaundice. It usually peaks on day 4 or 5 and then gradually disappears over 1-2
weeks. However there are certain other possibilities like jaundice of breast feeding or some
other pathological conditions or birth defects. I do suggest u to bring ur child to the medical
center for further evaluation. Meanwhile I will suggest u to feed ur baby every 1-2 hours during
the day and don’t let him sleep more than 4 hours at night without feeding.
Other than this if he has any signs like temperature of 104 F, any bluish discoloration of the
body, sign and symp, please call 911/come to hospital immediately.
Investigations:
CBC, Blood glucose, Serum Bilirubin (Total, Indirect, Direct), Direct Coomb’s, CRP, Titers for
CMV, Toxoplasmosis and Rubella.
37. Snapping (Being irritable for silly things)
DDs: MH-GAS
M: Menopause
A: Anemia
S: Stress
DOPEFAAA
Is it affecting ur daily activities?
Menopause:
Do u feel hotflashes/vaginal dryness?
GAD:
Are you anxious about anything?
Stress:
Do you have stress?
The information u give me may provide a very important part of my diagnosis. So please open
up.
Phone case:
Hello, I am Dr. David attending pediatrician in this medical center. May I know to whom am I
speaking to? Yes Dr. I am Mrs. Jones. Ok Mrs. Jones How can I help u?
Ohh, I am sorry to listen about ur child’s problem. I will try my level best to help him/her in this
regard. For that I need to ask u few questions. Do u mind if I make a short note while we
discuss..
How he is related to u?
DOPEF
Behavior:
Have u ever punished/rewarded ur child to alter his eating behavior?
Bowel:
Does he often have belly pain?
Any problem with bowel movements? If yes How many times a week does he have his bowel
movements?
ABCOP
Doe he strain while passing stool?
Toilet training:
When did he start sitting on the toilet?
Family:
How many children do u have?
Closure:
According to the information provided by u, I feel that ur son is probably passing through a
normal phase of growth. It is a common problem in this age group. Fortunately it responds to a
few behavioral changes.
First of all I would suggest u to follow a set schedule and offer him a variety of foods at meal
time.
Next important thing is environment at meal time, any argument or watching TV should b
avoided at same time.
Regarding the constipation I would suggest u to provide him high fiber diet like cereals and
vegetables. Encourage him to follow a schedule to use the toilet.
However I need to examine him/her personally and rum down few tests before I make my
diagnosis and give u my final opinion. Do u have any questions for
Me?
Investigations:
Physical exam, CBC, x-ray chest, Serum electrolytes, Serum lead level, TSH, T3, T4, TIBC, Serum
iron, Ferritin.
39. Stridor
DDs: F-CLEAR
C: Croup
L: Laryngitis/Laryngomalacia
E: Epiglottitis
A: Angioedema
R: Reteropharyngeal abscess
Phone case:
Introduction:
I can understand ur concern towards ur child’s health. Ur child is in safe hands, we have an
excellent ICU support here, who will take care of him. Ur emotional stability is very important
for ur child’s health. Please bear with me, for that I need to ask u few questions. Once I finish
asking u, I will attend ur child.
How is he related to u?
DOPEFAAA
Is this sound consistently there/does it come and go?
Associated quest
BIG-DACH
B: When it is better heard?/Breathlessness/Bluish discoloration.
A: Allergy
H: Hoarseness
Closure:
Thanks for letting me perform a brief physical examination, let me give u my impression what
might be cause of ur problem, well looking at the history and physical examination I’ve
performed I’ve a couple of possibilities in my mind, your problem can be due to foreign body
aspiration. However possibilities of some infections causing the same problem might not be
ruled out. I feel that she needs an emergency medical attention. I would suggest u to
immediately call 911 and bring him to the medical center. Meanwhile I will suggest u that
please do not put fingers in his mouth or perform any blind finger sweep bc the foreign body
ma become more deeply lodged, if it is actually present. In case if u observe a significant
respiratory compromise or chocking, please perform a Heimilich’s maneuver by thrusting
tummy with sudden pressure..
Investigations:
Physical exam, ABGs, CBC, x-ray chest, Direct laryngoscopy/Bronchoscopy.
40. Bed wetting
DDs: Primary: Normal <5 years, Family history
Secondary: UTI, Obs: sleep apnea, DM, Functional bladder disorder, Constipation, Cystitis
DOPEFAA
Associated:
Is he ever toilet trained?
You look anxious and concern, in there anything that is bothering you? Would you like to share
with me please?
I don’t know if this is the problem for you but many of pts are in a abusive relationship. So I
have started to ask about it routinely. Are you in a relationship where you are physically and
emotionally abused?
I assure you whatever you will tell me it will remain confidential bw us and nothing will be
released to anyone wilthout your permission.
Miss…. You can trust me. I might be right person for you with whom you can share your
problem. I will do everything possible to make sure that you are safe and sound.
SAFE-GARD
If you suspect that your child is being abused, I will inform child protective service.
Physical Examintion:
Closure:
Thank you for you kind co-operation and patience, I am done with my examination. Now I
would like to give you my impression regarding your problem. Is that ok?
Well miss I am really concerned about your relation with your husband/boyfriend, I would like
to inform you that violence is against the law and you don’t deserve to be abused. Violence
never ends on it own, it almost always increases in severity overtime. The only way to stop
abuse is to get away from abuse. Do you have any safe place to stay?
Miss plz don’t worry fortunately we have good social workers who will arrange safe place for
you.
Introduction:
DOPEFAA
When were you Hospitalized?
What was color of your stool? Consistency? Any blood in stool? Belly pain?
Closure:
43. Polyuria + not gaining weight
DDs: DM1, DI, Parasitic infection
Phone case:
Introduction:
Hello, I am Dr. David attending pediatrician in this medical center. May I know to whom am I
speaking to? Yes Dr. I am Mrs. Jones. Ok Mrs. Jones How can I help u?
Ohh, I am sorry to listen about ur child’s problem. I will try my level best to help him/her in this
regard. For that I need to ask u few questions. Do u mind if I make a short note while we
discuss..
How he is related to u?
DOPEFAA
What was his weight last year?
Closure:
Introduction:
Hello, I am Dr. David attending pediatrician in this medical center. May I know to whom am I
speaking to? Yes Dr. I am Mrs. Jones. Ok Mrs. Jones How can I help u?
Ohh, I am sorry to listen about ur child’s problem. I will try my level best to help him/her in this
regard. For that I need to ask u few questions. Do u mind if I make a short note while we
discuss..
How he is related to u?
Fever:
DOPEFAA
Did you check the temperature?
Seizure:
How long did it last?
Was the jerky movement generalized or it involve any specific part of body?
Closure:
45. Baby with belly pain (Psychiatric case)
Phone case:
Introduction:
Hello, I am Dr. David attending pediatrician in this medical center. May I know to whom am I
speaking to? Yes Dr. I am Mrs. Jones. Ok Mrs. Jones How can I help u?
Ohh, I am sorry to listen about ur child’s problem. I will try my level best to help him/her in this
regard. For that I need to ask u few questions. Do u mind if I make a short note while we
discuss..
How he is related to u?
Closure:
I will surely help you before I refill your medication I would like to ask you some questions
regarding your health and will do brief physical examination. Is that ok?
If history of esophagitis then since how long do you have? Are you taking any medications for
that?
FNVTTTTT
PAMHUGSFOS
Closure