LIQOR AAA
HPI (History of Present Illness):
L Location of the Symptom
I Intensity of the Symptom
Q Quality of the Symptom
O Onset of the Symptom + Precipitating Factors
R Radiation of the Symptom
A Associated Symptoms
A Alleviating Factors
A Aggravating Factors
PAM HUGS FOSS
PMH (Past Medical History):
P Previous Presence of the Symptom
A Allergies
M Medications
H Hospitalization for Any Illness in the Past
U Urinary Changes
G Gastrointestinal Complains
S Sleep Pattern
F Family History
O OB/GYN History
S Sexual Habits
S Socia
HEADACHE
Hx: LIQORAAA, neuro, GI, jaw claudication, recent tx, dentistry, sinusitis
PE: HEENT, fundoscope, neuro
Dx: Migraine, cluster, tension, trigeminal neuralgia, pseudotumor cerebri, sinusitis, temporal arteritis, meningitis
Labs: CBC, ESR, CT, MRI, LP, Doppl
CONFUSION/MEMORY LOSS
Hx: Include fam members, time course, delirium, ADL, stroke, B12, EtOH
PE: HEENT, MMSE, CV, Lungs, Abd, Ext, Neuro, Gait
Dx: Vascular, Alzheimers, NPH, Subdural, TIA, B12, Hypoglicemia, Hypothyroidism, CJD
Labs: CBC, CT, B12, Glucose, TSH, MRI, LP, VDRL
DIZZINESS
Hx: Lightheadedness vs. vertigo, � auditory (hearing, tinnitus), context (position, trauma), A (visual, URI, nausea, vascular)
PE: HEENT, Weber & Rinne, Neck, neuro (Romberg, nystagmus, Dix-Hallpike, gait), CV
Dx: Me?nie?re's, Vestibular neuronitis, Labyr
LOSS OF CONSCIOUSNESS
Hx: A(nausea, diaphoresis, palpitation, pallor, lightheadedness, tongue biting, incontinence, tonic-clonic, prolonged confusion), context
PE: full neuro; CV, Lung
Dx: Seizure, syncope, Substance, Hypoglycemia, orthostatic hypotension, arrhythmia, Malinger
NUMBNESS/WEAKNESS
Hx: LIQORAAA, diabetes, alcoholism, vascular
PE: neuro, Mmsk, CV
Dx: TIA, Hypoglycemia, Seizure, Diabetic PN, Stroke, Guillain-Barre?, MS, Polymyositis, Myasthenia, B12, Todds
Labs: CBC, Glucose, Electrolytes, CT, MRI, B12, Ach, LP
FATIGUE & SLEEPINESS
Hx: Duration; sleep hygiene, snoring, waking up choking/gasping, witnessed apnea; overexertion; stress, depression; diet; weight; thyroid; anemia; meds; EtOH, Drugs
PE: HEENT, CV, lung, ABD, neuro
Dx: PTSD, Depression, Diabetes, Anemia, Apnea, GAD, Hypoth
SORE THROAT
Hx: fever, cough, rash, sick contacts, HIV risk factors.
PE: HEENT, Neck, lung, abd, skin
Dx: mono, pharyngitis, Acute HIV
Labs: CBC, Monospot, Throat culture, HIV Ab & Viral, Anti-EBV
COUGH/SHORTNESS OF BREATH
Hx: sputum, A (URI, postnasal drip, dyspnea, wheezing, chest pain, heartburn)
PE: HEENT, Neck, CV, Lungs, Ext
Dx: Pneumonia, Asthma, GERD, Bronchitis, COPD, Bronchiectasis, CA, TB, Abscess, CHF
Labs: CBC, Sputum Gram stain culture, & cytology, CXR, CT, PP
CHEST PAIN
Hx: LIQORAAA, PAMHUGSFOSS
PE: BP both arms; complete CV, Lung, abd
Dx: MI, Angina, Costochondritis, Aortic dissection, Pericarditis, PE, Pneumo, GERD
Labs: ECG, CPK-MB, troponin, CXR
CBC, electrolytes, Echo, Doppler US, D-dimer
PALPITATIONS
Hx: exertion, caffeine, anxiety, A (lightheaded- ness, chest pain, dyspnea, hyperthyroid)
PE: HEENT, Full CV, Lung
Dx: Hypoglycemia, arrhythmias, Angina, Hyperthyroidism, Hyperventilation, Panic attacks
Labs: Glucose, CBC, electrolytes, TSH, BUN/Cr, ECG,
WEIGHT LOSS
Hx: Amount, duration, � intentional; diet, body image, anxiety/depression, thyroid disease
PE: Gen, CV, Lung, Abd
Dx: Hyperthyroidism, CA, HIV, Anorexia, Malabsorption
Labs: TSH, CBC, electrolytes, HIV, Urine tox
WEIGHT GAIN
Hx: Amount, duration, � intentional; diet, body image, anxiety/depression, thyroid disease
PE: complete, Cushing's
Dx: Smoking cessation, Drug, Hypothyroidism, Cushing's, PCOS, DM, Depression
Labs: CBC, electrolytes, glucose, TSH, 24-hour urine free corti
DYSPHAGIA
Hx: Solids vs liquids, � progressive, A (weight loss, drooling, regurgitation, odynophagia, GERD, Raynaud's) HIV risk.
PE: HEENT, Neck, CV, Lung, Abd, skin (CREST)
Dx: CA, GERD, Achalasia, Esophagitis, sclerosis, stricture, ALS, Zenckers, Plummer-Vinson
L
NAUSEA/VOMITING
Hx: PAMHUGSFOSS (headache, stiff neck, vertigo, focal numbness or weakness)
PE: HEENT (fundoscopic), CV, Abd, Lungs
Dx: Pregnancy, Gastritis, Hypercalcemia, DM, UTI, Depression
Labs: Urine hCG, Pelvic exam, U/S�pelvis
CBC, electrolytes, calcium, glucose,
ABDOMINAL PAIN
Hx: LIQORAAA, PAMHUGSFOSS
PE: CV, Lung, Abd (guarding, rebound, Murphy's, CVA)
Dx: Nephrolithiasis, Pyelonephritis, appendicitis, hepatitis (viral, etoh), pancreatitis, Cholecystitis/choledocholithiasis, AAA, PUD, Gastritis, ovarian torsion, diverticuliti
CONSTIPATION/DIARRHEA
Hx: PAMHUGSFOSS (tenesmus, melena, hematochezia)
PE: Gen, Neck, CV, Lungs, Abd
Dx: Colorectal CA, IBS/IBD, Diverticulosis, parasitic, Angiodysplasia, Low-fiber diet, Substance, Depression, lactose, Hypothyroidism
Labs: rectal, pelvic, CBC, Electrolytes, c
UPPER GI BLEEDING
Hx: PAMHUGSFOSS (severe vomiting, alcohol ingestion, nosebleed, abdominal pain, dyspepsia) (warfarin, NSAIDs)
PE: HEENT, CV, Lung, Abd
Dx: Bleeding peptic ulcer, Gastritis, CA, varices, Mallory-Weiss
Labs: rectal, CBC, electrolytes, AST/ALT/bilirubin/alka
BLOOD IN STOOL
Hx: PAMHUGSFOSS, Melena vs. bright blood; (tenesmus, warfarin)
PE: Gen, CV, Abd
Dx: CR CA, Anal fissure, Hemorrhoids Diverticulosis, Ischemic bowel disease, Angiodysplasia, IBD
Labs: rectal exams
HEMATURIA
Hx: PAMHUGSFOSS, (renal colic, dysuria, irritative voiding symptoms, vigorous exercise, trauma, smoking, stones, cancer, or easy bleeding)
PE: LAD, Abd, Ext
Dx: Bladder CA, Renal CA, Nephrolithiasis, Acute glomerulonephritis, Prostate CA, Coagulation, UTI
OTHER URINARY SYMPTOMS
Hx: PAMHUGSFOSS
(hesitancy, diminished stream, sense of incomplete bladder emptying, straining, postvoid dribbling, urgency, frequency, nocturia),
PE: Abd, focused neurological
Dx: BPH, Prostate CA, UTI, Bladder stones, Urethritis
Labs: genital, rectal UA
ERECTILE DYSFUNCTION
Hx: PAMHUGSFOSS (nocturnal erections, libido, stress, depression, trauma, incontinence)
PE: CV, Neuro
Dx: Drug-related, hypertension, diabetes, Psychogenic, Peyronie
Labs: Genital, Rectal, Glucose, CBC
AMENORRHEA
Hx: PAMHUGSFOSS (Primary vs. secondary, headache, decreased peripheral vision, galactorrhea, hirsutism, virilization, hot flushes, vaginal dryness, thyroid, anorexia, dieting, vigorous exercise ,D&Cs, uterine infections);
PE: Gen, CV, Lung, Abd
Dx: Pregna
VAGINAL BLEEDING
Hx: PAMHUGSFOSS (Pre- vs. postmenopausal, warfarin, contraceptives)
PE:Gen, CV, Lung, Abd
Dx: Dysfunctional uterine bleeding, endometriosis, Coagulation disorders, Cervical/Endometrial cancer, Molar pregnancy, Hypothyroidism, Ectopic, abortion
Labs: pelvi
VAGINAL DISCHARGE
Hx: PAMHUGSFOSS (color, consistency, smell)
PE: Gen, CV, Lung, Abd
Dx: Bacterial vaginosis, Vaginitis (candidal, trichomonal, Cervicitis (chlamydia, gonorrhea)
Labs: pelvic, Wet mount, Cervical cultures, KOH prep, pH of vaginal fluid
DYSPAREUNIA
Hx: PAMHUGSFOSS (discharge, rash, painful menses, hot flushes, adequacy of lubrication, libido)
PE: Gen, CV, Lung, Abd
Dx: Atrophic vaginitis, Endometriosis, Cervicitis, Depression, Domestic abuse
Labs: Pelvic, Wet mount, KOH prep, cervical
cultures, U/S�
ABUSE
Hx: PAMHUGSFOSS (Establish confidentiality, directly question about physical, sexual, or emotional abuse and about fear,
safety, backup plan; history of frequent accidents/injuries, mental illness, drug use; firearms in the home.)
PE: Gen, CV, Lung, Abd,
JOINT/LIMB PAIN
Hx: LIQORAAA, PAMHUGSFOSS (red eye, oral/genital ulceration, rash, focal numbness/weakness)
PE: HEENT, Mmsk, neuro
Dx: Arthritis (Rheumatoid, Psoriatic, Reiter's, IBD), Carpal tunnel syndrome, SLE, Infection (Parvovirus, gonorrhea, Lyme), Osteoarthritis,
LOW BACK PAIN
Hx: LIQORAAA, PAMHUGSFOSS
PE: HEENT, Mmsk (back palpation), neuro
Dx: Disk herniation, Ankylosing spondylitis, Lumbar muscle strain, Tumor, Vertebral compression fracture, Lumbar spinal stenosis
Labs: XR, MRI, CT, ABI
CHILD WITH FEVER
Hx: IQOAAA, PAMHUGSFOSS (sick contacts, day care, immunizations)
PE: HEENT, neck, CV, lung, abd, skin
Dx: Neonatal sepsis, Gastroenteritis, Meningitis
Pneumonia, UTI, AOM, URI
Labs: PE, CBC, electrolytes, UA, Blood/Urine/Stool, culture, CXR, AXR, LP