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 Fever, Rigor, Chills, Anorexia, Weight Loss, Fatigue, General Weakness, Sweating, Sleep disturbances
Eye Redness, Itching, Discharge, Tears Ear Redness, Pain, Discharge, Hearing disturbance
Mouth Ulceration, Bleeding Gum Neck Swelling or masses, Limitation in movement
Skin Rash, itching, Pain, Swelling, Hair loss, Nail problems, Hypo/Hyperpigmentation
CVS Chest Pain, SOB, Orthopnea, PND, Palpitation, Ankle Swelling, Syncope, Intermittent Claudication
SOB, Sneezing, Nasal obstruction, Nasal Discharge, Sore Throat, Hoarseness of voice, Epistaxis,
RS Cough, Sputum, Wheeze, Stridor, Hemoptysis,
Dysphagia, Nausea, Vomiting, Indigestion, Heartburn, Regurgitation, Hematemesis, Abdominal Pain,
GIS Distention, Diarrhea, Constipation, Melena, Rectal Bleeding, Rectal Pain, Jaundice
Flank Pain, Dysuria, Hematuria, Urine Discoloration, Hesitancy, Poor Stream, Double Stream,
GUS Dribbling, Incontinence, Frequency, Amount of urine, Frothy urine
MSS Gait, Muscle Pain, Muscle Wasting, Bone Pain, Joint Pain, Joint Swelling, Limitation in movement
Erectile Dysfunction, Ejaculation, Discharge, Testicular (Pain, Atrophy), Ulcers, Nodules, Skin
Genitalia ♂
Discoloration, impotence, loss of libido
 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,
CNS 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

Note:
= = when the symptom happen
When e.g. at rest, while watching TV
 Similar previous attacks  Similar Disease in 1st degree relatives
:
 Chr. Illnesses(MI, DM, HTN, …)  Hx of Chronic/Major Acute illnesses
 Admissions  Early Deaths Timing = variation of the symptom
: during the day/night
 Surgeries
 Blood transfusions
 Traumas  Income
 Hx of recent travel abroad  Insurance If you find any mistake or an
 Allergies  Smoking / Alcohol/ important point missing
Please inform us on:
 Vaccinations Drug abuse / Sexual practices
 Drugs (Now, Previous, Allergies)  Home (rooms, ventilation , floor ) [email protected]
 Occupation
 Marital Status
 Diet www.SAWA2006.com
 Pets
 Stress
 Continous MI , PE , Dissecting Aneurysm , Pneumonia
Duration of the attack
Sudden
Frequency Gradual

Angina , Tietze Syndrome, Da Costa syndrome Intermittent

MI , PE , Pericarditis , Pneumothorax , Rib fracture
When
Progression Crushing
Heaviness

Duration Burning GI

Tearing Dissecting Aneurysm

MI , PE , Pericarditis , Pneumothorax , Rib fracture Acute Character
Angina , Esophagitis , Hiatus Hernia Chronic Onset
Neck, Jaw, Left Arm MI

Back, Throat Esophagus

Radiation Back, Abdomen, Legs Dissecting Aneurysm

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

Chest Pain
s Dyspnea PE , Pneumonthorax , Pneumonia

PND & Orthopnea HF (MI, PE)

RA , SLE Arthritis ± Rash

Cough

Reflux Esophagitis Acid or Bitter Taste in mouth

Fever & Pus-like Sputum Pneumonia , Pleuritis

MI , GERD Nausea & Vomiting

Hemoptysis PE

Associated
Esophageal Spasm Intermittant
Adenophagia / Dysphagia Symptoms
Esophagitis constant WaterBrash GERD

Shingles Rash in the area of pain

Sypmtoms of Anxiety
Nervousness
Costochondritis , Fractured Rib Area of tenderness Tremor
Palpitations
Tachypnea
 Cardiac causes Gastrointestinal Psychosomatic Pulmonary Musculoskeletal Miscellaneous

Ischemic heart disease Gastroesophageal reflux disease Panic attack Pulmonary embolus Costochondritis Arthritis
Acute pericarditis Esophageal spasm Anxiety Pneumonia Fibromyalgia Herpes zoster
Aortic dissection Dysmotility Depression Pneumothorax
Aortic stenosis Cholecystitis
Cocaine-induced Peptic ulcer disease
Pancreatitis
 Sudden ARDS, PE, Pneumothorax, Lung Collapse

Duration of the attack

Frequency Gradual 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 Abscess

Sputum - Pus-like, Large Amt Pulmonary Edema

- Bloody

Cough Wheeze Asthma, COPD, Foreign Body, Tumor, Pulmonary Edema

Stridor Obstustion of the Large Airway Foriegn Body, Tumor, Infection

Rash Associated
Joint Pain Symptoms
Fever Pneumonea of mesothelioma

+ Pus-like Sputum PE

Especially
at Night TB

Sarcoidosis Fatigue
Sweating
HF Ankle Swelling
Arrythmias Palpitations Chest Pain
HF Orthopnea & PND + Bloody Sputum PE
 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
Progression When Trauma, Activity, Spontanous

Other Sites of Swelling Periorbital, Testicular, Ascites

Duration
Analysis
Acute Temperture

Chronic Onset
Stiff Muscles

Rapid Progression
Painful
Browny-Reddish Areas Fever

Cellulitis
Varicose
Veins
Leg Swelling Sharply Defined Edge

Pitting Edema Diffuse

Wt Loss
Fever
Tumor compressing
Night Sweats on a Vein DVT hot
Stiff Muscles

Parasthesia/Numbness
Associated
Urine Output
Renal Symptoms
Urine Color Sudden Sever Calf Pain
Failure Acute Compartment
Bloody Urine Syndrome
Weight Gain
Cold Intolerance
Pallor
Constipation

Skin Nodules Morning Stiffness Myxedema (non pitting Edema)

Rheumatoid Hypothyroidism Hoarseness of Voice

Deformities Arthritis Proximal Joint pain Spider Navi Fatigue
Varices
Jaundice Bilateral Course Dry Skin

Testicular Atrophy
Palmar erythema
Hemoptysis SOB (worse on Evening)
Acute Chest Pain PE Clubbing
Liver
Bilateral Failure Gynecomastia Poor Memory & concentration
Hepatic Encephalopath
Acute Chest Pain
Heart Bleeding tendency
Tachycardia MI Failure PND
Cold Sweating Bilateral
Ascities
exertion Induced
Orthopnia
 Local
General
Acute causes Chronic causes
DVT Pregnancy Heart Failure
Cellulitis Lymphedema (not pitting) Hypoproteinemia (Liver or Kidney Failure)
Allergy Varicose Veins Hypothyroidism
Ruptured Backer Cyst
Trauma
RA
 s

Sudden
Gradual
high Volume
Amount
Low volume of urine Progression
Red Hb, Blood

Transiet Color Dark Urobilinogen Extravascular hemolysis

V.intense Exersice
Frequency
Dark-Brown Bilirubin Inravascular hemolysis

Analysis
Acute All
Onset Which part of Sream Early
Urethral, Prostatic
Chronic Partial
Late Bladder

Odor
Clots

Red-Dark
Common Bile Duct Stone, Pancreatitis,
Anemia Symptoms Abdominal Pain + Jaundice Sclerosing Colingitis, Pancreatic CA,
Malaise Bile Duct CA, Viral or Alcoholic Hepatitis,
↑infection Leukemia
Butterfly Rash
Maliase
↑Bruising
Gum enlargement
Urine Renal Stones, Renal Embolism, Renal CA
Fever SLE Abdominal Pain Kidney Contusion, GN, Polycystic Kidney

Raynaud's
Discoid rash
Jaundice IntraVascular Hemolysis

Intense Pain Loin Fever Pyelonephritis, Lupus Erythmatosis, LE + Kidney Emboli

Radiating to the groin Urinary

Cloudy-Dark Urine Stones
Associated Palpitations
Poor Stream Symptoms
Drippling Prostatic SOB
Hematuria when Disease
Enlarged Vein Ruptures

Pale Stool Biliary Obstruction

Loin Pain
Nausea &
Vomiting Pyelonephritis
Fever Fatigue
Chills

Bad Odor Easy Bruising

Burning Micturition Urgency Bleeding Gum
Frequency UTI Burning Micturition Urethritis Bleeding Epistaxis
Urgency Discharge
Disorders Menorrhagia
Fever (if Upper) 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" Lung CA with involvement of the Left Laryngeal Nerve, Respiratory Muscle Weakness

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

Whooping
Type Character
Barking Epiglottitis
Sudden

Gradual

Progression
Nocturnal Asthma . HF

Acute Timing Early Morning + Sputum Chr. Bronchitis

Onset
Daytime Postnasal Drip , GERD , Bronchiectasis
Chronic
Analysis
Painful

Factors Relieving Drugs, Tea , Herbs

Worsening Drugs , Dust , Fumes , Smoke

Meals Esophageal Diverticulum , Fistula

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

Stridor Foriegn Body , Whooping , Larynx CA , Tracheal CA

Fever
sputum analysis
Infection , Bronchoiectasis

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

Amount
large Purulent affected by Posture Bronchiectasis
Associated
Amount
Sudden Large Purulent Ruptured Abcsess
Larger watery Pinkish (+ SOB) PE
Symptoms Odor
Color
Large Watery for long duration Alveolar cell cancer
Color CA
SOB
Clear (mucoid) COPD Sweating Asthma , COPD , Lung Fibrosis, Lung CA , CHF , PE
Green COPD with infection , Bronchiectasis
TB at Night
Yellow Acute Respiratory tract infection , Asthma Orthopnea + PND HF

Rusty Red Pneumococcal (in Hepatization phase) Chest Pain

Wt Loss CA

Smell Asthma e.g. Eczema Rash

Foul Smell Anaerobic Bacteria
Burning Sensation GERD

Solid Meterial HF Swelling of the Legs

e.g. Foreign Body, Food, Teeth, Mucous Plug
 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
Sudden Gradual

+ Mucus

Progression Consistancy

Dark
Color Bright (Hematochezia)
Bloody
Amount Streaks
Dark
Analysis Odor

Frequency Which part of motion

Specific time during month
rectal Endometriosis Painful All
Infection Acute Partial Early
Anal Fissure, Thrombosed Hemorroids
Onset Late
Chronic

Fatigue
Bloody-Dark
Fever
Palpitation
Dizziness Stool Abdominal pain

Angina Tenismus
Symptoms of
hypovolemia Dysphagia
Sweating SOB

Depression Anal itch Hemorroids, anal fissure, Diarrhea

Change in bowel habit

Abdominal Distension
Abdominal Pain Associated Hematemesis/ UPPER GI BLEEDING:
Esophageal Varices, PUD, Gastritis
Coffee-ground Vomiting
Intestinal Obstruction, Sypmtoms
Constipation intussusception, Mesentric Diverticulitis, Rectal CA,
Thrombosis or embolism Constipation Hemorroids, Anal Fissure
Vomiting

Gastritis, esophagitis, GERD, PUD, Stomach CA,

HeartBurn Mesentric embolism or thrombosis, meckles diverticulum

Easy Bruising
Wt loss
Bleeding Gum
Other Bleeding Epistaxis
↓ Appetite
Cancer Sites Hematuria
Swollen Painful Joints
Early Satiety
 Bleeding duodenal ulcer
Gastric ulcer
Gastric carcinoma
INFECTION: Esophageal carcinoma
- Shigella (bacillary) dysentery Esophageal varices
Acute bloody - Campylobacter enteritis
Meckel's diverticulum
diarrhea ± - Enteroinvasive Escherichia coli Melena
- Enterohaemorrhagic type 0157 E. coli Other causes: angiodysplasia, bleeding disorders
mucus
- Entamoeba histolytica (amoebic) dysentery 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 Rectal Carcinoma
Recurrent Ulcerative colitis Colonic carcinoma
diarrhea Red Bloody Ulcerative colitis
Colonic carcinoma
with blood ± Stool Meckel's diverticulum
Colorectal carcinoma
mucus Crohn's disease
Diverticular disease/ diverticulitis
Massive upper GI bleed
Trauma
Intussusception
 Sudden
Gradual

Amount

Frequency Progression
Acute Color
Chronic Onset

Character - Mixed
- Steaked
Make Sure it is - Clots
not something Else
Hematamesis, epistaxis, Bleeding Gums Analysis
Painful

Cough Analysis

Hemoptysis
Pneumoni, Abscess, Bronchiectasis Fever
Confusion
Foreign Body
CA, CHF Abnormal Breathing Sounds
General Weakness/Fatigue

PE, MI Chest Pain Palpitations

Associated
TB ,CA ,Cystic Fibrosis Wt Loss Symptoms Sweating TB

DVT, HF Leg Swelling SOB

Other Sites of Bleeding Sputum / Change in amt

Easy Bruising, Rectal Bleeding, Menorrhagia, Epistaxis
 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 DI

Progression
Amount

Frequency
At Day & Night Analysis Color
Acute
Onset
Chronic Thirst & Drinking Amt

Polyuria Chills (if upper) Fever (if upper)

Bad Odor Fatigue

Palpitations
menstrual disorders Abnormal Color Groin/Flank Pain
UTI
Tremor

Irritability ↓appetitie Thirst

Diarrhea Associated
Hyperthyroidism Burning Micturation Urgency
↑Appetite
Symptoms

Sweating
Polydepsia
Heat Intolerance
Wt loss
Wt loss
Fatigue

DM PVC Numbness
↑infections
Bone Pain
Blindness Impotence
Blurring Vision
Depression Constipation Late
Polyphagia
GN MI
Loin Pain
Stones
Hyperparathyroidism
Hematuria Abdominal pain Frothy urine

Nocturia
usually Severe Polyuria
Chronic
Nephritis Hematuria

↑Nocturia DI
Dehydration
Edema (if severe due to hypoproteinemia)
↑↑Thirst
 Celiac disease, chronic panceatitis
Fatty, Pale, Floating, difficult to flush Gastrectomy, Cystic fibrosis

Watery CA , Diverticulitis

Mucus IBD, irritable bowel syndrome, Infection

If Chronic Case
Infection , lactase intolerance Progression Consistancy
Z-E syndrome, Carcinoid syndrome
mg antiacids, bowel polyps
high Volume Pale Hemorrhoids
Bright
Amount Color Bloody
IBD, CA Low volume Streaks
IBD, Infection, CA
Occult Diverticulitis, Z-E syndrome
Ask about his
normal Bowel Habit
Frequency Odor
All
Which part of motion
Infection Acute
Onset
Analysis Partial Early
Late
Chronic
Difficulty to flush (steatorrhoea)

Persistance upon fasting

Painful

Diarrhea

Acute
Double vision Early Infection , UC , Severe amoebic Dysentry , Pseudomembranous Colitis
Blurred Vision Neurological Symptoms Fever Late Traveler's Diarrhea , Viral Gastroenteritis
Photophobia Clostridium Botulinum Toxin
poor coordination Burning Z-E syndrome
speech difficulty Cramping Cholera
Abdominal Pain
Steatorrhea
Associated Colicky Infection , IBD , IBS , CA

Wt loss
Fatigue
Symptoms
Abdominal Pain & distension
Celiac Disease Abdominal Distension
Bone fragility
Skin Rash Constipation (Alternating) CA, Irritable bowel syndrome

Heat intolerance
Wt loss Anal Itch
Irritability
Tremor HyperThyroidism
Increased Appetite Tinismus
Goiter

Skin Rash IBD , Celiac

Polyuria
Joint Pain
Polydepsia DM Complication Back Pain Wt loss CA
Blurred Vision Neuropathy
(Retinopathy)
Mouth Ulcers IBD
Skin Rash Toxic staphylacoccal gastroenteritis (2-4 after toxic ingestion)
Eye Redness Vomiting Travelers Diarrhea , Viral Gastroenteritis
 If Chronic Case

Progression Consistancy
Bloody (+ Painful) Hemorrhoids

Bloody (+ Painless) CA , Diverticulitis

Amount Color Bloody & Mucus IBD

Ask about his s

normal Bowel Habit Frequency Odor

Obstruction Acute
Onset Painful
Chronic
Diet , Emotional , Hirschsprung's disease
Analysis

Constipation
Fecal incontinance
Neurological Urinary Retention

Abdominal Pain Analyze

Palpitation Obstruction

Vomiting
Fever

Abdominal Distension
Sweating
Associated
Symptoms Diarrhea (Alternating) CA, Irritable bowel syndrome

Hair loss

Wt loss CA

Polyuria Tremor
DM Complication Slow Speech
Polydepsia
Neuropathy Cold intolerance
Blurred Vision Hypothyroidism
(Retinopathy) Wt gain

Dry Skin
 Hyperthyroidism , Fever Sudden
Caffiene , Drug overdose
Duration of the attack
Continous Gradual

Frequency
When
Intermittent Progression
Amount Ask the ptn
Arrhythmias
Rhythm
to tap it
Acute
Onset
Chronic Analysis Factors
Excercise , emotion , large meal , Anxiety
Stress , Breath holding (Valsalva Maneuver)
Alcohol , Coffee , Drugs , Anger , Position

Irritability
Palpitation
Tremor
inosomia
s
dizziness
poor coordination Anxiety
↑HR
Diarrhea
Throat lump
Urinary Frequency

Hot Flushes Chest Pain

Headache Appropriate Age Associated Angina , MI , Aortic Stenosis

Dry vagina
Dry skin Menopause Symptoms
Diffuse hair loss
Syncope
Night sweats
Pallor
Chest tightness
Dizziness & Fainting
Severity of the Arrhythmia
Heat intolerance SOB
Wt loss Anxiety , Mitral Stenosis , Asthma , Anemia
Irritability
Tremor Fever
Increased Appetite HyperThyroidism Bacterial Endocarditis , Rheumatic Fever
Goiter A CAUSE OF PALPITATION
Sweating
Menstrual Disorders
Diarrhea
Joint Pain Rheumatic Fever

Intermittent
SOB
Headache Polyuria after the attack Paroxymal SVT
Leg Swelling CHF
Pallor Pheochromocytoma ↑HR
chest tightness
Tremor
Sweating