MEDICINE 1 SKILLS LAB 3

1. Chest pain
2. edema (ankle, leg or sacral)
3. Palpitations
MEDICAL COMMUNICATION SKILLS
General
Data
HPI

Risk factors: Age, gender, occupation

FOR EACH SYMPTOM, DESCRIBE
- Onset/timing/duration/frequency
- location
- quality/character
- severity or quantity
- setting in which it occurs
- aggravating and relieving factors
- Associated manifestations: orthopnea, paroxysmal
nocturnal dyspnea, easy fatigability (exercise tolerance/stairs),
intermittent claudication, palpitations, dizziness, blackouts,
heartburn
- For DDx of chest pain, see Bates Table 8-1, pp. 350-351 and
pp. 88-90, DDx of common complaints
For DDx of palpitations, pp. 337-339, DDx of common
complaints
- For DDx of edema, pp. 379-381, DDx of common complaints;
Bates Table 12-1

Past
Medical
History

Family
History
Social,
Environmen
tal History
ROS

- hypertension, diabetes, hyperlipidemia, prior angina or

myocardial infarction, revascularization procedures, abdominal
aortic aneurysm, cerebrovascular disease, peripheral arterial
disease, chronic kidney disease
- medications, dose and compliance (if any)
- previous confinements
- allergies
- FOR CHEST PAIN:
- Risk factors for pulmonary embolism: recent surgery,
recent immobility (long flights, bedridden), on HRT, current
diagnosis of cancer, previously diagnosed pulmonary
embolism/deep vein thrombosis
- recent straining/lifting/chest trauma
- history of heartburn, hiatal hernia or reflux disease
- hypertension, diabetes
- premature cardiovascular disease or sudden death (men aged
<55 or women aged <65)
- smoking history (pack years)
- alcohol intake
- diet
- physical activity
3-5 representative symptoms per system apart from those
asked in the HPI

BASIC EXAMINATION SKILLS TO BE MASTERED (Please refer to

techniques of examination on Chapter 9 of Bates textbook as well as
Bates videos)
Vital Signs
- blood pressure, heart rate, respiratory rate
- calculate BMI
- measure waist circumference
HEENT
-Palpate carotid upstroke and auscultate for carotid bruits
- determine clinical JVP
Heart
- identify point of maximal impulse
- palpate for heaves, lifts and thrills
- identify rate and rhythm
- identify S1 and S2 at the base and apex
- auscultate for S3 (heard in early diastole) and S4 (heard later
in diastole)
- identify murmurs of MR, MS, AR and AS and describe according
to timing, intensity, location and transmission; use maneuvers
when needed (see two important maneuvers in Bates textbook
p. 378 or Bates pdf p. 406)
Lungs
Auscultate for crackles
Abdomen
palpate for hepatojugular reflux
- Observe the neck veins while pressing firmly over the patients
mid-abdomen for 10 seconds. A positive test is when the JVP
rises above 4 cm H20 and remains elevated for the entire 10
seconds. This is an accurate sign of elevated venous pressure
and left heart disease, especially in patients with dyspnea
Extremities
Palpate for pitting edema