General Physical Examination : For Step III - Help Guide

Step III candidates have to remember following procedures in order to get through this exam without difficulty.
Hope it helps!

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History
Introductory information

• Introduce, shake hands.
• Name, What age are you now [name clues: ethnicity or age-specific dz].
• Where from [if relevant].

Presenting complaint

• What is the problem lately. Alternatively: What is the problem that brought you to hospital [record in pt's own words].

History of presenting complaint
SOCRATES:

• Site: where, local/ diffuse, "Show me where it is worst".
• Onset: rapid/ gradual, pattern, worse/ better, what did when symptom began.
• Character: vertigo/ lightheaded, pain: sharp/ dull/ stab/ burn/ cramp/ crushing.
• Radiation [usually just if pain].
• Alleviating factors, "What do you do after it comes on?"
• Time course: when last felt well, chronic: why came now.
• Exacerbating factors, "What are you doing when it comes on?".
• Severity: scale of 1-10.
• Associated symptoms.
• Impact of symptoms on life: "Does it interrupt your life".

• "Were you referred here by your GP, or did you come in through casualty?"

Past medical, surgical history

• Past illnesses, operations.
• Childhood illness, obs/gyn.
• Tests and treatment prescribed for these.
  • Drugs remaining relevant: corticosteroids, OCP, anti-HTN, chemotherapy, radiotherapy.
• Checklist of dz's:
  MJ THREADS:
  MI
  Jaundice
  TB
  HTN ["Anyone told you, you have high BP?"]
  Rheumatic fever
  Epilepsy
  Asthma
  Diabetes
  Stroke
• Problems with the anesthetic in surgery.

Gynecological history

• Time of menarche, if periods regular, menopause.
• Possibility of pregnant, number of children, number of miscarriages.
• Length of cycles, length of period, first day of your last period.

Family history

• The current complaint in parents/ siblings: health, cause of death, age of onset, age of death [eg: heart dz, bowel CA, breast CA].
• Health of parents/ siblings/ children: "Are your parents still alive?" "How is the health of your..."
• Hereditary dz suspected: do a family tree.

Social, personal history

• Birthplace, residence.
• Race and migration [if relevant].
• Present occupation [and what do they do there], level of education.
  • Any others at workplace with same complaint.
• Social habits [if relevant].
• Smoking: "Ever smoked, how many per day, for how long, type [cigarette, pipe, chew]".
• Alcohol: do you drink. If yes: type, how much, how often.
• Travel: where, how lived when there, immunization/ prophylactic status when went [if relevant].
• Marital status [and quality], health of spouse/ children, sex activity [discretely, if relevant].
• Other household members, pets [if infections/ allergies], social support, whether patient can manage at home: "Who's with you there at home".
• Diet, physical activity.
• Community care: home help, meals on wheels.
• "Is there some things that worry you about the symptoms you are having?"

Drug history

• Prescriptions currently on [don't trust their written doses, do your own when re-prescribe].
• Over-the-counters.
• OCP.
• Supplements, HRT.
• Alternative medications.
• Recreational drugs.
• Allergies: drugs [and what was reaction], dyes. Pt. often will confuse side effect with a reaction.