GME Revision

HPI
Meds
Allergies
Prev Med
PMHx
PSurgHx
SocHx
FamHx
ROS
PE
Imp
Labs
Studies
A/P

HPI: common focused questions:
Eye: red/ painful/ painless vision loss/ acute “curtain” or “floater”/ central blurring
Ear: pressure/ hearing loss/ pruritis/ fullness
Acute Sinusitis: frontal HA/ worse when leaning forward/ purulent nasal dc/ fever/ malaise/ toothache/ abnormal or poor response to decongestants/ tenderness to palpation
Chronic Sinusitis: nasal congestion/ PND/ cough/ unable to clear the throat/ fever/ sinus pain
Common cold: congestion/ rhinorrhea/ sneezing/ sore throat/ HA/ fever/ myalgia/ malaise
Allergic Rhinitis: itchy eyes/ nose/ throat/ tearing/ seasonal or allergic pattern/ pale mucosa
Bacterial Pharyngitis: GAS exposure/ NO rhinorrhea or cough/ T>101/ cervical LAD/ tonsillar exudate

ROS
Pt uses: glasses/ contacts/ hearing aids/ dentures
Constitution: recent weight change/ weakness/ fatigue/ fever
Eyes and Vision: pain/ double vision/ blurred vision/ redness/ excessive tearing/ flashing lights/ glaucoma/ spots/ cataracts/ specks
Nose and Sinuses: stuffiness/ nose bleeds/ sinus trouble/ discharge
Mouth and Throat: sore throat/ sore tongue/ bleeding gums/ hoarseness/ dry mouth
Cardiovascular: chest pain/ edema/ palpitations/ orthopnea/ heart murmurs/ dyspnea/ paroxysmal nocturnal dyspnea/ claudication/ varicose veins
Respiratory: cough/ wheezing/ dyspnea/ hemoptysis/ sputum
Gastrointestinal Abdominal: nausea/ pain/ heartburn/ heartburn/ dysphagia/ rectal bleeding/ vomiting/ constipation/ regurgitation/ change in bowel habits
GU: pain/ urgency/ hesitancy/ incontinence/ frequency
Male: penis: discharge/ sores; testicles: pain/ masses
Female: vaginal: itching/ burning/ discharge/ sores/ lumps; bleeding: postmenopausal/ between periods; menopausal symptoms/ dyspareunia/ dysmenorrheal
Musculoskeletal: muscle or joint pain/ arthritis/ backache
Skin: rashes/ dryness/ lumps/ changes in hair/ sores/ changes in nails/ itching/ color changes
Neuro: fainting/ tingling/ blackouts/ numbness/ seizures/ tremors/ weakness/ involuntary movements/ paralysis
Psychiatric: tension/ nervousness/ memory problems/ sleep problems
Endocrine: intolerance to heat/ cold/ polyuria/ excessive sweating/ excessive thirst or hunger
Hematologic: anemia/ past transfusions/ easy bruisability/ easy bleeding/ neck: lymphadenopathy

PrevMed

Heart Health

• Risk: HTN, HPL, DM, Tobacco, Male, Age, Fam Hx of early CAD, PVD, Obesity
• Aspirin: Men age 40+, women age 50+; anyone, any age at high risk

Health Risks

• Tobacco, etoh
• obesity: BMI 18.5-25; waist: men<35inches, women < 32.5
• sexual health: GC/CT/RPR/HIV

Breast Cancer Screen, age 40-75: Last Mammogram, clinical exam.

• Risk: Pers Hx Breast CA/BRCA/rad tx to chest/ atypical ductal/lobular hyperplasia/ Lobulular CIS/ FamHx

Cervical Cancer Screen: 21-30 (qyr), 30+ (Q2-3y, past 3+neg), 70+ (past 3+neg); consider GC/CT, HIV, Hep, RPR testing if new recent partner/ increased risk

• Risk: pers h/o cerv CA, high risk HPV, HIV, recent change in sexual partner, multiple sexual partners, STD, DES exposure

Colorectal Cancer Screen, age 50-80: Last Colonoscopy (q10y)/Colonography (q5y);

• Risk: Crohn’s/UC/pers h/o polyp/ca/strong fam hx

Prostate Cancer Screen, age 50-70: Last PSA, DRE

• Risk: PIN (pros intraepi neo)/ FamHx/AfAm

Tobacco Use

Lipid Screening, age 20-75: q5y

Osteoporosis Screening, postmenopausal: one-time

• Risk: smoking/ etOH/ hypogonadism(low estrogen in women, low testosterone in men)/ thin/ caucasion/ asian/ pers or fam hx of hip fx or osteoporosis/ diet deficient in Ca or Vit D/ fall risk/ steroids/ rheumatoid arthritis/ men 70+

AAA Screen, age 65-75 with any smoking history: one-time

• Risk: CAD/ CVD/ HTN/ HPL/ PVD

Immunizations:

• Influenza, 50+
• Pneumovax, 65+; booster if 1^st vaccine at < 65yo and >5y ago; booster at 5y if inc risk
• Tetanus, q10y; if <65 yo and needs booster, use Adacel; Adacel booster if high risk and tetanus > 2y ago
• HPV, 9-26y
• Zoster, >65
• Other: consider varicella, hepatitis A, hepatitis B, and MMR