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Old 08-17-2012
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Help CS preparation help

I have a quick conceptual question for people who have already given the exam/know someone who has.

I have seen and read the mnemonics to be used while history-taking. Here are the big ones:
LIQOR AAA
SHIFT WATTS (I made this up for Associated symptoms)
PAM HUGS FOSS (for Past medical history and rest)

Now, I have noticed that while doing the cases a lot of these questions are not directly relevant to the present illness/chief complaint. My question is -

Is there enough time to ask LIQORAAA for the chief complaint and then all questions associated with all the differential diagnoses you have in mind, and then all associated symptoms questions (SHIFT WATTS) and then Past medical history (PAMHUGSFOSS)? In every case? If not, then which ones are optional in these mnemonics?

And where does review of systems fit in? optional or necessary? e.g. in a case of headache, should I spend time asking one or two questions from CVS/Respi. etc?

More elaborate example: history taking in a case of patient with headache.

1. History of present illness:
Location
Intensity
Quality
Onset
Radiation (I understand this one can be skipped for headache)
Duration
Frequency
Alleviating factors
Aggravating factors

2. History of all the differential diagnoses for headache:
Halos/auras
Vision loss
Tingling and numbness
Neck stiffness
Difficulty walking
Dizziness
Photophobia
Surgery
Trauma
Weakness
Jaw pain
Sinusitis symptoms
Seizures

3.Associated symptoms:
Sleep
Headache (chief complaint so not to be asked, obviously)
Intolerance to heat or cold
Fever
Trauma
Weight Loss
Appetite
Tick bite
Travel
Stress

4. Past medical history and others:
Past history of headaches
P/h of hypertension and DM
Allergies
Medications
Hospitalization
Urinary symptoms
GI symptoms
Sleep
Family history
Obs/Gyn (depending upon sex)
Social (SODA)
Sexual

5. Review of systems (all other than Neuro since this is a neuro case):
Chest pain, shortness of breath, edema (CVS)
Cough, (Respi)
Nausea, vomiting, diarrhea (GI)
Joint pain (Rheum)
Feeling sad, orientation, memory, energy (Psychi)

What I am trying to figure out is: Should I ask everything written above in ALL patients (of course #2 D/D history will vary in all)? Will I have enough time for this? What are the optional questions from the list above?
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