Osce surgery for tests

1. DR. MOHCEN AL. HAJ
1
CLINICAL
SURGERY
BY: DR. MOHCEN AL. HAJ

2. DR. MOHCEN AL. HAJ
2
INDEX
* Differential Diagnosis of Abdominal Pain & Vomiting ------------------------------ 3, 4
Cholecystitis OSCE --------------------------------------------------------------------- 5, 6, 7, 8
Appendicitis OSCE ------------------------------------------------------------------------- 9, 10, 11
Vomiting OSCE ---------------------------------------------------------------------- 12, 13, 14, 15
* Differential Diagnosis of Diarrhea & Constipation ------------------------------------- 16
Diarrhea OSCE --------------------------------------------------------------------- 17, 18, 19, 20
Constipation OSCE --------------------------------------------------------------------- 21, 22, 23
* Differential Diagnosis of Jaundice, Heamatemesis & Lower GIT Bleeding -- 24
Jaundice OSCE ------------------------------------------------------------------------- 25, 26, 27
Upper GIT Bleeding (Heamtemesis) OSCE --------------------------------- 28, 29, 30
Lower GIT Bleeding (Bleeding Per Rectum) OSCE ---------------------- 31, 32, 33
* Differential Diagnosis of Neck Swelling, Breast Lump & Diabetic Foot ------ 34
Neck Swelling OSCE ----------------------------------------------------------- 35, 36, 37, 38
Breast Lump OSCE -------------------------------------------------------------------- 39, 40, 41
Diabetic Foot OSCE ----------------------------------------------------------- 42, 43, 44, 45
* Differential Diagnosis of Hernia & Heamaturia ---------------------------------------- 46
Hernia OSCE ---------------------------------------------------------------------------- 47, 48, 49
Heamaturia OSCE --------------------------------------------------------------------- 50, 51, 52

3. DR. MOHCEN AL. HAJ
3
* ABDOMINAL AREAS & DIFFERENTIAL DIAGNOSIS *
RIGHT
HYPOCHONDRIUM:
--------------------------------------------
- Cholecystitis.
- Biliary Colic.
EPIGASTRIC AREA:
-----------------------------------------------
- Peptic Ulcer.
- Gastritis.
- Pancreatitis.
- Diabetic Keto Aidosis.
LEFT
HYPOCHONDRIUM:
-----------------------------------------
- Spleenic Infarction.
- Duodenal Ulcer.
- Pancreatitis.
RIGHT LUMBAR
AREA:
--------------------------------------------
- Ureteric Colic.
- Urinary Tract
Infection.
UMBALICAL AREA:
-----------------------------------------------
- Inflammatory Bowel
Disease.
- Early Appendicitis.
Pancreatitis.
LEFT LUMBAR
AREA:
-----------------------------------------
- Ureteric Colic.
- Urinary Tract
Infection.
RIGHT ILIAC
FOSSA:
--------------------------------------------
- Appendicitis.
- Meckles Diverticulitis.
- Ilio-Ceaca Crhons.
- Ilio-Ceaca TB.
- IN MALE  Torsion of
Un-descending Testis.
- IN FEMALE  Ectopic
Pregnancy & Torsion of
Ovarian Cyst.
SUPRA PUBIC AREA:
-----------------------------------------------
- Pelvic Inflammatory
Disease.
- Urinary Tract Infection.
- Inflammatory Bowel
Disease.
LEFT ILIAC
FOSSA:
-----------------------------------------
- Diverticulosis
(Diverticular Disease of
Colon).
- IN MALE  Torsion
of Un-descending Testis.
- IN FEMALE  Ectopic
Pregnancy & Torsion of
Ovarian Cyst.

4. DR. MOHCEN AL. HAJ
4
Differential Diagnosis of Abdominal Pain
Surgical Causes Medical Causes
Acute Causes Chronic Causes
1. Acute Cholecystitis.
2. Acute Pancreatitis.
3. Acute Appendicitis.
4. Acute Diverticulitis.
5. Intestinal Obstruction.
6. Peritonitis.
7. Torsion of
Undescending Testis.
8. Ectopic Pregnancy &
Torsion of Ovarian Cyst.
1. Chronic Cholecystitis.
2. Chronic Biliary Colic.
3. Chronic Pancreatitis.
4. Peptic Ulcer.
5. Renal Colic.
6. Ilio-Ceacal Crhons.
7. Ilio-Ceacal TB.
8. Diverticulosis.
9. Constipation.
CVS:
Myocardial Infarction.
Respiratory:
Pneumonia.
Endocrine:
1. Diabetic Keto Acidosis.
2. Addison’s Disease.
3. Pheochromocytoma.
Heamatology:
Sickle Cell Crises.
Others:
1. Hyer-Calceamia.
2. Lead Poisoning.
Differential Diagnosis of Vomiting
GIT Causes Non GIT Causes (AHMID)
1. Acute Abdomen:
Acute Cholecystitis.
Acute Pancreatitis.
Acute Appendicitis.
Intestinal Obstruction.
2. Peptic Ulcer.
3. Gastritis.
4. Gastro-Enteritis.
1. Acohol.
2. Hypercalceamia
3. Myocardial Infarction.
4. Meneirs Disease of Inner Ear.
5. Infection (UTI).
6. Increase Intra Cranial Pressure.
7. Diabetic Keto Acidodsis.
8. Drugs.
(Anti-Biotics, Digoxin, Chemotherapy).

5. DR. MOHCEN AL. HAJ
5
CHOLECYSTITIS OSCE
The Possible Main Complain in Clinic Exam is:
Upper Abdominal Pain: as Main Complain For Cholecystitis.
Also as Main Complain FOR Biliary Colic, Pancreatitis, Gastritis & Peptic Ulcer.
Cholecystitis Pain  Usually in Right Hypochondrial Area, Colicky In Character, Referring to the
Right Shoulder & Radiate to the Back, Aggravated by Fatty Meal, Relieved by Medication & Vomiting.
UPPER ABDOMINAL PAIN (RIGHT HYPOCHONDRIAL) as Main Complain:
INTRODUCE YOUR SELF & TAKE PERMISSION FROM THE PATIENT.
1. PERSONAL DATA: Name, Age, Nationality, Occupations.
2. MAIN COMPLAIN: What is Your Complain? & Duration.
3. ANALYSIS OF MAIN COMPLAIN:  SOCRRAATCS
S  Site Right Hypochondrial Area. ‫الوجع‬ ‫مكان‬ ‫وٌن‬ ‫حاج‬ ‫ٌا‬ ً‫ماعلٌش‬
‫علٌه؟‬ ‫اٌدك‬ ‫حط‬ ‫؟‬
O  Onset Sudden OR Gradual. ‫بشوٌة‬ ‫وإال‬ ‫فجأة‬ ‫معاك‬ ‫بدي‬ ‫الوجع‬ ‫هل‬
‫ٌزٌد‬ ‫مرة‬ ‫كل‬ ‫ومع‬
‫حاج‬ ‫ٌا‬
‫؟‬
Acute Chlecystitis  Sudden ,, Chronic Cholecystitis  Gradual.
C  Character of Pain Colicky  Cholecystitis. ً‫توصفل‬ ‫تقدر‬ ‫حاج‬ ‫ٌا‬ ً‫سامحن‬
‫بٌه؟‬ ‫اتحس‬ ‫كٌف‬ ‫الوجع‬
Pancreatitis Stabbing ,,, Peptic Ulcer & Gastritis  Burning.
R  Radiation Referred to the Right Shoulder & Radiate to the Back  Cholecystitis.
‫الوجع‬ ً‫ف‬ ‫اتحسش‬ ‫ما‬
‫اٌسمع‬
‫اٌشٌر‬ ‫أو‬
‫مكان‬ ً‫ف‬
ً‫ثان‬
‫ٌا‬
‫حاج؟‬
R  Relieving Factors Medications & Vomiting  Cholecystitis. ‫معٌن‬ ً‫ش‬ ‫مافٌش‬ ‫حاج‬ ‫ٌا‬ ً‫علٌش‬ ‫ما‬
‫الوجع‬ ً‫ف‬ ‫علٌك‬ ‫اٌنقص‬
‫استرٌحت‬ ‫رجعت‬ ‫لما‬ ‫أو‬ ‫استعملته‬ ‫دواء‬ ‫مثال‬ ‫زي‬
‫؟‬
In Case of Pancreatitis Decreased by Leaning Forward.
A  Aggravating Factors Fatty Meal  Cholecystitis. ‫حاج‬ ‫ٌا‬ ً‫باه‬
ٌ‫ا‬ ‫معٌن‬ ً‫ش‬ ‫مافٌش‬
‫زٌد‬
‫الوجع‬ ً‫ف‬ ‫علٌك‬
‫األكل‬ ‫من‬ ‫معٌن‬ ‫نوع‬ ‫مثال‬ ‫زي‬
‫؟‬
A  Associated Symptoms Vomiting, Jaundice, Change of Bowel Habits & Abdominal Distension.
‫مرة؟‬ ‫قداش‬ ‫رجعت؟‬ ‫حاج‬ ‫ٌا‬ ‫الوجع‬ ‫غٌر‬ ‫من‬
‫ما‬ ً‫باه‬ ‫دم؟‬ ‫أو‬ ‫مرار‬ ‫فٌه‬ ‫هل‬ ‫لونه؟‬ ‫كان‬ ‫شن‬
‫حاج‬ ‫ٌا‬ ‫البراز‬ ‫لون‬ ‫شن‬ ‫إسهال؟‬ ‫ماعندكش‬ ‫بعضه؟‬ ‫مع‬ ‫أصفر‬ ‫ولى‬ ‫لونك‬ ‫الحظتش‬
‫؟‬
T  Time of Pain Time of Pain Still Until the Patient Takes Medications or After Vomiting.
‫معاك‬ ‫ٌقعد‬ ‫تقرٌبا‬ ‫قداش‬ ‫ٌجٌك‬ ‫لما‬ ‫الوجع‬ ‫حاج‬ ‫ٌا‬ ً‫سامحن‬
‫؟‬
C  Course of Pain Regressive or Constant or Progressive. ‫علٌك؟‬ ‫خفش‬ ‫ما‬ ‫الٌوم‬ ‫ل‬ ‫الوجع‬ ‫جاك‬ ‫لما‬ ‫من‬
S  Severity Interfering with Daily Activity. ‫معاي‬ ‫تعبتك‬ ‫حاج‬ ‫ٌا‬ ً‫سامحن‬
,
‫امخلٌك‬ ‫مش‬ ‫الوجع‬ ‫هل‬
Interfering with Sleep. ‫و‬ ‫ترقد‬
‫مش‬
‫امخلٌك‬
‫ل‬ ً‫تمش‬
‫طبٌعٌة؟‬ ‫حٌاتك‬ ‫تمارس‬ ‫أو‬ ‫عملك‬

6. DR. MOHCEN AL. HAJ
6
4. SYSTEMIC REVIEW: Start with the Involved System First.
- GIT:  ASK ABOUT :-
*Jaundice  FOR Gall Stone Because Cholecystitis Commonly Caused by
Gall Stone, and Gall Stone Leads to Obstructive Jaundice.
*Diarrhea & Color of Stool  DUE TO Obstructive Jaundice  Obstructive
Jaundice Leads to Malabsorption & Diarrhea (In Chronic Case).
*Appetite & Weight Loss  FOR Malabsorption, Because Obstructive Jaundice
Leads to Malabsorption (Also Patient Fear From Fatty Meal).
*Fever & Rigor  FOR Charcot’s Triad (Ascending Cholangitis Due to Stone).
*Heart Burn, Dysphagia & Melena  TO EXLUDE Peptic Ulcer & Gastritis.
*Oral Ulcer, Diarrhea & Bleeding Per Rectum  FOR Crhons Disease Because
Crhons Disease Leads to Gall Stone. ‫الحظت‬ ‫ما‬ ,‫حاج‬ ‫ٌا‬ ً‫سامحن‬
‫الصفٌر؟‬ ‫وجاك‬ ‫أصفر‬ ‫ولى‬ ‫لونك‬ ‫ش‬
‫الحظت‬ ‫ما‬ ‫حاج؟‬ ‫ٌا‬ ‫األكل‬ ‫مع‬ ‫شهٌتك‬ ‫كٌف‬ ً‫باه‬ ‫البراز؟‬ ‫لون‬ ‫شن‬ ‫حاج؟‬ ‫ٌا‬ ‫إسهال‬ ‫عندك‬ ً‫باه‬
‫ش‬
‫حاج؟‬ ‫ٌا‬ ‫نقص‬ ‫وزنك‬
‫الحظت‬ ‫ما‬ ,‫تعبتك‬ ‫حاج‬ ‫ٌا‬ ً‫سامحن‬
‫ش‬
‫أو‬ ‫حموضه‬ ‫عندك‬ ‫حاج‬ ‫ٌا‬ ً‫باه‬ ‫بعضه؟‬ ‫مع‬ ‫ٌرعش‬ ‫بجسمك‬ ‫حسٌت‬ ‫و‬ ‫ارتفعت‬ ‫حرارتك‬
‫البراز‬ ‫لون‬ ‫الحظتش‬ ‫ما‬ ً‫باه‬ ‫البلع؟‬ ً‫ف‬ ‫صعوبة‬ ‫عندك‬ ‫المعده؟‬ ‫فم‬ ً‫ف‬ ‫حرقان‬
‫بدي‬
‫تقرحات‬ ‫أو‬ ‫طٌاب‬ ‫عندكش‬ ‫ما‬ ‫أسود؟‬
‫الشرج؟‬ ‫فتحة‬ ‫من‬ ‫نزٌف‬ ‫أو‬ ‫مشاكل‬ ‫أي‬ ‫أو‬ ‫إسهال‬ ‫عندكش‬ ‫ما‬ ,‫حاج‬ ‫ٌا‬ ً‫سامحن‬ ‫حاج؟‬ ‫ٌا‬ ‫الفم‬ ً‫ف‬
- CVS:  ASK ABOUT :-
*Chest Pain, Dyspnea & Sweating  TO EXCLUDE Inferior Myocardial Infarction
Because Inferior MI Can Cause Upper Abdominal Pain.
*Orthopnia, PND & Lower Limb Edema  TO EXCLUDE Heart Failure.
,‫حاج‬ ‫ٌا‬ ً‫ماعلٌش‬
‫عندك‬
‫القلب‬ ً‫ف‬ ‫وجع‬
‫؟‬
‫على‬ ‫ترقد‬ ‫حاج؟‬ ‫ٌا‬ ‫تدهش‬ ‫وبدٌت‬ ‫عرقت‬ ‫روحك‬ ‫الحظتش‬ ‫ما‬ ً‫باه‬
‫منفخات؟‬ ‫رجلٌك‬ ‫الهواء؟‬ ً‫ف‬ ‫ادور‬ ‫فجأة‬ ‫اللٌل‬ ً‫ف‬ ‫اتنوض‬ ‫روحك‬ ‫ماالحظتش‬ ً‫باه‬ ‫مخده؟‬ ‫من‬ ‫أكثر‬ ‫أو‬ ‫وحده‬ ‫مخدة‬
- Respiratory System:  ASK ABOUT :-
*Productive Cough, Dyspnea & Fever TO EXCUDE Lower Lobe Pneumonia Because
Lower Lobe Pneumonia Can Cause Upper Abdominal Pain. ‫كحة‬ ‫عندك‬
‫أ‬
‫و‬
‫حرارة‬ ‫و‬ ‫دهشة‬
‫؟‬
- Genito-Urinary System:  ASK ABOUT :-
*Color of Urine Because it Will Be Dark in Color in Case of Obstructive Jaundice.
*Loin Pain & HeamaturiaTO EXCLUDE Renal Stone Because Renal Stone Can Cause
Upper Abdominal Pain. ‫؟‬ ,‫حاج‬ ‫ٌا‬ ً‫سامحن‬
‫ش‬
‫جنابك‬ ً‫ف‬ ‫وجع‬ ‫عندك‬ ‫ماالحظتش‬ ‫دم؟‬ ‫معاه‬ ً‫ف‬ ‫البول؟‬ ‫لونه‬ ‫ن‬
- Endocrine System:  ASK ABOUT :-
*Polyuria, Polyphagia, Confusion & Drowsiness TO EXCLUDE Diabetic
Ketoacidosis (DKA) Because DKA Cause Abdominal Pain. ‫روح‬ ‫ماالحظتش‬
‫الحمام‬ ‫اتخش‬ ‫ك‬
‫عرفت‬ ‫ما‬ ‫أو‬ ً‫الوع‬ ‫فقدت‬ ‫أو‬ ‫دوخه‬ ‫ب‬ ‫حسٌتش‬ ‫ما‬ ً‫باه‬ ‫حاج؟‬ ‫ٌا‬ ‫بكثرة‬ ‫واتجوع‬ ‫بكثرة‬
‫ش‬
‫وٌن؟‬ ‫روحك‬

7. DR. MOHCEN AL. HAJ
7
- Hematology:  ASK ABOUT :-
*Generalized Fatigability, Dizziness, Pallor  FOR Hemolytic Aneamia Because of
Hemolytic Aneamia Can Cause Pigmented Gall Stone.
,‫معاي‬ ‫تعبتك‬ ‫حاج‬ ‫ٌا‬ ً‫سامحن‬
‫بعضه؟‬ ‫مع‬ ‫فاشل‬ ‫جسمك‬ ً‫ف‬ ‫اتحسش‬ ‫ما‬
‫حاج؟‬ ‫ٌا‬ ‫شحوب‬ ‫وال‬ ‫دوخه‬ ‫ماعندكش‬ ً‫باه‬
- IN FEMALE: Gynea & Obstetric:  ASK ABOUT :-
*Ask About  Menstrual Cycle & Abortion OR Ectopic Pregnancy.
5. PAST MEDICAL HISTORY:
*History of Same Illness Before? If Yes How Many Times? When Was the Last Time?
Does He Admitted or No? Does He Admitted to ICU or No?
‫ماصارتلكش‬ ‫حاج‬ ‫ٌا‬ ً‫ماعلٌش‬
‫نفس‬
‫المشكلة‬
‫دخلوك‬ ‫هل‬ ‫مرة؟‬ ‫آخر‬ ‫كانت‬ ‫أمتى‬ ‫صارتلك؟‬ ‫مرة‬ ‫قداش‬ ‫قبل؟‬ ‫من‬ ‫هادي‬
‫الٌوم؟‬ ‫نفس‬ ً‫ف‬ ‫طلعت‬ ‫واال‬ ‫المستشفى‬
‫العناٌة؟‬ ‫خشٌت‬ ‫هل‬
*History of Any Chronic Illness (Like DM, HTN, CRF)? If Yes  What is the Duration of
the Chronic Illness? What is the Treatment? Does He in Regular Follow up? ‫ٌا‬ ً‫سامحن‬
‫ماعندكش‬ ,‫حاج‬
‫لتوا‬ ‫عالج‬ ً‫ف‬ ‫وتاخدلها‬ ‫قدٌمة‬ ‫صحٌة‬ ‫مشكلة‬ ‫أي‬
‫مثال)؟‬ ‫ضغط‬ ‫أو‬ ‫(سكر‬
‫حاج؟‬ ‫ٌا‬ ‫المشكلة‬ ‫هٌا‬ ‫شن‬
‫لٌه‬ ‫قداش‬
‫ا‬
‫عالج؟‬ ‫من‬ ‫تاخدلها‬ ‫وشن‬ ‫؟‬
‫وم‬ ‫اتراجع‬ ‫هل‬
‫الكالوي؟‬ ً‫ف‬ ‫تغسل‬ ‫حاج؟‬ ‫ٌا‬ ‫ال‬ ‫وإال‬ ‫مراجعاتك‬ ً‫ف‬ ‫نتظم‬
*Viral Screen  FOR Hepatitis. ‫النتٌجة؟‬ ‫كانت‬ ‫وشن‬ ‫درتها؟‬ ‫صحٌة‬ ‫شهادة‬ ‫آخر‬ ‫أمتى‬ ‫حاج‬ ‫ٌا‬
6. DRUG HISTORY:
*Ask the Patient About Any Drugs Can Cause Gall Stone Such as  OCP (Progesterone).
*Also Aspirin, Warfarine Steroid Thyroxin, Insulin (What is the Dose if He Knows?) &
ACE I (What is the Dose if He Knows?). ‫مس‬ ‫ولتوا‬ ‫طوٌلة‬ ‫فترة‬ ‫من‬ ‫دواء‬ ً‫ف‬ ‫تاخد‬ ‫حاج‬ ‫ٌا‬ ً‫ماعلٌش‬
‫تمر‬
‫علٌه؟‬
‫حاج‬ ‫ٌا‬ ‫الدواء‬ ‫هوا‬ ‫شن‬
‫الجرعة؟‬ ‫وقداش‬
7. PAST SURGICAL HISTORY:
*Any History of Stone Extraction, CBD Stricture Surgery,
*Previous General Anesthesia (Halothane).
*Any History Of Tattooing  FOR Hepatitis.
*Any History of Recurrent Blood Transfusion FOR Heamolytic Anemia.
*Any History of Blood Transfusion FOR Hepatitis.
*Any History of Heamo-Dialysis  FOR Hepatitis. ‫عملٌة‬ ‫أي‬ ‫امداٌر‬ ‫مش‬
‫ع‬ ‫جراحٌة‬
‫الكبد‬
‫المرارة‬ ‫ع‬ ‫حصوة‬ ‫أو‬ ‫الصفراوٌة‬ ‫القنوات‬ ‫أو‬
‫؟‬
‫لٌها‬ ‫قداش‬
‫؟‬
‫نوع‬ ‫شن‬ ‫حاج؟‬ ‫ٌا‬ ً‫موضع‬ ‫أو‬ ‫عام‬ ‫تخدٌر‬ ‫دارولك‬
‫تعرفه؟‬ ‫لو‬ ‫المخذر‬
‫مضاعفات‬ ‫أو‬ ‫مشاكل‬ ‫أي‬ ‫ماصارتلكش‬ ‫حاج‬ ‫ٌا‬ ً‫سامحن‬
‫العملٌة؟‬ ‫بعد‬
‫ماعندكش‬
‫وشم؟‬ ‫أي‬
‫وفترة؟‬ ‫فترة‬ ‫بٌن‬ ‫دم‬ ً‫ف‬ ‫اٌزٌدولك‬
‫زاٌد‬ ‫وال‬ ‫مرة؟‬ ‫قداش‬
‫دم‬
‫حاج‬ ‫ٌا‬ ‫حٌاتك‬ ً‫ف‬ ‫بكل‬
‫؟‬
ً‫باه‬
ٌ‫كالو‬ ً‫ف‬ ‫تغسل‬
‫ك‬
‫؟‬

8. DR. MOHCEN AL. HAJ
8
8. FAMILY HISTORY:
*Any History of Same Illness in His Family (Especially Heamolytic AnemiaGilbert Synd)
*Any History of Sudden Death in His Family.
*Ask if His First Relative Degrees Had Any Chronic Illness (Like DM, HTN, CRF).
‫عنده‬ ‫عٌلتك‬ ‫من‬ ‫حد‬ ‫مافٌش‬
‫نف‬
‫العٌلة‬ ً‫ف‬ ‫حد‬ ً‫ف‬ ‫هل‬ ‫المشكلة؟‬ ‫س‬
‫ٌاحاج‬ ‫طول‬ ‫السبب‬ ‫عرفتوش‬ ‫وما‬ ‫فجأة‬ ‫مات‬
‫؟‬
‫ع‬ ‫عٌلتك‬ ً‫ف‬ ‫حد‬ ً‫ف‬
‫نده‬
‫الضغط‬ ‫أو‬ ‫السكر‬ ‫زي‬ ‫وقدٌمة‬ ‫مزمنة‬ ‫صحٌة‬ ‫مشكلة‬ ‫أي‬
‫الكلى‬ ً‫ف‬ ‫فشل‬ ‫أو‬
‫؟‬
9. SOCIAL HISTORY:
*Ask If He is Alcoholic (If He is Alcoholic Ask about Duration & Amount).
(Because Alcohol is a Strong Risk Factor for Hepatitis & Liver Cirrhosis).
*Ask If He is Smoker or Ex-Smoker (If He is Smoker Ask about Duration & Amount).
*Ask About Sedentary Life, Obesity & Fat Intake.
‫حاج‬ ‫ٌا‬ ‫السؤال‬ ً‫ف‬ ً‫سامحن‬
,
‫المسكرات‬ ‫من‬ ‫نوع‬ ‫أي‬ ً‫ف‬ ‫تشرب‬
‫هل‬ ‫تشرب‬ ‫قداش‬ ‫كل‬ ‫بمعدل‬ ,‫حاج‬ ‫ٌا‬ ً‫سامحن‬ ‫؟‬
‫حاج‬ ‫ٌا‬ ً‫باه‬ ‫مرة؟‬ ‫الشهر‬ ً‫ف‬ ‫أو‬ ‫مرة‬ ‫األسبوع‬ ً‫ف‬ ‫أو‬ ‫ٌوم‬ ‫بعد‬ ‫ٌوم‬ ‫أو‬ ‫ٌومٌا‬
‫ادخن؟‬
‫لٌك؟‬ ‫قداش‬
‫شن‬ ‫حاج‬ ‫ٌا‬
‫الحوش؟‬ ً‫ف‬ ‫راقد‬ ‫دٌما‬ ‫وإال‬ ‫وتتمشى‬ ‫حاج‬ ‫ٌا‬ ‫تتحرك‬ ً‫باه‬ ‫هلبا؟‬ ‫دهنٌات‬ ‫فٌها‬ ‫هل‬ ‫أكلك‬ ‫طبٌعة‬
10. TRAVEL HISTORY: FOR Hepatitis. ‫األخٌرة؟‬ ‫الفترة‬ ‫مكان‬ ‫ألي‬ ‫سافرت‬
‫لٌها؟‬ ‫قداش‬
‫وٌن؟‬
11. OCCUPATIONAL HISTORY: Medical Stuff  Needle Stick Hepatitis.
12. SEXUAL HISTORY: FOR Hepatitis.

9. DR. MOHCEN AL. HAJ
9
ACUTE APPENDICITIS OSCE
The Possible Main Complain in Clinic Exam is:
Right Iliac Fossa: as Main Complain For Acute Appendicitis.
Also as Main Complain FOR Meckles Diverticulitis, Crhons Colitis, Inguinal Hernia,
Ectopic Pregnancy in Female & Torsion of Un-descending Testis in Male.
Appendicitis Pain  Start Around Umbilicus then toward Right Iliac Fossa, Stabbing In Character,
Aggravated by Cough & Movement, Relieved by Medication (Analgesia).
RIGHT ILIAC FOSSA PAIN as Main Complain:
INTRODUCE YOUR SELF & TAKE PERMISSION FROM THE PATIENT.
1. PERSONAL DATA: Name, Age, Nationality, Occupations.
2. MAIN COMPLAIN: What is Your Complain? & Duration.
3. ANALYSIS OF MAIN COMPLAIN:  SOCRRAATCS
S  Site Right Iliac Fossa. ‫الوجع‬ ‫مكان‬ ‫وٌن‬ ‫حاج‬ ‫ٌا‬ ً‫ماعلٌش‬
‫اٌدك‬ ‫حط‬ ‫؟‬
‫علٌه؟‬
O  Onset Sudden OR Gradual. ‫بشوٌة‬ ‫واال‬ ‫فجأة‬ ‫معاك‬ ‫بدي‬ ‫الوجع‬ ‫هل‬
‫ٌزٌد‬ ‫مرة‬ ‫كل‬ ‫ومع‬
‫حاج‬ ‫ٌا‬
‫؟‬
C  Character of Pain In the Beginning  Colicky ,,, Then Later  Stabbing.
ً‫توصفل‬ ‫تقدر‬ ‫حاج‬ ‫ٌا‬ ً‫سامحن‬
‫بٌه؟‬ ‫اتحس‬ ‫كٌف‬ ‫الوجع‬
R  Radiation Usually  Non.
R  Relieving Factors Medications (Analgesia)  Appendicitis. ‫معٌن‬ ً‫ش‬ ‫مافٌش‬ ‫حاج‬ ‫ٌا‬ ً‫علٌش‬ ‫ما‬
‫الوجع‬ ً‫ف‬ ‫علٌك‬ ‫اٌنقص‬
‫استعملته‬ ‫دواء‬ ‫مثال‬ ‫زي‬
‫؟‬
A  Aggravating Factors Cough & Movement  Appendicitis. ‫حاج‬ ‫ٌا‬ ً‫باه‬
ٌ‫ا‬ ‫معٌن‬ ً‫ش‬ ‫مافٌش‬
‫زٌد‬
‫علٌك‬
‫الوجع‬ ً‫ف‬
‫اتكح‬ ‫أو‬ ‫تتحرك‬ ‫لما‬ ‫مثال‬ ‫زي‬
‫؟‬
A  Associated Symptoms Nausea, Vomiting, Fever. ‫لونه؟‬ ‫كان‬ ‫شن‬ ‫مرة؟‬ ‫قداش‬ ‫رجعت؟‬ ‫حاج‬ ‫ٌا‬ ‫الوجع‬ ‫غٌر‬ ‫من‬
‫مرار‬ ‫فٌه‬ ‫هل‬
‫حاج‬ ‫ٌا‬ ‫ارتفعت‬ ‫حرارتك‬ ‫الحظتش‬ ‫ما‬ ً‫باه‬ ‫دم؟‬ ‫أو‬
‫؟‬
T  Time of Pain Time of Pain Still Until the Patient Takes Medications (Analgesia).
‫تقرٌبا‬ ‫قداش‬ ‫ٌجٌك‬ ‫لما‬ ‫الوجع‬ ‫حاج‬ ‫ٌا‬ ً‫سامحن‬
‫؟‬ ‫معاك‬ ‫ٌقعد‬
C  Course of Pain Regressive or Constant or Progressive. ‫علٌك؟‬ ‫خفش‬ ‫ما‬ ‫الٌوم‬ ‫ل‬ ‫الوجع‬ ‫جاك‬ ‫لما‬ ‫من‬
S  Severity Interfering with Daily Activity. ‫معاي‬ ‫تعبتك‬ ‫حاج‬ ‫ٌا‬ ً‫سامحن‬
,
‫امخلٌك‬ ‫مش‬ ‫الوجع‬ ‫هل‬
Interfering with Sleep. ‫و‬ ‫ترقد‬
‫مش‬
‫امخلٌك‬
‫ل‬ ً‫تمش‬
‫طبٌعٌة؟‬ ‫حٌاتك‬ ‫تمارس‬ ‫أو‬ ‫عملك‬

10. DR. MOHCEN AL. HAJ
10
4. SYSTEMIC REVIEW: Start with the Involved System First.
- GIT:  ASK ABOUT :-
*Oral Ulcer, Diarrhea & Bleeding Per Rectum  TO EXCLUDE Ilio-Ceacal Crhons
Because Ilio-Ceacal Crhons Leads to Right Iliac Fossa Pain.
*Jaundice  TO EXCLUDE Crhons , Because Crhons Can Cause Gall Stone & Auto-
Immune Hepatitis Which Leads to Jaundice.
*Appetite, Fever & Weight Loss  TO EXCLUDE Ilio-Ceacal TB, Because
Ilio-Ceacal TB Leads to Right Iliac Fossa Pain.
‫فتحة‬ ً‫ف‬ ‫مشكلة‬ ‫أي‬ ‫أو‬ ‫نزٌف‬ ‫أو‬ ‫اسهال‬ ‫عندكش‬ ‫ما‬ ً‫باه‬ ‫فمك؟‬ ً‫ف‬ ‫تقرحات‬ ‫أو‬ ‫طٌاب‬ ‫أي‬ ‫الحظتش‬ ‫ما‬ ,‫حاج‬ ‫ٌا‬ ً‫سامحن‬
‫نقص؟‬ ‫وزنك‬ ‫الحظت‬ ‫ما‬ ‫حاج؟‬ ‫ٌا‬ ‫األكل‬ ‫مع‬ ‫شهٌتك‬ ‫كٌف‬ ً‫باه‬ ‫الصفٌر؟‬ ‫وجاك‬ ‫أصفر‬ ‫ولى‬ ‫لونك‬ ‫الحظتش‬ ‫ما‬ ً‫باه‬ ‫الشرج؟‬
‫سا‬
‫ارتفعت؟‬ ‫حرارتك‬ ‫الحظتش‬ ‫ما‬ ,‫تعبتك‬ ‫حاج‬ ‫ٌا‬ ً‫محن‬
- CVS:  ASK ABOUT :-
*Chest Pain, Dyspnea & Sweating  TO EXCLUDE Inferior Myocardial Infarction
Because Inferior MI Can Cause Abdominal Pain.
,‫حاج‬ ‫ٌا‬ ً‫ماعلٌش‬
‫عندك‬
‫القلب‬ ً‫ف‬ ‫وجع‬
‫؟‬
‫حاج؟‬ ‫ٌا‬ ‫تدهش‬ ‫وبدٌت‬ ‫عرقت‬ ‫روحك‬ ‫ماالحظتش‬ ً‫باه‬
- Respiratory System:  ASK ABOUT :-
*Productive Cough, Dyspnea & Fever TO EXCUDE Lower Lobe Pneumonia Because
Lower Lobe Pneumonia Can Cause Abdominal Pain. ‫كحة‬ ‫عندك‬
‫أ‬
‫و‬
‫حرارة‬ ‫و‬ ‫دهشة‬
‫؟‬
- Genito-Urinary System:  ASK ABOUT :-
*Loin Pain & HeamaturiaTO EXCLUDE Renal Stone Because Renal Stone Cause
Abdominal Pain. ‫؟‬ ,‫حاج‬ ‫ٌا‬ ً‫سامحن‬
‫ش‬
‫جنابك‬ ً‫ف‬ ‫وجع‬ ‫عندك‬ ‫ماالحظتش‬ ‫دم؟‬ ‫معاه‬ ً‫ف‬ ‫البول؟‬ ‫لونه‬ ‫ن‬
- Endocrine System:  ASK ABOUT :-
*Polyuria, Polyphagia, Confusion & Drowsiness TO EXCLUDE Diabetic
Ketoacidosis (DKA) Because DKA Cause Abdominal Pain. ‫ماالحظتش‬
‫الحمام‬ ‫اتخش‬ ‫روحك‬
‫عرفت‬ ‫ما‬ ‫أو‬ ً‫الوع‬ ‫فقدت‬ ‫أو‬ ‫دوخه‬ ‫ب‬ ‫حسٌتش‬ ‫ما‬ ً‫باه‬ ‫حاج؟‬ ‫ٌا‬ ‫بكثرة‬ ‫واتجوع‬ ‫بكثرة‬
‫ش‬
‫وٌن؟‬ ‫روحك‬
- IN FEMALE: Gynea & Obstetric:  ASK ABOUT :-
*Ask About  Menstrual Cycle & Abortion OR Ectopic Pregnancy.

11. DR. MOHCEN AL. HAJ
11
5. PAST MEDICAL HISTORY:
*History of Same Illness Before? If Yes How Many Times? When Was the Last Time?
Does He Admitted or No? Does He Admitted to ICU or No?
‫ماصارتلكش‬ ‫حاج‬ ‫ٌا‬ ً‫ماعلٌش‬
‫نفس‬
‫المشكلة‬
‫دخلوك‬ ‫هل‬ ‫مرة؟‬ ‫آخر‬ ‫كانت‬ ‫أمتى‬ ‫صارتلك؟‬ ‫مرة‬ ‫قداش‬ ‫قبل؟‬ ‫من‬ ‫هادي‬
‫الٌوم؟‬ ‫نفس‬ ً‫ف‬ ‫طلعت‬ ‫وإال‬ ‫المستشفى‬
‫العناٌة؟‬ ‫خشٌت‬ ‫هل‬
*History of Any Chronic Illness (Like DM, HTN, CRF)? If Yes  What is the Duration of
the Chronic Illness? What is the Treatment? Does He in Regular Follow up? ً‫سامحن‬
‫ٌا‬
‫لتوا‬ ‫عالج‬ ً‫ف‬ ‫وتاخدلها‬ ‫قدٌمة‬ ‫صحٌة‬ ‫مشكلة‬ ‫أي‬ ‫ماعندكش‬ ,‫حاج‬
‫مثال)؟‬ ‫ضغط‬ ‫أو‬ ‫(سكر‬
‫المشكلة؟‬ ‫هٌا‬ ‫شن‬
‫لٌه‬ ‫قداش‬
‫ا‬
‫عالج؟‬ ‫من‬ ‫تاخدلها‬ ‫وشن‬ ‫؟‬
‫وم‬ ‫اتراجع‬ ‫هل‬
‫الكالوي؟‬ ً‫ف‬ ‫تغسل‬ ‫حاج؟‬ ‫ٌا‬ ‫ال‬ ‫واال‬ ‫مراجعاتك‬ ً‫ف‬ ‫نتظم‬
6. DRUG HISTORY:
*If Patient Has Any Chronic Illness That Means He Has Drug History Such as 
Insulin (What is the Dose if He Knows?) & ACE I (What is the Dose if He Knows?).
*Also Steroid, Mesalazine  For Crhons. Also Aspirin, Statin, or Anti-Coagulant. ‫حاج‬ ‫ٌا‬
‫مس‬ ‫ولتوا‬ ‫طوٌلة‬ ‫فترة‬ ‫من‬ ‫دواء‬ ً‫ف‬ ‫تاخد‬
‫ت‬
‫تعرفه؟‬ ‫لو‬ ‫حاج‬ ‫ٌا‬ ‫الدواء‬ ‫هوا‬ ‫شن‬ ‫علٌه؟‬ ‫مر‬
‫تعرفها‬ ‫لو‬ ‫الجرعة‬ ‫وقداش‬
‫؟‬
7. PAST SURGICAL HISTORY:
*Any History of Lapratomy Surgery  FOR Peritonitis
*Any History of Incision & Drainage of Appendicular Abscess,
*Any History of Blood Transfusion.
‫عملٌة‬ ‫أي‬ ‫امداٌر‬ ‫مش‬
‫جراحٌة‬
‫بطن‬ ‫ع‬
‫؟‬
‫لٌها‬ ‫قداش‬
‫؟‬
‫مضاعفات‬ ‫أو‬ ‫مشاكل‬ ‫أي‬ ‫ماصارتلكش‬ ‫حاج‬ ‫ٌا‬ ً‫سامحن‬
‫حاج‬ ‫ٌا‬ ‫دم‬ ‫زادوك‬ ً‫باه‬ ‫العملٌة؟‬ ‫بعد‬
‫؟‬
8. FAMILY HISTORY:
*Any History of Same Illness in His Family.
*Ask if His First Relative Degrees Had Any Chronic Illness (Like DM, HTN, CRF).
‫عنده‬ ‫عٌلتك‬ ‫من‬ ‫حد‬ ‫مافٌش‬
‫نف‬
‫ع‬ ‫عٌلتك‬ ً‫ف‬ ‫حد‬ ً‫ف‬ ‫المشكلة؟‬ ‫س‬
‫نده‬
‫زي‬ ‫وقدٌمة‬ ‫مزمنة‬ ‫صحٌة‬ ‫مشكلة‬ ‫أي‬
‫الضغط‬ ‫أو‬ ‫السكر‬
‫الكلى‬ ً‫ف‬ ‫فشل‬ ‫أو‬
‫؟‬
9. SOCIAL HISTORY:
*Ask If He is Alcoholic (If He is Alcoholic Ask about Duration & Amount).
*Ask If He is Smoker or Ex-Smoker (If He is Smoker Ask about Duration & Amount).
‫حاج‬ ‫ٌا‬ ‫السؤال‬ ً‫ف‬ ً‫سامحن‬
,
‫المسكرات‬ ‫من‬ ‫نوع‬ ‫أي‬ ً‫ف‬ ‫تشرب‬
‫هل‬ ‫تشرب‬ ‫قداش‬ ‫كل‬ ‫بمعدل‬ ,‫حاج‬ ‫ٌا‬ ً‫سامحن‬ ‫؟‬
‫حاج‬ ‫ٌا‬ ً‫باه‬ ‫مرة؟‬ ‫الشهر‬ ً‫ف‬ ‫أو‬ ‫مرة‬ ‫األسبوع‬ ً‫ف‬ ‫أو‬ ‫ٌوم‬ ‫بعد‬ ‫ٌوم‬ ‫أو‬ ‫ٌومٌا‬
‫ادخن؟‬
‫لٌك‬ ‫قداش‬
‫؟‬

12. DR. MOHCEN AL. HAJ
12
VOMITING OSCE:
INTRODUCE YOUR SELF & TAKE PERMISSION FROM THE PATIENT.
1. PERSONAL DATA: Name, Age, Gender, Nationality, Occupations.
2. MAIN COMPLAIN: What is Your Complain? & Duration.
3. ANALYSIS OF MAIN COMPLAIN:  DOARA CS + Properties of
the Vomiting
D  Duration Acute  Acute Abdomen & Gastro-Enteritis. ‫قداش‬ ‫حاج‬ ‫ٌا‬ ً‫سامحن‬
Chronic  Peptic Ulcer. ‫ا‬ ‫لٌه‬
‫لترجٌع‬
‫معا‬
‫ك؟‬
O  Onset Sudden  Acute Abdomen & Gastro-Enteritis. ‫فجأة‬ ‫معاك‬ ‫بدي‬ ‫هل‬
Gradual  Peptic Ulcer ‫معاك؟‬ ‫اٌزٌد‬ ‫مرة‬ ‫كل‬ ‫ومع‬ ‫بشوٌة‬ ‫وإال‬
A  Aggravating Factors Aggravated By Food  Acute Abdomen & Gastric Ulcer. ً‫ف‬ ‫علٌك‬ ‫اٌزٌد‬ ً‫الل‬ ‫شن‬
Aggravated By Fasting  Duodenal Ulcer. ‫الترجٌع‬
‫ٌا‬
‫حاج؟‬
‫لما‬ ‫الحظتش‬ ‫ما‬ ً‫ٌعن‬
Also May Aggravated By Alcohol & Drugs. ٌ‫الترج‬ ‫اٌزٌد‬ ‫اتجوع‬ ‫لما‬ ‫أو‬ ‫تاكل‬
‫ع‬
‫عندك‬
‫؟‬
R  Relieving Factors Relieved By Fasting  Acute Abdomen & Gastric Ulcer ‫ٌنقص‬ ً‫الل‬ ‫شن‬
Relieved By Food  Duodenal Ulcer. ‫علٌك‬
ً‫ف‬
‫حاج؟‬ ‫ٌا‬ ‫الترجٌع‬
‫لما‬ ‫الحظتش‬ ‫ما‬ ً‫ٌعن‬
Also May Relieved By Medications. ‫اتجوع‬ ‫لما‬ ‫أو‬ ‫تاكل‬
‫ٌنقص‬
ٌ‫الترج‬
‫ع‬
‫عندك‬
‫؟‬
Relieved By Leaning Forward  Acute Pancreatitis
A  Associated Symptoms Epigstic Pain & Upper GIT Bleeding  Peptic Ulcer. ً‫ف‬ ‫وجع‬ ‫ماعندكش‬
‫ترجٌع‬ ‫عندك‬ ‫وال‬ ‫المعدة؟‬ ‫فم‬
‫حاج‬ ‫ٌا‬ ‫أسود‬ ‫بدي‬ ‫البراز‬ ‫لون‬ ‫الحظتش‬ ‫ما‬ ً‫باه‬ ‫دم؟‬
‫؟‬
Upper Abdominal Pain Radiate to Right Shoulder Acute Cholecystitis.
‫الٌمٌن؟‬ ‫كتفك‬ ً‫ف‬ ‫اٌسمع‬ ‫فوق‬ ‫من‬ ‫بطنك‬ ً‫ف‬ ‫وجع‬ ‫عندكش‬ ‫ما‬ ‫حاج‬ ‫ٌا‬ ً‫باه‬
Generalized Abdominal Pain & Constipation  Intestinal
Obstruction. ‫حاج‬ ‫ٌا‬ ‫إمساك‬ ‫ومعاها‬ ‫كلها‬ ‫بطنك‬ ً‫ف‬ ‫وجع‬ ‫ماعندكش‬ ً‫باه‬
‫؟‬
Loin Pain & Dysuria  Urinary Tract Infection. ً‫ف‬ ‫وجع‬ ‫عندكش‬ ‫ما‬ ‫حاج‬ ‫ٌا‬
‫فٌك؟‬ ‫ٌحرق‬ ‫البول‬ ً‫باه‬ ‫جنابك؟‬
Diarrhea & Fever  Gastro-Enteritis. ‫ماع‬
‫ند‬
‫ك‬
‫ش‬
‫حاج‬ ‫ٌا‬ ‫حرارة‬ ‫و‬ ‫إسهال‬
‫؟‬
Anorexia & Weight Loss  Malignancy. ‫ملحوظ؟‬ ‫بشكل‬ ‫نقص‬ ‫وزنك‬ ‫الحظتش‬ ‫ما‬
C  Course Regressive or Constant or Progressive. ‫ا‬ ‫معاك‬ ‫بدي‬ ‫لما‬ ‫من‬
‫لترجٌع‬
‫نقص‬ ‫هل‬ ‫الٌوم‬ ‫ل‬
‫قبل؟‬ ‫على‬ ‫زاٌد‬ ‫أو‬ ,‫قبل‬ ‫زي‬ ‫قاعد‬ ‫أو‬ ,‫علٌك‬
S  Severity Interfering with Daily Activity. ‫ا‬ ‫هل‬ ,‫معاي‬ ‫تعبتك‬ ‫حاج‬ ‫ٌا‬ ً‫سامحن‬
‫لترجٌع‬
‫امخلٌك‬ ‫مش‬
Interfering with Sleep. ‫ا‬ ‫ومش‬ ‫ترقد‬
‫طبٌعٌة؟‬ ‫حٌاتك‬ ‫تمارس‬ ‫أو‬ ‫لعملك‬ ً‫تمش‬ ‫مخلٌك‬

13. DR. MOHCEN AL. HAJ
13
Properties
of Vomiting 
FAT CBC PP
Frequency  ‫ات‬ ‫مرة‬ ‫قداش‬ ,‫حاج‬ ‫ٌا‬ ً‫سامحن‬
‫رجع‬
‫الٌوم؟‬ ً‫ف‬
Amount  ‫كمٌة‬ ‫حاج‬ ‫ٌا‬ ً‫باه‬
‫الترجٌع‬
‫هل‬
‫كاملة‬ ‫طاسة‬ ً‫اتعب‬ ‫شوٌة؟‬ ‫او‬ ‫با‬
‫؟‬
Time  ‫حاج‬ ‫ٌا‬
,
ً‫ف‬ ‫علٌك‬ ‫اٌزٌد‬ ‫الترجٌع‬ ‫الحظتش‬ ‫ما‬
‫معٌن‬ ‫وقت‬ ‫مافٌش‬ ‫وإال‬ ‫أكثر‬ ‫الصبح‬
‫؟‬
(Vomiting Increase In the Morning In  High of Intra Cranial Pressure).
Content  ‫حاج‬ ‫ٌا‬
ً‫ثان‬ ً‫ش‬ ‫وإال‬ ‫ماكلة‬ ‫هل‬ ً‫ٌعن‬ ‫الترجٌع؟‬ ً‫ف‬ ‫ٌطلع‬ ً‫الل‬ ‫بالزبط‬ ‫هوا‬ ‫شن‬
‫؟‬
Coffee Ground Vomiting  Upper GIT Bleeding.
Bilious Vomiting (Green to Yellow)  Intestinal Obstruction Distal to
Ampulla of Vater.
Bloody or Not  ‫الترجٌع؟‬ ‫مع‬ ‫دم‬ ً‫ف‬ ,‫حاج‬ ‫ٌا‬ ً‫سامحن‬
Color  ‫حاج‬ ‫ٌا‬ ً‫باه‬
‫الترجٌع‬ ‫لونه‬ ‫شن‬
‫؟‬
Projectile or Not  ,‫حاج‬ ‫ٌا‬ ً‫سامحن‬
‫عادي؟‬ ‫ٌنزل‬ ‫وإال‬ ‫لمسافة‬ ‫ٌتنطر‬ ‫الترجٌع‬ ‫هل‬
Persistent or Not ‫تاكل‬ ‫تقدر‬ ‫معاش‬ ‫لدرجة‬ ‫كان‬ ‫مهما‬ ‫اترجعه‬ ‫تاكله‬ ً‫الل‬ ‫هل‬ ‫حاج‬ ‫ٌا‬
‫؟‬
4. SYSTEMIC REVIEW: Start with the Involved System First.
- GIT:  ASK ABOUT :-
*Epigastric Pain & Heamatemesis OR Melena  FOR Peptic Ulcer.
*Upper Abdominal Pain Radiate to Right Shoulder Related to Fatty Meal  FOR
Acute Cholecystitis.
*Generalized Abdominal Pain & Constipation  FOR Intestinal Obstruction.
*Diarrhea & Fever  FOR Gastro-Enteritis.
*Anorexia & Weight Loss  FOR GIT Malignancy.
‫حاج‬ ‫ٌا‬ ً‫سامحن‬
,
‫عندك‬
‫لون‬ ‫الحظتش‬ ‫ما‬ ‫حاج‬ ‫ٌا‬ ً‫ماعلٌش‬ ‫دم؟‬ ‫رجعتش‬ ‫ما‬ ‫حاج‬ ‫ٌا‬ ً‫باه‬ ‫المعدة؟‬ ‫فم‬ ً‫ف‬ ‫وجع‬
‫الماكلة‬ ‫مع‬ ‫واٌزٌد‬ ‫الٌمٌن‬ ‫كتفك‬ ً‫ف‬ ‫اٌسمع‬ ‫والوجع‬ ‫فوق‬ ‫من‬ ‫وجع‬ ‫فٌها‬ ‫بطنك‬ ‫حاج‬ ‫ٌا‬ ً‫باه‬ ‫داكن؟‬ ‫أسود‬ ‫بدي‬ ‫البراز‬
‫حاج‬ ‫ٌا‬ ‫حاج؟‬ ‫ٌا‬ ‫إمساك‬ ‫معاها‬ ً‫وف‬ ‫بعضها‬ ‫مع‬ ‫كلها‬ ‫بطنك‬ ً‫ف‬ ‫وجع‬ ً‫ف‬ ‫وال‬ ‫الدهنٌة؟‬
‫ومعاها‬ ‫إسهال‬ ‫عندك‬
‫وملحوظ؟‬ ‫كبٌر‬ ‫بشكل‬ ‫نقص‬ ‫وزنك‬ ‫انه‬ ‫امالحظ‬ ‫مش‬ ,‫علٌك‬ ‫كثرت‬ ‫حاج‬ ‫ٌا‬ ً‫سامحن‬ ‫حرارة؟‬
- CVS:  ASK ABOUT :-
*Chest Pain & Sweating  TO EXCLUDE Myocardial Infarction  Because MI Can
Cause Vomiting. ‫حاج‬ ‫ٌا‬ ً‫سامحن‬
,
‫وعرقت‬ ‫فجأة‬ ‫صدرك‬ ‫نص‬ ً‫ف‬ ‫وجع‬ ‫ب‬ ‫ماحسٌتش‬
‫هلبا‬
‫معاها؟‬

14. DR. MOHCEN AL. HAJ
14
- Genito-Urinary System:  ASK ABOUT
*Loin Pain & Dysuria  TO EXCLUDE Urinary Tract Infection. ,‫حاج‬ ‫ٌا‬ ً‫سامحن‬
‫الحظتش‬ ‫ما‬
‫داكن‬ ‫ولونه‬ ‫قوٌة‬ ‫رٌحه‬ ‫فٌه‬ ‫الحظت‬ ‫وال‬ ‫فٌك‬ ‫ٌحرقش‬ ‫ما‬ ‫البول‬ ‫حاج‬ ‫ٌا‬ ً‫باه‬ ‫جنابك؟‬ ً‫ف‬ ‫وجع‬ ‫أي‬
‫؟‬
- Endocrine System:  ASK ABOUT :-
*Polyuria, Polydepsia, Confusion & Drowsiness TO EXCLUDE Diabetic Keto Acidosis
 Because DKA Can Cause Vomiting. ‫ه‬ ‫الحمام‬ ‫اتخش‬ ‫روحك‬ ‫الحظتش‬ ‫ما‬ ‫حاج‬ ‫ٌا‬
ً‫ف‬ ‫تشرب‬ ‫وبدٌت‬ ‫لبا‬
‫وٌن‬ ‫روحك‬ ‫عرفتش‬ ‫وما‬ ً‫الوع‬ ‫وفقدت‬ ‫حاج‬ ‫ٌا‬ ‫دختش‬ ‫ما‬ ً‫باه‬ ‫بكثرة؟‬ ‫مٌه‬
‫؟‬
- CNS:  ASK ABOUT :-
*Headache & Blurred Vision  TO EXCLUDE High Intra Cranial Pressure.
*Vertigo  TO EXCLUDE Menieres Disease Because Menieres Disease Cause Vomiting.
‫معاي‬ ‫تعبتك‬ ‫حاج‬ ‫ٌا‬ ً‫سامحن‬
,
‫النظر‬ ً‫ف‬ ‫ادغدٌش‬ ‫أو‬ ‫ضبابة‬ ‫اي‬ ‫الحظتش‬ ‫ما‬ ً‫باه‬ ‫صداع؟‬ ‫عندكش‬ ‫ما‬
‫؟‬
‫ادور‬ ‫الدنٌا‬ ‫ب‬ ‫اتحسش‬ ‫ما‬ ‫حاج‬ ‫ٌا‬ ً‫باه‬
‫مرة‬ ‫مرة‬ ‫بٌك‬
‫؟‬
5. PAST MEDICAL HISTORY:
*History of Same Illness Before? If Yes  How Many Times? When Was the Last
Time? Does He Admitted or No? Does He Admitted to ICU or No? What are the
Investigations? ‫حاج‬ ‫ٌا‬ ً‫ماعلٌش‬
,
‫آخر‬ ‫كانت‬ ‫أمتى‬ ‫صارتلك؟‬ ‫مرة‬ ‫قداش‬ ‫قبل؟‬ ‫من‬ ‫هادي‬ ‫المشكلة‬ ‫نفس‬ ‫ماصارتلكش‬
‫الٌوم؟‬ ‫نفس‬ ً‫ف‬ ‫طلعت‬ ‫وإال‬ ‫المستشفى‬ ‫دخلوك‬ ‫هل‬ ‫مرة؟‬
‫العناٌة؟‬ ‫خشٌت‬ ‫هل‬
‫دارول‬ ‫شن‬ ‫متفكر‬ ‫مش‬ ‫حاج‬ ‫ٌا‬ ً‫باه‬
‫ك‬
‫من‬
‫إجراءات؟‬ ‫أو‬ ‫تحالٌل‬
*History of Any Chronic Illness (Like DM, HTN) If Yes What is the Duration of the
Chronic Illness? What is the Treatment? Does He in Regular Follow up? ,‫حاج‬ ‫ٌا‬ ً‫سامحن‬
‫لتوا‬ ‫عالج‬ ً‫ف‬ ‫وتاخدلها‬ ‫معاك‬ ‫فترة‬ ‫لٌها‬ ‫قدٌمة‬ ‫صحٌة‬ ‫مشكلة‬ ‫أي‬ ‫ماعندكش‬
‫مثال)؟‬ ‫ضغط‬ ‫أو‬ ‫(سكر‬
‫هٌا‬ ‫شن‬
‫المشكلة‬
‫تعرف؟‬ ‫لو‬ ‫عالج‬ ‫من‬ ‫تاخدلها‬ ‫وشن‬ ‫المشكلة؟‬ ‫معاك‬ ‫لٌها‬ ‫قداش‬ ‫حاج؟‬ ‫ٌا‬
‫وم‬ ‫اتراجع‬ ً‫تمش‬ ‫هل‬
ً‫ف‬ ‫نتظم‬
‫حاج؟‬ ‫ٌا‬ ‫ال‬ ‫وإال‬ ‫مراجعاتك‬
6. DRUG HISTORY:
*Ask the About Any Drug Can Cause Vomiting Such as  Anti-Biotics, Opiate, Digoxin
and Chemotherapy.
Also Insulin (What is the Dose if He Knows?) & ACE I (What is the Dose if He Knows?).
‫دواء‬ ً‫ف‬ ‫تاخد‬ ‫حاج‬ ‫ٌا‬ ً‫ماعلٌش‬
‫مس‬ ‫ولتوا‬ ‫طوٌلة‬ ‫فترة‬ ‫من‬
‫ٌا‬ ‫الدواء‬ ‫هوا‬ ‫شن‬ ‫علٌه؟‬ ‫تمر‬
‫حاج‬
‫الجرعة؟‬ ‫وقداش‬

15. DR. MOHCEN AL. HAJ
15
7. PAST SURGICAL HISTORY:
*Any History of Abdominal Surgery (Intestinal Surgery OR Lapratomy)
*Also History of Any Surgery Done By General Anesthesia.
*If Patient has History of Surgery Before  Does He Received Blood or Not? ‫امداٌر‬ ‫مش‬
‫عملٌة‬ ‫أي‬
‫البطن‬ ‫ع‬ ‫جراحٌة‬
‫؟‬
‫لٌها‬ ‫قداش‬
‫تحت‬ ‫عملٌة‬ ‫أي‬ ‫امداٌر‬ ‫وال‬ ً‫باه‬ ‫موضعً؟‬ ‫أو‬ ‫عام‬ ‫تخذٌر‬ ‫دارولك‬ ‫هل‬ ‫؟‬
‫؟‬ ‫العام‬ ‫التخذٌر‬
‫مضاعفات‬ ‫أو‬ ‫مشاكل‬ ‫أي‬ ‫ماصارتلكش‬
‫العملٌة؟‬ ‫بعد‬
‫دم‬ ‫زادوكش‬ ‫ما‬ ‫حاج‬ ‫ٌا‬ ً‫باه‬
‫؟‬
8. FAMILY HISTORY:
*Any History of Same Illness in His Family.
*Ask if His First Relative Degrees Had Any Chronic Illness (Like DM, HTN).
‫عنده‬ ‫عٌلتك‬ ‫من‬ ‫حد‬ ‫مافٌش‬
‫نف‬
‫ع‬ ‫عٌلتك‬ ً‫ف‬ ‫حد‬ ً‫ف‬ ‫المشكلة؟‬ ‫س‬
‫نده‬
‫السكر‬ ‫زي‬ ‫وقدٌمة‬ ‫مزمنة‬ ‫صحٌة‬ ‫مشكلة‬ ‫أي‬
‫الضغط؟‬ ‫أو‬
9. SOCIAL HISTORY:
*Ask If He is Smoker or Ex-Smoker (If He is Smoker Ask about Duration & Amount).
*Ask If He is Alcoholic (If He is Alcoholic Ask about Duration & Amount).
‫حاج؟‬ ‫ٌا‬ ‫ادخن‬
‫لٌك؟‬ ‫قداش‬
‫حاج‬ ‫ٌا‬ ‫السؤال‬ ً‫ف‬ ً‫سامحن‬
,
‫المسكرات؟‬ ‫من‬ ‫نوع‬ ‫أي‬ ً‫ف‬ ‫تشرب‬
ٌ‫ل‬ ‫قداش‬
‫ك؟‬

16. DR. MOHCEN AL. HAJ
16
Differential Diagnosis of Diarrhea
Acute Chronic
1. Gastro-Enteritis.
2. Food Poisoning.
3. Drugs:
- Anti-Biotic.
- NSAIDS.
- Proton Pump Inhibitors.
1. Inflammatory Bowel Disease:
- Crhons Disease.
- Ulcerative Colitis.
2. Malabsorption:
- Cealiac Disease.
- Giardiasis.
- Small Intestine Resection.
- Obstructive Jaundice.
- Chronic Pancreatitis.
3. Irritable Bowel Syndrome.
4. Hyperthyroidism.
Differential Diagnosis of Constipation
GIT Causes Non GIT Causes
1. Low Fiber Diet & Decrease Fluid
Intake.
2. Cancer Colon.
3. Peri-Anal Condition:
- Hemorrhoids.
- Fissure.
4. Irritable Bowel Syndrome.
5. Hirschsprung Disease.
1. CNS:
- CVA (Stroke).
- Multiple Sclerosis.
Parkinsonism.
2. Endocrine Causes:
- Diabetes Mellitus.
- Hypothyroidism.
- Hypocalceamia.
3. Drugs:
- Iron Supplements.
- Opiate.
4. Pregnancy.
5. Depression.

17. DR. MOHCEN AL. HAJ
17
DIARRHEA OSCE:
INTRODUCE YOUR SELF & TAKE PERMISSION FROM THE PATIENT.
1. PERSONAL DATA: Name, Age, Gender, Nationality, Occupations.
2. MAIN COMPLAIN: What is Your Complain? & Duration.
3. ANALYSIS OF MAIN COMPLAIN:  Bowel Habit Before +
Properties of the Diarrhea + DOARA CS
Bowel Habit Before ‫هادي‬ ‫المشكلة‬ ‫قبل‬ ‫من‬ ‫حاج‬ ‫ٌا‬ ً‫ماعلٌش‬
,
‫الحمام؟‬ ‫مرة‬ ‫اتخش‬ ‫كنت‬ ‫قداش‬
Properties
of Diarrhea 
Frequency  ‫الٌوم؟‬ ً‫ف‬ ‫الحمام‬ ‫اتخش‬ ‫مرة‬ ‫قداش‬ ,‫حاج‬ ‫ٌا‬ ً‫سامحن‬
Amount  ‫زاٌده‬ ‫وإال‬ ‫قبل‬ ‫زي‬ ‫هل‬ ‫البراز‬ ‫كمٌة‬ ‫حاج‬ ‫ٌا‬ ً‫باه‬
‫ال؟‬ ‫وإال‬
Consistency  ‫زي‬ ‫سائل‬ ‫البراز‬ ,‫حاج‬ ‫ٌا‬ ً‫ماعلٌش‬
‫ا‬
‫شوٌة؟‬ ‫روحه‬ ‫شاد‬ ‫وإال‬ ‫لمٌه‬
Urgency  ‫شً؟‬ ‫ٌطلع‬ ‫وما‬ ‫تتبرز‬ ً‫تب‬ ‫قوٌة‬ ‫رغبة‬ ‫عندك‬ ‫مرات‬ ‫بروحط‬ ‫اتحسش‬ ‫ما‬ ‫حاج‬ ‫ٌا‬
Incontinence  ‫؟‬ ‫البراز‬ ً‫ف‬ ‫تتحكم‬ ‫تقدرش‬ ‫ما‬ ‫انك‬ ‫روحك‬ ‫الحظتش‬ ‫ما‬ ,‫حاج‬ ‫ٌا‬ ً‫سامحن‬
With Mucous or Not  ‫البراز؟‬ ‫مع‬ ‫ٌنزل‬ ‫سالبٌن‬ ً‫ف‬ ‫حاج‬ ‫ٌا‬ ً‫باه‬
Bloody or Not  ,‫حاج‬ ‫ٌا‬ ً‫سامحن‬
‫ما‬ ً‫باه‬ ‫البراز؟‬ ‫مع‬ ‫ٌنزل‬ ‫دم‬ ً‫ف‬
‫أسود؟‬ ‫لونه‬ ‫الحظتش‬
Alternate with Constipation ‫إمساك؟‬ ‫ومره‬ ‫إسهال‬ ‫مره‬ ‫وإال‬ ‫حاج‬ ‫ٌا‬ ‫إسهال‬ ‫دٌما‬
Steatorrhea  ‫تج‬ ‫لما‬ ‫حاج‬ ‫ٌا‬ ً‫باه‬
‫ب‬
‫وإال‬ ‫كله‬ ‫ٌتصرف‬ ‫هل‬ ً‫السٌفون‬ ً‫ف‬ ‫د‬
‫فوق؟‬ ‫ٌطفوا‬
D  Duration Acute  Gastro-Enteritis & Drugs (ANTI-BIOTICS). ‫قداش‬ ‫حاج‬ ‫ٌا‬ ً‫سامحن‬
Chronic  IBD (Crhons + Ulcerative Colitis) & Cealiac. ‫معا‬ ‫اإلسهال‬ ‫لٌه‬
‫ك؟‬
O  Onset Sudden  Gastro-Enteritis & Drugs (ANTI-BIOTICS). ‫بد‬ ‫هل‬
‫ي‬
‫فجأ‬ ‫معاك‬
‫ة‬
Gradual  IBD (CD + UC) & Cealiac. ‫مرة‬ ‫كل‬ ‫ومع‬ ‫بشوٌة‬ ‫وإال‬
ٌ‫ا‬
‫معاك؟‬ ‫زٌد‬
A  Aggravating Factors In IBD Aggravated By: Milk & Its Derivatives. ً‫ف‬ ‫علٌك‬ ‫اٌزٌد‬ ً‫الل‬ ‫شن‬
‫اإلسهال؟‬
In Cealiac Aggravated By:  Bread, Wheat (Gluten(. ً‫ف‬ ‫أو‬
‫فٌه؟‬ ‫اٌزٌد‬ ‫معٌن‬ ‫أكل‬
R  Relieving Factors In IBD  Relieved By Stop Eating of Milk Derivatives. ‫ٌنقص‬ ً‫الل‬ ‫شن‬
In Cealic  Relieved By Stop Eating of Gluten Derivatives. ‫ع‬
‫لٌك‬
‫اإل‬ ً‫ف‬
‫سهال‬
‫؟‬
ً‫ف‬ ً‫باه‬
‫حاج؟‬ ‫ٌا‬ ‫بعده‬ ‫اإلسهال‬ ‫علٌك‬ ‫ٌنقص‬ ‫اتوقفه‬ ‫لما‬ ‫معٌن‬ ‫أكل‬
A  Associated Symptoms Oral ulcer & Peri-anal Conditions  Crhons Disease. ‫كثرت‬ ‫حاج‬ ‫ٌا‬ ً‫سامحن‬
ً‫ف‬ ‫مشاكل‬ ‫أي‬ ‫أو‬ ‫بواسٌر‬ ‫عندكش‬ ‫ما‬ ً‫باه‬ ‫فمك؟‬ ً‫ف‬ ‫طٌاب‬ ‫ماعندكش‬ ,‫أسئلة‬ ‫علٌك‬
‫الشرج‬ ‫فتحة‬
‫؟‬
Blood, Mucous & Abdominal Pain  Ulcerative Colitis. ‫عند‬
‫ك‬
‫البطن؟‬ ً‫ف‬ ‫وجع‬
‫االسهال؟‬ ‫مع‬ ‫سالبٌن‬ ‫أو‬ ‫دم‬ ً‫ف‬
Steatorrhea & Weight Loss with Good Appetite Cealiac. ‫من‬
‫شن‬
‫تشك‬
ً‫ثان‬ ً
‫من‬
‫غٌر‬
‫قبل؟‬ ‫زي‬ ‫واال‬ ‫ناقص‬ ‫حاج‬ ‫ٌا‬ ‫وزنك‬ ‫و‬ ‫الماكلة؟‬ ً‫ف‬ ‫شهٌتك‬ ‫شن‬ ‫حاج‬ ً‫باه‬ ‫اإلسهال؟‬
ً‫باه‬
‫أصف‬ ‫لونه‬ ‫البراز‬ ‫الحظتش‬ ‫ما‬
‫ما‬ ً‫السٌفون‬ ‫تجبد‬ ‫ولما‬ ‫ر‬
‫كله‬ ‫ٌتصرفش‬
‫فوق؟‬ ‫ٌطفوا‬ ‫وٌبدا‬
Vomiting & Fever  Gastro-Enteritis. ‫عند‬
‫ك‬
‫؟‬ ‫حاج‬ ‫ٌا‬ ‫حرارة‬ ‫أو‬ ‫ترجٌع‬

18. DR. MOHCEN AL. HAJ
18
C  Course Regressive or Constant or Progressive. ‫نقص‬ ‫هل‬ ‫الٌوم‬ ‫ل‬ ‫اإلسهال‬ ‫معاك‬ ‫بدي‬ ‫لما‬ ‫من‬
‫قبل؟‬ ‫على‬ ‫زاٌد‬ ‫أو‬ ,‫قبل‬ ‫زي‬ ‫قاعد‬ ‫أو‬ ,‫علٌك‬
S  Severity Interfering with Daily Activity. ‫معاي‬ ‫تعبتك‬ ‫حاج‬ ‫ٌا‬ ً‫سامحن‬
,
‫ه‬
‫ا‬ ‫ل‬
‫إلسهال‬
‫امخلٌك‬ ‫مش‬
Interfering with Sleep. ‫و‬ ‫ترقد‬
‫ل‬ ً‫تمش‬ ‫امخلٌك‬ ‫مش‬
‫طبٌعٌة؟‬ ‫حٌاتك‬ ‫تمارس‬ ‫أو‬ ‫عملك‬
IF DIARRHEA GOES WITH Inflammatory Bowel Disease:
4. SYSTEMIC REVIEW:
Start with the Involved System First.
- GIT:  ASK ABOUT :-
*Appetite & Weight loss Due to  Chronic Diarrhea.
*Oral Ulcer, Peri-Anal Conditions & Fistula  For Crhons Disease.
*Right Hypochondrial Pain  Due to Ulcerative Colitis Causes Primary Sclerosing Cholangitis.
*Abdominal Distension  Due to Gases.
*Jaundice  Due to IBD Cause Gall Stone & Auto-Immune Hepatitis.
,‫علٌك‬ ‫كثرت‬ ‫حاج‬ ‫ٌا‬ ً‫سامحن‬
‫فمك؟‬ ً‫ف‬ ‫طٌاب‬ ‫ماعندكش‬ ‫حاج‬ ‫ٌا‬ ً‫ماعلٌش‬ ‫ناقص؟‬ ‫وإال‬ ‫قبل‬ ‫زي‬ ‫وزنك‬ ً‫باه‬ ‫كوٌسة؟‬ ‫الماكلة‬ ً‫ف‬ ‫شهٌتك‬
ً‫باه‬ ‫الشرج؟‬ ‫فتحة‬ ً‫ف‬ ‫مشاكل‬ ‫أو‬ ‫بواسٌر‬ ‫عندك‬ ‫وال‬
‫بدي‬ ‫لونك‬ ‫أو‬ ‫حاج‬ ‫ٌا‬ ‫الصفٌر‬ ‫جاكش‬ ‫ما‬ ‫بطنك؟‬ ً‫ف‬ ‫انتفاخ‬ ‫أو‬ ‫وجع‬ ‫عندك‬ ‫حاج‬ ‫ٌا‬
‫أصفر؟‬
- CVS:  ASK ABOUT :-
*Palpitation & Dyspnea  For Aneamia  Because IBD Causes Aneamia Due to Loss of Iron & Folic
acid Due to Chronic Diarrhea.
*Lower Limb Edema  Because IBD Usually Causes Loss of Albumin Due to Chronic Diarrhea.
‫حاج‬ ‫ٌا‬ ً‫سامحن‬
‫عندك‬
‫القلب‬ ً‫ف‬ ‫رفة‬
‫؟‬
‫حاج؟‬ ‫ٌا‬ ‫نفاخ‬ ‫فٌهم‬ ‫رجلٌك‬ ‫الحظتش‬ ‫ما‬ ‫مجهود؟‬ ‫تبذل‬ ‫لما‬ ‫خصوصا‬ ‫حاج‬ ‫ٌا‬ ‫دهشة‬ ‫عندك‬ ً‫باه‬
- CNS:  ASK ABOUT :-
*Tetany & Carpo-Pedal Spasm For IBD  Because IBD Cause Hypo-Calciemea Due to
Chronic Diarrhea. ‫حاج‬ ‫ٌا‬ ً‫سامحن‬
‫خضة‬ ‫نوبة‬ ‫صارتلكش‬ ‫ما‬
‫بعض؟‬ ‫مع‬ ‫اتشكلوا‬ ‫وصوابعك‬ ‫جسمك‬ ‫أو‬
- Endocrine System:  ASK ABOUT :-
*Poly-Urea & Poly-DypsiaFor Diabetes Mellitus I  Because IBD May Associate with Other Auto-
Immune Diseases Like Diabetes Mellitus DMI. ‫حاج‬ ‫ٌا‬ ً‫ماعلٌش‬
‫هلبا؟‬ ‫وكمٌته‬ ‫بقبل؟‬ ‫مقارنة‬ ‫كبٌر‬ ‫بشكل‬ ‫للحمام‬ ‫اتخش‬
‫م‬ ً‫باه‬
‫حاج؟‬ ‫ٌا‬ ‫هلبا‬ ‫تعطش‬ ‫بدٌت‬ ‫روحك‬ ‫الحظتش‬ ‫ا‬
*Heat or Cold Intolerance & Goiter For Auto-Immune Thyroid Diseases  Because IBD May
Associate with Other Auto-Immune Diseases.
‫ما‬
‫هلبا‬ ‫تصقع‬ ‫روحك‬ ‫الحظتش‬
‫؟‬
‫النو؟‬ ً‫ف‬ ‫ماتتحملش‬ ‫روحك‬ ‫الحظت‬ ‫وال‬
ٌ ً‫باه‬
‫رقبتك‬ ً‫ف‬ ‫طوبة‬ ‫أو‬ ‫انتفاخ‬ ‫أي‬ ‫عندكش‬ ‫ما‬ ‫حاج‬ ‫ا‬
‫من‬
‫القدام؟‬

19. DR. MOHCEN AL. HAJ
19
- Hematology:  ASK ABOUT :-
*Generalized Fatigability, Dizziness, Pallor  FOR Anemia  Because IBD Causes Anemia Due to loss
of Iron and Folic acid Due to Chronic Diarrhea.
*Bleeding From Any Orifice, OR Ecchymosis  FOR Vitamin K Deficiency  Because IBD Causes
Vitamin K Deficiency Due to Chronic Diarrhea.
‫وال‬ ‫جسمك‬ ً‫ف‬ ‫مكان‬ ‫أي‬ ‫من‬ ‫نزٌف‬ ‫ماعندكش‬ ‫حاج‬ ‫ٌا‬ ً‫باه‬ ‫شحوب‬ ‫وال‬ ‫دوخه‬ ‫ماعندكش‬ ً‫باه‬ ‫فاشل؟‬ ‫جسمك‬ ً‫ف‬ ‫اتحسش‬ ‫ما‬ ‫حاج‬ ‫ٌا‬
‫جسك؟‬ ً‫ف‬ ‫زرق‬ ‫أو‬ ‫حمر‬ ‫بقع‬ ‫طلعولك‬
- Loco-Motor System:  ASK ABOUT :-
*Joints Pain & Back Pain  For Arthritis & Ankylosing Spondylitis  Due to IBD Cause That.
*Uni-Lateral Leg Swelling DVT  Due to IBD.
‫حاج‬ ‫ٌا‬
‫رجلٌك؟‬ ‫من‬ ‫وحده‬ ً‫ف‬ ‫انتفاخ‬ ‫الحظتش‬ ‫ما‬ ‫مرتاح؟‬ ‫وانت‬ ‫خصوصا‬ ‫الظهر‬ ً‫ف‬ ‫ألم‬ ‫ماعندكش‬ ً‫باه‬ ‫مفاصلك؟‬ ً‫ف‬ ‫وجع‬ ‫ماعندكش‬
- Eyes & Skin:  ASK ABOUT :-
*Red Eye & Pain For Conjunctivitis, Iritis, Scleritis.
*Red Nodules or Redness For Erythema Nodusom.
ً‫ف‬ ‫طلعوا‬ ‫طوبات‬ ‫أو‬ ‫احمرار‬ ‫أي‬ ‫الحظتش‬ ‫ما‬ ً‫باه‬ ‫فٌك؟‬ ‫ٌاكلوا‬ ‫و‬ ‫حمر‬ ‫بدوا‬ ‫انهم‬ ‫الحظتش‬ ‫ما‬ ‫عٌونك‬ ,‫تعبتك‬ ‫حاج‬ ‫ٌا‬ ً‫سامحن‬
‫رجلٌك‬
‫؟‬
-----------------------------------------
---------
-----------------
-----------------------------------------
----------------------
5. PAST MEDICAL HISTORY:
*History of Same Illness Before? If Yes  How Many Times? When Was the Last Time? Does He
Admitted or No? Does He Admitted to ICU or No? What are the Investigations? ‫حاج‬ ‫ٌا‬ ً‫ماعلٌش‬
,
‫نفس‬ ‫ماصارتلكش‬
‫الٌوم؟‬ ‫نفس‬ ً‫ف‬ ‫طلعت‬ ‫واال‬ ‫المستشفى‬ ‫دخلوك‬ ‫هل‬ ‫مرة؟‬ ‫آخر‬ ‫كانت‬ ‫أمتى‬ ‫صارتلك؟‬ ‫مرة‬ ‫قداش‬ ‫قبل؟‬ ‫من‬ ‫هادي‬ ‫المشكلة‬
‫العناٌة؟‬ ‫خشٌت‬ ‫هل‬
‫شن‬
‫دارول‬
‫تحالٌل؟‬ ‫من‬ ‫ك‬
*History of Any Chronic Illness (Like DM, HTN)? If Yes  What is the Duration of the Chronic Illness?
What is the Treatment? Does He in Regular Follow up? ‫فترة‬ ‫لٌها‬ ‫قدٌمة‬ ‫صحٌة‬ ‫مشكلة‬ ‫أي‬ ‫ماعندكش‬ ,‫حاج‬ ‫ٌا‬ ً‫سامحن‬
‫لتوا‬ ‫عالج‬ ً‫ف‬ ‫وتاخدلها‬ ‫معاك‬
‫مثال)؟‬ ‫ضغط‬ ‫أو‬ ‫(سكر‬
‫المشكلة‬ ‫هٌا‬ ‫شن‬
‫عالج‬ ‫من‬ ‫تاخدلها‬ ‫وشن‬ ‫المشكلة؟‬ ‫معاك‬ ‫لٌها‬ ‫قداش‬ ‫حاج؟‬ ‫ٌا‬
‫تعرف؟‬ ‫لو‬
‫وم‬ ‫اتراجع‬ ً‫تمش‬ ‫هل‬
‫حاج؟‬ ‫ٌا‬ ‫ال‬ ‫وإال‬ ‫مراجعاتك‬ ً‫ف‬ ‫نتظم‬
6. DRUG HISTORY:
*If Patient Has Any Chronic Illness That Means He Has Drug History Such as  Insulin (What is the Dose if
He Knows?) & ACE I (What is the Dose if He Knows?).
*Also Steroid, Azathioprin, Aspirin, Statin, or Anti-Coagulant.
‫مس‬ ‫ولتوا‬ ‫طوٌلة‬ ‫فترة‬ ‫من‬ ‫دواء‬ ً‫ف‬ ‫تاخد‬ ‫حاج‬ ‫ٌا‬ ً‫ماعلٌش‬
‫علٌه؟‬ ‫تمر‬
‫ل‬ ‫حاج‬ ‫ٌا‬ ‫الدواء‬ ‫هوا‬ ‫شن‬
‫تعرفه‬ ‫و‬
‫الجرعة؟‬ ‫وقداش‬

20. DR. MOHCEN AL. HAJ
20
7. PAST SURGICAL HISTORY:
*Any History of Abdominal Surgery (Bowel Resection)
*Any History of Peri-Anal Surgery (Heamoroidectomy, Sinus Operation)
*If Patient has History of Surgery Before  Does He Received Blood or Not?
‫عملٌة‬ ‫أي‬ ‫امداٌر‬ ‫مش‬
‫مثال‬ ‫األمعاء‬ ‫من‬ ‫جزء‬ ‫فٌها‬ ً‫امنح‬
‫؟‬
‫لٌها‬ ‫وقداش‬
‫؟‬
‫مثال؟‬ ‫بواسٌر‬ ‫عملٌة‬ ‫زي‬ ‫الشرج‬ ‫فتحى‬ ‫على‬ ‫عملٌة‬ ‫امداٌر‬ ‫وال‬
‫مضاعفات‬ ‫أو‬ ‫مشاكل‬ ‫أي‬ ‫ماصارتلكش‬ ‫حاج‬ ‫ٌا‬ ً‫سامحن‬
‫العملٌة؟‬ ‫بعد‬
‫دم‬ ‫زادوكش‬ ‫ما‬ ‫حاج‬ ‫ٌا‬ ً‫باه‬
‫؟‬
8. FAMILY HISTORY:
*Any History of Same Illness in His Family.
*Any History of IBD Disease in His Family.
*Ask if His First Relative Degrees Had Any Chronic Illness (Like DM, HTN).
‫عنده‬ ‫عٌلتك‬ ‫من‬ ‫حد‬ ‫مافٌش‬
‫نف‬
‫المشكلة؟‬ ‫س‬
‫العٌلة‬ ً‫ف‬ ‫حد‬ ً‫ف‬
‫األمعاء؟‬ ً‫ف‬ ‫التهابات‬ ‫عنده‬
‫ع‬ ‫عٌلتك‬ ً‫ف‬ ‫حد‬ ً‫ف‬
‫نده‬
‫الضغط‬ ‫أو‬ ‫السكر‬ ‫زي‬ ‫وقدٌمة‬ ‫مزمنة‬ ‫صحٌة‬ ‫مشكلة‬ ‫أي‬
‫؟‬
9. SOCIAL HISTORY:
*Ask If He is Smoker or Ex-Smoker (If He is Smoker Ask about Duration & Amount).
*Ask If He is Alcoholic (If He is Alcoholic Ask about Duration & Amount).
‫حاج؟‬ ‫ٌا‬ ‫ادخن‬
‫لٌك؟‬ ‫قداش‬
‫حاج‬ ‫ٌا‬ ‫السؤال‬ ً‫ف‬ ً‫سامحن‬
,
‫المسكرات؟‬ ‫من‬ ‫نوع‬ ‫أي‬ ً‫ف‬ ‫تشرب‬
ٌ‫ل‬ ‫قداش‬
‫ك‬
‫؟‬
10. Nutritional HISTORY:
*Ask about Diet That Patient Eat.
‫فٌها‬ ‫تاكل‬ ‫معاش‬ ‫علٌها‬ ‫وقفت‬ ‫حاجات‬ ً‫ف‬ ‫هل‬ ,‫توا‬ ‫أكلك‬ ‫طبٌعة‬ ‫ع‬ ‫بنسألك‬ ‫حاج‬ ‫ٌا‬ ً‫ماعلٌش‬
‫ال؟‬ ‫أو‬
ً‫باه‬
ٌ‫ف‬ ‫تاكل‬ ً‫الل‬ ‫البدٌل‬ ‫شن‬
‫ه‬
‫توا؟‬

21. DR. MOHCEN AL. HAJ
21
CONSTIPATION OSCE:
INTRODUCE YOUR SELF & TAKE PERMISSION FROM THE PATIENT.
1. PERSONAL DATA: Name, Age, Gender, Nationality, Occupations.
2. MAIN COMPLAIN: What is Your Complain? & Duration.
3. ANALYSIS OF MAIN COMPLAIN:  Bowel Habit Before +
Properties of the Constipation + DOARA CS
Bowel Habit Before ‫هادي‬ ‫المشكلة‬ ‫قبل‬ ‫من‬ ‫حاج‬ ‫ٌا‬ ً‫ماعلٌش‬
,
‫الحمام؟‬ ‫مرة‬ ‫اتخش‬ ‫كنت‬ ‫قداش‬
Properties
of Constipation 
Frequency  ,‫حاج‬ ‫ٌا‬ ً‫سامحن‬
‫الٌوم؟‬ ً‫ف‬ ‫الحمام‬ ‫اتخش‬ ‫مرة‬ ‫قداش‬
Consistency  ‫البراز‬ ,‫حاج‬ ‫ٌا‬ ً‫ماعلٌش‬
‫عادي‬ ‫أو‬ ‫روحه‬ ‫وشاد‬ ‫هلبا‬ ‫صلب‬ ‫هل‬ ‫ٌنزل‬ ‫لما‬
‫؟‬
Tensmus  ‫حاج‬ ‫ٌا‬
‫التبرز‬ ً‫ف‬ ‫رغبة‬ ‫عندك‬ ‫مازال‬ ‫انه‬ ‫اتحسش‬ ‫ما‬ ‫البراز‬ ‫ٌنزل‬ ‫ما‬ ‫بعد‬
‫؟‬
Straining  ‫روحك‬ ‫الحظتش‬ ‫ما‬ ,‫حاج‬ ‫ٌا‬ ً‫سامحن‬
‫تتبرز‬ ‫لما‬ ‫هلبا‬ ‫تتعصر‬
‫؟‬
Bloody or Not  ,‫حاج‬ ‫ٌا‬ ً‫سامحن‬
‫البراز‬ ‫مع‬ ‫ٌنزل‬ ‫دم‬ ً‫ف‬
‫؟‬
D  Duration Acute Drugs (Iron Supplement, Opiate) ‫معاك؟‬ ‫اإلمساك‬ ‫لٌه‬ ‫قداش‬ ‫حاج‬ ‫ٌا‬ ً‫سامحن‬
Chronic  Cancer Colon, Irritable Bowel Syndrome, Low Fiber Diet.
O  Onset Sudden  Drugs (Iron Supplement, Opiate). ‫بد‬ ‫هل‬
‫ي‬
‫فجأ‬ ‫معاك‬
‫بشوٌة‬ ‫وإال‬ ‫ة‬
Gradual  Cancer Colon & Low Fiber Diet. ‫مرة‬ ‫كل‬ ‫ومع‬
ٌ‫ا‬
‫معاك؟‬ ‫زٌد‬
A  Aggravating Factors It Acute Constipation Aggravated By  Drugs (Iron Supplement, Opiate).
ً‫ف‬ ‫علٌك‬ ‫اٌزٌد‬ ً‫الل‬ ‫شن‬
‫ا‬
‫إل‬
‫مساك‬
‫؟‬
‫معٌن‬ ‫دواء‬ ‫تاخد‬ ‫لما‬ ‫علٌك‬ ‫اٌزٌد‬ ‫الحظتش‬ ‫ما‬ ‫أو‬
‫؟‬
R  Relieving Factors Relieved By Medications (Laxatives). ‫ٌنقص‬ ً‫الل‬ ‫شن‬
‫حاج؟‬ ‫ٌا‬ ‫اإلمساك‬ ً‫ف‬ ‫علٌك‬
‫أو‬
‫اإلمساك؟‬ ‫علٌك‬ ‫نقص‬ ‫خذٌته‬ ‫معٌن‬ ‫دواء‬ ‫مافٌش‬
A  Associated Symptoms Catchexia, Weight Loss, Bleeding Per Rectum Cancer Colon.
‫ملحوظ؟‬ ‫بشكل‬ ‫نقص‬ ‫وزنك‬ ‫الحظتش‬ ‫ما‬ ‫حاج‬ ‫ٌا‬ ‫االمساك‬ ‫غٌر‬ ‫من‬ ً‫باه‬
‫ٌنزل؟‬ ‫دم‬ ً‫ف‬ ‫اإلمساك‬ ‫مع‬ ‫الحظتش‬ ‫ما‬ ً‫باه‬
Alternate with Diarrhea & Abdominal Pain  Irritable Bowel Syndrome.
‫كثرت‬ ‫حاج‬ ‫ٌا‬ ً‫سامحن‬
‫البطن‬ ً‫ف‬ ‫وجع‬ ‫معاها‬ ً‫وف‬ ‫إسهال‬ ‫ٌجٌك‬ ‫مره‬ ‫مره‬ ‫الحظتش‬ ‫ما‬ ,‫علٌك‬
‫؟‬
Pain with Defecation & Bleeding Per Rectum Peri-Anal Diseases.
‫دم‬ ‫معاها‬ ً‫وف‬ ‫تتبرز‬ ‫لما‬ ‫وجع‬ ً‫ف‬ ‫اتحسش‬ ‫ما‬ ‫حاج‬ ‫ٌا‬ ً‫سامحن‬
‫ٌنزل‬
‫؟‬
Cold Intolerance & Goiter  Hypothyroidism.
‫الصقع؟‬ ً‫ف‬ ‫تتحمل‬ ‫بدٌت‬ ‫معاش‬ ‫روحك‬ ‫الحظتش‬ ‫ما‬ ً‫باه‬ ‫حاج؟‬ ‫ٌا‬ ‫رقبتك‬ ً‫ف‬ ‫انتفاخ‬ ‫عندك‬
C  Course Regressive or Constant or Progressive. ‫نقص‬ ‫هل‬ ‫الٌوم‬ ‫ل‬ ‫اإلمساك‬ ‫معاك‬ ‫بدي‬ ‫لما‬ ‫من‬
‫قبل؟‬ ‫على‬ ‫زاٌد‬ ‫أو‬ ,‫قبل‬ ‫زي‬ ‫قاعد‬ ‫أو‬ ,‫علٌك‬
S  Severity Interfering with Daily Activity. ‫معاي‬ ‫تعبتك‬ ‫حاج‬ ‫ٌا‬ ً‫سامحن‬
‫هل‬ ,
‫اإلمساك‬
‫امخلٌك‬ ‫مش‬
Interfering with Sleep. ‫و‬ ‫ترقد‬
‫ل‬ ً‫تمش‬ ‫امخلٌك‬ ‫مش‬
‫طبٌعٌة؟‬ ‫حٌاتك‬ ‫تمارس‬ ‫أو‬ ‫عملك‬

22. DR. MOHCEN AL. HAJ
22
4. SYSTEMIC REVIEW: Start with the Involved System First.
- GIT:  ASK ABOUT :-
*Anorexia, Weight loss & Bleeding Per Rectum  FOR Cancer Colon Because
Cancer Colon One of the Common Causes of Constipation Especially In Old Ages.
*Abdominal Pain & Alternate with Diarrhea  FOR Irritable Bowel Syndrome.
*Left Iliac Fossa Pain  TO EXCLUDE Diverticular Disease Because Diverticular
Disease Can Cause Constipation.
*Pain During Defecation & Bleeding Per Rectum  TO EXCLUDE Peri-Anal
Diseases (Hemorrhoids OR Fissure) Because Patient Who Has Hemorrhoids OR
Fissure Fear From Defecation Which Leads to Constipation.
*Jaundice & Abdominal Distension  FOR Cancer Colon Metastases.
*Vomiting & Abdominal Pain  TO EXCLUDE Hypercalcaemia Because
Hypercalcaemia Can Cause Constipation. ‫حاج‬ ‫ٌا‬ ً‫سامحن‬
,
‫كبٌر‬ ‫بشكل‬ ‫نقص‬ ‫وزنك‬ ‫الحظتش‬ ‫ما‬
‫ماالحظ‬ ‫بطنك؟‬ ً‫ف‬ ‫وجع‬ ‫ماعندكش‬ ‫حاج‬ ‫ٌا‬ ً‫باه‬ ‫الشرج؟‬ ‫فتحة‬ ‫من‬ ‫نزٌف‬ ‫عندك‬ ,‫حاج‬ ‫ٌا‬ ً‫ماعلٌش‬ ‫وملحوظ؟‬
‫تش‬
,‫ٌاحاج‬ ً‫سامحن‬ ‫الٌسار؟‬ ‫جٌهة‬ ‫خصوصا‬ ‫حزامك‬ ً‫ف‬ ‫وجع‬ ‫عندك‬ ً‫باه‬ ‫اإلمساك؟‬ ‫بدل‬ ‫إسهال‬ ‫اٌجٌك‬ ‫مره‬ ‫مره‬ ‫انه‬
‫لونك‬ ‫الحظتش‬ ‫ما‬ ً‫باه‬ ‫البطن؟‬ ً‫ف‬ ‫انتفاخ‬ ‫عندك‬ ‫البراز؟‬ ‫ٌنزل‬ ‫ما‬ ‫بعد‬ ‫ٌنزل‬ ‫دم‬ ً‫ف‬ ً‫باه‬ ‫تتبرز؟‬ ‫لما‬ ‫بوجع‬ ‫اتحس‬
‫هل‬ ‫حاج؟‬ ‫ٌا‬ ‫اترجع‬ ً‫باه‬ ‫حاج؟‬ ‫ٌا‬ ‫الصفٌر‬ ‫وجاك‬ ‫أصفر‬ ‫ولى‬
‫بطن؟‬ ‫وجع‬ ‫معاه‬
- CVS:  ASK ABOUT :-
*Palpitation & Dyspnea  For Anemia  Especially In Case of Bleeding Per Rectum
Which May Lead to Loss of Iron & Folic acid Due to Chronic Blood Loss.
‫حاج‬ ‫ٌا‬ ً‫سامحن‬
,
‫عندك‬
‫القلب‬ ً‫ف‬ ‫رفة‬
‫؟‬
‫مجهود؟‬ ‫تبذل‬ ‫لما‬ ‫خصوصا‬ ‫حاج‬ ‫ٌا‬ ‫دهشة‬ ‫عندك‬ ً‫باه‬
- Endocrine System:  ASK ABOUT :-
*Cold Intolerance & Goiter TO EXCLUDE Hypothyroidism  Because
Hypothyroidism Leads to Constipation (Due to Decrease of Bowel Movement).
‫ح‬ ‫ٌا‬ ‫هلبا‬ ‫تصقع‬ ‫روحك‬ ‫الحظتش‬ ‫ما‬
‫الوقت؟‬ ‫أغلب‬ ‫ببطانٌة‬ ‫وتتغطى‬ ‫اج‬
ً‫ف‬ ‫طوبة‬ ‫أو‬ ‫انتفاخ‬ ‫أي‬ ‫عندكش‬ ‫ما‬ ‫حاج‬ ‫ٌا‬
‫رقبتك‬
‫القدام‬ ‫من‬
‫؟‬
- Hematology:  ASK ABOUT :-
*Generalized Fatigability, Dizziness, Pallor  Especially In Case of Bleeding Per
Rectum Which May Lead to Loss of Iron & Folic acid Due to Chronic Blood Loss.
‫معاي‬ ‫تعبتك‬ ‫حاج‬ ‫ٌا‬ ً‫سامحن‬
,
‫بعضه؟‬ ‫مع‬ ‫فاشل‬ ‫جسمك‬ ً‫ف‬ ‫اتحسش‬ ‫ما‬
‫با‬
‫حاج؟‬ ‫ٌا‬ ‫شحوب‬ ‫وال‬ ‫دوخه‬ ‫ماعندكش‬ ً‫ه‬
- Genito-Urinary System:  ASK ABOUT :-
*Polyurea & PolydepsiaTO EXCLUDE Hpercalceamia & Diabetes Mellitus.
‫هلبا؟‬ ‫تعطش‬ ‫بدٌت‬ ‫روحك‬ ‫الحظت‬ ‫وال‬ ‫هلبا؟‬ ‫وتتبول‬ ‫الحمام‬ ‫اتخش‬ ‫بدٌت‬ ‫روحك‬ ‫الحظتش‬ ‫ما‬ ,‫حاج‬ ‫ٌا‬ ً‫سامحن‬

23. DR. MOHCEN AL. HAJ
23
5. PAST MEDICAL HISTORY:
*History of Same Illness Before? If Yes  How Many Times? When Was the Last
Time? Does He Admitted or No? Does He Admitted to ICU or No? What are the
Investigations? ‫حاج‬ ‫ٌا‬ ً‫ماعلٌش‬
,
‫آخر‬ ‫كانت‬ ‫أمتى‬ ‫صارتلك؟‬ ‫مرة‬ ‫قداش‬ ‫قبل؟‬ ‫من‬ ‫هادي‬ ‫المشكلة‬ ‫نفس‬ ‫ماصارتلكش‬
‫الٌوم؟‬ ‫نفس‬ ً‫ف‬ ‫طلعت‬ ‫وإال‬ ‫المستشفى‬ ‫دخلوك‬ ‫هل‬ ‫مرة؟‬
‫العناٌة؟‬ ‫خشٌت‬ ‫هل‬
‫دارول‬ ‫شن‬ ‫متفكر‬ ‫مش‬ ‫حاج‬ ‫ٌا‬ ً‫باه‬
‫ك‬
‫من‬
‫إجراءات؟‬ ‫أو‬ ‫تحالٌل‬
*History of Any Chronic Illness (Like DM, HTN, CVA, Parkinsonism) If Yes What is the
Duration of the Chronic Illness? What is the Treatment? Does He in Regular Follow up?
,‫حاج‬ ‫ٌا‬ ً‫سامحن‬
‫لتوا‬ ‫عالج‬ ً‫ف‬ ‫وتاخدلها‬ ‫معاك‬ ‫فترة‬ ‫لٌها‬ ‫قدٌمة‬ ‫صحٌة‬ ‫مشكلة‬ ‫أي‬ ‫ماعندكش‬
‫مثال)؟‬ ‫ضغط‬ ‫أو‬ ‫(سكر‬
‫تعرف؟‬ ‫لو‬ ‫عالج‬ ‫من‬ ‫تاخدلها‬ ‫وشن‬ ‫المشكلة؟‬ ‫معاك‬ ‫لٌها‬ ‫قداش‬ ‫حاج؟‬ ‫ٌا‬ ‫المشكلة‬ ‫هٌا‬ ‫شن‬
‫اتراجع‬ ً‫تمش‬ ‫هل‬
‫وم‬
‫حاج؟‬ ‫ٌا‬ ‫ال‬ ‫وإال‬ ‫مراجعاتك‬ ً‫ف‬ ‫نتظم‬
6. DRUG HISTORY:
*Ask the About Any Drug Can Cause Constipation Such as  Iron Supplements, Opiate.
Also Insulin (What is the Dose if He Knows?) & ACE I (What is the Dose if He Knows?).
‫دواء‬ ً‫ف‬ ‫تاخد‬ ‫حاج‬ ‫ٌا‬ ً‫ماعلٌش‬
‫مس‬ ‫ولتوا‬ ‫طوٌلة‬ ‫فترة‬ ‫من‬
‫علٌه؟‬ ‫تمر‬
‫حاج‬ ‫ٌا‬ ‫الدواء‬ ‫هوا‬ ‫شن‬
‫الجرعة؟‬ ‫وقداش‬
7. PAST SURGICAL HISTORY:
*Any History of Abdominal Surgery (Intestinal Surgery)
*Also History of Any Surgery Done By General Anesthesia.
*If Patient has History of Surgery Before  Does He Received Blood or Not? ‫امداٌر‬ ‫مش‬
‫عملٌة‬ ‫أي‬
‫البطن‬ ‫ع‬ ‫جراحٌة‬
‫؟‬
‫لٌها‬ ‫قداش‬
‫تخذٌر‬ ‫دارولك‬ ‫هل‬ ‫؟‬
‫تحت‬ ‫عملٌة‬ ‫أي‬ ‫امداٌر‬ ‫وال‬ ً‫باه‬ ‫موضعً؟‬ ‫أو‬ ‫عام‬
‫؟‬ ‫العام‬ ‫التخذٌر‬
‫مضاعفات‬ ‫أو‬ ‫مشاكل‬ ‫أي‬ ‫ماصارتلكش‬
‫العملٌة؟‬ ‫بعد‬
‫دم‬ ‫زادوكش‬ ‫ما‬ ‫حاج‬ ‫ٌا‬ ً‫باه‬
‫؟‬
8. FAMILY HISTORY:
*Any History of Same Illness in His Family (Hirschprung Disease, FAP).
*Ask if His First Relative Degrees Had Any Chronic Illness (Like DM, HTN).
‫عنده‬ ‫عٌلتك‬ ‫من‬ ‫حد‬ ‫مافٌش‬
‫نف‬
‫ع‬ ‫عٌلتك‬ ً‫ف‬ ‫حد‬ ً‫ف‬ ‫المشكلة؟‬ ‫س‬
‫نده‬
‫السكر‬ ‫زي‬ ‫وقدٌمة‬ ‫مزمنة‬ ‫صحٌة‬ ‫مشكلة‬ ‫أي‬
‫الضغط؟‬ ‫أو‬
9. SOCIAL HISTORY:
*Ask If He is Smoker or Ex-Smoker (If He is Smoker Ask about Duration & Amount).
*Ask If He is Alcoholic (If He is Alcoholic Ask about Duration & Amount).
*Ask About Sedentary Life & Exercise. ‫حاج؟‬ ‫ٌا‬ ‫ادخن‬
‫لٌك؟‬ ‫قداش‬
‫حاج‬ ‫ٌا‬ ‫السؤال‬ ً‫ف‬ ً‫سامحن‬
,
‫المسكرات؟‬ ‫من‬ ‫نوع‬ ‫أي‬ ً‫ف‬ ‫تشرب‬
ٌ‫ل‬ ‫قداش‬
‫ك؟‬
‫الحوش؟‬ ً‫ف‬ ‫راقد‬ ‫دٌما‬ ‫وإال‬ ‫وتتحرك‬ ً‫تتمش‬ ‫حاج‬ ‫ٌا‬ ً‫باه‬
10. Nutritional HISTORY:
*Ask About if the Patient Eats Any Fiber Diet Such as  Vegetables, Wheat, Barley.
‫هل‬ ,‫توا‬ ‫أكلك‬ ‫طبٌعة‬ ‫ع‬ ‫بنسألك‬ ‫حاج‬ ‫ٌا‬ ً‫ماعلٌش‬
‫الخضروات‬ ً‫ف‬ ‫تاكل‬
‫نشوٌات‬ ‫بس‬ ‫ماكلتك‬ ‫وإال‬ ‫واأللٌاف؟‬ ‫والقمح‬
‫ودهنٌات‬ ‫ولحوم‬
‫؟‬

24. DR. MOHCEN AL. HAJ
24
Differential Diagnosis of Jaundice
Non-Obstructive Obstructive
1. Heamolytic Jaundice.
2. Congenital Jaundice:
- Gilbert Syndrome.
- Crigler-Najjar Syndrome.
Intra-Hepatic Extra-Hepatic
1. Viral Hepatitis.
2. Liver Cirrhosis.
3. Primary Biliary Cirrhosis.
4. Primary Sclerosing Cholangitis.
5. Alcohol.
6. Drugs.
7. Pregnancy.
1. CBD Stone (Commonest).
2. CBD Stricture.
3. Primary Sclerosing
Cholangitis.
4. Chronic Pancreatitis.
5. Carcinoma of Biliary Tract.
6. Cancer Head of Pancreas.
7. Peri-Ampullary Carcinoma.
Differential Diagnosis of Upper GIT Bleeding (Heamatemesis)
1. Peptic Ulcer (Commonest).
2. Gastritis.
3. Oesophagitis.
4. Oesophageal Varices.
5. Mallory Weiss Syndrome.
6. Vascular Malformation.
7. Cancer Stomach & Oesophagus.
Differential Diagnosis of Lower GIT Bleeding
Acute Chronic
1. Diverticular Disease of Colon
Commonest Cause of Massive
Bleeding.
2. Meckles Diverticulum.
3. Angiodysplasia.
4. Mesenteric Ischaemia.
1. Peri-Anal Condition:
- Hemorrhoids (Commonest Cause).
- Fissure.
- Anal Carcinoma.
2. Cancer Colon.
3. Large Colon Polyps (FAP).
4. Inflammatory Bowel Disease:
- Crhons Disease.
- Ulcerative Colitis.

25. DR. MOHCEN AL. HAJ
25
JAUNDICE OSCE:
INTRODUCE YOUR SELF & TAKE PERMISSION FROM THE PATIENT.
1. PERSONAL DATA: Name, Age, Gender, Nationality, Occupations.
2. MAIN COMPLAIN: What is Your Complain? & Duration.
3. ANALYSIS OF MAIN COMPLAIN:  DO CAP
D  Duration Acute  CBD Stone OR Stricture, Acute Hepatitis & Drugs.
Chronic  Liver Cirrhosis, Primary Biliary Cirrhosis, Cancer Head of
Pancreas, Heamolytic Anemia & Alcohol.
‫معاك؟‬ ‫الصفٌر‬ ‫لٌه‬ ‫قداش‬ ‫حاج‬ ‫ٌا‬ ً‫ماعلٌش‬
O  Onset Sudden  CBD Stone OR Stricture, Acute Hepatitis & Drugs.
Gradual Liver Cirrhosis, Primary Biliary Cirrhosis, Cancer Head of
Pancreas, Heamolytic Anemia & Alcohol.
‫وإال‬ ‫وحده‬ ‫مرة‬ ً‫ف‬ ‫الصفٌر‬ ‫طلعلك‬ ‫هل‬ ‫حاج‬ ‫ٌا‬ ً‫باه‬
‫اٌزٌد‬ ‫مرة‬ ‫كل‬ ‫ومع‬ ‫بالشوٌة‬ ‫معاك‬ ‫ابدي‬
‫؟‬
C  Color of Urine & Stool Dark Urine & Pale Stool  Obstructive Causes (CBD Stone, Liver
Cirrhosis, Primary Biliary Cirrhosis, Cancer Head of Pancreas).
Dark Urine & Dark Stool  Heamolytic Anemia.
‫ال؟‬ ‫أو‬ ‫داكن‬ ‫حاج‬ ‫ٌا‬ ‫البراز‬ ‫لون‬ ً‫باه‬ ‫ال؟‬ ‫أو‬ ‫داكن‬ ‫امتاعك‬ ‫البول‬ ‫لون‬ ‫شن‬ ,‫حاج‬ ‫ٌا‬ ً‫سامحن‬
A  Associated Symptoms Abdominal Pain (Right Hypochondrial Area)  CBD Stone OR Stricture.
Fever + Rigor + Abdominal Pain  Ascending Cholangitis.
Stigmata of Liver Cirrhosis (Abdominal Distension, Lower Limb Edema,
Heamatemesis)  Liver Cirrhosis.
Catchexia, Weight Loss & Deep Jaundice  Cancer Head of Pancreas.
Generalized Fatigue, Dyspnea & Pallor  Heamolytic Anemia.
‫ما‬ ‫الصفٌر‬ ‫غٌر‬ ‫من‬
‫البطن‬ ً‫ف‬ ‫وجع‬ ‫أي‬ ‫عندك‬ ‫الحظتش‬
‫؟‬
‫رعشة‬ ‫أو‬ ‫حرارة‬ ‫ماعندكش‬ ‫حاج‬ ‫ٌا‬ ً‫باه‬
‫الحرارة؟‬ ‫مع‬ ‫جسمك‬ ً‫ف‬
‫عندكش‬ ‫ما‬ ‫حاج‬ ‫ٌا‬
‫البطن‬ ً‫ف‬ ‫انتفاخ‬
‫أو‬ ,‫الرجلٌن‬ ‫و‬
‫دم؟‬ ‫ترجٌع‬
‫الحظتش‬ ‫ما‬
‫الجسم؟‬ ً‫ف‬ ‫عام‬ ‫فشل‬ ‫أو‬ ‫شحوب‬ ‫أو‬ ‫دهشة‬ ‫ماعندكش‬ ‫حاج؟‬ ‫ٌا‬ ‫وملحوظ‬ ‫كبٌر‬ ‫شكل‬ ‫ب‬ ‫نقص‬ ‫وزنك‬
P  Pruritis Especially FOR Primary Biliary Cirrhosis.
If Patient Has Pruritis ask About:
1. Duration.
2. Does the Pruritis Before Jaundice or Jaundice Before Pruritis.
( Because in Primary Biliary Cirrhosis Pruritis Proceed Jaundice May
be By Years).
‫الصفٌر‬ ‫وإال‬ ‫الحكة‬ ‫قبل‬ ‫بدي‬ ً‫الل‬ ‫من‬ ً‫باه‬ ‫حاج؟‬ ‫ٌا‬ ‫لٌها‬ ‫قداش‬ ‫حكة؟‬ ‫عندك‬ ,‫حاج‬ ‫ٌا‬ ً‫سامحن‬
‫؟‬

26. DR. MOHCEN AL. HAJ
26
4. SYSTEMIC REVIEW: Start with the Involved System First.
- GIT:  ASK ABOUT :-
*Abdominal Pain (Right Hypochondrial)FOR CBD Stone & Primary Biliary Cirrhosis.
*Diarrhea & Steatorrhea  FOR Obstructive Jaundice  Obstructive Jaundice
Leads to Malabsorption & Diarrhea.
*Abdominal Distension (Ascites) & Lower Limb Edema  FOR Liver Cirrhosis
Because Liver Cirrhosis Leads to Jaundice.
*Marked Weight Loss & Anorexia  FOR Cancer Head of Pancreas. ً‫ف‬ ‫مكان‬ ‫مافٌش‬
‫كله؟‬ ‫ٌتصرف‬ ‫هل‬ ً‫الٌفون‬ ‫تجبد‬ ‫لما‬ ً‫باه‬ ‫حاج؟‬ ‫ٌا‬ ‫البراز‬ ‫لون‬ ‫شن‬ ‫لٌه؟‬ ‫قداش‬ ‫اسهال؟‬ ‫عندك‬ ‫فٌك؟‬ ‫ٌوجع‬ ‫بطنك‬
‫رجلٌك؟‬ ‫أو‬ ‫بطنك‬ ً‫ف‬ ‫انتفاخ‬ ‫أي‬ ‫عندك‬
‫وهلبا؟‬ ‫ملحوظ‬ ‫بشكل‬ ‫نقص‬ ‫وزنك‬ ‫الحظتش‬ ‫ما‬ ,‫حاج‬ ‫ٌا‬ ً‫سامحن‬
- CVS:  ASK ABOUT :-
*Palpitation & Dyspnea  FOR Heamolytic Aneamia.
,‫حاج‬ ‫ٌا‬ ً‫ماعلٌش‬
‫عندك‬
‫القلب‬ ً‫ف‬ ‫رفة‬
‫؟‬
‫مجهود؟‬ ‫تبذل‬ ‫لما‬ ‫خصوصا‬ ‫حاج‬ ‫ٌا‬ ‫دهشة‬ ‫عندك‬ ً‫باه‬
- Hematology:  ASK ABOUT :-
*Generalized Fatigability, Dizziness, Pallor  FOR Heamolytic Aneamia.
,‫معاي‬ ‫تعبتك‬ ‫حاج‬ ‫ٌا‬ ً‫سامحن‬
‫بعضه؟‬ ‫مع‬ ‫فاشل‬ ‫جسمك‬ ً‫ف‬ ‫اتحسش‬ ‫ما‬
‫حاج؟‬ ‫ٌا‬ ‫شحوب‬ ‫وال‬ ‫دوخه‬ ‫ماعندكش‬ ً‫باه‬
- CNS:  ASK ABOUT :-
*Disorientation with Person + Place + Time FOR Hepatic Encephalopathy 
Due to Liver CirrhosisBecause Ammonia Reach the Brain Cause Disorientation of
Conscious Level. ‫ما‬ ‫حاج‬ ‫ٌا‬
‫معاك‬ ‫من‬ ‫وال‬ ‫وٌن‬ ‫روحك‬ ‫عرفت‬ ‫ومعاش‬ ‫بدوخة‬ ‫حسٌت‬ ‫وال‬ ‫بكل؟‬ ً‫الوع‬ ‫فقدتش‬
‫؟‬
5. PAST MEDICAL HISTORY:
*History of Same Illness Before? If Yes How Many Times? When Was the Last Time?
Does He Admitted or No? Does He Admitted to ICU or No?
*Ask if He Done Endoscopic Sclerotherapy or Ligation ? ‫ماصارتلكش‬ ‫حاج‬ ‫ٌا‬ ً‫ماعلٌش‬
‫نفس‬
‫المشكلة‬
‫المستشفى‬ ‫دخلوك‬ ‫هل‬ ‫مرة؟‬ ‫آخر‬ ‫كانت‬ ‫أمتى‬ ‫صارتلك؟‬ ‫مرة‬ ‫قداش‬ ‫قبل؟‬ ‫من‬ ‫هادي‬
‫الٌوم؟‬ ‫نفس‬ ً‫ف‬ ‫طلعت‬ ‫واال‬
‫العناٌة؟‬ ‫خشٌت‬ ‫هل‬
‫حاج‬ ‫ٌا‬ ً‫باه‬
‫ربط؟‬ ‫أو‬ ‫كوي‬ ‫معاه‬ ‫داروا‬ ‫و‬ ‫علوي‬ ‫منظار‬ ‫دارولك‬ ‫هل‬
*History of Any Chronic Illness (Like DM, HTN, CRF)? If Yes  What is the Duration of
the Chronic Illness? What is the Treatment? Does He in Regular Follow up? ‫ٌا‬ ً‫سامحن‬
‫لتوا‬ ‫عالج‬ ً‫ف‬ ‫وتاخدلها‬ ‫قدٌمة‬ ‫صحٌة‬ ‫مشكلة‬ ‫أي‬ ‫ماعندكش‬ ,‫حاج‬
‫مثال)؟‬ ‫ضغط‬ ‫أو‬ ‫(سكر‬
‫حاج؟‬ ‫ٌا‬ ‫المشكلة‬ ‫هٌا‬ ‫شن‬
‫لٌه‬ ‫قداش‬
‫ا‬
‫عالج؟‬ ‫من‬ ‫تاخدلها‬ ‫وشن‬ ‫؟‬
‫وم‬ ‫اتراجع‬ ‫هل‬
‫الكالوي؟‬ ً‫ف‬ ‫تغسل‬ ‫حاج؟‬ ‫ٌا‬ ‫ال‬ ‫واال‬ ‫مراجعاتك‬ ً‫ف‬ ‫نتظم‬
*Viral Screen  FOR Hepatitis. ‫النتٌجة؟‬ ‫كانت‬ ‫وشن‬ ‫درتها؟‬ ‫صحٌة‬ ‫شهادة‬ ‫آخر‬ ‫أمتى‬ ‫حاج‬ ‫ٌا‬

27. DR. MOHCEN AL. HAJ
27
6. DRUG HISTORY:
*Ask the Patient About Any Drugs Can Cause Hepatitis & Liver Cirrhosis Such as 
Amiodarone, Anti-TB, Methotrexate, Panadol, α-Methyl-Dopa, Halothane.
*Also Statin, Insulin & ACE I (What is the Dose if He Knows?).
‫دواء‬ ً‫ف‬ ‫تاخد‬ ‫حاج‬ ‫ٌا‬ ً‫ماعلٌش‬
‫مس‬ ‫ولتوا‬ ‫طوٌلة‬ ‫فترة‬ ‫من‬
‫علٌه؟‬ ‫تمر‬
‫حاج‬ ‫ٌا‬ ‫الدواء‬ ‫هوا‬ ‫شن‬
‫الجرعة؟‬ ‫وقداش‬
7. PAST SURGICAL HISTORY:
*Any History of Stone Extraction, CBD Stricture Surgery,
*Any Previous General Anesthesia (Halothane).
*Any History Of Tattooing  FOR Hepatitis.
*Any History of Recurrent Blood Transfusion FOR Heamolytic Anemia.
*Any History of Blood Transfusion FOR Hepatitis.
*Any History of Heamo-Dialysis  FOR Hepatitis. ‫عملٌة‬ ‫أي‬ ‫امداٌر‬ ‫مش‬
‫الكبد‬ ‫ع‬ ‫جراحٌة‬
‫المرارة‬ ‫ع‬ ‫حصوة‬ ‫أو‬ ‫الصفراوٌة‬ ‫القنوات‬ ‫أو‬
‫؟‬
‫لٌها‬ ‫قداش‬
‫؟‬
‫نوع‬ ‫شن‬ ‫حاج؟‬ ‫ٌا‬ ً‫موضع‬ ‫أو‬ ‫عام‬ ‫تخذٌر‬ ‫دارولك‬
‫المخ‬
‫تعرفه؟‬ ‫لو‬ ‫ذر‬
‫مضاعفات‬ ‫أو‬ ‫مشاكل‬ ‫أي‬ ‫ماصارتلكش‬ ‫حاج‬ ‫ٌا‬ ً‫سامحن‬
‫العملٌة؟‬ ‫بعد‬
‫ماعندكش‬
‫وشم؟‬ ‫أي‬
‫وفترة؟‬ ‫فترة‬ ‫بٌن‬ ‫دم‬ ً‫ف‬ ‫اٌزٌدولك‬
‫زاٌد‬ ‫وال‬ ‫مرة؟‬ ‫قداش‬
‫دم‬
‫حاج‬ ‫ٌا‬ ‫حٌاتك‬ ً‫ف‬ ‫بكل‬
‫؟‬
ً‫باه‬
ٌ‫كالو‬ ً‫ف‬ ‫تغسل‬
‫ك‬
‫؟‬
8. FAMILY HISTORY:
*Any History of Same Illness in His Family (Especially Heamolytic AnemiaGilbert Synd)
*Any History of Sudden Death in His Family.
*Ask if His First Relative Degrees Had Any Chronic Illness (Like DM, HTN, CRF).
‫عنده‬ ‫عٌلتك‬ ‫من‬ ‫حد‬ ‫مافٌش‬
‫نف‬
‫العٌلة‬ ً‫ف‬ ‫حد‬ ً‫ف‬ ‫هل‬ ‫المشكلة؟‬ ‫س‬
‫ٌا‬ ‫طول‬ ‫السبب‬ ‫عرفتوش‬ ‫وما‬ ‫فجأة‬ ‫مات‬
‫حاج‬
‫؟‬
‫ع‬ ‫عٌلتك‬ ً‫ف‬ ‫حد‬ ً‫ف‬
‫نده‬
‫الضغط‬ ‫أو‬ ‫السكر‬ ‫زي‬ ‫وقدٌمة‬ ‫مزمنة‬ ‫صحٌة‬ ‫مشكلة‬ ‫أي‬
‫الكلى‬ ً‫ف‬ ‫فشل‬ ‫أو‬
‫؟‬
9. SOCIAL HISTORY:
*Ask If He is Alcoholic (If He is Alcoholic Ask about Duration & Amount).
(Because Alcohol is a Strong Risk Factor for Hepatitis & Liver Cirrhosis).
*Ask If He is Drug Abuser, Alone or with Group?.
*Ask If He is Smoker or Ex-Smoker (If He is Smoker Ask about Duration & Amount).
‫حاج‬ ‫ٌا‬ ‫السؤال‬ ً‫ف‬ ً‫سامحن‬
,
‫المسكرات‬ ‫من‬ ‫نوع‬ ‫أي‬ ً‫ف‬ ‫تشرب‬
‫هل‬ ‫تشرب‬ ‫قداش‬ ‫كل‬ ‫بمعدل‬ ,‫حاج‬ ‫ٌا‬ ً‫سامحن‬ ‫؟‬
‫تتعاطاش‬ ‫ما‬ ‫حاج‬ ‫ٌا‬ ً‫باه‬ ‫مرة؟‬ ‫الشهر‬ ً‫ف‬ ‫أو‬ ‫مرة‬ ‫األسبوع‬ ً‫ف‬ ‫أو‬ ‫ٌوم‬ ‫بعد‬ ‫ٌوم‬ ‫أو‬ ‫ٌومٌا‬
‫من‬ ‫نوع‬ ‫أي‬ ً‫ف‬
‫فٌها؟‬ ‫تستعملوا‬ ‫الٌبرة‬ ‫نفس‬ ‫هل‬ ‫مجموعة؟‬ ‫مع‬ ‫أو‬ ‫بروحك‬ ‫هل‬ ‫لٌك؟‬ ‫قداش‬ ‫المخدرات؟‬
‫حاج؟‬ ‫ٌا‬ ‫ادخن‬
‫لٌك؟‬ ‫قداش‬
10. TRAVEL HISTORY: FOR Hepatitis. ‫األخٌرة؟‬ ‫الفترة‬ ‫مكان‬ ‫ألي‬ ‫سافرت‬
‫لٌها؟‬ ‫قداش‬
‫وٌن؟‬
11. OCCUPATIONAL HISTORY: Medical Stuff  Needle Stick Hepatitis.
12. SEXUAL HISTORY: FOR Hepatitis.

28. DR. MOHCEN AL. HAJ
28
UPPER GIT BLEEDING (HEAMATEMESIS) OSCE:
INTRODUCE YOUR SELF & TAKE PERMISSION FROM THE PATIENT.
1. PERSONAL DATA: Name, Age, Gender, Nationality, Occupations.
2. MAIN COMPLAIN: What is Your Complain? & Duration.
3. ANALYSIS OF MAIN COMPLAIN:  DOARA CS + Properties of
Upper GIT Bleeding (Heamatemesis)
D  Duration Acute  Oesophagitis. ‫الدم‬ ‫ترجٌع‬ ‫موضوع‬ ‫لٌه‬ ‫قداش‬ ‫حاج‬ ‫ٌا‬ ً‫سامحن‬
‫معاك‬
‫؟‬
Chronic or Recuurent  Oesophageal Varices & Peptic Ulcer.
O  Onset Sudden  Oesophagitis. ‫بد‬ ‫هل‬
‫ي‬
‫بشوٌة‬ ‫وإال‬ ‫فجأة‬ ‫معاك‬
Gradual  Oesophageal Varices & Peptic Ulcer. ‫ا‬ ‫مرة‬ ‫كل‬ ‫ومع‬
ٌ
‫معاك؟‬ ‫زٌد‬
A  Aggravating Factors If Aggravated By Drugs (NSAIDS)  Peptic Ulcer.
Spontaneously  Oesophageal Varices.
‫الدم‬ ‫ترجٌع‬ ً‫ف‬ ‫علٌك‬ ‫اٌزٌد‬ ‫تستعمله‬ ‫معٌن‬ ‫دوا‬ ‫وال‬ ,‫معٌن‬ ً‫ش‬ ‫مافٌش‬
‫بروحه‬ ‫ٌطلع‬ ‫أو‬
‫؟‬
R  Relieving Factors If Relieved By Stopping Drugs (NSAIDS)  Peptic Ulcer.
May Relieve By Intervention (Urgent Endoscopic Ligation OR
Sclerotherapy)  in Case of Esophageal Varices.
‫حاج‬ ‫ٌا‬ ً‫ماعلٌش‬
‫الدم‬ ‫ترجٌع‬ ‫علٌك‬ ‫ٌنقص‬ ‫هذا‬ ‫الدوا‬ ‫اتوقف‬ ‫أمتى‬
‫لٌن‬ ‫أو‬ ‫بروحه؟‬ ‫ٌوقف‬ ‫وإال‬
‫العلوي‬ ‫بالمنظار‬ ‫ربط‬ ‫أو‬ ‫كوي‬ ‫ودارولك‬ ‫المستشفى‬ ‫خشٌت‬
‫؟‬
A  Associated Symptoms Epigastric Pain, Heart Burn & Melena (Black Tarry Stool)  Peptic Ulcer.
ً‫ف‬ ‫وجع‬ ‫ماعندكش‬ ‫حاج‬ ‫ٌا‬ ً‫باه‬
ً‫ف‬ ‫مكان‬ ‫أي‬
‫بطن‬
‫ك‬
‫المكان‬ ‫وٌن‬ ‫؟‬
ً‫ف‬ ‫لو‬
‫؟‬
‫ما‬ ‫حاج‬ ‫ٌا‬
‫حرقان‬ ‫أو‬ ‫صهد‬ ‫أو‬ ‫قداد‬ ‫عندكش‬
ً‫ف‬
‫فم‬
‫المعدة‬
‫؟‬
‫حاج‬ ‫ٌا‬ ً‫سامحن‬
,
‫الحظتاش‬ ‫ما‬ ‫البراز‬ ‫لون‬
‫وبدي‬ ‫اتغٌر‬
‫داكن؟‬ ‫أسود‬
Jaundice & Ascites + Lower Limb Edema Oesophageal Varices.
‫الصفٌر‬ ‫جاكش‬ ‫ما‬
‫حاج‬ ‫ٌا‬
‫؟‬
‫أي‬ ‫الحظتش‬ ‫ما‬ ‫حاج‬ ‫ٌا‬ ً‫باه‬
‫انتف‬
‫ا‬
‫خ‬
ً‫ف‬
‫بطنك‬
‫رجلٌك‬ ‫أو‬
‫؟‬
Cachexia & Weight Loss  Cancer Stomach & Esophagus.
‫وزنك‬ ‫الحظتش‬ ‫ما‬
‫حاج؟‬ ‫ٌا‬ ‫وملحوظ‬ ‫كبٌر‬ ‫بشكل‬ ‫نزل‬
C  Course Regressive or Constant or Progressive. ,‫الٌوم‬ ‫ل‬ ‫الدم‬ ‫ترجٌع‬ ‫معاك‬ ‫بدي‬ ‫لما‬ ‫من‬
‫قبل؟‬ ‫على‬ ‫زاٌد‬ ‫أو‬ ,‫قبل‬ ‫زي‬ ‫قاعد‬ ‫أو‬ ,‫علٌك‬ ‫نقص‬ ‫هل‬
S  Severity Interfering with Daily Activity. ‫معاي‬ ‫تعبتك‬ ‫حاج‬ ‫ٌا‬ ً‫سامحن‬
,
‫هل‬
‫مش‬ ‫هذا‬ ‫الدم‬ ‫ترجٌع‬
Interfering with Sleep. ‫امخلٌك‬
‫و‬ ‫ترقد‬
‫ل‬ ً‫تمش‬ ‫امخلٌك‬ ‫ال‬
‫طبٌعٌة؟‬ ‫حٌاتك‬ ‫تمارس‬ ‫أو‬ ‫عملك‬
Properties
of Upper GIT
Bleeding 
Ask about: FAS
Frequency  ‫مرة‬ ‫قداش‬ ,‫حاج‬ ‫ٌا‬ ً‫سامحن‬
‫دم‬ ً‫ف‬ ‫اترجع‬
‫الٌوم؟‬ ً‫ف‬
Amount  ‫كمٌة‬ ‫حاج‬ ‫ٌا‬ ً‫باه‬
‫الدم‬
‫هل‬
‫متجلط‬ ‫ٌطلع‬ ‫دم‬ ‫معاه‬ ً‫ف‬ ً‫باه‬ ‫با؟‬
‫؟‬
Spontaneously or Not  ,‫حاج‬ ‫ٌا‬ ً‫ماعلٌش‬
‫الدم‬ ‫ترجٌع‬ ‫لو‬ ‫الحظتش‬ ‫ما‬
‫عندك‬ ً‫الل‬
ً‫ثان‬ ً‫ش‬ ‫أي‬ ‫أو‬ ‫دوا‬ ‫تاخد‬ ‫ما‬ ‫بعد‬ ‫وإال‬ ‫بروحه‬ ‫ٌطلع‬
‫؟‬

29. DR. MOHCEN AL. HAJ
29
4. SYSTEMIC REVIEW: Start with the Involved System First.
- GIT:  ASK ABOUT :-
*Abdominal Pain (Epigastric), Heart Burn & Melena  For Peptic Ulcer.
*Jaundice, Abdominal Distension (Ascites)  For Liver Cirrhosis Because Liver
Cirrhosis Leads to Oesophageal Varices  Oesophageal Varices Cause Heamatemesis.
*Bleeding Per Rectum  FOR Heamtochisia.
‫حرقان‬ ‫أو‬ ‫قداد‬ ‫عندك‬ ً‫باه‬ ‫فٌك؟‬ ‫ٌوجع‬ ‫بطنك‬ ً‫ف‬ ‫مكان‬ ‫مافٌش‬
‫المعدة؟‬ ‫فم‬ ً‫ف‬
‫الحظتاش‬ ‫ما‬ ‫البراز‬ ‫لون‬ ‫حاج‬ ‫ٌا‬
‫وال‬ ‫بطنك؟‬ ً‫ف‬ ‫انتفاخ‬ ‫أي‬ ‫الحظتش‬ ‫ما‬ ً‫باه‬ ‫حاج؟‬ ‫ٌا‬ ‫الصفٌر‬ ‫جاكش‬ ‫ما‬ ‫داكن؟‬ ‫أسود‬ ‫بدي‬
ً‫ف‬ ‫انتفاخ‬ ‫الحظت‬
‫رجلٌك؟‬
‫الشرج؟‬ ‫فتحة‬ ‫من‬ ‫نزٌف‬ ‫أي‬ ‫عندكش‬ ‫ما‬ ,‫حاج‬ ‫ٌا‬ ً‫سامحن‬
- CVS:  ASK ABOUT :-
*Palpitation & Dyspnea  For Aneamia  Due to Chronic Blood Loss.
,‫حاج‬ ‫ٌا‬ ً‫ماعلٌش‬
‫عندك‬
‫القلب‬ ً‫ف‬ ‫رفة‬
‫؟‬
‫مجهود؟‬ ‫تبذل‬ ‫لما‬ ‫خصوصا‬ ‫حاج‬ ‫ٌا‬ ‫دهشة‬ ‫عندك‬ ً‫باه‬
- Hematology:  ASK ABOUT :-
*Generalized Fatigability, Dizziness, PallorFOR Anemia Due to Chronic Blood Loss.
,‫معاي‬ ‫تعبتك‬ ‫حاج‬ ‫ٌا‬ ً‫سامحن‬
‫بعضه؟‬ ‫مع‬ ‫فاشل‬ ‫جسمك‬ ً‫ف‬ ‫اتحسش‬ ‫ما‬
‫حاج؟‬ ‫ٌا‬ ‫شحوب‬ ‫وال‬ ‫دوخه‬ ‫ماعندكش‬ ً‫باه‬
- CNS:  ASK ABOUT :-
*Loss of Consciousness  FOR Hypo-Volemic Shock  Due to Acute Blood Loss.
*Disorientation with Person + Place + TimeFOR Hepatic EncephalopathyDue to
Liver Cirrhosis  Because Ammonia Reach the Brain Causing Disorientation of Conscious
‫ما‬ ‫حاج‬ ‫ٌا‬
‫معاك‬ ‫من‬ ‫وال‬ ‫وٌن‬ ‫روحك‬ ‫عرفت‬ ‫ومعاش‬ ‫بدوخة‬ ‫حسٌت‬ ‫وال‬ ‫بكل؟‬ ً‫الوع‬ ‫فقدتش‬
‫؟‬
5. PAST MEDICAL HISTORY:
*History of Same Illness Before? If Yes  How Many Times? When Was the Last
Time? Does He Admitted or Not? Does He Admitted to ICU or Not?
*Ask if He Done Endoscopic Sclerotherapy or Ligation ? ‫ماصارتلكش‬ ‫حاج‬ ‫ٌا‬ ً‫ماعلٌش‬
‫نفس‬
‫المشكلة‬
‫المستشفى‬ ‫دخلوك‬ ‫هل‬ ‫مرة؟‬ ‫آخر‬ ‫كانت‬ ‫أمتى‬ ‫صارتلك؟‬ ‫مرة‬ ‫قداش‬ ‫قبل؟‬ ‫من‬ ‫هادي‬
‫نفس‬ ً‫ف‬ ‫طلعت‬ ‫واال‬
‫الٌوم؟‬
‫العناٌة؟‬ ‫خشٌت‬ ‫هل‬
‫حاج‬ ‫ٌا‬ ً‫باه‬
‫ربط؟‬ ‫أو‬ ‫كوي‬ ‫معاه‬ ‫داروا‬ ‫و‬ ‫علوي‬ ‫منظار‬ ‫دارولك‬ ‫هل‬
*History of Any Chronic Illness (Like DM, HTN, CRF)? If Yes  What is the Duration of
the Chronic Illness? What is the Treatment? Does He in Regular Follow up? ‫ٌا‬ ً‫سامحن‬
‫لتوا‬ ‫عالج‬ ً‫ف‬ ‫وتاخدلها‬ ‫قدٌمة‬ ‫صحٌة‬ ‫مشكلة‬ ‫أي‬ ‫ماعندكش‬ ,‫حاج‬
‫مثال)؟‬ ‫ضغط‬ ‫أو‬ ‫(سكر‬
‫حاج؟‬ ‫ٌا‬ ‫المشكلة‬ ‫هٌا‬ ‫شن‬
‫عالج؟‬ ‫من‬ ‫تاخدلها‬ ‫وشن‬ ‫لٌها؟‬ ‫قداش‬
‫وم‬ ‫اتراجع‬ ‫هل‬
‫الكالوي؟‬ ً‫ف‬ ‫تغسل‬ ‫حاج؟‬ ‫ٌا‬ ‫ال‬ ‫وإال‬ ‫مراجعاتك‬ ً‫ف‬ ‫نتظم‬
*History of Regular Endoscopy & Sclerotherapy  ‫علوي‬ ‫منظار‬ ً‫ف‬ ‫ادٌر‬ ‫هل‬ ‫حاج‬ ‫ٌا‬ ً‫ماعلٌش‬
‫أ‬
‫و‬
‫بٌن‬ ‫ربط‬
‫كل‬
‫علٌه‬ ‫ومنتظم‬ ‫وفترة‬ ‫فترة‬
‫؟‬
*Viral Screen  FOR Hepatitis.  ‫النتٌجة؟‬ ‫كانت‬ ‫وشن‬ ‫درتها؟‬ ‫صحٌة‬ ‫شهادة‬ ‫آخر‬ ‫أمتى‬ ‫حاج‬ ‫ٌا‬

30. DR. MOHCEN AL. HAJ
30
6. DRUG HISTORY:
*Ask the Patient About Any Drugs Can Cause Bleeding & Peptic Ulcer Such as 
Anti-Coagulant (Heparin, Warfarin), or NSAIDS, Aspirin.
*Also Insulin (What is the Dose if He Knows?) & ACE I (What is the Dose if He Knows?).
‫مس‬ ‫ولتوا‬ ‫طوٌلة‬ ‫فترة‬ ‫من‬ ‫دواء‬ ً‫ف‬ ‫تاخد‬ ‫حاج‬ ‫ٌا‬ ً‫ماعلٌش‬
‫علٌه؟‬ ‫تمر‬
‫حاج‬ ‫ٌا‬ ‫الدواء‬ ‫هوا‬ ‫شن‬
‫الجرعة؟‬ ‫وقداش‬
7. PAST SURGICAL HISTORY:
*Any History of Abdominal Surgery (Lapratomy)  Due to Perforation of Peptic Ulcer.
Or Any History of Porto-Systemic Shunt Operation Due to Liver Cirrhosis.
*If Patient has History of Surgery Before  Does He Received Blood or Not?
*Also If there is Any History Of Tattooing  FOR Hepatitis.
(Hepatitis Cause Liver Cirrhosis Cirrhosis Leads to Oesophageal Varices 
Oesophageal Varices Cause Heamatemesis).
*Any History of Heamo-Dialysis  FOR Hepatitis. ‫عملٌة‬ ‫أي‬ ‫امداٌر‬ ‫مش‬
‫البطن‬ ‫ع‬ ‫جراحٌة‬
‫؟‬
‫لٌها‬ ‫وقداش‬
‫؟‬
‫مضاعفات‬ ‫أو‬ ‫مشاكل‬ ‫أي‬ ‫ماصارتلكش‬ ‫حاج‬ ‫ٌا‬ ً‫سامحن‬
‫عملٌات‬ ‫أي‬ ‫امداٌر‬ ‫مش‬ ‫العملٌة؟‬ ‫بعد‬
‫حاج؟‬ ‫ٌا‬ ‫الكبد‬ ‫ع‬ ‫وصالت‬
‫دم‬ ‫زادوكش‬ ‫ما‬ ً‫باه‬
‫؟‬
‫م‬
‫اعندكش‬
‫وشم‬ ‫أي‬
‫حاج‬ ‫ٌا‬ ‫جسمك‬ ً‫ف‬
‫؟‬
‫كالوٌك؟‬ ً‫ف‬ ‫تغسل‬
8. FAMILY HISTORY:
*Any History of Same Illness in His Family.
*Any History of Sudden Death in His Family.
*Ask if His First Relative Degrees Had Any Chronic Illness (Like DM, HTN, CRF).
‫عنده‬ ‫عٌلتك‬ ‫من‬ ‫حد‬ ‫مافٌش‬
‫نف‬
‫العٌلة‬ ً‫ف‬ ‫حد‬ ً‫ف‬ ‫هل‬ ‫المشكلة؟‬ ‫س‬
‫ٌاحاج‬ ‫طول‬ ‫السبب‬ ‫عرفتوش‬ ‫وما‬ ‫فجأة‬ ‫مات‬
‫؟‬
‫ع‬ ‫عٌلتك‬ ً‫ف‬ ‫حد‬ ً‫ف‬
‫نده‬
‫الضغط‬ ‫أو‬ ‫السكر‬ ‫زي‬ ‫وقدٌمة‬ ‫مزمنة‬ ‫صحٌة‬ ‫مشكلة‬ ‫أي‬
‫الكلى؟‬ ً‫ف‬ ‫فشل‬ ‫أو‬
9. SOCIAL HISTORY:
*Ask If He is Smoker or Ex-Smoker (If He is Smoker Ask about Duration & Amount).
(Because Smoking is a Risk Factor for Peptic Ulcer that Cause Heamatemesis).
*Ask If He is Alcoholic (If He is Alcoholic Ask about Duration & Amount).
(Because Alcohol is a Risk Factor for Mallory Wis Syndrome & Liver Cirrhosis 
Cirrhosis Cause Osephageal Varices  That Varices Cause Heamatemesis).
‫حاج؟‬ ‫ٌا‬ ‫ادخن‬
‫لٌك؟‬ ‫قداش‬
‫حاج‬ ‫ٌا‬ ‫السؤال‬ ً‫ف‬ ً‫سامحن‬
,
‫المسكرات؟‬ ‫من‬ ‫نوع‬ ‫أي‬ ً‫ف‬ ‫تشرب‬
‫لٌك؟‬ ‫قداش‬
‫مرة؟‬ ‫الشهر‬ ً‫ف‬ ‫أو‬ ‫مرة‬ ‫األسبوع‬ ً‫ف‬ ‫أو‬ ‫ٌوم‬ ‫بعد‬ ‫ٌوم‬ ‫أو‬ ‫ٌومٌا‬ ‫هل‬ ‫تشرب‬ ‫قداش‬ ‫كل‬ ‫بمعدل‬ ,‫حاج‬ ‫ٌا‬ ً‫سامحن‬

31. DR. MOHCEN AL. HAJ
31
LOWER GIT BLEEDING (BLEEDING PER RECTUM) OSCE:
INTRODUCE YOUR SELF & TAKE PERMISSION FROM THE PATIENT.
1. PERSONAL DATA: Name, Age, Gender, Nationality, Occupations.
2. MAIN COMPLAIN: What is Your Complain? & Duration.
3. ANALYSIS OF MAIN COMPLAIN:  DOARA CS + Properties of
Lower GIT Bleeding (Bleeding Per Rectum)
D  Duration Acute  Diverticular Diseases. ‫النزٌف‬ ‫موضوع‬ ‫لٌه‬ ‫قداش‬ ‫حاج‬ ‫ٌا‬ ً‫سامحن‬
‫معاك‬
‫؟‬
Chronic or Recurrent  Cancer Colon, Peri-Anal Condition.
O  Onset Sudden  Diverticular Diseases. ‫بد‬ ‫هل‬
‫ي‬
‫بشوٌة‬ ‫وإال‬ ‫فجأة‬ ‫معاك‬
Gradual  Cancer Colon, Peri-Anal Condition. ‫ا‬ ‫مرة‬ ‫كل‬ ‫ومع‬
ٌ
‫معاك؟‬ ‫زٌد‬
A  Aggravating Factors Constipation & Straining  Peri-Anal Condition (Fissure, Heamorrhoids).
‫الدم‬ ‫ترجٌع‬ ً‫ف‬ ‫علٌك‬ ‫اٌزٌد‬ ‫تستعمله‬ ‫معٌن‬ ‫دوا‬ ‫وال‬ ,‫معٌن‬ ً‫ش‬ ‫مافٌش‬
‫بروحه‬ ‫ٌطلع‬ ‫أو‬
‫؟‬
‫التبرز؟‬ ‫بعد‬ ‫مثال‬ ‫زي‬
R  Relieving Factors May Relieve By  Some Medications OR Intervention. ‫حاج‬ ‫ٌا‬ ً‫ماعلٌش‬
‫الدم؟‬ ‫نزٌف‬ ‫عندك‬ ‫ٌوقف‬ ‫أمتى‬
‫بروحه‬ ‫ٌوقف‬ ‫وإال‬
‫؟‬
‫النزٌف؟‬ ً‫ف‬ ‫علٌك‬ ‫ٌوقف‬ ‫دواء‬ ً‫ف‬ ‫تستعمل‬ ‫أو‬
A  Associated Symptoms Pain During Defecation  Peri-Anal Condition (Fissure, Heamorrhoids).
ً‫سامحن‬
‫وتتبرز؟‬ ‫الحمام‬ ‫تخش‬ ‫لما‬ ‫وجع‬ ‫أي‬ ‫ب‬ ‫اتحس‬ ‫هل‬ ,‫حاج‬ ‫ٌا‬
Weight Loss & Constipation Cancer Colon.
‫حاج‬ ‫ٌا‬ ‫إمساك‬ ‫عندك‬ ‫هل‬ ً‫باه‬ ‫نقص؟‬ ‫وزنك‬ ‫الحظتش‬ ‫ما‬ ‫حاج‬ ‫ٌا‬ ً‫باه‬
‫؟‬
Ascites & Jaundice  Liver Metastasis.
‫الحظتش‬ ‫ما‬
‫حاج‬ ‫ٌا‬ ‫الصفٌر‬ ‫وجاك‬ ‫اصفر‬ ‫ولى‬ ‫ولونك‬ ‫انتفخت‬ ‫بطنك‬
‫؟‬
Diarrhea & Abdominal Pain  IBD. ‫ع‬
‫ن‬
‫ٌا‬ ‫إسهال‬ ‫دك‬
‫بطنك؟‬ ً‫ف‬ ‫وجع‬ ً‫ف‬ ً‫باه‬ ‫حاج؟‬
C  Course Regressive or Constant or Progressive. ‫هل‬ ,‫الٌوم‬ ‫ل‬ ‫الدم‬ ‫نزٌف‬ ‫معاك‬ ‫بدي‬ ‫لما‬ ‫من‬
‫قبل؟‬ ‫على‬ ‫زاٌد‬ ‫أو‬ ,‫قبل‬ ‫زي‬ ‫قاعد‬ ‫أو‬ ,‫علٌك‬ ‫نقص‬
S  Severity Interfering with Daily Activity. ‫معاي‬ ‫تعبتك‬ ‫حاج‬ ‫ٌا‬ ً‫سامحن‬
,
‫هل‬
‫مش‬ ‫هذا‬ ‫الدم‬ ‫نزٌف‬
Interfering with Sleep. ‫امخلٌك‬
‫و‬ ‫ترقد‬
‫ل‬ ً‫تمش‬ ‫امخلٌك‬ ‫ال‬
‫طبٌعٌة؟‬ ‫حٌاتك‬ ‫تمارس‬ ‫أو‬ ‫عملك‬
Properties
of Lower GIT
Bleeding 
Ask about: FAS
Frequency  ‫مرة‬ ‫قداش‬ ,‫حاج‬ ‫ٌا‬ ً‫سامحن‬
‫دم‬ ً‫ف‬ ‫تنزف‬
‫الٌوم؟‬ ً‫ف‬
Amount  ‫كمٌة‬ ‫حاج‬ ‫ٌا‬ ً‫باه‬
‫الدم‬
‫هل‬
‫متجلط‬ ‫ٌطلع‬ ‫دم‬ ‫معاه‬ ً‫ف‬ ً‫باه‬ ‫با؟‬
‫؟‬
Spontaneously or Not  ,‫حاج‬ ‫ٌا‬ ً‫ماعلٌش‬
‫عندك‬ ً‫الل‬ ‫الدم‬ ‫نزٌف‬ ‫لو‬ ‫الحظتش‬ ‫ما‬
‫التبرز‬ ‫بعد‬ ‫أو‬ ‫دوا‬ ‫تاخد‬ ‫ما‬ ‫بعد‬ ‫وإال‬ ‫بروحه‬ ‫ٌطلع‬
‫؟‬