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flanker99 - 04/07/09 23:45
	small things which are easy to forget but can make a big difference if remembered during the encounter not necessary to ask all questions but even if we ask most, that can make a big difference the list is not complete, so feel free to add anything which is important 1. ASK ABOUT MEDICATIONS, MEDICATIONS CAN BE THE CAUSE OF THE CONDITION OR AN EFFECT ie SOMETHING THE PT TAKES TO GET RELIEF eg MULTIVITAMINS IN CASES OF FATIGUE 2. ASK ABOUT FAMILY HISTORY , ALWAYS 3. PMH ,ASK ABOUT SIMILAR COMLAINTS AND ALSO ABOUT RELATED COMPLAINTS eg HEARTBURN AND DYSPEPSIA ie INDIGESTION IN CASES OF ABDOMINAL AND CHEST PAIN 4. TREATMENT HISTORY OR DIAGNOSTIC PROCEDURES eg BLADDER CATHERTERIZATION IN INCONTINENCE AND BPH, IT CAN ALSO BE THE CAUSE OF A COMPLAINT eg INCONTINENCE SPECIFIC Qs FOR DIFFERENT Pt GROUPS 1. INFANTS & CHILDREN: ALWAYS ASK ABOUT THE THINGS WHICH CHILDREN LIKE DO ie EATING,PEEING,PASSING STOOLS,SLEEPING,PLAYING. REMEMBER TO ALWAYS ASK ABOUT CONTACT HISTORY(SIBLINGS OR DAYCARE), ABOUT ANY MOOD CHANGES SINCE ILLNESS BEGAN. ALWAYS ASK ABOUT DEVELOPMENTAL AND IMMUNIZATION HISTORY, REGULAR MEDICAL CHECKUPS. IN CASES OF ILLNESS ASK ABOUT DISCHARGE FROM EYES,EARS & NOSE, RASH ON SKIN, TUGGING OF EARS. 2. IN ADOLSCENTS ASK ABOUT BODY IMAGE PROBLEMS, EATING DISORDERS, STUDIES, EXTRACURRICULAR ACTIVITIES, SEX, DRUGS, ALCOHOL, MOOD CHANGES 3. IN FEMALES ASK ABOUT PAP SMEARS (WHEN DONE THE LAST TIME, ANY ABNORMAL SMEARS) , ABOUT PERIODS (IF EVER A MISSED OR DELAYED PERIOD), BREAST EXAMINATION ( ANY DISCHARGE NOTED), ANY HAIR CHANGES(FALL OR EXCESSIVE GROWTH), PILL USAGE 4. IN ELDERLY PEOPLE ALWAYS ASK ABOUT HEART PROBLEMS ie BP, ANGINA, DYSPNEA, CHOLESTEROL LEVELS. ASK ABOUT SUPPORT SYSTEMS ie FAMILY & FRIENDS. COUNSEL ABOUT ADVANCED DIRECTIVES, SENIOR HOUSING, HOSPICE(TERMINALLY ILL CASES) 5. IN CASES OF FATIGUE ASK ABOUT HAIR CHANGES, SKIN CHANGES, APPETITE, COLD INTOLERANCE, VOICE CHANGES, BOWEL MOVEMENTS, BLEEDING, DEPRESSIVE SYMPTOMS 6. IN CASES OF JOINT PAIN ASK ABOUT SKIN RASH, TRAVEL HISTORY AND INSECT BITES( LYME DISEASE), ORAL ULCERS, EYE PROBLEMS(REDNESS, PAIN). ASK ABOUT SEXUAL HISTORY, DISCHARGE, BURNING MICTURITION, ANY WEAKNESS AND NUMBNESS OF THE LIMB 7. IN ABDO PAIN ASK ABOUT JAUNDICE, COLOR CHANGES OF STOOL/URINE, BURNING MICTURITON, FEVER, FOOD PEFERENCES, SKIN COMLAINTS(ITCHING, DARKENING), DYSPEPSIA, HEART BURN 8. IN CHEST PAIN ASK ABOUT ANGINA, PAIN IN LEGS WHILE WALKING, PALPITATIONS, COUGH, DYSPNEA(POSTURAL/EXERTIONAL), FEVER, RELATION OF PAIN TO BREATHING, ANY LEG COMPLAINTS LIKE SWELLING/TRAUMA/PROLONGED IMMOBILIZATION , SEXUAL DYSFUNCTION SPECIFICALLY IMPOTENCE, CHOLESTEROL MEASUREMENTS. ALWAYS ASK ABOUT WEIGHT AND HEIGHT 9. IN HEADACHE ASK ABOUT AURA(REPEATED HEADACHES), NUMBNESS/WEAKNESS, PHOTOPHOBIA, NECK STIFFNESS, FEVER, VISION/HEARING PROBLEMS, SEIZURE EPISODES, ABDO PROBLEMS, IF Pt USES READING GLASSES AND LAST TIME VISION WAS CHECKED, ANY NASAL/EYE DISCHARGE. ASK ABOUT ANY Jt PAIN(POLYMYALGIA RHEUMATICA IN ELDERLY PTs), ASK ABOUT ANY PAIN IN JAW WHILE EATING. ALWAYS KEEP GLAUCOMA AS DD IN MIND INCASES OF UNILATERAL HEADACHES. ALWAYS RULE OUT DEPRESSION AS A CAUSE OF CHRONIC HEADCHES AND ALWAYS RULE OUT TRAUMA TO CERVICAL SPINE. 10. IN HIV/AIDS CASES ASK ABOUT MEDICATION COMPLAINCE, CD4 COUNTS, HEADACHE/WEAKNESS/MOOD CHANGES/FORGETFULLNESS, VISION PROBLEMS, CHEST PAIN/DYSPNEA/COUGH/FEVER, ABDO PAIN(PANCREATITIS)/DIET/APPETITE/WEIGHT, BLADDER COMPLAINTS, SKIN RASH(KAPOSI’S SARCOMA), PREVIOUS HISTORY OF STDs . ASK THEM IF THEIR PARTNER SHOWS ANY SIGNS OF AIDS. ADVICE THEM TO USE PROTECTION 11. IN STROKE CASES ALWAYS ASK ABOUT PREVIOUS EPISODES AND THE COMPLAINTS IN SUCH EPISODES LIKE VISION, SPEECH DIFFICULTIES, WEAKNESS(LIMBS/FACE), SENSORY PROBLEMS, HEART PROBLEMS, HYPERTENSION, DM, CHOLESTEROL LEVELS. ALWAYS ASK ABOUT WEIGHT AND HEIGHT 12. IN CHRONIC ILLNESS/MEDICATION REFILL ASK ABOUT THE COMPLAINTS OF THE ILLNESS, ANY MEDICATION SIDE EFFECTS ie BOTH CAUSE AND EFFECT, ANY CHANGES THE PT WAS TOLD TO MAKE IN DIET AND EXERCISE AND IF HE FOLLOWS THEM OR NOT. ASK ABOUT WEIGHT AND HEIGHT 13. IN ABUSE CASES ASK ABOUT GUILT, WEAPONS/POISONS. ASK IF THE PT IS BEING ILLTREATED AT HOME 14. IN STD CASES ASK IF THE Pt HAS PREVIOUS HISTORY OF STDs, IF HE/SHE KNOWS IF THE PARTNER HAS STDs. ALWAYS ADVICE THEM TO SEND THE PARTNER TO YOU TO GET TREATED. ALWAYS ASK THEM TO AVOID SEX UNTIL TREATED COMPLETELY AND THEN USE PROTECTION AND CONTRACEPTIVES 15. IN BACK PAIN ASK ABOUT RADITION OF PAIN TO LEGS, ANY WEAKNESS AND NUMBNESS IN LEGS, BOWEL/BLADDER INCONTINENCE, ANY CHANGE IN PAIN WHILE COUGHING/STRAINING(PROLAPSED DISK WITH NERVE ENTRAPMENT) 16. IN CASES OF DIARRHEA BESIDES ASKING ABOUT NATURE OF STOOLS ALSO ASK ABOUT THE THINGS WHICH ARE PASSED IN ADDITION TO STOOLS LIKE BLOOD, MUCUS AND ALSO ASK FOR TENESMUS 17. IN CASES OF LOSS OF CONSICIOUSNESS ASK IF THE Pt LOST CONSCIOUSNESS AND THEN FELL TO THE GROUND OR IF HE FELT DIZZY, FELT DIZZY, FELL TO THE GROUND AND THEN LOST CONSCIOUSNESS. ALSO ASK ABOUT THE SYMPTOMS HE FELT BEFORE LOSING CONSCIOUSNESS LIKE PALPITATIONS, CHEST PAIN, DIFFICULTY IN BREATHING 18. IN CASES OF EAR PAIN/HEARING LOSS/DIZZINESS ASK ABOUT FEVER, EAR DISCHARGE, FULLNESS IN EAR, ANY EAR COMPLAINTS AS A CHILD 19. ALWAYS COUNSEL Pts ABOUT PRECAUTIONS THEY HAVE TO TAKE UNTIL THEY COME AGAIN FOR THE REULTS OF THE LAB INVESTIGATIONS eg IN DIABETES/HT Pts COUNSEL ABOUT MEDICATION COMPLAINCE/REGULAR EYE CHECK UPS/DIET/SALT/SUGAR/EXERCISE/SMOKE/ALCOHOL , IN PEPTIC ULCER/GERD CASES COUNSEL ABOUT FREQUENT SMALL MEALS, AVOIDING SMOKE/ALCOHOL, AVOIDING GOING TO SLEEP FOR 2 HOURS AFTER MEALS, IN STDS COUNSEL ABOUT AVOIDING SEX, ALCOHOL(METRONIDAZOLE TREATMENT), CONTRACEPTIVES, REGULAR PAP SMEARS, IN CHILDREN COUNSEL ABOUT ORS, IN JOINT PAIN COUNSEL ABOUT MEDICATION COMPLAINCE/ REST/SOFT SOLE SHOES, IN DEPRESSED Pts COUNSEL ABOUT CALLING YOU ASAP IF THEY FEEL VERY SAD 20. IN CASES OF DIABETES, HYPERTENSION, OBSEITY ALWAYS ASK THE DIET IN DETAIL ie THE TYPE OF FOOD WHICH THE PT IS CONSUMING 21. IN ELDERLY CASES ALWAYS ASK THE SURROGATE IF HE NEEDS ANY HELP IN TAKING CARE OF THE Pt. IN ELDERLY AND CHILD CASES ALWAYS ASK WHO ELSE IS RESPONSIBLE FOR TAKING CARE OF THE Pt 22. IN FEMALES ALMOST EVERY CASE HAS PREGNANCY AS A DIFF DIAGNOSIS eg WEIGHT GAIN, INSOMNIA, UNCONTROLLED OR NEW ONSET HYPERTENSION, HEADACHE, FATIGUE 23. IN HEADACHE CASES IN FEMALES ALWAYS ASK FOR THE RELATION OF THE HEADACHE WITH THE PERIODS 24. IN CHRONIC JOINT PAINS ALWAYS KEEP HEPATITIS AND LYME DISEASE AS DDs IN MIND AND ASK Qs ABOUT TRAVEL HISTORY AND TICK BITE 25. IN ALCOHOLICS ASK ABOUT COUGH AND FEVER EVEN IF NO RESPIRATORY COMPLAINTS ARE PRESENT TO RULE OUT ASPIRATION 26. IN OLD PEOPLE COMING FOR ROUTINE CHECKUP ALWAYS ASK ABOUT HEART(HYPERTESION, CHOLESTEROL, DIABETES), LUNGS(DYSPNEA), CANCER(SORES ON SKIN, CHANGE IN BOWEL HABIT, DIFFICULTY IN SWALLOWING) 27. IN FATIGUE, HEADACHE CASES ALWAYS KEEP SLEEP APNEA IN MIND 28. IN TRAUMA AND DOMESTIC ABUSE CASES ALSO ASK ABOUT BLOOD IN URINE AND ALSO DO U/A FOR THE SAME, ALSO CHECK CVA TENDERNESS 29. IN CASE OF Pt TAKING DRUGS FOR SEIZURES, CHECK THE DRUG LEVEL. IN CASE Pt TAKING ANTICOAGULANTS CHECK PT/INR 30. CVS CASES- ALWAYS ASK ABOUT PAIN IN LEGS WHILE WALKING(PVD) ERECTILE DYSFUNCTION 31. IN CHRONIC CASES SUSPECTED TO BE COLLAGEN VASCULAR DISEASES ASK ABOUT EYE CHANGES, SORES IN MOUTH 32. IN JOINT PAIN CASES ASK ABOUT SORES IN MOUTH AND PRIVATE PARTS 33. DON’T EVER FORGET TO ADVICE/COUNSEL THE PATIENTS , IN ACUTE CASES TELL Pt TO WAIT UNTIL THE REPORTS ARRIVE. SOMETREATMENT LIKE ORS CAN BE GIVEN TO Pt. IN CHRONIC CASES COUNSEL HIM ABOUT DIET/EXERCISE/SMOKING/ALCOHOL/REGULAR FOLLOW Ups/CONTRACEPTIVES/ COMPLAINCE 34. DEMENTIA/CONFUSION/FORGETFULLNESS CASE- ASK ABOUT ONSET(SUDDEN/GRADUAL), DIURNAL VARIATION(SUN DOWNING), MEDICATIONS(PAIN KILLERS), GAIT, INSIGHT, MOOD CHANGES 35. HEADACHE CAUSES WORTH REMEMBERING- CAFFIENE/NSAID WITHDRAWAL, OBSTRUCTIVE SLEEP APNEA, PREGNANCY, PSEUDOTUMOUR CEREBRI 36. IN STD CASES ASK ABOUT GROIN SWELLINGS AND SWELLINGS IN ANY PART OF BODY LIKE NECK 37. IN INFECTIOUS MONONUCLEOSIS/ SORE THROAT CASES ASK ABOUT ANY RASH ON SKIN(PENICILLIN USE) 38. IN DYSPHAGIA CASES ASK IF THE Pt’s FINGERS AND TOES HAVE BECOME SENSITIVE TO COLD(RAYNAUD’S PHENOMENON) 39. IN TELEPHONE/SURROGATE CASES ALWAYS ASK THE Pt TO COME FOR A VISIT. IF NOT URGENT, THE Pt CAN ALSO COME ON A SATURDAY 40. IRREGULAR PERIODS IRRESPECTIVE OF AGE/SEXUAL ACTIVITY- ALWAYS SUSPECT PREGNANCY AND ORDER URINE PREGNANCY TEST 41. IF OBSTRUCTIVE SLEEP APNEA, ALWAYS DO ORAL AND NASAL EXAMINATION 42. IN CHILDREN ALWAYS ASK ABOUT STUDIES, HOBBIES, IMMUNIZATION IRRESPECTIVE OF THE CASE. IF PARENT NOT PRESENT, ASK ABOUT THE REASON 43. IN ANY CHRONIC RESPIRATORY PROBLEMS(NON INFECTIOUS) LIKE ALLERGY, ASTHMA, HYPERSENSITIVITY PNEUMONITIS, ASK ABOUT SNORING 44. IN LONG STANDING CHRONIC DISEASES WHICH ALWAYS PRESENT IN EPISODES, ALWAYS ASK HOW THE Pt IS BETWEEN EPISODES AND ALSO ASK HOW THE Pt’s LIFE HAS BEEN AFFECTED BY THE CONDITION 45. IN HIGLY SUSPECTED CASES OF DEPRESSION, GRIEF eg AFTER DEATH OF A RELATIVE, ASK IF COUNSELLING WAS GIVEN, IF NOT ,ADVICE ABOUT THE SAME 46. THYROID CASES- CHECK REFLEXES, LOOK AT EYES, SKIN AND IN HYPOTHYROID CASES, ASK ABOUT NECK SURGERY, MEDICATIONS, EXPOSURE TO RADIATION 47. IN ABDOMINAL PAIN AND HEAD ACHE, ASK ABOUT THE RELATION OF PAIN TO FOOD AND ALSO ABOUT PERIODS 48. IN MENOPAUSAL AGE GROUP FEMALES ,ALWAYS ASK ABOUT MENOPAUSAL SYMPTOMS 49. IN VAGINAL BLEEDING CASES ASK ABOUT THE RELATION OF VAGINAL BLEEDING TO SEXUAL INTERCOURSE 50. IN CASES OF PREGNANCY ,ALWAYS ASK IF THE PREGNANCY WAS PLANNED OR NOT AND IF CONTRACEPTIVES WERE BEING USED 51. IN MISSED PERIODS ASK ABOUT THE TELLTALE SIGNS OF PREGNANCY LIKE NAUSEA, VOMITTING, BREAST FULLNESS OR TENDERNESS AND ANY NIPPLE DISCHARGE 52. IN LONG STANDING AMENORRHEA AND IRREGULAR PERIODS ASK ABOUT ANY FACIAL HAIR 53. IN ERECTILE DYSFUNCTION CASES ALWAYS ASK ABOUT MORNING ERECTIONS 54. IN SUSPECTED BPH CASES ,IN ADDITION TO ASKING ABOUT URINARY SYMPTOMS , ALSO ASK ABOUT BACK PAIN, TRAUMA, LEG WEAKNESS AND NUMBNESS, WEIGHT LOSS AND FAMILY HISTORY OF PROSTATE CANCER. ALSO ASK ABOUT ANY EPISODE OF URINARY RETENTION AND SUBSEQUENT CATHETERIZATION 55. ALWAYS KEEP APA SYNDROME IN MIND AS A DD IN CASES OF DVT/PE 56. HEADACHE ---- CEREBRAL VENOUS THROMBOSIS ------ OCP USE 57. NAUSEA/ VOMITTING/ ABDO PAIN IN DIABETIC Pt ---- DIABETIC KETOACIDOSIS 58. ABDO PAIN / VOMITTING IN OBESE ----- HYPERTRIGLYCERIDEMIA / PANCREATITIS 59. IN ADDICTION CASES , ALWAYS ASK THE REASON FOR ADDICTION AND IF THE Pt HAS MADE ANY EFFORTS TO QUIT THEM 60. IN STD CASES ALWAYS ASK THE Pt IF SHE NOWS F THE PARTNER HAS ANY STD AND IF HE KNOWINLY TRANSMITTED THEM 61. IN DEPRESSION CASES DUE TO DEATH OF RELATIVE, ASK IF DEATH WAS SUDDEN AND UNEXPECTED 62. IN CHEST PAIN OF SUDDEN ONSET AND PROLONGED COUGH , ALSO ASK ABOUT ANY RASH ON SKIN, NIGH SWEATS, SWELLINGS IN NECK(LYMPHADENOPATHY) TO RULE OUT TB 63. ALWAYS ASK THE Pt IF HE WOULD LIKE TO TELL ANYTHING ELSE ABOUT HIS HEALTH. 64. ALWAYS THANK THE Pt IF HE VOLUNTEERS ANY USEFUL INFO BY HIMSELF. ALWAYS CONGRATULATE THE Pt IF HE HAS GIVEN UP ANY BAD HABIT RECENTLY 65. IN EVERY PERIOD RELATED CASE IN FEMALES, ASK THE FOLLOWING WITHOUT FAIL : PREVIOUS PREGNANCIES AND ABORTIONS, OCP USE, PREVIOUS STDs , PAP SMEAR, BREAST EXAMINATION, MENOPAUSAL SYMPTOMS, AGE OF MENOPAUSE IN MOTHER, VISION PROBLEMS, THYROID COMPLAINTS , EXCESSIVE FACIAL HAIR 66. BEFORE BEGINNING OCP, ALWAYS ASK ABOUT AN KIND OF CONTRAINDICATION THE Pt MIGHT BE HAVING , NAMELY : LEG PAIN, HEADACHE, ABDOMINAL PAIN/JAUNDICE, ANY ABNORMAL PAP SMEAR, ABNORMAL BREAST EXAMINATION, FAMILY HSTORY OF BREAST AND UTERINE CANCERS 67. TEENAGE PREGNANCIES, ALWAYS ASK: EDUCATION, GOALS FOR FUTURE, R/O ABUSIVE RELATIONSHIP, PLANNED PREGNANCY OR NOT, ANY CONTRACEPTIVE USE. ALSO ADVICE REGARDING PARENTING CLASSES AND ASK HER TO BRING PARTNER ALONG WITH HER DURING THE NEXT VISIT 68. IN CHEST PAIN WHICH IS HIGHLY SUSPICIOUS OF ANGINA , EXAMINE FOR COSTOCHONDRAL TENDERNESS JUST TO r/o COSTOCHONDRITIS AND ALSO COMMENT ON THIS IN THE PE 69. NEWLY DIAGNOSED AIDS CASE--- MOUTH, CERVICAL LYMPHADENOPATHY, SKIN, ABDO, CVS/RS(QUICK) 70. IN CHRONIC ACHES , ASK IF THE PT IS TAKING ANY MEDICATION AND IF IT HAS HELPED IMPORTANT THINGS FOR PE 1. ALWAYS LOOK AT THE FACE OF THE Pt TO SEE WHAT KIND OF EMOTIONS HE IS SHOWING , ESPECIALLY IN CASES OF PAIN 2. IN CASES OF FATIGUE, DEPRESSION, INSOMNIA/EXCESSIVE SLEEP ALWAYS KEEP THYROID CONDITIONS IN MIND AND SO WHILE WASHING HANDS ALWAYS FILL A CUP OF WATER. ALSO IN SUCH CASES MAKE A POINT TO CHECK REFLEXES 3. IN HEART AND RESPI CASES ALWAYS CHECK THE NAILS FOR CLUBBING 4. IN HEART CASES ALWAYS CHECK THE PMI 1ST AND THEN GO FOR AUSCULTATION 5. IN CVS CASES Pt SHOULD BE MADE TO LIE IN RECLINING POSITTION AND THEN EVERYTHING CAN BE CHECKED ie EYES, NAILS, PULSES, JVP, PMI, AUSCULTATION AT THE SAME TIME. THEN MAKE THE Pt TO SIT UP AND AUSCULTATE ONCE AGAIN, IF RUNNING SHORT OF TIME JUST AUSCULTATE IN 2 PLACES 6. KEEP IN MIND TO CHECK LIVER SPAN AND SHIFTING DULLNESS 7. IF Pt SHOWS PAIN WHILE LIGHT PALPATION, DON’T LET GO AT ONCE , INSTEAD PRESS A LITTLE MORE DEEPLY AND THEN LET GO WITH A FLOURISH TO ELICIT REBOUND TENDERNESS 8. IN HEADACHE CASES ALWAYS PALAPATE FOR TENDERNESS ESPECIALLY OVER SINUSES 9. SPECIAL TESTS IN HEADACHE: NECK STIFFNESS, KERNING’S SIGN, BRUDZINKI’S SIGN 10. SPECIAL TESTS IN CHEST PAIN: TENDERNESS OVER COSTOCHONDRAL JUNCTION AND OVER RIBS IN CASES OF TRAUMA 11. SPECIAL TESTS IN ABDOMINAL PAIN: MURPHY’S SIGN, ROVSINGS SIGN, PSOAS SIGN, OBTURATOR SIGN, CVA TENDERNESS 12. SPECIAL TESTS IN BACK PAIN: STRAIGHT LEG RAISING TEST AND CVA TENDERNESS 13. CHECK THE POSITION OF TRACHEA IN CASES OF SUDDEN ONSET CHEST PAIN IN WHICH PNEUMOTHORAX IS SUSPECTED 14. IN DIABETES CASES CHECK JOINT POSITION AND VIBRATION SENSATION 15. ALWAYS RUB HANDS AND THE DIAPHRAGM BEFORE PE 16. CN 7 CAN BE COMMENTED UPON IN THE PATIENT NOTES WITHOUT EVEN TESTING FOR IT ie WHETHER FACE IS SYMMETRICAL OR NOT 17. IF Pt DOES NOT HAVE COMPLAINT REGARDING A PARTICULAR SYSTEM, DO MINIMUM OR NO EXAMINATION OF THE SYSTEM eg IN A CAR ACCIDENT CASE IN WHICH Pt HAS HURT HIS HEAD BUT NOT HIS EXTREMITIES, JUST PALPATE THE EXTREMITIES FOR ANY TENDERNESS AND INSPECT THEM QUICKLY 18. IN SUSPECTED CYSYTIS/UTI/PID CASES ALWAYS PALPATE THE SUPRAPUBIC AREA FOR ANY TENDERNESS 19. CHECK HOMAN’s SIGN AND CALF TENDERNESS IN CHEST PAIN CASES WITH SUSPECTED PE 20. CHECK FOR SIGNS OF LIVER STIGMATA LIKE PALMAR ERYTHEMA, LIVER FLAP, PERI-UMBILICAL VEINS, ASCITES, GYNECOMASTIA 21. LOOK AT THE WAY THE Pt IS DRESSED, WHETHER HE IS MAINTAINING EYE CONTACT AND COMMENT UPON THIS IN THE PE NOTES 22. IN ACCIDENT CASES/ DOMESTIC ABUSE CASES ALSO LOOK INSIDE THE MOUTH TO SEE IF ANY TEETH ARE MISSING AND ALSO COMMENT ON THAT 23. CHECK POSITION OF TRACHEA IN CASES OF SUSPECTED PNEUMOTHORAX 24. IN HEADACHE CASES EXAMINE THE CERVICAL SPINE, TEST ROM ONLY IF NO HISTORY OF TRAUMA 25. IN HEADACHE CASES ALSO EXAMINE TM JOINT. ASK Pt TO OPEN AND CLOSE THE JOINT. COMMENT IF ROM IS FULL AND WITHOUT ANY CLICKS