🧠 Mental Health & Clinical Interviewing
FIFE Model: Feelings, Ideas, Function, Expectations
PHQ-9: Depression screening; ≥10 = moderate depression. Always assess suicide risk if
>0 on question 9.
Reflection: Echoing patient’s own words (“You mentioned feeling stuck…”)
Summarization: Shows active listening and organizes the encounter
Empathy: “That sounds difficult.”
Open-ended questions: Begin interviews with “What brings you in today?”
Mental Status Exam (MSE): Includes appearance, behavior, speech, mood, affect,
thought process/content, cognition, insight, judgment.
🧠 Cardiovascular System
S1/S2: Normal heart sounds
Fixed Split S2: Heard in both inspiration and expiration → think ASD
Aortic Stenosis (AS): Systolic crescendo-decrescendo murmur, radiates to carotids;
symptoms = SAD (Syncope, Angina, Dyspnea)
JVP >3 cm: Sign of right-sided heart failure or fluid overload
PMI (Point of Maximal Impulse): L 5th ICS, MCL; displaced in LVH
Pulsus Paradoxus: ↓ SBP >10 mmHg on inspiration (seen in tamponade, asthma)
Thorax & Lungs
Inspection, Palpation, Percussion, Auscultation – in that order
Egophony: “E” sounds like “A” → consolidation
Tactile Fremitus: Decreased = effusion/pneumothorax; Increased = pneumonia
Percussion: Dull = fluid; Hyperresonant = air (e.g., pneumothorax)
Forced Expiratory Time (>6 sec): May suggest COPD
HEENT Highlights
Papilledema: Blurred disc margins, ↑ ICP
Macular degeneration: Central vision loss; trouble reading
Cataracts: Cloudy lens; blurry vision
Glaucoma/Corneal Ulcer: Eye pain + vision change = urgent referral
Weber: Lateralizes to affected side (conductive loss)
Rinne: Bone > air = conductive loss
