CCCA/OSCE

1. Headache
a. History: 7Cs, paresthesia, visual disturbance, weakness, numbness, ataxia,
congestion, FH, trauma, fever, neck pain
b. PE: VS, inspect/palpate head, ENT, full neuro, fundoscopy
c. Ddx: migraine, tension HA, cluster HA, pseudotumor cerebri, sinusitis,
meningitis, temporal arteritis, trigeminal neuralgia, neoplasm, TMJ d/o,
partial seizure, SAH
2. Confusion/memory loss
a. History: 7Cs, include hx from caregivers, time course, delirium,
medications, alcohol use, FH Alzheimers
b. PE: VS, full neuro, MMSE, gait, ENT, CV, Pulm, Ab, Ext
c. Ddx: Alzheimers, vascular dementia, NPH, chronic subdural, depression,
B12 deficiency, hypothyroid, neoplasm, neurosyphilis, CJD, Lewy body
dementia, hypoglycemia, TIA, delirium, SIADH causing hyponatremia
3. Loss of vision
a. History: 7Cs, progression, ability to see light, pain, discharge,
photophobia, HA, weakness, numbness, floaters, jaw claudication, meds,
trauma
b. PE: VS, CV, HEENT, fundoscopic, full neuro
c. Ddx: CRAO, CRVO, glaucoma, retinal detachment, temporal arteritis, age
related macular degeneration, diabetic retinopathy
4. Depressed mood
a. History: 7Cs, sleep pattern, appetite, weight, T/A/D, stressors,
SIGECAPS, MMSE
b. PE: 7Cs, head and neck, full neuro, MMSE, psych
c. Ddx: MDD, dysthymia, normal bereavement, adjustment disorder, bipolar,
cyclothymic, SAD, schizoaffective disorder
5. Psychosis
a. History: Delusions, hallucinations, behavior, negative symptoms,
cognitive symptoms, onset of symptoms, previous psych dx/meds, T/A/D.
b. PE: VS, MSE, general appearance
c. Ddx: schizophrenia, schizotypical, schizoid, schizophreniform, psychosis
due to general medical condition, substance induced psychosis, depression
with psychotic features, brief psychotic disorder
6. Dizziness
a. History: 7Cs, lightheadedness, vertigo, auditory, visual, URI, nausea,
neck pain, trauma, meds, atherosclerotic vascular dz
b. PE: VS, full neuro, Romberg, nystagmus, Dix-Hallpike, hearing, Weber,
Rhinne, ENT, CV
c. Ddx: Menieres, vestibular neuronitis, BPPV, vestibular neuronitis,
acoustic neuroma, orthostatic hypotension, labyrinthitis (inner ear
infection), vertebrobasilar insufficiency, brain stem/cerebellar tumor
7. LOC

a. History: Prodrome, context, tongue biting, incontinence, dehydration,

post-ictal state, dyspnea, heart dz, arrhythmia, hypertension, T/A/D
b. PE: VS, orthostatics, full neuro, carotid, cardiac, lung, lower extremitis
c. Ddx: Syncope, seizure, substance abuse, hypoglycemia, arrhythmia,
stroke, MI, PE, severe AS
8. Numbness/weakness
a. History: 7Cs, distribution, duration, progression, pain incl. HA,
constitutional, diabetes, alcohol, HLD, diet
b. PE: VS, full neuro, MSK, vascular incl, carotid
c. Ddx: TIA, stroke, hypoglycemia, seizure, Todds paralysis, facial nerve
palsy, neoplasm, SDH, EDH, GBS, MS, polymyositis, MG, peripheral
neuropathy, vertebral tumor, neurosyphilis, syringomyelia, B12 deficiency,
ALS, carpal tunnel, medial epicondylitis
9. Fatigue/sleepiness
a. History: 7Cs, duration, sleep hygiene, snoring, apnea, stress, depression,
lifestyle/work changes, diet, weight, thyroid, bleeding/anemia, meds,
alcohol, caffeine, drugs
b. PE: VS, ENT, CV, lung, abdominal, full neuro, EXT, rectal/fecal occult
blood
c. Ddx: depression, hypothyroidism, anemia, adjustment disorder, PTSD,
GAD, colon cancer, OSA, chronic fatigue, narcolepsy, DM, shift work
sleep disorder
10. Insomnia
a. History: 7Cs, duration, pattern, daytime sleepiness, pain, polyuria, OSA,
RLS, caffeine, alcohol, medication, drugs, jet lag, shift work, stressors,
sleep hygiene, psych (delusions, grandiosity)
b. PE: VS, MSE, thyroid
c. Ddx: stress induced insomnia, caffeine induced insomnia, circadian sleep
disorder, MDD, OSA, primary hypersomnia
11. Night sweats
a. History: 7Cs, recent infection, hemoptysis, travel, sick contacts, IVDU,
alcohol, sexual history, menstrual history, menopause
b. PE: VS, HEENT incl, throat and lymph nodes, CV, Pulm, Ab for HSM,
skin, MSK
c. Ddx: TB, HIV, lymphoma, leukemia, hyperthyroidism,
pheochromocytoma, carcinoid
12. Sore throat
a. History: 7Cs, fever, ear pain, congestion, odynophagia, lymph nodes,
cough, rash, sick contact, HIV
b. PE: VS, ENT for oral thrush/tonsillar exudate, lymph nodes, Pulm, Ab for
splenomegaly, skin
c. Ddx: Mono, Viral/bacterial pharyngitis, HIV, secondary syphilis, strep
throat, scarlet fever, mycoplasma pneumonia
13. Cough/SOB
a. History: 7Cs, timeline, sputum, wheezing, CP, heartburn, smoking, HF,
allergic, meds (ACEi)

b. PE: VS, pulse ox, nasal exam, throat exam, CV, Pulm, lymph nodes, EXT
c. Ddx: asthma, bronchitis, pneumonitis, foreign body, GERD, COPD,
bronchiectasis, lung ca, TB, pneumonia, RAD, postnasal drip, CHF, URI,
sarcoidosis, pulmonary edema, mitral stenosis
14. Chest pain
a. History: 7Cs, sweating, nausea, SOB, palpitations, sense of doom, fever,
medications, past episodes, PMH re: heart and lung, PE risk factors
b. PE: VS, BP both arms, JVD, PMI, chest wall tenderness, heart sounds,
pulses, edema, lung and abdomen, BLE
c. Ddx: MI, GERD, angina, costochondritis, aortic dissection, pericarditis,
PE, pneumothorax, sickle cell acute chest, pneumonia, esophagitis, PUD,
stable angina, esophageal rupture, muscle strain, rib fracture, pancreatitis
15. Palpitations
a. History: 7Cs, gradual vs acute, caffeine, anxiety, lightheadedness, LOC,
CP, dyspnea, fever, sweating, flushing, diarrhea, hyperthyroid,
bleeding/anemia, PMH heart dz, HTN, DM
b. PE: VS, endocrine/thyroid incl, eyes, carotid bruits, tremor, CV
c. Ddx: hypoglycemia, arrhythmia, angina, hyperthyroidism,
hyperventilation, panic attack, pheochromocytoma, carcinoid syndrome,
GAD, acute stress d/o, specific phobia, drugs, MVP
16. Weight gain
a. History: 7Cs, hypothyroidm, menstrual irregularities, hirsutism, PMH,
alcohol and drug use
b. PE: VS, complete exam incl. Cushing, edema
c. Ddx: normal weight gain, smoking cessation, hypothyroidism, PCOS,
DM, atypical depression, insulinoma
17. Dysphagia
a. History: 7Cs, solids or liquids, beginning of middle of swallow, weight
loss, hoarseness, drooling, regurgitation, odynophagia, GERD, meds, HIV,
anxiety, smoking, Raynaud
b. PE: VS, head and neck, CV, Pulm, Ab, skin
c. Ddx: GERD, esophagitis, achalasia, esophageal ca, systemic sclerosis,
esophageal stricture, ALS, Plummer Vinson, mitral stenosis, Zenkers
diverticulum
18. Neck mass
a. History: 7Cs, mobility, pain, movement with swallowing, obstructive
symptoms, sick contacts
b. PE: VS, HEENT, lymph nodes, spleen, tonsils, CV, Pulm, Ab
c. Ddx: thyroid nodule, goiter, TB, lymphoma
19. Nausea/vomiting
a. History: 7Cs, ab pain, meals, sick contacts, recent diet, pregnancy, neuro
(HA, stiff neck, vertigo), urinary symptoms, GI, CP, PSH
b. PE: VS, ENT, fundoscopy, Ab, CV/Pulm/rectal
c. Ddx: gastroenteritis, gastritis, pregnancy, kidney stone, RCC, pyelo,
appendicitis, pancreatitis, pancreatic cancer, acute cholescystitis,
cholangiocarcinoma, hepatitis, AAA, PUD, Boerhaave, Fitz Hugh Curtis,

sclerosing cholangitis, mesenteric ischemia, rib fracture, pneumonia,

splenic rupture, ovarian torsion, diverticulitis, IBS, IBD, PID,
endometriosis, etc.
20. Constipation/diarrhea
a. History: 7Cs, thyroid, meds, sick contacts, travel, camping, HIV, PSH,
diabetes, pancreatitis, alcohol, drugs, FH colon cancer
b. PE: VS, thyroid/endocrine, abdominal, rectal, pelvi
c. Ddx: CRC, IBS, diverticulosis, GI parasite, IBD, low fiber diet, drugs,
hypothyroidism, celiac, lactose intolerance, C diff, cryptosporidiosis,
small bowel lymphoma
21. Upper GI Bleeding
a. History: 7Cs, nausea, ab pain, dyspepsia, medications incl, NSAIDS and
blood thinners, PUD, liver dz, AAA repair, hx easy bleeding
b. PE: VS, orthostatics, ENT, CV, Pulm, Ab, rectal
c. Ddx: PUD, gastritis, gastric cancer, varices, Mallory Weiss tear
22. Blood in Stool
a. History: 7Cs, color, amount, duration, pain, menstruation, trauma, prior
colonoscopy, meds incl. blood thinners, alcoholism, liver dz, FH colon ca
b. PE: VS, orthostatics, ab, rectal
c. Ddx: CRC, anal diffure, diverticulosis, diverticulitis, ischemia bowel,
IBD, hemorrhoids, angiodysplasia
23. Hematuria
a. History: 7Cs, amount, duration, clots, pain, initial vs throughout vs
terminal, medication, exercise history, trauma, smoking, stones, cancer,
easy bleeding
b. PE: VS, lymph nodes, abdominal exam, GU/rectal, EXT
c. Ddx: Bladder ca, RCC, renal stones, glomerulonephritis, prostate ca,
coagulation d/o, PKD, UTI, pyelo
24. Other urinary symptoms
a. History: 7Cs, obstruction, urgency, frequency, nocturia, past UTIs, stones
b. PE: VS, ab, CVA, rectal, genital
c. DDx: BPH, prostate ca, UTI, stones, RCC, urethritis, cystitis, prostatitis,
pyelo, stress incontinence, urge incontinence, overflow incontinence, DM
25. Erectile dysfunction
a. History: 7Cs, nocturnal erections, libido, stress, depression, trauma,
urinary symptoms, gynecomastia, meds, HTN, DM, HLD, liver, thyroid,
T/A/D
b. PE: VS, CV, genital, rectal
c. Ddx: Peyronie, psychogenic, HTN, DM, drug related
26. Amenorrhea
a. History: 7Cs, duration, pregnancy, HA, peripheral vision, galactorrhea,
hirsutism, virilization, menopause, thyroid, anorexia nervosa, excessive
dieting, vigorous exercise, GYNHx, Gs and Ps
b. PE: VS, breast exam, pelvic exam
c. Ddx: pregnancy, anovulatory cycle, hyperprolactinemia, UTI,
hypothyroidism, PCOS, ovarian malignancy, premature ovarian failure,

prolactinoma, menopause, Sheehans, Ashermans, anorexia nervosa,

anxiety, PTSD, depression
27. Vaginal bleeding
a. History: 7Cs, duration, amount, menstrual history, discharge, pain, urinary
syptoms, trauma, meds (blood thinners, OCPs), easy bleeding, ab paps
b. PE: VS, ab, pelvic
c. Ddx: ectopic pregnancy, spontaneous abortion, coagulation disorder,
endometrial cancer, cervical cancer, dysfunctional uterine bleeding
28. Vaginal discharge
a. History: 7Cs, amount, history, color, odor, duration, vaginal burning, pain,
pruritis, recent sexual activity, onset of LMP, contraception, use of
tampons/douches, history of STDs
b. PE: VS, ab, pelvic
c. Ddx: Physiologic, BV, vaginitis (candida or trichomonal), cervicitis
29. Dyspareunia
a. History: 7Cs, bleeding, discharge, GI symptoms, menopause, libido,
sexual history, sexual trauma, endometriosis, PID, PSH
b. PE: VS, ab, pelvic
c. Ddx: atrophic vaginitis, endometriosis, cervicitis, depression, DV, PTSD,
vulvodynia
30. Abuse
a. History: Establish confidentiality, question physical, sexual, emotional
abuse, ask about fear, safety, backup plan, history of frequent injuries,
mental illness, drug use, firearms in the home
b. PE: VS, complete exam, pelvic
c. Ddx: DV, OI, substance abuse, consensual violent sexual behavior, rape
31. Joint/Limb pain
a. History: 7Cs, swelling, redness, warmth, rash, numbness, weakness,
morning stiffness, trauma, medications, DVT risk factors, T/A/D, FH of
RA
b. PE: VS, HEENT, MSK, neurovascular
c. Ddx: DV, factitious disorder, substance abuse, carpal tunnel,
radiculopathy, DQTS, SLE, RA, SLE, disseminated gonorrhea, psoriatic
arthritis, gout, fracture, dislocation, OA, meniscal or ligament damage,
septic arthritis, Lyme arthritis, Reiters syndrome, stress fracture, plantar
fasciitis, peripheral vascular disease, spinal stenosis, DVT, Bakers cyst,
cellulitis, angina/MI, tendinitis, rhabdo from statins, polymyositis
32. Low back pain
a. History: 7Cs, trauma history, timing, wake from sleep, incontinence,
PMH cancer, UTIs, diabetes, kidney stones, IVDU, smoking
b. PE: VS, L4-S1 neuro exam, back palpation, ROM, hip exam, rectal
c. Ddx: disk herniation, muscle strain, tumor, vertebral compression fracture,
spinal stenosis, peripheral vascular disease, malingering, leg fractice,
ankylosing spondylitis
Pediatrics

1. Child with fever

a. History: 7Cs, rash, wheezing, cough, ear discharge, appetite, convulsions,
lethargy, sleepiness, sick contacts, day care, immunizations
b. PE: VS, HEENT, neck, heart, lung, ab, skin
c. Ddx: neonatal sepsis, meningitis, pneumonia, UTI OM, URI, measles,
rubella, roseola, fifth disease, varicella, scarlet fever, gastroenteritis, food
poisoning, volvulus, intussusception
2. Child with GI symptoms
a. History: 7Cs, timing in relation to meals, weight, rash, stools, PSH, meds,
sick contacts, day care, immunizations
b. PE: VS, BP, HR, turgor, CV, Pulm, Ab, rectal, pelvic
c. Ddx: Pyloris stenosis, duodenal atresia, GERD, gastroenteritis, hepatitis,
UTI, OM, Hirschsprungs disease, low-fiber diet, anal stenosis,
hypothyroidism, lead poisoning, intussusception, appendicitis, Meckels
diverticulum, volvulus, enterocolitis, trauma, somatoform disorder,
malingering, IBS, lactose intolerance, child abuse, colic, formula allergy,
strangulated hernia
3. Child with red eye
a. History: 7Cs, discharge, pain, itching, photophobia, tearing, ROS, meds,
sick contacts, day care, immunizations
b. PE: VS, HEENT
c. Ddx: bacterial/viral conjunctivitis, keratitis, seasonal allergies, uveitis
4. Child with short statue
a. History: ROS, meds, prenatal and birth history, PMH, FH, cognitive,
school
b. PE: VS, height, weight, HEENT, CV, Pulm, Ab, neurologic
c. Ddx: constitutional short stature, GH deficiency, hypothyroidism, chronic
renal insufficiency, genetic, CF
5. Behavioral problems in childhood
a. History: Onset, severity, duration, triggers, physical violence, weapons,
substance use, developmental history, changes in social history, change in
personality, anhedonia
b. PE: VS, full neuro
c. Ddx: ADHD, ODD, manic episode, conduct disorder, hyperthyroidism,
adjustment disorder, substance use, age-appropriate behavior