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Y3 OSCE > Focussed Hxs > Flashcards

Focussed Hxs Flashcards

1
Q

What are the 4 presentations of cardiac disease?

A
  • SOB
  • angina
  • palpitations
  • LOC
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2
Q

Which systems must be covered in a systems review for a cardiac case?

A

Cardio

Resp

GI

General

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3
Q

What qs are asked in a cardiac case’s systems review?

A
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4
Q

What are the presentations of respiratory disease from a Hx?

A
  • chest pain
  • cough
  • haemoptysis
  • dyspnoae
  • wheeze
  • night sweats
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5
Q

What are the presentations of respiratory disease on examination?

A

‐ Clubbing

‐ Cyanosis

‐ Stridor

‐ Hypoxia (T1RF and T2RF)

‐ Pleural effusion

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6
Q

What is important to ask in the PMH, DH, FH and SH for a respiratory case?

A
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7
Q

Which systems must be included in the systems review for a respiratory case?

A
  • Resp
  • Abdo
  • CVS
  • Neuro
  • GU
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8
Q

What must be asked in a systems review for a respiratory case?

A
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9
Q

What are some commonn GI Hx presentations?

A

‐ Abdominal pain

‐ Abdominal distension

‐ Bloody diarrhoea

‐ Constipation

‐ Diarrhoea

‐ Dyspepsia

‐ Dysphagia

‐ GI bleeding

‐ Nausea and Vomiting

‐ Weight loss

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10
Q

What is important to ask when a pt has abdo pain (GI)?

A

‐ Site – aware of embryological origin of parts of gut: fore, mid and hind

‐ Onset – acute/insidious

‐ Character – colicky/burning/sharp/dull

‐ Radiation – back/shoulder/groin

‐ Associated – nausea/vomiting/diarrhoea

‐ Time course

‐ Exacerbating/relieving – food/position/antacids

‐ Severity

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11
Q

What is important to ask when a pt has N&V (GI)?

A

‐ Onset – especially in relation to food, maybe infective, could be related to

oesophageal stricture

‐ Quantity

‐ Colour – food/bile/blood

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12
Q

What is important to ask when a pt has diarrhoea/constipation (GI)?

A

Onset and time course – chronic can be sign of malignancy, acute if related to food maybe infective

‐ Associated features – fever, weight loss

‐ Blood/black stool

‐ Pain on defecation

‐ Tenesmus

‐ Diet

  • Steatorrhoea

‐ Urgency/incontinence

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13
Q

What is important to ask when a pt is experiencing dysphagia?

A

‐ Onset and time course

‐ Level of obstruction (where do they feel food getting stuck)

‐ Solids/liquids

‐ Associated features – heartburn/weight loss/vomitin

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14
Q

What is important to ask when a pt is jaundiced (GI)?

A

‐ Onset (after an alcohol binge, sudden/progressive)

‐ Urine/stool colour

‐ Associated symptoms – abdo pain/fever/weight loss/ascites/itchiness/fatigue

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15
Q

What is important to ask when a pt has abdo distension (GI)?

A

‐ Investigate 5Fs – fluid, flatus, fetus, fat, faeces

‐ Dragging/heavy feeling in abdomen in women should raise suspicion of ovarian Cancer

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16
Q

What must be asked in a systems review for a GI case?

A
17
Q

What is important to ask in a GI case for:

a) PMH
b) DH
c) FH
d) SH

A
18
Q

What are some common neuro CN Hx presentations?

A

‐ Back pain

‐ Blackouts (loss of consciousness)

‐ Facial pain

‐ Headache

‐ Seizure

‐ Sensory disturbance

‐ Vertigo

‐ Visual loss

19
Q

What must be asked in a neuro specific review when conducting a neuro CN Hx?

A

‐ ‘Faints, fits or funny turns’ (seizures, LOC)

‐ Previous headaches

‐ Mood

‐ Cognition

‐ Senses – hearing, taste, smell, numbness, vision (inc diplopia)

‐ Speech and swallowing problems

‐ Weakness

‐ Numbness or tingling

‐ Balance

‐ Bladder and bowel

20
Q

What must be asked of all neuro cases?

A

‐ Malaise / lethargy

‐ Appetite change / weight loss

‐ Fevers / night sweats

‐ Rashes / skin changes

21
Q

What are the red flags for a headache?

A

‐ Abrupt, severe (Thunderclap) headache

‐ Age of onset >50 yrs old (Giant Cell Arteritis)

‐ Progressively severe or worsening frequency of headache

‐ Significant change in pattern of headache

‐ Triggers posture (worse lying down), straining coughing suggests raised ICP

‐ Any neurological signs – meningism (stiff neck), confusion, reduced LOC, neurological symptoms or focal signs

‐ Secondary risk factors

  • ‐ Immunocompromised e.g. IVDU, HIV status
  • ‐ Old age
  • ‐ Previous history of cancer
  • ‐ Pregnancy (3rd trimester and postpartum)
  • ‐ Recent trauma, head injury
22
Q

What must be asked in a neuro CN Hx for:

a) PMH
b) FH
c) DH
d) SH

A
23
Q

What are some common presentations for a neuro limbs Hx?

A

‐ Back pain

‐ Blackouts (loss of

consciousness)

‐ Facial pain

‐ Headache

‐ Seizure

‐ Sensory disturbance

‐ Vertigo

‐ Visual loss

24
Q

What must be asked in a neuro specific review if a pt presents with neuro limbs complaint?

A

‐ ‘Faints, fits or funny turns’ (seizures, LOC)

‐ Headaches

‐ Mood

‐ Cognition

‐ Senses – hearing, taste, smell, numbness, vision (including diplopia)

‐ Speech and swallowing problems

‐ Weakness

‐ Numbness or tingling

‐ Balance

‐ Bladder and bowel function

‐ Nausea and vomiting

25
Q

What are the important risk factors to ask when a pt presents with back pain?

A
  • Immunocompromised e.g. IVDU, Diabetes, older age, chronic steroid use, HIV status
  • ‐ Steroid use as risk factor for osteoporosis and subsequent compression fractures
  • ‐ Previous history of cancer
  • ‐ Recent violent trauma
26
Q

What are the red flags for back pain?

A

‐ Thoracic back pain

‐ Pain that wakes you up at night

‐ Progressive neurological deficit (weakness / numbness)

‐ Reduced peri-anal sensation (does it feel different when you wipe yourself after a

bowel movement?)

‐ Difficulty passing urine or urinary incontinence

‐ Difficulty having a bowel movement or loss of bowel control

‐ Fever

‐ Weight loss

‐ History of cancer

‐ Recent violent trauma (e.g. RTA)

‐ Age<20or>55years

27
Q

What must be asked in a systems review for a neuro limbs Hx?

A
28
Q

What must be asked in a neuro limbs Hx of:

a) PMH
b) FH
c) DH
d) SH

A
29
Q

What is the full structure of a neuro examination?

A
  1. Gait
  2. speech
  3. mental state
  4. Cranial Nerves
  5. Peripheral nervous system
30
Q

Vascular: what must be asked of the HPC when suspecting intermittent claudication?

A

Pain history - SOCRATES

‐ Alleviating/aggravating factors including:

  • o How far can the patient walk before pain? (claudication distance)
  • o What effect does rest have on the pain?
  • o Pain at night, relieved by hanging leg over side of bed
  • o Establish a baseline to compare activities preformed in the past
31
Q

What associated symptoms (SOCRATES, HPC) must be asked about when suspecting intermittent claudication?

A
32
Q

What must be asked in the HPC when suspecting acute limb ischaemia?

A

Pain history – SOCRATES

o Rapidity of onset
o Severity

33
Q

What associated symptoms (SOCRATES, HPC) must be asked about when suspecting acute limb ischaemia?

A

Associated symptoms:
o Numbness / change in sensation o Paralysis
o Altered appearance of limb

34
Q

What must be asked during PMH for any vascular Hx?

A
35
Q

What must be asked during FH during any vascular Hx?

A
  • Hypercoagulable states
  • ‐ Family history of arterial disease
36
Q

What must be asked during SH for any vascular Hx?

A

‐ Smoking (pack-years), alcohol, illicit drug use

‐ Occupation

‐ Diet and exercise tolerance

‐ Travel history

37
Q
  • What must be asked during DH for any vascular Hx?
A

Gather complete list, but specifically ask about:

‐ Cardiac medication incl. antihypertensives

‐ Anticoagulant or antiplatelet drugs

‐ Pro-thrombotic drugs e.g. hormone replacement

‐ Statins

38
Q
A

Y3 OSCE (16 decks)

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