Focussed Hxs Flashcards
What are the 4 presentations of cardiac disease?
- SOB
- angina
- palpitations
- LOC
Which systems must be covered in a systems review for a cardiac case?
Cardio
Resp
GI
General
What qs are asked in a cardiac case’s systems review?
What are the presentations of respiratory disease from a Hx?
- chest pain
- cough
- haemoptysis
- dyspnoae
- wheeze
- night sweats
What are the presentations of respiratory disease on examination?
‐ Clubbing
‐ Cyanosis
‐ Stridor
‐ Hypoxia (T1RF and T2RF)
‐ Pleural effusion
What is important to ask in the PMH, DH, FH and SH for a respiratory case?
Which systems must be included in the systems review for a respiratory case?
- Resp
- Abdo
- CVS
- Neuro
- GU
What must be asked in a systems review for a respiratory case?
What are some commonn GI Hx presentations?
‐ Abdominal pain
‐ Abdominal distension
‐ Bloody diarrhoea
‐ Constipation
‐ Diarrhoea
‐ Dyspepsia
‐ Dysphagia
‐ GI bleeding
‐ Nausea and Vomiting
‐ Weight loss
What is important to ask when a pt has abdo pain (GI)?
‐ 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
What is important to ask when a pt has N&V (GI)?
‐ Onset – especially in relation to food, maybe infective, could be related to
oesophageal stricture
‐ Quantity
‐ Colour – food/bile/blood
What is important to ask when a pt has diarrhoea/constipation (GI)?
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
What is important to ask when a pt is experiencing dysphagia?
‐ Onset and time course
‐ Level of obstruction (where do they feel food getting stuck)
‐ Solids/liquids
‐ Associated features – heartburn/weight loss/vomitin
What is important to ask when a pt is jaundiced (GI)?
‐ Onset (after an alcohol binge, sudden/progressive)
‐ Urine/stool colour
‐ Associated symptoms – abdo pain/fever/weight loss/ascites/itchiness/fatigue
What is important to ask when a pt has abdo distension (GI)?
‐ Investigate 5Fs – fluid, flatus, fetus, fat, faeces
‐ Dragging/heavy feeling in abdomen in women should raise suspicion of ovarian Cancer
What must be asked in a systems review for a GI case?
What is important to ask in a GI case for:
a) PMH
b) DH
c) FH
d) SH
What are some common neuro CN Hx presentations?
‐ Back pain
‐ Blackouts (loss of consciousness)
‐ Facial pain
‐ Headache
‐ Seizure
‐ Sensory disturbance
‐ Vertigo
‐ Visual loss
What must be asked in a neuro specific review when conducting a neuro CN Hx?
‐ ‘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
What must be asked of all neuro cases?
‐ Malaise / lethargy
‐ Appetite change / weight loss
‐ Fevers / night sweats
‐ Rashes / skin changes
What are the red flags for a headache?
‐ 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
What must be asked in a neuro CN Hx for:
a) PMH
b) FH
c) DH
d) SH
What are some common presentations for a neuro limbs Hx?
‐ Back pain
‐ Blackouts (loss of
consciousness)
‐ Facial pain
‐ Headache
‐ Seizure
‐ Sensory disturbance
‐ Vertigo
‐ Visual loss
What must be asked in a neuro specific review if a pt presents with neuro limbs complaint?
‐ ‘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
What are the important risk factors to ask when a pt presents with back pain?
- 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
What are the red flags for back pain?
‐ 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
What must be asked in a systems review for a neuro limbs Hx?
What must be asked in a neuro limbs Hx of:
a) PMH
b) FH
c) DH
d) SH
What is the full structure of a neuro examination?
- Gait
- speech
- mental state
- Cranial Nerves
- Peripheral nervous system
Vascular: what must be asked of the HPC when suspecting intermittent claudication?
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
What associated symptoms (SOCRATES, HPC) must be asked about when suspecting intermittent claudication?
What must be asked in the HPC when suspecting acute limb ischaemia?
Pain history – SOCRATES
o Rapidity of onset
o Severity
What associated symptoms (SOCRATES, HPC) must be asked about when suspecting acute limb ischaemia?
Associated symptoms:
o Numbness / change in sensation o Paralysis
o Altered appearance of limb
What must be asked during PMH for any vascular Hx?
What must be asked during FH during any vascular Hx?
- Hypercoagulable states
- ‐ Family history of arterial disease
What must be asked during SH for any vascular Hx?
‐ Smoking (pack-years), alcohol, illicit drug use
‐ Occupation
‐ Diet and exercise tolerance
‐ Travel history
- What must be asked during DH for any vascular Hx?
Gather complete list, but specifically ask about:
‐ Cardiac medication incl. antihypertensives
‐ Anticoagulant or antiplatelet drugs
‐ Pro-thrombotic drugs e.g. hormone replacement
‐ Statins
