H&P Flashcards
CNS General H&P
I would start with a complete history and physical focusing on symptoms onset and presenting symptoms including headache, focal neurological deficit, seizures, personality change (frontal lobe), nausea, vomiting, CN deficits, blurred vision, weakness, abnormal sensation, urinary incontinence or retention, ocular symptoms. I would perform a careful neurologic exam focusing on CNs, assessing motor strength, loss of sensation, problems with gait and vision changes. I would also perform a fundoscopic exam to assess for CNS lymphoma and intracranial pressure.
Primary CNS lymphoma H&P
I would start with a complete history and physical focusing on symptoms onset and presenting symptoms including headaches, focal neurological deficits, seizures, personality change that may indicate frontal lobe abnormality, nausea, vomiting, CN deficits, blurred or changes in visions, weakness, abnormal sensation such as numbness or tingling, urinary incontinence or retention, ocular sx.
I would also perform a careful neurological exam, testicular exam (if male), and refer to optho for slit lamp exam (15-20% retinal/vitreous/choroid seeding). I would also inquire about hx of immunodeficiency (congenital or acquired, such as HIV)
H&P for pituitary adenoma
Complete history and physical asking about visual field deficits especially bitemporal hemianopsia, headaches, oculomotor palsies (CNs III, IV, VI, V1, V2), hypopituitarism (common presentation of non-hormone secreting adenoma)
Head and Neck H&P
I would like to start with a complete history and physical focusing on symptom onset and presenting symptoms including skin changes, enlarged cervical, supraclavicular, or Ax LN, skin lesions, oral sores, HN lesions/masses, changes in taste, dysphagia, cranial neuropathies, and UE/hand weakness/numbness, shortness of breath, and weight loss. I would then assess risk factors including tobacco, EtOH, STD, and sexual history/HPV positivity, hx of skin cancer, immunodeficiency, ethnicity (East Asian –> higher risk for NPX)
I would then perform a careful HN exam with fiberoptic direct laryngoscopy focusing on the subsite of suspicion based on presenting symptoms, dentition assessment, and CN exam.
I would order labs including CBC, CMP, EBV titers, HPV status, and imaging including CT head and neck with IVC, CT chest WOC, and PET CT for advanced disease.
Then, I would refer the patient to ENT for exam under anesthesia and biopsy. I would also refer the patient to speech and swallow, audiology, nutrition, dentist and GI (or general surgery) if prophylactic PEG tube is needed. I would also refer the patient to medical oncology if chemotherapy is needed.
Oral Cavity H&P
I would start with a complete history and physical focusing on symptom of onset and presenting symptoms including lip lesions/ulcers, otalgia (CN 5, 7, 9, 10 involvement), bleeding gums, loose teeth, ill-fitting dentures, trismus (CN 7 involvement), halitosis, tongue mobility, speech, oral sores, changes in taste, dysphagia, cranial neuropathies, enlarged cervical or supraclavicular LN, UE/hand weakness/numbness, shortness of breath, and weight loss.
I would then assess risk factors including tobacco, EtOH, betel nut, STD, sexual history/HPV positivity, hx of leukoplakia, and immunodeficiency.
I would then perform careful HN exam with fiberoptic direct laryngoscopy if available, focusing on tongue mobility, trismus, and dentition.
I would also perform a neck exam to assess lymphadenopathy and do cranial nerve exams.
Then, I would order labs including CBC, CMP, and order imaging including CT head and neck with contrast, CT chest, PET CT for advanced disease.
Then I would refer the patient to ENT for EUA and biopsy.
I would also refer the patient to speech and swallow, audiology, nutrition, dentist, and GI or surgery for prophylactic PET tube if needed.
Then I would refer the patient to medical oncology if chemotherapy is needed.
H&P for oropharynx
I would start with complete history and physical focusing on the symptom onset and presenting symptoms including dysphagia, odynophagia, trismus, otalgia, changes in speech, cranial neuropathies, enlarged cervical or supraclavicular LN, UE/hand weakness/numbness, weight loss.
I would assess for risk factors including tobacco, EtOH, STD, sexual hx, HPV positivity, hx of tonsillectomy.
I would perform a careful HN exam with fiberoptic direct laryngoscopy focusing on extent and features of the primary if visible, tongue mobility, trismus, and dentition. I would also perform neck exam to assess lymphadenopathy and also do cranial nerve exams.
Then I would order labs including CBC, CMP, and imaging including CT head and neck with contrast and CT chest. PET CT if it’s advanced disease.
I would refer the patient then to ENT for EUA and biopsy. Refer the pt to speech, swallow, audiology, nutrition, dentists, and GI or surgery for prophylactic feeding tube placement if needed.
H&P for Nasopharynx
I would start with a complete history and physical focusing on symptoms onset and presenting symptoms including nasal obstruction, epistaxis, otalgia, diminished hearing, headaches, dysphagia, odynophagia, double vision (CN III, IV, VI), facial numbness (V1, V2), enlarged cervical or supraclavicular LN, shortness of breath, and weight loss.
I would also assess the risk factors such as East Asian ethnicity, use of tobacco and EtOH.
I would then perform a careful HN exam with fiberoptic direct laryngoscopy, focusing on the extent and features of primary if visible, otoscopy, neck exam to assess regional lymph node, and a detailed cranial nerve exam.
I would then order labs including CBC, CMP, and EBV titers, and imaging including CT head and neck with IVC, thin sliced MRI head and neck with IVC, CT chest, and PET CT.
Then I would refer the patient to ENT for EUA and biopsy, speech/swallow, audiology, nutrition, dentist, and GI or surgery for feeding tube placement consult if prophylactic PEG tube is indicated. I would also refer the patient to medical oncology if the chemo is indicated (unless it’s T1 N0).
H&P for Larynx
I would start with complete history and physical focusing presenting symptoms including hoarseness, otalgia, dysphagia, *** aspiration/recurrent pneumonias, enlarged cervical or supraclavicular LN, weight loss.
I would then assess risk factors including tobacco, EtOH, and ask about the occupation if the patient uses daily voice or if so if there has been any changes in their voice quality.
I would then perform a careful H&N exam with fiberoptic direct laryngoscopy focusing on the extent and features of primary, laterality, VC mobility, anterior commissure involvement, and tongue mobility.
I would then order labs including CBC, CMP, and imaging including CT head and neck with IVC, CT chest, and PET CT for advance disease.
I would then refer the patient to ENT for EUA and biopsy. I would also refer the patient to speech/swallow, audiology, nutrition, dentition, and GI or surgery for prophylactic feeding tube if needed. I would also refer to medical oncology if chemotherapy is indicated.
H&P for Small Cell Lung Ca
I would start with a complete history and physical exam focusing on pulmonary symptoms including cough, dyspnea, hemoptysis, postobstructive pneumonia, pleural effusion, pain, SVC syndrome (face and neck swelling, distended neck vein, cough, SOB), clubbing, superior sulcus (Pancoast) triad (shoulder pain, brachial plexus palsy (weakness), and Horner’s syndrome –> constricted pupil (miosis), drooping of the upper eyelid (ptosis), absence of sweating of the face (anhidrosis)).
I will also ask about hoarseness (left recurrent laryngeal nerve) and constitutional symptoms including performance status, weight loss, dizziness, weakness, and delirium (SIADH).
I would also assess for risk factors including smoking hx and radon/asbestos exposure.
My physical exam includes special attention to auscultation of lungs, percussion to evaluate for pleural effusion, and looking for cervical/supraclavicular lymphadenopathy.
I would also do a full neuro exam including cranial nerves, brachial plexus, evaluating for ptosis, meiosis, and/or anhidrosis (Horner’s syndrome –> due to the blockage or damage to the sympathetic nerves that lead to your eyes)
H&P for Non-small cell lung cancer
