histories Flashcards
1
Q
key things to ask about in a PC section of GI history?
A
- pain
- abdo distention
- nausea and vomiting
- dysphagia (difficulty swallowing)
- dyspepsia (indigestion), hiatus hernia, peptic ulcers
- history of gallstones / previous pancreatitis
- jaundice
- altered bowel habit e.g. diarrhoea, constipation
- blood loss (haematemesis or rectal)
- mucus or slime per rectum
- appetite
- weight change
- continence
- mouth ulcers
2
Q
PC - dysphagia –> what do you want to ask?
A
- how long have you had difficulty swallowing?
- getting worse or staying same?
- is swallowing painful?
- where does the food stick?
- is it solids, liquids or both?
- does difficulty ease after first few swallows?
- does fluid ever regurgitate back and cause patient to choke?
- history of acid reflux?
- noticed a lump in their neck?
- do they have a cough, SOB or noticed their voice getting hoarse?
- oesophageal carcinoma risk factors - smoking, alcohol, obesity and diet lacking fruit/veg
- weight loss?
- any antibiotics?
3
Q
PC - dyspepsia –> what do you want to ask?
A
- describe sensation
- do you notice it after particular food/drinks?
- does bending/stooping/lying down aggravate symptoms
- anything that relieves heartburn?
- ever get a sour/bitter taste in mouth?
- vomiting?
- weight loss?
- vomited blood or noticed blood in stool?
- feeling unusually full after small amounts of food?
- feel bloated after meals?
4
Q
pc - vomiting –> what do you want to ask?
A
- how often?
- sudden onset or longstanding?
- vomit at particular times of day/ triggers?
- related to abdo pain? does it relieve pain?
- how much vomit do you bring up?
- what colour is the vomit?
- coffee grounds / blood stained?
- vomit contains residues of food from night before?
- feel systemically unwell?
- eaten anything unusual? family members have similar symptoms?
- change in bowel habit?
- appetite and early satiety?
- any chance they could be pregnant?
- alcohol consumption
5
Q
PC - jaundice –> what do you want to ask?
A
- when patient first noticed it?
- change in colour of stools or urine?
- any abdominal pain (pancreatic cancer pain usually felt in back)
- weight loss
- skin itching
- vomiting
- easy bruising/bleeding
- alcohol
- recent travel abroad
- recent surgery
- blood transfusion
- tattoo
- unprotected sex
6
Q
PC - altered bowel habit –> what do you want to ask?
A
- diarrhoea / constipation or both?
- NORMAL bowel habits
- relationship between diarrhoea and meals?
- frequency of stools?
- abdo discomfort or urgency?
- passing wind?
- bloating?
- incontinence
- appearance of stool? formed or unformed? floating? associated blood, pus or mucus?
- associated vomiting?
- foreign travel?
- mediations
- FHx of cancer or inflammatory bowel?
7
Q
PC - rectal bleeding –> what do you want to ask?
A
- first noticed?
- colour
- blood mixed in stool, on outside of stool, in toilet bowel or on toilet paper
- change in bowel habit
- mucus or slime
- associated abdo pain?
- painful defecation?
- history of haemorrhoids?
- weight loss & appetite?
- dragging sensations?
- passing urine normally?
- warfarin?
- feeling tired or SOB
- FHx of bowel cancer or inflammatory bowel disease
8
Q
key things to ask about in a general cardiac history?
A
- chest pain
- SOB, orthopnoea and paroxysmal nocturnal dyspnoea
- palpitations
- cough, sputum and haemoptysis
- dizziness
- lightheadedness
- nausea and sweating
- ankle oedema
- syncope
- intermittent claudication
- fatigue
- history of HTN, IHD, high cholesterol, rheumatic fever, diabetes, stroke and asthma
- family history of MI / stroke before age of 65
- smoking and alcohol
- home circumstances
- drugs
9
Q
PC - chest pain –> what do you want to ask?
A
- where is pain?
- radiates?
- character of pain?
- onset & duration
- constant or intermittent
- anything makes pain better or worse?
- ever had anything like this before?
- noticed any ankle/leg swelling ?
- associated symptoms –> nausea, sweating, cough, anxiety, dyspnoea
- risk factors for MI (FHx, HTN, diabetes, smoking, high cholesterol)
- previous history of DVT/PE
- recent surgery, immobility, malignancy or pregnancy
- past/current meds
factors AGAINST cardiac ischemia as cause - ‘knife like’ stabbing pain, aggravated by respiration
10
Q
PC - palpitations –> what do you want to ask?
A
- any palpitations / aware of heart racing?
- tap out rate and rhythm
- start suddenly or gradually?
- stop suddenly or gradually?
- how long does it last?
- can you do anything to stop them?
- any other symptoms?
- associated symptoms - breathless, chest pain, fainting
- history of cardiac issues
- noticed any weight loss, heat intolerance, increased stool frequency or irritability
- feeling anxious or any unusual stress?
11
Q
PC - intermittent claudication –> what do you want to ask?
A
- describe problem
- where in leg is pain
- how far do they walk before they get pain
- is this distance staying the same or decreasing
- how long they need to rest before pain eases
- ever get pain at rest / at night
- bending forward relieves pain?
- ever get back pain/weakness, tingling, numbness?
- impotence
- skin changes in legs?
- RF - HTN, high cholesterol, diabetes, smoking and FHx
- history of angina, MI, stroke
12
Q
general respiratory history ?
A
- history of cough
- SOB
- chest pain
- wheeze
- recent weight loss
- fever / night sweats
- TB, pneumonia, DVT/PE, asthma, chronic bronchitis, emphysema
- FHx of TB, cystic fibrosis and emphysema (A1AT is genetic cause of emphysema)
- occupational history
- smoking/alcohol
- home inc. pets
13
Q
PC - cough –> what do you want to ask?
A
- onset
- timing
- duration (<2 months = acute)
- variation (recent changes or diurnal variation)
- dry or productive
- volume of sputum
- coughed up blood
- made worse by particular conditions?
- fever/night sweats
- systemically unwell
- weight loss
- indigestion or regurgitation
- travelled abroad
- contact with pneumonia
- history of asthma, COPD or TB
- inhalers
- work in dusty environment?
- smoke
- childhood respiratory disease
- BCG immunisation
14
Q
PC - shortness of breath –> what do you want to ask?
A
- describe
- when did they first notice it?
- chest pain
- constant or comes and goes
- what activities can’t they do because of breathlessness
- how far can they walk on flat ground
- level of exertion at which they get breathless staying same or increasing
- anything makes it better / worse
- can they lie flat without getting breathless & how many pillows do they use at night
- ever wake up breathless from sleep?
- noticed swelling in legs / ankles
- associated wheeze, cough, illness
- history of asthma, COPD, cardiac disease
- smoke?
- inhaler?
- ever get tingling in fingers or feel light headed when they are short of breath
15
Q
PC - haemoptysis –> what do you want to ask?
A
- origin (coughed up or vomited)
- onset, timing, duration, variation
- quantity
- colour
- consistency
- sputum
- chest pain
- recent trauma
- recent / current DVT
- weight loss, fever, night sweats?
- breathlessness?
- bleeding or bruising elsewhere?
