histories

Question 1

key things to ask about in a PC section of GI history?

Answer 1

• 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

Question 2

PC - dysphagia –> what do you want to ask?

Answer 2

• 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?

Question 3

PC - dyspepsia –> what do you want to ask?

Answer 3

• 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?

Question 4

pc - vomiting –> what do you want to ask?

Answer 4

• 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

Question 5

PC - jaundice –> what do you want to ask?

Answer 5

• 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

Question 6

PC - altered bowel habit –> what do you want to ask?

Answer 6

• 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?

Question 7

PC - rectal bleeding –> what do you want to ask?

Answer 7

• 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

Question 8

key things to ask about in a general cardiac history?

Answer 8

• 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

Question 9

PC - chest pain –> what do you want to ask?

Answer 9

• 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

Question 10

PC - palpitations –> what do you want to ask?

Answer 10

• 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?

Question 11

PC - intermittent claudication –> what do you want to ask?

Answer 11

• 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

Question 12

general respiratory history ?

Answer 12

• 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

Question 13

PC - cough –> what do you want to ask?

Answer 13

• 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

Question 14

PC - shortness of breath –> what do you want to ask?

Answer 14

• 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

Question 15

PC - haemoptysis –> what do you want to ask?

Answer 15

• 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?

Question 16

general neurological history?

Answer 16

• headache / facial pain
• neck stiffness
• fits or faints
• dizziness or vertigo
• disturbance to vision, hearing, smell
• difficulty with walking?
• episodes of sudden onset weakness
• altered sensation in limbs
• history of disturbance of sphincter control (e.g. bladder)
• tremor or involuntary movements
• history of speech, language or swallowing difficulties
• PMH: HTN, IHD, high cholesterol, diabetes, stroke, epilepsy, meningitis, head or spinal injuries, previous operations
• risk factors for HIV infection or syphilis
• FHX of heart or vascular disease & neurological or psychological disease
• occupation & toxin exposure

Question 17

PC - headache –> what would you ask about?

Answer 17

• location
• character of pain
• onset - was it sudden?
• anything makes it better or worse?
• worse at particular time of day
• constant or intermittent pain
• rate severity
• visual disturbance?
• nausea or vomiting?
• weakness or sensory disturbance?
• neck stiffness or fever?
• under particular stress?
• takes regular painkillers?

Question 18

PC - collapse –> what would you ask about?

Answer 18

• onset
• time of day
• situation pt was in at the time?
• how they felt before collapse
• did they lose consciousness & how long for?
• was it witnessed?
• incontinent or bit tongue?
• banged head or other injuries?
• how did they feel when they came around?
• how do they feel now –> any problems with speech, vision or moving arms/legs?
• experienced anything like this before?
• history of cardiac disease
• patient ever feels dizzy or weak when standing up from sitting/lying position?
• pregnant? abdo pain?
• diabetic? when did they eat?
• medications
• none prescriptions drugs or heavy drinking
• drives motor vehicle

Question 19

PC - joint pain –> what do you want to know?

Answer 19

• pain in muscles, joints or back?
• associated with swelling or stiffness?
• how long have symptoms been going on?
• symptoms getting worse or staying same?
• one or more joints involved?
• sequence of onset of joint involvement?
• symptoms worse at particular time of day?
• how long does it take for stiffness to wear off?
• pain ever keep you awake at night?
• how do symptoms interfere with your daily life?
• joint injuries in the past?
• noticed skin or nail changes?
• bowel, eye or urinary symptoms?
• recent infections, psoriasis, IBD, diabetes, HTN, osteoporosis, malignancies
• FHx of RA, gout, OA, spondyloarthropathies, psoriasis, IBD
• medication and allergies
• smoking and alcohol
• work and home

Question 20

PC - back pain –> what do you want to know?

Answer 20

• exact site of pain
• radiating pain?
• associated numbness or tingling
• difficulty controlling bladder or bowel movements
• onset (sudden?)
• pain at rest or only on movement
• anything makes pain better / worse
• do analgesics relieve pain
• rate severity of pain
• does the pain keep you awake at night / wake you up from sleep
• patient strained or injured themselves in any way?
• weight loss?
• fever or night sweats?
• bowel or eye symptoms?
• feeling low in mood or under particular stress?
• history of RA, osteoporosis, TB or malignancies

Question 21

key things to ask about in a general endocrine history?

Answer 21

• history of appetite and weight changes
• altered bowel habit
• menstrual and obstetric history
• history of impotence
• excessive sweating
• change in hair distribution
• history of lethargy
• skin changes
• lump in neck
• passing more urine than normal or unusually thirsty
• headache or visual disturbance
• how are you feeling emotionally and mentally
• relevant PMH - thyroid disease, HTN, diabetes, pituitary disease and TB
• FHx of thyroid, diabetes, pituitary tumours, pheochromocytoma, pancreatic tumours
• smoking and alcohol
• home and work circumstances
• meds and allergies

Question 22

PC - suspected diabetes mellitus - what do you want to know?

Answer 22

• how many times a day they pass water
• unusually thirsty?
• any recent changes in weight
• unusually tired or lethargic
• problems with eyesight
• regularly suffer from infections?
• noticed any tingling or numbness in hands / feet
• suffers from impotence?
• history of heart disease or strokes
• any medications?
• alcohol
• FHx of diabetes

Question 23

PC - thyroid dysfunction –> what do you want to know?

Answer 23

• change in body weight
• change in appetite (dysphagia?)
• change in voice
• change in bowel habit
• change in energy level
• change in mood
• change in concentration
• change in heat tolerance
• change to skin, nails & hair
• change in heart rate / rhythm
• change in menstrual cycle
• tremor and muscle weakness
• symptoms onset & durations and any associated pain
• previous thyroid disease, surgery and treatment
• meds –> thyroxine, within, amiodarone and glucocorticoids
• smoking, alcohol, diet (iodine?)
• FHx

Question 24

what are the key things you want to know in a general urological history?

Answer 24

• how many times a day on average the patient passes
  water
• how many times they have to get up at night to pass water
• do they feel like they’re passing more water than usual or are they just having to go more often?
• do they find they have to rush to the toilet when they feel they need to go
• incontinent?
• painful to pass water?
• ever noticed blood in urine?
• any difficulty starting to pass water?
• noticed a decrease in size of the stream?
• ever gets terminal dribbling?
• history of suprapubic or loin pain?
• fever or vigorous shivering?
• history of headache, vomiting, fits, drowsiness or peripheral oedema
• weight loss?
• PMHx - UTIs, diabetes, gout, HTN, IHD, stroke
• FHx - diabetes, HTN, PKD
• smoking and alcohol
• home
• meds and allergies

Question 25

PC - haematuria –> what do you want to know?

Answer 25

• first noticed?
• isolated incident or regular occurrence?
• frank blood or small amount alluring urine
• clots?
• pain?
• timing within stream (initial/continuous/terminal)
• fever and riggers?
• trauma or exercise?
• urgency and frequency
• hesitancy, poor stream & terminal dribbling
• weight loss
• PMHx of prostatic disease, stones, UTIs, TB and bleeding disorders
• FMHx renal tracy disorders
• exposure to aromatic hydrocarbons e.g. rubber and dye industry
• smoking
• meds –> rifampicin or anticoagulants

Question 26

UTI symptoms?

Answer 26

• dysuria
• frequency
• urgency
• strangury - painful passage of small amounts of urine
• fever
• acute confusion

Question 27

symptoms of chronic renal failure?

Answer 27

• oliguria
• nocturia
• polyuria
• anorexia
• insomnia
• metallic taste in mouth
• vomiting
• anaemia
• fatigue
• pruritus
• oedema
• bruising/ bleeding due to abnormal platelets
• sallow complexion
• uraemia fetor