Histories Flashcards
IHD
Risk factors:
- Previous IHD, CTCA, Ca score
- Metabolic: hyperlipidaemia, HTN, obesity, exercise, DM
- FHx
- Smoking and details
- Premature menopause, OCP
- Chronic inflammatory disease, long term use of COX2i and NSAIDs
- High serum homocysteine levels
- Erectile dysfunction
And make sure to ask about successful management of risk factors
IE
Presenting Sx
Sx of emboli
Antibiotic allergies
Risk factors:
- Recent dental, endoscopic or operative procedures
- Rheumatic fever
- Other heart disease, heart operations
- IVDU
- Previous abx use
- Congenital heart disease
- Immune suppression
CCF
Sx of heart failure
- Orthopnoea
- PND
- Reduced ET and quantification
- Change in weight
MUST include NYHA
Risk factors:
- Arryhthmias
- Discontinuation of medications
- MI
- Anaemia
- Infection/fever
- Thyrotoxicosis
- Surgery
- PE
- High salt intake, meds that can cause salt/water retention
- Pregnancy
- FHx, haemochromatosis
- Other Coronary risk factors (see IHD)
Ix - make sure to to ask re TTE and LVEF
Cx - arrhythmias
HTN
Risk factors:
- T2DM
- FHx of premature stroke/CVD
- Smoking
- ETOH
- Obesity
- High salt intake
Cardiac transplant
Cause of cardiac failure ?cardiac investigations - LHC, TTE Symptoms prior to surgery Treatment prior to surgery How long since transpant, complications post op Rejection, biopsies (weekly first 3/52, then 2wkly for months, then 6/12ly) Admissions since Drugs, immunosuppressants, complications of medications Understanding re rejection Impact on life and QoL Control of other risk factors Risk of cancer, skin cancer, HTN
Arrhythmias
Symptoms, SOB
Syncope, freq, duration etc.
HF symptoms
CKD
Risk factors:
- Infections - HIV, HCV, HBV
- AI conditions
- CTD disease
- Drugs
- HTN
- DM
- Recent infections
- FHx
- Malignancies
- Occupational exposures
Symptoms
- Nocturia
- Lethargy, anorexia
- Fluid retention, weight, dry weight
- Pruritis
- Uricaemia: CP, pericarditis, confusion, GIB, neuropathy
- Serositis
Precipitants:
- NSAIDs
- abx - trimethoprim, aminoglycosides
- Contrast
- Infection
- ACEi, ARB
- Dehydraiton
- Anaemia
Complications:
- MBD
- Anaemia
- HTN
- Gout
- HF, fluid overload
- Peripheral neuropathy
- Altered cognition
- Nutrition
- Mental health
Risk factors for progression
- Low birth weight
- HTN
- AKI
- Proteinuria
- Smoking
- Hyperuricaemia
Dialysis
Access
- Fistula - when, how many, which side, USS
- Permacath - when, where, how many
- Vascath
HDx versus PD
Where dialysis happens
Regime
Side effects
- HTN
- Hypotension
- Adjustment of medications
- Issues with access
- Pain
- Bleeding
- Infections
Transplant work-up
Social arrangement
Renal Transplant
Work up
- Cause of ESRF
- Management of ESRF
- How long on list?
Contraindications
- Recent malignancy
- Frailty
- Untreatable infection
- Untreatable, severe IHD
- Active vasculitis, anti-GBM
Previous transplant - How many, kind of transplant - Post op complications and course - Improvement in Sx, QoL Immunosuppression - Which drugs - Complications - HTN, DM, hair loss Rejection episodes - Symptoms - How managed - Signs to be aware of Infection, CMV status Thrombosis Graft failure Recurrence of disease Malignancy - Monitoring - Biopsies, USS
Bronchiectasis
- Symptoms: Haemoptysis SOB, wheeze Chronic sinusitis CP LoW, fever, anorexia RHF (late event)
Risk factors:
- Childhood whooping cough/measles
- History of recurrent LRTI
- Immunocompromise, HIV, AI conditions
- Immunisation history
- Smoking
- COPD, airway disease
- ABPA
Investigations
- CXR, CT chest
- Sputum mcs, history of bugs
- Immunoglobulins, immune function
- Testing for CF
- Eosinophils
Management
- ?Prophylaxis
- Abx
- Pulm rehab, clearance methods
- Vaccinations
- Home O2
- Surgery? (uncommon)
Complications
- Precipitating causes
- History of hospital admissions, history of abx courses
How it impacts life
Lung Cancer
How and when diagnosed
- Symptoms: LoW, fatigue, fever, night sweats, cough, haemoptysis, Sx of paraneoplastic/mets
- Scans at time
Risk factors:
- Smoking
- COPD, b/g airway disease
- Immunosuppression, CT
- Systemic conditions
- Genetics, FHx
- Occupational exposures - asbestos, mining, uranium
- Chronic scarring, TB, scleroderma, ILD
Ix:
- CXR, CT
- Bronchoscopy
- Bx
- PET scan
Management
- CT, RT
- Surgery
- Follow up
Complications
- CT and RT
- Post op Cx
- Mets
- Paraneoplastic
- SVC obstruction
Trajectory
Follow up, monitoring scans
Impact on QoL, SOB, independence
Prognosis, GoC
Pall care involvement
COPD
Risk factors:
- Smoking
- Workplace exposures, wood, charcoal, coal smoke, dust
- Plastic, textile and rubber manufacturing
- Leather and food industry
Ix:
- PFT
- CXR, CT chest
- Blood gases
- ECG
- Echo
- Alpha-1-antitrypsin
Management
- Inhalers, steroids
- CPAP, BiPAP
- Smoking cessation
- Abx prophylaxis
- Vaccinations
- Home O2
- Management of pulmonary HTN
- Lung transplant
Complications
- Infections
- PTX, chest drains
- Cx of inhalers
- Hospital admissions, ICU admissions
- Cardiac
- Pulmonary HTN
Trajectory
Prognosis
Sleep apnoea
Symptoms: daytime somnolescence, snoring, fatigue, unexplained resp failure
Risk factors
- Obesity
- ETOH
- Meds
- Tonsillar enlargement
- COPD
- Hypothyroidism
Ix
- Sleep study
- PFTs
- Epworth sleepiness scale
- Echo
Management
- Sleep hygiene
- Weight loss
- Surgery
- CPAP
Complications
- Pulmonary HTN
- HTN
- CVD, CCF
- Restless legs
Trajectory
Adherence
ILD
Symptoms: SOB, Low, fevers, fatigue, reduced ET
Duration
Risk factors:
- Smoking
- Occupational exposures
- Pets
- FHx
- CTD, AI conditions
- Meds: bleomycin, MTX, Amiodarone
- TB, chronic infections
- Pre-existing asthma
- RT
Investigations:
- CXR, HRCT
- PFT
- ABG
- Blood film
- TTE
- Biopsy
Management
- Depends on exposure
- Smoking cessation
- Antifibrotics (perfenidone)
- Steroids
- Home O2
- Abx
- Immunosuppressants
- Lung transplant
Complications
- Respiratory arrest
- Infections, hospital admissions
Pulmonary HTN
Risk factors: - FHx - CTD - COPD - ILD - Smoking - HF, LH disease - Drugs, CT - HIV - TB - OSA, OHS - Arteritis Try to classify based on type of PHTN I guess
Ix
- TTE
- HRCT/CT chest
- R heart cath
- ECG
- Blood gas
Management
- Manage underlying condition
- Prostacyclins
- Sildenafil
- Endothelin antagonists
- Home O2
