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
Sarcoidosis
Risk factors
- FHx
- Other AI conditions
- Viral infections, triggers
Investigations
- CXR, HRCT
- ESR
- ACE level (nonspecific)
- Ca levels
Management
- PNL
- Other immunosuppressnts
Complications
- Cutaneous: erythema nodosum, plaques, maculopapular, subcut nodules, migratory polyarthralgia
- Lofgren
- Eye: blurred vision, excess tears, uveitis, sicca
- Nasal congestion
- Renal disease
- Neuro: faocial nerve palsy
- Arthralgia
- Cardiac: heart block, arrhythmias, PPM, ICD
- Pregnancies: complications
- GIT, liver
CF
Risk factors
- FHx
- Other AI conditions
Investigations
- Infancy - sweat test, DNA markers
- CXR
- CT chests
Management
- CFTR inducers and potentiators
- Abx courses, prophylaxis
- Pulmonary rehab
- Lung transplant
- Vaccinations
Complications
- Infections
- Bronchiectasis
- Pulmonary HTN
- HF
- Mental health
- DM
- Fertility/sexual fx
- GIT
- Nasal polyps, sinusitis
Trajectory
?work up for transplant
Adherence to therapy
Pt’s coping
Prognosis
TB
Risk factors
- Ethnicity/place of birth
- Overseas travel
- Immunosuppression/compromise
Ix
- Mantoux, QFG
- CXR, CT chest
- Sputum AFB, TB PCR
- Resistance testing
- HIV, HBV, HCV
- Bronch, biopsies
Management
- RIPE treatment
- Family tracing, contact tracing
Lung Transplant
Why in hospital?
Cause of lung failure
Initial Sx
Risk factors
Contraindications, relative contraindications
Investigations
- TTE
- Heart cath
- PFTs
- Blood gases
- CXR, CT imaging, PET scans
Management
- One side? Both
- Immunosuppression regimen
- Subsequent imaging, biopsy
- Post-op care
Complcations
- Post-op, bleeding
- Thrombosis
- Infection
- Rejection
- Immunosuppressants
- CVD, HF
- Mental health
- Disease recurrence
IBS
Symptoms:
- Pain
- Diarrhoea/constipation
- Bloating
- ABSENCE of red flags/alarm symptoms: Onset >50yo, anaemia, Fe def, weight loss, rectal bleeding, FHx IBD, FHx coeliac, nocturnal symptoms
- Nil structural cause found
Risk factors
- History of gastro
- FHx of IBS
- Food intolerances
- PHx physical or sexual abuse
- PHx somatisation
Ulcers
Risk factors:
- DM
- Thyroid dysfunction
- Hyperparathyroidism
- CTD
- PHx ulcers, gastric surgery
- Meds, NSAIDs
- FHx endocrine disorders, MEN1
- Anticoagulation
Investigations: scope, imaging, biopsies
Malabsorption, diarrhoea
Presenting symptoms
- Steatorrhoea
- LoW
- weakness
- anaemia
- bone pain
- glossitis, angular stomatitis
- Bruising
- Oedema
- Peripheral neuropathy
- Rashes
- Amenorrhoea
- Cognitive impairment
Aetiology
- Gastrectomy
- Liver disease
- Drugs: ETOH, neomyucin, cholestyramine, isoniazid, PPIs
- IBD
- Previous RT
- Coeliac disease
- DM
- HIV
Investigations:
- AXR, CTAP
- stool mcs, PCR
- ?Whipples disease
- Bloods
- Vitamin deficiencies
- Scopes, biopsies
IBD
Symptoms
- Diarrhoea, blood
- Chronology of symptoms
- Disease activity
- Fever, malaise, LoW
- Obstruction
Risk factors
- FHx
- Other AI conditions
- PHx cancer
- Smoking, ETOH
Investigations
- CTAP, AXR
- Bloods, antibodies
- Scopes, biopsies
- Genetic testing, NOD2
- Faecal calprotectin
- Cancer screening
Complications
- UC
> Intestinal: toxic megacolon, perforation, haemorrhage, strictures, CRC
> Extra-intestinal: ulcers, pyoderma gangrenosum, erythema nodosum, uveitis, conjunctivitis, episcleritis, NAFLD, PSC, cirrhosis, cholangiocarcinoma, amyloid, anaemia, VTE, arthropathy, ank spon
- CD
> Intestinal: anal disease, fistulas, fissures, abscesses, obstruction, toxic megacolon, CRC
> Extra-intestinal: ulcers, pyoderma gangrenosum, erythema nodosum, sweet syndrome, uveitis, conjunctivitis, episcleritis, stones, renal disease, malabsorption, osteomalacia
CRC
Symptoms
- LOW, anorexia, fever, night sweats
- Change in bowel motions
- Mets
- IBD
- Nerve pain
Risk factors
- FHx, FAP, Lynch, MUTYH
- IBD
- Smoking
- Polyps
- Other cancers
- PHx infections, SA, polymicrobial growths
- DM
- Immunosuppression/compromsie
Investigations
- Imaging
- Genetic testing
- Scopes, biopsies
- PET
- Cancer screening
CLD
Symptoms
- Jaundice, pruritis
- Confusion, hepatic encephalopathy
- Change in bowel motions
- Anaemia
- Symptoms from portal HTN
Risk factor
- ETOH
- Viral infections: HIV, HBV, HCV
- NAFLD, obesity, metabolic syndrome
- IBD
- DM, CCF, arthropathy
- Haemochromatosis
- Wilson’s disease
- IVDU
- AIH
Investigations
- USS, fibroscan
- Viral testing
- Biopsy
- LFTs, FBE
Management
- Treatment of underlying cause
- Diet advice
- Banding
- BB
- Prophylaxis
- Cancer screening
- Vaccinations
- Transplant work-up
Complications
- Malnutrition
- Portal HTN - varices, bleeding, ascites, SBP
- Bleeding
- CVD
- HCC
- Hepatorenal
- Hepatocardiac
- MBD
- Complications of medications
- Cryoglobulins
Liver transplant
Symptoms
- Initial cause of liver failure
- Duration of disease
- Timing of transplant
Contraindications
- Active infection
- Active/untreatable malignancy
- Severe/untreatable CVD
- CholangioCa
- Ongoing ETOH
- Onoging IVDU and non-compliance
- AIDS
- diffuse portal bein thrombosis, advanced hepatorenal/cardiac disease
- Poor social support
- Frailty
Investigations
- TTE
- Viruses, infections
- Ca screening
- ?heart cath
- PFTs
Management
- When was transplant
- How many
- Types of transplant
- How long did they last
- Immunosuppression
Complications
- Immunosuppressants
- Acute thrombosis
- Infection
- Rejection
- CVD
- Bleeding
- Graft failure
- CKD
- DM
- Recurrent disease
- MBD
- Nutrition
- De novo cancer