Histories Flashcards
Neurological history
General
Fits/falls/LOC
Headache
Dizziness
Vision/hearing
Memory loss
Neck stiffness/photophobia
Motor
Weakness
Incontinence
Sensory
Pain
Numbness
Tingling
ENT history?
Ear
Hearing loss
Tinnitus
Otalgia
Nose
Rhinorrhoea
Epistaxis
Throat
Sore throat
Odynophagia
Cardio history?
Chest pain
Palpitations
SOB/wheeze
Cough
Sputum
Haemoptysis
Leg swelling
Always remember?
ICE and FLAWS!!
GI history?
Weight loss
Appetite change
Dysphagia
Nausea/vomiting
Indigestion/heartburn
Abdominal pain
Bowel habit
Tenesmus
Blood/mucus in stool
Flatus
Urological history
Storage
Frequency
Volume
Urgency
Nocturia
Incontinence (overflow/stress/urge)
Infection
Dysuria
Haematuria
Odour
Prostatic/voiding (if male)
Hesitancy
Poor flow/dribbling
Feeling of incomplete emptying
Rheum history?
Joints
Pain
Stiffness
Swelling
Work down body
Skin (rashes, ulcers, Raynaud’s)
Hair loss
Eyes (redness, dryness)
Mouth (dryness)
Chest (breathlessness, SOB)
GI (IBD symptoms)
Genitourinary (discharge)
Orthopaedic history?
Joints/bone/soft tissue
Pain
Stiffness
Swelling
Movement restriction/ability to weight-bear
Mechanical symptoms
Locking
Giving way
Neurological symptoms distally
Weakness
Numbness
Paraesthesia
Respiratory history?
Cough +- productive
Wheeze
SOB
Chest pain
FLAWS
HEPS = occupation, pets, smoking, allergens
Childhood infections
Hypothyroidism symptoms:
constipation, weight gain, cold intolerance, menorrhagia
Glaucoma symptoms:
visual blurring, red eye, halos around lights
Headache Red Flags:
Intracranial bleed: thunderclap headache, recent trauma
Raised intracranial pressure: posture/Valsalva-related
SOL: immunosuppression, malignancy, focal neurology, onset >50 years
Meningitis: rash, fever, neck stiffness, photophobia
Giant cell arteritis: visual problems, jaw claudication, scalp tenderness
Glaucoma: visual blurring, red eye, halos
SOB?
Current vs. normal exercise tolerance (what makes them stop?)
Orthopnoea
Paroxysmal nocturnal dyspnoea
Diurnal/seasonal variation if chronic
Sputum questions
How much, how often
Colour, consistency
Any blood
Palpitations?
Fast or slow
Regular or irregular (ask patient to tap out palpitation on table)
Any dizziness, LOC, nausea, sweating/clamminess, dyspnoea
Associated cardiorespiratory symptoms (see systems review)
Dysphagia questions?
Solids/liquids/both, which came first
Constant/intermittent, progressive/non-progressive
Odynophagia
Weight loss, food intake
Associated gastrointestinal and neurological symptoms (see systems review)
Back pain red flags?
Cauda equina: urinary incontinence/retention, faecal incontinence/constipation, bilateral leg pain, severe/progressive neurological deficit, decreased anal tone/saddle anaesthesia
Infection or cancer: age <20 or >55 years at onset, weight loss, fever/night sweats, recent infection, cancer history, injecting drugs, immunosuppression
Fracture: trauma, severe central spinal pain, structural spine deformity, spinal tenderness
Spondyloarthropathy: early morning stiffness, night pain, worse with rest
Joint pain/stiffness?
Worse in morning?, how long for (>30 minutes suggests inflammatory cause)
Better with exercise (inflammatory) or worse after exercise (osteoarthritis)
Sleep disturbance
Loss of function
Associated rheumatological symptoms (see systems review)
Dementia history questions?
Living situation, carer/home support
Mobility/walking aids
Effect on function/coping with activities of daily living: washing, dressing, cooking, cleaning
Working/driving
Smoking, alcohol and other cardiovascular risk factors
RISK:
To self: wandering, leaving gas on, abuse, neglect by self or others
To others: aggression, risky behaviour
Carer’s needs: empathise with the demands; ask about stress, coping, and support
Metallic valve replacement sounds?
Abnormal S1 = mitral
Abnormal S2 = aortic
Pulmonary fibrosis signs?
Oxygen therapy
Dry cough
Tachypnoea
Reduced expansion
Fine end-inspiratory crepitations
Pleural effusion signs?
Reduced expansion
Stony dull percussion note
Reduced breath sounds
Reduced tactile fremitus and vocal resonance
Causes of Distension?
(5Fs: Fluid, Flatus, Fat, Fetus, Faeces),
Proximal weakness → Normal sensation
DENIM:
Dystrophies – Becker’s/Duchenne, limb girdle, facioscapulohumeral (shoulder, face and truncal weakness)
Endocrinological – Cushing’s syndrome, hyper/hypothyroidism, diabetic amyotrophy (lower limbs)
Neuromuscular – myasthenia gravis (fatigable), Lambert–Eaton myasthenic syndrome
Inflammatory – dermato-/polymyositis, inclusion body myositis (proximal in legs but distal in arms), viral myositis
Metabolic/congenital/mitochondrial myopathies
Complex ophthalmoplegia causes?
Soft tissue – Graves’ disease
Muscle – mitochondrial myopathy
Neuromuscular junction – myasthenia gravis (test fatigability)
Multiple CN’s – cavernous sinus lesion, mononeuritis multiplex, MS
Brainstem – stroke, SOL, trauma
SOB key differentials?
PE
Pneumothorax
Asthma/COPD
Pneumonia
Acute LVF (heart failure)
ACS
Chest pain key differentials?
ACS
PE
Aortic dissection
Pneumothorax
Pneumonia
Abdo pain key differentials?
AAA, peritonitis, ischaemic bowel
Cholecystitis, cholangitis, pancreatitis, peptic ulcer, hepatitis
Appendicitis, IBD, diverticulitis
Renal colic, UTI, pyelonephritis
Testicular torsion, ectopic pregnnacy, ovarian torsion, PID
Medical: DKA, Addison’s, MI/pneumonia
Headache key differentials>
SOL
Subdural/extradural haemorrhage
Migraine
Cluster headache
Tension headache
GCA
Meningitis
Sinusitis
definitive imaging in suspected dissection.
CT angiogram
Mx of ILD?
Corticosteroids may help in acute exacerbations
Antifibrotics (pirfenidone/nintedanib) may be used in idiopathic pulmonary fibrosis
Treat/withdraw cause if possible (may include corticosteroids and immunosuppressants)
Supplementary measures
Smoking cessation
Pulmonary rehabilitation
Long-term oxygen therapy – indications below
Lung transplant (option for some patients)
Bronchiectasis mx?
Exercise and improved nutrition
Chest physiotherapy
Prompt treatment of infections (choose antibiotics based on culture sensitivities)
Rotating antibiotics may be used for prophylaxis if recurrent infections
Trial of bronchodilator and nebulised hypertonic saline
Pneumococcal/influenza vaccines
Lung resection may be considered in localised disease with a poor response to medical management
Decompensation of liver?
Signs: jaundice, ascites, encephalopathy
radio-radial delay
aortic coarctation or aortic dissection.
Approach to summarising acute care stastion?
Use SBAR
Situation and the background
Assesment: Findings of examination etc.
Chronic idiopathic demyelinating polyneuropathy (CIDP)
peripheral neuropathy which is mainly motor
Poliomyelitis
In old polio, there is a lower motor neurone pattern of weakness with no sensory signs. The signs are often asymmetrical and the lower limbs are more commonly affected than the upper limbs. Patients may have contractures and fixed flexion deformities from long-standing immobility.
Meningitis tx?
Ceftriaxone + ampicillin
dexamethasone
Prophylaxis for contacts
Salicylate poisoning
Toxbase
Risk assessment
Liasion Psych
Aortic dissection:
should be in resus.
Requires close monitoring.
IV labetalol + CT
Cardiogenic shock treatment?
Dobutamine
Displaced apex beat causes?
AR/MR
Pronator drift is really important: which side?
Ipsilateral
PURE MOTOR PROBLEM?
Polio
Portal hypertension signs?
Splenomegaly, ascites, caput medusae
Causes of ascites?
Liver failure, nephrotic syndrome, portal hypertension, ovarian malignancy
Intraperitoneal organs?
include the stomach, liver and spleen.
Retroperitoneal?
oesophagus, rectum and kidneys are all primarily retroperitoneal.
Hypoglycaemia symptoms?
feeling shaky.
feeling confused.
sweating.
being anxious or irritable.
going pale.
palpitations and a fast pulse.
lips feeling tingly.
blurred vision.
Glucose targets for T1DM?
- a fasting plasma glucose level of 5 to 7 mmol/litre on waking and * a plasma glucose level of 4 to 7 mmol/litre before meals at other times of the day. [2015]
