Histories Flashcards
Name 5 presenting features of DKA
Thirst/ urine frequency
Weight loss
Vomiting (or diarrhoea)
Abdo pain
Lethargy
Confusion
Think also teenager, recurrent infections etc
Name 5 reasons to consider HIV testing?
Prolonged/ severe/ recurrent infections
Persistent lymphadenopathy
Glandular fever type illness
Conditions related to immune suppresion
Social factors (MSM, IVDU, high risk populations)
Possible exposure is medical emergency, same day for PEP
ADHD questions and criteria?
Attention syx (cocentration, not listening, detailed tasks difficult etc)
Hyperactivity/ impulsivity syx (figiting, up and on the go lots, can’t sit, blurting out in conversation, very loud, can’t play quietly)
At least 2 settings, more than 6 months, over age 12
Rape/ PTSD episode following rape - what key closed questions? (6)
Feel safe with that person
Police involved
Pregnancy possibility
STI possibility
Mood/ keep self safe
Alcohol/ drugs etc
Management options for PTSD? (3 key areas)
Combast stress (military), Rape Crisis charity, Victim support (crime victims) - offer support group
If more than 1 month after event
- Talking/ EMDR therapies
- SSRI/ venlafaxine - consider mirtazapine if sleep
- Can consider short term sleeping tablets
Differential features of baby blues vs. post natal depression?
BB- Day 2-D5 postnatal (short time frame, resolves quickly, affects up to 80% mums and settles)
PND- Starts within a few weeks of birth and up to 1 year later
- Affects 1 in 10
5 questions specific to post-natal depression history?
Do you feel safe at home?
How are you bonding with baby?
How are you doing physically?
Any thoughts of harming self or baby?
Any strange voices or thoughts?
Eczema history specifics?
Current + prev treatment (what’s worked) - incl frequency
Affected areas/ scatches/ bleeding/ weeping/ fever
Triggers
FHx and atopy
Impact on child/ carers
New HIV disclosure in consult - quick 3 questions?
Under local HIV service?
On medications?
Any sexual partners? Are they aware of diagnosis?
Emergency contraception request - 5 key areas to cover?
a) Choice of EC Q’s
b) Pregnancy test in 3 weeks
c) STI’s
d) “Do you feel safe with this parter?”
e) Home situation/ support/ alcohol/ drugs
Emergency contraception - questions to decided which one?
Timing UPSI/ any other unprotected in that cycle?
When last period (after Day 14+5 = 19 in cycle oral unlikely effective)
Ulipristal as long as:
- No progesterone in last 7/7
- No Enzyme medications
- No severe asthma
- Can avoid breastfeeding 7/7
New domestic violence - key history Qs?
SPECSS
-Safe/ seperation- “Is there somewhere safe you can go?”
-Pregnancy
-Escalation - “Are you worried it could get worse?”
-Children
-Sexual assult or strangulation
Screen - who’s at home? Alcohol or drugs?
Criteria for menopause diagnosis over 45/ under 45?
Over 45
- Not on hormonal contraception
- No periods for 12 months
(On symptoms when no uterus)
40-45 - Do FSH, usually 2x 6 weeks apart if has symptoms
Perimenopause can be diagnosed over 45 if vasomotor symptoms + irregular periods
14 year old new pregnancy. What to be considered in terms of Gillick competence?
Child under 16 can consent if able to fully understand options/ risks etc
- Only if not being pressured from others
Always would try to persuade to tell parents or other trusted adults
14 year old new pregnancy - key questions to ask (6)
Feelings about it?
Partner (safety screen, age, how known)
Are you safe? Anyone pressuring?
STI’s
How many weeks/ midwife booking?
Sharing with parents, assessing gilick competence etc
Pre-eclampsia - how does it present?
Hypertension + one of:
- Proteinuria
- Renal/ liver abdnormal bloods
- Headache, confusion, stroke etc
Sleep apnea - Key hx questions (5)
Daytime sleepiness
Witnessed breathing pauses
Snoring
Unfreshing sleep - tired/ concentration
Waking up at night
Morning headache
Polycystic kidney disease - presenting features?
Autosomal Dominant- FHx
Excessive urine/ nocturia/ loin pain
- Hypertension
ADHD - history features for diagnosis?
2 or more settings
>6months
Inattention:
- Concentration, not listening
Hyperactivity
- Fidgiting, restless, can’t play quietly
Name 5 core presenting features of addisonian crisis?
Severe fatigue
Muscle weakness
Abdo pain
N+V
Hypotension, stock, reduced consciousness, fever etc
Hyponatremia, hypoglycemia, hyperkalaemia
- Consider in anyone also with preecisting autoimmune
Presenting features of sarcoidosis? (3)
Resp (90%), skin or eye organ systems
(Neuro, cardiac, renal)
Often normal exam
CXR -Bilateral hilar lymphadenopathy
Mild hypercalcaemia (possible raised vit D, ALP - could also have renal etc
> Refer resp, steroids if active or severe disease
Presenting features of MND? (3)
Stiff or weak hands (gripping)
Weak feet/ legs (stairs, foot drop, falls or trips)
Spasms or twitches
Speech, swallowing, behaviour changes
New contraceptive pill - key COCP questions?
Migraines with aura/ hx of
Smoking (>15/day over 35)
VTE
Breast cancer
Heart problems - any major CVD risk
Liver problems - severe
BMI >35
Suspected GORD in 2 month old - what specific medical questions to rule out other differentials?
Projectile vomiting - Consider pyloric stenosis up to 2months
Blood in stools/ rash - CMPA
Bile (green vomit) - Obstruction/ atresia/ hirsprung
Other causes of unwell (breathing, fluids in/ out etc)
How does MS typically present (5)
Between 20-50
Symptoms evole over hours/ days
- Visual (loss, painful movements, dipolpia)
- Sensory disturbances
- Weakness
- Cerebellar (verigo, ataxia etc)
Early urgent referral to neurologist!
How long after periods finish is a bleed “post menopausal”
12 months
Name 5 risk factors for endometrial cancer?
Nulliparous
Obesity
Late menopause
Diabetes
PCOS
Name 3 presenting investigation results and 3 symptoms of Conns syndrome (hyperaldosteronism)?
Ix - Hypertension with low K+, high Na+ and metabolic acidosis
Syx: Weakness, polyuria, polydipsia
What history features are concerning for AKI - what is the definition to diagnose?
Reduced urine output/ signs volume changes
Creatinine rise 26mmol in 48 hrs or 50% rise within 7 days
(or <0.5mls/kg/6hrs)
New clinic BP 190/120 - what questions to ask? (6)
Chest pain
Confusion
New swelling legs (HF)
SOB (HF)
Not passing urine (AKI)
Papilloedema (blurring vision)
- If any present then refer same day
New pregnancy (i.e. hyperemesis consultation) - what pregnancy bits to cover? (3)
Gestation
- Are you booked on badgernet?
- Folic acid
N+V in pregnancy - closed questions? (4)
Fluids/ urine
Fever/ UTI syx
PV bleeding
Abdominal pain
New hyperemesis - when to follow up in GP?
Follow up appt 24-48hrs
Hx features where you might suspect autism? (5)
Langauge delay
Reduced responsiveness (to name, smiling etc)
Reduced interaction/ social interest
Reduced eye contact
Restrictive or repatative behaviours
Referral to community paediatrics
Concern about FHx of breast cancer - when to refer to secondary care? (5)
BRCA in familty (autosomal dominant)
- One first degree relative under 40
- Any male relative
- Bilateral breast cancer relative
- Two (first or second) relatives with breast or ovarian
Any Jewish or other complicated patterns also refer
How is hereditary haemachromotisis inherited?
Autosomal recessive
Parkinsons - 4 key features?
How to manage?
Slow and gradual onset
- Bradykinesia
- Reduced movements
- Stiffness
- Resting tremor
Often may present as balance or gait problems/ falls etc
Stop causative drugs (prochlorperazine, metoclopramide, antipyschotics)
Urgent neurology referral
Name 3 core features of anorexia and 3 of bulimia?
Anorexia - Must have low BMI, plus restricted intake and behaviour which interferes with weight gain/ fear of weight gain
Bulimia - binge eating followed by compensating behaviour. can be normal BMI
How does CMPA typically present?
Always before age 1
2-72 hours post ingestion
- Urticaria/ Itch/ cough/ breathless (igE)
- GORD, constipation, blood in stools, atopic eczema (non-igE)
How is late puberty defined and how is it managed?
Boys - absence of testicle development by age 14
Girls - absence of breast development by 13 or absence of periods (with normal breasts) by 15
Refer for paeds investigations (refer sooner if restricted growth, hirsuitism, abdominal pain etc)
What is the definition of precoscious puberty?
Puberty before
Age 8 in girls
Age 9 in boys
Refer to paeds
What are 3 features of peripheral vertigo and 3 of central vertgio?
Peripheral - No neurology, severe N+V, hearing loss - can walk but be unsteady
Central - New onset/ recent trauma, CVS risk factors, can’t even stand, prolonged or severe
What presenting features may be concerning for CLL? What would an FBC show?
Any of pallor, bruising, sweats, lymphadenopthy, enlarged spleen, fatigue, infections
FBC- Often only raised lymphocytes in inital phase
- A=G haematology or 2ww
“I want the pill” as opening line - how would you structure consultation?
Tell me more about why
- Understand contraception
- Relationships, safety
- Knowledge of other options
- Preferences “WHAT’s IMPORTANT TO YOU ABOUT CONTRACEPTION” “ANY WORRIES YOU WANT TO SHARE
- Medical (periods etc)
Present options (LARC vs. pills/ patch)
- If keep for oestrogen based, screening Q’s
What is the key goal of every consultation in James SCA plan!
Identify RIGHT goal(s)
- Important to patient
- Important medically
Address that goal(s)
Severe learning difficulties - presenting ethical dilema - i.e. pill request - how to structure?
Data gather patient part (Story, understanding, impact, ICE - patients part)
VERBALISE DILEMA “I need to make sure your choice/ you’re safe making this decision”
Doctors part - Closed Q’s
Management plan - shared, with ICE
How does chronic prostatis present?
Over 3 months
- Perineal, inguinal, scrotal, penile pain
LUTS
ED
How does seratonin syndrome present?
Multiple serotonin drugs
Presents with - neuromuscular (tremor, spams), autonomic (HTN, tachy) and mental state symptoms (agitation, confusion)
Falls - areas to review in doctors part as framework?
D- Drugs
Age- Eyesight, mobility/ ADL’s
Med - cardiac / postural/ neuro/ parkisons etc
Enviro - OT support
How does PUPPP present - what are the mx options?
Very itchy stretch like urticarial rash on abdomen/ thights/ buttocks etc
- Third trimester pregnant
Resolves with deliver
- Moisturisors
- Mild steroid
- Antihistamine for itch (cetirizine)
How does eustacian dysfunction present?
How to manage?
Dulled hearing/ ear pressure/ pain or popping - occasional tinnitus or mild vertigo
- Usually post viral URTI
Usually self resolves in weeks to months (yawning/ swallow/ valsalva)
- Nasal steroid + antihistamine
- Refer if no better by 6 weeks or sudden/ severe hearing loss
- Smoking etc cut down
According to NICe - what features raise suspicion of ovarian cancer?
Especially over 50
- Bloating
- Early satiety
- Urinary urgency/ incontience
- Pelvic or abdo pain
Think any over 50 with new IBS
Also screen weight loss, change in bowels
NICE - when to suspect myeloma (4)
Especially over 60:
Unexplained bone pain (thoracic or lower back)
- Hypercalcaemia (abdo pain, weakness, thirst, polyuria)
- Weight loss
Fatigue/ cognitive/ pathological fractures/ recurrent infection
Pancreatitis (acute) - common presentation?
Gallstones or alcohol (75%)
Acute, upper or generalised abdo pain
- May radiate to back
N+V
(Associated either gallstones syx or alcohol misuse)
Severity does not equal degree of pain = ALL same day admission
How does PAD present - what features would be considered red flag?
Presents - fatigue, discomofrt, cramping or pain after walking predictable distances and relieved by rest
- Not present at rest, reproduced walking same distance
(Uni or bilateral)
Red flag - (Chronic or acute limb threatening) - Pain (rest), pallor, pulselessness, perishing cold, paralysis or parasthesia
Tinnitus - red flags which prompt urgent referral?
Same day - Suicidiality, sudden onset with neuro symptoms or uncontrolled vertgo OR pulsatile
Within 24 hrs - If tinnitus and hearing loss which developed in less than 3 days, within last 30 days
Within 2 weeks - Hearing loss >30days ago or rapidly worsening hearing loss over <90days
OR persistent ear pain or discharge not resolving with tx
Name 5 anorexia history/ assessment features which would prompt immediate
BMI below safe range (<15) or loss >1kg per week
- CV syx (syncope, bradycardia)
- Hypothermia
- Reduced muscle power (sit to stand)
- Rapid deteroration
- Electrolyte imbalance or hypoglycaemia
HTN and pregnancy - key closed questions?
Pre-eclampsia
- Headache/confusion
- Frothy urine
Folic acid/ baby movements etc
Eyes - 4 red flags which need urgent admission?
Eye pain
Vision loss (blurred or field)
Sudden flashes/ floaters (retinal detachment)
Chemical eye injury
Also trauma/ suspected FB
New mum - discussing at 8 weeks - key red flag history questions?
Thoughts self-harm/ suicide
Thoughts harming baby
Psychosis
- Previous mental health conditions
Wanting to rule out stroke - what are the BE-FAST symtpoms?
Balance (severe ataxia)
Eyesight
Face
Arms
Speech
Time to call ambulance
Suspected eating disorders - 5 SCOFF questions?
Sick
Control (worry can’t control)
One stone weight loss
Feel fat
Food dominate life
2 question mood screening?
Feeling down, low or hopeless at all?
Are you still able to enjoy some things in life? / What things do you enjoy doing?
New gynocomastia in male - red flag questions?
Screen hormone Q’s
Testicular lumps
Visual changes/ neuro signs
Lung ca/ liver/ TFT’s etc can also cause so screen these syx
Brief sexual history - 5 questions?
Partners - How many? Gender
Practices - Type of intercourse
Protection - Condoms
Prevention - STI’s in past
Pregnancy - Contraception
What things need to be clarified for a diagnosis of OCD? (2)
Red flags (4)
Obsessional thoughts
Compulsive actions
Suicidality
Substance misuse
Severe depression
(s)Psychosis
Starting results station - opening line?
I can see you’ve had some blood tests done which we can certainly talk about… is there anything you were hoping to discuss?
