Histories - exploring the symptoms Flashcards
Explore the symptoms of tiredness
(what other questions to ask in HPC?)
Tiredness
- what do they mean by ‘tiredness’: what, constant/episodic, duration
- how it affects the patient?
- sleep (amount, quality, any snoring/apnoeic episode)
- anaemia: SOB on excretion, dizziness, headache
- hypothyroidism: menorrhagia, intolerance to cold, weight gain
- depression: mood, early waking
- diabetes symptoms: polyuria, polydipsia
Explore the symptoms of headache
(what other questions to ask in HPC?)
Headache
- SOCRATES
- meninginsm: rash, fever, photophobia, neck stiffness
- temporal arteritis: jaw claudication, scalp tenderness (e.g. while brushing hair), visual problems
- glaucoma: halos around the lights, visual blurring, red eyes
- associated neuro symptoms: fits, falls, LOC, dizziness, weakness, incontinence, numbness, tingling
- red flags (different flashcard)
Red flags for headache (6 categories)
- intracranial bleed (thunderclap headache, recent trauma)
- raised intracranial pressure (posture/ valsava manouver relate)
- other: immunosupression, malignancy, focal neurology, age >50y
- meningitis (rash, fever, neck stiffness, photophobia)
- temporal arteritis (visual problems, scalp tenderness, jaw claudication)
- glaucoma (halos around the lights, blurring, red eye)
Explore the symptoms of fit/fall/syncope
(what other questions to ask in HPC?)
*Get a collateral history
- Before: warning, circumstance
- During: LOC, color, movements, tongue biting/incontinence
- After: speed of recovery, weakness, amnesia, sleepiness/ confusion
*injuries from a fall?
Background to attacks: previous episodes, frequency, impact on life
Associated symptoms: cardio/respiratory/neuro (RoS)
*check if pt drives - may be restriction
Explore the symptoms of SOB
(what other questions to ask in HPC?)
SOB
- current and previous/normal exercise tolerance (what makes them stop?)
- Orthopnea
- Paroxysmal Nocturnal Dyspnoea
- diurnal/ seasonal variation (if chronic)
- associated cardio-respiratory symptoms
(chest pain, palpitations, wheeze, cough, sputum, haemoptysis, leg swelling)
Explore the symptoms of cough
(what other questions to ask in HPC?)
Cough
- productive/non-productive
- sputum
- hemoptysis
- diurnal/nocturnal variation
- triggers
- associated cardio-respiratory symptoms (SOB, wheeze, palpitations, chest pain, dizziness, leg swelling,)
Explore the symptoms of sputum
(what other questions to ask in HPC?)
Sputum
- quantify: how much and how often
- color
- consistency
- any blood
Explore the symptoms of hemoptysis
(what other questions to ask in HPC?)
- volume and frequency
- fresh vs altered blood
- nature of associated sputum/ mixed in
Explore the symptoms of palpitations
(what other questions to ask in HPC?)
Palpitations
- slow or fast
- regular/irregular (ask pt to tap out palpitation rhythm on the table)
- any dizziness, SOB, sweating/clamminess, LOC, nausea
- associated cardiorespiratory symptoms (haemoptysis, wheeze, SOB,chest pain, cough, sputum, haemoptysis, leg swelling)
Explore the symptoms of diarrhoea/ constipation
(what other questions to ask in HPC?)
- how much/how often
- colour/consistency/ content (mucus, blood)
- weight loss/appetite
- associated GI symptoms: dysphagia, nausea/vomiting, indigestion, heartburn/reflux, abdominal pain, bowel habit, tenesmus, blood/mucus in stool
Explore the symptoms of dysphagia
(what other questions to ask in HPC?)
Dysphagia
- solid/liquids (what came first)
- constant/intermittent, progressive/non-progressive
- odynophagia
- weight loss, food intake
- associated GI and neuro symptoms
Explore the symptoms of dyspepsia/reflux
(what other questions to ask in HPC?)
Dyspepsia
- SOCRATES
- associated GI symptoms
- red flags (different flashcard)
Red flags for dyspepsia/reflux
(mnemonic + extras)
A L A R M S
A - anemia
L - loss of weight
A - anorexia
R - recent onset progressive symptoms
M - melaena/haematemesis
S - swallowing difficulties
* age >55 years
* >4 weeks relapsing symptoms
*persistent vomiting
Explore the symptoms of vaginal discharge
(what other questions to ask in HPC?)
- quantity
- colour/ blood
- smell
- itching
- associated gynae symptoms: 4 P’s (different flashcard), examples: bleeding, dyspareunia, pain
Obstetric and Gynae RoS/symptoms
(4 P’s)
PV bleeding: mennorhagia, intermenstrual, post-coital, post-menopasusal
PV discharge
Pain: pelvic, dysmenorrhoea, dyspareunia
Pregnancy:
- chance of pregnancy
- if pregnant: foetal movements, contractions/tightening, PV loss, pre-eclampsia symptoms (headache, visual disturbance, epigastric pain, oedema)
*also menstrual, obstetric,sexual and contraception/cervix history (MOSC)
M O S C for gynae Hx
M - menstrual
O - obstetric
S - sexual
C - contraception and cervical
+ 4 P’s:
PV bleed
PV discharge
Pain
Pregnancy
Explore the symptoms of abnormal PV bleeding
(what other questions to ask in HPC?)
- Type: menstrual/menorrhagia, intramenstrual, post-coital, post-menopausal
- Quantity: number of sanitary towels/tampons
- any clots/flooding
- associated pain
- anemia symptoms
- thyroid symptoms
- chance of pregnancy
- associated gynae symptoms (4 P’s)
How to ask about/explore the symptoms in secondary amenorrhoea?
Work down the body
General: weight loss, stress, exercise, diet
Head: visual problems, headaches
Thyroid: hyperthyroidism symptoms
Torso: hirsutism, acne
Abdomen: possibility of pregnancy
Explore the symptoms of back pain
(what other questions to ask in HPC?)
- explore as pain (SOCRATES)
- early morning stiffness
- sciatica
- urinary incontinence/retention; faecal incontinence/constipation
- neuro symptoms of lower limbs (paraesthesia, pain, weakness)
- red flags (separate flashcard)
Red flags for back pain - manes of conditions only
- Cauda Equina
- Infection or cancer
- Spondyloarthropathy
Red flag symptoms for cauda equina
- urinary incontinence/retention
- faecal incontience/constipation
- bilateral leg pain
- severe/progressive neuro deficit
- decreased anal tone
- saddle anaesthesia
Red flags symptoms for infection/ cancer in back pain
- age <20 or >55
- weight loss
- fever/night sweats
- recent infection
- IVDU
- cancer history
- immunosupression
Red flags symptoms for fracture in back pain presentation
- trauma
- severe central spinal pain
- structural spine deformity
- spinal tenderness
Red flags symptoms for spondyloarthropathy in back pain
- early morning stiffness
- night pain
- worse with rest
What two features would suggest an inflammatory cause of joint problems?
joint pain/stiffness/swelling
- worse in the morning
- last for longer than >30 minutes
Joint pain/stiffness/swelling and …
A. Better with exercise
B. Worse with exercise
Possible causes
A. better with an exercise - inflammatory
B. worse with an exercise - osteoarthritis
Describe lesion in a dermatology
- Distribution and side (distal, flexor, extensor, generalised/localised, dermatomal)
- Characteristics (SEC)
S- shape (circular, linear, annular, irregular)
E - edge and elevation (well-demarcated, ill-defined, raised/flat)
C - colour (erythematous, pigmented/depigmented, purpuric)
- Secondary features: crust, scale, pigmentation, keratosis, lichenfication, erosion, excoriation, fissure, ulceration
