Histories (specialties)

Question 1

Paediatric Hx (what extra questions to include)?

Answer 1

B F G D

B = Birth

F = feeding (+ toileting)

G = growth

D = development

Question 2

Paeds Hx questions:

(B F G D)

What does B include?

Answer 2

B = birth

Pregnancy: any abnormal scans? maternal illness? alcohol/drug use?

Birth: location, gestation time, mode of delivery, birth complications, neonantal problems (jaundice, fits, admisisons to neonatal units)

Question 3

Paeds Hx questions:

(B F G D)

What does F include?

Answer 3

F = Feeding

• how much child normally feeds - compare against normal feeding
• mode: breast/bottle/weaning/solid meals?
• toileting (usually trained 2-4 y)

*dry by day 2 y

*dry by night 3-4 y

Question 4

Paeds Hx questions:

(B F G D)

What does G include?

Answer 4

G = growth

• Weight: ask for red book (0-5y)
• Puberty: boys 12y, girls 11y

Question 5

Paeds Hx questions:

(B F G D)

What does D include?

Answer 5

D = development

• any concerns
• school: progress and attendance
• developmental screen (if <5)

Question 6

Components of the developmental screen (6)

Answer 6

• smiling -> by 6 weeks
• turning to sound -> by 6 months
• sitting -> by 9 months
• first word -> by 18 months
• walking -> by 18 months
• short sentence -> by 3 years

Question 7

SH in paeds

Answer 7

• family: parents, sibilings/who lives at home
• does anyone smoke at home?
• housing situation
• social services involvement/ safeguarding issues
• playgroup/school/nursery attendance - performing well?
• other: travel, hobbies, pets

Question 8

PC in psychiatric history (3)

Answer 8

• symptoms that brought pt in
• voluntary/detained admission
• who prompted to come in (e.g. friend, family)

Question 9

Components of the psychiatric system review

Answer 9

• Psychosis screen (1st rank symptoms): auditory hallucinations, commentary auditory hallucinations, delusions of thought/control/perception
• Depression screen: core (mood anhedonia), biological (sleep, energy), future (hopeless, suicidal thoughts)
• Other: memory loss, anxiety, insight
• RISK: self/others

Question 10

Past psychiatric Hx (5)

Answer 10

• diagnoses
• first onset/last episodes
• how many admissions (voluntary vs involuntary)
• previous self-harm/suicide attempts
• mental health worker

Question 11

What to ask in psychiatric Hx in FHx section?

Answer 11

• family psychiatric history
• FHx of suicide

Question 12

SH in psychiatric Hx (5)

Answer 12

• alcohol and drug use
• social circumstances (current situation, relationship, dependants, home, finances, education/work, coping with AoDL?
• forensic history
• personal upbringing history (ay child abuse?)
• pre-morbid personality

Question 13

What extra subheadings the gynae Hx must contain?

Answer 13

• HPC: gynae RoS -> 4 P’s: PV bleed, PB discharge, pelvic pain, pregnancy (chance)
• M O S C

M - menstrual Hx

O - obstetric Hx

S - sexual Hx

C - contraception/cervical smears

Question 14

M O S C for gynae history

What M is?

Answer 14

M = menstrual history

• 1st day of last menstrual period (LMP)
• menarche age +/- menopause age
• cycles: regular, how long
• periods: durations, character (heavy, number of pads per day, flooding, pain)

Question 15

M O S C for gynae history

What O is?

Answer 15

O = obstetric

• gravida and para
• miscarriages, ectopic pregnencies, terminations (stage, treatment and complications)
• children (living): number, ages, types of deliveries, any problems during pregnancy/delivery

Question 16

What ages do these usually occur:

menarche

menopause

Answer 16

Menarche: 12 - 13 y

Menopause: 48 - 55 y

Question 17

What’s:

• gravida/ gravidity
• para/parity

Answer 17

• gravidity -> number of times being pregnant
• parity -> birth of foetus > 24 weeks (regardless of if born alive or not)

Question 18

M O S C for gynae history

What S is?

Answer 18

S = sexual history

• Partners: current (gender, relationship duration), previous partners (last 6 months), high risk encounters
• Intercourse: type, pain/discomfort, contraception use
• Subfertiliy

Question 19

M O S C for gynae history

What C is?

Answer 19

C = contraception and cervical smear

• Contraception: current use, previous methods
• Cervical smears: date of last smear, results

Question 20

Obstetric Hx system review (in HPC section)

Answer 20

4 P’s : PV bleed, PV discharge, Pain, Pregnancy *

*some extra questions to ask if pregnant -> another flashcard

Question 21

Obstetric Hx. What extra questions to ask in 4 P’s in a pregnancy-related bit?

Answer 21

P = pregnancy

• foetal movements (if over 16-20 weeks)
• contractions/tightening
• PV blood loss
• Pre-eclampsia symptoms (headache, visual disturbance, oedema, epigastric pain)

Question 22

Obstetric Hx. What extra headings to ask for?

Answer 22

• HPC: gynae/obs RoS -> 4 Ps (PV bleed, PV discharge, Pelvic pain, Pregnancy)
• Current pregnancy questions (LMP, scans, Ix, problems, vomiting.hydration)
• Obs bit: GMC (Gravida and para; miscarriages/ectopic pregnancy/terminations; children - number of living/ any problems during preg/delivery)

Question 23

What’s G M C in obstetric history?

Answer 23

G M C

G - gravida/para

M - miscarriages, terminations, ectopic pregnencies (stage, treatments, ocmplicaitons)

C - children (living children) -> ages, complications during delivery/pregnencies

Question 25

What questions to ask about current pregnancy in obstetric history?

Answer 25

Current pregnancy

• LMP
• scans
• Ix (Rhesus group, Down Syndrome etc)
• problems/ admissions during this pregnancy
• vomiting/hydration