History

Question 1

6 cardinal sy

For each one write out what you would ask to explore these symptoms!!!

Answer 1

Chest pain – SOCRATES
Dyspnoea – exertional / orthopnea / paroxysmal nocturnal dyspnoea
Palpitations – ask patient to tap out the rhythm
Syncope / dizziness – postural / exertional / random
Oedema – peripheral oedema (e.g. lower limbs) / sacral oedema
Intermittent claudication – e.g. leg pain worsened on exertion / improved at rest

Question 2

DOPT for general symptoms?

SOCRATES used to ask about chest pain

Answer 2

Duration
Onset (Sudden/gradual)
Progression
Timing (Intermittent/continuous)

Question 3

SOB - What to ask?

Answer 3

Current vs normal (baseline)
Orthopnoea - pillows at night
PND

Rest
Self-care
Flat
Uphill
House/stairs

Question 4

Syncope

What to ask about before? - 3
What to ask about during? - 5
What to ask about after? - 3

Answer 4

When
What were you doing
Symptoms before

Conscious or unconscious
Duration
Decolouration
Jerky movements
Witness available

Incontinence
Injuries - Tongue biting
Recovery

Question 5

Past medical and surgical history
Drug history

Family history - key q?

Answer 5

Unexplained young death - young QT

Question 6

Social Hx - 8 areas to explore

Answer 6

Smoking – How many cigarettes a day? How many years have they smoked for?

Alcohol – How many units a week? – type / volume / strength of alcohol

Recreational drug use – e.g. Cocaine – coronary artery vasospasm

Diet – Overweight? Fatty foods? Salt intake? – cardiovascular risk factors

Exercise – baseline level of patient’s day to day activity

Living situation:
• House/bungalow? – adaptations / stairs
• Who lives with the patient? – is the patient supported at home?
• Any carer input? – what level of care do they receive?

Activities of daily living:
• Is the patient independent and able to fully care for themselves?
• Can they manage self hygiene / housework / food shopping?

Occupation – sedentary jobs – ↑ cardiovascular risk – e.g. lorry driver

Question 7

Pack years - how do you calculate it?

Answer 7

1 pack-year = 20 cigarettes (1 pack) per day for 1 year, or 40 cigarettes per day for half a year, and so on.

So if they have 10 a day for a yr, then they have half a pack yr