History Questions Flashcards

Question

Pregnant Woman Using Heroin

Answer 1

* How does she know she is pregnant? * Feelings about pregnancy? * Establish level of current opioid use: * Amount * Frequency * Type * Duration and extent of problem? * How much spending on? * How is she administering? If injecting where? Sharing/reusing needles? * Other risky behaviours - unprotected sex? overdoses? * Use of alcohol and other drugs? * Medical problems? * Psychiatric problems? * Legal problems? * Insight and motivation to stop? * Social support? Relationship with partner? * Any other children at home?

Answer 2

* Onset * Duration * Precipitating and relieving factors * Sex life pre-depression? * Pre-antidepressant use? * Differential for sexual dysfunction: * Performance anxiety * Physical health issues - diabetes, CVD * Marital stress * Impact on relationships * Advise on risks of cessation too early * Treatment options: * Switch to alternative antidepressant * Sexual counselling * Wait and see - may improve with depression * Viagra

Answer 3

* SOCRATES * Onset * Frequency * Progression * Triggers - sleep deprivation, stress, strobe lighting * Associated with a particular change - medication? * ABC of seizures: * Before - aura? * Visual * Smell * Gastric sensations * Deja Vu * During: * Unresponsive? * Involuntary movements? * Tongue biting? * Incontinence? * Duration of episodes? * Injuries? * After: * Sleepy or confused (post-ictal) * Past medical history - head injury? * Medications - seizure inducing? * Drugs/ETOH? * Driving? * Work - with machinery?

Answer 4

* Start with open questions * Existing diagnosis? History? * Onset and progression? * Trigger/link with anything\> * ABC of behaviours Differentials * Organic causes - intake and elimination, pain, new complaints/unwell, recent falls, fevers? * Psychiatric - changes in mood? irritability? emotional lability? anhedonia? actively responding or talking to himself? * Medication - any recent changes to medication? * Environmental - any changes to staff, routine, activities, visitors?

Answer 5

* Start with open questions * Existing diagnosis? History? * Onset and progression? * Trigger/link with anything\> * ABC of behaviours Differentials * Organic causes - intake and elimination, pain, new complaints/unwell, recent falls, fevers? * Psychiatric - changes in mood? irritability? emotional lability? anhedonia? actively responding or talking to himself? * Medication - any recent changes to medication? * Environmental - any changes to staff, routine, activities, visitors?

Answer 6

* When did this begin? * How many episodes? * Getting more frequent? * Daytime/ night-time? * Does she go for a walk every day? * Where does she go? Same place? Doing what? * Drinking/spending lots of money? * Who has been bringing her back and at what time? * Medical history? * Medications? * Risks: * To self - Crossing roads/falls * To others - Agression to others/disinhibition * From others - Exploitation by others including carers * Neglect - not taking medications? Eating and drinking? Exposure?

Answer 7

* Onset of problem, any trigger, progression - gradual or stepwise? * 5As - memory, skills, disorientation, speech, personality * Memory * Misplaces things? * Forgets appointments? * What about the past? * Disorientation: * Muddled up with day and dates? * Gets confused at times? * Difficulty recognising people? * Speech: * Difficulties word finding? * Able to follow conversations? * Differential: * Low in mood before the onset of problems? (pseudementia due to depression) * Visual hallucinations? Movement difficulties? Falls? Fluctuating? (suggests LBD) * Cardiac risk factors - HTN, diabetes, hypercholesterolaemia, CVD? (suggests vascular) * Increased apathy? Impulsivity? Irritability? Insight? - (suggests frontal lobe) * Impact on functioning? * What is he having difficulties with? * Dressing, washing/toilet, walking, shopping, cooking, transport, finances? * Risk * Are there concerns about his behaviour? * Risk to self: * Episodes of wandering * Falls * Accidents due to fire/flooding at home? * Risk to others: * Episodes of aggression? * Risk from others: * Risk of exploitation/abuse by caregivers * Physical health * Past psych history * Medications * Drugs/ETOH

Answer 8

* Orientation: * Year, season, month, date, time * Country, town, district, hospital, ward * Registration: * I would like you to remember three objects and repeat them to me immediately, then again in 5 minutes: * Apple, table, penny * Attention and Calculation: * Can you spell the word WORLD for me? * Could you spell it backwards? * Recall: * Please repeat the three words I told you earlier back to me * Language: * Please name the objects I point at (pen, watch) * Please repeat the phrase: 'no ifs, ands or buts' * Please follow my instructions (three stage command): * Place the index finger of your right hand on your nose, on your forehead then on your ear * Can you please read this sentence and do what it says: write 'close your eyes' on a piece of paper. * Could you give me a sentence with a subject and a verb * Copying: * Draw two intersecting pentagons and then ask patient to copy Scoring: 24-30 = no cognitive impariment 18-23 = mild cognitive impairment 0-17 = severe cognitive impairment

Answer 9

* Clarify presenting complaint * Onset and duration? * Fluctuating with time of day? * Aware of surroundings? * More alert or subdued? * Possible causes: * Any underlying medical conditions? * Seen recently by GP * Any new medications * Elimination * Complaints of constipation? * Difficulties PU? New odour, pain or increased frequency? * Comorbid psychiatric symptoms * Mood over the past 2 weeks? * Decreased interest in doing things recently? * Changes in appetite or sleep? * Responding to things that aren't there? * More suspicious than usual? * Risk: * More agitated than usual? * Done anything to risk harming himself or others? * Wandering? * Underlying memory issues: * Prior to onset of confusion how was memory? * Issues with short term memory? Long term? * Word finding difficulties? * Not orientated to time? * Not recognising people? * Functioning and ADLs? * Grooming, dressing and finances?

Answer 10

* Age? * Current education? * Onset of problems? How long for? (ADHD \>6 months and onset before age of 7) * Birth/developmental issues?

Answer 11

* Do they make eye contact when being spoken to? * Reciprocates when hugged? * Does he come to you when hurt? * Able to make friends with other children? * Can he play games and share toys with other children?

Answer 12

* Any difficulties using language? * Able to sustain a conversation? * Delay in speech/first words? * Tends to repeat things?

Answer 13

* Any unusual interests? * Any unusual interactions with toys? * Able to have imaginative play? * Does he do anything repeatedly? * Any rituals? * Repetitive movements? e.g. hand flapping * How does he react to changes in his environment/routine? * Sensitivity to certain stimuli?

Answer 14

* How was the pregnancy? Any complications before/during/after? * Did he meet developmental milestones? * When did he first smile, turn over, crawl, sit and walk? * Any skills he used to have he has now lost? * Any unusual physical characteristics? * Past medical history? Any history of seizures or head injury? * Has he had his hearing and vision checked?

Answer 15

* How has mood been recently? Any loss of interest in things he used to enjoy? * Any things he is specifically afraid of? * How has sleep and appetite been? * Any agressive behaviour to others? Any self-harming behaviour?

Answer 16

Defiance * Frequently argumentative? * Violated set rules by adults? * Staying out after dark? Running away? Truanting? * Evidence of stealing? * Involvement in any crimes? * Relationship with peers?

Answer 17

Aggression/violence * Getting into fights? * Physically agressive to others? * Sexually coercive? * Cruel to others/animals? Destruction of property * Any incidents of deliberately destroying things?

Answer 18

* Family history of mental health problems? * Crimes/substance use in family? * Financial situation at home? * Severe physical/verbal punishments when growing up?

Answer 19

* How has mood been recently? Any loss of interest in normal things they used to enjoy? * Any evidence of increased anxiety? * Can they focus on things? Are they always on the go? Do they interrupt a lot? * Problems during infancy/growing up? * What was previous academic perfomance like? Always struggling? Paricular areas? * Any possibility using alcohol or drugs at the moment?

Answer 20

* Impact - at home, at school, socially, bullying? * Past psych history * Past medical history * Medication

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History Questions Flashcards

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