History Quickfires

Question 1

What are James’ key first and second question?

Answer 1

What would you like to talk about today?
- Follow with “Ok, so we have X… Was there anything else you had planned to discuss today?”

Question 2

What are James’ 3 key questions for ideas?

Answer 2

• What do you put it down to?
• What do you think is causing it?
• Before you came in today, what thoughts did you have about what might be going on?

Question 3

What are James’ 3 key questions for concerns?

Answer 3

• I’m interested to hear, what’s worrying you most about this?
• Sometimes we all have worries before we come to see the doctor, what was the worst worry that you had?
• You mentioned X, are you worried this might affect your X? (Home life, relationship, work, stress levels etc.)

Question 4

What are James’ 3 key questions for expectations?

Answer 4

• I’ve got some thoughts, but I’m interested to hear what you were hoping our next steps would be?
• Before you came today, what were you hoping we would be able to do?
• So can I clarify our aim today is… work out what’s causing this pain/ to make sure it isn’t something sinister/ INSERT AIM

Question 5

Name 5 red flag symptoms for a headache?

Answer 5

Focal neurological signs (weakness, lost sensation)
Fever
Sudden onset and severe
Neck stiffness (are you able to turn your head)
Diplopia
Seizure

Question 6

Name 5 common symptoms of hyperthyroidism?

Answer 6

Weight loss (despite increased appetite)
Heat intolerance
Diarrhoea
Tremor or new sweating or anxiety
Oligomenorrhoea or amenorrhoea

+tiredness/ weakness/ low libido

Question 7

Name 5 common symptoms of hypothyroidism?

Answer 7

Weight gain (despite possible less appetite)
Cold intolerance
Dry skin, thinning or hair loss
Constipation
Menorrhagia (can be followed by oligo/amenorrhoea)

+tiredness/ weakness/ low libido

Question 8

5 common categories of menopause symptoms?

Answer 8

Vasomotor- Hot flushes
Periods - Can be less/ more frequent and heavy/lighter
Pysch - Sleep, low mood, low energy, low libido
Vaginal - Dryness, itching, painful
General - Joint pains, headaches, urinary syx, palpitations

Question 9

Name 6 Q’s in a tinnitus history?

Answer 9

1) Uni or bilateral
2) Continuous or episodic
3) Pulsatile (does it match with HR) - think cardiac
4) Red flags
- Sudden onset, sudden hearing loss, head trauma, neurological symptoms (facial weakness), vertigo, dizziness, balance problems
5) Exacerbating or relieving factors
6) Functional impact

Examine: ENT, if pulsatile also examine CVS

Question 10

Name 3 positive and 3 negative symptoms of schizophrenia?

Answer 10

Positive: Delusions, hallucinations, thought disorder, lack of insight
Negative: Self neglect, withdrawal, emotional flattening, low motivation

Question 11

Name 5 alarm symptoms for dyspepsia?

Answer 11

Dysphagia
Bleeding
Recurrent vomiting
Unintentional weight loss

Question 12

What are the 3 N’s of back pain?

Answer 12

Nasty causes - red flags
> Cancer
> Abcess/ osteomyelitis/ fracture
> CES/ cord compression
(Bilateral sciatica a red flag)

Nerve compression syx
- Sciatica (no objective neurology)

Non-specific

Question 13

What are the TUNA FISH red flags for back pain?

Answer 13

Trauma
Unexplained weight loss
Neurological syx
Age <20 or >55ys

Fever
Inflammatory pain/ IVDU
Steroid use
Hx of cancer