History Reviews

Question 1

General Questions

Answer 1

Fever, Weight change, Tiredness, Loss of appetite, night sweats, SOB, urine/bowels, recent infections

Question 2

Cardiac

Answer 2

Chest pain, SOB, Palpitations, Orthopnoea, PND, Ankle swelling, Calf pain/swelling/tenderness, syncope

Question 3

Respiratory

Answer 3

Cough, sputum (blood), SOB, Fever, Night sweats, calf swelling, chest pain, Wheeze

Question 4

GI

Answer 4

Change in appetite, Problems swallowing, Indigestion/acid reflux, Bowel habit change, diahorroea/constipation, blood in poo, nausea, vomiting, haematemesis, pain, jaundice

Question 5

Neuro

Answer 5

Headaches, Visual disturbances/ hearing/ speech, dizziness, faints/fits, weakness/numbness, sleep, tremors, concentration, N+V

Question 6

GU

Answer 6

Incontinence, frequency/dysuria/nocturia, hesitancy/dribbling, change in quanitiy/colour, blood in urine, genital rashes/lumps, menstrual cycle/pregnancy

Question 7

Endocrine

Answer 7

Heat or cold intolerance, sweating, fatigue, tremor, neck swelling, gain weight or loss, polydipsia/polyuria

Question 8

Skin

Answer 8

Itch, rash, bruising, swellings/lumps, pigmentation changes,

Question 9

Haem

Answer 9

Easy bruising, bleed excessively, lumps in axilla, neck groin, previous thromboses/PE, fever, night sweats, weight loss

Question 10

MSK

Answer 10

Joint pain, stiffness, swelling, dry mouth, sore eyes, skin rash, back or neck pain, sweating, fever, autoimmune conditions

Question 11

Mental Health

Answer 11

Anxiety, preocupations, mood, self harm, suicidal thoughts, unusual beliefs, delusions, hallucinations, memory problems/cognitive impairments, learning difficulties

Question 12

Thyroid

Answer 12

Change in weight, appetite, voice change, bowel habit, energy level, mood, concentration, heat intolerance, change skin, hair, nails, change heart rate/rhythm, menstrual cycle

Question 13

INR/ Warfarin

Answer 13

Recent infections, diahorroea/vomiting, blood in stool, headache, stomach ache, increased bruising, prolonged bleeding- cuts, menstrual bleeding, gums, haematuria, weakness, loss sensation, visual changes, speech changes, pain, swelling in leg, redness, heat, SOB, chest pain

Question 14

HbA1c

Answer 14

Recent infections/illnesses, D+V(insulin requirement change, DKA/hypo, polyuria, polydipsia, weight loss, vision changes, tingling in feet, impotence

Question 15

Peak flow/Spirometery

Answer 15

Recent illnesses/infections, SOB, exacerbating factors, wheeze, ADL effect, PND, cough, inhaler frequency

Question 16

CRP

Answer 16

Inflammation- flare up in condition or infection

Rheumatology (RA, ankylosing spondylitis, reactive arthritis, psoriatic arthritis), Crohn’s, pancreatitis, vasculitis
Infective endocarditis, post op infection. SLE vs RA. Crohn’s vs UC.
Burns, trauma, infections (pneumonia/TB), MI, IBD, cancers

Ask all questions

Question 17

ESR

Answer 17

ESR a test which see how fast your RBCs settle in a tube

Malignancy- lymphoma, colon, breast, MM.
Haem- anaemia
Connective tissue- SLE, RA, polymyalgia rheumatica/temporal arteritis
Infection- TB, acute hepatitis, bacterial

Question 18

Albumin

Answer 18

Low- malnutrition (crohn’s, UC, coeliac), Kidney, liver (hepatitis, cirrhosis)
High- hepatitis, infections, chronic inflammatory diseases

Question 19

Liver enzymes

Answer 19

Alcohol excess, obesity, smoking, drug reaction

Question 20

ALP

Answer 20

Bile duct obstruction- obstructive liver disease, it D deficiency

Question 21

AST/ALT

Answer 21

Liver disease- drugs, toxins, viral

Question 22

GGT

Answer 22

Liver disease- drugs/alcohol

Question 23

Diabetes Risk

Answer 23

0-6 Low, 7-15 Increased, 16-24 Moderate, 25-47 High risk

Age, Male, Ethnicity, Relative with diabetes, wait measurement, BMI, HTN

Symptoms- Polyuria, polydipsia, fatigue, thrush (genital itching), weight loss

Advice- weight loss, exercise, diet- regular meals, portion size, sugar, fat, salt, alcohol

Question 24

QRISK3

Answer 24

Heart attack next 10 years risk

<10% Low Risk 10-20% Moderate risk >20% High risk

Age, Sex, Ethnicity, BMI, PMH (CARD)- CKD, AF, Rheumatoid Arthritis, Diabetes, antihypertensives, angina/MI in family under 60, smoking, cholesterol, BP

Cardiovascular and respiratory symptoms

<10%- Low risk but lifestyle advice- smoking, diet, exercise/weight loss, medication adherence

Question 25

CHA2DS2VaSc

Answer 25

Stroke in AF risk 0- No anticoag 1-consider anticoag 2+- give anticoag Congestive heart failure, HTN, Age, Diabetes, Stroke/TIA, vascular disease, female Check risk for bleeding, stroke like INR, clotting Lifestyle- alcohol, smoking, diet, exercise, warfarin/DOAC advice

Question 26

FRAX

Answer 26

Spine, hip, shoulder, risk fracture in next 10 years <10%- low 10-20%- moderate >20%- high. Low reassess in 5 years. Moderate- DEXA scan for BMD- if low treat with bisphosphonate- alendronate, denosumab. High- DEXA- ok reassess in 2 years, below-2.5 tx Age, Sex, Weight, Height, rheumatoid arthritis, previous fractures, secondary osteoporosis conditions- kidney failure, hyperthyroidism, coeliac disease, T1DM, chronic liver disease, lithium or glucocorticoids, parental fractured hip, smoking, alcohol intake Regular weight bearing exercise, diet high in calcium leafy green veg, if you struggle can give calcium supplements

Question 27

ABCD2

Answer 27

Risk of stroke after TIA Up to 3 see within 7 days, 4 or 5 see within 24 hours, 6 or 7 see immediately Age, BP, Unilateral weakness/speech without weakness, duration- 10-60 or 60+, Diabetes TIA- how long did it last, what happened- neuro/stroke q's, any other TIAs, other clotting questions, systemic questions TIA treatment- Lifestyle- diet, exercise, smoking Antithrombotic treatment- aspirin immediatley them clopidogrel Secondary- Control HTN, statin Don't drive for 1 month

Question 28

Wells’ score

Answer 28

Risk of DVT 0- Unlikely, 1,2- Moderate risk, >3 DVT likely Recent immobilisation, tenderness along deep venous system, entire leg swollen, calf swelling >3cm compared to other leg, pitting oedema only on one leg, bedridden/surgery, active cancer, previous DVT, alternate Dx more or as likely Ask clotting questions, SOB, cardio D-dimer, USS doppler, CTPA if SOB LMWH, oral warfarin/DOAC INR 2-3, compression stockings, treat/seek cause, diet, exercise, smoking cessation

Question 29

Detailed Drug History

Answer 29

“Do you know how many times you are meant to be taking ….?” “How and when do you take it’’ “Have you missed any doses-if so, did you double the dose?’’ “Are you struggling with your current medication regime or is it okay?’’ “Any other/new medications – including over the counter