history taking

Question 1

what should you ask in a patient who presents with LOC

Answer 1

before was there a warning? 
did anything bring it on?
did you hit your head? 
during did you bite your tongue? 
how long were you unconscious for?
after
how long did it take you to come around? where you groggy or confused after the fall?

Question 2

sensation of an oesophageal or tracheal obstruction?

Answer 2

globus

Question 3

inspirational noise due to airway obstruction around the larynx

Answer 3

stridor

Question 4

inspiratory noise due to airway obstruction in the pharynx

Answer 4

stertor

Question 5

painful swallowing

Answer 5

odynophagia

Question 6

difficulty swallowing

Answer 6

dysphagia

Question 7

lump in throat sensation

Answer 7

globus

Question 8

progressive dysphagia indicative of

Answer 8

stricture beign or malignant

Question 9

intermittent dysphagia is most likely to be

Answer 9

motility disorder

Question 10

coughing after eating?

Answer 10

coordination disorder like parkinson’s

Question 11

bad breath?

Answer 11

zenkers diverticulum

Question 12

how does asking about the timing of the onset of for shortness of breather influence your differential?

Answer 12

acute: is more likely to be a vascular or mechanical origin

whereas is if it is weeks to months it could be organ failure or cancer. (lung ca or pulmonary fibrosis)

Question 13

how about asking about what makes the SOB worse?

Answer 13

most SOB will be worse on exertion
but may be worse on lying flat (heart failure and pulmonary oedema)
asthma is seasonal or only occurring in certain areas with a trigger (dusty moldy)
will have diurnal variation or can be exercise induced.

Question 14

what are the risk factors to ask about in SOB

Answer 14

smoking this increases the risk of COPD, lung CA,
pets= asthma trigger if allergic to dander
occupational history
medications- hypersensitivity pneumonitis (type of interstitial lung disease) nitrofurantoin, amiodarone, methotrexate, bleomyocin
past medical history if they autoimmune conditions RA and SLe can cause interstitial lung disease.

Question 15

cough tells you?

Answer 15

persistant productive cough- pneumonia
if it is for three months it suggests- chronic bronchitis
dry cough present at bedtime- asthma, LV failure
bloodstained sputum= PE, lung CA, cavitationing pneumonia
bovine cough- lung CA

Question 16

pleuritic chest pain definition

Answer 16

sudden sharp stabbing burning pain associated with expiration or inspiration this is due to irritation of the parietal pleura
suggestive of pneumonia, PE, pneumothorax

Question 17

when you are trying to screen for cancer symptoms what would you ask?

Answer 17

recent unexplained weight loss, night sweats, loss of appetite

Question 18

red flags for back pain immediate referral

Answer 18

sphincter problems

patient unable to self-care or walk

Question 19

red flags back pain referral within a week

Answer 19

weight loss
fever
back tenderness to palpation
thoracic spinal pain
trauma

Question 20

red flag back pain see as soon as possible

Answer 20

age less than 20 or greater than 50
severe morning stiffness
structural deformity
nerve root pain not resolving.