history taking Flashcards
what should you ask in a patient who presents with LOC
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?
sensation of an oesophageal or tracheal obstruction?
globus
inspirational noise due to airway obstruction around the larynx
stridor
inspiratory noise due to airway obstruction in the pharynx
stertor
painful swallowing
odynophagia
difficulty swallowing
dysphagia
lump in throat sensation
globus
progressive dysphagia indicative of
stricture beign or malignant
intermittent dysphagia is most likely to be
motility disorder
coughing after eating?
coordination disorder like parkinson’s
bad breath?
zenkers diverticulum
how does asking about the timing of the onset of for shortness of breather influence your differential?
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)
how about asking about what makes the SOB worse?
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.
what are the risk factors to ask about in SOB
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.
cough tells you?
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
pleuritic chest pain definition
sudden sharp stabbing burning pain associated with expiration or inspiration this is due to irritation of the parietal pleura
suggestive of pneumonia, PE, pneumothorax
when you are trying to screen for cancer symptoms what would you ask?
recent unexplained weight loss, night sweats, loss of appetite
red flags for back pain immediate referral
sphincter problems
patient unable to self-care or walk
red flags back pain referral within a week
weight loss fever back tenderness to palpation thoracic spinal pain trauma
red flag back pain see as soon as possible
age less than 20 or greater than 50
severe morning stiffness
structural deformity
nerve root pain not resolving.
