History Taking (F2 23/11)

Question 1

What are the steps in a cardiovascular interview?

Answer 1

1. Introduction:

• Wash hands
• Introduce yourself
• Patient name and DOB
• Explain purpose and gain consent
• Reposition patient

2. Presenting Complaint: What can I do for you today? Give them a golden minute to talk, without interrupting.
3. SOCRATES:

• Site: where is the pain?
• Onset: when did you first get pain?
• Character: what does the pain feel like, throbbing, dull, burning, intermittent.
• Radiation: does this pain spread?
• Associated syptoms: eg. vomitting
• Time: how long had it, how long dies an episode last?
• Exacerbating/ Relieving factors: exercise, rest
• Severity: on a scale of 1 to 10, with one being no pain, and 10 the worst pain imaginable, how severe is the pain?

4. Systematic Review: E.G. cardio-vascular review.

• Ask them whether they have the four cardinal signs of cardio-vascular diseas (SOAPS).
• Risk factors: hypertension, smoking, diabetes and family history).

5. Past Medical History:

• Ask if have pre-existing conditions (DEATH)
• Rule out sytemic syptoms (fever, weight loss, loss of apetite and fatigue).
• Been to hospital: emergency or surgery
• On any medications: contraceptive pill, ST Johns Wort?
• Allergies?

6. Family History:

• Any conditions that run in family, that their parents or siblings have.
• Ask about parents: if past away ask COD and age.

7. Social History:

• Smoking: smokes per day
• Drinking: glasses/ pints per week
• Recreational Drugs
• Typical diet per day
• Exercise per day
• Concerns about job

8. ICE

• Ideas: ‘What do you think might be happening?’
• Concens: ‘Is there anything particular or specific that you were concerned about?’
• Expectations: ‘What were you hoping we might be able to do for this?’

Question 2

What are the five cardinal signs of cardiovascular disease?

Answer 2

1. Shortness of breath
2. Oedema in ankles
3. Angina
4. Palpitations
5. Syncope

Question 3

What pre-conditioning conditions do patients always forget to tell you they have?

Answer 3

• Diabetes
• Eczema
• Asthma
• Thyroid
• Hypertension

Question 4

What systemic syptoms must you always ask all patients about, to check they don’t have cancer?

Answer 4

• Weight loss
• Fatigue
• Loss of apetite
• Fever