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YEAR 6 > HPC qs based on presentation > Flashcards

HPC qs based on presentation Flashcards

1
Q

Intermittent claudication

A
  • Quantify distance before pain and pain gets better on rest
  • Rest pain and better if foot out of bed
  • Ask about skin changes to the foot & shin (ulcers that don’t heal or hair loss or change in colour or red tender nodules (thromboangitis oblierans)
  • Ask about changes to sensation to the foot
  • Ask about ED and bum pain
  • Rule out neurological cause (ask about pain getting better when you lean forward)
  • Ask about angina & palpitations
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2
Q

Haematuria

A

• Quantify: amount, thick blood or discoloured urine, anaemia sx
Any general abdominal pain
•FUNDHIPS + Frothy urine
•Recent cold + HAEMOPTYSIS?
•Oliguria
•Trauma -> catheter, car accident
•Hope it isn’t cancer -> FLAWS and recurrent UTIs

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3
Q

Weight gain

A
  • Tired? Constipated? Appetite? Cold intolerance? Depression? Hypothyroid
  • Irregular periods? Bruise easily? Weight gain in specific areas? Proximal weakness? Hirsuitism if female? Cushings
  • Swelling of legs? Worse at end of day, better with rest? Ask about other end organ damage e.g. eye sight Nausea? Reduced Appetite? Kidney
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4
Q

Fatigue

A

TODDL E R (RBC)
•Low mood? Low energy? (Depression rule out)
•Appetite? Weight? Cold intolerance? (Rules out Hypothyroidism)
•Pallor? SOB? Diet? (Rules out IDA)
•Sleeping well, no snoring (Rules out OSA)
•No diabetes symptoms
•Aches and pains in joints? New rashes? (SLE , CTD e.g. APS)
o SLE Malar rash – painful pruritic rash lasting a few days, can recur with sun exposure
o Further questions: ulcers, raynauds, renal, CNS signs (seizure, depression and CN abnormalities e.g. visual defects), cardio/pulmonary manifestations
•Fever, weight loss, night sweats, lymph nodes (Malignancy / SLE)
•Visual symptoms, tinnitus, headaches, itching

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5
Q

Dizziness

A

•Characterises the dizziness: person spinning or room spinning, duration, frequency
Associated symptoms:
o N&V
o Hearing Loss or tinnitus or aural fullness or ear pain
o CN palsy – facial weakness
o Loss of balance – cerebellar dysfunction
o LoC
o Palpitations, syncope, SOB - arrthymia
•Any previous trauma
•Triggers -> alcohol, foods, positioning

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6
Q

Unprotected sex

A 
Consensual? Barrier/pregnancy?
STI questions: discharge, pain
Hep questions
HIV questions:
SOB, productive cough, fevers, weight loss, malaise, rash, sore throat, diarrhoea, lymphadenopathy, maculopapular rash
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7
Q

RUQ pain

A 
SOCRATES
N&V 
Stool and urine
Fevers and rigors ?confusion
SOB (R lower lobe pneumonia)
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8
Q

Dysphagia ddx

A

•Inflammatory = tonsillitis, gastritis, oral candidiasis
• Motility = achalasia, spasm, neurological e.g. CVA/MND, CREST
• Mechanical:
o Luminal – food bolus
o Mural – Benign stricture, malignant stricture, pharyngeal pouch.
o Extra-mural – lung Ca, goitre, aortic aneurysm, hiatus hernia, LN’s.

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9
Q

PR bleed

A

PR bleed questions: Constipation, vomiting + infective contacts, IBD, malignancy
• Type of blood, mixed in, how long, happened before, frequency
• SOB or pallor (IDA)
• Vomiting or nausea, abroad, infective contacts (gastroenteritis)
• Blood on toilet paper, bleeding on defection, constipation (fissure if painful, haemorrhoids if not)
• Diarrhoea, mucous, ulcers, fatigue, weight loss, fever, (IBD)
oskin changes or joint pains
•Fatigue, night sweats weight loss, change in bowel habit, tenesmus (Malignancy, polyp) Faecal incontinence? Burning/itching sensation around the anus (rectal cancer)

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10
Q

Increased frequency

A
  • FLAWS
  • FUNDHIPS + incomplete voiding
  • Diabetic q: Polyuria, polydipsia
  • SIADH: No head trauma or recent surgeries
  • UTI questions: smelly urine, burning, STI
  • Pyelonephritis: fever, rigors
  • Urinary history: Previous hospitalisation requiring catheter, urethral surgery
  • Sexual dysfunction present
  • Other ddx: Knee pain (reactive arthritis), ulcers (reactive, behcets)
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11
Q

Back pain red flags

A

o Cauda equina: urinary retention/incontinence, faecal incontinence, bilateral leg pain, weakness in legs, severe/progressive neurological deficit, decreased anal tone, saddle parasthesia
o Cancer: age <16 or >55 years at onset, cancer history, weight loss, fever, night sweats, pain that is still present when lying down, pain that wakes you up in the middle of night,
o Infection: injecting drugs, immunosuppression, fever, recent chest infection or UTI
o Fracture: trauma, relieved by lying down, sudden onset, central spinal pain
o Spondyloarthropathy: early morning stiffness, night pain, worse with rest

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12
Q

Back pain qs

A

Does the pain change with your posture? (Y= neurogenic)
Disc herniation:
o Better with standing, worse with sitting
o Symptoms worse on coughing
o Lower back pain
Leg weakness? Tingling/numbness in legs? CE
Pain radiating down legs can be both CE and disc herniation

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13
Q

Pre Op history

A 
•	Determine journey (PC -> today)
•	Determine investigations done already 
•	Determine what the patient has been told and what they would like to know 
•	Systems review
•	Check list: Dallas buyers club
o	Determine previous anaesthetic procedures  LA/GA, complications
o	Allergies 
o	Loose teeth /caps 
o	Last time eat /drank (fasting intentions)
o	Alcohol intake (risk of withdrawal)
o	Systems Review
o	Baby chance? Pregnancy
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14
Q

Stoma indications

A

• Feeding, + breathing e.g. feeding gastrostomy/Jejunostomy
• Lavage, e.g. appendicostomy
• Decompression-bypass of an 
obstructive lesion distal to the 
stoma
• Diversion:
Protection of a distal bowel anastomosis in a previously contaminated peritoneal cavity or for anatomical considerations- ileorectal anastamosis
Urinary diversion following cystectomy
• Exteriorisation
Permanent stoma, e.g. AP resection or rectum or
Perforated/contaminated bowel, e.g. distal abscess/fistula

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15
Q

Dyspepsia questions

A
  • N&V
  • Positioning
  • Early satiety
  • DHx: NSAIDs, steroids, PPI
  • FLAWS
  • GORD – metallic taste, burning pain, positioning /sx worse when flat
  • Regurgitation
  • UGI Cancer - Voice hoarseness
  • Lower GI sx – meleana, tenesmus
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16
Q

Dysphagia

A

• Intraluminal: Foreign body or Poylpoid tumour
• Intramural: Benign stricture (GORD/radiotherapy), Malignancy, Achalasia,
o Oesophagitis
o Oesophageal spasm – corkscrew ba swallow
o Scleroderma
o Pharyngeal pouch
o Plummer-Vinson web – IDA
o Achalasia (failure of lower of oesophageal sphincter relaxation) – bird beak
• Extra-mural: Lymph nodes, Rolling hiatus hernia, Retrosternal goitre
o Bronchial carcinoma
o Thoracic aortic aneurysm
o Enlarged left atrium
• Neurological: Myasthenia gravis, Stroke/TIAs, Bulbar/Pseudobulbar palsy
o Syringobulbia
o Parkinson’s
o Bulbar polio

17
Q

Neck lump

A

Neck Lump questions to ask:
• Clarifies location of mass (patient thinks it’s on the her right side of her neck)
• Onset of mass - 7 days (inflammatory), 7 months (malignancy) , 7 years (benign)
• Recent trauma

Inflammatory qs
• Infectious symptoms – nausea/vomiting, fever, diarrhea (thyroiditis post URTI)
• Tenderness

Malignancy qs:
• Progression in size
• Pain
• Dysphagia & Odynophagia
• Change in voice
• Systemic symptoms – weight loss, night sweats, anorexia
• Exposure to head and neck irradiation
• Exposure to tobacco, smoking, alcohol, and betel nuts
• Asks patient about ethnic origin (South East Asia)
• Hearing loss or ear pain

Thyroid qs:
• Symptoms suggestive of hyperthyroidism
• Symptoms suggestive of hypothyroidism
• Thyroidtoxicosis screen – palpitations – plummer’s

Other differentials:
Halitosis?
Gargle noise?

18
Q

Jaundice

A

oHep: Abroad recently, IVDU, unprotected sex, blood transfusiosn
oObstructive jaundice? Pruruitis, dark urine, pale stools
oFever?
oPancreatitis – ask about alcohol history, gall stones, pain radiates to back or getting better when leaning forwards
oBiliary colic – pain with fatty meals, pain radiates to shoulder
o Chronic liver disease – abdominal swelling, ankle oedema
o Drugs – Any recent penicillins, sulphonamides, rifampicin, radiocontrast
o Recent blood transfusions
o Fatigue? Primary Biliary Cirrhosis? AI disease history?

Malignancy questions + Mets Screen (thrombophlebitis migrans- trousseau sign)
PUD?

19
Q

Epigastric pain

A 
•	Pancreatitis
o	Does pain radiate to the back? 
o	Relieved by sitting forward?
o	Vomiting?
•	PUD 
o	Made better by food? Duodenal  (better initially then worse a few hours later)
o	Made worse by food?
o	Any conditions requiring NSAIDs? H Pylori?
o	Haematemsis 
•	GORD
o	Weird taste in mouth
o	Indigestion
o	Burn
o	Worse when lying down

YEAR 6 (11 decks)

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