Key Hx/PEx

Question 1

LoC — Hx:

Answer 1

1. Preceding symptoms (nausea, diaphoresis, palpitations, pallor, lightheadedness).
2. Context ==> Exertional—postural—traumatic—stressful—painful—claustrophobic experience—dehydration.
3. Associated tongue biting—incontinence—tonic-clonic movements—prolonged confusion—dyspnea or pulmonary embolism risk factors.
4. H/o heart disease—arrhythmia—HTN—DM—alcohol or drug use.

Question 2

LoC — PEx:

Answer 2

1. VS + orthostatics.
2. Complete neuro.
3. Carotid and cardiac exam.
4. Lung exam.
5. Exam of the lower extremities.

Question 3

Numbness/weakness — Hx:

Answer 3

1. Distribution ==> unilateral—bilateral—proximal—distal.
2. Duration—progression.
3. Pain (especially headache, neck or back pain).
4. Constitutional Sx.
5. Other neuro sx.
6. H/o DM—alcoholism—Atherosclerotic vascular disease.

Question 4

Numbness/weakness — PEx:

Answer 4

1. VS.
2. Neurologic and musculoskeletal exams.
3. Relevant vascular exam.

Question 5

Fatigue and sleepiness — Hx:

Answer 5

1. Sleep hygiene.
2. Snoring.
3. Waking up choking/gasping.
4. Witnessed apnea.
5. Overexertion—stress—depression—other emotional problems.
6. Lifestyle changes—shift changes at work.
7. Diet and weight changes.
8. Other constitutional symptoms—symptoms of thyroid disease.
9. Hx of bleeding or anemia.
10. Medications—alcohol—caffeine—drug use.

Question 6

Fatigue and sleepiness — PEx:

Answer 6

1. ENT exam ==> conjunctival pallor, oropharynx/palate, lymphadenopathy, thyroid exam.
2. Heart, lung, abdominal, neurologic, and extremity (pallor, coolness at distal extremities).
3. Consider rectal exam and occult blood testing.

Question 7

Night sweats — Hx:

Answer 7

1. Patterns ==> escalating—waxing—waning.
2. Precipitants ==> food—medications.

3.