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Long case clinical skills > Long case general history > Flashcards

Long case general history Flashcards

1
Q

Social history

A
  1. Relationship, family children, pets
  2. Occupational history, past-time
  3. Driving, GP, access
  4. Independence, home modifications, ACAS
  5. Community/associations/faith
  6. Anxiety/depression
  7. Sleep/nutrition
  8. Perspective/insight/problem
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2
Q

Medical history - Cardiac

A

Symptoms - reduced exercise tolerance, palpitations. orthopnoea, paroxysmal noctural dyspnoea, cough

i. Coronary artery disease– MI, valve disease, pericarditis; HTN, dyslipidaemia, T2DM, family history, bypass grafts, angiograms
ii. Heart failure - echocardiograms; cardiac devices/pacing
iii. Arrhythmias- AF, SVT, VT, cardioversions, arrests
iv. Pericardial disease and valves

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3
Q

Medical history - Lung

A

Exercise tolerance, cough

i. Obstructive airways - asthma, COPD, bronchiectasis childhood infections – pertussis, smoking, cystic fibrosis CT chests, spirometry prior intubations
ii. Pulmonary hypertension - right heart catheterisation
iii. pleural disease - pneumothorax, effusions, empyema, resections
iv. interstitial lung disease, occupational exposure – silica, coal, dust, hay, birds, fumes/gases
v. sleep apnoea

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4
Q

Medical history - gastrointestinal

A

Heartburn, reflux, Abdominal pain, nausea/vomiting, diarrhoea, difficulty swallowing, dysphasia, constipation

i. Liver – etOH, hepatitis, ascites, pancreatitis
ii. Upper GI – peptic ulcer disease, GORD, gall bladder issues
iii. Lower GI - diarrhoea FI, colonscopies/gastroscopies, GI masses, coeliac disease

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5
Q

Medical history -renal

A

CKD -T2DM, HTN,

proteinuria – protein in urine, haematuria – dark urine

renal calculi, prostatitis, cysts

i. Dialysis – fluid management – fluid restriction,

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6
Q

Medical history - Infectious disease - systemic symptoms

A

loss of weight, loss of appetite, sweats, chills, rigors, myalgias, malaise

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7
Q

Medical history- Infectious disease - location of disease

A

cough/coryzal symptoms

meningism

joint pain

lower urinary tract symptoms

obstructive outflow symptoms

back pain

Abdomina RUQ pain

rashes

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8
Q

Medical history - Infectious disease - endogenous risk factors

A

lines

joint prostheses

cardiac prostheses/valve replacements

spinal fusions

vertebral fractures

recent surgery/dental extraction

renal calculi

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9
Q

Medical history - rheumatology

A

i. SLE/RA /scleroderma/vasculitis/PsA;
ii. OA gout reactive arthritis
iv. Function - Joint aspirates and injections, joint and tendon surgery and replacement, mobility and function, disease activity
v. associated lung/heart/GI/renal and neurological sequellae, serology

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10
Q

Medical history - oncology

A

i. Oncology previous cancer in family or patient, previous CTx/RTx surgeries, ii. Haematology -blood clots, bleeding disorders, previous bone marrow trephines, lymph node dissections; anaemia FI

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11
Q

Medical history - Endocrinology - bone and thyroid

A

i. Bone and thyroid- previous osteoporosis, fragility fractures, bisphosphonate

thyroid issues, previous parathyroid surgeries, pituitary syndromes, pituitary surgery, hypogonadism

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12
Q

Medical history - endocrine - metabolism

A

T2DM/T1DM insulin, hypoglycaemic issues,

microvascular disease (nephropathy, neuroapthy, retinopathy, gastroparesis, orthostatic hypotension, urinary overflow, erectile dysfunction)

macrovascular disease (stroke, PVD, IHD)

OSA, gastric bypass surgery, B12/thiamine deficiencies

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13
Q

Medical history - neurology -CNS

A

i. Neurology CNS – stroke, thrombolysis, rehab, residual deficit; migraines, epilepsy, neurosurgery – clips/coils

tumours

multiple sclerosis

cerebellopontine angle tumour

meningitis/encephalitis prior

syringomyelia

hydrocephalus

spinal cord impingement – cervical myelopathy

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14
Q

Medical history - neurology -PNS

A

ii. Neurology PNS – neuropathy, myopathy – disuse, drug related; mobility; parkinson’s disease, tremors, effect on daily life; carpal tunnel syndrome, nerve entrapments

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15
Q

Symptom history - chest pain

A

Cardiac MI - non MI - percarditis, valve prolapse, arrythmia Non cardiac - dissection, PE, chest wall Oesophageal

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16
Q

Symptom history - dyspnoea

A

Obstructive/restrictive lung disease - COPD/asthma/bronchiectsis, ILD, Pulmonary hypertension Angina, APO, arrhythmia - cardiac Anaemia Metabolic acidosis - lactic (sepsis, other cause shock), renal, DKA Vertebral - thoracic Muscle - MND, peripheral neuropathy, phrenic nerve palsy

17
Q

Symptom history - weightloss, fatigue, sweats etc.

A

Malignancy Chronic infection Inflammatory disease Malabsorptive - pancreatic/small intestine (coeliac, surgery) hyperglycaemia/hypoglycaemia Hypothyroidism/hyperthyroidism/panhypopit renal failure cardiorespiratory failure Sleep apnoea Depression/anxiety

18
Q

Symptom history - headache - secondary

A

Subarachnoid haemorrhage/ICH meningitis Central venous thrombosis Giant cell arteritis Acute glucoma Tumour Idiopathic intracranial hypertension

19
Q

symptom headache - primary

A

Migraines Tension headache trigeminal neuralgia cervicogenic OA Cluster headaches post coital headache

20
Q

Symptom - syncope/funny turn

A

Cardiac/vasovagal

PE

Micturition syncope

cough syncope

Orthostatic

hypotension

Seizure

TIA/stroke

cataplexy

acute hydrocephalus

21
Q

Symptoms - back pain

A

Osteomyelitis/abscess

AAA rupture

Bony metastasis

Inflammatory back pain - seronegative ank spond

Vertebral fracture Muscle spasm

Facet joint

OA

22
Q

Symptoms - diarrhoea

A

Infective -c.diff/HIV

transient bacteria/viral drug related

inflammatory cancer

malabsorptive thyroid/T2DM

carcinoid/VIPoma

23
Q

Symptoms - joint/limb pain

A

PVD - acute ischaemic limb

DVT

synovitis – septic joint, viral, gout, RA, PsA, reactive arthritis, rheumatic fever,

Scl

Tendonitis

Tendon/ligamentous injury

Neuropathy - compressive/non compressive

24
Q

Specialty history - atopy/allergy

A

childhood eczema

rhinitis

polyps

urticaria

anaphylaxis

drug allergies

RAST/skin tests

25
Q

Specialty history - geriatric

A

glasses

macular degeneration

cataracts

hearing aids

optometry

appointments and access

mobility

hearing aids

urinary incontinence

faecal incontinence

end of life issues

falls and balance

vertigo/postural dizziness

26
Q

Specialty history - HIV

A

HIV – diagnosed, CD4 count

medication history

compliance

sexual history

opportunistic infections

cancers

autoimmune disease

CVD

OP

etOH

27
Q

Specialty history - transplantation

A

Live or cadaveric

HLA matching

CMV EBV status

bone marrow (allogenic/autogenic)

liver

kidney

lung

heart pre-transplant work up

indications and contraindications

post transplant rejection

Opportunistic infection

GVHD

Veno-occlusive disease of the liver

Chronic hypothyroidism, solid organ Ca, AML, infertility, recurrence, PTSD

28
Q

Specialty history- immunosuppressives

A

prednisolone

cyclosporine

tacrolimus

mycophenylate

methotrexate

azathioprine

anti-TNF inhibitors

29
Q

specialty - immunosuppressive SEs

A

Opportunistic infections - all

Coarse tremors, gingival hypertrophy, hirustism (cyclosporine, tacro)

T2DM, HTN, dyslipidaemia (pred, tacro, cyclospo)

Bone marrow suppression, mucositis, deranged LFTs, lymphoma (mycophenylate, methotrexate, azathioprine)

Demyelination, infusion site reactions, TB, hep B,C reactivation, CCF (anti-TNF)

30
Q

Specialty -maternal

A

pregnancies

miscarriages

terminations

antepartum, peripartum, post partum complications

vaginal or caesarean births

cervical and breast cancer screening

age of menarche

31
Q

Specialty - sexual history

A

number of sexual partners

barrier protection

OCP

erectile dysfunction

libido

32
Q

Specialty - mental health

A

depression

anxiety

bipolar

schizophrenia

Suicidal ideation

Number of admits

psychiatrist

Medications currently taking

Vegetative Sx- lethargy, loss of interest and appetite, sleep disturbance, psychomotor retardation

33
Q

Specialty -etOH - AUDIT-C

A

How often do you have alcohol drink-

0 never, 1 monthly or less,

  1. 2-4 times per month,

3- 2-3 times per week,

4, 4> times How many standard drinks containing alcohol do you consume?

• 0 1 or 2, 1. 3 or 4, 2. 5 or 6, 3. 7 to 9, 4. 10 or more

How often do you have 6 or more drinks on a single occasion

• 0. Never, 1. Less than monthly, 2. Monthly, 3. Weekly, 4. Daily or almost daily

4 or more men, 3 or more woman, but if questions 2 and 3 are 0 then likely below limits to drinking

34
Q

Medical history - Rheumatology - differentiating symptoms

A

Raynauds

morning stiffness - difficulty getting out of bed

rashes- soles of feet, hands, prior psoriasis

Back pain with rest

joint pain with rest

eyes - pain, dryness, redness, visual loss

generalised loss of weight and appetite, malaise

Long case clinical skills (12 decks)

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