PCP Hx

Question 1

Questions to ask for Hx of palpitations

Answer 1

Site.

Quality. Regular or irregular. Can you tap it out? Does it feel forceful? Does it flutter? Does it skip a beat?

Severity. How fast does it beat? Is it faster than when you exercise?

Time. Does it come on suddenly? Does it go away suddenly? How long does it last?

Context.

Aggravating. Coffee, exercise, stress

Relieving. Deep breathing? Holding your breath?

Associated. SOB, chest pain, fatigue, dizziness, blackouts

MHx. IHD

SHx. Smoking. EtOH

Question 2

Questions to ask for Hx of syncope

Answer 2

Before. What were you doing when it happened? Was there any warning?
During. Did anyone witness it? What did they say? How long were you unconscious for?
After. How long did it take you to recover? Did you make a complete recovery?
MHx. Has this ever happened before? Any CVS Hx?

Question 3

Questions to ask for Hx of chest pain

Answer 3

S
Q Dull, pressure, squeeze, crushing.  Sharp suggests pain to pleura.  Radiation.
S 
T
	D How long did episode last? >15-20 mins suggests irreversible myocardial necrosis
	O Did it come on quickly?
	O Did/how did it get better?
	F How many episodes?
	S Are the episodes getting worse, more often or lasting longer?
C Exercise, physical activity
A Exercise
R Nitroglycerine. Rest.  
A SOB, nausea, diaphoresis, sweating
MHx HT, DM, cholesterol, smoking

Question 4

Questions to ask for Hx of oedema

Answer 4

S Where? Which side or both?
Q
S More difficult to put on shoes or socks? Functional disturbances? How far up the leg does the swelling go?
T
D
O Gradual onset? Onset over weeks suggests heart failure
O
F
S
C Swelling worse at end of day suggests heart failure. Any recent changes in medications or doses?
A Drinking more?
R Resting and elevating legs? Compression socks? Sleeping with extra pillows.
A SOB. Coughing (frothy white). Red. Hot. Painful. Dyspnoea at night? Orthopnoea.

Question 5

Questions to ask for Hx of dyspnoea

Answer 5

S
Q Is breathing shallow or heavy? Fast or slow?
S How far can you walk before you become SOB? Is it present at rest?
T
D
O Sudden or insidious onset?
O
F
S Is it episodic? Is it getting worse?
C Smoking? Recent travel? Recent operations? Seasonal? OCP? Recent infections
A Worse when lying down (suggests heart failure)? How many pillows do you sleep with?
R Meds?
A Chest pain? Wheeze? Ankle swelling? Productive or dry cough? Fever?
MHx. Smoking. Immunisation Hx.

Question 6

Questions to ask for Hx of previous asthma

Answer 6

S
Q
S How often do you need your puffer? How does your asthma affect your life?
T
D How old were you when you developed asthma?
O
O Did it go away in your teenage years?
F How often do you get an attack?
S Are attacks getting more frequent, more severe or lasting longer?
C Worse in cold weather? Smoking? Exercise? Allergies?
A as above
R Puffer? Rest?
A
MHx Atopy: eczema, hayfever, itchy skin, allergies
FHx Atopy. Asthma

Question 7

Questions to ask for Hx of current episode of asthma

Answer 7

S
Q 
S How many puffs of your med did you use?
T
	D How long did the episode last?
	O 
	O 
	F 
	S 
C What were you doing when the episode occurred?
A 
R 
A Did you lose consciousness?

Question 8

How to perform peak expiratory flow rate

Answer 8

I want to measure how hard and fast you can blow out, which will give us an idea of how your lungs are working.
Stand up.
Make sure your lips are closed around the tube and sealed tight so no air can escape.
Blow as hard and as fast as you can.
Hold the device horizontal so it’s parallel with the ground.
We will repeat it 3 times and use your best one

Question 9

Questions to ask for Hx of smoking

Answer 9

S
Q What do you smoke? Cigarettes? Roll you own? Strength? Pipe?
S How much do you smoke? How many cigarettes per day
T
D How long have you been smoking?
O
O
F
S Have you always smoked the same amount?
C Are there any triggers for your smoking? Stress? Social situations?
A
R
A Have you noticed any problems associated with your smoking? SOB, cough, premature aging, social damage, asthma?

Dependence. When do you have your first cigarette for the day? How long can you go without a cigarette? Airoplane flight? Movie?

Quitting. Have you ever tried to quit? How long did you go without a cigarette? Did you use any aids like gum, patches or medications? How many times have you tried to quit? Have you given any thought to quitting now?

Question 10

Questions to ask for Hx of vomiting

Answer 10

S
Q colour. Consistency. Contents. Smell. Blood
S amount. How many times have you vomited.
T
D When did the vomiting start?
O
O
F how often
S
C eaten anything. Recent travel. Other people sick. Any new or changes to meds.
A nausea. pain. Abdominal cramps. Bloating. Systemic infection Sxs. Diarrhoea. Recent illness. Dizziness. Vertigo. Head spinning. Headache. Thirsty. Weight loss.
R any meds? Metoclopramide = maxolon. Prochlorpremazine = stemetil.
A

MHx
Any medications
Any chance you could be pregnant

Question 11

Questions to ask for Hx of dysphagia

Answer 11

S Where does the food get stuck? Point to where it gets stuck.  
Q Does food get stuck immediately upon swallowing, or does it get stuck after you've swallowed??
S Food? Drinks?
T
	D
	O
	O
	F
	S 
C
A Loss of weight.  Fatigue.  Cough.  Choke.  Nasal regurgitation.  Pain. 
R Mashed up foods?
A

MHx. Stroke. Parkinson’s disease.

Question 12

Questions to ask for Hx of diarrhoea

Answer 12

S 
Q Describe the faeces.  Colour.  Watery. Blood.  Pus.  Mucous.  Smell
S How much? More than usual?
T 
	D When did it start?
	O 
	O 
	F Every day? How many times per day?
	S  
C Change in diet? Camping.  Water source.  Med changes.  Infectious contacts.  
A Certain foods?
R Immodium.  
A Flatulence.  Dry mouth.  Thirsty.  Nausea.  Fever.  Vomiting.  Cramps.  Abdo pain.  Weight loss. 

MHx. Diet

Question 13

Questions to ask for Hx of EtOH

Answer 13

S 
Q What do you drink? 
S How much?  How often?  How many alcohol-free days per week?  How many times per week would you have 4 or more drinks?
T 
	D When did you start drinking?
	O 
	O 
	F 
	S Have you always drunk the same amount?
C Social? Stress?  Boredom?
A 
R 
A 

Dependence Have you ever needed a drink first thing in the morning? Do you drink alone? Has your drinking caused any difficulties for you? Drink-driving? Trouble with police? Injured yourself or others? Have you ever thought you should cut down? Have people expressed concern about your drinking? Have you ever felt guilty about your drinking?
Quit Have you ever tried to cut back or stop drinking? Did you use any quitting aids? How long did you last for? Do you want to cut down or stop drinking now?

Question 14

Questions to ask for Hx of rectal bleeding

Answer 14

S 
Q What colour is the blood?  Is it mixed in the faeces or separate?
S How much blood?  Tea-spoon vs cup?
T 
	D 
	O 
	O 
	F 
	S 
C Trauma?  Change in diet?
A Pain on defecation?  Change in bowel habits?  Abdominal pain?  Weight loss?  Loss of appetite?  Haemorrhoids? 
R 
A 

SHx Smoke?

MHx Bowel cancer, Crohn’s disease, ulcerative colitis,

FHx Bowel cancer

Question 15

Questions to ask for Hx of constipation

Answer 15

S 
Q Straining?  
S 
T How often do you usually use your bowels?  
	D
	O
	O
	F
	S
C  What is your diet like?  Change in diet?  Drink water?  Medications and recent changes?  Codeine?  Are you an active person?   
A Blood in stools?  Loss of weight?  Loss of appetite?  
R 
A 

SHx

MHx

FHx Bowel cancer?