PCP1 Hx Flashcards
Time course Q’s
Onset/offset- sudden or slow
Duration- how long the pain lasts
Temporal profile- is it a constant pain, is it getting worse or does it come and go?
Previous episodes
Questions to ask for Hx of palpitations
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
Questions to ask for Hx of syncope
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?
Questions to ask for Hx of chest pain
Site/Quality Dull, pressure, squeeze, crushing. Sharp suggests pain to pleura.
Radiation.
Timecourse. Duration How long did episode last? >15-20 mins suggests irreversible myocardial necrosis
- Onset Did it come on quickly?
- Offset Did/how did it get better?
- Frequency How many episodes?
Severity. Are the episodes getting worse, more often or lasting longer?
Context. Exercise, physical activity
Aggravating. Exercise
Relieving. Nitroglycerine. Rest.
Associated. SOB, nausea, diaphoresis, sweating
MHx. HT, DM, cholesterol, smoking
Questions to ask for Hx of oedema
S Where? Which side or both?
QS 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.
Questions to ask for Hx of dyspnoea
SQ 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.
Questions to ask for Hx of previous asthma
SQ 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
Questions to ask for Hx of current episode of asthma
SQ 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?
How to perform peak expiratory flow rate
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
Questions to ask for Hx of smoking
SQ 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? Aeroplane 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?
Questions to ask for Hx of vomiting
SQ 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, Diarrhoea. Recent illness. Dizziness. Vertigo. Head spinning. Headache. Thirsty. Weight loss.
R any meds? Metoclopramide = maxolon. Prochlorpremazine = stemetil.
MHx Any medications Any chance you could be pregnant
Questions to ask for Hx of dysphagia
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 CA Loss of weight. Fatigue. Cough. Choke. Nasal regurgitation. Pain.
R Mashed up foods?
AMHx. Stroke. Parkinson’s disease.
Questions to ask for Hx of diarrhoea
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
Questions to ask for Hx of EtOH
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?
CAGE
Cut down
Annoyed
Guilt
Eye-opener
Questions to ask for Hx of rectal bleeding
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
Questions to ask for Hx of constipation
S Q Straining?
S T How often do you usually use your bowels?
D O O F SC 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 SHxMHxFHx Bowel cancer?
What are 4 important things to ask about when taking a syncope history?
Before. What were you doing before it happened? Did you noticing anything else just before it happened?
During. How long were you unconscious for? Did anyone see it happen…what did they say?
After. How long did it take you to recover? How did you feel afterwards?
PMHx previous episodes? Heart problems?
Using the cardinal features, what particular features are you looking for in the following with respect to diarrhoea?Quality:Severity: Time course: Context:Associated features:
Quality: mucous, blood, waterynessSeverity: frequency and volumeTime course: Ask how long it’s been; establish acute (days) or chronic (4+ weeks) and progress of the disease; is it getting worse or better?Context: food, travel, contactsAssociated features: fever, nasuea, vomiting, weight loss, affected contacts
Important associated features for jaundice?
4 P’s Pale poo, dark pee, pruritus (itchy) and pain.
Associated symptoms: weight loss, medication (rifampicin), alcohol consumption, recent travel, immunisations, IV drug use/tattoos, unprotected intercourse, contacts
Family hx questions for jaundice?
Sickle cell anaemia
Questions to ask in cases of suspected ischaemic chest pain?
Risk factors for coronary artery disease:
smoking, high BP, high cholesterol (hyperlipemia) diabetes, physical inactivity, poor diet and family hx.
What is the different prodromes present in TLOC (syncope vs seizures)?
- Cardiac syncope- absent
- Vasovagal- light headed, wobbly legs, vision going dim, noises becoming distant
- Seizure- aura, hallucinations
Precipitating factors in TLOC?
Vasovagal- fasting, pain, emotional events, prolonged standing
Cardiac- can occur on exertion? Palpitations
Seizure- spontaneous but also triggered by sleep deprivation or stress
Different time courses in TLOC?
Vasovagal & Cardiac- <30 secs
Seizure- 1-2 mins
