Semester 1 Interviews Flashcards
Time Course
Duration (of symptom, of episode?).
Onset/offset (gradual or sudden?).
Temporal profile (improving or worsening?).
Periodicity (if >1 episode, regular or irregular?)
Special Features: Palpitations
Quality: can you tap the rhythm? Quality: forceful or flutter? Quality: if missed beat, short or long? Severity: speed. Time course: >1 episodes?
Associated Features: Palpitations
Shortness of breath.
Fatigue.
Fainting/blackouts.
Chest pain.
Further History
Past medical history. Family history. Social history. Occupational history. Smoking. Alcohol. Medications. Allergies. Immunisations (if relevant).
Special Features: Syncope
Prodrome: do you remember anything before it happened?
Quality: did anyone describe what happened?
Quality: was there any warning?
Aggravating factors: if vasovagal - fasting, pain, emotion, prolonged standing.
Aggravating factors: if cardiac - usually none!
Associated Features: Syncope
Sweaty.
Pallor.
Difficulty breathing.
Chest pain.
Special Features: Claudication
Severity: walking distance before developing pain?
Note - if neuropathic, worse when standing and better when walking (less tension on sciatic nerve).
Note - if vascular, better when standing and worse when walking.
Associated Features: Claudication
Shortness of breath. Chest pain. 6 Ps: Pain. Pallor. Polar (cold). Paraesthesia. Paralysis. Pulseless.
Special Features: Chest Pain
Site: radiation.
Associated Features: Chest Pain
Sweating. Nausea. Vomiting. Shortness of breath. Fainting. Palpitations. Light-headedness.
Special Features: Oedema
Site: both limbs?
Quality: pitting or non-pitting?
Severity: level of swelling, pain?
Associated Features: Oedema
Pain in chest/abdomen/legs. Shortness of breath at rest/exertion. Orthopnoea. Fever. Weight loss.
Special Features: Dyspnoea
Quality: heavy or shallow.
Severity: how far can you walk before developing shortness of breath?
Severity: does it wake you at night?
Aggravating factors; lying down? - Ask about number of pillows used when sleeping.
Associated Features: Dyspnoea
Chest/leg pain.
Cough.
Swollen ankles.
Wheeze.
Special Features: Cough
Quality: productive?
Quality: if productive, blood?
Severity: frequency of cough.
Associated Features: Cough
Haemoptysis - but differentiate if coughing or vomiting!
Shortness of breath.
Fever.
Wheeze.
Smoking.
Cancer: weight loss, pain, night sweats, orthopnoea or paroxysmal nocturnal dyspnoea.
Differentiating between haemoptysis and haematemesis?
Ask about prodrome!
Haemoptysis - irritation in chest and desire to cough.
Haematemesis - nausea and abdominal discomfort.
Ask about colour/texture!
Haemoptysis - usually bright red and frothy.
Haematemesis - dark red and not frothy.
Special Features: Nausea/Vomiting
Quality: colour - blood or bile-stained?
Severity: how many times?
Severity: small or large amounts?
Time course: pattern?
Time course: relationship to meals, or first thing in mornings?
Context: new medication, possibility of pregnancy, contact with others with nausea/vomiting/diarrhoea, travel.
Associated Features: Nausea/Vomiting
Abdominal pain. Diarrhoea. Fever. Headache. Vertigo. Symptoms of dehydration: increased thirst, dry mouth, weakness, dizziness, palpitations, confusion, fainting. Weight loss.
Special Features: Dysphagia
Site: where does it get stuck?
Quality: difference between solids and liquids?
Associated Features: Dysphagia
Weight loss.
Cough.
Choking.
Nasal regurgitation.
Special Features: Diarrhoea (Constipation)
Quality: how does it compare to normal bowel habits?
Quality: watery, colour?
Quality: blood or mucus - HOW MUCH blood, MIXED OR NOT in stool.
Quality: difficult to flush?
Severity: frequency and volume.
Context for diarrhoea: diet, travel, contact with people with diarrhoea/vomiting, medication.
Context for constipation: diet, medication.
Associated Features: Diarrhoea (Constipation)
Diarrhoea: Nausea. Fever. Vomiting. Dehydration (thirst, changes in urine colour/amount, dizziness, fainting). Abdominal pain. Weight loss (diarrhoea AND constipation). If black/melaena - HAEMATEMESIS!
Special Features: Rectal Bleeding
Quality: change in bowel habit i.e. diarrhoea or constipation?
Quality: colour of stools.
Quality: colour of blood, amount of blood, mixed/not mixed in stool.
Quality: PAIN?
Severity: every time when using toilet?
Associated Features: Rectal Bleeding
Change in bowel habit (may be cancer). Constipation/diarrhoea. Abdominal pain. Fatigue (due to anaemia). Vomiting/nausea, fever (infection).
Special Features: Jaundice
Site. Quality N/A Severity N/A Time course! Context: recent travel, tattoos, alcohol.
Associated Features: Jaundice
4 Ps Pruritis - itch. Pain. Pee - dark urine. Poop - pale or clay coloured stools.
Further History: Jaundice
Alcohol!
Recent travel, immunisations, tattoos, IV drug use, unprotected intercourse.
Special Features: Asthma
Severity: ADLs, days off school/work.
Severity: have you ever been admitted to hospital for asthma?
Time course!: how long, how often, progression (better or worse)?
PSYCHO-SOCIAL CONTEXT: impact of asthma on lifestyle?
PSYCHO-SOCIAL CONTEXT: impact of lifestyle on asthma?
PSYCHO-SOCIAL CONTEXT: adherence to medications?
Context: what brings it on (night, pollen, allergens, etc.).
! Do you have an asthma management plan?
Associated Features: Asthma
Wheeze
Hayfever, hives, eczema - i.e. atopy.
