Specific Histories Flashcards
Paediatric Hx
PC
HPC - DOPT
Paeds System Review
Fever, behaviour, activity/apathy/alertness, rashes, growth and weight.
Cardiorespiratory: cough, noisy breathing (strider, croup, wheeze), Dyspnoea, cyanosis.
Gastro intestinal: vomiting, abdominal pain, diarrhoea/constipation.
Genitourinary: wetting nappies/toilet trained, dysuria, frequency.
Neuromuscular: seizures/fits, headaches, abnormal movements.
ENT: sore throat, snoring, noisy breathing, Ear ache.
Birth
Pregnancy
Birth Hx - mode of delivery, gestation.
Any complications.
Feeding
Diet and appetite
Toileting
Growth
Weight
Puberty
Development
Any concerns
School progress
Developmental chart.
Red flags - Loss of skills, not fixing/following objects, hearing loss, low muscle tone/floppy, can’t hold objects by 5 months, can’t sit unsupported by 12 months, call can’t walk by 18-24 months, persistent toe walking, no speech by 18 months.
PMH - as normal. DH - Immunisation, allergies. FH - normal
SH -
Family - who lives at home
Social services involvement / safeguarding concerns.
Hobbies, pet, travel.
Immunisation schedule
Two months: 6 in 1, Rotavirus, pneumococcal, meningitis B
Three months: 6 in 1, Rotavirus
Four months: 6 in 1, Pneumococcal, meningitis B.
One year: MMR, Pneumococcal, meningitis B, haemophilus influenza type B/meningitis C
Preschool (3yrs 4mnths): MMR, four in one (diphtheria, polio, tetanus, pertusis).
Girls 12–13 years: HPV two injections
Teens: 3 in 1(diphtheria, tetanus, polio), meningitis ACWY
6in1: Area, tetanus, polio, producers, haemophilus influenza type B, hepatitis B.
Psychiatric Hx
PC - came here or were detained? Anyone prompted you to come?
HPC -
Explore every symptom
Psychiatric system review:
Psychosis screen: (First rank symptoms): third person auditory hallucinations, running commentary auditory hallucinations, delusions of thought/control/perception.
Depression screen car (mood, anhedonia), biological(Sleep, energy), future (hopelessness, suicidal thoughts).
Past psychiatric history - Diagnosis First and last episodes How many episodes Previous self harm suicide attempts Mental health worker/care coordinator
Drug history - as usual
Family history -
family psychiatric history,
family history of suicide.
Social history: Alcohol and drug use including recreational drugs Social circumstances Current situation Relationships Dependents in contact with children – determine if the children are safe Home (support, housing situation) Finances (benefits, debt) Occupation Coping with activities of daily living
Forensic history
Personal upbringing history
Premorbid personality stop
Alcohol Hx
Introduction:
Alcohol Use
Current use:
What: type of alcohol how much (units equal %ABV x by litres volume).
When: times of day, days of week, continuous/binge
Where, pub, home alone, work
Why: social, underlying issues (family, relationships, depression etc..)
Past: Alcohol timeline
Treatment and detox
relapse reasons
ever tried to cut down.
Social effects: Self (injuries, medical conditions) Effect on family/friends Effect on work Effect on finances Any trouble with police related to alcohol Driving
Dependence
Physical dependence
Tolerance
Autonomic withdrawal symptoms: tremor, sweating, nausea/vomiting, palpitations
Neurological withdrawal symptoms: agitation, headache, hallucinations, seizures, insomnia
Psychological dependence
Compulsion/persistent desire to drink
Lots of time spent drinking
Given up activities/hobbies are spending less time with family/friends
Mood and risk
Effects on mood
Assess risk of self harm/suicide
Rest of history
Past psychiatric history: any disorders including Anxiety and depression
Rest of normal history.
Help Available for Alcoholics
Groups/charities – alcoholic Anonymous
Community alcohol team
Detox options
Gradual reduction of the time
Community detox – chlordiazepoxide weaning regiment
Hospital detox – if previous delivery I’m tremens, poor response, a lack of support
Help with reducing relapses Acamprosate (reducing cravings) Disulfiram (creates unpleasant reaction in response to alcohol) Naltrexone (blocks affect of alcohol) Vitamin B supplements
