Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

PACES > Station 2: History > Flashcards

Station 2: History Flashcards

1
Q

Approach to history-taking?

A
  1. Patient’s perception - concerns, worries
  2. Alarm symptoms - list of emergencies associated with disease categories
  3. Disease interaction - e.g COPD with new ascending weakness will warrant ICU referral
  4. Therapeutic success or failure - adherence, side effects, unnecessary drugs
  5. Risk to others - epilepsy and driving, HIV, hereditary problems
Systematic flow:
HPC
Systems review (constitutional/B symptoms, cardio, resp, GI, GU + period/infertility, neuro, CTD, metabolic, autoimmune)
PMHx + surgery
DHx
Allergies
FHx (genetic test where relevant)
SHx (smoking, alcohol, occupation, home, independence e.g. driving/shopping/cleaning/finances)
Travel Hx
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Cue words

A

Intro

  • What’s the best name to call you by?
  • As we’re discussing I might be writing some things down on this piece of paper, so please excuse me if I do that.
  • Can I start by asking how old you are?
  • I’ve had a letter from your GP and it says that you…can you tell me more about that?

HPC

  • Have you managed to see if there is a pattern to this, can you think of anything that might be common amongst these events?
  • Now I’m just going to ask some quick fire questions, I’m afraid they might come of as a bit thick and fast, but this is to ensure that I do not miss out anything important.

PMHx

  • Have you had any illnesses in the past (apart from the ones you’ve mentioned)?
  • Have you seen any specialist or been admitted to hospital for any conditions?

Fillers

  • I’m just going to recap on what you’ve been talking about very briefly, if you think you can add anything or if anything is incorrect, just interrupt me.
  • That’s good to know / That’s helpful, thank you.
  • I can imagine that you’re worried about that, and we will talk a bit more about that in a short while.

ICE

  • Do you have any ideas of what this could be?
  • What about anything that you’re worried about, or any concerns you have in particular?
  • What are you hoping might come out of today’s conversation?

Closing

  • What I’m going to do now is talk you through the things that I think it might be
  • And what we might do to investigate this further so that we can confirm and exclude a few things
  • Is there anything that you would like me to explain further or anything that you are unsure about?
  • Is there anything else from your side that you feel we have not talked about or we needed to mention?
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Dysphagia - approach?

A
  1. Determine whether oropharyngeal or oesophageal cause
  2. Trouble initiation or food gets stuck?
  3. Worse with solids or fluids?
  4. Progressive or comes and goes (oesophageal web/ring)?
  5. Location of dysphagia - pharynx or sternum?
  6. Associated symptoms - Odynophagia? Chest pain? Heartburn esp at night? Acid brash esp in the morning? Nasal regurgitation? Regurgitation? Neuro symptoms i.e. weakness, tremors, dysarthria, ptosis?
  7. PMHx - neuro disease i.e. CVA/PD/MND/MS/MG, systemic sclerosis, Sjogren’s, OA (extrinsic compression), prev radio to thorax (radiation oesophagitis), asthma/atopy (eosinophilic oesophagitis), HIV/immunosuppression
  8. Drugs
  9. Smoking and alcohol
  10. Social - how they maintain nutrition? Any distressing events recently (globes pharyngeus)?
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Dysphagia - features of oesophageal dysphagia?

A
  1. Food sticks after swallowing
  2. Worse with solids than liquids
  3. Associated with reflux and dyspepsia
  4. Progressive symptoms
  5. May be associated with alarm symptoms
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Dysphagia - causes of oesophageal dysphagia?

A
  1. Peptic stricture
  2. Oesophageal malignancy
  3. Oesophagitis
  4. Oesophageal spasm
  5. Oesophageal infection
  6. Achalasia
  7. Systemic sclerosis
  8. Extrinsic compression
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Dysphagia - features of oropharyngeal dysphagia?

A
  1. Trouble initiating swallowing
  2. Worse with fluids than solids
  3. Nasal regurgitation
  4. Associated with neurological disease or symptoms i.e. dysarthria/weakness
  5. History of aspiration pneumonia
  6. Coughing and choking
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Dysphagia - approach to oropharyngeal dysphagia?

A
  1. Upper GI endoscopy and possibly oesophageal manometry
  2. Investigation under speech therapy and ENT
  3. Video fluoroscopy with barium - filmed during real-time to study the mechanism of swallowing
  4. Treatment for neuromuscular abnormalities (found either from aspiration, pooling of barium, or muscle paralysis) - fluid thickener or swallowing manoeuvres i.e. head tilting
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Dysphagia - surveillance for Barrett’s oesophagitis?

A
  1. Barrett’s oesophagitis develops as a consequence of chronic GORD.
  2. Predisposes to the development of oesophageal adenocarcinoma.
  3. Rate of transformation to adenocarcinoma is 0.2-2% per year.
  4. Endoscopy is used as a surveillance tool - the British Society of Gastroenterology recommends endoscopic surveillance every 2-3 years for patients who would be candidates for oesophagectomy.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Dysphagia - medications implicated in dysphagia?

A

Corrosive drugs causing injury - NSAIDs, bisphosphonates, doxycycline, iron sulphate
Drugs affecting lower oesophageal sphincter pressure - nitrates, calcium antagonists

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Risk factors for gastric cancer?

A
  1. H.pylori infection - atrophic gastritis, metaplasia, dysplasia, cancer
  2. Prev gastric surgery - hypochlorhydria or bile reflux
  3. Smoking
  4. Certain cancer syndromes e.g. hereditary non-polyposis colorectal carcinoma, familial adenomatous polyposis. Peutz-Jegher’s syndrome
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How to diagnose H.pylori infection?

A
  1. Non-invasive - urea breath test and H.pylori stool antigen detection (sensitivity and specificity > 95% but usage of PPI can lead to false negative)
  2. Rapid urease testing from endoscopic biopsy
  3. Routine histology from gastric antrum and body
  4. Bacterial C&S not routinely recommended, but may provide information in refractory disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

H.pylori infection association?

A
  1. Peptic ulcer disease (95% of duodenal ulcer, 65-95% of gastric ulcers)
  2. Gastric adenocarcinoma (70-90%)
  3. Mucosal-associated lymphoid tissue (MALT) type lymphoma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the role of H.pylori infection in peptic ulcer disease?

A 
The mechanism of disease is thought to be due to bacterial effects on:
Gastric acid secretion
Gastric metaplasia
Immune responses to infection
Mucosal defence mechanisms
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Dyspepsia - approach?

A
  1. Location, duration, frequency, intensity, character
  2. Reflux symptoms?
  3. Relieved by or precipitated by meals?
  4. Nausea or vomiting?
  5. Pancreatic - radiating to back, precipitated by eating, relieved by leaning forward?
  6. Biliary - right side, precipitated by eating?
  7. Colonic - lower abdomen, colicky, relieved by defecation?
  8. Alarm features - LOW, LOA, early satiety, dysphagia, jaundice
  9. PMHx - GORD, gastric surgery, dyslipidaemia, pancreatitis, gallstones, haemoglobinopathy (pigment gallstones), FHx of gastric Ca?
  10. Drugs - PPI, NSAIDs, bisphosphonates, steroids, nitrates, calcium antagonists, drugs causing pancreatitis (AZA, ART, diuretics)
  11. Smoking and alcohol
  12. Social - eating late at night, affecting QoL?
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Dyspepsia - plan of action?

A
  1. Explain that there are many possible causes
  2. A trial of therapy may be the best initial strategy prior to investigation
  3. Arrange endoscopy if any alarm symptoms or age > 55
  4. If endoscopy not indicated, give trial of PPI for 4 weeks and if no improvement, arrange for H.pylori test
  5. Suggest abdominal ultrasound if suspicion of pancreatic or billiary cause
  6. If reflux - suggest elevating head and not eating so late at night
  7. General advise on weight loss, smoking cessation and limiting alcohol intake
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Joint pain - approach?

A
  1. Onset and duration? Acute vs chronic - acute as in MSK emergency e.g. septic arthritis
  2. Monoarticular or polyarticular?
  3. Symmetrical or asymmetrical?
  4. Small or large joints?
  5. Swelling?
  6. Stiffness?
  7. When is it worse - in the mornings, or later in the evenings? With activity?
  8. Night pain? -> RED FLAG, suggests malignancy or very severe arthritis
  9. Neuropathic pain? -> RED FLAG, suggests carpel tunnel, acute myelopathy/radiculopathy
  10. Associated symptoms:
    - Fever, weight loss, malaise, night sweats
    - Recent infection: UTI, GI, URTI sx
    - Rash
    - Oro-genital ulcers
    - Alopecia
    - Eyes: red (episcleritis), painful (scleritis) or dry eyes (keratoconjunctivitis sicca)
  11. FHx, SHx, DHx
    - How does it affect QoL and ADL, relationships?
    - What is the house like, any mobility restrictions, any aids to assist mobility?
    - Occupation
17
Q

Joint pain - diagnostic criteria for RA?

A

ACR/2010 EULAR criteria require at least > 6 scores for the classification of RA:

  • Joint involvement (small/large joints)
  • Presence of +ve RF or anti-CCP antibody
  • Abnormal ESR or CRP
  • Duration > 6 weeks
18
Q

Joint pain - infections associated with arthralgia?

A

Viral:

  • Hep B, C
  • Dengue
  • Rubella
  • Parvovirus B19
  • HIV
  • EBV
  • Mumps
  • Coxsackie virus

Bacterial (reactive arthritis):

  • Enteritis: salmonella, shigella, campylobacter, yersinia, C.Diff
  • Urethritis: chlamydia trachomatis
19
Q

Joint pain - differential diagnosis of monoarthritis or oligoarthritis?

A
  • Trauma
  • Infection
  • Crystal arthritis
  • Seronegative arthritis (reactive arthritis, psoariatic arthritis, enteropathic arthritis, ankylosing spondylitis)
  • Malignancy
  • Lyme disease
20
Q

Joint pain - differential diagnosis of polyarthritis?

A
  • OA (asymmetrical: hands, knees, hips, spine)
  • RA (symmetrical: hands, shoulders, knees, cervical spine)
  • Seronegative arthritis (asymmetrical: large joints) - reactive arthritis, psoriatic arthritis, enteropathic arthritis, ankylosing spondylitis
  • Systemic disease: SLE, vasculitis
  • Viral infections
  • Malignancy
  • Sarcoidosis

PACES (7 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions