Stroke Flashcards
A 45 year old man presents to he emergency department with sudden onset weakness then inability to move his right hand and leg. On examination his right limbs were weak and he has difficulties lifting his right eye lid Take a focused history from him.
GRIP
Good morning Sir/Ma… Good morning Sir
How are you
My name is “x” a candidate of the ongoing den exam, for the purpose of the exam, I
would like to ask vou some questions
Please May I proceed
BIODATA
What is your name
How old are you
What do you do for a living
Are you married or single
Where do you live
What religion do you practice
What tribe a you
5C
¡. Presenting complain: what brought to the hospital today? / I see here that you are complaining of inability to move your right hand and leg, is that right?
Doctor
Doctor: When did you notice this
Onset : was sudden on gradually
Character: since it started has it gotten worse or remain the same
did the weakness in one limb start before the other? Or did it happen together.
Has it progressed to any other part of your body?
Time: Did you notice this when you woke up or during a physical activity
Other symptoms: any numbness or tingling sensation is any part of your body?
have you noticed drooling of saliva from your mouth ?
Related phenomenon: have you been having headache, blurry vision, nausea or vomiting
has there been any loss of consciousness
Causes
1)Chronic illness: Are you a know hypertensive or diabetic patients; are you compliant with your medications and routine follow up
2) Trauma: where you involved in any accident or fall recently? Do you box? Did you have any recent blow to your head ?
3) Cardiac diseases /MI: did you have any recent chest pain that radiated to your arm or neck,. Do you have any known cardiac pathologies?
4) lifestyle: do you smoke or drink alcohol, do you use illegal intravenous drugs
5) Sickle cell: Do you know your genotype ( more common for younger children/ adults)
6) family history: do you have any history of similar condition in your family
7)bleeding disorder : when you have a cut, does it bleed abnormally or for a long time?
8) Obesity / diet : do you eat a lot fatty food? Do you know your weight/ height?
9) Medications: are you on any anticoagulant like heparin
10 )brain tumor : any history of recurrent headache, seizures. Have you done a previous brain CT scan ? what any abnormalities seen on the scan?
11) Tuberculosis/ Hiv: have you noticed drenching night sweats, excessive weight loss? Do you know your hiv status, do you have multiple sexual partners
TIA: have you have similar condition in the past?
Complications
1) seizures: have you been having recurrent seizures or loss of consciousness
2) Incontinence: since this happened, have you noticed any leakage of urine or do you defecate on yourself
3) Memory loss: have you been having memory disturbance, do you sometimes forget who you are or where you are?
4) speech impairment: has this caused your speech to become slow, have you been having difficulties swallowing
5)increased ICP ( intracranial pressure): have you been a having forceful vomiting or difficulties breathing?
6) Do you feel depressed or has this caused you any emotional disturbance
7) Visual impairment: has this caused any change to your vision ?
Care so far
Care so far
since this started what have you done have you visited any pharmacy or hospital have you taken any local concoction or medication have you done any investigations
Past medical history
Family, social and drug history
Past medical history
Have you had similar condition in the past
Do you have any chronic illness like hypertension, epilepsy, asthma, diabetes or sickle cell
Have you had any hospitalization, blood transfusion or surgery in the past
Family history
Any history of similar condition in the family
Any history of chronic illnesses like hypertension epilepsy asthma diabetes or sickle cell disease
Social /drug history
Do you smoke, drink alcohol or have multiple sexual partners
Are you on any long term medications
Are you on any current medications
Do you have any drug allergy.
Review of system
Sir just to be sure I have covered all the symptoms, I would like you to say yes or no to the following questions
Cns: any headache, blurry vision, seizures
Cvs: any palpitations, cough, are you easily tired and out of breathe
Endo: any neck swelling, cold or heat intolerance
Resp: any fast breathing, noisy breathing, difficulty breathing ,cough
Dig.; any abdominal pain, nausea, diarrhea or constipation
GUS: any flank pain, urgency or frequency to urinate , abnormal discharge
MSS: bone pain, bone swelling, joint stiffness
