Symptom Specific Questions

Question 1

Which questions should be asked in the case of a patient presenting with jaundice?

Answer 1

Alcohol history

Drug history (prescription and non-prescription)

Travel abroad

Blood transfusions

Tattoos

Unprotected sexual activity

Cigarette use (associated with cancer of the head of the pancreas)

Question 2

Which questions should you be asking a patient presenting with a headache?

Answer 2

1. SOCRATES
2. When it started
3. How long it lasts
4. When does it occur: Postural triggers or stimuli triggers
5. Nausea, vomiting or see bright lights
6. Previous headaches (history of presenting complaint)
7. Smoking and drinking (both make headaches worse)
8. Family history of migraines, tension headaches
9. Use of codeine or oral contraceptive (can both cause headaches)

Question 3

Which questions should be asked for a patient presenting with penis pain?

Answer 3

1. SOCRATES
2. Genitourinary systems questions (dysuria, haematuria, prostatism, incontinence, frequency, discharge, flow, volume, nocturia
3. Sexual history: new sexual partners, engagement in unsafe sex

Question 4

Which questions must be covered for a patient with a suspected bleeding disorder?

Answer 4

Do you tend to bleed easily and for long periods when cut?
Have you ever had trouble with bleeding in any surgical or dental procedures?
Do you have nosebleeds frequently?
Are your periods heavy? Did you bleed much after giving birth?
Is there ever any blood in your stools?
Have you noticed any blood in your urine?

Personal history of bleeds; (-where can blood be seen?)

1. Bruises
2. Epistaxis
3. GI tract bleeding - anywhere from mouth to anus
4. Menses
5. Urine
6. Surgical bleeding
7. Dental bleeding
8. Injury bleeding

Family history of bleeding;

1. Known bleeding disorders
2. Bleeding due to surgery
3. Bleeding due to dentistry

Question 5

What questions should you ask a patient presenting with weight loss?

Answer 5

Appetite

GI symptoms: bowel habit change, dysphagia, indigestion, reflux.

Eating disorder symptoms

Diabetes symptoms

Drug and alcohol use (cocaine, alcohol, amphetamines, cannabis)

Night sweats/fever (Malignancy, HIV, TB, lymphomas)

Question 6

What questions should you ask someone presenting with a lump in their throat?

Answer 6

1. Dysphagia - are you swallowing normally?
2. Neck pain
3. Hoarseness (-indicates recurrent laryngeal nerve palsy and possible invasion)
4. History of neck irradiation: radio-iodide treatment or treatment for thyroid cancer
5. Family history of thyroid cancer

Question 7

What questions should you ask a patient presenting with transient loss of consciousness?

Answer 7

Two systems- Cardiovascular and neurological

Before:
1. Circumstance (What they were doing when it started)

2. Warning signs

During:
3. Duration

4. Loss of consciousness (differentiates syncope from seizures/falls/TIA/drop attacks/pseudosyncope)
5. Movements - floppy or stiff jerking
6. Incontinence or bite tongue
7. Complexion (how they looked)

After:
8. Amnesia

9. Muscle pain
10. Confusion or sleepiness
11. Impact on life

Background:
12. Past history of syncope: frequency and effect on life

12. Go through cardio and neuro symptoms

Question 8

In a patient with chest infection and a long pack year history, what questions will we ask to screen for symptoms of cancer?

Answer 8

Weight loss (>5% in 3 months)

Fever/Night sweats

Haemoptysis

Persistent cough

Dyspnoea

Chest pain

Changes in fingers suggesting clubbing

Pain in the limbs (indicating Hypertrophic osteoarthropathy)

(10 cigarettes every day reduces your life expectancy by 27 days for every year you smoke, or 11 minutes per cigarette)

Question 9

A patient presents with dysphagia, what questions must you ask in the consultation?

(Think of what you want to eliminate first)

Answer 9

1. Any red flag symptoms:
   - Have you lost weight? Deliberately? Over what timescale?
   - Have you had any vomiting? Haematemesis?
   - Had any symptoms of anemia? (Fatigue, paleness, Dyspnoea, headache, sore tongue, hair loss)
   - Any pain anywhere?
   - Had any night sweats or fever?
   - History of cancer? (cancer will kill them first)
2. Past medical history
   - Any Previous investigations? e.g. UGI endoscopy
   - Taken Any NSAIDs recently?
   - Previous abdominal surgery?
   - e.g. GORD, asthma (steroid use - candidiasis), irradiation, hiatus hernia
3. Family history - oesophageal/oral cancer, goitre or thyroid issues, GORD
4. Lifestyle - diet, alcohol use, smoking history
5. Social history - employment, exposures
6. Dysphagia - is it solids only (obstruction/stricture) or solids and liquids (uncoordinated swallowing - neuro/achalasia)

Question 10

A patient presents with acute abdomen, which questions must you cover?

Answer 10

Nausea?

Vomiting?

Diarrhoea?

Complete constipation - failure to pass wind?

Fever?

Question 11

How do we approach chest pain?

Answer 11

1. SOCRATES;
   Worse on: Eating, walking, positional, deep breathing
2. Is it acute onset - more insidious
   Or is it chronic
3. Is it sharp or dull?
   Sharp is pleuritic
   Dull is visceral
4. Is it pleuritic; worse on breathing in?
   Pleura are involved - PE, Pericarditis, pneumonia, costochondritis
5. Is there a positive family history?
   Onset <55 in men and <65 in women
6. Any breathlessness; Dyspnoea, orthopnoea and paroxysmal nocturnal Dyspnoea, ALL indicate HF
7. Any cough?
   Pneumonia, HF
8. Risk factors:
   PE: clotting disorders, recent cancer/surgery/long flights
   Cardiovascular: Angina, DM, HTN, FHx
   Gastrointestinal: Reflux

Question 12

Dyspnoea?

Answer 12

PC: 
Quantify dyspnoea 
Cough
Wheeze
CP
Palpitations- rhythm 
Leg swelling
Fever, weight loss, appetite
Anxiousness 

PMH:
Any asthma, COPD or heart disease

DHx:
Any inhalers, nebulisers or oxygen at home

FHx:
IHD and asthma

SocHx:
Smoking, asbestos job, managing at home

Question 13

What questions should be asked of a patient who presents with transient loss of consciousness?

Answer 13

What were you doing at the time? Sat or standing?
Any warning it was going to happen?
Any dizziness?
How did you feel when you came round?
Did you injure yourself, any tongue biting?
Could you remember what happened?

Ask spectator:
Did you notice any jerks before or during?
What kind of jerks, can you show me?
How long did they go on for?
Were they stiff or rigid?
What colour did they look?