Systematic Enquiries

Question 1

What symptoms would you ask about in a urinary history taking

Answer 1

Frequency
Urgency
Nocturia
Dysuria
Polyuria/Oliguria
Incontinence
Incomplete emptying of bladder
Retention
Abdominal Pain
Fever
Weight loss
Back pain
Nausea/V+

Question 2

What does SOCRATES stand for

Answer 2

Site
Onset
Character
Radiates
Associated Symptoms
Timing
Exacerbating/Relieving factors
Severity

Question 3

What symptoms would you ask about in a cardio history taking

Answer 3

Chest pain
Dyspnoea, at rest/exercise
Palpitations
Ankle Oedema
Varicose Veins
Claudication

Question 4

What symptoms would you ask about in a respiratory history taking

Answer 4

Cough
Sputum
Haemoptysis
Dyspnoea
Wheeze
Chest pain
Sinusitis symptoms, blocked nose, discharge, f pain, 
Earache
Sore throat
Change in taste (COVID)

Question 5

What symptoms would you ask about in a neuro history taking

Answer 5

Speech disturbance 
Cognitive impair (MSQ)
Headache
Fits/faints/LOC
Dizziness, vertigo
Balance
Vision - acuity, diplopia 
Hearing
Weakness
Numbness/tingling/paraesthesia

Question 6

What symptoms would you ask about in an endocrine history taking

Answer 6

Fatigue
Lethargy
Sleep quantity/quality
Sweating
Weight change/appetite
Thirst
itchy skin
bruising, neck lumps
hair loss/growth

CVS - tachycardia, palpitations, chest pain
Neuro - headache, dizzy, visual loss, confusion, blackout
GI - change in bowel habit, weight/appetite change
Urinary - polyuria/nocturia, erectile dysfunction, menstruated cycle, skin colour
Psych - low mood, depression, anxiety, personality change

Question 7

What symptoms would you ask about in a alimentary history taking

Answer 7

appetite/weight loss or change
mouth/teeth/tongue
dysphagia
dyspepsia/heartburn
nausea, v+
haematemesis 
Fat intolerance
Jaundice
Abdominal pain
abdominal distension (+ bloating)
Bowel habit: change/constipation/D+/blood/mucus/maleana 
faecal incontinence 
perianal symptoms, haemorrhoids, pain, itching

Question 8

What symptoms would you ask about in a general history taking

Answer 8

fatigue/malaise
fever/rigors
weight/appetite
skin: rashes/bruising/bleeding
sleep disturbances
thirst
pruritis
night sweats
neck swelling/lumps

Question 9

What questions would you ask in a male sexual health history

Answer 9

Erectile dysfunction - how long, can they develop one at all? can they have sex. morning erections? affecting their relationship? have they discussed with their partner. any other changed with their body at the same time?

prem or delayed ejaculation
urinary symptoms - dysuria, frequency, dribbling, flow
penile discharge
testicular swelling, any pain
penile rashes, ulcers, lumps
infertility? how long trying
sexual history, partners?, how long together, protection?
high risk partners? gay, sex workers, iv drug users
any prev STIs?

Question 10

What questions would you ask in a female sexual health history?

Answer 10

menstrual history - age periods started, intermenstrual or post coital bleeding
last menstrual period
dysmenorrhoea or menorrhagia
pelvic and sexual infections - discharge, pelvic pain, ulcers
smear history, when was last
menopause? any PMB?
obstetric history - parity and gravidity, terminations? miscarriages
infertility?
past and present use of contraception
incontinence, stress and urge?
sexual history, partner? type of sex, high risk partners?

Question 11

What extra questions would you ask in a paediatric history?

Answer 11

Birth History
- gestation, mode of delivery, weight, mothers health, any labour problems, need any help delivering, neonatal care?
Immunisations
Development - milestones, smiling (6-8weeks) sitting (8mths), crawls (9mths) walking (by 18mths) first words (12mths)

Question 12

What is part of the mental state exam

Answer 12

Appearance and Behaviour
Mood
Speech
Thought form - phobia, obsessions
Thought content - delusions
Abnormal perception - hallucinations
Insight - do you think there is something wrong?
Cognition - memory orientation

Question 13

What is part of the mental state exam

Answer 13

Appearance and Behaviour
Mood
Speech
Thought form - phobia, obsessions
Thought content - delusions
Abnormal perception - hallucinations
Insight - do you think there is something wrong?
Cognition - memory orientation

Question 14

How would you ask a patient about hallucinations

Answer 14

Do you ever hear things where you cant work out where they come from?
see things
feel things
smell things

Question 15

How would you ask a patient about delusions

Answer 15

Do you have any beliefs that other people wouldn’t agree with?

Question 16

What extra things do you ask in a psychiatric history

Answer 16

After presenting complaint
- Past psychiatric history - prev illnesses? treatment, duration
Past medical history
Drug and allergies
Family history
- Personal history - early development, childhood, education, occupation, relationships
Social - drugs and alc, any dependancies?
- Forensic - have you ever had any trouble with the police?
- Pre-Morbid personality - what were you like before this happened

Mental state exam
ask about delusions, hallucinations
elated mood?
memory disturbance?
suicidal thoughts? harming others?

Question 17

Cerebellar exam pneumonic?

Answer 17

DANISH
disdiadochokinesis
Ataxia
Nystagmus
Intention tremor
slurred speech
hypotonia, heel shin

Question 18

What should be assessed in cerebellar examination

Answer 18

• general inspection
• gait (broad based ataxic gait), turn, heel toe
• Romberg’s test (sensory ataxia)
• Speech - ataxic dysarthria, slurred
• Eyes - nystagmus, H
• Upper limbs - dysd, finger nose, tremor, tone (hypotonia)
• Lower limbs - leg roll, knee lift for tone, knee reflex (hyporeflex), heel shin test