the systematic review - questions for the system specific Hx taking. Flashcards
SR - cvs questions
1 - chest pain (SOCRATES)
2 - palpitations (uncomfortable sensation of your heart beating in your chest)
3 - claudication (pain on walking a certain distance that will get better if you rest for a few minutes)
4 - shortness of breath
5 - paroxysmal nocturnal dyspnoea (wake up breathless)
6 - perpheral oedema
SR - rs questions
1 - cough 2 - sputum 3 - haemoptysis 4 - wheeze 5 - exercise tolerance 6 - chest pain (always pain for any system)
SR - Gi questions
1 - appetite change 2 - vomiting 3 - haematemesis 4 - malaena 5 - rectal bleeding (in/around stool or on wiping) 6 - change in bowel habit 7 - abdominal pain (socrates)
SR - CNS questions
1 - headaches 2 - visual disturbances 3 - syncope or presyncope (black out or light headed) 4 - weakness 5 - paraesthesia 6 - fits/ siezures 7 - smell/hearing/ taste changes 8 - balance problems
SR - locomotor questions
1 - joint or bone pain inc back 2 - stiffness 3 - swelling 4 - is it worst in the morning when you wake up or after a long day. (inflame vs mech) 5 - rashes 6 - hair loss 7 - eye problems (epi/scleritis) 8 - mouth problems (ulcers) 9 - breathing problems (pleuritis) 10 - chest pain/heart problems (pericarditis) 11 - raynaud's 12 - haematuria 13 - muscle pain or weakness 14 - sphincter control 15 - previous episode 16 - recent infections
SR - genitourinary questions
1 - haematuria (blood in urine) 2 - dysuria (pain on urination) 3 - frequency 4 - voiding difficulty 5 - any strange discharges or pus 6 - any chance of pregnancy? when was your last period.
SR - general questions to ALWAYS ask
1 - weight loss 2 - night sweats (wake up drenched) 3 - fevers 4 - rashes 5 - name, age and occupation 6 - whether they've had similar episodes before 7- ICE at the end (and reassure) 8 - risk factors for the system affected 9 - allergies!
abbreviated mental test score - questions if you are concerned the patient is confused
1- ask their age 2 - date of birth 3 - what year is it 4 - what time is it 5 - where are you 6 - what is your home address 7 - recall identity of 2 people present 8 - who the current monarch or prime minister is 9 - when was world war 2 10 - count back from 20 to 1
a score of less than or equal to 8 suggests confusion.
things to ask in social history
1 - smoking status 2 - ETOH consumption 3 - recent foreign travel if relevant 4 - housing type/ stairs/ with whom/ pets 5 - community support 6 - mobility 7 - activities of daily living 8 - urinary/bowel continence
things to do at the very start of the HX
WIPER
intro = your full name and role
name, age and occupation
Be explicit in getting consent (the purpose of this interview is… so is it ok if i ask you some questions?)
start with a broad question (so tell me about what has brought you in today)
general format of answer when asked how to manage a PT
1 - full clinical examination 2 - DRABCDE 3 - blood tests 4 - imaging 5 - medical and surgical interventions.
PMSH - questions to ask
1 - other medical conditions
2 - anything else you see your GP regularly for (now screen for relevant risk factors e.g. cholesterol, bp, diabetes, clotting problems, thyroid problems, asthma, COPD…)
3 - any previous operations
4 - anything else you’ve been into hospital for
some general principles for Hx taking in the OSCE
1 - ask a few open questions at the start and the actor will give you everything you need.
- what’s brought you in today
- what concerns you most about this
- is there anything else you’ve noticed
- how have these things affected your life.
2 - ask what they’re concerned about at the start to build rapport and get ICE out of the way.
3 - for the PC/hpc/ as SOCRATES, do the red flag checks, systemic symptoms, and flair questions to show you know what it is
