Unique features Flashcards
Cardiac syncope
Questions:
1) Features suggesting cardiac: Loss of tone, injury, sitting rather than standing, no prodrome
2) Environmental factors that predispose to vasovagal: Heat, dehydration, long standing, stress
Aim: Vasovagal or serious (cardiac, seizure)
- Witness?
Context:
- Sitting or standing?
- Suggests vasovagal: Heat, fasting, medications, stress, standing for long time
Associated features:
- Before: Warning? e.g. sweaty, dizzy, palpitations, chestpain
- During: Muscle twitching, appearance (floppy, pale)
- After: Any injury?
- System: Chest pain, palpitations, edema, SOB
Past Hx and fam Hx:
- Cardiac issues
Dx:
- Vasovagal
- Cardiac
Palpitations
1) Give 2 features from history that may indicate serious cause: e.g. sudden onset, presence of SOB
2) Give 3 causes of non-serious/physiological palpitations: Caffeine, exercise, anxiety, medications
Aim: Serious or not serious? Quality: - Tap out: irregular or regular - Forceful or flutter Context: - Coffee, exercise (also aggravating factors) Associated features: - Sx: Fatigue, dizziness, blackout - System: Chest pain, edema, SOB Dx: - VT, AF, heart failure, PE, heart attack, thyroid problems, anaemia, social
Chest pain/angina
Questions:
1) Key cardiac risk factors: Diabetes, high cholesterol, hypertension, smoking
2) What three features suggest ischemic chest pain? Central, radiates, on exertion, SOB
Aim: Dangerous (IHD, aortic dissection, PE) or non-dangerous
Associated features:
- Sx: Nausea, sweating
- Risk factors: Smoking, hypertension, high cholesterol, diabetes, physical inactivity, family history
- System: SOB, palpitations, edema
Dx:
- MI, PE, Transient ischemia, Muscle strain, Infection, Fracture, Abdo pain, Cancer
Intermittent claudication
Severity:
- How far can you walk without pain? Clarify distance if given arbitrary value e.g. around the park
- Pain at night? Foot pain in the night = “rest pain”
Associated features:
- Risk factors: Smoking, hypertension, high cholesterol, diabetes, physical inactivity, family history
- System: SOB, palpitations, edema
Edema
Site: - Is it uni or bilateral? - Focal or diffuse? Quality: - Tight, puffy, pitting or not Timecourse: - Is it worse towards the end of the day? Context: - DVT: Pill, pregnant, plane, (operation, hospitalisation), cancer Associated features: - Sx: Swelling, risk factor, blue/hot - System: SOB, palpitations, chest apin
SOB/dyspnoea
Aim: Cardiac or respiratory
What do you mean by breathlessness?
Quality:
- Do you find yourself taking heavy or shallow breaths?
Severity:
- Present at rest?
- How far can you walk before SOB? If given arbitrary value e.g. around park, confirm distance
- How much exertion before you are SOB?
Context:
- Pill, pregnant, plane (operation, hospitalisation)
Relieving factors:
- How many pillows do you use at night?
- Does sitting up make it better/lying down make it worse?
Associated features:
- Cardiac: Chest pain, edema, palpitations
- Resp: Cough, wheeze, calf pain, fever
*Don’t forget smoking
Asthma (acute)
Quality: - What do you mean by asthma? Severity: 1. Ventolin use - How much - How often - How effective 2. Hospitalisations? Context: - 5 common triggers: Infection, exercise, allergy, cold, smoke Associated features: - Resp: Cough, wheeze, SOB, fever, infection - Atopy: Eczema, asthma, , allergies, hay fever, hives Past history: - Asthma before? Family history: - Atopy (same ones as A/F)
Asthma (chronic)
1) 2 features that reflect severity: Hospital, severe attacks, oral steroids, medications not working
2) 3 triggers that exacerbate asthma: Allergies, exercise, cold, smoking, infections
3) 2 other conditions that co-exist with asthma: Allergies, hay fever, eczema
Severity:
1. Ventolin use (reliever)
- How much
- How often
- How effective
2. Steroids (preventer)
- Using or past use?
- Which ones?
3. Frequency of attacks (in contrast to episode which is a non-severe flare)
4. Hospitalisations/ambulance
Timecourse:
Context:
- Infections, exercise, allergens, cold, smoke
Associated features:
- Resp: Cough, wheeze, SOB, fever, infection
- Atopy: Eczema, hives, hayfever, allergies (also ask in past history and family history)
Social Hx:
- Effect of asthma on life and life on asthma
Cough
1) 3 causes of chronic cough: Lung cancer, chronic bronchitis, bronchiectasis, COPD, asthma, TB, heart failure, smoking, post-nasal drip, reflux
Aim: Acute or chronic Quality: 1. Sound e.g. barking, hacking, whooping 2. Dry or productive? If productive: 3. Blood? If yes, go to hemoptysis at end 4. Colour, volume, thickness, odour Severity: - Does it affect sleep? Aggravating features: Is it worse at night? Associated features: Sx: Night sweats (TB), chest pain (pleuritic), heart burn symptoms, weight loss Resp: SOB, wheeze, chest pain, fever, infection
Hemoptysis
Site/quality: - What colour? - Foamy? - Volume - Mixed in? e.g. specks, lumps, frank - Nose: Any nose bleeds, pain? - Lungs: Any irritation in chest area before coughing? - GI: Any nausea, abdo discomfort or vomiting? Timecourse: - How long
Vomiting
Quality: 1. Green? 2. Any blood? - How much - How often - How long - What colour 3. Forceful or not? Severity: - How much Timecourse: - Sick/nauseous before? Context: - In the morning? - Pregnant? - With meals? - Gastro: Other people sick?, suspicious food? - Other: Alcohol? Associated features: - Sx: Abdo pain, nausea, headache, vertigo, dehydration (dizzy, floppy, pale) - System: Bowel habits, fever, weight loss/loss of appetite
Dysphagia
- What do you mean by difficulty swallowing?
Quality: - Initiation or stuck?
- Solid vs. liquid
Severity: - Can anything go through? (i.e. do you need to vomit or cough to bring food up?)
Associated features: - Sx: Coughing, choking, nasal regurgitation
- System: Vomiting, diarrhoea, bowel habits, fever, weight loss/loss of appetite
Past history: - Sx: Heart burn, reflux, neurological conditions, smoking
Bowel habits
- What are your normal bowel motions like? i.e. consistency/frequency
Quality: - Consistency, colour
- Any blood? If yes: colour, how much, how often, how long
- Any mucous?
Severity: - How often do you go to toilet?
- Volume
- Straining? (for constipation)
Context: - Travel, travel vaccinations
- Suspicious food
- Other people affected?
Associated features: - Sx: dehydration, urine colour, bleeding, anaemia, changes in mood
- System: Vomiting, diarrhoea, bowel habits, fever, weight loss/loss of appetite
- If black stools, must ask about hematemesis!!!
Past history: - Sx: Previous colonoscopy
Jaundice
Context:
- Anyone else you know with these symptoms?
- pre-hepatic: blood disorders, infection/fever, meds
- Hepatic: travel (where, food, water, when), IVDU, tattoos, needle sticks, blood transfusions, injury, immunisations, unprotected sex, alcohol
- Post-hepatic: previous gallstones, 5Fs (female, >40, fat, fair, fertile),
Associated features:
- Sx: fever, infection, anemia, ‘flu-like’ symptoms, fatigue, pain/discomfort, edema, RUQ/central pain, pale poo, dark pee, pruritus (itch)
- System: Vomiting, diarrhoea, bowel habits, fever, weight loss/loss of appetite
Px:
- Symptom: Gall stones, liver disease, pancreas problems
Fam Hx:
- Same as Px + blood disorders, pancreatic cancer, blood borne diseases
