- Site - Onset - Character - Radiation - Associated symptoms (DD and Red Flags) - Timing - Exacerbating and Relieving Factors - Score (start with that and ask if ok to continue)

- Diet / Drugs (recreational - ask when applicable) - Exercising - Smoking - Alcohol

- Pregnancy - Periods - Pills (COCP) - Pap Smear (last time and results) - Practice (Sexual Hx)

- Timing - Relation - Amount - Colour/Consistency

- Face (drooping, etc) - Arms (cannot move, etc) - Speech (slurred, cannot speak, etc) - Time (to call the ambulance / time is brain)

- Back Pain - Cough - Difficulty Breathing - Fever - Leg Pain (also rash in the leg) - Long Flight - Rash (in the chest) - Sweating Also: - Radiation - Timing - Type of pain - Worsening/Relieving factors

- Fever - Cough absent - Tonsillar Exudates - Anterior Cervical Lymph Nodes 1 point fot each - scores 3/4 - give Abx

Communication Tips Flashcards by Gabriela Grangeiro Laude

SOCRATES (Pain)

Site
Onset
Character
Radiation
Associated symptoms (DD and Red Flags)
Timing
Exacerbating and Relieving Factors
Score (start with that and ask if ok to continue)

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(F)ODPARA (for the rest)

Frequency
Onset
Duration
Progression
Aggravating Factors
Relieving Factors
Associates symptoms

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Social Hx (DESA)

Diet / Drugs (recreational - ask when applicable)
Exercising
Smoking
Alcohol

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5 P’s - Women

Pregnancy
Periods
Pills (COCP)
Pap Smear (last time and results)
Practice (Sexual Hx)

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TRAC - Fluids

Timing
Relation
Amount
Colour/Consistency

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FLAWS - Infection and Cancer

Fever
Lethargy
Appetite loss
Weight loss
(Night) Sweats

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FAST - Stroke

Face (drooping, etc)
Arms (cannot move, etc)
Speech (slurred, cannot speak, etc)
Time (to call the ambulance / time is brain)

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Chest Pain Questions

Back Pain
Cough
Difficulty Breathing
Fever
Leg Pain (also rash in the leg)
Long Flight
Rash (in the chest)
Sweating

Also:
- Radiation
- Timing
- Type of pain
- Worsening/Relieving factors

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CENTOR Criteria

Fever
Cough absent
Tonsillar Exudates
Anterior Cervical Lymph Nodes

1 point fot each - scores 3/4 - give Abx

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PAMGUD - DD’s and Red Flags for Paeds

Pneumonia (cough, fast breathing)
AOM (discharge from the ear or pain/tugging on the ear, decreasing hearing)
Meningitis (neck stiffness, rash, shy to light, irritability, persistent crying)
Gastroenteritis (problems with poo, vomiting)
UTIs (problems with wee, irritable)
Dehydration (tears, how many nappings used in the day, skin turgor, increased thirst, weak/lethargic)

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MAM F PBINDS - Hx Taking for Paeds

Medical history (any medical condition)
Allergies (any allergies)
Medications (using any medications)
Family History
Pregnancy (how was that, any problems)
Birth (problems at birth, delivery method)
Immunisation history (up to date with the jabs, giving immunisations)
Nutrition (currently on breast milk, feeding with what at the moment, eating well)
Development milestones (ask if the child is ok with the red book)
Support (who takes care of the child, if the person has support for that - covers social history)

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STAR Approach - Counselling (changing habits, etc)

Set: make a deadline date for the plan
Tell: tell family and friends you start in this journey
Anticipate: I know it will be difficult/challenging. Acknowledge the challenge
Remove: remove the substance and give the counselling programs/support

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ABCDE - DD’s for Low Mood, Loosing Weight (for Psych)

Anaemia (lightheadedness, palpitations)
Tb or Bone pain/MM (night sweats/fever, cough, back/loin pain, urine problems)
Cancer or Chronic Fatigue Syndrome (weight loss, lumps and bumps, changes in the appetite)
Depression (low mood and the 2 core questions - if they have enough energy to do things in the day and if they have sleeping problems or not)
Endocrine - DM and Hypo/Hyperthyroidism (temperature)

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FAMISH - Psych (General)

Family, friends, finances and forensics (do it after drugs to make more sense - sometimes when people are going through those difficult problems we can act a bit outside of our normal, so I would like to ask if by any chance, have you ever have any problems with the law?)
Alcohol, smoking (very important to explore if they smoke, if they increased the amount to cope with the low mood) and recreational drugs
Medical history, medications, hospitalisations, operations, allergies
Insight, interest in life
Stress, sleep, appetite
Hallucinations and psychosis (more for schizophrenia, but it is a red flag)

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AND I C REST - GAD (General Anxiety Disorder)

Anxious about lots of things, most of the time
No control over the worry
Duration > 6 minutes
Irritability
Concentration is low
Restlessness
Energy is low
Sleep impairment
Tension muscles

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DIG FAST - Maniac Episode

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Distractibility
Impulsivity
Grandiosity
Flight of ideas
Activity increased
Sleep deficit
Talkativeness

DUSTBIN (lack os self-care) - Schizophrenia

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Delusion (control/reference)
Unseen (hallucination - visual/auditory/tactile)
Speech disorganised/Scared
Thought broadcasting/withdrawal
Behaviour disorganised (catatonic)
Insertion (thoughts)
Negative symptoms (apathy and blunted affect)

Questions, CAGE, DWT, MISH, FAM - Alcohol

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Questions:
- Do you drink alcohol?
- What?
- How much?
- How often?
- For how long?

CAGE:
- Cutdown
- Annoyed
- Guilty
- Eye opener
(2 or more YES answers - positive)

DWT:
- Dependency
- Withdrawal
- Tolerance

MISH:
- Mood
- Insight
- Suicide
- Hallucination (ask in third person)

FAM:
- Family/Friends/Finances/Forensic (problems with the law)
- Addictions (drugs, smoking)
- Medical conditions/Medications

ANOREXIA - Anorexia

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Amenorrhoea
No organic disease to explain weight loss
Obviously thin but feels fat
Refusal to maintain a normal body weight
Epigastric discomfort/Exercise increased/Enems/Episodes of vomiting (calluses on finger - Russel’s sign) and binge eating
X - symptoms (x food = fasting)
Intense fears of gaining weight
Always thinking about food

DEPRESSION - Depression

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Depressed mood
Energy loss/fatigue
Pleasure lost
Retardation or excitation
Eating changed - appetite/weight
Sleep changed
Suicidal thoughts
I am a failure (loss of confidence)
Only me to blaim (guilt)
No Concentration

LITHIUMS - Lithium Side Effects

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Levels (maintenance of 0.6-1.0 mEq/L - monitor 2-4 times per year once at stable dose)
Increased urination (once daily dosing - if tolerant - can reduce polyuria)
Thirsty/Tremors (maintain adequate fluid intake as dehydration can result in lithium toxicity)
Hair thinning/Hypothyroidism (occurs in 8-19% of patients)
Interactions - Medications that increase Lithium levels: NSAIDs (by 16-60%), ACEi/ARBs (by 30-40%) and Diuretics (by 25-40%)
Upset stomach (nausea, vomiting and diarrhoea)
Muscle weakness
Skin effects (acne and psoriasis)

Cravings

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ACamprosate

WithDrawal Symptoms

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ChlorDiazepoxide

Deterrent

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Disulfiram

Relapses

NaltRexone

NuTrition

Thiamine/Vit B1

SPIKES - BBN

- Setting (find a private location, etc) - Perception (assess understanding) - Invitation (check if they would like to have someone with them) - Knowledge (narrative approach - chronologic timeline - break the bad news) - Emotions and Empathy (EVE Protocol - explore emotions, validate emotions and empathetic response) - Strategy and Summary (support, explain what will be done, etc)

CONES - Medical Error

- Context - Opening shot - Narrative approach - Emotions - Strategy and Summary

Assessing Capacity

- What do you know about the condition? - What treatment is given for the condition? - Do you know the benefits of the treatment? - What will happen if stop the treatment? Remember 4 things to confirm the patient has capacity: - Are they able to understand the information? - Are they able to retain the information? - Are they able to verbalize the information back? - Are they able to make an informed decision based on the information given?

MSE (Full Psych Examination)

- Appearance (general appearance, features, weight, personal care, etc) - Behaviour (eye contact, facial expressions, body language, etc) - Speech (rate, quantity, tone, etc) - Mood and Affect (low/high/normal mood and apparent emotions, such as sadness, anger, etc) - Thought (speed, flow, coherence, content, delusions, obsessions, compulsions, suicidal thoughts, though insertion, thought withdrawal, thought broadcasting, etc) - Perception (visual, auditory and tactile hallucinations, pseudo-hallucinations, illusions, etc) - Cognition (MMSE) - Insight (assess their insight regarding their current state, such as if they believe they have a problem and need help with that, etc)

MMSE - Steps

- Orientation in Time (year, season, month, date and time) - Orientation in Space/Place (country, county, city, hospital, ward/floor) - Registration (ATP - Apple, Table, Penny/Pencil) - Attention and Calculation (spell WORLD backwards) - Recall (remember ATP words)

MMSE - Score

- 24-30: Normal (no cognitive impairment) - 18-23: Mild Cognitive Impairment - 0-17: Severe Cognitive Impairment

Communication Tips Flashcards

(32 cards)