Exploring symptoms - Physical symptoms

Question 1

How would you explore the symptom of tiredness?

Answer 1

• What they mean
• Sleep - hours, quality, snoring/apnoea
• How it affects the patient
• Associated symptoms
  
  • Anaeamia symptoms
  • Hypothyroid symptoms
  • Depression symptoms
  • Diabetes symptoms

Question 2

What associated symptoms would you want to ask about in someone with tiredness?

Answer 2

• Anaemia
• Hypothyroid
• Depression
• Diabetes

Question 3

What symptoms of anaemia would you want to ask about in someone describing symptoms of tiredness?

Answer 3

• SOB on exertion
• Dizziness
• Headache
• Chest pain - if angina

Question 4

What hypothyroid symptoms would you want to ask about in someone reporting tiredness?

Answer 4

• Constipation
• Feeling cold
• Weight gain
• Menorrhagia

Question 5

What depression symptoms would you want to ask about in someone with feeling tired all the time?

Answer 5

• Mood
• Early morning waking
• Anhedonia

Question 6

What diabetic syptoms would you want to ask about in someone with tiredness?

Answer 6

• Polyuria
• Polydipsia
• Weight loss

Question 7

What would you want to ask about in relation to someone having a headache?

Answer 7

• SOCRATES pain
• Red flags
  
  • Meningism symptoms
  • Temproal arteritis symptoms
  • Galucoma symptoms
  • SAH symtpoms
  • GCA symptoms
  • SOL/ICP symptoms
  • Trauma
• Associated neurological symptoms

Question 8

What symptoms of meningism would you want to ask about in someone with a headache?

Answer 8

• Neck Stiffness
• Photophobia
• Fever
• Headache
• Rash

Question 9

What symptoms of glaucoma would you want to ask about in someone with a headache?

Answer 9

• Visual blurring
• Red eye
• Halo around lights

Question 10

What would you ask when asking about temporal arteritis as part of exploring headache?

Answer 10

• Scalp tenderness
• Jaw claudication
• Scalp Tenderness

Question 11

What are red flag symptoms of a headache?

Answer 11

• Signs of meningitis
• Signs of temporal arteritis
• Signs of raised ICP
• Signs of SOL
• Signs of glaucoma
• Trauma
• Signs of SAH

Question 12

How would you explore weakness as a symptom?

Answer 12

• Pattern of weakness
• Characterise weakness
• Associated neurological symptoms

Question 13

When exploring symptoms of weakness, what is meant by asking someone to characterise the weakness?

Answer 13

Asking if it is constant, fatiguable etc.

Question 14

What would you want to ask about when exploring the symptom of SOB?

Answer 14

• Current vs normal exercise tolerance
• Orthopnoea
• PND
• Diurnal/seasonal variation
• Associated cardiorespiratory symptoms

Question 15

What would you ask about in someone with a fall when exploring what happened?

Answer 15

• Before - warning/circumstances
• During - duration, LOC, movements, incontinence/tongue biting, complexion
• After - amnesia, muscle pain, confusion/sleepiness, impact
• Background to attacks - previous, frequency
• Associated cardioresp/neuro symptoms

Question 16

What would you ask about when exploring the symptom of a cough?

Answer 16

• Productive/unproductive
• Triggers
• Nocturnal
• Assocaited cardiorespiratory symptoms

Question 17

What would you want to ask about in terms exploring the symptoms of sputum?

Answer 17

• How much
• How often
• Colour
• Consistency
• Any blood

Question 18

What would you ask about when edploring the haemoptysis?

Answer 18

• Volume
• Frequency
• Fresh/altered
• Nature of associated sputum

Question 19

What questions would you ask about palpitations when exploring it as a symptom?

Answer 19

• Fast or slow
• Regular or irregular
• Dizziness/LOC
• Nausea
• Sweating/clamminess
• Dyspnoea
• Associated cardiorespiratory symptoms

Question 20

What would you want to ask when expploring the symptoms of diarrhoea/vomiting/constipation?

Answer 20

• How much
• How often
• Any at night
• Colour, consistency, contents (mucus, blood, bile if vomit)
• Weight loss
• Appetite/intake
• Associated GI symptoms

Question 21

What would you want to ask about when exploring dyshpagia?

Answer 21

• Solids/liquids/both - which came first
• Constant/intermittent
• Progressive/non-progressive
• Odynophagia
• Weight loss, food intake
• Associated GI symptoms
• ALARM symptoms

Question 22

What would you want to ask when exploring symptoms of dyspepsia?

Answer 22

• SOCRATES
• Associated GI symptoms
• Red flag symptoms

Question 23

What are red flag symptoms of reflux?

Answer 23

ALARMS >55

• Anaemia
• Loss of weight
• Anorexia
• Recent onset progressive
• Malaena/haematemesis
• Swallowing difficult
• >55

Question 24

What would you want to ask about when exploring symptoms of Vaginal discharge?

Answer 24

• Quantity
• Colour
• Odour
• Itching
• Associated gynae symptoms

Question 25

What would you want to ask about when explorig symptoms of PV bleeding?

Answer 25

* **Type** - menorrhagia, intermentrual, post coital, post-menopausal * **Quantitiy** - number of towels/tampons, passage of clots/flooding * **Pain with blood loss** * **Anaemia symptoms** * **Thyroid symptoms** * **Chance of preganncy** * **Associated gynae symptoms**

Question 26

What would you ask about when exploring sceondary amenorrhoea?

Answer 26

* **General** - weight loss, stress, exercise, diet * **Head** - visual problems, headaches * **THyroid** - heat intolerance, tremor, palpitations, diarrhoea * **Torso** - hirsuitism, acne * **Abdomen** - possible pregnancy

Question 27

What would you ask about when exploring back pain?

Answer 27

* **SOCRATES** * **Early morning stiffness** * **Sciatica** * **Urinary incontinence/retention** * **Faecal incontinence/retention** * **Associated neuro symptoms**

Question 28

What are red flag symptoms of back pain to watch out for?

Answer 28

* **Urinary/faecal symptoms** * **Bilateral leg pain** * **Severe progressive neuro deficit** * **Decreased anal tone** * **Saddle anaesthesia** * **Weight loss** * **Fever/Night sweats** * **Immunocompromise** * **Trauma** * **Severe central spinal pain** * **Deformity** * **Early morning pain** * **Worse with rest**

Question 29

What would you want to ask about when exploring symptoms of joint pain/stiffness/swelling?

Answer 29

* **Worse in the morning - how long** * **Better/worse with exercise** * **Sleep disturbance** * **Loss of function** * **Associated rheumatological symptoms**

Question 30

What would you ask when exploring symptoms of Bone/tissue/joint injury?

Answer 30

* **SOCRATES** * **Stiffnes/swelling** * **ROM** * **Ability to weight bear** * **Mechanical symptoms - locking, giving way** * **Neuro symptoms distally** - weakness, numbness, paraesthesia

Question 31

What would you ask when exploring the symptom of a rash?

Answer 31

* **Duration** * **Progression** * **Frequency** * **Sites, size, shape** * **Description** - looks like; blisters; colour;does it blanch * **Secondary features** - itching/painful, crusting * **Exacerbating/relieving factors** - heat, sunlight, cold, allergies * **Associated rheumatological symptoms**