Head to toe Flashcards
(29 cards)
Systems review
FLAWS
Cardio - Chest pain, SOB
Resp - cough (blood), wheeze
Upper GI - Dysphagia, N+V
Lower GI - tummy pain, Bowel Habit changes, Blood in stools
Gento urinary - urinating more? Blood, Discharge from penis/changes in period
Neuro - Headaches, Blackouts/dizziness. Vision
Endo - Feeling hot or cold recently?
Musc - muscle/joint pain.
Skin/Lump - rash or lumps
Headaches
SOCRATES
Diagnosis of exclusion = GIMMIST:
GCA - pain when eating/tender scalp
ICP - coughing, straining, position (lying down/standing)
Migraines - sound/smell/light
Meningitis - stiffness of neck
Sinusitis - movement
Trigeminal neuralgia - Pain on touching face or shaving
Tension headache - stress
CHocolate, CHeese Oral contraceptive pill Caffeine alcohOL Anxiety Travel Exercise
Associated Sx:
Previous head injuries
Altered level of consciousness
N & V
Fits, faints, funny turns
Altered smell/hearing
Sensory disturbances - paresthesia, paresis, paralysis
Tremor
Vision
Loss of memory
Anxiety
Depression
Loss of consciousness
Before: What are you doing at the time? Eating and drinking water? Did you get any warning signs (before these events come on, can you predict that it was going to happen? Do you see any lights or anything) e.g. dizziness, funny lights, SOB? Have you had any previous head injury?
During: Has anyone seen these events happen? How long do they last? Any tongue biting, urinary/faecal incontinence? Funny movements? Are you aware during it?
After: How long does it take to recover? Were you confused?
Has this ever happened before? - if yes then ODPARA
(When was the first time? Is it getting better or worse? Anything that brings it on?)
PANFASTVLAD
Cardiac associated symptoms (palpitations, chest pain, SOB, swelling/pain in the legs?)
FLAWS
Systems review
Dysphagia
S: Where does it get stuck? O: When did it start? Progressive/intermittent? How long does it last? Getting better or worse? C: Solids/liquids? Swallowing saliva? R: A: Triple H Was Not Crap T: Worse at any time of day, E: Anything make it better or worse? Pickles. Does drinking cold water make it better? S:
Heartburn Haematemesis Hoarse voice Weight loss Nausea Coughing/choking Regurg Anaemia Pain (SOCRATES)
Risk factors - smoking, alcohol, pickled food (GORD), medication
Then carry on with FLAWS + systems review
Vomiting history
QUANTIFY - How much (cupfuls)?, How often? Same each time?
QUALIFY - Colour? Any food in it? Blood? Watery or thick?
O: When did this start?
D: How long does it last when you start vomiting?
P: Has it been getting worse?
A: Does anything make the nausea/vomiting go away?
R: Does anything bring the vomiting on?
A:Is there anything you’d like to add?
ABDO systems review (if jaundice then itching + skin colour)
Associated Sx:
Triple H Was Not CRAP (from dysphagia)
Upper GI: Ulcers, difficulty/pain swallowing, nausea and vomiting (blood?), coughing up blood, heartburn, chest pain,
Lower GI: abdo pain, bowel habits (qualify + quantify and blood), bleeding from back passage, pregnancy
Diagnosis of exclusion = 3Ps
Any change you might be Pregnant?
Any Previous head injury?
Any Peculiar food you’ve eaten recently?
(there’s other shit but covered by system review/history)
Drug history - ask about abx
Haematemesis
Qualify/Quantify. Same as vomiting
Additional Qs: Recent GI endoscopy? Long standing hepatic disease
Chest Pain
SOCRATES
Associated Sx
CVS Sx = SOB (exertion, PND, lying down), syncope, palpitation, ankle swelling
Sweating, N&V
Vision blurring, paresthesia of lower limbs
Diagnosis of exclusion: Aortic stenosis - any faints Anaemia - lethargy, change in diet, bowel habits, coughing up any blood or blood in rectum. Ass sweating (and grey face (MI)) and N+V
Palpitations
Have you had this before? ODPARA multiple episodes
Before-during-after (tap out rhythm in during!)
Associated Sx:
Syncope – pre-syncopal/syncopal symptoms
SOB
Sweating
Chest pain
Diagnosis of exclusion:
PTH:
Phaeochromocytoma - episodic headache, sweating, tachycardia, flushing
Thyrotoxicosis - heat intolerance, tremor
Hypoglycaemia - diabetes (poly/nocturia, polydipsia), hunger, dizziness
SOB
Associated Sx:
Cough (characterize, quantify + qualify sputum production)
Wheeze, sputum, haemoptysis, chest pain, fever, rigors, night sweats, weight loss, lethargy, swollen glands
Cough (sputum), wheeze, chest pain, rigors, swollen glands
Haemoptysis
CODPARA
Then Cardiac and resp qs
Then HIBBE(R)T: Headaches (mycoplasma pneumonia) I (intubations) Birds (psittaci) Bone pain (mets) Endo (cushings and hypercalcaemia and lambert eaton) R Travel
PMH:
Frequent infections as a child?
Drug history:
Warfarin
Social:
Pets
Neck lumps
S: Where is it?
O: When did it begin? Sudden or gradual? How did you notice?
C: 3Ss (size, shape, symmetrical), 3Cs (colour, contour, consistency), 4Ts (tethered, tenderness, Temperamental, Temperature), 1D = discharge
R: lumps anywhere else
A: endo Sx + swelling of face (SVCO) + faints (chemodectoma)
T: pain worse at any time of day
E: Anything make it better or worse? Seeing food, eating?
Endo Sx: Menstrual changes Increased/decreased hair Palpitations Increased/decreased urine dryness/hot or cold Difficulty swallowing/changes in voice
Cough
CODPARA
Character - Had this before? Are you coughing anything up or is it a dry cough. QUANTIFY/QUALIFY
Qualify - Do you feel weezy? What colour is the sputum? Is it thick or watery? Is there any blood in the sputum? What does it sound like? (could be bovine or gurgling)
O - When did it begin? Worse at any time of day (asthma)
D
P
A -
R - exercise? Lying flat?
A
FLAWS
HIBBERT
Resp symptoms
Cardio symptoms
Dyspepsia
C- What do you mean by heartburn, Does it fluctuate throughout the day
O-
D-If been going on for a long time, what brought you into hospital?
P
A
R
A- Triple H Was Not CRAP + Gastro systems review + FLAW
Jaundice
O- Acute or Chronic D- How long? P- A R Associated symptoms = UR NIPS:
Urine, Rigors, N&V, Itching, Pain, Stool
Risk Factors - ABCDEF- Alcohol & smoking Blood products/blood borne viruses Coitus Diabetes/drug Expeditions Food/family hx
Abdo pain
S O C - colicky, burning, tender R - to back, scapula, loin → Groin, middle → RIF A - Triple H Was Not CRAP + YURNIPPPS E S
Yellowing, Urine, Rigors, N&V, Itching, Peculiar foods, Pregnancy, PR bleeding
Diarrhoea
(Need to finish)
CODPARA
What do you mean by diarrhoea? Normal bowel habit?
Qualify - colour, very watery, bloody (IBD, infectious, Ca), mucousy, foul smelling/floating (pancreatic cancer, coeliac, CF), pale (chronic panc, gallstones)
Quantify - increased frequency?
C -
O - Acute or gradual? One-off? Every time or intermittent? Nocturnal?
D -
P -
A - Anything bring it on? Particular foods?
R -
A - WHAT UC
WHAT UC = Weight loss, Heat intolerance, Abdo pain, Tenesmus, Urgency, Chunder
Diagnosis of exclusion:
Infectious gastroenteritis - vomiting, fever, sweating
IBD - urgency, weight loss, uveitis, erythema/pyoderma
Malabsorption - weight loss, floating stools
Hyperthyroid - heat intolerance
Functional bowel disorder - sleep disturbance (at night)
Colon Ca - tenesmus
Haematuria
Is there any Pain? Is it real (beetroot, ethambutol, porphyria, rifampacin)
ODPARA
C - Qualify/Quantify - Is there blood for the whole stream or beginning middle end. how clear is it? (smoky shows glomerulonephritis), Colour (brown is retention). Frothy (proteinuria). Are there any clots of blood? Frequency Urgency Nocturia Dysuria
Stream
Hesitancy
Incontinence
Terminal dribbling
FLAWS
Change in bowel habits, back pain, PR bleeding.
Abdo mass
N + V, Numbness
Trauma to back
PMH - recent catheters
Urinary retention
Same as haematuria
Leg swelling
Previous history or similar
SOCRATES for pain/swelling
S - uni/bilateral O - sudden onset C - cramping/ shooting R A - Infective signs, ischaemia, skin changes, ulcers T - Intermittent (claudication), constant (diabetes, cellulitis) E - walking/ resting. Burgers test S
Diagnosis of exclusion = HCDD(R)
Hepatic failure - jaundice
Cardiac failure - review
DVT - travel, pregnancy, OCP, bed rest, surgery, thrombophilia history
Diabetes - polydipsia, polyuria, nocturia
(Renal failure - nocturia, increased frequency)
Weight loss
(quite a lot of crap, so if stuck just whip out a full systems review)
CODPARA:
Most important = characterise = how much, since when/how quickly, intentional, trouser size, happened before
Noticed anything else with it?
FLAWS first for this one
Then exclusion
Diagnosis of exclusion:
HAMIM CDD:
Hyperthyroidism - PATHS = palpitations, anxiety, tremor, hot/cold, sweating/swelling
Addison’s - weakness, dizziness, skin pigmentation
Malnutrition - diet + changes
Infection - fever, N&V, rigors, night sweat, sputum, rashes, lumps
Malabsorption - diarrhoea, abdo pain, vomiting, abdo pain
Cancer - FLAWS
Diabetes - polydipsia, polyuria, nocturia, UTIs(dysuria)
Depression - low mood, early morning weakness
Uro questions- dysuria, hesitancy, stream
PMH - think IBD (bowel resection→ malabsorption)
Personal history- Smoking and recreational drugs
Meds - diuretics + laxatives + thyroxine
Fam history of diabetes and thyroid shiz + malignancies (breast)
TRAVEL HISTORY - dutty diseases
Occupation - stress + sleeping
Diet
Weight
do you know how much you weigh?
Increasing or decreasing?
Noticed clothes getting tighter/looser?
How do you feel about your weight? Any concerns about it? Unintentional loss (malignancy, hyperthy, IBD, diabetes) Unexpected gain (hypothy, Cushing’s, oedema, ovarian cancer) Are you happy with your weight? (anorexia, bulimia, body image disorders)
Can you take me through a typical day’s food and drink? (From wake up to bedtime)
Ask good diet - carbs, protein, fats, fruit + veg (5-a-day)
Ask bad diet - Maccy D’s diet = high fat, sugar, salt
Snacks - in between meals, bedtime, at night
Drinks - fizzy, alcohol, tea/coffee (calorific/vitamin deficiency, anxiety)
Do you eat a special diet? Medically - gluten free Cultural/Religious diet Veggie/vegan Fad diets Food allergies/intolerance
Breast
HPC:
Lump characterisation = 3S 3C 4T 1D
S: Where is the lump? O: When did you notice it? Characterise the lump: how big is the lump? Is it painful? Does it move? Any nipple discharge? Any discharge from the lump? Any changes in your skin? R: A: T: E: Does the size/change with your periods? Is it more painful around your periods S: pain out of 10
Do you have any medical conditions? RF: When did you have your first period? Do you have any children? Did you breastfeed? Do you smoke? Drink alcohol?
Family history
Any family history of breast cancer?
Any family history of ovarian cancer?
Drugs
On the OCT? HRT?
Lethargy
(To be completed)
Diagnosis of exclusion: Anaemia Hypothyroidism Diabetes Renal failure Malignancy Addison’s disease Cardiac failure Chronic infection Depression Chronic fatigue syndrome IBS
Bloody stools
Need to finish!
