Histories

Question 1

What must you ask in regards to vomiting?

Answer 1

• colour: bile, blood, clear
• frequency
• how much
• triggers?

Question 2

What must you ask in regards to changes in bowel habit?

Answer 2

• establish normal
• constipation/diarrhoea
• steatorrhoea
• Mucus
• Blood and it’s colour
• frequency of change?

Question 3

List some associated symptoms in GI history?

Answer 3

• n/v
• change in bowel habit
• rectal bleeding
• mouth ulcers
• reduced appetite
• weight loss
• jaundice
• fever

Question 4

What specific q do you ask about family history in GI hx?

Answer 4

IBD, cancers

Question 5

What do you ask in a joint pain history?

Answer 5

• site: bilateral or uni, symmetry, joints affected, changed or evolved
• stiffness and time of stiffness
• hand deformities or nail changes
• appearance-:red or swollen or blue
• fever
• weight bear?
• trauma
• urinary sx and visual sx
• diarrhoea
• skin nodules or rashes

Question 6

PMHx / Fx in joint pain history?

Answer 6

• PMHx of ra/oa/osteoporosis
• Fx of psoriases, ra, IBD, cancers

Question 7

What are some things you’d ask about in a urinary hx?

Answer 7

• FUNI SHID
• fever
• flank mass or pain
• urine appearance
• recent flu like symptoms
• stool changes
• headaches?
• change in sexual activity or partner?

Question 8

Elderly male with voiding symptoms?

Answer 8

BPH

Question 9

Elderly male with painless haematuria?

Answer 9

Bladder cancer

Question 10

F postpartum with incontinence?

Answer 10

Stress incontinence

Question 11

Overweight px w polydipsia, polyuria and initial weight loss?

Answer 11

T2DM

Question 12

3 sections of a collateral hx

Answer 12

Before during after

Question 13

What to ask about before a collapse?

Answer 13

• triggers?
• prodromal sx: aura, nv, tinnitus, visual or olfactory disturbances, déjà vu

Question 14

Qs to ask about during a collapse?

Answer 14

• lose consciousness?
• injury?
• signs of seizure?
• vomit?
• incontinence?
• signs of cyanosis?

Question 15

Qs to ask about after a collapse?

Answer 15

• how long did it take to return to normal state?
• anything that helped resolve?
• in any pain?

Question 16

Syncopal épisode while driving?

Answer 16

Advise not to drive till fully investigated!

Question 17

Generally how do you navigate a chronic disease hx station?

Answer 17

1. Understanding why the pt is here, what they understand about the results and it it’s abnormal or not
2. Symptoms: how the pt is currently feeling, symptoms they get with condition or any new sx
3. PMHx: specific for certain ones
4. DHx: what meds, instructions, missed any doses, coping okay with regime
5. SHx, same as standard plus impact condition has on daily life
6. FHx: condition specific

Question 18

Things to consider in a diabetic review concerning HBA1c levels?

Answer 18

• do the patient know why they’re here?
• establish t1 or 2
• positives of HBa1c reduction
• current symptoms
• then standard DHx, SHx, impact on life

Question 19

What do peak flow and spirometry measure?

Answer 19

Peak flow is total lung volume (FVC)
Spirometry generates functional lung capacities

Question 20

Restrictive spirometry?

Answer 20

Reduced FEV1 and FVC but normal ratio

Question 21

Obstructive spirometry?

Answer 21

Reduced FEV1 and slightly reduced FVC
Reduced ratio

Question 22

Things to cover in LFTs counselling?

Answer 22

• explain results, establish why pt is here
• sx: how are you feeling? Jaundice, RUQ pain, flu like sx
• DHx and vaccines
• SHx of alcohol, ivdu, recent travel, contaminated food, sexually active plus impact
  FHx of Gilbert’s

Question 23

Main thing to cover in cancer marker counselling?

Answer 23

Explain tumour markers are non specific so may be raised in cancer but there are also other reasons