Histories

Question 1

Neurological history

Answer 1

General
Fits/falls/LOC
Headache
Dizziness
Vision/hearing
Memory loss
Neck stiffness/photophobia
Motor
Weakness
Incontinence
Sensory
Pain
Numbness
Tingling

Question 2

ENT history?

Answer 2

Ear
Hearing loss
Tinnitus
Otalgia
Nose
Rhinorrhoea
Epistaxis
Throat
Sore throat
Odynophagia

Question 3

Cardio history?

Answer 3

Chest pain
Palpitations
SOB/wheeze
Cough
Sputum
Haemoptysis
Leg swelling

Question 4

Always remember?

Answer 4

ICE and FLAWS!!

Question 5

GI history?

Answer 5

Weight loss
Appetite change
Dysphagia
Nausea/vomiting
Indigestion/heartburn
Abdominal pain
Bowel habit
Tenesmus
Blood/mucus in stool
Flatus

Question 6

Urological history

Answer 6

Storage
Frequency
Volume
Urgency
Nocturia
Incontinence (overflow/stress/urge)
Infection
Dysuria
Haematuria
Odour
Prostatic/voiding (if male)
Hesitancy
Poor flow/dribbling
Feeling of incomplete emptying

Question 7

Rheum history?

Answer 7

Joints
Pain
Stiffness
Swelling
Work down body
Skin (rashes, ulcers, Raynaud’s)
Hair loss
Eyes (redness, dryness)
Mouth (dryness)
Chest (breathlessness, SOB)
GI (IBD symptoms)
Genitourinary (discharge)

Question 8

Orthopaedic history?

Answer 8

Joints/bone/soft tissue
Pain
Stiffness
Swelling
Movement restriction/ability to weight-bear
Mechanical symptoms
Locking
Giving way
Neurological symptoms distally
Weakness
Numbness
Paraesthesia

Question 9

Respiratory history?

Answer 9

Cough +- productive
Wheeze
SOB
Chest pain
FLAWS
HEPS = occupation, pets, smoking, allergens
Childhood infections

Question 10

Hypothyroidism symptoms:

Answer 10

constipation, weight gain, cold intolerance, menorrhagia

Question 11

Glaucoma symptoms:

Answer 11

visual blurring, red eye, halos around lights

Question 12

Headache Red Flags:

Answer 12

Intracranial bleed: thunderclap headache, recent trauma
Raised intracranial pressure: posture/Valsalva-related
SOL: immunosuppression, malignancy, focal neurology, onset >50 years
Meningitis: rash, fever, neck stiffness, photophobia
Giant cell arteritis: visual problems, jaw claudication, scalp tenderness
Glaucoma: visual blurring, red eye, halos

Question 13

SOB?

Answer 13

Current vs. normal exercise tolerance (what makes them stop?)
Orthopnoea
Paroxysmal nocturnal dyspnoea
Diurnal/seasonal variation if chronic

Question 14

Sputum questions

Answer 14

How much, how often
Colour, consistency
Any blood

Question 15

Palpitations?

Answer 15

Fast or slow
Regular or irregular (ask patient to tap out palpitation on table)
Any dizziness, LOC, nausea, sweating/clamminess, dyspnoea
Associated cardiorespiratory symptoms (see systems review)

Question 16

Dysphagia questions?

Answer 16

Solids/liquids/both, which came first
Constant/intermittent, progressive/non-progressive
Odynophagia
Weight loss, food intake
Associated gastrointestinal and neurological symptoms (see systems review)

Question 17

Back pain red flags?

Answer 17

Cauda equina: urinary incontinence/retention, faecal incontinence/constipation, bilateral leg pain, severe/progressive neurological deficit, decreased anal tone/saddle anaesthesia
Infection or cancer: age <20 or >55 years at onset, weight loss, fever/night sweats, recent infection, cancer history, injecting drugs, immunosuppression
Fracture: trauma, severe central spinal pain, structural spine deformity, spinal tenderness
Spondyloarthropathy: early morning stiffness, night pain, worse with rest

Question 18

Joint pain/stiffness?

Answer 18

Worse in morning?, how long for (>30 minutes suggests inflammatory cause)
Better with exercise (inflammatory) or worse after exercise (osteoarthritis)
Sleep disturbance
Loss of function
Associated rheumatological symptoms (see systems review)

Question 19

Dementia history questions?

Answer 19

Living situation, carer/home support
Mobility/walking aids
Effect on function/coping with activities of daily living: washing, dressing, cooking, cleaning
Working/driving
Smoking, alcohol and other cardiovascular risk factors

RISK:
To self: wandering, leaving gas on, abuse, neglect by self or others
To others: aggression, risky behaviour
Carer’s needs: empathise with the demands; ask about stress, coping, and support

Question 20

Metallic valve replacement sounds?

Answer 20

Abnormal S1 = mitral
Abnormal S2 = aortic

Question 21

Pulmonary fibrosis signs?

Answer 21

Oxygen therapy
Dry cough
Tachypnoea
Reduced expansion
Fine end-inspiratory crepitations

Question 22

Pleural effusion signs?

Answer 22

Reduced expansion
Stony dull percussion note
Reduced breath sounds
Reduced tactile fremitus and vocal resonance

Question 23

Causes of Distension?

Answer 23

(5Fs: Fluid, Flatus, Fat, Fetus, Faeces),

Question 24

Proximal weakness → Normal sensation

Answer 24

DENIM:

Dystrophies – Becker’s/Duchenne, limb girdle, facioscapulohumeral (shoulder, face and truncal weakness)
Endocrinological – Cushing’s syndrome, hyper/hypothyroidism, diabetic amyotrophy (lower limbs)
Neuromuscular – myasthenia gravis (fatigable), Lambert–Eaton myasthenic syndrome
Inflammatory – dermato-/polymyositis, inclusion body myositis (proximal in legs but distal in arms), viral myositis
Metabolic/congenital/mitochondrial myopathies

Question 25

Complex ophthalmoplegia causes?

Answer 25

Soft tissue – Graves’ disease Muscle – mitochondrial myopathy Neuromuscular junction – myasthenia gravis (test fatigability) Multiple CN’s – cavernous sinus lesion, mononeuritis multiplex, MS Brainstem – stroke, SOL, trauma

Question 26

SOB key differentials?

Answer 26

PE Pneumothorax Asthma/COPD Pneumonia Acute LVF (heart failure) ACS

Question 27

Chest pain key differentials?

Answer 27

ACS PE Aortic dissection Pneumothorax Pneumonia

Question 28

Abdo pain key differentials?

Answer 28

AAA, peritonitis, ischaemic bowel Cholecystitis, cholangitis, pancreatitis, peptic ulcer, hepatitis Appendicitis, IBD, diverticulitis Renal colic, UTI, pyelonephritis Testicular torsion, ectopic pregnnacy, ovarian torsion, PID Medical: DKA, Addison's, MI/pneumonia

Question 29

Headache key differentials>

Answer 29

SOL Subdural/extradural haemorrhage Migraine Cluster headache Tension headache GCA Meningitis Sinusitis

Question 30

definitive imaging in suspected dissection.

Answer 30

CT angiogram

Question 31

Mx of ILD?

Answer 31

Corticosteroids may help in acute exacerbations Antifibrotics (pirfenidone/nintedanib) may be used in idiopathic pulmonary fibrosis Treat/withdraw cause if possible (may include corticosteroids and immunosuppressants) Supplementary measures Smoking cessation Pulmonary rehabilitation Long-term oxygen therapy – indications below Lung transplant (option for some patients)

Question 32

Bronchiectasis mx?

Answer 32

Exercise and improved nutrition Chest physiotherapy Prompt treatment of infections (choose antibiotics based on culture sensitivities) Rotating antibiotics may be used for prophylaxis if recurrent infections Trial of bronchodilator and nebulised hypertonic saline Pneumococcal/influenza vaccines Lung resection may be considered in localised disease with a poor response to medical management

Question 33

Decompensation of liver?

Answer 33

Signs: jaundice, ascites, encephalopathy

Question 34

radio-radial delay

Answer 34

aortic coarctation or aortic dissection.

Question 35

Approach to summarising acute care stastion?

Answer 35

Use SBAR Situation and the background Assesment: Findings of examination etc.

Question 36

Chronic idiopathic demyelinating polyneuropathy (CIDP)

Answer 36

peripheral neuropathy which is mainly motor

Question 37

Poliomyelitis

Answer 37

In old polio, there is a lower motor neurone pattern of weakness with no sensory signs. The signs are often asymmetrical and the lower limbs are more commonly affected than the upper limbs. Patients may have contractures and fixed flexion deformities from long-standing immobility.

Question 38

Meningitis tx?

Answer 38

Ceftriaxone + ampicillin dexamethasone Prophylaxis for contacts

Question 39

Salicylate poisoning

Answer 39

Toxbase Risk assessment Liasion Psych

Question 40

Aortic dissection:

Answer 40

should be in resus. Requires close monitoring. IV labetalol + CT

Question 41

Cardiogenic shock treatment?

Answer 41

Dobutamine

Question 42

Displaced apex beat causes?

Answer 42

AR/MR

Question 43

Pronator drift is really important: which side?

Answer 43

Ipsilateral

Question 44

PURE MOTOR PROBLEM?

Answer 44

Polio

Question 45

Portal hypertension signs?

Answer 45

Splenomegaly, ascites, caput medusae

Question 46

Causes of ascites?

Answer 46

Liver failure, nephrotic syndrome, portal hypertension, ovarian malignancy

Question 47

Intraperitoneal organs?

Answer 47

include the stomach, liver and spleen.

Question 48

Retroperitoneal?

Answer 48

oesophagus, rectum and kidneys are all primarily retroperitoneal.

Question 49

Hypoglycaemia symptoms?

Answer 49

feeling shaky. feeling confused. sweating. being anxious or irritable. going pale. palpitations and a fast pulse. lips feeling tingly. blurred vision.

Question 50

Glucose targets for T1DM?

Answer 50

* a fasting plasma glucose level of 5 to 7 mmol/litre on waking and * a plasma glucose level of 4 to 7 mmol/litre before meals at other times of the day. [2015]