History

Question 1

PMHx for patient bleeding

Answer 1

Surgical / dental history
Obstetric history
Trauma history
Ulcers
Jaundice
Kidney disease
Cancer / Chemotherapy
Spleen
NSAIDS / aspirin allergy

Question 2

Hypertension history - symptoms

Answer 2

Headache, nausea, vomiting, blurred vision
Sweat / tremor (Phaeo)
Anorexia / weight loss / lethargy / itch (renal)

Question 3

Mouth ulcer history - symptoms

Answer 3

Onset / location / duration
Associated: Bleeding, pain, discharge, halitosis, sensation, chewing, swallowing, taste, lumps in neck, ear pain, weight loss, fatigue, diet, trauma
Previous ulcers

Question 4

Mouth ulcer history - PMHx

Answer 4

Cancer, infection, HIV, TB, STIs, cold sores, syphillis

Question 5

Constipation history - symptoms

Answer 5

Onset, duration, frequency, character.

Associated symptoms - blood, mucus, diarrhoea, pain, prolapse, diet, lifestyle changes, psychiatric history / mood, neurological symptoms, weight loss, temperature, nausea, anorexia

Question 6

Constipation - PMHx

Answer 6

Hirschsprung’s, abdominal surgery, diverticular disease, haemorrhoids, hypothyroidism, stroke, diabetes, pregnancy, Parkinson’s, MS.

Question 7

Diarrhoea history - symptoms

Answer 7

Onset, timing, context, frequency, amount, character.
Ass sx - blood, mucus, urgency, incontinence, abdominal pain, bloating, vomiting, sick contacts, travelling, lethargy, dizziness.

Question 8

Diarrhoea - PMHx

Answer 8

Past or FHx of IBD / bowel cancer / coeliac disease
Smoking / alcohol

Question 9

HIV and elective surgery history

Answer 9

Introduce and clarify operation
Do they want to have it
Acknowledge HIV
History, current status, general medical / surgical history, social history
HIV history - when dx, sx, how infection, illnesses, labs, medications
Social
Allergies
Questions

Question 10

Reflux history - symptoms

Answer 10

Pain - SOCRATES, relation to meal (duo better with food, gastric worse with food), triggers (coffee, cholesterol, EtOH, smoking, pregnancy, obesity, drugs e.g. NSAIDS)
Regional sx - dysphagia, odynophagia, vomiting, haematemesis, distension, acid, night cough, volume reflux, hoarse voice, night cough, resp sx, burp, regurgitation, malaena
General - weight loss, appetite, sweat, pallor, SOB, early satiety

Question 11

Reflux PMHx

Answer 11

CKD
Hiatus hernia
Prev OGD
Gallstones
Scleroderma
Meds: steroids, iron, NSAIDs

Question 12

Reflux investigations

Answer 12

FBC, iron studies
CXR
ECG
Urea breath test or stool antigen test for H pylori
Endoscopy + biopsy
Manometry (oesophageal motility study)

Question 13

Jaundice history HxPC

Answer 13

Onset - when started, intermittent or constant
How noticed - eyes / skin / urine / stool
Pruritis
Previous episodes

Question 14

Jaundice history - risk factor questions

Answer 14

Viral symptoms
Travel
Drugs
Blood transfusions
Pain (obstruction)
Weight loss
Pregnancy

Question 15

Jaundice history - PMHx

Answer 15

Anaemia / sickle cell
Hepatitis
Liver disease
Gall stones
Biliary surgery
Breast or bowel cancer

Question 16

Jaundice history - FHx

Answer 16

Hereditary spherocytosis
Gilberts syndrome
Jaundice

Question 17

Jaundice history - SHx and Medications

Answer 17

Alcohol
Drugs
Occupational exposure to hepatotoxic chemicals
Meds: OCP, paracetamol

Question 18

Claudication history - symptoms

Answer 18

Pain - site, onset, character, duration, aggravating / relieving factors (night, rest, stairs), radiation, severity
Walking distance
Associated symptoms - cold intolerance, sores on feet, buttock pain, impotence, chest pain, fainting episodes, visual disturbance, neurology suggestive of a stroke
Previous episodes and how they were managed

Question 19

Claudication history - PMHx, SHx

Answer 19

IHD
CVA
DM
HTN
Hypercholesterolaemia
Renal disease

Medications and allergies

Smoking, drinking, occupation

Question 20

Leg ulcer history - symptoms

Answer 20

Location
- Venous painless unless infected
- Arterial painful especially when legs elevated
Discharge
Bleeding
Cosmetic - arterial = punched out
Progression - how changed, shape, size, pain, ever disappear
Prior rx
Associated sx - other ulcers, local LNs, infection, claudication, white/blue shiny feet
Impact on work / social life

Question 21

Leg ulcer history - PMHx

Answer 21

Diabetes
Smoking
Alcohol
Steroids
Venous or arterial disease (claudication)

Question 22

Causes of leg ulcers

Answer 22

Venous insufficiency - leg swelling, varicose veins, pigmentation, high BP, sitting or standing for long periods, fracture or injury, previous surgery, obesity

Arterial insufficiency - diabetes, smoking, high cholesterol, high BP, renal failure, RA, obesity, PVD, clotting disorders

Trauma

Malignancy - skin cancers

Neuropathic - spine or neurological disorder, decreased sensation

Vasculitis - IV, SLE, RA

Psychiatric

Question 23

Carpal tunnel history - symptoms

Answer 23

Onset
Unilateral or bilateral
Duration
Character
Aggravating - ? nocturnal
Relieving - ? shaking hand
Severity
Impact on activities
Radiation to arm

Ass sx:
Weakness
Clumsiness
Numbness
Cold intolerance (thyroid)
Injury
Wrist arthritis
Pain or lumps in axilla or neck
Weight change

Impact on ADLs

Question 24

Carpal tunnel - PMHx and SHx

Answer 24

Pregnant
Arthritis
Myxedema
Acromegaly

Occupation, smoking, alcohol, activities

Question 25

Causes of carpal tunnel syndrome

Answer 25

Pregnancy Obesity Hypothyroidism Acromegaly Diabetes Amyloidosis Occupation RA

Question 26

Paediatric history - HxPC

Answer 26

Details of presentation Related symptoms: oral intake, diet, breast or bottle fed, wet nappies (hydration), blood in motions Ask parent concerns

Question 27

Paediatric history - birth

Answer 27

Maternal medical and obstetric history History of pregnancy Delivery - when and what method Complications Gestation and birth weight Events since delivery

Question 28

Paediatric history - developmental

Answer 28

Movement and posture - gross and fine motor skills Vision and manipulation Hearing and speech Social behaviour

Question 29

Paediatric history - SHx, FHx, Psych

Answer 29

Immunisation status SHx Who is at home, siblings also healthy Smoking Issues with school FHx Psych Symptoms Impact RFs for mental health Strength and protective factors Abuse??

Question 30

Breast lump history - lump

Answer 30

Onset Trauma Hormones / menses association Location Duration Character - size / shape / feel / compressible

Question 31

Breast lump history - associated symptoms

Answer 31

Pain Redness Itch Discharge Nipple changes / retraction Skin changes - discolouration / peau d'orange Lymph nodes Weight loss Anorexia SOB Dizzy Bone pain Other lumps Menstrual history - menarche, childbirth, age, breastfeeding, LMP Previous episodes History of breast cancer Mammograms Investigations previously

Question 32

Breast lump history - PMHx / meds / FHx

Answer 32

Usual PMHx OCP / HRT FHx breast cancer / BRCA

Question 33

DDx breast lump

Answer 33

Benign: Fibroadenoma Cyst Fat necrosis Lipoma Acute mastitis Abscess Galactocele Mammary duct Malignant: Breast cancer

Question 34

Neck lump history - lump

Answer 34

Onset Location Duration Progress / change in shape / size / position Exacerbation - swallowing, tongue protrusion Past history of lumps