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History Specific Qs Flashcards

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1
Q

Chronic dry cough - 5 causes

A

Asthma, GORD, COPD, Pulmonary oedema, lung cancer

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2
Q

Chronic prod cough

A

Bronchiectasis, TB, lung cancer

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3
Q

Acute dry cough causes

A

Asthma, URTI, small PE, inhaled foreign body, lung cancer, pulmonary oedema

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4
Q

Prod acute cough

A

Pneumonia, TB, bronchitis,

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5
Q

Cough Hx SOCRATES character

A

Wheeze/haemoptysis/stridor/painful

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6
Q

Cough Hx SOCRATES Timing

A

Night -> asthma

Lying flat -> pulmonary oedema

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7
Q

Cough Hx SOCRATES associated

A

FLAWS rigors - malignancy
SOB - asthma, COPD, pneumonia, pulmonary oedema….
Chest pain - pneumonia, pneumothorax, PE, pleurisy
Wheeze - asthma COPD

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8
Q

Cough PMHx MJ THREADS

A

MI TB HTN RhF ASTHMA
Freq childhood infections - bronchiectasis
Recent intubation

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9
Q

Cough FHx

A

Asthma
HF
Lung cancer

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10
Q

Cough SHx

A

Asbestos
Travel
Close contact illness
Pets at home

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11
Q

Cough Hx asthma importants

A 
When diagnosed 
Control
Hospital admission
Medications 
Triggers
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12
Q

Abdominal Pain Hx SOCRATES associated top to bottoming in

A 
Heartburn - GORD gastric ulcer 
Haematemesis - UGI bleeds
N+V - cholangitis, pancreatitis, Ob bowel, infective causes
Pain on inspiration - Acute chol
Steatorrhoea - pancreatitis, coeliacs, crohns
Jaundice - hepatobiliary, pancreatitis 
PR bleed - ischaemic, IBD, perforated divert, Gi malignancy etc etc
Change in bowel habits
Haematuria - renal calc, pyelonephritis
Fever 
Rigors - pyelonephritis 
Sweating and weakness - MI AAA rupture 
SOB - DKA
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13
Q

Abdominal Pain Hx SOCRATES exacerbations

A

Pancreatitis - coughing, eating, alchohol, movement - relief forwards
Cholecystitis - deep inspiration, fatty foods
Peptic ulcer - lying down (food for gastric/better duo)
Perforation - movement
Isch - eating

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14
Q

Abdominal Pain Hx EXCLUSIONS

TOP TO BOTTOM

A 
Ectopic - pregnancy 
Hep/gastroenteritis - recent travel/food, sex
IBD + coeliacs - FHx + Hx
Ulcers - Alcohol + NSAIDs
DM - Hx
Ruptured organ - trauma 
Ischaemia - CVD Hx
Pancreatitis - recent endoscopy 
Hep B - sexual risks
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15
Q

Abdominal Pain Hx PMHx

A

MJ THREADs
MI, Jaundice, HTN, DM, stroke
Abdo illness
Endoscopy and surgery

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16
Q

Abdominal Pain Hx DHx

A

NSAIDS

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17
Q

Abdominal Pain Hx FHx

A

DM, CVD, IBD, Coeliacs

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18
Q

Abdominal Pain Hx SHx

A

Sexual Hx, travel

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19
Q

CVS systems review

A 
SOB
Syncope
Ankle oedema 
Chest pain 
Claudication
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20
Q

Resp systems review

A

Cough
Sputum
Haemoptysis
Wheeze

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21
Q

GI systems

A 
Appetite 
WL 
Vomiting 
Haematemesis/Melaena
Fresh blood 
Bowel habits 
Abdo pain
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22
Q

CNS systems rev

A 
Headache
Visual disturbances 
Syncope
Weakness
Parasthesia
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23
Q

GU systems review

A

Haematuria
Dysuria
Frequency
Voiding difficulties

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24
Q

Locomotor systems review

A 
Joint pain/swelling
Morning stiffness 
Back pain 
Nocturnal back pain 
Rash
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25
SOB Hx SOCRATES ASS
``` Cough Wheeze Sputum Chest pain Fever Rigors WL Sweats Swollen glands Weakness Tender limbs ```
26
SOB Hx Exclusions | CHAPDV
``` HF - orthopnoea, oedema, frothy, PND, Valvular - RhF, dizziness, syncope Diabetes - Hx Anaemia - diet, malabsorption, GI bleed Pulmonary fibrosis - Hx asbestos, silica, coal, methrotrexate Chronic asthma COPD - sputum > 3 months ```
27
SOB Hx PMHx
MJ THREADS ``` MI TB HTN RHF ANAEMIA DM Asthma Asthma - Hospital/medications/control/PEFR diary Lung disease Hx Heart problems Eczema, hay fever ```
28
SOB Hx FHx
TB, lung conditions hereditary, asthma, thrombosis
29
Haemoptysis Hx Causes
TB, malignancy, PE, LVF, iatrogenic, warfarin
30
Haemoptysis Hx character
Amount | Whether it is haemoptysis ie nosebleed, gums, sick
31
Haemoptysis Hx Associated
Cough, WL, Pain, SOB, PND, Orthopnoea, oedema, leg swelling, muscle pains
32
Haemoptysis Hx Exclusions | TTMMCE
``` Trauma TB / legionella - Travel M.pneumonia - headaches Malignancy C psittaci - birds Extrapulmonary - cushings, hypercalcaemia - polyuria dipsia ```
33
Haemoptysis Hx PMHx
MI TB HTN RHF ASTHMA | Thrombophilia, recent intubation
34
Haemoptysis Hx DHx
Warfarin, drug allergies
35
Haemoptysis Hx FHx
Lung cancer, HF
36
Haematemesis Hx Causes
Varices (ALD), mallory, oesophagitis, oesoph cancer, post endoscopy, peptic ulcer, gastric cancer, resp cough
37
Haematemesis Hx Associated
Jaundice, WL, Pain, dysphagia, before/after vomit, Alcohol amounts
38
Chest pain Hx Red flags
ACS, AD, pneumothorax, PE, Borhaaves
39
Chest pain Hx associated
SOB, syncope, dizziness, palpitations, oedema, PND, sweating, N+V, vision blurring, parasthesia lower limbs
40
Chest pain Hx exclusions | MAPA ACS
Pericarditis - relief forwards and fever AS - syncope Anaemia - lethargy, GI bleed, diet, malabsorption Malignancy - FLAWS
41
Chest pain Hx PMHx
Cholesterol HTN Lipid (fat) levels, Hx cardiac disease, MI Hx, surgery Hx, prev hospital admissions
42
Chest pain Hx DHx
GTN, aspirin, statin, antihypertensive, drug allergies
43
Palpitations Hx Causes
``` Pharm - caffeine, cocaine, adrenaline, thyroxine, atropine, nifedipine PE, SVT, WPW, CCF Endo - Phaeo, hypoglycaemia, thyrotoxicosis Anaemia/infections HOCM Anxiety, stress, pregnancy Vasovagal AF, flutter, ectopics ```
44
Palpitations Hx Exclusions | CTPH
Cardiac - chest pain, exertional dyspnoea, oedema, PND, Thryotoxicosis - heat intolerance, WL, tremor, appetite increase, sweating Phaeo - Episodic headache, sweating, tachy, tremor HypoG - DM, anxiety, dizziness, missed meal/OD
45
Palpitations Hx PMHx
``` MI HTN RhF DM CVA Hx angina Depression/anxiety Thyroid disease Pacemaker ```
46
Palpitations Hx DHx
GTN spray, aspirin, statin, hypertensives, allergic
47
Palpitations Hx FHx
Cardiac disease - HF, MI, angina, arrhythmia | Prem cardiac death
48
Dyspepsia Hx causes
Gastritis, peptic ulcer, GORD, oesoph gastro cancer, achalasia Pancreatitis Cardiac chest pain
49
Dyspepsia Hx SOCRATES Assoc
``` WL - Malig Haematemesis - ulcer Dysphagia - oesoph cancer/achalasia Lethargy / weakness - malignancy anaemia Vomiting - gastritis / cancer Bloating / fullness - gastric cancer Jaundice - chron panc / panc C Early satiety - chron illness/malig Certain food / lying down - GORD /// ulcer exacerbation ```
50
Dyspepsia Hx PMHx
Jaundice MI Hpylori gallstones indigestion | Endoscopic procedures
51
Dyspepsia Hx DHx
NSAIDs Aspirin
52
Dyspepsia Hx FHx
Gastric carcinoma MI
53
Jaundice Hx MOST IMPORTANT STEP
After pt speaks - pre/hep/post = the best way to eliminate | SKIN/EYES/EVEN YELLOW???
54
Jaundice Hx SOCRATES associated
``` RUQ NV pruritus arthralgia - hepatitis viral/a/i/drugs/ald RUQ, fever, insp pain - cholecystitis Fever/diarrhoea - viral hep, ascending chol, abscess WL - malig Steatorrhoea - panc/hep/panc-cancer Pain abdo - anything localises Bronzed and DM - haemochromatosis Hepatospenomegaly - ALD, Hep, HPC Spleno - malaria, hep A Joint pain - HEP Pruritus - PBC, PSC ```
55
Jaundice Hx Timing
Episodic = haem anaemia / gallstones potentially
56
Jaundice Hx exclusions H+T
Recent travel - malaria Contact with jaundice - hep A/E Hep RFs - IVDU, Sex, tattoos, blood transfusions
57
Jaundice Hx PMHx
``` Jaundice Gallstones DM Liver disease, UC, ERCP, surgery, transfusions, ```
58
Jaundice Hx DHx
OCP, aspirin, steroids,
59
Jaundice Hx FHx
Sickle, jaundice, thalassaemia, G6P, liver disease
60
Constipation Hx DDx
Depression, IBS, hypothyroid, autonomic neuropathy, MS, dec diet fibre, SCC, dehydration, DRUGS - opiates, CCBs, antidepressants Obstruction - SBO, BO, hernia, strictures, malignancy, adhesions, volvulus, Pushing problems - haemorrhoids, anal fissure, prolapse, pelvic floor dysfunction
61
Constipation Hx SOCRATES Character - consistency
Pellet stool - IBS No flatus - ob Straining Pain when passing
62
Constipation Hx SOCRATES associated
FLAWS - malignancy Intermittent diarrhoea - IBS, cancer diverticulae Tenesmus - tumour, crohns Bleeding PR Neurological signs - autonomic neuropathy / SC N+V - SBO Thyroid - Bradycardia, mental slowing, dec appetite, weight gain Polyuria and thirst - hypercalcaemia Bloating and distension - IBS BO
63
Constipation Hx Exclusions | HHHSDP
Depression -> Recent traumatic events, wake up early, anhedonia Physical immobility -> bed bound Hypothyroid Hypercalcaemia - nocturia, N+V, abdo pain, mental changes SC injury Hernia
64
Constipation Hx PMHx
Jaundice DM Abdo Surg | Hx back problem
65
Constipation Hx DHx
Opiates, Loperamide, CCBs, antidepressants, antimuscarinics
66
Constipation Hx FHx
Bowel disorders
67
Constipation Hx SH
Norm Diet Hydration - normal urine colour
68
Diarrhoea Hx Causes
Malabsorption - Coeliac Inc motility - Hyperthyroid, IBS, DM, addisons Inflammation + blood/mucus - carcinoma, IBD, diverticulitis, isch col Osmotic (stops with fasting) - lactulose intolerance, short bowel, coeliac, pancreatic dysfunction Secretory (doesn't) - Bacterial CHESS, Viral - rotavirus HIV, Parasitic - amoebic dysentery, giardiasis, cryptosporidium, misc - carcinoid, adenoma rectum, anxiety Important to gauge normal habit
69
Diarrhoea Hx SOCRATES character
Colour/consistency/quantity Mucoid/jelly-like = salmonella/villous polyps Foul smelling / floating = malabsorption/duct ob/biliary insuff Pale = chron panc / gallstones Urgency = infectious/IBD Tenesmus = Carcinoma
70
Diarrhoea Hx SOCRATES associated
``` Vomiting/fevers/rigors - infectious Pain - localises WL - IBD, Malab, carcinoma Relief on def - IBS Urgency - IBD/infectious Hyper - Heat intolerance, palpitations, double vision appetite Eye problems - IBD ```
71
Diarrhoea Hx Exclusions | IIICC
``` Infectious - fever, meals, travels IBS - stress, relief IBD - ulcers, eye problems, rashes C.dif - recent infection Cancer - FLAWS Blood ```
72
Diarrhoea Hx PMHx
Jaundice, DM, Gallstones, Coeliacs, Surgery
73
Diarrhoea Hx DHx
Abx, PPI
74
PR Bleed Hx Causes
Anorectal - Haemorrhoids, carcinoma, fissure, abscess, varices... Colonic - Diverticular disease, colonic tumour, colitis Iliojejunal - Peptic ulceration, crohns, UGI
75
PR Bleed Hx SOCATES Character
Quantity, colour, relationship to stool
76
PR Bleed Hx Associated symptoms
``` Pain - ischaemia, IBD, Perforation Prolapse - Haemorrhoids, prolapse Pain on poo - fissure Tenesmus - carcinoma colitis Mucus - colitis, rectal cancer, villous adenoma, prolapse WL Fever - infective/mali Haematemesis - UGI bleed Lethargy - anaemia ```
77
PR Bleed Hx PMHx
MI Jaundice DM stroke CVS - isch bowel Trauma - surgery, enemas Surgery - aorta/transrectal
78
PR Bleed Hx DHx
A/cs - inc risk of bleeding NSAIDs - ulcer risk (+steroids) ABx, PPI - C dif Iron and bismuth - black stools
79
Haematuria Hx Causes
Menses, renal stones, prostate bladder renal cancer, trauma (catheter), strenuous exercise, pyelonephritis, prostatis Abx S/Es, A/cs
80
Haematuria Hx SOCRATES Site
Ensure it is really haematuria - not menses/poop
81
Haematuria Hx Onset
Continuous/intermittent - intermittent most likely stones When in stream Beginning = urethra / prostate End = prostate / bladder base / schistosomiasis Throughout = bladder ureter kidneys
82
Haematuria Hx Character
``` Colour/quantity/visibility Brown = urinary retention Smokey = glomelunephritis Clots = bladder cancer if round Elongated = ureteric ```
83
Haematuria Hx SOCRATES associated
``` Post exercise = normal Stones = calculus Loin pain = pyelonephritis/stones Pain + still pt = renal colic Frothy = proteinuria ``` Infective - frequency, urgency, nocturia, dysuria, fever LUTS - poor stream, hesitancy, incontinence, terminal dribbling
84
Haematuria Hx Exclusions | RUTM
RCC - Flaws + palpable Uraemia - NV, pruritus, lethargy, numbness Trauma to back Metastasis - change in bowels, WL, bleeding, back pain
85
Haematuria Hx PMHx
TB, HTN, DM, UTI Hx | Recent catheterisation/cystoscopy
86
Haematuria Hx DHx
ACEi/HTNs ABx
87
Haematuria Hx FHx
Renal stones Kidney disease Bleeding PKD
88
Haematuria Hx SHx
Occupation reds - rubber, mechanics, black smiths, bus driver, hair dresser
89
Leg swelling Hx Causes
DVT, Cellulitis, Pregnancy, Vasodilation, RHF+/-CHF
90
Leg swelling Hx Site
Bilateral - preg, vaso, RVF, localised muscle injury, along deep veins, distal oedema, arthritis..., gout
91
Leg swelling Hx associated symptoms
Infective - fever/red/swollen/hot Arthritic - joint immobility, stiffness (<>30-1hr), keratoderma, recent infections..... Skin changes and ulcers 6 Ps of ischaemia - pale, pulseless parasthesia, paralysis, pain, PERISHINGLY COOOOOOLD Chest pain SOB haemoptysis Relation to walking Relation to leg raise
92
Leg swelling Hx exclusions | DDONC
DVT - hx travel, COC, pregnancy, malignancy, immobility, haem disorders, FHx, Hx, DM - symptoms / Hx O - HF - orthopneoa, tolerance, PNDO O - RF - nocturia, uraemic symptoms O - Liver failure - Jaundice Neuropathic - back pain Cardiac RFs - DM, HTN, smoking, cholesterol, FHx
93
Leg swelling Hx PMHx
MI, jaundice, DM, stroke | Hx CVD, DVT
94
Leg swelling Hx DHx
COCs, HRT, CCBs,
95
Leg swelling Hx FHx
heart disease, DVT, clotting, malignancy
96
Leg swelling Hx SHx
Mobility assessment key
97
Weight loss Hx Normal/increased appetite vs diminished
N/I - Malnutrition, malabsorption, thryotoxicosis, phaeo, chron infection, DM Red - carcinoma, depression, infection, TB, addisons, anorexia, dysphagia
98
Weight loss Hx Exclusions | CHAD MD C
Cancer - appetite change, lethargy, bowel habit, haemoptysis, cough.. gen screen Hyperthyroid - ... DM - polyuria, nocturia, polydispia, inc infections Malabsorption - ID signs, diarrhoea, abdo pain, vomiting, steatorrhoea, PR bleed Chronic infections - fever, malaise, rigors, nightsweats, sputum, rashes Addisons - weakness, dizziness, postural hypotension, skin pigmentation depression - low mood, early morning, anhedonia, lethargy DIET
99
Weight loss Hx PMHx
Malignancy, thyroid, malabsorption, anaemia, depression, anxiety
100
Weight loss Hx DHx
Diuretics, laxatives, diet pills, thyroxine
101
Weight loss Hx FHx
DM, thyroid, cancer
102
Weight loss Hx Systems
Cardio - chest pain, dyspnoea, palpitations, oedema, PND, syncope, Resp -cough, haemoptysis, sputum, chest pain FLAWS GI - bowel change, blood, dysphagia, oydonophagia, PR, NV, diarrhoea GU - dysuria, haematuria, polyuria, nocturnia Neuro - headaches, visual change, fits, sensory change, parasthesia, faints..
103
Fatigue and Lethargy Hx Causes
``` Endo - DM, addisons, hypothyroid Haem - anaemia CV - HF Neoplasms - carcinoma, lymphoma GI - IBD, cirrhosis, malab... Sleep disorders - OSA, depression, insomnia Resp - asthma, COPD Renal failure Infections ```
104
Fatigue and Lethargy Hx Important Q
Define what you mean by tiredness
105
Fatigue and Lethargy Hx Exclusions | CHAD MAID
Anaemia - exertional SOB, angina, lethargy Hypo - weight gain, appetite loss, deep voice, constipation..... DM - polyuria, nocturia, polydipsia, WL, infections Malignancy - FLAWS + blood + Bowel Addisons - postural hypotension, salt craving, dizziness, vomiting, skin pig Cardiac Failure - dec exercise, SOB, frothy, orthopnoea, oedema Depression - anhedonia, dec mood, waking up early, suicidal ideation IBD - ocular, pain, bowels, rash
106
Fatigue and Lethargy Hx PMHx
MI TB Anaemia DM Cancer Depression Thyroid
107
Fatigue and Lethargy Hx FHx
Thyroid, DM
108
Fatigue and Lethargy Hx DHx
Antidepressants, metformin, NSAIDs, opiates
109
Dietary Hx unintentional WL
Malignancy - change in bowel, bleeding, FLAWs Thryotoxicosis - ....... IBD - abdo pain, diarrhoea, bleeding, eye signs, joint, rashes DM - polyuria, nocturia, polydipsia
110
Dietary Hx Weight GAIN
Pregnancy Hypothyroid - ...... Oedema - SOB, syncope, uraemic, uncomp cirr, hepatomegaly Ovarian cancer - night sweat, anorexia, lump on flank/iliac fossa
111
Dietary Hx Important Qs
``` Appetite How much do they weigh/height Clothes size changing Dec/inc How do you feel about your weight? Typical days food AMOUNT Drinks - fizzy, alcohol, caffeine Do they diet Allergies Exercise ```
112
Neck lump Hx exclusions | TTLMC
``` Lymphoma - B symptoms Malignancy - FLAWS Cervical ribs - parasthesias, cold hands TFT Qs Thyrocyst - movement ```
113
Neck lump Hx PMHx
Thyroid, cancer, TB
114
Neck lump Hx DHx
Phenytoin lithium
115
Dysphagia Hx SOCRATES character
solids/liquids/difficult to initiate swallow | eating influence
116
Dysphagia Hx associated
Cough, haematemesis, choking, angling to swallow, WL, anaemia, hoarse voice, GORD, regurgitation
117
Dysphagia Hx Exclusions | GLIC
Signs of infection - fever Lumps and swallowing - extrinsic compression CVA GORD
118
Dysphagia Hx PMHx
Stroke | GORD
119
Vomiting Hx SOCRATES character
Define by feeling sick | Undigested vs billows vs large volume
120
Vomiting Hx associated
``` Signs of infection Malignancy Bleeding Jaundice Steatorrhoea chest pain Pain localise ICP Dizziness/vertigo ```
121
Vomiting Hx Exclusions | MAID PIM
``` MI DM Pregnancy Medication related Infective - fever, sweats, contact, strange food ICP - trauma Adhesions - prev surg ```
122
Vomiting Hx PMHx
MI, DM, Jaundice | DH - opiates, cytotoxics, digoxin, abx
123
Headache Hx exclusions
Fever, photophobia, neck stiffness, rash, jaw claudication, pain on combing hair, visual changes, sensory changes, LOC, worse lying down, pain on strain, pain wake up
124
Headache Hx PMHx
MI HTN Epilepsy, DM, stroke
125
Headache Hx FHx
Migraine CVA
126
Headache Hx SHx
Occupation Diet - cheese, yog, caffeine Marital
127
LOC Hx Causes
Beat - arrhythmia, bradycardia, HB Brain - diffuse - epilepsy, SAH - Hemi - SOL, stroke, epi/sub Blood - Vasovagal (pooling), postural hypo, hypovolaemia, anaemia, hypoG
128
LOC Hx important SOCRATES ONSET
Onset | duration progression frequency predisposing causation
129
LOC Hx Before associated features
warning no=arrhythmia/PE aura dizziness = VV
130
LOC Hx During
WITNESS collateral | Associated features - shaking, incontinence, time, pallor/flush
131
LOC Hx After
Complete recovery delayed recovery Feelings
132
LOC PMHx
DM Cardiac epilepsy anaemia PVD psychiatric illness
133
LOC Hx DHx
Antihypertensives insulin antiarrythmias antidepressants vasodilators
134
Loss of vision Hx causes MMM NIT GIV C
``` Inflammation Giant cell ICP/neoplasm TIA Cataracts Normal red Migraine Macular degeneration Visual fields MS ```
135
Loss of vision Hx Imp Q
What do you mean by loss of vision | Last eye test
136
Loss of vision Hx associated
Aura, diplopia, focal neuro, one/both eyes, halos, tunnel vision, headache, N+V
137
Loss of vision Hx Exclusions MMMIIVCG
Temporal - jaw claud, pain combing, shoulder pain Inflammation - watery, pustular, red ICP/neoplasm - focal neuro too TIA - duration symptoms/focal Migraine - aura, throbbing, photo Visual fields- bump into stuff Macular degeneration - problems reading words, facial distortion MS - associated focal neuro, colour change Cataracts - at night, glare
138
Loss of vision Hx PMHx
DM CVA MI HTN RHF

Sdpeh (50 decks)

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