Weakness
- Have you felt weakness on both sides of the** body? (
speaking**Suggests spinal cord disease, myopathy or myasthenia gravis) - Ascending vs descending?
- Is the weakness just on one side of the body or face? (Transient ischaemic attack or stroke)
- Has the weakness affected just an arm or a leg or part of a limb? (Peripheral neuropathy or radiculopathy, stroke or multiple sclerosis)
- Have you had trouble getting up from a chair, brushing your hair or lifting your head? (Proximal muscle weakness—myasthenia gravis, diabetic amyotrophy [involves lower limbs], polymyositis)
- Have you had trouble swallowing or difficulty in **
speaking**? (Myasthenia gravis, polymyositis) - Have you noticed double vision? (Myasthenia gravis, cranial nerve mononeuritis multiplex)
- Are you taking any medications? (Steroid-induced proximal myopathy)
- Have you had problems with your neck or back, or with severe arthritis? (Radiculopathy)
- Have you had a cancer diagnosed at any stage? (Paraneoplastic, Eaton–Lambert syndrome)
- Is there any problem like this in your family? (Familial myopathy, Charcot–Marie–Tooth disease)
- Have you had HIV infection? (Various neurological lesions and drug reactions)
- Have you ever had MS diagnosed?
- Are you a diabetic? (Mononeuritis multiplex, amyotrophy)
Rash
Where?
Long
Had it before?
Progression
- getting worse
- flat vs raised vs blistered
- itchy
Treatments
Diet
Systems
- fever
- joint pains
Changes
- cream
- soap/shampoo
Occupational exposure
Travel Hx
Sick contacts
Fever
How long
How high?
Rigors/ Shakes/ chills suggesting bacteraemia
Sick contacts
Recent ops/ procedures
Pets?
Returned traveller
- where to
- jabs / prophylaxis
- high risk - ivdu, tattoos, swimming in lakes, sex
Mental Health Hx
Psychosis / Schizophrenia Hx
Have you ever heard people speaking when there is no-one around?
Do you ever hear voices speaking as if someone is there?
Have you had your thoughts spoken out loud, as if by someone else?
Do you have thoughts or beliefs that someone else might find strange?
Have you felt people are against you?
Have the TV or radio been sending you messages?
Do you feel as though someone is spying on you or plotting to hurt you?
Do you have any ideas that you don’t like to talk about because you are afraid that no-one will believe you or think there is something wrong with you?
Mania
Have you felt especially good about yourself?
Have you been needing less sleep than usual?
Do you feel like you are special or that you have special powers?
Have you been spending more than usual?
Depression
How have you been feeling in yourself?
What has your mood been like?
Have you been feeling sad / blue / down / depressed? For how long?
Have you lost interest in things you usually enjoy?
Have you been sleeping and eating well?
Anorexia
Do you worry about your weight?
What are your feelings about your weight? Do you worry that you are fat?
Do you diet or try to control your weight? What things have you tried?
Have you ever made yourself sick after a meal?
Adolescent Mental Health
Altered Mental Status / Confusion / Seizures / Syncope
★ Drugs:
The “OB’s 5Cs” as the Critical diagnoses:
1. Opiates
2. Beta-blockers
3. Carbon monoxide
4. Cyanide
5. CCBs
6. Cyclic antidepressants
7. Cardiac glycosides
Ø Abuse: heroin, opiates, benzodiazepines, alcohol, cocaine, amphetamines, marijuana,
LSD, mushrooms, GHB
Ø Accidental: Carbon Monoxide / Cyanide
Ø Acquired: BB, CCBs, digoxin, TCAs, acetaminophen, ASA, SSRI, anticonvulsants
★ Infection
○ Meningitis, encephalitis,
○ Septic shock and sepsis
★ Metabolic (by organ system)
○ Hypoglycaemia
○ Na, K, Ca, PO4, Mg
○ DKA, HONK
○ Thyroid (hyper or hypothyroid)
○ Kidneys (electrolyte derangements, kidney failure with uremic state)
○ Liver (hepatic encephalopathy)
★ Environmental
○ High altitude cerebral edema
○ Heat stroke
○ Hypothermia
○ Dysbarism
★ Structural
○ Intracranial Catastrophe
§ ICH, Stroke, Epidural hematoma, Subdural hematoma, SAH
§ Status epilepticus, acute hydrocephalus
○ Cardiac
§ ACS, Aortic Dissection
§ Cardiogenic / Hypovolemic / Obstructive / Distributive shock
§ HTN crisis, malignant arrhythmia
