Flashcards in History Taking Deck (60):
Obstetric history taking?
Clarify details: W+D, number, due date
HPC (vaginal bleeding, vaginal discharge, N&V, fetal movements, abdominal pain, headaches, visual changed, swelling, urinary symptoms, fever)
Gravidity and parity (total number of pregnancies and total number over 24 weeks)
Current pregnancy details (scans, screening, folic acid, delivery plans, immunisations)
Previous pregnancy details (Term, BW, mode, complications, assisted reproduction)
Previous TOP, miscarriages, still births
Gynae history (smear, STIs, procedures)
PMH (diabetes, HTN, psychiatric, VTE, epilepsy, hypothyroid)
DH and allergies, contraception
FH (congenital disorders, pre-eclampsia)
SH (alcohol, smoking, drugs, diet & weight, living situation, working, domestic abuse)
10 key symptoms to ask in HPC?
Vaginal bleeding, vaginal discharge, N&V, foetal movements, headache, visual changes, swelling, abdominal pain, urinary symptoms, fever
What are the details of pregnancy scans to ask about?
Baby growth, placenta, anomolies
What are the details of screening to ask about?
Down's syndrome screening, Hep B, HIV, syphillis
Pre eclampsia diagnosis?
BP >140/90 past 20 weeks
What is severe pre eclampsia?
Explain pre-eclampsia and the dangers of it?
Multi system condition affecting mum and the baby. In severe cases can be life threatening.
Dangerous for the babies growth
Can affect multiple body organs including the eyes, kidneys, liver, and the brain
What is the management for pre-eclampsia?
The ultimate treatment is delivery but the decision is based on gestational age, symptoms and severity
Full assessment in hospital
Treat the hypertension with labetalol
Seizure prophylaxis with magnesium sulphate
Pregnant abdo exam?
Take urine sample first to prevent discomfort
Inspection: scars, stretch marks, linea nigra
Palpate: fundal height with blind measurement, lie (longitudinal, transverse, oblique), presentation (cephalic, breech), 5ths palpable, heart beat (120-160)
Back pain history?
HPC (SOCRATES, Red flags: loss of bowel and bladder control, saddle anaesthesia, bilateral sciatica, pain waking you at night, weight loss, fever)
PMH (cancer, osteoporosis, depression)
DH and allergies (steroids)
SH (Smoking, alcohol, drugs, diet and exercise, work, home life, impact on daily life)
Key conditions to rule out in back pain?
Management if red flags in back pain?
Management of sciatica?
WHO pain ladder: Paracetamol, NSAIDs
Antiepileptics: Gabapentin, pregabalin
Class of drug for amitriptyline and main SEs?
Anticholinergic effects (drowsy, dry mouth, blurry vision)
Sedation and weight gain
What are the main side effects of antiepileptics?
drowsy, confusion, dizziness, change in appetite
Focused examination of the spine summary?
Look: alignment from back and side (cervical lordosis, thoracic kyphosis, lumbar lordosis)
Feel: spinous processes, parasternal muscle bulk, iliac crest height
Move: Cervical: chin to chest and back, look over left and right shoulder, ear to shoulder. Lumbar region: Schobers (10 above, 5 below should increase to >20cm), back extension, lateral flexion
What should be offered if suspect cauda equina?
What is sciatica?
Compression or irritation of the sciatic nerve if no worrying signs can be treated with pain relief, physio to help strengthen the muscles and activity.
Lower neuro exam?
Gait, heel toe, tip toes (plantar fleion), heels (dorsi flexion)
Tone: leg roll, leg lift, ankle clonus
Power: hip x4, knee x2, ankle x4, EHL
Reflexes: knee L4, ankle S1, babinski
Sensation: L2, L3, L4, L5, S1 light touch, pin prick, vibration, proprioception
5 aspects of neuro exam?
Bulk, tone, power, reflexes, sensation
HPC (SOCRATES, Red flags: fever, neck stiffness, altered consciousness, focal neurology, red eye, visual disturbance, tender temporal region, WL, trauma)
ICE and summary
DH and allergies
Visual acuity - snellon chart (30cm or 6m)
Peripheral visual fields
Specific eye visual fields
Pupils (direct, consensual, RAPD)
Haemothorax vs pneumothorax?
Blood in pleural cavity: dull to percuss
Air in pleural cavity: hyperresonant
Airway: assess, manouvre, suction, adjunct
B: O2 sats and oxygen, RR and resp distress, Trachea, resp exam
C: Pulse and peripheral temp, BP and CRT, ECG and HS, IV access (grey or orange)
D: AVPU, GCS, pupils, glucose
E: Temperature, rashes, abdomen, bleed areas (chest, abdo, pelvis, long bones)
How to administer bloods and FFP in trauma?
What type of injury should you avoid catheterisation?
Types of pelvic fractures?
Stable: posterior arch intact
Partially stable: posterior arch partially disrupted
Unstable: posterior arch completely disrupted
Investigations and team involvement in trauma patient with potential haemothorax, internal injuries and pelvic fracture?
Transfer to trauma centre as likely to need theatre or interventional radiology
A&E, ortho, gen surg, anaethatist
Main headaches, features of each and management?
Migraine: unilateral, with aura, photophobia (NSAID + triptan, propanalol as prophylaxis)
Tension: bilateral, tight band around head, stress related (simple analgesia)
Cluster: Severe, unilateral, eye symptoms (100%O2 + triptan, verapamil as prophylaxis)
GCA: pain over temple, jaw claudication, high ESR, skip lesions on biopsy (high dose prednisolone)
Trigeminal neuralgia: brief, electric shock triggered by touch (carbamazapine)
SAH: thunderclap headache, occipital (CT, LP, pain relief and anti emetics)
SOL: worse when coughing/sneezing, worse in morning, waking at night, neurological deficits (Non contrast brain CT)
Meningitis: neck stiffness, fever, rash
Stroke: neurological deficits (urgent CT)
Acute angle glaucoma: red eye, reduced visual acuity, N&V, fixed mid dilated pupil (IV acetazolamide, topical timolol)
Differentials of headache with neurological defecits and investigation?
SOL (primary brain tumour- gliblastoma, secondary brain tumour, bleed, cerebral abscess or cyst)
Brain CT: see whats going on. Neurosurgical opinion
Relevent CN exam (CNII/optic nerve to look for visual field defects, ophthalmoscopy to look for papillodema, CN3,4,6 all long course so vulnerable to compression)
Power in upper and lower limbs
What does papilledema look like on fundoscopy?
Bilateral optic disc swelling due to raised ICP
blurry margins and poorly defined optic disk contour
May have flame haemorrhages
Red reflex, optic disc (colour (pale in ischaemia), contour (poorly defined in papillodema), cupping (increased cup to disc ratio seen in glaucoma)), retinal vessels (cotton wool spots, neovascularisation in diabetes, AV nipping and flame haemorrhages in HTN) macula (drusen)
What is a left sided homonymous hemianopia and where is the lesion?
Can't see left halves (temporal in left eye, nasal in right eye)
Lesion is in right the optic tract
Path of the optic nerve?
Optic chiasm (nasal cross over)
Primary visual cortex in occipital lobe
Upper limb neuro exam?
Tone: shoulder, elbow, wrist
Power: shoulder x2, elbow x2, wrist x2, fingers x2, EPL
Reflexes: Biceps (C5/6), Triceps (C7), supinator (C5/6)
Sensation: light touch, pin prick, vibration, proprioception (C4, C5, C6, C7, C8, T1)
Effects of drinking alcohol during pregnancy?
Alcohol can pass through placenta and into baby
Baby's underdeveloped liver can't process alcohol the same way we can
Too much exposure can damage development
If drinking in first 3 months: increased risk of: misscarriage, premature birth and low birth weight
If drinking in last 3 months increased risk of learning disabilities, behavioural problems, fetal alcohol syndrome (poor growth, facial anomalies, behvioural problems)
Risk is greater the more you drink
If stopped drinking as soon as found out pregnant should not worry unnecessarily as the risks are low
Key aspects of a paediatric history?
Birth (before during after (APGAR score))
Feeding (bottle or breast)
Growth and development
Normal markers for <1year old?
What is the danger of high UCB in foetal circulation?
UCB is fat soluble so can collect in the basal ganglia of the brain causing kernicterus
Why does physiological jaundice in the newborn occur and at what time?
Increased destruction of foetal Hb
Immature liver enzymes so reduced ability to conjugate and increased UCB levels in the blood
2-3 days after birth and get better in a couple of weeks if persists greater than 2/3 weeks then further investigation needed
When does pathological jaundice occur and what are some common causes?
Within first 24 hours, rapid rise in bilirubin visible early and large body involvement
Haemolytic anemia: Rh/ABO incompatability, rare antibodies in the mother
G6PD deficiency (enzyme in RBCs, without it the cells are destroyed prematurely)
What is the treatment for jaundice?
Test serum levels of bilirubin and plot on chart, if too high then phototherapy needed (Light induces structural changes in the UCB meaning it cant pass into the brain) or exchange transfusion (slowly remove baby's blood and replace it with fresh donor blood)
Plotting of pathological jaundice?
Bilirubin vs age in hours
Fall into high (above 95th centile), intermediate (40-95th centile) and low risk (below 40th centile)
If a few values present can then predict the trend and number of days at risk to bilirubin toxicity
History for jaundiced baby?
Gestation, maternal blood group/Rh, delivery mode, infection risk
Baby: Blood group/Rh, foetal distress/birth trauma, feeding effectiveness, timing of jaundice onset
Signs of bilirubin encepalopathy/kernicterus?
lethargy, hypotonia, absent startle reflex, poor feeding and sucking
Seizures, bulging fontanel, sun setting eyes
Complications and everything else (PMH, SH, lifestyle, RFs)
Management of PAD?
Lifestyle (smoking, diabetes control, lipid control, weight and exercise)
T2DM treatment regime?
Lifestyle (30mins exercise at least 5 times a week)
Mono therapy then combination
What is metformin and possible SE?
nausea, diarrhoea, abdo pain (doesn't cause hypos, weight neutral, reduces micro and macro)
What is glicazide and its possible SE?
SU increases insulin secretion
Risk of hypos, weight gain (reduces micro)
What is glitazone and its possible SE?
TZD insulin sensitiser
Risk of hypo with SU, fractures, fluid retention, HF (prevents macro)
Normal blood glucose levels?
Normal HbA1C levels?
What are the main complications in diabetes?
Macro: stroke, MI, claudication
Micro: Eyes, kidneys, neuropathy (feet)
RFs for diabetes?
Smoking, diet, weight, cholesterol, high BP
MDT involvement in diabetes?
Diabetic hba1c levels?
Diabetes random glucose?