Intro to PMH, SX, MEDS, Flashcards Preview

Week 8- SHANE > Intro to PMH, SX, MEDS, > Flashcards

Flashcards in Intro to PMH, SX, MEDS, Deck (14):
1

History of Present Illness can be summarized using what mnemoic?

OLDCARTS

2

What should the HPI start with?

patient age, sex, and gender

3

When should past medical history be discussed?

after CC, HPI, and pertinent +/-

4

What is included in PMH?

past medical history, past surgery, medications, allergies, social and family history

5

What should be included in past medical history?

medical illness/disease- who has been treating that illness
blood transfusions
obstetric/gyn history
pertinent childhood illness

6

Notes on past surgical history

list chronologically, list surgeon, dates, hospital, complications, did they have a blood transfusion, outpatient or inpatient

PSX: Patient had an open appendectomy at Erlanger hospital in 2004 by Dr. Smith; no complications; 1 day stay; he had a laparascopic cholecystectomy at Emory University in Atlanta in 2001 by Dr. Jones; no complications; outpatient surgery.

7

Notes on obgyn history

menstrual onset (menarche), menstrual frequency, describe the bleeding during menstrual cycle (how long does it last?), contraceptives (“Are you planning on trying to have a baby in the next year”), age at menopause

obstretics- any pregnancies, were they full term (37-42 weeks), any abortions, any living children

8

Best way to ask physicatric questions

Have you ever had any mental health issues that have required treatment? If so, what kind of treatment, how long, diagnosis (would go in medical history)- also get name of consouler

9

Notes on medication recording

need name of drug, dose, route of administration of drug, frequency of use (per day, per week?), and for what- **IN THAT ORDER***

i.e. Synthroid 125mcg oral once daily for hypothyroidism

put medications in a simple, numbered list**

don't forget about OTC and herbs (these can interact with drugs)

10

Notes on Drug Allergies

What is the drug name?
What happens when you take it?
How severe is the reaction?

Any food or environmental allergies?

11

Mneomic for illness/infection

SICK HEALTH SCAMS

12

Onset of first period is called what?

menarche

13

Mneomonic for pregnancy history

TPAL (full semester, premature, abortions, living children)

14

A 42 year-old female provides you the following maternity history: she has had 4 pregnancies, one of which was twins. All deliveries were full term, except for the twins who delivered at 32 weeks. She lost one pregnancy at 12 weeks. She has three living children at home (son was shot at age 10). What is the quick shorthand way to document this?

G4P2213

How many pregnancies? (gravida)
How many deliveries? (para)
How many full-term?
How many pre-term?
How many abortions/miscarriages?
How many living children?