Lecture Flashcards
What are the 5 steps of the inner consultation outlined by roger neighbour?
- Connecting with the patient
- Summarising
- Handing over
- Safety netting - What if?
- Housekeeping
How to elicit a history od presenting complaint?
- Description of symptoms
- Give them time to speak
- Establish a full timeline of events
- Relevant systems enquiry
What areas should be addressed in a past medical history?
- Medical conditions
- Hospital/GP visits
- Operations/Procedures
- Are problems: ongoing/managed/resolved
In a PHM what diseases are of high priority to establish information about when the complaint is related to the CVS?
- History of vascular disease (coronary artery/ cerebrovascualr/ peripheral vascular)
- Diabtetes
- Hypothyroidism
- Renal disease
- Hypertension
- Hypercholestroameia
What information should be collected when discussing drug history and allergies?
- Precription medication
- OTC mediciation
- WHY are they taking them
- Are the taking them correctly?
- Allergy and adverse effects
Name some of the components of a social history
- Upbringing
- home lifer
- occupation
- finance
- relationships
- house
- community support
- sexual histroy
- leisure activites
- exercise
- smoking and alcohol
Outline the system enquiry for the CVS
- chest apin
- breathlessness
- Orthopnoea
- Paroxysmal Nocyural dysnpnoea
- Palpitations
- Syncope/dizziness
- Oedema
- Peripheral vascular symptoms
- Intermittent claudication
What are the cardiovascular causes for chest pain?
- stable angina
- acute coronary syndromes
- pericarditis
- aortic dissection
What are the respiratory causes of chest pain?
- pulmonary embolus
- pneumothorax
- pneumonia
- lung cancer
- mesothelimona
Upper GI causes of chest pain
oesphgeal disease
Musculoskeletal causes of chest pain
- trauma
- muscual/rib injury
- costochondritis
What is angina?
A clinical syndrom eof chest pain or pressure precipitated by activites such as exercise or emtoional stress which increase myocardial oxygen demand
Describe a myocardial infarction
Considered part of a spectrum referrred to as acute coronary syndrome
SOCRATES
- Site
- Onset
- Character
- Radiating?
- Associated symptoms
- Timing
- Exacerbations
- Severity
Modifable risk factors
- Obesity
- High blood pressure
- Diabetes
- High cholestrol
- Psychosocial factors
- Smoking
Unmodifiable risk factors
- Ethnicity
- Gender
- Age
- Family history
How to differentiate between oesophageal disease from angina pectoris
Multistage exercise tests or normal angiogram should be evaluated for oesophageal disease
What is pericarditis?
inflammation of the pericardium
What is the clinical presentation of pericarditis?
Acute onset of chest pain; eased by sitting up or leaning forward
Pain may be anywhere over the anterior chest wall; usually retrosternal
May radiate to the arm but characteristic radiation to the trapezius ridge
Aortic Dissection
- sudden and severe pain
- Tearing and deep pain
- Radiating to left shoulder/back
Dyspnoea
Shortness of breath
Cardiac causes of SOB
cardiac failure associated with angina or MI
PND =
sensation of SOB that awakens the patient, often after 1- or 2- hours sleep and is relieved when sitting in the upright position
Orthopnoea
Sense of breathlessness in the recumbent position, relieved by sitting or standing
