Semester 1 Interviews

Question 1

Time Course

Answer 1

Duration (of symptom, of episode?).
Onset/offset (gradual or sudden?).
Temporal profile (improving or worsening?).
Periodicity (if >1 episode, regular or irregular?)

Question 2

Special Features: Palpitations

Answer 2

Quality: can you tap the rhythm?
Quality: forceful or flutter?
Quality: if missed beat, short or long?
Severity: speed.
Time course: >1 episodes?

Question 3

Associated Features: Palpitations

Answer 3

Shortness of breath.
Fatigue.
Fainting/blackouts.
Chest pain.

Question 4

Further History

Answer 4

Past medical history.
Family history.
Social history.
Occupational history.
Smoking.
Alcohol.
Medications.
Allergies.
Immunisations (if relevant).

Question 5

Special Features: Syncope

Answer 5

Prodrome: do you remember anything before it happened?
Quality: did anyone describe what happened?
Quality: was there any warning?
Aggravating factors: if vasovagal - fasting, pain, emotion, prolonged standing.
Aggravating factors: if cardiac - usually none!

Question 6

Associated Features: Syncope

Answer 6

Sweaty.
Pallor.
Difficulty breathing.
Chest pain.

Question 7

Special Features: Claudication

Answer 7

Severity: walking distance before developing pain?
Note - if neuropathic, worse when standing and better when walking (less tension on sciatic nerve).
Note - if vascular, better when standing and worse when walking.

Question 8

Associated Features: Claudication

Answer 8

Shortness of breath.
Chest pain.
6 Ps:
Pain.
Pallor.
Polar (cold).
Paraesthesia.
Paralysis.
Pulseless.

Question 9

Special Features: Chest Pain

Answer 9

Site: radiation.

Question 10

Associated Features: Chest Pain

Answer 10

Sweating.
Nausea.
Vomiting.
Shortness of breath.
Fainting.
Palpitations.
Light-headedness.

Question 11

Special Features: Oedema

Answer 11

Site: both limbs?
Quality: pitting or non-pitting?
Severity: level of swelling, pain?

Question 12

Associated Features: Oedema

Answer 12

Pain in chest/abdomen/legs.
Shortness of breath at rest/exertion.
Orthopnoea.
Fever.
Weight loss.

Question 13

Special Features: Dyspnoea

Answer 13

Quality: heavy or shallow.
Severity: how far can you walk before developing shortness of breath?
Severity: does it wake you at night?
Aggravating factors; lying down? - Ask about number of pillows used when sleeping.

Question 14

Associated Features: Dyspnoea

Answer 14

Chest/leg pain.
Cough.
Swollen ankles.
Wheeze.

Question 15

Special Features: Cough

Answer 15

Quality: productive?
Quality: if productive, blood?
Severity: frequency of cough.

Question 16

Associated Features: Cough

Answer 16

Haemoptysis - but differentiate if coughing or vomiting!
Shortness of breath.
Fever.
Wheeze.
Smoking.
Cancer: weight loss, pain, night sweats, orthopnoea or paroxysmal nocturnal dyspnoea.

Question 17

Differentiating between haemoptysis and haematemesis?

Answer 17

Ask about prodrome!
Haemoptysis - irritation in chest and desire to cough.
Haematemesis - nausea and abdominal discomfort.

Ask about colour/texture!
Haemoptysis - usually bright red and frothy.
Haematemesis - dark red and not frothy.

Question 18

Special Features: Nausea/Vomiting

Answer 18

Quality: colour - blood or bile-stained?
Severity: how many times?
Severity: small or large amounts?
Time course: pattern?
Time course: relationship to meals, or first thing in mornings?
Context: new medication, possibility of pregnancy, contact with others with nausea/vomiting/diarrhoea, travel.

Question 19

Associated Features: Nausea/Vomiting

Answer 19

Abdominal pain.
Diarrhoea.
Fever.
Headache.
Vertigo.
Symptoms of dehydration: increased thirst, dry mouth, weakness, dizziness, palpitations, confusion, fainting.
Weight loss.

Question 20

Special Features: Dysphagia

Answer 20

Site: where does it get stuck?
Quality: difference between solids and liquids?

Question 21

Associated Features: Dysphagia

Answer 21

Weight loss.
Cough.
Choking.
Nasal regurgitation.

Question 22

Special Features: Diarrhoea (Constipation)

Answer 22

Quality: how does it compare to normal bowel habits?
Quality: watery, colour?
Quality: blood or mucus - HOW MUCH blood, MIXED OR NOT in stool.
Quality: difficult to flush?
Severity: frequency and volume.
Context for diarrhoea: diet, travel, contact with people with diarrhoea/vomiting, medication.
Context for constipation: diet, medication.

Question 23

Associated Features: Diarrhoea (Constipation)

Answer 23

Diarrhoea:
Nausea.
Fever.
Vomiting.
Dehydration (thirst, changes in urine colour/amount, dizziness, fainting).
Abdominal pain.
Weight loss (diarrhoea AND constipation).
If black/melaena - HAEMATEMESIS!

Question 24

Special Features: Rectal Bleeding

Answer 24

Quality: change in bowel habit i.e. diarrhoea or constipation?
Quality: colour of stools.
Quality: colour of blood, amount of blood, mixed/not mixed in stool.
Quality: PAIN?
Severity: every time when using toilet?

Question 25

Associated Features: Rectal Bleeding

Answer 25

``` Change in bowel habit (may be cancer). Constipation/diarrhoea. Abdominal pain. Fatigue (due to anaemia). Vomiting/nausea, fever (infection). ```

Question 26

Special Features: Jaundice

Answer 26

``` Site. Quality N/A Severity N/A Time course! Context: recent travel, tattoos, alcohol. ```

Question 27

Associated Features: Jaundice

Answer 27

``` 4 Ps Pruritis - itch. Pain. Pee - dark urine. Poop - pale or clay coloured stools. ```

Question 28

Further History: Jaundice

Answer 28

Alcohol! | Recent travel, immunisations, tattoos, IV drug use, unprotected intercourse.

Question 29

Special Features: Asthma

Answer 29

Severity: ADLs, days off school/work. Severity: have you ever been admitted to hospital for asthma? Time course!: how long, how often, progression (better or worse)? PSYCHO-SOCIAL CONTEXT: impact of asthma on lifestyle? PSYCHO-SOCIAL CONTEXT: impact of lifestyle on asthma? PSYCHO-SOCIAL CONTEXT: adherence to medications? Context: what brings it on (night, pollen, allergens, etc.). ! Do you have an asthma management plan?

Question 30

Associated Features: Asthma

Answer 30

Wheeze | Hayfever, hives, eczema - i.e. atopy.