History taking OSCE
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- Breathlessness, loss of consciousness, palpitations, ankle swelling, nausea, vomiting, sweating
- Cough, wheeze, haemoptysis
- Heartburn, GORD, pain related to eating
- Weight loss (also appetite loss, diet if true), night sweats
- Notes - hyperlipidaemia, hypertension, diabetes, angina
- Onset and activity
- Exac/relieving factors
- Cough + sputum, wheeze, chest pain, haemoptysis, fever, PND, orthopnoea, oedema
- Weight loss, anorexia, sleep disturbance, night sweats
- Notes - occupation, pets, travel
- Establish circumstances of fall - time, place, activity
- Loss of consciousness/confusion on recovery
- Any focal neuro cfs before, e.g. vision/power/face/dysphasia
- Exclude mechanical cause of fall/any mobility aids
- Was the fall witnessed
- Any injury after fall?
- Hx of falls, seizures, angina, SOB, anxiety
- Full smoking history: amount, reasons, attempts, barriers and benefits
- Advice and support
- Clarify symptoms and where things are sticking
- Progressive or intermittent?
- Solids, liquids or both?
- Pain? Coughing? Choking? Gargling?
- Neuro - limb weakness, tiredness after chewing, speech
- Rheum - pain, stiffness or swelling in any joints
- Weight loss, anorexia, lethargy anaemia
- Hx of GORD, peptic ulcer, stroke, MS, malignancy
- NSAIDS, indigestion tablets taken?
- Quantify drinking/smoking
- Appearance, volume, projectile, blood (especially if present in first vomit).
- Occuring with meals? Relieve any pain/nausea? Effortless?
- Abdominal pain, weight loss, appetite change, constipation, diarrhoea
- GORD, ulcers, pancreatitis, gallstones or angina
- Alcohol, smoking and foreign travel
- Acute or chronic? Who noticed it?
- Pain? Pale stools/dark urine? Bowel habit? Pruritis? Fever? Night sweats? Weight loss? Nausea/vomiting?
- Gallstones, liver disease, IBD, diabetes, blood transfusions Hx?
- Unprotected sex? Past STIs?
- IV drug use, tattoos, alcohol, foreign travel
- Nausea/vomiting, fever, anorexia, bowel habit change, FOB, dysuria
- Trauma, gallstones, diverticulitis, IBD, HIB, CV disease
- Alcohol, smoking, foreign travel
Altered bowel habit
- Frequency? Volume? Character? Colour- blood/mucous?
- IBD/IBS, ulcers, abdominal surgery?
- Laxatives? opiates, gluten sensitivity?
- Family - bowel cancer, IBD, coeliac disease
- Alcohol, tobacco, diet, foreign travel, contact with diarrhoea, STI
- Volume? Frequency? Clots? Pain? Pain on straining?
- Colour,? Blood mixed/separate?
- Lethargy/SOB for anaemia
- Weight loss, anorexia, fatigue for malignancy
- History of rectal bleeding, IBD, bowel surgery
- Family - polyps/bowel cancer
- Reassure of confidentiality
- Partners: Last time, gender, regular/casual, recent activity, where did they meet?
- Practices: Type of sex, gave/received
- Protection: Type and problems
- Past history: Both patient and partner
- Any sex overseas?
- Itching, sores, dysuria
- Lumps: size, site, onset, duration. SOCRATES
- Discharge, bleeding, skin/nipple changes
- Tiredness, fever, weight loss, chest/back pain
- Related to menstrual cycle?
- Hypertension, cardiac disease, obesity
- Family - male/female breast cancer, ovarian
- Alcohol, smoking, early menarche, nulliparity, late menopause, HRT, obesity
- Nausea, vomiting, aura, diplopia, photophobia, fever/chills
- Weight loss, rash, neck pain/stiffness, myalgia, lacrimation, altered consciousness, paraesthesia/power
- Worsened by - prone/supine, caffeine, alcohol, dehydration, stress, eye strain, hunger, lights, menses, foods
- Hx of headache, migraine, travel sickness, trauma, IC lesion
- NSAIDS, opioids, GTN spray, CCBs, recreational drugs
- FHx - migraine
- SHx - alcohol, smoking, mood, employment
- Current mood?
- Precipitating factors/major events?
- Establish course of symptoms
- Loss of interest, appetite, tiredness, poor concentration, self esteem, guilt, pessimism
- Sleep disturbance
- Mania, anxiety, delusions, hallucinations, self harm
- Alcohol or narcotic use
- Triggers (stressors and events)
- Delusions - Content, belief, thought interference
- Hallucinations - Type (auditory, visual) and what happens
- Violence - Risk to self and others
- Assess insight into problems and if willing to be helped
- SHx - recreational drugs, alcohol, social support, coping
- How (especially type and quantity of drug, including alcohol)
- Was it planned? (Alone, steps to avoid discovery, 'final acts'
- Did they want to die?
- Do they regret being alive? How did they feel when help arrived/woke up in hospital?
- Still feeling suicidal?
- Ask about mood
- Hx of psychiatric disorder (previous attempts, self harm, psychosis, traumatic past)
- Amount, type, place, time
- Features - compulsion, patterns, tolerance, withdrawal, reinstatement after abstinence
- History of depression
- Describe complications of alcohol abuse
- FHx of alcohol/substance abuse
- DHx of prescribed and illicit medication
- Main symptoms, duration and severity
- Weight loss, tremor, vision change, sweating, heat intolerance, palpitations, menses change, diarrhoea
- Mental state, anxiety, loss of libido, irritability
- Ask about neck swelling
- Urination, hunger, thirst - quantify change and severity
- Xerostomia, weakness, fatigue, blurred cision, slow healing wounds
- Type of diabetes and monitoring
- History of diabetes
- Use of insulin, oral hypoglycaemics
- Alcohol, smoking, diet, exercise, weight, cholesterol
Mini mental state
- Orientation (10): Year, season, month, day, date + country, city, district, hospital, floor
- Objects (3): Name three objects, ask patient to repeat until all three in under 1 sec each
- Calculation (5): Serial subtraction of 7 from 100, stop after 5 answers. Or spell "world" backwards
- Recall: ask for three objects
- Naming (2): Name two objects indicated
- Diction (1): No ifs, ands or buts
- Comprehension (3): Three stage command - paper in right hand, fold in half, put on floor
- Reading (1): Read and obey "close your eyes"
- Writing (1): Write a sentence
- Draw (1): Copy two intersecting pentagons
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