History taking OSCE

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  1. Chest pain
    • 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
  2. Breathlessness
    • 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
  3. Palpitations/falls
    • 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
  4. Intermittent claudication
    • Full smoking history: amount, reasons, attempts, barriers and benefits
    • Advice and support
  5. Dysphagia
    • 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
  6. Vomiting/haematemesis
    • 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
  7. Jaundice
    • 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
  8. Abdominal pain
    • Nausea/vomiting, fever, anorexia, bowel habit change, FOB, dysuria
    • Trauma, gallstones, diverticulitis, IBD, HIB, CV disease
    • Alcohol, smoking, foreign travel
    • NSAIDS
  9. 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
  10. Rectal bleeding
    • 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
    • Antiplatelet/anticoagulants?
    • Family - polyps/bowel cancer
  11. Sexual
    • 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
  12. Breast
    • 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
  13. Headache
    • 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
  14. Depression
    • Current mood?
    • Onset?
    • 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
  15. Schizophrenia
    • Duration
    • 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
  16. Suicide
    • How (especially type and quantity of drug, including alcohol)
    • Why
    • 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)
  17. Alcohol abuse
    • Amount, type, place, time
    • Features - compulsion, patterns, tolerance, withdrawal, reinstatement after abstinence
    • CAGE
    • History of depression
    • Describe complications of alcohol abuse
    • FHx of alcohol/substance abuse
    • DHx of prescribed and illicit medication
    • SHx
  18. Hyperthyroidism
    • 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
  19. Diabetes
    • 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
  20. 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
Card Set
History taking OSCE
All the diseases
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