medicine history and counselling

8/10/2019 Medicine history and counselling

1/13

MEDICINE H&CRead task Carefully.

HISTORY & COUNSELLING

Read task carefully.Take history roer & discuss !ith atie"t.

Take history & No discussio".

Take History & #$# & #iscuss !ith E%ai"atio".

Take History & #iscuss a"a'ee"t !ith E%ai"er.

HISTORY TAKING

UNCONSCIOUS

RE# EYE

(EIGHT G)IN

HO)RSNESS O* +OICE

#I)RRHE)

LOSS O* CONSCIOUSSNESS

H)E,ETE,ESIS

#RY COUGH

-)C /)IN

*E+ER

+O,ITING

#I/LO/I)

C)L* /)IN

EL#ERLY CONSTI/)TION

NEE /)IN

H)E,O/TOSIS

+ERTIGO

E)R)CHE

COUNSELLING

E/ILE/SY

,ULTI/LE SCLEROSIS

)STH,)

CHRONIC REN)L *)ILURE

#I)-ETES COUNSELLING

/OST ,I COUNSELLING

Unconscious:,a"a'ee"t0

O1ser2e

CT Sca"

3i"utes History taki"'Last Seco"ds0 #iffere"tial

/4 ,)*TOS)


2/13

/5 O#I/)R)

O 6 O"set

# 6 #uratio"

I 6 I"te"sity

/ 6 /ro'ressio"

) 6 )lle2iati"'

R 6 Relie2i"') 6 )ssociated Sytos

/ai"0 Offer /ai"killers.

Vomiting, Di!!"#:

Ru$# out %#"%!tion:

)re you feeli"' e%cessi2ely thirsty7

)re your lis 'o"e dry7

#ecrease uri"atio" 0 /assi"' less !ater tha" 1efore7

'$oo% Loss:

Rule out Anaemia:

)l!ays tired7

Raci"' of heart7

Short"ess of 1reath7

M#ningitis:

*e2er8 'rade of fe2er8 hi'her e2e"i"' sikes. +oiti"'. Neck stiff"ess.

/hotoho1ia0 Is the li'ht 1otheri"' you7

Rash0 Ha2e you "oticed a"y rash i" your 1ody7

Su(!c"noi% H#mo!!"g#:

Headache0 Sudde"8 fe! hours.

(orst headache i" y life8 i" the 1ack of y head.

)ssociated0 +oiti"'8 "eck stiff"ess 9is "eck hurti"' you:

GCA:

)'e0 ;< years. *eale usually.

U"ilateral ai"less o"e side. Teoral.

(he" I co18 touchi"' hair it !orse"s.

Ha2e you "oticed a"y 2isual ro1les7

S)c# Occu)ing $#sion

(orse"i"' headache o2er tie.Nausea8 2oiti"' i" or"i"'8 !he" you !ake u i" the or"i"'7

Ha2e you "oticed a"y 2isual ro1les7

Ha2e you "oticed a"y "u1"ess i" your face or li1s7

)cute Glaucoa

)'e 6 Old

Headache feel it i" the 1ack of the eyes.

Ha2e you "oticed a"y colour haloes7

,edicatio"0 Steroids. )ytritili"e.

,i'rai"e

Ha2e you 1ee" dia'"osed !ith a co"ditio" called i'rai"e7Ha2e you e%erie"ced a"y auras 1efore this headache coi"' to you7

Cluster Headache


3/13

)'e 6 ,iddle a'e.

O"set 6 It=s ore i" the "i'ht.

O"e sided.

It=s coes a'ai" a"d a'ai"8 alost 5> !eeks8 e2ery >?3 !eeks.

Te"sio" Headache

-a"d?like headache.Gets !orst 1y the e"d of the day.

Si"usitis

History of fe2er8 ru""i"' "ose.

Traua

I* THEY

#ON=T UN#ERST)N# YOUR )CCENT0 /)TIENT S)YS0 /)R#ON #OCTOR.

RED EYED/D:

Trauma

Foreign Body

Conjunctivitis

Uveitis

Acute Glaucoma

Rheumatoid Arthritis

Reiter Syndrome Systemactic Lupus Erythemaous SLE!

"n#lammatory Bo$el %isease

RULES OF ENGAGEMENT: Ruled out at least 5 differentials according to age.

D/D:

Trauma:Did ou !urt ourself"

Foreign Body: Do ou t!in# so$et!ing !as gone into our ee % accident"

Conjunctivitis:&atering disc!arge fro$ our ee" 'ain in t!e ee in t!e $orning"Anone in t!e fa$il suffering fro$ so$et!ing si$ilar.

U(eitis: )oung *atient+ fa$il !istor+ %ac# *ain. D,: U(eitis secondar to An#losingS*ondilantis

Acute Glauco$a: Old *atient. 'ain in t!e ee+ coloured !alos.

R!eu$atoid Art!ritis: 'ain or stiffness in -oints in t!e $orning.

Reiter Syndrome: 'ri(ac and confidentialit. Tra(el istor / T!ailand. 0urningsensation 1!en ou *assed urine" 2oint *ains.

3on-uncti(itis.

Art!ritis.

Urinar Tract 4nfection.

Diagnosis: 3on-uncti(itis due to Reiter sndro$e. Gi(e D, of s$*to$.


4/13

SLE: a(e ou noticed an ras! in our face" Fe(er+ 2oint 'ain.4nfla$$ator 0o1el Disease: Altered %o1el a%its.

WEIGHT GI! *ot!roidis$ 3us!ing Sndro$e

'3OD

Acro$egal

Hypothyroidism: Feel cold in t!e sa$e $o$ent as ot!ers feel nor$al. Decreaseda**etite. Tired. Dr !ands. 3onsti*ation.

Cus"ing #yndrome:

0luis! striae.

Facial !air gro1t!.

Medication: Steroids.

$C%D:

Tring !ard to concentrate sa$e last $ont!.

'eriods !istor.

Facial air gro1t!.

&!en 1as our last $enstrual *eriod" 4s t!ere an c!ance ou are

*regnant"

Hereditary:Fa$il istorHa&itua':Diet istor: 3ar%o!drates.

cromega'y:Male *atient. a(e ou noticed an c!ange in ring or s!oe sie.4ncreased s1eating.

HOARSNESS O* VOICESoki"'. +ocal )1use.

DIRRHEYou"' atie"t.

Acute:GE8 *ood /oiso"i"'.

Chro"ic0 La%ati2e a1use. #o%i'i".

C"!onic:

,ali'"a"cy


5/13

I-S 9I"flaatory -o!el Sy"droe:

I-# 9I"flaatory -o!el #isease:

Lactose i"tolera"ce

#ia1etic Neuroathy.

,ala1sortio" 9Celiac #isease:

Hyothyroidis.

HI+

U$c#!ti+# Co$itis:

I was admitted at a hospital, they gave some medication.

Old hospital admissions for tummy. Travel/Family history.

Cnc#! o Co$on:Loss of !ei'ht8 aetite8 *aily history. -lood i" stools.

I'D0 Ski" lesio"s. -lood i" stools.Joint pain.

I'S:)lter"ate 1o!el ha1its. )fter eati"' a eal I ha2e to 'o to a 1athroo.

M$(so!)tion:

Ha2e you e2er 1ee" dia'"osed !ith Celiac #isease7

#o you thi"k that after eati"' a articular food you are ha2i"' this ro1le7

H)#!t"!oi%ism:(ei'ht loss. Heat I"tolera"ce. #iarrhea.

Di(#tic N#u!o)t"0 Ha2e you e2er 1ee" dia'"osed !ith #ia1etes7

Lctos# Into$#!nc#0 )re you aller'ic to a"y ilk roducts7

LOSS O* CONSCIOUSSNESSD-D:

Su1arach"oid Haeorrha'e

Traua

,e"i"'itis

Stroke$TI)

)rrhythias Hyote"sio"

Hyo'lycaeia

You"' atie"t0 Traua. Hyo'lycaeia. ,e"i"'itis.

@>3 Stroke

A>3 TI)

St!o.#-TIA:/ast history of #ia1etes8 Hyerte"sio".

A!!"t"mis:History of heart ro1les.

H)ot#nsion:/rolo"'ed sta"di"'. Hyerte"sio".

H)og$c#mi0 ,issed the eal. *aily history of #ia1etes ,ellitus. )lcohol 9e%cessi2e:.


6/13

Mi%%#$ g#% /omn:

Ha2e you 1ee" sta"di"' a lo"' tie7 (as soe1ody !ith you 9dau'hter:7 #id you "otice

ale7

Eilesy0 Ha2e you e2er 1ee" #ia'"ose !ith Eilesy7

Third erso" testio"y0 LOC. To"'ue 1itti"'.

HAEMETEMESIS Oesoha'eal 2arices

Oesoha'eal Carci"oa

,allory (eiss Sy"droe

Oesoha'itis

Gastric erosio"

Haeeteesis0 -lood i" 2oiti"'. Rule out a"aeia. E"doscoy rece"t.

)'e factor0 >< years 3< years.

Oesoha'eal +arices0 )lcohol @B?; U"its$day.

Ha2e you e2er 1ee" dia'"osed !ith ro1les !ith your li2er7

Carci"oa0 History of !ei'ht loss a"d loss of aetite. *ull"ess i" ei'astriu.

,allory (eiss Sy"droe0 -i"'e dri"ki"'.

Oesoha'itis0 #o you feel a"y heart1ur"7 (he" or after lyi"' do!" or after eati"' your eal

at "i'ht7

Gastric erosio"0 /ai"killers. -lood thi""ers. I"strue"tatio".

CHE#T $I!Diagnosis:

Cardiac:A3S+ 'ericarditis. DAA. Sta%le Angina.

Respiratory:'neu$onia. 3ostocondritis. 'neu$otora,.

'ul$onar e$%olis$. Gastrointestinal:GERD. Gastroeoso*!ageal reflu,.

$'eura' E((usion: 'ain relie(ed % ling in o**osite side.

)yocardia' In(arction:

'ain#illers firts.

3!est *ain 678 $inutes+ doesn9t go 1it! rest.

ngina: 3entral c!est *ain 78 $inutes+ *ain goes 1it! rest. Medications:'rescri%ed a GTN s*ra.

$u'monary em&o'ism:Tra(el !istor. Surger. Fa$il istor. S!ar* localied *ainin c!est. 'ain is aggra(ated % ins*iration.

$ericarditis: Localied+ s!ar*ed *ain in c!est. 'ain is relie(ed % $o(ing for1ard.


7/13

$'eura' E((usion: S!ortness of %reat!+ fe(er+ coug!. 'ain graduall 1orsens+ notsudden. 'ain relie(ed % ling in o**osite side.

Dissecting ortic neurysm: 'ain radiating to t!e %ac#.

GERD:

Fracture ri&: Trau$a: Did ou !urt ourself"Her*es +oster:a(e ou noticed a *ainful ras!"

Eoso*"agea' s*asm:'ain aggra(ates 1it! !ot or is relie(ed % cold drin#s.

DRY C%,GH4;: 'neu$ocstc carrini.

Causes:

Asthma

&neumonia

Smo'ing

(ccupational

Smo'er)s Cough*

D


8/13

DI#CT%)

Disc 'rola*se

4nfection

Secondar

3auda e=uine

Trau$a

Osteo*orosis

Multi*le Melo$a

An#lo S*ondilosis

'el(ic 4nfla$$ator Disease

Disc $ro'a*se:Nu$%ness in our %od+ tingling in t!e %ac#. 'ain radiates fro$ our%ac# to t!e !eel"

In(ection:Fe(er+ &eig!t loss+ Se(ere %ac# *ain.

#econdaries: a(e ou e(er %een diagnosed 1it! a cancer" 3A *rostate.

Cauda e.uina: 'ain in %ac#. Nu$%ness+ 1ea#ness in lo1er li$%s.

Trauma:Muscle s*as$.

%steo*orosis:Age: fe$ale+ old *atient. 0ac# *ain+ 2oint *ain+ stiffness in e(ening.

)u'ti*'e )ye'oma:55 ears old. Anae$ia =uestions. Tired.

ny'os*ondi'osis: >5 ear old. )oung $an.$e'vic In('ammatory Disease: 0ac# 'ain+ tired.

*EVER ,e"i"'itis

,alaria

Eideo Oruitis0 S!elli"'. *e2er. Scrotal /ai". Ha2e you "oticed

a"y s!elli"'7

-%)ITI!G Gastroenteritis

D?A


9/13

'regnanc

ead 4n-ur

Medication

Accidental 4n-ur

+o$ many episodes,

-hen did it start,-ith .lood,-ith pain,

Allergic reactions: Lactose intolerance. 3eliac Disease.

D?A: Fruit s$ell. 'ain in a%do$en"

Medication: AT0+ Antitu%erculosus+ drugs.

Migraine

'ancreatitis: Multi*les e*isodes of (o$iting. Alco!ol.;o$iting: 0inge drin#ing.

DI0LO0IA

G)C #HIRT

Giant 3ell Arteritis

Multi*le sclerosis+ Mast!enia Gra(is

3ataract

S*ace Occu*ing lesion

*ot!roidis$

4nfla$$ator Or%ital Mositis

Refractor error

Trau$a

M: Multi*le Sclerosis. Mast!enia Gra(is. Malignanc. Muscle 'als.

Myasthenia Gravis:Do ou feel e,cessi(el tired at t!e end of t!eda"

Multiple Sclerosis:&ea#ness in li$%s. Difficult in coordinating. Lossof %o1el and %ladder control.

Muscle Palsy:Do ou see dou%le in s*ecific directions"

Malignancy:4nfraor%ital: Loss of 1eig!t and a**etite.

Cataract:Are ou dia%etic" Are ou ta#ing an $edication for longter$"

Hyperthyroidism:Fe(er+ S1elling around edge. Feel *ain.

Refractive error:Do ou 1ear glasses" &!en 1as t!e last ti$e ougot our ees c!ec#ed"


10/13

Trauma:Did ou !urt ourself"

C0F $I!

BBC DR #ET 0urger Disease

0a#er Ru*ture

3laudication


11/13

*#c$ Im)ction0 *eel a"y ass i" your tuy. Hard stools.

'c. In3u!0 Traua or History of fall.

An$ *issu!#s:/ai" & -leedi"'. Shar8 shooti"' ai" !he" assi"' stool.

1!EE $I!GR%##

G@ Gout

H/ e$artrosis

R/ Reacti(e art!ritis. Reiter sndro$e.

%/ Osteoart!ritis.

#/ Se*tic art!ritis. #/ S*orts 4n-ur.

Gout:Triggers. Medication: &ater ta%lets DiureticsB.

Hemartrosis:Fa$il !istor. 0leeding disorder.

Reactive art"ritis: Diarr!ea.

Reiter #yndrome:

%steoart"ritis: E(ening stiffness. Large -oints.

#e*tic rt"ritis:Fe(er+ s1eating. Tenderness.

HE)%$T%#I# T0

Malignanc

'E

'neu$onia

3O'D

Medications

4nstru$entation

TB: Tra(el !istor. Localied *ain. Loss of 1eig!t.)a'ignancy:3A 0ronc!us. Loss of 1eig!t. Middle age.$u'monary Em&o'ism:$neumonia:Fe(er+ coug!+ *leuritic c!est *ain

C%$D:istor of s$o#ing.)edications: 0lood t!inners.


12/13

Instrumentation:0lood $icrosco*.

$0$ITTI%!#2 Anae$ia

*ot!roidis$

'anic attac#s.

3affeine.

Arr!t!$ias.

Hyperventilation: 'anic attac#s. 0reat! in and out do t!e !el* ou"

Hypoglycaemia:'ro*er $eals.

#rrhythmias:a(e ou e(er %een diagnosed 1it! !eart *ro%le$s.

$%cessive alcohol:Alco!ol inta#e.

Caffeine:

Stress& 'ear& #n%iety: S*ecial $o$ents.

#naemia:3old feet.

VERTIGO

Menierre disease

Fullness in ear

Acoustic Neuroma0 Nu1"ess i" face. Cha"'e i" facial

features.

-e"i'" ositio"al 2erti'o.

Traua. Basilar insufficiency0 Raise your shoulders.

Ototoxicity:Ge"taici"e. )"tico"2ulsio"a"ts.

EARACHE Trau$a &a, i$*actation

Foreign 0od


13/13

Mastoiditis

Otitis $edia

Otitis E,terna

0arotrau$a

0oil+ Furuncle

Trauma:Did ou !urt our ear % an c!ance"(a% impactation: 'ain starts after ta#ing !ot s!o1ers.

'oreign Body:Do ou feel so$eti$es is cra1ling"

Mastoiditis: 4s t!ere an *ain near t!e %one of %ac#.

)titis media: Fe(er+ disc!arge+ di$inis!ed !earing.

)titis $%terna: Fe(er.

Barotrauma: Recent flig!t. Di(ing.

Boil& 'uruncle: istor of dia%etes.

COUNSELLING

E/ILE/SY

,ULTI/LE SCLEROSIS

)STH,)

CHRONIC REN)L *)ILURE

#iet

#ru's

#yalisis

Re"al tra"sla"t

Re"al Tra"sla"t0

/riority list for kid"ey tra"sla"t i" NHS. Not sile rocedure. (e !ill take kid"ey tra"sla"t

fro a healthy do"or. *irst ha2e to do soe e%te"si2e 1lood i"2esti'atio"s for you as !ell as the

do"or. Norally it !ill take till ; o"ths fi"al sur'ery. I" case situatio"s !orse"s for you8 !e !ill

ut you i" a riority list.

#I)-ETES COUNSELLING

,edicatio" !ill 1e 'i2e" you i" for of i"Dectio"s. ,y co"sulta"t !ill 1e rescri1i"' it for you.

You "eed to take the re'ularly. You ha2e to take it yourself. You !ill 1e attached to a #ia1etic

"urse. I"suli" reuiree"ts as !ell as a"y colicatio"s arise duri"' treate"t.

0OST MI COUNSELLING

Lo!8 fat diet.

3 !eeks.

Colete rest.

No !alk.

No alcohol.

No stress.

medicine history and counselling

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