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29 Cards in this Set
- Front
- Back
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Headache
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Hx- location (unilateral vs bilateral), PQRST, Associated symptoms: nausea,jaw claudication, trauma, dental surgery, sinus symptoms. PMH and FamHX of migraines
PE: HEENT, Neuro |
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Confusion/memory loss
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Hx: Time course of deficits, ADL status, falls, meds and med changes, h/o stroke or vascular dz, syphilis, HIV, EtOH use, vit B12 def. FamHx of Alzheimer's. Associated Sxs: constitutional, incontinence, ataxia, hypothyroid, depression.
***Address that hx should come from family, friend or caretaker. PE: HEENT, Neuro (including MMS) |
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Dizziness
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Hx: Lightheadedness vs vertigo, auditory symptoms, duration of episodes, context (occurs with positioning, following head trauma), neck pain or injury, meds, h/o vascular dz. Associated Sxs: visual disturbance, URI, n/v.
PE: Neuro, HEENT, Cardio |
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Loss of consciousness
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Hx: +/- preceding symptoms (nausea, diaphoresis, palpitation, pallor, lightheadedness), context (exertional, postural, traumatic, stress, painful, claustrophobic experience, dehydration). H/o heart dz or arrhythmia, EtOH or drug use. Associated Sxs: toungue biting, incontinence, tonic-clonic movements, prolonged confusion, dyspnea or PE risk.
PE: Neuro, Cardio and carotids, Resp |
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Numbness and weakness
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Hx: distribution, duration, +/- progressive, pain, constitutional symptoms, neuro symptoms, h/o DM, EtOH abuse or vascular dz.
PE: Neuro, MS and vascular |
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Fatigue and sleepiness
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Hx:Duration, sleep hygiene, snoring, waking up choking/gasping, witnessed apnea, overexertion, stress, depression, emotional problems, diet, wt changes, constitutional sxs, sxs of thyroid dz, h/o bleeding/anemia, meds, EtOH and drug use
PE: HEENT, Cardio, Resp, Neuro |
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Sore throat
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Hx: Duration, fever, ENT sxs, sick contacts. Associated Sxs: odynophagia, swollen glands, +/- cough, rash.
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Cough/ShOB
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Hx: Acute v Chronic. Sputum, PQRST. Exposures, smoking hx, h/o lung dz, allergies, meds. Associated Sxs: consitiutional, URI, postnasal drip, dyspnea, wheezing, chest pain, heartburn
PE: HEENT, Cardio, Resp, Lymph nodes, Ext |
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Chest Pain
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Hx: PQRST. Context: exertional postprandial, positional, cocaine use, truama. Prior hx of similar sxs, known heart or lung dz, cardiac risk factors (htn, hyperlipidemia, smoking, FamHx) PE risk factors. Associated Sxs: sweating n/v, dyspnea, palpitation, sense of doom
PE: Cardio, Resp, Abd |
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Palpitations
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Hx: gradual v acute onset/offset, context (exertion, caffeine, anxiety) Hyperthyroid sxs, h/o bleeding/anemia or heart dz. Associated Sxs: light headedness, CP, dyspnea
PE: Cardio, Endocrine exam (thyroid, exophthalmos, lid retraction, lid lag, bruit and tremor) |
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Weight loss
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Hx: Amount/duration, intentional, diet, body image, anxiety/depression. Constitutional symptoms. FamHx thyroid dz, HIV risk factors, EtOH and drug use, meds h/o Cancer. Associated sxs: palpiations, tremor, diarrhea,
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Weight gain
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Hx: Amount/duration, timing (relation to med changes, smoking cessation, depression) diet, hypothyroid sxs, menstrual irregularity, PMH, EtOH and drug use.
PE: Look for sigs of Cushing's (htn, central obesity, moon face, buffalo hump, supraclavicular fat pads, purple abd striae) |
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Dysphagia
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Hx: Solids v solids and liquids, constitutional sxs, meds, HIV risk, h/o smoking, h/o Raynaud's. Associated Sxs: drooling, regurgitation, odynophagia, GERD
PE: HEENT, Cardio, Resp, Abd, Skin (look for signs of scleroderma/CREST) |
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Nausea/vomiting
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Hx: PQRST. Acuity of onset, +/- abdominal pain, relation to meals, sick contacts, possible food poisoning, possible pg, neuro symptoms. Meds. Associated sxs: CP, GI
PE: HEENT, Cardio, Resp, Abd |
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Abdominal Pain
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Hx: PQRST, prior hx of similar symptoms, h/o abd Sx, gallstones, kidney stones, vascular dz, meds, EtOH and drug use, domestic violence. Associated sxs: constitutional, GI, cardiac, pulmonary, renal, pelvic
PE: Cardio, Resp, Abd (remember guarding, rebound, Murphy's sign, and CVA palpation. Mention DRE and pelvic exam in plan if needed) |
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Constipation/diarrhea
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Hx: Frequency and volume, duration of change, sxs of thyroid dz, diet, meds, sick contacts, travel, camping, HIV risk factors, h/o abd SX, DM, pancreatitis, EtOH and drug use, and FamHx colon ca. Associated sxs: constitutional, abd pain, bloating, sense of incomplete evacuation,melena/hematochezia.
PE: Abd, consider endocrine, (mention DRE and pelvic in plan if needed) |
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Upper GI bleeding
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Hx: Amount, duration, context (after severe vomiting, EtOH ingestion, nosebleed), meds, h/o PUD, liver dz, AAA repair, easy bleeding. Associated sxs: constitutional, nausea, abd pain, dyspepsia
PE: HEENT, Cardio, Resp, Abd (mention DRE in plan) |
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Blood in stool
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Hx: Melena v bright red, amount, duration, trauma, prior h/o similar sxs, prior colonoscopy, meds, h/o easy bleeding or vascular dz. Associated sxs: constitutional, abd or rectal pain, tenesmus, c/d.
PE: Abd (mention DRE) tilt test |
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Hematuria
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Hx: Amount duration, +/- clots, meds, h/o viorous exercise, trauma, smoking, stones, cancer, or easy bleeding. Associated Sxs: constitutional, renal colic, dysuria, irritative voiding sxs.
PE: Abd, GU, Ext, Lymph nodes (mention DRE if needed) |
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Urinary symptoms
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Hx: Duration, obstructive sxs (hesitancy, diminished, stream, sense of incomplete voiding, straining, postvoid dribble), irritative sxs ( urgency, frequency, nocturia), constitutional sxs, bone pain, meds, h/o UTIs, urethral stricture, urinary tract instrumentation, stones, DM or EtOH abuse.
PE: focused neuro, Abd, (GU and DRE mentioned in plan if needed) |
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Erectile dysfunction
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Hx: Duration, severity, +/- nocturnal eretions, libido, stress or depression, trauma, incontinence, meds, PMH (htn, dm, high CH, known vascular dz, prior prostate sx) smoking, EtOH and drug use.
PE: Cardio, vascular, (mention DRE and GU exam in plan) |
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Amenorrhea
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Hx: Primary v secondary, duration, possible pg, h/o anorexia, excessive dieting, vigorous exercise, pg, D&Cs, unterine infxn, drug use, meds. Associated sxs: HA, decreased peripheral vison, galactorrhea, hirsutism, virilization, hot flashes, vaginal dryness, symptoms of thyroid dz.
PE: ( mention Breast, pelvic in plan), Abd |
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Vaginal bleeding
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Hx: Pre v Post menopausal, duration, amount, menstrual hx and relation to LMP, discharge, pelvic/abd pain, urinary sxs. trauma, meds, h/o easy bleeding/bruising, h/o abnormal pap.
PE: Abd (mention pelvic in plan) |
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Vaginal Discharge
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Hx: amount, color, odor, duration, vaginal burning, pain or pruritus, recent sexual activity, FDLMP, use of contraceptives, tampons, and douches, h/o similar sxs, h/o STDs.
PE: Abd, (mention pelvic in plan) |
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Dyspareunia
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Hx: duration, timing, adequacy of lubrication, libido, sexual hx, h/o sexual trauma or domestic violence, h/o endometriosis, PID, prior abd/pelvic Sxs. Associated sxs: vaginal discharge, rash, painful menses, GI sxs, hot flashes
PE: Abd (mention pelvic in plan) |
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Abuse
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Hx: Establish confidentiality; directly question about physical, sexual, or emotional abuse and about fear, safety, backup plan; history of frequent accidents/injuries, mental illness, drug use; firearms in the home
PE: Complete including pelvic |
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Joint pain
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Hx: PQRST. pattern (small vs. large joints, number involved; swelling, redness, warmth; trauma (including vigorous exercise); medications; DVT risk factors; alcohol and drug use; family history of rheumatic disease. Associated sxs: (constitutional, red eye, oral or genital ulceration, diarrhea, dysuria, rash, focal numbness/weakness),
PE: HEENT, MS and relevant neurovascular |
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Low Back Pain
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Hx: PQRST, context (moving furniture, bending/twisting, trauma), timing (disturbs sleep), history of cancer, recurrent UTIs, diabetes, renal stones, IV drug use, smoking. Associated sxs: (especially constitutional, incontinence),
PE: neurologic exam, back palpation and range of motion hip exam (can refer pain to the back) |
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Child with fever
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Hx: Severity, duration, associated localizing symptoms, appetite, rash, sick contacts, day care, immunizations, past history.
PE: HEENT, neck, heart, lung, abdominal, and skin exam |
