Computer generated transcript

Warning!
The following transcript was generated automatically from the content and has not been checked or corrected manually.

History Taking Part 1 MarsdenR3@cardiff.ac.uk • Standard history taking • Paediatric history taking • Common paediatric presenting complaints Overview • Obstetric history taking • Common obstetric presenting complaints • Gynae history taking • Common gynae presenting complaintsStandard History • Presenting complaint-SOCRATES • Relevant system reviews: Always do quick general review (red flags-Weight loss, fevers, malaise) + other reviews (e.g. chest pain PC-resp and cardio) • ICE NEVER FORGET • PMHx: MD HEAT (MI, Diabetes, HTN, Epilepsy, Asthma/COPD, TB) • DHx: Over the counter + Prescription meds + ALLERGIES!!!! (If yes then what reaction?) • FHx: any issues like this in the family + any conditions that run in the family that I should know about • SHx: LOST (Living situation, Occupation, Smoking/Alcohol/Recreational drugs, Travel (and anything else that could be a risk factor in a socialhx))Paediatric history • Who is the patient being seen with? Family member/friend? On their own? • Explore symptom o Especially important in babies to ask about feeding, wet nappies, fevers, difficulties breathing etc. • Relevant system reviews • ICE • PMHx/DHx/FHx/SHx • Specific paeds hisotry points o Pregnancy and birth – premature, complications, vaginal vs C section, SCBU o Feeding if baby – bottle vs breast o Growth and development – any concerns with health visitor? Ask to see red book if <5 y/o, if at school ask if any concerns at school? o Up to date with vaccinations? o Who the child lives with? o Does anyone in the household smoke? o Have social services been involved with the child's care?Common Paediatric PresentationsCommon paediatric presentations • Failure to thrive o GASTROINTESTINAL: Coeliac disease, dietary intolerance (CMPA/lactose intolerance), Pyloric stenois, IBD, GORD/oesophagitis o NON-GI: Neglect, Eating disorder, CHRONIC ILLNESS (could be anything-always perform a quick system review) • Childhood bruising o Abuse o Cancer/leukaemia o ITP, HSP o Meningococcal septicaemia • Developmental delay o Determine generalised vs focal, motor delay, language delay or social delay • Mental health/behavioural issues o ADHD o Autism • Last years paediatric stations: IBD and ITPAny questions?Obstetric history • Gravida and Parity • Explore symptom • Relevant system reviews • The 4 P’s: Pain, PV discharge,PV bleeding& Pre-eclampsia(headaches,visual disturbances,abdominalpain) • FETAL MOVEMENTS!!! • ICE • Current pregnancy history: Any problems identified on scans? Rhesus status? Midwife vsObsetric led? Single vs multiple pregnancy? Hyperemesis gravidarum? Gestational diabetes? • Miscarriages/Ectopics/Terminations: Sensitive questions-prewarn; “I’m sorry to ask this but have you had any miscarriages?…… ever had something called an ectopic pregnancy?....... Have you ever had a termination of a pregnancy? • Children- If they have other children then were there any issues during their pregnancy or delivery? Previous pre-eclampsia? • PMHx/DHx/FHx/SHx • Sgravida X parity X with this being her 1 /2 /3 pregnancy. She has presented with pregnant female, who is at 16 weeks gestation. She isCommon obstetric presentationsCommon obstetric presentations • Ectopic -RIF pain, PV bleeding • Miscarriage – PV bleeding early in pregnancy • Placental abruption – painful PV bleeding • Placenta praevia - painless PV bleeding • Pre-eclampsia – Headaches, visual disturbances, abdominal pain and leg swelling • Chorioamnionitis – signs of infection e.g. fever, foul smelling discharge • Reduced fetal movements- look at causes for this • We had no obstertic stations last year and so I feel this could be very likely for your year!!Any questions?Gynaecological history • Explore symptom • Relevant system reviews • Gynae system review: The 3 P’s: Pain, PV discharge, PV bleeding • Subfertility/Infertility • Menstrual history: 1 day of LMP, menarche/menopause, cycle length, regularity, Character or periods, Dysmenorrhoea (painful periods), Menorrhagia (heavy periods) • Obstetric history: GMC (Gravida/parity, Miscarriages/ectopics/terminations, Children) • Sexual history – sexually active? Is partner male or female? Dysparunia (pain on sexual intercourse) • Contraception/HRT • Cervical smear history • PMHx/DHx/FHx/SHx • •SHx can be useful for presentations like secondary amenorrhoea (stress, exercise, diet) • ICE- important to ask about impact on lifeCommon gynaecological presentationsCommon gynaecological histories • Endometriosis: abdominal pain, dyspareunia, subfertility • PID: Vaginal discharge, sexually active • Ovarian cyst/torsion • Endometrial cancer: Post-menopausal bleeding • Fibroids/Ectropion: PV bleeding • PCOS: Dark hair growth, acne, irregular/absence periods, cysts on ovaries on USS • Last year's stations: PID and urinary incontinence (urge)Next week: Explaining contraception Khan Academy: and HRT The ovarian cycle | Reproductive system physiology - https://www.youtube.com/watch?v=VYSFNwTUkG0&t=380s https://www.youtube.com/watch?v=gmKAuceSf-s&t=293s These are some Reproductive cycle graph - Luteal phase - suggestions of videos to https://www.youtube.com/watch?v=uA7Xny276sk&t=9s Osmosis - The menstrual cycle = https://www.youtube.com/watch?v=7HlHGLr1hTA watch in preparation for OR next week's session. Armando Hasudungan = Female Reproductive System - Menstrual Cycle, Hormones and Regulation Thank you for listening. Any questions? Please can you fill in the feedback form before you go. https://app.medall.org/feedback/feedback- flow?keyword=7068d4c4558b5654abbc5024&organisation=isce101