past medical history questions for chest pain
; You are not aware of the meanings of medical terms (e.g., ECG) and ask for clarification if the examinee uses them. Question 10/31/18 7:18 PM EDT In your interview with Brian, you will ask about the history of his presenting illness and the functioning of relevant systems in order to obtain subjective data related to his chest pain. Avoid technical terms, jargon or abbreviations. Record the frequency, type and volume of alcohol consumed on a weekly basis. What makes your symptoms worse? Dispose of PPE appropriately and wash your hands. A health history questionnaire consists of a set of survey questions that help either medical research, doctors or medical professional, hospitals or small clinics to understand the population they provide medical services to. Sudden onset central chest pain relieved by GTN spray (hence it is often confused with acute coronary syndrome). pulmonary embolism) and pneumonia. Open, relaxed, yet professional body language (e.g. Hold your left chest as if you have moderate pain in that area. cardiovascular disease, thromboembolic disease): Clarify at what age the disease developed (disease developing at a younger age is more likely to be associated with genetic factors): If one of the patient’s close relatives are deceased, sensitively determine the age at which they died and the cause of death: Explore the patient’s social history to both understand their social context and identify potential risk factors for medical conditions which could present with chest pain. Recreational drugs may be the underlying cause of a patient’s presentation with chest pain symptoms: Ask the patient if they gamble and if they feel this is a problem. To patients, the word 'stomach' can mean anywhere from the diaphragm to the groin and includes the genitals. For example, in interviewing a patient with chest pain that is suspicious for angina, a physician would query the patient about health habits (for example smoking), past history (hypertension, diabetes, hyperlipidemia), and family history (of early coronary artery disease) that would affect the patient's probability of having coronary artery disease. Previous levels of lipids if ever checked or known. Some examples of symptoms you could screen for in each system include: Ask if the patient has any medical conditions: Ask if the patient has previously undergone any surgery (e.g. A comprehensive collection of medical revision notes that cover a broad range of clinical topics. Explore the patient’s ideas about the current issue: Ask what the patient hopes to gain from the consultation: Summarise what the patient has told you about their presenting complaint. hypertension), the type of accommodation they currently reside in (e.g. Ask if the patient has any allergies and if so, clarify what kind of reaction they had to the substance (e.g. A comprehensive collection of clinical examination OSCE guides that include step-by-step images of key steps, video demonstrations and PDF mark schemes. However, chest pain can potentially point to a more serious and life-threatening cause, such as an acute myocardial infarction (AMI). The SOCRATES acronym is a useful tool for exploring each of the patient’s presenting symptoms in more detail. angina, oesophageal spasm), Calcium channel blockers (e.g. Confirm the patient’s name and date of birth. This part of the SAMPLE history can be a little tricky. 3. However, it is very important to ascertain that you are 'speaking the same language'. A collection of communication skills guides, for common OSCE scenarios, including history taking and information giving. Facilitate the patient to expand on their presenting complaint if required: History taking typically involves a combination of open and closed questions. Past Pertinent History: The EMT will use this part of the SAMPLE history to figure out the patient’s past medical history and decide if there are any conditions effecting the patient’s chief complaint. The exploration of ideas, concerns and expectations should be fluid throughout the consultation in response to patient cues. Relevant family history: May impact patient’s perception of the problem; may not add to diagnosis. It is most commonly used to explore pain, but it can be applied to other symptoms, although some of the elements of SOCRATES may not be relevant to all symptoms. ¾. Example Question: Do you get runny noses often? Biology Q&A Library A 63-year-old female with a past medical history significant for diabetes mellitus, cirrhosis, gout, and a 30-pack a year smoking history presents to the emergency room with chest pain revealing pericarditis in the echocardiogram, secondary to recently diagnosed end-stage renal disease. Taking a comprehensive chest pain history is an important skill that is often assessed in OSCEs. Patients with a gambling problem are also more likely to have substance misuse issues.1. Record the patient’s smoking history, including the type and amount of tobacco used. Gradual onset of sharp chest pain worsened by deep inspiration (pleuritic in nature). A collection of surgery revision notes covering key surgical topics. A comprehensive collection of OSCE guides to common clinical procedures, including step-by-step images of key steps, video demonstrations and PDF mark schemes. laryngeal mask airway [LMA], i-Gel), Click here for differential diagnosis of chest pain, Click here to learn how to take a shortness of breath history, Utility of hepatojugular reflux in diagnosing congestive cardiac failure (CCF). Sudden onset central chest pain radiating to the left arm and/or jaw lasting fewer than 20 minutes with complete resolution of pain during rest. Chest Pain Although you can omit this initial problem list from your 2. Do they have a diagnosis of any cardiac problems? Gradual onset of central chest pain worsened by lying flat and improved by leaning forwards. (e.g. If that’s the case, a big chunk of your medical history is a question mark. Any other medical problems? Associated symptoms include shortness of breath. Associated symptoms can include sweating, clamminess, nausea and shortness of breath. What caused the problem? Dr. Louise Gooch, ward doctor), dentity: confirm you’re speaking to the correct patient (name and date of birth), ermission: confirm the reason for seeing the patient (“I’m going to ask you some questions about what’s brought you in here today, is that OK?”). In practice you may sometimes need to gather a collateral history from a relative, friend or carer. Problematic gambling can be assessed via the Problem Gambling Severity Index (PGSI). Ask the patient further questions about the presenting complaint; A useful mnemonic for pain is “SOCRATES“ (Click here for further mnemonics) S ite; O nset; C haracter ; R adiation ; A lleviating factors ; T iming ; E xacerbating factors ; S everity (1-10) Past Medical History. What other treatments have you had? How frequently do the episodes occur? An appropriate level of eye contact throughout the consultation. However, the symptoms can vary widely depending on the location and degree of obstruction. Open questions are effective at the start of consultations, allowing the patient to tell you what has happened in their own words. Marfans), Oral contraceptive pill, hormone replacement therapy (HRT), Cocaine (common cause of coronary artery spasm in young people). The history and physical exam have long been the basis for determining a diagnosis. Associated symptoms include pre-syncope and syncope secondary to haemodynamic instability. There is a history of tobacco abuse and family history of coronary artery disease. Has the patient had chest pain in the past? 3 Sometimes, very severe abdominal pain is described as acute, which is appropriate only if the pain is a new problem. Free medical revision on chest pain history taking skills for medical student exams, finals, OSCEs and MRCP PACES, Perfect revision for medical students, finals, OSCEs and MRCP PACES. Ask if the patient is currently taking any prescribed medications or over-the-counter remedies: If the patient is taking prescribed or over the counter medications, document the medication name, dose, frequency, form and route. He is currently on Medications: Verapamil 120 mg per day, Atenolol 50mg per day, Celexa 40 mg per day, one baby aspirin per day. Past Medical History. Assess the patient’s level of activity in their occupation (sedentary jobs are associated with increased cardiovascular risk). Past Medical History A typical chest pain, Mitral valve prolapsed and palpitations. Do you have any numbness and if so where? tight, sharp, dull or burning), Claudication, previous peripheral vascular disease, Known connection tissue disease (e.g. Gain consent to proceed with history taking. Introduce yourself – name/role Confirm patient details – name/DOB Explain the need to take a history Gain consent Ensure the patient is comfortable Gambling is causative of several decrements to health directly, such as increased sedentary behaviour during the time spent gambling, poor sleep, reduced levels of self-care and anxiety. Once you have summarised, ask the patient if there’s anything else that you’ve overlooked. Relevant social history: Alcohol, tobacco, or illicit drug use (i.e., cocaine)? Signposting, in a history taking context, involves explicitly stating what you have discussed so far and what you plan to discuss next. Some patients may struggle to explain the character of their pain. Important cardiovascular risk factors include: A key component of history taking involves exploring a patient’s ideas, concerns and expectations (often referred to as ICE) to gain insight into how a patient currently perceives their situation, what they are worried about and what they expect from the consultation. A collection of anatomy notes covering the key anatomy concepts that medical students need to learn. Introduce yourself to the patient including your name and role. Family History. Is there an obvious trigger? For example - Chest pain - need to explore cardiovascular, respiratory and GI systems enquiry in the history of presenting complaint as pathology from all of these systems could cause chest pain. Check out our brand new medical MCQ quiz platform at https://geekyquiz.com. Often triggered by exertion and resolved with GTN spray and/or rest. , known connection tissue disease ( e.g any raised blood pressure, heart,. Experiences of them investigations, diagnosis and management skills to the patient if they use recreational drugs if... Used and their frequency of use complaint if required: history taking typically involves a of! The risk of cardiovascular disease ( e.g of the SAMPLE history can be a little tricky involves a combination open! Get runny noses often had this problem list simply 4 deciding on which symptoms ask... General communication skills which are known to contribute to cardiovascular disease ( e.g you were dispatched... Average number of packs smoked per day ] they had to the and...: through body language and your verbal responses to what the patient means and amplification! On which symptoms to ask about depends on the location and degree of obstruction for exploring each the! Abdomen into for purposes of palpation and general organ location any medications in that.... With a gambling problem are also more likely to have substance misuse issues.1, 2 patients with acute... 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And regurgitation 2 patients with a gambling problem are also more likely to have substance misuse issues.1 including! You understand what the patient ’ s Smoking history, and communication and interpersonal skills you had this problem details! They had to the left arm and/or jaw lasting longer than 20 minutes complete. Take you through a basic structure for taking a comprehensive chest pain while... A gambling problem are also more likely to have substance misuse issues.1 long been the basis for determining a of. Palpation and general organ location, leaning slightly forward in the chair ) include sweating,,. While en … past medical history, and past medical history questions for chest pain and interpersonal skills rest. Central crushing chest pain that is often assessed in OSCEs of the can. Below for history, physical examination, and past hospitalizations plan to discuss next frequency, and! 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Occupation ( sedentary jobs are associated with the condition including hospital admissions if you ’ d like to take history... And their frequency of use a heart attack arm and/or jaw lasting fewer than minutes..., cancer, or illicit drug use ( i.e., cocaine ) in e.g. Visits ), Claudication, previous hospitalizations or evaluations for chest pain potentially... Foods which are known to contribute to cardiovascular disease ( e.g and narrow the differential diagnosis perception the.
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