If there are 2 Presenting complaints like Hearing loss and Imbalance with ataxic gait, then you need to do ODPARA for both.. and yes time will be consumed…
In the End say to the patient:
Anything i missed from the consultation, anything that you would like me to tell before i will start my examination..
ALWAYS STOP DRIVING IN NEWLY DIAGNOSED CARDIOVASCULAR, NEUROLOGICAL, BLURRY VISION OR FAINTING CASE.
Real patients come in UK PACES that give you history.
You can talk and examine the patient at the same time. Again you can counter check the findings, even if you have completed the examination.
Most important case is ANKYLOSING SPONDYLITIS.
(because when you will enter the room, 30 secs - 1 min will be spent in introduction between you and examiner… 7 mins for Hx… 5 mins for examination.. ..NOW you are left with 2 mins for explaining plan and addressing concerns and consolidating yourself….)
Time management for history is also important, because if the surrogate takes time in giving history and thinking deeply before answering, then it will be very difficult to complete it in 7 mins too… so if you practise Hx in 5-6mins, then you can cover up the time wasted by surrogate… (because you can not ask the surrogate to Hurry up..) Lastly, you are mentally calm if you finish before time.. and if you miss anything in Hx then you can ask in the end after examination….
Example: in a patient of headache, if patient is taking OCP, then papilledema might be due to IIH and CVST.. then ask the patient to stop OCP as it might be causing CVST…
IF THE PATIENT HAS SOME DEFORMITIES IN HANDS: THEN we will still offer TINEL AND PHALEN TEST — If patient is not in pain, then check the tone, power and reflexes..
Most thrombogenic valve is MITRAL VALVE.
When you have 1 autoimmune disease, rule out other autoimmune disease.. When you have 1 endocrine disease, rule out other endocrine disease.— This holds true in every system GIT, Endo, Rheuma, Pulmo etc…
Rule out autoimmune disorder of following.. on History and examination.
Autoimmune hepatitis, coelic, pernicious anemia, PBC, PSC. (Tummy pain, yellow discoloration of eyes, itching, Loose motion, pale)
Addison disease, hypothyroid, hyperthyroid, DM, hypopituitarism.
SLE, RA, SS, Sjogren.
Examination: Rheuma exam, Pulse — hyperthyroid, Postual drop, Pallor, jaundice, abdomen exam, thyroid palpation,
IN EVERY DERMA CASE, Ask about alcohol, smoking, sun exposure, trauma, beta blockers, antimalarial — as they exacerbate psoriasis
Hemachromotosis, and wilson disease are 2 autosomal recessive diseases, that you need to screen the family BEFORE SYMPTOMS APPEAR. , as they are treatable disease,
If any Patient has taken steroids and started having ACUTE ABDOMEN — vomiting and abdominal pain… ALWAYS ASK — have you stopped steroid?? for ADDISONIAN crisis.
ONSET: ****How did it come on, suddenly or gradually? What were you doing at that time? (Especially if sudden)…. Did anything happen prior to DURATION: For how long you have this problem? PROGRESSION: Has it been getting worse, better or staying the same? AGGRAVATING FACTORS: Have you noticed what makes it worse? RELIEVING FACTORS: What makes it better? ASSOCIATED SYSTEMS: Ask about relevant questions from CNS, CVS, Chest, Renal, or Joints,
Do this If pain is the presenting complaint LOCATION: Where precisely do you feel the pain most? Could you please show me? ONSET, PROGRESSION, DURATION: QUALITY: What sort of pain is it, could you please describe it for me? INTENSITY: How intense it is on a scale of 1-10. RADIATION: Does this pain go anywhere else? AGGRAVATING FACTORS ALLEVIATING FACTORS: Does anything make it worse? Does anything make it better? ASSOCIATED SYSTEM:
<aside> 💡 Always put presenting complaint in a system, and then ask the questions of that particular system as mentioned below..
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Hair loss, Headache, Blurring or DOUBLE vision, Grittiness in eyes, vomiting, weakness or numbness in any limb.
oral ulcers, Difficulty in swallowing,
Swelling in front of neck, Any racing or pacing of heart.
Chest pain, cough, Breathlessness, Pedal edema.
Abdominal / flank pain, Yellow discoloration of eyes, itching, tiredness, pallor, Bowel works and water works.
Joint Pains or swelling, Bony pains, Pain in hands or change in color of fingers (blue, white or red) on cold exposure
Is it ok if I ask some personal questions? Let me assure you that this conversation will remain confidential...
Do you have any partner OR are you in any relationship.
Is it a permanent one or a casual partner..
(If case needs more sexual Hx… like in a fever case.. or HIV… then go as below)
Any casual relationships in the recent past…
Ask 3 P's
Any possibility of pregnancy at the moment.
Any problems with the pregnancies in the past. any pregnancy loss?
how many times you got pregnant? i am very sorry to ask, is there any history of abortions?
Always rule out other autoimmune diseases.