CHAPTER 4 THE CARDIOVASCULAR HISTORY

CHEST PAIN

PAGEQUESTION

45Describe the pathophysiological basis of angina or myocardial infarction pain.

Why are those with diabetes more likely to be diagnosed with silent infarct?

47Is ischaemic pain usually affected by respiration? If the chest pain is affected by respiration, which diagnoses are more likely?

Name >4 differences between angina & myocardial infarction pain.

48Describe the typical location, radiation, aggravating and relieving factors of typical angina. How does atypical angina differ?

Patient present for > ____ minutes is more likely to be ACS than angina. What about pain lasting for several days continuously?

Name >4 associated symptoms of ACS.

Define pleuritic pain. 2 main causes? Pleurisy can be primary or secondary to what causes? Often relieved by?

Name >3 characteristics of chest wall pain

Name >3 specific characteristics of aortic dissection pain How can you clinically differentiate b/w proximal & descending aortic dissection? 3 risk factors for aortic dissection

>2 features of chest pain from massive PE

Characteristics of pain in spontaneous pneumothorax

DYSPNOEA

PAGEQUESTION

ANKLE SWELLING

PAGEQUESTION

49

PALPITATIONS

PAGEQUESTION

SYNCOPE, PRESYNCOPE AND DIZZINESS

PAGEQUESTION

CHAPTER 31 THE NEUROLOGICAL HISTORY

PRESENTING SYMPTOMS

PAGEQUESTION

393Most important aspect of neurological symptoms to determine underlying aetiology?

Acute onset of symptoms suggests an underlying _______ problem. Give >3 examples of vascular causes.

What symptoms are very suggestive of a major or complex partial seizure?

Stroke/CVA causes symptoms appearing over how long typically?

Definition of a TIA

Symptoms characteristic of a hemiplegic migraine? Why may it be difficult to differentiate with a TIA?

How do you differentiate between a myopathy and a vascular event?

Subacute onsets suggests what type of underlying pathology?

394More chronic symptoms from weeks to months to years suggests what type of underlying aetiology?

2 main aims of the history and examination 4 levels of the nervous system

What do you ask about after presenting problems in the history?

HEADACHES AND FACIAL PAIN

PAGEQUESTION

394Main difference between common & classical migraine?

395Describe the typical pain seen in cluster headache 3 associated symptoms? Typical pattern of presentation?

Typical headache of a raised ICP? When is it worse? Name some associated symptoms

Typical headache seen in meningitis? Name >3 associated symptoms

Typical headache seen in temporal arteritis? Typical site Associated symptoms

Typical headache seen in acute sinusitis? Associated symptoms?

Typical headache seen in subarachnoid haemorrhage? Associated symptoms?

Typical headache seen in idiopathic intracranial hypertension? It is more commonly seen in who?

The most frequent type of headache Typical sites? Typical sensation / description of pain Associated symptoms

How can one differentiate between migraine & tension headache? Name each letter of the mnemonic

Name >3 causes for pain of the face.

FAINTS AND FITS

PAGEQUESTION

395Name >5 differentials for syncope (transient LOC)

Name >4 associated features seen in generalized tonic-clonic seizures

2 possible causes of seizures affecting only one part of a body?

Difference b/w complex and simple seizures

Typical presentation of absence seizures Most commonly seen in?

Definition of drop attacks? Is there typically aura associated?

396Associated symptoms of hypoglycaemia before LOC?

BOX31.4For a patient with syncope, how do you ask for suspected: Postural hypotension Vertigo LV outflow obstruction Micturition syncope

What are 3 important types of drugs which can cause dizziness or syncope?

1 commonality & 1 difference b/w cardiac syncope & seizure?

DIZZINESS

PAGEQUESTION

396Definition of true vertigo 3 associated symptoms 2 key factors to help with your differentials of vertigo? Name >4 differentials

What causes BPV and vestibular neuronitis?

Name some ototoxic drugs. What does the vertigo it cause also associated with?

TABL31.1For the following diagnoses, describe whether the vertigo is persistent/intermittent, and if there is associated hearing loss: Vestibular neuronitis Benign positioning vertigo Labryrinthitis Menieres disease

VISUAL DISTURBANCES AND DEAFNESS

PAGEQUESTION

396Define diplopia and amblyopia

DISTURBED SENSATION OR WEAKNESS IN THE LIMBS

PAGEQUESTION

397Pins and needles in the hands & feet 2 main differentials?

Carpal tunnel syndrome is due to? Main symptoms experienced Typically worse when? Relieved by?

Definition of a UMN lesion Effect on tone, reflexes and muscle bulk? Greatest effect on which group of muscles? AKA?

Definition of a LMN lesion Effect on tone, reflexes & muscle bulk?

Pattern/distribution of weakness in muscle disease Effect on tone, reflexes & muscle bulk?

Pattern/distribution of weakness in NMJ disease (eg. myasthenia gravis)? Effect on tone & reflexes?

TREMOR AND INVOLUNTARY MOVEMENTS

PAGEQUESTION

397Definition of a tremor?

Difference b/w resting and intention tremors Intention tremors are due to?

Parkinsons tremors are typically what type?

3 causes of exaggerated physiological tremor

Typical tremor seen in benign essential (familial) tremor Most easily seen when?

TABL31.3(398)Definition of: Chorea Dyskinesia Hemiballismus Myoclonic jerk

PAST HEALTH, MEDICATION, SOCIAL AND FAMILY HISTORY

PAGEQUESTION

397Name >5 relevant conditions to ask for in a patient with neurological symptoms

LIST31.1(393)Name >5 risk factors for cerebrovascular disease

398Name >5 groups of medications you should ask about in the medication history

If a neurological disease affects ones ability to work and look after themselves, what are some relevant topics in the social history?

TABL31.4(399)Name at least 4 inheritied neurological conditions to ask for bonus points if you can also name the mode of inheritance.