Clinical Case History Quiz
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Questions and Answers

What constitutes symptoms in a clinical context?

  • Disease features reported by the clinician
  • Results obtained from diagnostic tests
  • Disease features reported by patients (correct)
  • Features observed during a physical examination

Which of these is a component of a comprehensive case history?

  • Diagnosis potential from laboratory tests
  • Demographics of the clinician
  • Therapeutic plans from previous visits
  • Patient's medical history (correct)

The SOCRATES acronym is useful for detailing which aspect of a patient's condition?

  • Differential diagnosis considerations
  • Physical examination findings
  • History of presenting complaint (correct)
  • Demographics and identification

What is the primary purpose of obtaining a patient's medical history?

<p>To formulate a diagnosis and treatment plan (C)</p> Signup and view all the answers

Which statement best describes 'physical signs' in clinical examination?

<p>Features observed or elicited by the clinician (B)</p> Signup and view all the answers

What type of questions are considered 'closed' questions in medical history-taking?

<p>Questions aimed at confirming specific diagnostic possibilities (C)</p> Signup and view all the answers

Which element should be included in the 'identification and demographics' of a case history?

<p>Name, age, and gender of the patient (C)</p> Signup and view all the answers

In the context of case history, what is referred to as the 'presenting complaint'?

<p>The reason the patient seeks medical attention (A)</p> Signup and view all the answers

What is typically included in the past medical history section of a case history?

<p>Previous surgeries and allergies (B)</p> Signup and view all the answers

Which of the following is NOT a part of the drug history component?

<p>Family history of drug addiction (D)</p> Signup and view all the answers

What details should be gathered in the social history component?

<p>Job, marital status, and substance use (B)</p> Signup and view all the answers

Which of the following is a constitutional symptom relevant to general enquiry?

<p>Fever and weight loss (B)</p> Signup and view all the answers

In which component of a case history would you assess for significant family diseases?

<p>Family history (D)</p> Signup and view all the answers

Which condition is primarily associated with angina?

<p>Hypertrophic cardiomyopathy (C)</p> Signup and view all the answers

What is the primary purpose of the review of systems in a case history?

<p>To uncover symptoms related to specific organ systems (C)</p> Signup and view all the answers

What type of chest pain is likely to be caused by pleuritic inflammation?

<p>Pleuritic pain exacerbated by inspiration (C)</p> Signup and view all the answers

What kind of information is particularly important to gather regarding drug allergies?

<p>Experiences of intolerances or minor reactions (D)</p> Signup and view all the answers

Which of the following best describes general enquiry within a case history?

<p>An evaluation of systemic symptoms affecting the whole body (A)</p> Signup and view all the answers

What is a common cause of exertional dyspnea?

<p>Chronic heart failure (D)</p> Signup and view all the answers

Which symptom is most likely associated with paroxysmal atrial flutter?

<p>Regular fast palpitations (C)</p> Signup and view all the answers

What defines claudication?

<p>Cramping leg pain during exertion (B)</p> Signup and view all the answers

What does dizziness in a patient often refer to?

<p>Illusion of rotation or difficulty walking/staying balanced (B)</p> Signup and view all the answers

Which of the following histories is most pertinent in assessing cardiovascular health?

<p>History of hypertension (A)</p> Signup and view all the answers

Which medication type is least likely to contribute to bradycardia?

<p>Diuretics (A)</p> Signup and view all the answers

What does the physical examination assess regarding the patient's breathing pattern?

<p>Breathing pattern and abnormalities (D)</p> Signup and view all the answers

Which condition is related to abnormal distribution of body hair in males?

<p>Endocrine disease (C)</p> Signup and view all the answers

What skin finding indicates jaundice during a physical examination?

<p>Yellowing of the sclera and skin (C)</p> Signup and view all the answers

Which physical examination finding is most indicative of Addison’s disease?

<p>Dark brown or black skin pigmentation (B)</p> Signup and view all the answers

What physical sign is characterized by increased curvature of fingernails?

<p>Clubbing (B)</p> Signup and view all the answers

Which coloration of the skin is associated with cyanosis?

<p>Blue/Purple (C)</p> Signup and view all the answers

What might an anxious or confused mental state during a physical examination suggest?

<p>Possible metabolic disturbance (D)</p> Signup and view all the answers

What skin condition is associated with a butterfly rash?

<p>Systemic Lupus Erythematosus (SLE) (B)</p> Signup and view all the answers

What is the cause of Heberden’s nodes?

<p>Osteoarthritis (C)</p> Signup and view all the answers

Which symptom is indicative of acute inflammation in joints?

<p>Swelling and redness (D)</p> Signup and view all the answers

What does muscle wasting typically indicate in a physical examination?

<p>Nerve lesions (D)</p> Signup and view all the answers

Which reassessment of chest pain suggests the possibility of angina?

<p>Pain is relieved by rest or GTN (A)</p> Signup and view all the answers

Signs of dehydration in a physical examination may include which of the following?

<p>Sunken eyes (C)</p> Signup and view all the answers

What characteristic of aortic dissection pain is notable?

<p>Instantaneous and tearing (C)</p> Signup and view all the answers

Which factor is considered a precipitating factor for cardiac pain?

<p>Exercise or emotional stress (D)</p> Signup and view all the answers

What might improved pain from leaning forward indicate?

<p>Pericarditis (D)</p> Signup and view all the answers

What condition is indicated by koilonychias?

<p>Iron deficiency (D)</p> Signup and view all the answers

What skin change is associated with cirrhosis?

<p>Palmar erythema (C)</p> Signup and view all the answers

What do Beau's lines indicate?

<p>Temporary arrest of nail growth (C)</p> Signup and view all the answers

Which condition is associated with splinter haemorrhages in nails?

<p>Infective endocarditis (D)</p> Signup and view all the answers

What does onycholysis refer to?

<p>Nail detachment from the nail bed (A)</p> Signup and view all the answers

What may pallor of the palms suggest?

<p>Anemia (B)</p> Signup and view all the answers

How are nail-fold infarcts characterized?

<p>Embolic phenomena (D)</p> Signup and view all the answers

Which condition is noted for causing transverse lines in the nails?

<p>Chemo treatment (B)</p> Signup and view all the answers

Flashcards

Symptoms

Information reported by the patient about their health condition, such as pain, itching, or difficulty breathing.

Physical signs

Observable features of a disease detected by a clinician during a physical examination, like swelling in fractures or Trousseau's sign in hypocalcemia.

Medical history

Information gathered by a physician through questions asked directly to the patient or other individuals. It aids in determining the diagnosis and treatment plan.

Presenting complaint

The core reason for a patient's visit to the clinic or hospital, defining the primary health concern and its progression.

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History of presenting complaint

Information detailing the chief complaint, including its onset, progression over time, previous occurrences, and specific characteristics of the symptom (like pain).

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Specific or closed questions

Asking specific questions related to potential diagnoses, risk factors, and relevant body systems to gather more information about the patient's health.

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Case history

A standardized method for gathering information from a patient that includes identification, demographics, presenting complaint, history of presenting complaint, and a review of systems.

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Review of systems

Gathering information from a patient about specific body systems to understand their overall health status.

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Past Medical History

Information about past hospitalizations, illnesses, surgeries, and specific conditions like heart attack, jaundice, or diabetes.

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Drug History

A list of all medications the patient takes, including tablets, injections, over-the-counter drugs, herbal remedies, and oral contraceptives.

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Allergies

Information about allergies and the reactions experienced, ranging from mild intolerance to severe allergic reactions.

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Social History

Information about the patient's job, marital status, living situation, mobility, alcohol, tobacco, and recreational drug use.

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Family History

Information about the health history of the patient's family, particularly focusing on diseases like heart disease, diabetes, cancer, and inherited conditions.

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General Enquiry

A systematic questioning about the patient's overall health, including symptoms like fever, weight loss, night sweats, fatigue, and rash.

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Constitutional Symptoms

Symptoms that affect the entire body rather than a specific organ or location.

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Palmar erythema

Redness of the palms, often associated with liver disease (cirrhosis).

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Pallor of the palms

Pale color of the palms suggesting a lack of red blood cells (anemia).

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Koilonychias

A concave (spoon-shaped) appearance of the nails, suggesting iron deficiency or other conditions like endocrine disorders.

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Onycholysis

Separation of the nail plate from the nail bed, often seen with thyroid disorders.

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Beau's lines

Horizontal grooves or lines across the nails, signifying a temporary disruption in nail growth, often caused by illness or stress.

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Splinter hemorrhages

Small, linear, reddish streaks under the nails, usually caused by blood clots or trauma.

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Nail-fold clubbing

A condition where the nail folds become swollen and tender, often associated with inflammatory bowel disease or connective tissue disorders.

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Nail abnormalities

A general term for changes in the appearance of the nails, such as discoloration, thickening, or splitting.

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Dupuytren's contracture

Thickening and contracture of the palmar fascia, causing a bent finger that cannot be straightened. It's often linked to liver disease, trauma, aging, and diabetes.

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Heberden's and Bouchard's nodes

Bony growths on the joints of the fingers, particularly the distal interphalangeal (DIP) and proximal interphalangeal (PIP) joints. Frequently seen in osteoarthritis.

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Muscle wasting

Muscle wasting can indicate nerve damage or problems with the nervous system.

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Swollen and red joints

Redness and swelling in joints suggest acute inflammation.

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Joint deformities

Deformities in joints often indicate chronic, long-standing inflammation or injury.

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Tenderness

Pain caused by pressing on a specific area.

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Chest pain radiating

The pain radiating to the shoulder, arm, or neck/jaw is often linked to cardiac ischemia.

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Relieving factors for chest pain

Pain relieved within minutes by rest or nitroglycerin (GTN) suggests angina. Antacids may help with GI issues, and leaning forward relieves pericarditis pain.

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Physical Examination

The process of examining a patient's body for signs of disease.

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General Examination

A general overview of the patient's overall appearance, including things like their weight, skin color, and breathing pattern.

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Physical Appearance

The way a person looks and acts can provide clues about their health. For example, a person who is in pain might grimace or have a labored breathing pattern.

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Skin Color

Abnormal skin color like yellowing (jaundice) can signal liver problems, blueness (cyanosis) can mean low oxygen levels, and paleness (pallor) can be a sign of anemia.

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Finger Clubbing

The nails of the fingers having an increased curvature and loss of the angle between the nail and the nail fold.

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Butterfly Rash

A butterfly-shaped rash that appears on the face, often seen in people with lupus.

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Abnormal Hair Distribution

An abnormal distribution of body hair, such as excessive facial hair in women or hair loss in men, can sometimes indicate an endocrine disease.

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Cushing's Syndrome

A condition characterized by excessive production of the hormone cortisol, leading to symptoms like weight gain in the face and trunk, thin limbs, and purple stretch marks.

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Pleuritic pain

Chest pain that gets worse when breathing in, often due to inflammation of the lungs.

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Exertional dyspnea

Shortness of breath that occurs during exercise, often a sign of heart failure or other lung problems.

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Orthopnea

A type of breathlessness that worsens when lying flat, often a sign of heart failure.

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Claudication

Pain in the legs when walking that is relieved by rest, a common sign of poor blood flow in the legs due to narrowed arteries.

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Palpitations

A sensation of rapid or irregular heartbeats, which may be due to various heart problems or anxiety.

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Vertigo

The illusion of movement of oneself or one's surroundings, often accompanied by dizziness and balance problems.

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Faintness

A feeling of lightheadedness or faintness, which can be caused by a variety of factors like low blood pressure or anaemia.

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Imbalance

A difficulty in walking straight, without the sensation of spinning like in vertigo, which may result from problems in the brain or nerves.

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Study Notes

Clinical Chemistry Case Study

  • A clinical chemistry case study involves evaluating a patient's history, examination, and relevant clinical chemistry tests (such as cardiac troponin).
  • The study includes aspects of history and examination, focusing on general and cardiac health.
  • Cardiac Troponin plays a crucial role in diagnosing myocardial infarction (MI).

History and Examination

  • Symptoms and Signs: Symptoms are patient-reported disease features (e.g., pain, itching, dyspnea). Physical signs are clinician-observed features (e.g., swelling, Trousseau sign).

  • Components of a Case Report: The case report includes the case history (medical history) and physical examination.

  • Case History: Information gathered by a physician from questioning patients and those familiar with their health (e.g. family members). The aim is to collect useful data for forming a diagnosis and treatment plan.

    • Components of the history include identification, demographics and chief complaint (reason for presentation).
    • The history should detail the complaint and its evolution over time. A formal way of recording pain is using the mnemonic 'SOCRATES'(Site, Onset, Character, Radiation, Associations [eg nausea, sweating], Timing, Duration, Exacerbating and alleviating factors, Severity [scale of 1-10) )
    • The history should include past medical history, detailing previous hospital visits, illnesses, surgeries, and relevant conditions.
    • Drug history notes any medications, including over-the-counter drugs, herbal remedies and allergies.
    • Social history includes details like occupation, marital status, residence, mobility needs, limitations due to the illness and substance use.
    • Family history includes details about relevant health conditions and diseases (such as heart disease, diabetes).
    • General enquiry records any constitutional symptoms (affecting the entire body) like fever, weight loss, fatigue, etc. and is not disease-specific.
    • Review of Systems systematically examines different organ systems (to uncover undeclared symptoms).

  • Physical Examination: The process where a healthcare professional examines a patient's body to detect disease signs. The general examination evaluates well-being, physical appearance (e.g., well or ill, in pain), breathing pattern, and other relevant physical characteristics including skin, hair and eye appearance.

Other Systems

  • Cardiac, Respiratory, and Genitourinary systems, and newborn examination are explored in the later sections of the course material.

The cardiovascular system: History and Examination

  • Presenting Symptoms:
    • Chest Pain: Site, onset (sudden or gradual), character (crushing, heavy, stabbing, etc.), radiation (does it radiate to arm, neck, or jaw), associating symptoms (shortness of breath, nausea, sweating), timing/duration, and exacerbating and alleviating factors.
    • Severity (out of 10): How severe is the pain experienced by the patient. Important to note if the pain is better/worse with exercise or movement and if the symptoms improves with GTN.

Cardiovascular system: Examination

  • General Inspection: General assessment of patient's general health. Evaluating for presence or absence of pain or dyspnea. Important to note any scars (e.g., median sternotomy from heart surgery), relevant findings related to congenital heart disease.

  • Hands: Include general inspection of hands for physical abnormalities like finger clubbing, splinter hemorrhages.

  • Blood Pressure: Measuring blood pressure, noting any hypertension or hypotension, and postural changes. Important to know if the patient is showing signs of shock.

  • Auscultation and Palpation of the Heart: Listening to and palpating the heart to identify murmurs, abnormal heart sounds, and the location of the apex beat. Important to identify any abnormalities or specific patterns and characteristics.

    • Identify normal or abnormal sounds or murmurs.
    • Identify the location of the apex beat (important to note any abnormalities or changes in location).

  • Face: Inspecting the patient's face, noting signs of dyslipidemia, signs of conditions like Graves' disease, and Marfan's syndrome, facial or body dysmorphia.

  • Oedema: presence and assessment of pitting edema.

  • Abdomen: Examining the abdomen to look for conditions like hepatomegaly or ascites.

  • Pulses: Assessing peripheral pulses, including character, rhythm and rate.

  • ECG (electrocardiogram): Identifying any abnormalities or patterns indicative of cardiac conditions.

  • Cardiac Markers: measuring cTnI, CK-MB and the relative index for the diagnosis of MI or other related conditions.

Specific Case Examples

  • Present case-study data, including patient age, gender, chief complaint, ECG findings, cardiac markers, physical examination findings.

Acute Coronary Syndromes (ACS)

  • Types of acute coronary syndromes including STEMI and NSTEMI.
  • Common causes of acute coronary syndromes.
  • Diagnostic criteria for acute coronary syndromes including history and examination, ECG findings and biomarker results.
  • Biochemical Changes in Acute Myocardial Infarction (MI).
  • Time-course of cardiac marker changes after acute cardiac injury.
  • Classification of acute coronary syndromes.

Heart Failure (HF)

  • Causes of Heart Failure
  • Signs and symptoms of Heart Failure
  • Diagnostic criteria (Framingham criteria).

Natriuretic Peptides (NP)

  • BNP levels are important in diagnosing conditions, such as acute dyspnea.
  • BNP assays, predictive and prognostic value.
  • Role in cardiac injury diagnosis.

Myoglobin

  • A cardiac marker that appears early but lacks cardiac specificity.
  • Useful alongside cardiac troponins.

Additional Notes

  • Relevant figures, diagrams, tables providing detailed information about each topic are included in the original presentation.
  • Various types of cardiac biomarkers are described in detail in particular sections. Each with strengths and weaknesses related to speed of detection, specificity in identifying a cause, and how accurate the information is.

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Description

Test your knowledge on the essentials of clinical case history taking. This quiz covers symptoms, medical history, and various components involved in a comprehensive patient assessment. Enhance your understanding of the clinical process and terminology.

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