MH taking

Question 1

What process should be followed when taking a medical history?

Answer 1

• intoduce yourself to pt
• ask pt reason for their visit (c/o)
• Hx of presenting complaint
• pain history (SOCRATES)
• past medical history (systematic review)
• past dental history
• social hostory
• family history

Question 2

What does SOCRATES stand for?

Answer 2

S - Site
O - onset 
C - charasteristics
R - radiating pain
A - associated symptoms
T - time 
E - exacerbatin fsactors 
S - severity

Question 3

What words can be used to characterise in a pain history?

Answer 3

Sharp, dull, aching, crushing, throbbing, shooting

Question 4

What questions can be asked in onset ( socrates - O)

Answer 4

Was it sudden
Was it during exertion or rest
how long have you had it

Question 5

What are good systemic signs of sepsis?

Answer 5

Sweating, Nausea, Palpitations

Question 6

What information do you want re time (SOCRATES - T)

Answer 6

duration

improving/worsening

Question 7

What information do you want re: exacerbating factors (SOCRATES - E)

Answer 7

made worse or better by anything, ie temps or biting

Question 8

What is useful to ask patient to do when asking about severity of pain ( SOCRATES - - last S)

Answer 8

Score pain out of 10, 0 being nothing and 10 being worst pain

Question 9

What is the Systematic Review process re: past medical history?

Answer 9

• Cardiovascular (heart probs)
• Respiratory ( breathing/chest probs)
• Gastrointestinal (stomach/bowels probs)
• Neurological (epilepsy, fits or faints)
• Endocrinology (Diabetes or thyroid probs)
• musculoskeletal (Joint or bone problems)
• Blood disorders (bleeding issues after cut, hep B etc)
• other medical conditions, surgery, hospital stays
• current medication, inc homeopathic, pills, tablets, creams & ointments
• Allergies

Question 10

Whjat things could come up in Systematic review of cardiovascular?

Answer 10

• BP
• CVA
• Cardiac - Anginem, MI (medical Tx, stents, CABG), Valvular Dx

Question 11

What things could come up in systematic review of respiratory?

Answer 11

• Infections - pneumonia
• Airflow obstruction - asthma, COPD (chronic bronchitis, empyhsema)
• Gas exchange failure - fibrosis
• OSA (obstructive sleep apnea)
• Tumours

Question 12

What problems could come up in Systematic review of GI?

Answer 12

• Bowels: Crohns, Ulcerative colitis

- Liver: ALD, cirrhosis

Question 13

What could come up in systematic review of neurological?

Answer 13

• Fits: Seixure control, precipitating factors, change in meds
• Faints
• Headaches

Question 14

What could come up in sytematic review of endcrine?

Answer 14

• Diabetes: Type 1 (insulin deficiency), Type 2 (insulin resistant)
• Thyroid dysfunction

Question 15

What could come up in sytematic review of musculoskeletal?

Answer 15

• Pain, stiffness, swelling: Rheumatoid arthritis, Osteo arthritis, Polymyalgia theumatica
• Joint prothesis
• Osteoporosis

Question 16

What could come up in sytematioc review of blood disorders?

Answer 16

• Generic: Bleeding a while after cut, issues with tooth XLAs, any blood disorders
• Focussed: Hep B & C, HIV; hasemophilia A & B; VW Dx

Question 17

What are some notable drugs?

Answer 17

• Anticoagulants - warfarin, Factor 10a inhibitor: apixyban, riveroxyban
• Antioplatelets: Clopidogrel, aspirin
• Bisphosponates: Alendronic acid - BRONJ
• sterois in last 2 years

Question 18

What infotmation should be gathered in a past dental history?

Answer 18

• regular attender?
• phobias
• adverse effecrs to LA
• Hx of bleeding after XLA
• Tx under sedation (Oral, RA, IV)

Question 19

What information should be gathered in a social history?

Answer 19

• whether pt drinks alcohol & how much
• Smoking (remember smoking cessation advice - ever thought about quitting? ref to GP)
• Occupation ( are you working at moment?)
• Exercise
• Recreational drug use
• living situation: House/flat; who is at home; mobility; carer; activities of daily living