antipsyotic drug

TRADITIONAL/ TYPICAL

ATYPICAL

LOW POTENCY: · chlorpromazine (thorazine) · thioridazine (mellaril) HIGH POTENCY: · Haloperidol (haldol) · Fluphenazine (prolixin) · Trifluoperazine (stelazine) · Perphenazine (trilafon) · Pimozide (orap) DESCRIPTIONS · Lower affinity for dopamine receptors.high dose needed.not level of efficacy.it have increased incidence of anticholinergic & antihistaminic s/e. · High incidence of EPSEs and NEUROLEPTIC MALIGNANT SYNDROME. TREAT POSITIVE PSYCHOTIC SYMPTOMS SIDE EFFECTS: · Antidopaminergics effects: EPSE: - DYSTONIA of face, neck, tongue (few days) - AKATHISIA (restlessness) (after weeks) - PARKINSONISM (resting tremor, rigidity, bradykinesia- few months) - TARDIVE DYSKINESIA (high potency- after years) · Anti- HAM effects: - Sedation - Dry mouth - Cardiac, sexual prob · Weight gain · Elevated liver enzymes, jaundice · Opthal probs · Dermatology · seizure

Ø Clozapine (clozaril) Ø Risperidone ( risperidal) Ø Quetiapine (seroquel) Ø Olanzapine (zyprexa) Ø Ziprasidone ( geodon) DESCRIPTION Ø Block serotonin and dopamine receptors Ø Fewer side effects Ø Treating negative symptoms Ø First line treatment SIDE EFFECTS Ø Anti HAM (histaminic, adrenergic,muscarinic) Ø Agranulocytosis- clozapine Ø Lactation - risperidone Ø Seizure with clozapine Ø Olanzapine- hyperlipidemia, glucose intolerance, weight gain, liver toxicity (metabolic) Ø Quetiapine -cataracts NEUROLEPTIC MALIGNANT SYNDROME Ø Fever Ø Autonomic instability -tachy,labile HPT Ø Leukocytosis Ø Tremor Ø Elevated creatinine Phosphokinase Ø Rigidity

sAMPLE FOR PSCYHIATRY CASE WRITE UP

http://www.psych.uic.edu/psyclerk/write_up.PDF

Glossary of psychiatric

Appearance & Behaviour

Agitation - a state of motor restlessness with a background of anxiety, especially seen in depression. A high level of activity or excitement may be seen in mania but anxiety usually not a feature.

Ambivalence - this term has two uses:

1. In psychodynamic use it means conflicting emotions or attitudes towards an object, person or idea.
2. In schizophrenia and some organic disorders it refers to an abnormal psychomotor state in which the patient physically vacillates between two opposing courses of action (c.f. catatonia)

Compulsion - repetitive, apparently purposeful behaviour performed in a stereotyped way accompanied by a subjective sense that it must be carried out despite the recognition of its senselessness and often resistance by the patient. Recognised as morbid by the affected individual. Often associated with an obsession.

Mannerism - a sometimes bizarre elaboration of normal activities.

Psychomotor Retardation - slowing of thoughts and movements, to a variable degree. Occurs in depression but other causes include psychotropics, Parkinson’s disease etc.

Stereotypies - uniform, repetitive non goal-directed actions (may take a variety of forms from simple movement to an utterance. Usually ascribed to schizophrenia but may be due to an organic disorder.

Stupor (a.k.a. Akinetic Autism) - more or less complete loss of activity with no response to stimuli; may mark a progression of motor retardation; found in a wide range of neurological and psychiatric conditions.

Speech

Flight of Ideas - rapid skipping from one thought to distantly related ideas, the relation often being so tentative as for instance the sound (rhyming) of different utterances.

Mutism - may be elective or involuntary; like slowing it is a feature of retardation and shares its causes, or may result from schizophrenia, hysteria or be behavioural (e.g. elective in children).

Neologism - a word holding no generally recognisable meaning, either completely new in form. or the condensation of pre-existing words e.g. 'conterbole' (meaning a difficult question) and found mainly in schizophrenia and structural brain disease.

Pressure of speech - is manifest in a very rapid rate of delivery, a wealth of associations which may be quite unusual, (e.g. rhymes and puns) and often wanders off the point of the original conversation. This is highly suggestive of mania.

Word Salad - sometimes called schizophasia; speech is an incomprehensible jumble of words recounted with normal intonation. Apart from language use the schizophrenicpatient is often reasonably capable.

Mood

Affect - expression of an experience of an emotion.

• Blunting of affect - an objective absence of normal emotional responses, without evidence of depression or psychomotor retardation.
• Loss of affect - a purely subjective sense of an ability to feel deeply about anything or anyone.
• Incongruity of affect - Emotional responses which seem grossly out of tune with the situation or subject being discussed.

Anxiety - a state consisting of psychic (dread, apprehension, fear) and somatic (palpitations, tremor, dry mouth, loose stools) symptoms.

Apathy - emotional indifference and lack of activity, often associated with a sense of futility.

Depression - a subjective feeling of sadness, grief or dejection. The word is used to describe a symptom and also is a diagnostic label.

Emotional Lability - a fluctuation of emotions more marked and intense than the existing circumstances might be expected to produce.

Mood - pervasive and sustained emotion in the continuum between sad and happy.

Thought

Autism - a form of thinking in which the individual withdraws from the real world to a private world of his own. This monopolises his interest and attention, objectivity is lacking and there is a complete disregard of reality. It serves to gratify unfulfilled desires and takes the form of daydreams, fantasies and delusions.

Circumstantiality - irrelevant wandering in conversation. Talking at great length around the point.

Deja vu - an individual develops an intense feeling of having 'been here before'.

Delusions - false beliefs which persist in spite of incontrovertible evidence to the contrary and which are out of harmony with the individual's cultural and religious background.

1. Primary delusions - arise ‘out of the blue’
1. Sudden Delusional (Autochthonous) Ideas - delusional ideas suddenly entering consciousness like a 'brainwave', unrelated to previous real or psychic events.
2. Delusional Perception - a normal perception is suddenly interpreted in a delusional manner - one of Schneider’s first rank symptoms of schizophrenia.
3. Delusional Mood - a state of perplexity in which the patient has some sense of some inexplicable change in his environment. He senses ‘something going on’ which he cannot identify, but which has a peculiar significance for him.
2. Secondary delusions - these arise from a ‘morbid’ experience such as an hallucination.

Depersonalisation - a feeling of some change in the self, associated with a sense of detachment from one's own body. Perception fails to awaken a feeling of reality, actions seem mechanical and the patient feels like an apathetic spectator of his own activities.

Derealisation - a sense of one's surroundings lacking reality, often appearing dull, grey and lifeless.

Disorders of Form of Thinking (Formal Thought Disorder) - there is a lack of logical association between succeeding thoughts. It gives rise to incoherent speech (in the absence of brain pathology). It is impossible to follow the patients train of thought (c.f. loosening of associations; knight’s move thinking).

Hypochondriasis - A persistent belief in the presence of at least one serious physical illness despite negative physical findings and reassurance. Alternatively the patient may have a persistent preoccupation with a presumed deformity or disfigurement.

Ideas of Reference - incorrect interpretation of remarks, incidents and external events as referring directly to oneself. May be of delusional intensity when it becomes known as a Delusion of Reference.

Jamais vu - the feelings of strangeness in familiar surroundings as though one had never been there before.

Obsession - a recurrent persistent thought, image, or impulse that enters consciousness unbidden, is recognised as being ones own and often remains despite efforts to resist.

Overvalued Idea - an idea that takes disproportionate precedence in the individual's mind despite its often trivial content. It is firmly held but may be swayed with considerable effort.

Paramnesia - inaccurate recall of memory.

Passivity phenomena - subjective experience that one's actions and/or thoughts are being controlled by some outside agency. Found in schizophrenia.

Thought Alienation - the collective grouping for thought insertion, withdrawal andbroadcasting.

Thought Block - an objective phenomenon in which the patient abruptly breaks off his conversation and is silent for a few seconds and then resumes on a different topic. Subjectively they experience a complete cessation of all thought.

Thought Broadcasting - the experience of thoughts escaping from the boundaries of the self and being known to others, even strangers or people some distance away.

Thought Echo - a form of auditory hallucination in which the patient hears his thoughts spoken aloud, either simultaneous with him thinking it or a moment or two afterwards.

Thought Insertion - the subjective feeling that thoughts in one's mind are not one's own, often explained by a secondary delusion of insertion by some outside agency.

Thougth withdrawal - the subjective feeling that thoughts are missing from one's mind, often explained by a secondary delusion of extraction by some outside agency.

Perception

Hallucination - a perception, indistinguishable from reality, occurring in the absence of an external stimulus.

• Hypnagogic hallucination - an hallucination occurring on falling asleep.
• Hypnopompic hallucination - an hallucination occurring on waking up.

Illusion - misperception of a stimulus, usually occurring at times of environmental or personal dulling e.g. at night; when suffering a serious infection.

Cognitive/neurological

Agnosia - an impaired recognition of an object which cannot be accounted for by sensory defecits, impaired consciousness or unfamiliarity with the object. Includes:

• Anosagnosia - lack of awareness of disease. Most common with left hemiplegic limbs.
• Autopagnosia - an inability to name or point on command to various parts of the body - right and left.

Amnesia - loss or impairment of memory, whether psychogenic or due to cerebral disturbance.

Aphasia - here there is difficulty understanding (primary sensory or receptive), producing (motor or expressive) speech or finding the appropraite word (nominal or anomic).

Apraxia - an inability to carry out puposful voluntary movements, or sequences of movements, which cannot be explained by paresis, incoordination, sensory loss or involuntary movements. Examples include constructional apraxia (inability to construct representations of spatial patterns e.g. copying line drawings) and dressing apraxia (difficulty putting on clothe due to loss of spatial awareness of clothes i.e. may put them on inside out or back-to-front)

Catalepsy - the patient maintains a fixed posture which can be changed by the examiner without any resistance unlike waxy flexibility.

Catatonia - a state of excited or inhibited motor activity in the absence of a mood disorder or neurological disease. It includes a number of other terms:

• Waxy flexibility- the patient's limbs when moved feel like wax or lead pipe, and remain in the position in which they are left. Found rarely in (catatonic) schizophrenia and structural brain disease.
• Echolalia - automatic repetition of words heard.
• Echopraxia - an automatic repetition by the patient of movements made by the examiner.
• Logoclonia - repetition of the last syllable of a word.
• Negativism - the patient does exactly the opposite of what is required.
• Palilalia- repetition of a word over and again with increasing frequency.
• Verbigeration - repetition of one or several sentences or strings of fragmented words, often in a rather monotonous tone.

Confabulation - giving a false account to fill a gap in memory.

Delirium (a.k.a. acute confusional state) - a syndrome due to brain disturbance and characterised by impairment of consciousness. The mood is commonly one of terror and bewilderment, accompanied by transient delusions and hallucinatory experiences. Afterwards there is more or less complete amnesia for external events which occurred during the period of illness.

Dyskinesia - a wide variety of movement patterns e.g. choreoathetosis, rocking, pouting, with a wide range of causes such as drugs, schizophrenia, structural brain disease.

Forced grasping - patient repetitively and persistently takes the examiner's hand whenever offered, perhaps revealing their dementia or chronic schizophrenia.

Perseveration - repetition of a word, theme or action beyond that point at which it was relevant and appropriate.

Twilight State - a chronic state of clouding of consciousness, lasting from several hours to several weeks.

Defence mechanisms

Defence Mechanism - a way of dealing with aspects of the self, which, if consciously experienced, might give rise to unbearable anxiety or psychic pain.

Denial - the person refuses to recognise the reality of a traumatic perception.

Displacement - A defence mechanism where an idea's emphasis, interest or intensity is liable to be detached from it and placed on to other ideas which were originally of little intensity but which are related to the first idea by a chain of association.

Dissociation - Process by which a mental structure loses its integrity and is replaced by two or more part-structures.

Identification - A defence mechanism where the person assimilates an aspect, a property of anchor person, and is transformed, wholly or partially, after the model the other person provides.

Intellectualisation - A defence mechanism consisting of an attempt to gain detachment from an emotionally threatening situation, by dealing with it in abstract.

Introjection - A defence mechanism where in fantasy the person transposes objects and their inherent qualities from the outside to the inside of himself.

Projection - a defence mechanism where our own undesirable ideas are perceived to reside in exaggerated amount in others.

Rationalisation - a defence mechanism where the person attempts to present an explanation that is logical or ethically acceptable. For his true motives, feelings, ideas, actions.

Reaction Formation - a defence mechanism where disturbing ideas are kept unconscious by the presence of the opposite ideas on consciousness. We conceal our motives by giving a strong expression to its opposite.

Regression - a defence mechanism where there is a reversion to an earlier state or mode of functioning. The person avoids anxiety by returning to an earlier state of libidinal and ego development.

Repression - a defence mechanism where an unacceptable impulse or idea that is too threatening and is excluded from the conscious awareness.

Reversal - a defence mechanism where the aim of an instinct is transformed into its opposite in the transition from activity to passivity.

Sublimation - Human activities and pursuits which have no apparent connection with sexuality but are assumed to be motivated by the force of sexual instinct.

Undoing - a defence mechanism that is an action designed to prevent or atone some unacceptable thought or impulse.

Other terms

Addiction - a stage, psychic and sometimes physical, resulting from interaction between a living organism and a drug, characterised by behavioural and other responses that always include a compulsion to take the drug on a continuous or periodic basis in order to experience its psychic effects and sometimes to avoid the discomfort of its absence. Tolerance may or may not be present. (W.H.O. 1969).

Cataplexy - abrupt loss of muscle tone leading to the patient's falling to the floor; a frequent accompaniment to narcolepsy.

Conversion - Unconscious mechanism of symptom formation, which operates in conversion hysteria, is the transposition of a psychological conflict into somatic symptoms which may be of a motor or sensory nature.

Fugue - a state of aimless wandering which is found in two conditions of dissimilar aetiology:

1. Clouded consciousness - there is no psychological advantage for the patient
2. Conversion disorder - (see above).

Insight - four facets, are;

1. morbid experiences seen as abnormal
2. as the result of illness
3. as the result of a mental illness
4. open to medical intervention.

Malingering - the conscious mimicry of physical disease to achieve some material gain.

Obsessive Compulsive Disorder (OCD) - an illness characterised by the presence of obsessions and/or compulsions.

Phobia - an irrational, disproportionate fear of an object or situation leading to avoidance behaviour.

Psychotic - this term causes confusion, because it is used in two different senses. In the past it was used to describe illnesses that are severe (e.g. dementia, schizophrenia and severe affective disorder). The other usage, which is more accepted nowadays, is referring to symptoms (hallucinations and delusions) that are qualitatively different to normal experience as opposed to quantitatively different (e.g. anxiety, depression).

Schneider’s First Rank Symptoms - a group of symptoms that Schneider proposed were diagnostic of schizophrenia in the absence of overt brain disease.

1. Auditory hallucinations of a specific type:
1. Thought echo.
2. Two or more voices discussing the patient in the third person.
3. Voices commenting on the patient's behaviour.
2. Thought alienation
3. Passivity phenomena
4. Delusional perceptions

PHARMACOLOGY PAST YEAR QUESTION

PHARMACOLOGY PAST YEAR QUESTION

CASE 1- Patient with heart burn went to the hospital was given ANTACID for immediate relieve.

1) How does it provide immediate relieve

Neutralize HCL that already secreted in the stomach

2) Why give coz advantages

Magnesium Hydroxide diarrheoa rapid acting

Aluminium Hydroxide constipation sustain effects

3) How to detect H.Pylori?

Urease test: give urea (-/+ve)-ammonia+O2

4) Drug used tp cure

Omeprazole: PPI /lanoprazole/ranitidine bismuth citrate

Clarithromycin:antimicrobial

Amoxicilin:penicillin based

CASE 2-Boy with URTI given antibiotic + Paracetamol

1) Reason to give PCM. What MOA?

PCM is antipyretic and analgesic. As an antipyretic, it is effective to the brain. By inhibiting cyclo oxygenase I (cox I) it reset the thermoregulatory by increase body sweat. It also have poor inflammatory effects.

2) Patient accidentally taken 14 tablets of PCM and was taken to the hospital within 4hour. What measure should be taken?

a) Gastric lavage: food can stay up to 4 hour in the stomach

b) Acetylcystein+methionine: liver damage due to PCM toxicity (depletion of glutathione leading to hepatic necrosis

3) Investigation should be taken?

Lung Function Test: coagulation,plasma protein, ALP,ALT, INR

CASE 3- 51 years old man having severe osteoarthritis on right knee and has underwent knee replacement surgery. After 4 days, he complained of increase pain and swelling of calf of right leg. A Doopler Ultrasound demonstrated a thrombosis in the deep vein in the left extending up to popliteal vein of right leg was started on 12 hourly injectionof LMWheparin (5mg IV) + Enoxaparin (20-25 SC) simultaneously started on oral tablets Warfarin 5mg (once/day)

1) What investigation to check the drugs are working?

Heparin- APTT (intrinsic pathway)

Warfarin- INR (Extrinsic pathway) + PT

2) Why warfarin take longer?

Warfarin effects Vit K clotting factor (2,7,9.10) in the liver. Some already flow in the blood therefore it is establish after 3-4days of Heparin

3) Complication of DVT: pulmonary embolism

4) Platlete function:

a) What is X: aspirin (NSAIDS)

b) Disadvantage of endothelial COX

Inhibit prostaglandin2. This will lead more thromboxane than prostacyclin leading to platlete aggregation which cause thrombus formation.

c) Pharmacological effect of X.

Inhibit thromboxane II, lead to inhibiton of platlete aggregation

Antiinflammatory and analgesic function

Good SLE patient.

d) Stage measure to have effect on platlet but no endothelial without inhibiting COX

Aspirin (200mg) + clopidogrel (100mg)

Aspirin: unable to inhibit, irreversible inhibition

Clopidogrel: antiinflammatory, inhibit ADP platlet aggregation

CASE 4- Myocardial cell.

1) What is Na+K+ATPase inhibitor

Digoxin

2) Pharmacological effect for CCF

+ve inotropic effect

-ve gonadotropic (decrease HR-allow to fill properly= vagomymetic effect

3) why not use adrenaline

It produce the same effect but increase HR

4) not use in post use of CCF

low therapeutic index cause extrasystole cardiac arrhythmia (excess of Ca2+)

it doesn’t increase survival time, only use to relieve symptom

5) drug use in Atrial Fibrillation and in CCF? Why?

-digoxin: it delay AV conduction 9vagomymetic effect)

-verapamil: Ca Channel blocker (-ve inotropic)

-B-adrenergic blocker: -ve inotropic effect delay AV

6) Uncontrol HT lead to CCF

a) Drug for CCF

b) What the mode of action of ACE inhibitor?

c) 2 drugs acting on myocardial to increase Stroke volume in Acute heart failure

d) 2 signs of right sided heart failure

CASE 5- Asthma

MDI (metered dose inhaler)

Spacer spacehaler

Rotahaler (Dry powder inhaler)

1) What are the advantage/disadvantage MDI?

2) What are advantage/disadvantages spacer spacehaler?

3) How to prevent oral candidiasis?

CASE 6- Myasthenia Gravis

1) What are the symptoms of MG

Bilateral ptosis,muscle weakness, unable to swallow

2) What type of receptor does it effect?

Nicotinic receptor

3) How to prevent it? Drug?

Inhibit the enzyme cholinesterase

Drug:neostigme

4) What happen in cholinergic crisis?

=excess of neotigme

5) What test should be done?

Adrenophonia test

Tensilone test

HISTORY TAKING

HISTORY TAKING

A. MEDICINE

1. HAEMOPTYSIS

CS: Male,50 years old. Complain of coughing out blood.

HOPI

· Frequency – is it recurrent?

· Quantity and appearance

o Amount: ½ teaspoon?

o Fresh blood?

o Any blood streak+clear sputum

o Blood clot in sputum?

· Associated symptoms

o SOB?

o Chest pain? (ask for pleuritic pain, central?)

o Fever?

§ Chills and rigor?

§ Low grade or high?

§ Night sweats?

· TB history

o Any TB in the past? On treatment(complete)?

o Contact with people having TB?

o Closed contact with TB pt?

Systemic Review

· Any loss of weight or appetite?

· Ask for signs of anemia (tiredness, diziness, gidiness)

· Calf pain?

Past Medical History

· Any childhood infection?

· History of any chronic illness?(DM, HT)

· History of valvular damage?

· Admitted/investigated?(Any xray, sputum examination,bronchoscope,any blood transfusion?)

Drug History

· On drugs? (anticoagulant)

Social History

· Chronic smoker?

· History of travel overseas/crowded places?

2. INTERMITTENT CLAUDICATION

CS: Male, 50 years. Complain of old pain at the right leg while walking for the pass 1 month.

HOPI

· Site of pain? (Right calf?)

· What brought on the pain? (Onset)

· Nature of pain?

· Radiate to buttock? (Gluteal claudication)

· Duration: last for?

· Relief at rest?

· Do you have swelling on calf?

· Claudication distance (how long were the pt able to walk before he experience the pain?(100m?2km?)

· Severity: Impact on job?

Risk Factors

· DM(on treatment?)

· HPT (on treatment?)

· Chronic smoker?

· History of coronary heart disease?

· Previous stroke?Chest pain? TIA?

· Any investigation done?(doppler's ultrasound?) Medication given?

· Family history?

3. MIGRAINE

CS: Female, 16 years old. Complain of frequent headache.

HOPI

· Site of pain

o Unilateral? Bilateral? Temporal side? Frontal?

· Experience since?

· Nature of the pain (throbbing)

· Duration? (minutes? Hours?)

· Intensity (scale out of 10, 1 is least pain 10 is the worse)

· Associated symptoms

o Nausea, vomiting (relief after vommiting?)

o Aura(mood changes, flashes of light, fortification spectrum-zig zag lines)

o Neck stiffness

· Aggravating factors

o Noise, lights(photophobia) stress, menstrual cycle

o Food(cheese,chocolate, red wine, OCP)

· Relieving

o Dark room and quiet, medication-what?

· Any trauma

· Infection

Family history

· Family members who also had migrain?

Drug History

· Contraceptive?

Social History

· Occupation? Is it stress?

· Smoking? Alcohol?

· Is the headache investigated?? (CT? MRI?)

4. WHEEZING

CS: Male, 18 years old. Complain of wheezing

HOPI

· First time having the problem? Since when?

· Progression

· Duration: How long? Any particular time?

· Severity: how long it lasts

· Aggravating factors/worsen?

o Smoke, at night, drugs, food, weather, dust(ask any carpets or plush toys at home)pets, excess exercise,eczema/skin rash, any allergy to drugs, stress, eating seafood:worse?

· Relieving factors?

o Inhaler(blue:short acting, brown-long acting: how frequent? How many puffs? Nebulizer? Any admission to the hospital?)

o Getting better when taking it?

Systemic Review

· Chest pain? (describe it.. Tightness of the chest?)

· Any dry cough?

Past Medical History

· Any life threatening episodes(emergency admitted)? Any nebulizer/ventilator given?

Family History

· Any family history of astma?

Social History

· Chronic smoker?

· Occupation? (factory worker)

· Exposure to insecticides

5. SHORTNESS OF BREATH

CS: Male,45 years old. Complain shortness of breath

HOPI

· Duration?

· First time?

· Worsening?

· Associated symptoms

o Cough?

o Chest pain?

o Wheezing?

o Palpation?

· Any sputum production?

o Mucoid/pus purulent/foul smelling

o Hemoptysis

o Amount

· Early morning cough?

· Paroxysmal Nocturnal dyspnea?

· Aggravating factor

o Changes of weather, environmental pollution:smoke/haze

· Relieving factor

o Inhaler, nebulizer(any admission)

Systemic Review

· Recent loss of weight, loss of appetite

· Leg swelling?

Past Medical History

· Past history of TB?

· History of DM?

· Admission for life, threatening episodes

Social History

· Smoking?

· Occupational history?

6. ACUTE CHEST PAIN

CS: Male, 40 years old. Complain of chest pain for 1 hour duration

HOPI

· Site: central

· Onset: sudden

· Nature of pain: crushing pain

· Radiation: left arm, neck and jaw

· Associated symptoms:

o Profuse sweating, nausea, vomiting, coughing

· Duration: more than 20 minutes

· Intensity: grade 1-10

· Relieving factors

o No relieving factor, not relieved by nitrates

· Frequency

o Is this first episode? Ask whether first time admitted? Intensity compared to previous episode.

o If 2nd episode, ask about nitrates/GTN.

Risk Factors

· Atherosclerosis

· Hypertension

· Diabetes Mellitus

· Hyperlipidaemia

· Chronic smoking

· Significant family history(first degree family):-M<55,f<65

· Sedentary lifestyle

B. SURGERY

1. JAUNDICE

CS: male, 20 years old. Complain of yellow discoloration of the skin for 1 week

HOPI

· Duration?

· Getting worse?

· Tea colour urine? Pale colour stool? Change in bowel habit?

· Anemic?(lethargic, tired..etc)

· Any bruises/itchiness?

· Git symptoms

o Any mass?

o Pain at rhc?

· Associated symptoms

o Nausea? Vommiting?

o Fever (low grade? High? Chills and rigor?)

o Weight loss? Loss of appetite?

Past medical history

· Hepaitis, Cholecystitis

Surgical history

· Cholengitis or gall stone removal?

Family history

· Any family members experience the same thing or gotten sick

Drug history

· Oral contraceptives

· Drugs? Antibiotic? PCM? Anti Tb?

Social history

· Occupation: health care professional(needle prick), gardener/farmer:leptospira

· Eat seafood? Iv drugs usage? promiscuity? tatooing? alcoholic?

· Distaste for cigarettes? (if previously he is a chronic smoker..)

· Leptospirosis(any trips to those area affected)

· Mushroom poisoning

2. THYROID

HOPI

· Mass

o Site

o Size (larger/shrunken)

o Tenderness

o Mobility

o Since when?

· Any hoarseness of voice, dysphagia?

· GI - Loss of weight despite increase in appetite

· CNS - Restless, easily feel irritated/emotionally disturbed

· Insomnia?

· Profuse sweating/heat intolerance

· CVS - Palpation

· Any muscle weakness(usually prox), difficult in doing activities(comb hair, etc)

Menstrual history

· oligomenorrhea

Past surgical history

· Surgery at the neck?

Drugs History

· Drug for heart(amiodarone-drug induced thyrotoxicosis)

Family history

· Any with same problem?

3. BREAST LUMP

HOPI

· Site: upper inner/upper outer/lower inner/lower outer

· Duration: when discover first lump

· Size: how big:10 cent, enlarge/shrink? Shape?

· Consistency: soft, firm, hard, regular/irregular, nodular?

· Pain: painful/painless

· Mobility

· Any nipple discharge? What color?, Any skin changes? any lymph node in axilla?

Menstrual History

· Menarche and menapause-when?

· When get first child/breastfeeding-how long?, why stop?(if abrupt)

· Take any oral contraceptives/ hormone replacement theraphy?

Family History

· Any Ca history?

Social History

· Smoking? Fatty diet? Exposure to radiation, sunbathing?

· Any investigation done before, mammogram?

4. ULCER/LUMP

HOPI

· Onset - how notice?, is is first time?, getting worse?

· Site & size(change in size?)

· Change in character (color, discharge)

· Painful/tender?

· Severity? - movement affected?

· Any history trauma?

· Muscle weakness/Numbness?

Past medical history

· Any chronic illness – DM, HT

Drugs History

· In any drugs(DM)

· Compliance?

Family history

· History of Ca

· Family history of DM

5. BENIGN PROSTATIC HYPERPLASIA

HOPI

· Dysuria

o Onset

o Site of pain

o Duration

o Getting worse

o Nature of pain

o Relieving factor

· Sign of BPH

o Weak urinary stream

o Prolonged emptying of the bladder

o Abdominal straining

o Hesitancy

o Irregular need to urinate

o Incomplete bladder emptying

o Post-urination dribble

o Frequent urination

o Nocturia (need to urinate during the night)

o Urgency

o Incontinence (involuntary leakage of urine)

o Problems in ejaculation

· Any fever(rule out UTI)

· Hematuria

· Passing stone in urine

Past Medical & Surgical History

· History of kidney disease(renal stones?)