1) Premalatha – 6 yrs – epistaxis – anterior nares – nad, therefore bleeding posterior or sinus origins =>? red flag => onset after 55 yrs => any other ENT sx like tinnitus, ear ache without ear pathology, etc =>
2) Menorrhagia
3) Myopia – major symptom blurred distance vision, major sign reduced unaided distance visual acuity
4) Use FBC as a cancer-detecting tool in the elderly, those with fatigue, low, any bleeding from any orifice,
5) Some dangerous pediatric symptoms and signs – bulging fontanelle, extensor attacks, persistent vomiting, abnormal increase in head size, arrest or regression of motor development, altered behavior, abnormal eye movements, lack of visual following, poor feeding/failure to thrive, squint,
6) Get the daily milk requirements from somewhere – in ml/kg/day
7) Minimum Data Set for acute lower respiratory infection of children – ht, wt, temp, HR, RR, chest in drawing, alveolar rales, cyanosis, nose flaring, grunting, anorexia, wheezing, drowsiness, laryngeal stridor
9) Some questions to assess the respiratory effort in children – color changes, cyanosis, respiratory effort, apnea
10) Careful auscultation of the nose, oropharynx, neck, and chest help locate the site of the stridor
11) Classic signs of compartment syndrome are – pain out of proportion to the trauma and physical findings, exquisite pain on passive stretch of the muscles of the affected compartment (FitzSimmons and Wardrobe)
12) Collect some info on necrotizing enterocolitis
13) ALARMS - Anaemia, Loss of weight, Anorexia or early satiety, Recurrent persistent or poorly controlled symptoms, Mass or Melena, Swallowing difficulties.
14) Primary survey-positive patients – collapse, shock (pulse < 50 or > 120, SBP < 90), rigid abdomen, heavy vaginal bleeding, complications of labor, airway obstruction (stridor, anaphylaxis, Hx of FB,), Respiratory rate < 10 or > 29, oxygen saturation < 93% on air with no p/h of COPD, altered level of consciousness (GCS < 12 acute deterioration ) (vital signs – pulse, blood pressure, respiratory rate, oxygen saturation, temperature, GCS, - AROPuGST – In primary care common causes of airway obstruction are inhaled FB, epiglottitis, quinsy, anaphylaxis/angioedema, croup, facial fractures ) – symptoms suggestive of primary survey positivity – fainting, postural dizziness, fast breathing, breathing difficulty, noisy breathing, stridor, wheeze, recessions, accessory muscle use, agitation, impending doom, weakness of body, sweating, cold body, pallor, confusion, unresponsiveness,
15) How to elicit a history of mania – for bipolar disorders – “Have you ever had 4 continuous days when you were feeling so good, high, excited, or hyper, that other people thought you were not your normal self or you got into trouble” and “have you experienced 4 continuous days when you were so irritable that you found yourself shouting at people or starting fights or arguments ” – positive responses for these 2 questions require psychiatric referral
16) Causes of symptoms – psychological conflicts being manifest as physical symptoms, communication of certain thoughts and feelings in physical symptoms that cannot be expressed verbally, reinforcement and social learning variables, underlying depression, anxiety or abuse, precipitation by a depressing psychological event,
17) Queer turns – vertigo, seizures, syncope (sudden brief transient loss of consciousness and postural tone from which there is spontaneous recovery), drop attacks (no LOC but loss of postural tone)
18) Respiratory distress – CADORA – Cyanosis, Agitation, Dyspnea, Oxygen saturation < 93% in air, Recessions, Accessory muscle use, new additions – grunting, tachypnea, nasal flaring or alar flare, (TAG)
19) Early shock – tachycardia, tachypnea, skin mottling, CRD > 2 sec, Intermediate shock – tachycardia, tachypnea, hypotension, cold and pale skin, CRD > 4 secs, Severe shock – bradycardia, bradypnea, hypotension, cold and pale skin, CRD > 6 secs