Clinical History-Taking & Communication Flashcards

During a psychiatric history, what does 'MSE' stand for and what does it assess?

Answer: Mental State Examination — a systematic assessment of appearance, behaviour, speech, mood, affect, thought, perception, cognition, insight, and judgement

The MSE is the psychiatric equivalent of a physical examination. It assesses: Appearance and behaviour; Speech (rate, volume, form); Mood (subjective) and Affect (objective); Thought (form, content — including suicidal ideation); Perception (hallucinations, illusions); Cognition (orientation, memory); Insight; Judgement.

A 55-year-old man presents with 3 weeks of low mood. Which specific questions should you ask to assess suicide risk?

Answer: Directly ask about suicidal ideation ('Have you had thoughts of harming yourself or ending your life?'), and if present: frequency, intent, plans, means, and protective factors

Directly asking about suicidal ideation does not increase risk — it may provide relief. A complete suicide risk assessment includes: passive ideation ('life not worth living') → active ideation → plan → means → intent → previous attempts → protective factors (family, religion, hope). Risk stratification guides management.

Which of the following best describes a 'systematic inquiry' (systems review) in clinical history-taking?

Answer: Screening questions about symptoms in body systems not already covered, to avoid missing important diagnoses

The systems review (or systematic inquiry) asks brief screening questions about common symptoms in major body systems (cardiovascular, respiratory, GI, neurological, etc.) that haven't already been covered. It serves as a safety net to catch symptoms the patient has forgotten to mention or doesn't connect with their main complaint.

A patient presents with headache. Which 'red flag' features require urgent investigation to exclude dangerous causes?

Answer: Thunderclap onset ('worst headache of life'), associated neurological deficit, fever + photophobia + neck stiffness, waking from sleep, new onset in >50 years, or following head trauma

Red flags for headache (SNOOP4): Systemic symptoms/signs (fever, weight loss); Neurological symptoms; Onset sudden (thunderclap); Onset after 50; Positional (worse lying down); Papilloedema; Progressive worsening; Prior headache history change. These require urgent investigation (CT, LP) to exclude SAH, meningitis, or intracranial mass.

When taking a social history, which four key areas should always be covered?

Answer: Occupation, smoking, alcohol, recreational drugs, living situation, social support, functional status, and relevant travel

A thorough social history covers: Occupation (current and past — exposure risks, sick leave), Smoking (pack years), Alcohol (units per week — use CAGE or AUDIT if concerned), Illicit drugs, Home situation (who they live with, housing conditions), Social support, Functional status (ADLs), and recent travel (for infectious disease screening).

A patient presents with a 6-week history of weight loss, fatigue, night sweats, and a lump in their neck. Which additional history questions are most important?

Answer: Ask about fever, pruritis, alcohol-induced pain in the lump, family history of malignancy, travel to TB-endemic areas, and full systematic review for malignancy symptoms

Constitutional B symptoms (weight loss, night sweats, fever) with a neck lump raise concern for lymphoma. Important questions: fever pattern (Pel-Ebstein in Hodgkin's), pruritus, alcohol-induced pain (Hodgkin's), occupational exposures, travel (TB), family history of malignancy, and full systems review for primary malignancy with nodal spread.