Medical Exchange & Discovery 2017

Takayuki OSHIMI MD

Clinical English Course Lesson 2: History of Present Illness

1

Lesson 1 Chief Complaint

Lesson 2 History of Present Illness (OPQRST)

Lesson 3 Risk Factors (PAM HITS FOSS) 1

Lesson 4Risk Factors (PAM HITS FOSS) 2

Lesson 5 Physical Examination

MED 2017 Clinical English Course2

Lesson 1 Chief Complaint

Lesson 2 History of Present Illness (OPQRST)

Lesson 3 Risk Factors (PAM HITS FOSS) 1

Lesson 4 Risk Factors (PAM HITS FOSS) 2

Lesson 5 Physical Examination

MED 2017 Clinical English Course3

Doorway Information4

Joseph Short, a 46-year-old male, comes to the ER complaining of chest pain.

Vital Signs

BP: 134/86 mmHg

Temp: 36℃

RR: 18/min

HR: 90/min, regular

Doorway Information5

BP: 134/86 mmHg

“Blood pressure (is) one thirty four over eighty six millimeters (of) mercury.”

• hypertension/hypertensive

• hypotension/hypotensive

Blood Pressure (BP)6

Hypertension

StagesSystolic Pressure

Diastolic Pressure

Prehypertension 120-139 or 80-89

Hypertension Stage 1 140-159 or 90-99

Hypertension Stage 2 160 or higher or 100 or higher

7

Shock

Types Causes Skin

Hypovolemic• hemorrhage• dehydration• burns

cold &clammy

Cardiogenic• myocardial infarction• heart failure• arrhythmia

cold &clammy

Obstructive • cardiac tamponade

• pulmonary embolismcold &clammy

Distributive• sepsis• anaphylaxis• CNS injury

warm &dry

8

Temp: 36℃

“(The body) temperature is thirty six degrees Celsius.”

• fever (noun)

•pyrexia (noun)

• febrile (adjective)

•hyperthermia

•hypothermia

Temperature (Temp)

98℉ = 36.7℃

100℉ = 37.8℃

101℉ = 38.3℃

104℉ = 40℃

9

RR: 18/min

“(The) respiratory rate is eighteen per minute.”12-20 (adults)

• tachypnea/tachypneic

• bradypnea/bradypneic

Respiratory Rate (RR)10

HR: 90/min, regular

“(The) heart rate is ninety per minute, regular.”60-100 (adults)

• tachycardia/tachycardiac

• bradycardia/bradycardiac

• arrhythmia/arrhythmic

Heart Rate (HR)11

1. Greeting & Introduction 2. Chief Complaint 3. History of Present Illness 4. Risk Factors 5. Summary 6. Physical Examination 7. Diagnostic Impression 8. Followup Plan 9. Counseling 10.Q&A

Patient Encounter Structure12

Emma Roberts, a 46-year-old female, comes to the ER complaining of chest pain.

Vital Signs

BP: 165/88 mmHg

Temp: 101°F

RR: 22/min

HR: 102/min, regular

Doorway Information13

1. Greeting & Introduction 2. Chief Complaint 3. History of Present Illness 4. Risk Factors 5. Summary 6. Physical Examination 7. Diagnostic Impression 8. Followup Plan 9. Counseling 10.Q&A

Patient Encounter Structure14

• “Hello.”

• “Are you Ms Emma Roberts?”

• “My name is Takayuki Oshimi, one of the student doctors at this hospital.”

• “I will be helping you today.”

• “Would that be all right with you?”

Greeting & Introduction15

1. Greeting & Introduction 2. Chief Complaint 3. History of Present Illness 4. Risk Factors 5. Summary 6. Physical Examination 7. Diagnostic Impression 8. Followup Plan 9. Counseling 10.Q&A

Patient Encounter Structure16

History Taking Mnemonics

CC

RF

HPI

ChiefComplaint

History ofPresentIllness

RiskFactors

OPQRST

ICE & DNA

PAM HITS FOSS

17

“How can I help you today?”

“Could you tell me more about the (symptom)?”

Chief Complaint18

Ideas

“Do you have any ideas about it yourself?”

Concerns

“Is there anything particular that you are concerned about?”

Expectations

“What are your expectations about this visit today?”

ICE Questions19

Day

“How does it affect your day?”

Night

“How does it affect your night?”

Activities

“How does it affect your activities of daily living?”

DNA Questions20

1. Greeting & Introduction 2. Chief Complaint 3. History of Present Illness 4. Risk Factors 5. Summary 6. Physical Examination 7. Diagnostic Impression 8. Followup Plan 9. Counseling 10.Q&A

Patient Encounter Structure21

Onset

Provoking & Palliating Factors

Quality

Region & Radiation

Severity

Timing

History of Present Illness22

Onset

Provoking & Palliating Factors

Quality

Region & Radiation

Severity & Symptoms

Timing

History of Present Illness23

Associated Symptoms

•Do you have (symptom: noun)?

•Do you feel (symptom: adjective)?

•Have you noticed any change in (habit)?

•Has anyone you know noticed any change in (appearance)?

•Have you been (verb)ing more than usual?

•Sometimes patients with (chief complaint) have (symptom: noun). Has this happened to you?

24

Associated Symptoms

• Medical term?

• Lay term?

• Clinical questions?

Associated Symptoms25

dyspnea shortness of breath

“Do you have (symptom: noun)?”

“Do you have shortness of breath?”

Associated Symptoms26

paresthesia

feeling pins and needles “Do you feel (symptom: adjective)?”

“Do you feel pins and needles?”

Associated Symptoms27

anorexia

loss of appetite “Have you noticed any change in (habit)?”“Have you noticed any change in your appetite?

Associated Symptoms28

ptosis

drooping upper eyelids

“Has anyone you know noticed any change in (appearance)?”

“Has anyone you know noticed any change in your facial expression?”

Associated Symptoms29

diaphoresis

abnormal sweating

“Have you been (verb)ing more than usual?”

“Have you been sweating more than usual?”

Associated Symptoms30

decreased libido loss of sexual drive

“Sometimes patients with (chief complaint) have (symptom: noun). Has this happened to you?”

“Sometimes patients with depression have loss of sexual drive. Has this happened to you?”

Associated Symptoms31

Associated Symptoms

•Do you have (symptom: noun)?

•Do you feel (symptom: adjective)?

•Have you noticed any change in (habit)?

•Has anyone you know noticed any change in (appearance)?

•Have you been (verb)ing more than usual?

•Sometimes patients with (chief complaint) have (symptom: noun). Has this happened to you?

32

1. Greeting & Introduction 2. Chief Complaint 3. History of Present Illness 4. Risk Factors 5. Summary 6. Physical Examination 7. Diagnostic Impression 8. Followup Plan 9. Counseling 10.Q&A

Patient Encounter Structure33

You Stay Classy MED!

oshimi@iuhw.ac.jp

34