Family History and Systemic review

Family History and Systemic review

General Principles of History taking

A medical history is the first step in making a diagnosis.

It will often help to direct physical exam

It will determine what investigation are appropriate.

The history is also of course the least expensive way of making a diagnosis

Scheme for history taking

present illness : presenting complaint (s) H.O. presenting complaint prev. H.O. PC past medical history drugs and allergy social and personal history family history system review

Family History

Many diseases run in families Some diseases are directly inherited. Ask about any history of similar illness in the family Inquire about the health and cause and age at death of the parents and sibling.

Family History

In case of hereditary disease a complete family tree should be obtained

Consanguinity increases the probability of autosomal recessive diseases .

Family History

Family history of CVS

MI Cardiomyopathy Congenital heart disease MVP Marfan’s syndrom.

Systemic Review

Inquire About Common symptoms

Three or Four Common Disorders in the Major System.

Pain frequent in all systems

Where is it ?

Where did it start ? (sudden,gradual,interm,contin,duration)

What is it like ? (severity,type,assoc. sym)

What relieves it ? (rest,posture,food,med)

What aggrevates it ? (posture food,cough)

What do you do during the attack ?

Cardiovascular System

Chest pain, dyspnoea SOB and PND Ankle swelling Palpitation Syncopy Intermittent claudication

Major symptoms:

Chest pain

Cardiac Vascular Pulmonary Pleuropericardial Chest wall Esophageal Mediastinal

Dyspnoea

Orthopnea

Paroxysmal nocturnal dyspnea (PND)

Exertional dyspnea

Other forms

Palpitation Uncomfortable awareness of the heartbeat

Fast or slow Regular or irregular Sudden or gradual onset Associated symptoms Hx of syncopy

Syncopy and Dizzeness

Postural syncopy

Vasovagal syncopy

Exertional syncopy

Tussive syncopy

Arrhythmia syncopy

(Syncopy: transient loss of consciousness due to inadequate blood flow)

What to ask about CVS system ?

Have you had any chest pain ?

Are you short of breath on exertion?

Have you ever been awaken at night SOB?

Can you lie flat without breathless?

Have you noticed irregular heart beating?

Do you have pain in your leg on exercise?

Risk factors for CVD

Hypertention Diabetes mellitus Hyperlipidemia Smoking Atrial fibrellation Myocardial infarction

Respiratory System

Cough Haemoptysis Dyspnea Wheeze Chest pain Hoarseness

Major Symptoms:

Cough and haemoptysis

Pneumonia and bronchitis Bronchial carcinoma Tuberculosis Pulmonary embolism Vasculitis COPD and bronchiectasis Lung abscess Foreign body

Wheeze

Bronchial asthma COPD Cardiac Recurrent PE Eos. pneumonia Sleep apnoea

How to ask about RS ?

Have you had any cough? Have you coughed up blood? Do you have ever wheeze? Have you ever had pneumonia/ TB? Do you snore loudly?

GIT symptoms(1)

Abdominal pain Nausea and vomiting Heartburn Dysphagia Bleeding Disturbed bowel habbit Jaundice

GIT symptoms(2)

Dark urine pale stool Pruritus Abdominal swelling Poor appetite or wt loss

Abdominal pain

Frequency and duration Site and radiation Character Aggravating and relieving factors

causes

PUD Pancreatic Biliary Renal Vascular Bowel obstruction

Abdominal pain

vomiting

GIT Drugs Metabolic Central Pregnancy Toxin Psychogenic

Dysphagia

Internsic Extrinsic Motility disorder

Diarrhea &constipation

Onset Duration Ferquency Associated symptoms

GI Bleeding

Hematemesis

Melena

Hematochezia

How to ask about GIT ?

Have you had pain in your belly? Has your bowel changed recently? How many bowel motion /day? Have you ever seen blood in your

bowel or vomited blood? Have you had any swallowing

difficulty? Has your appetite or wt changed?

How to ask about GIT ?

Do you have heart burn?

Have your eyes ever been yellow?

Have you ever had hepatitis, PUD, colitis, bowel cancer ?

Genitourinary system

Change in appearance of urine Change of urine volumePolyuria, Anuria, nocturia ,incontinence, urinary retention dysuria, Renal colic Urethral discharge

Major symptoms

Genitourinary system

Symptoms suggestive of CRF

menstrual Hx

Sexual Hx

Haematological system

fatigue palpitation syncopy and dyspnoea.

Easy brusing, purpura, Infection fever Jaundice Bone pain Skin rash

Anemic symptoms:

Haematological system

Do you bruise easily? Do you had fever, jaundice? Do you have difficulty in stopping small

cut bleeding? Do you have bone pain? Have you noticed any lumps? Have you ever had blood clot in legs or

lung?

What to ask about ?

Musculoskeletal System

Joint pain ,swelling Skin rash Mouth ulcer Raynaud’s phenomenon Dry eyes or mouth

Causes of polyarthritis

Rheumatoid arthritis SLE Seronegative spondyloarthritis Primary OA Gout Infection

Mouth Ulcers

Aphthous

GIT (CD, UC)

Rheumatological

Infection (Herpes S, HZ, Syphilis)

What to ask ?

Do you have painful joints? Do you have any neck or back pain? Have you had any skin rash? Have you ever had mouth ulcer? Have you ever had dry eye or mouth? Do your fingers ever become painful

or blue in cold?

Mouth Ulcers

Endocrine system

Preference for cooler weather WT loss with increased appetite Palpitation ,dyspnoea Sweating Nervousness, irritability Diarrhea Muscle weakness

Thyrotoxicosis

HYPOTHYROIDISM

Neck swelling Preference for warmer weather Lethargy Swelling of eyelids Hoarse voice Constipation Coarse skin

DIABETES MELLITUS

Polyuria , polydipsia ,thirst Blurred vision, weakness Infection Weight loss, tiredness,

lethargy Hypoglycemic symptoms

Acromegaly

Fatigue ,weakness Sweating , heat intolerance Enlarged hands and feet Headache and ↓ vision ↓ libido ,impotence

Adrenal insufficiency

Pigmentation Wt loss Vomiting and diarrhea Tiredness

Reproductive HX

Have you had any miscarriage? Have you had high blood pressure or blood sugar in pregnancy?

Neurological system

Headache Fits and faints Dizziness or vertigo Disturbed vision or hearing Loss of sensation weakness in a limb

Major symptoms

Neurological system

Disturbed gait Disturbance of sphincter control Involuntary movements or tremors Altered cognition

Major symptoms

Skill in History Taking

1st establish rapport and understanding

2nd ask Q in logical sequence

3rd listen to the answer

4th proper interpretation of the symptoms

Observe

non verbal

clues

obtained

and maintained

by practice.

These skills can only be

Clinical Skills Patient assessment

1. (H) history 2. (E) exam3. (I) investigation

4. Interpretation of H, E, I5. problem solving6. effective utilisation of resources7. knowledge