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