1. Family History and Systemic review

3. 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

4. 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

5. 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.

6. Family History  In case of hereditary disease a complete family tree should be obtained  Consanguinity increases the probability of autosomal recessive diseases.

7. Family History

8. Family history of CVS  MI  Cardiomyopathy  Congenital heart disease  MVP  Marfan’s syndrom.

9. Systemic Review  Inquire About Common symptoms  Three or Four Common Disorders in the Major System.

10. 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 ?

11. Cardiovascular System  Chest pain, dyspnoea  SOB and PND  Ankle swelling  Palpitation  Syncopy  Intermittent claudication Major symptoms:

12. Chest pain  Cardiac  Vascular  Pulmonary  Pleuropericardial  Chest wall  Esophageal  Mediastinal

13. Dyspnoea  Orthopnea  Paroxysmal nocturnal dyspnea (PND)  Exertional dyspnea  Other forms

14. Palpitation Uncomfortable awareness of the heartbeat  Fast or slow  Regular or irregular  Sudden or gradual onset  Associated symptoms  Hx of syncopy

15. Syncopy and Dizzeness  Postural syncopy  Vasovagal syncopy  Exertional syncopy  Tussive syncopy  Arrhythmia syncopy ( Syncopy: transient loss of consciousness due to inadequate blood flow)

16. 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?

17. Risk factors for CVD  Hypertention  Diabetes mellitus  Hyperlipidemia  Smoking  Atrial fibrellation  Myocardial infarction

18. Respiratory System  Cough  Haemoptysis  Dyspnea  Wheeze  Chest pain  Hoarseness Major Symptoms:

19. Cough and haemoptysis  Pneumonia and bronchitis  Bronchial carcinoma  Tuberculosis  Pulmonary embolism  Vasculitis  COPD and bronchiectasis  Lung abscess  Foreign body

20. Wheeze  Bronchial asthma  COPD  Cardiac  Recurrent PE  Eos. pneumonia  Sleep apnoea

21. 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?

22. GIT symptoms(1)  Abdominal pain  Nausea and vomiting  Heartburn  Dysphagia  Bleeding  Disturbed bowel habbit  Jaundice

23. GIT symptoms(2)  Dark urine pale stool  Pruritus  Abdominal swelling  Poor appetite or wt loss

24. Abdominal pain  Frequency and duration  Site and radiation  Character  Aggravating and relieving factors

25. causes  PUD  Pancreatic  Biliary  Renal  Vascular  Bowel obstruction Abdominal pain

26. vomiting  GIT  Drugs  Metabolic  Central  Pregnancy  Toxin  Psychogenic

27. Dysphagia  Internsic  Extrinsic  Motility disorder

28. Diarrhea &constipation  Onset  Duration  Ferquency  Associated symptoms

29. GI Bleeding  Hematemesis  Melena  Hematochezia

30. 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?

31. 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 ?

32. Genitourinary system  Change in appearance of urine  Change of urine volumePolyuria,  Anuria, nocturia,incontinence, urinary retention dysuria,  Renal colic  Urethral discharge Major symptoms

33. Genitourinary system  Symptoms suggestive of CRF  menstrual Hx  Sexual Hx

34. Haematological system  fatigue palpitation syncopy and dyspnoea.  Easy brusing, purpura,  Infection fever  Jaundice  Bone pain  Skin rash Anemic symptoms:

35. 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 ?

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

37. Causes of polyarthritis Rheumatoid arthritis SLE Seronegative spondyloarthritis Primary OA Gout Infection

38. Mouth Ulcers Aphthous GIT (CD, UC) Rheumatological Infection (Herpes S, HZ, Syphilis)

39. 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

40. Endocrine system  Preference for cooler weather  WT loss with increased appetite  Palpitation,dyspnoea  Sweating  Nervousness, irritability  Diarrhea  Muscle weakness Thyrotoxicosis

41. HYPOTHYROIDISM  Neck swelling  Preference for warmer weather  Lethargy  Swelling of eyelids  Hoarse voice  Constipation  Coarse skin

42. DIABETES MELLITUS  Polyuria, polydipsia,thirst  Blurred vision, weakness  Infection  Weight loss, tiredness, lethargy  Hypoglycemic symptoms

43. Acromegaly  Fatigue,weakness  Sweating, heat intolerance  Enlarged hands and feet  Headache and ↓ vision  ↓ libido,impotence

44. Adrenal insufficiency  Pigmentation  Wt loss  Vomiting and diarrhea  Tiredness

45. Reproductive HX  Have you had any miscarriage?  Have you had high blood pressure or blood sugar in pregnancy?

46. Neurological system Headache Fits and faints Dizziness or vertigo Disturbed vision or hearing Loss of sensation weakness in a limb Major symptoms

47. Neurological system Disturbed gait Disturbance of sphincter control Involuntary movements or tremors Altered cognition Major symptoms

48. Skill in History Taking 1 st establish rapport and understanding 2 nd ask Q in logical sequence 3 rd listen to the answer 4 th proper interpretation of the symptoms

49. Observe non verbal clues

50. obtained and maintained by practice. These skills can only be

52. Clinical Skills Patient assessment 1. (H) history 2. (E) exam 3. (I) investigation 4. Interpretation of H, E, I 5. problem solving 6. effective utilisation of resources 7. knowledge