HISTORY TAKING:

Past history

Family history

5/8/12

PAST HISTORY...
Information about previous

childhood illnesses chronic childhood illnesses adult illnesses

which can help with the diagnosis and management of current conditions. 5/8/12

ADULT ILLNESSES...
-Medical illnesses -Surgical -Obstetric/gynecologic -Psychiatric
5/8/12

HISTORY TAKING:

Past history

Family history

5/8/12

Family History
Is One of the 9 Items of history taking.

5/8/12

Family History
It consists of information about:
the biological relationships between family members and the patient . any medical conditions they may have.
5/8/12

Family History
Why taking family history is important?

The strength of the genetic component in a family may be apparent by the number of people aected by a particular condition can reveal patterns of inheritance. may help make or rene a diagnosis helps assess the likelihood of genetic disease in relative
5/8/12

Family History
Key points for taking a family history:

The health of parents, brothers and sisters should be asked for. If they are not living, the cause of death should be recorded. Similar diseases in the family should be enquired about.
5/8/12

Family History
Examples of Common diseases with hereditary tendency:

diabetes. Hypertension. allergy. mental diseases. nephritis. migraine.

5/8/12 degenerative neurological disorders

Family History
Summary
Family history should Present:

the health of the parents, brothers and sisters. Similar illness or symptoms in family
5/8/12

ROLE-PLAY Doctor: Fatimah AlGhamdi Patient1: Nouf AlSubaie

5/8/12

:SYMPTOMS

Cough

21/8/5

COUG H
Wha At? cough is an action your body takes to

get rid of substances that are irritating to your air passages, which carry the air you breath in from the nose and mouth to the lungs.
5/8/12

COUG H

How ? A cough occurs when special cells

along the air passages get irritated and trigger a chain of events. So, air in your lungs is forced out under high pressure. You can choose to cough (a voluntary process), or your body may cough on its own (an involuntary process). 5/8/12

Acute cough

Caus es

one that been present for less than 3 weeks

Chronic coughs
those present for more than 3 weeks.

infectio us

noninfecti ous

environmental irritants. conditions within the lungs. conditions along the passages that transmit air from the lungs to the environment conditions within the chest cavity but outside 5/8/12 of the lungs

Sinus infections
Infection Tumors: benign malignant, primary, secondary Aspiration Gastro-esophageal reflux Foreign body Irritant dusts

Larynx, trachea, large airways

5/8/12

Sinus infections
Small airways

Asthma Post-viral airway reactivity Chronic bronchitis Bronchiectasis Bronchiolits Irritant dusts

Alve oli

Drugs ( angiotensinconverting enzyme inhibitors) Infection ( pneumonia, tuberculosis) Alveolitis 5/8/12 Left ventricular failure

Indications related to cough

Smoker Cough
Dry, painful and nonproductive cough Paroxysmal dry cough

Chronic bronchitis Tracheitis, pneumonia Asthma associated with lung injuries and bronchitis
Interstitial disease: cryptogenic fibrosing 5/8/12

Chronic dry cough

Circumstances of the cough

Nocturnal cough: common symptom of asthma q Occult gastro-oesophageal reflux : common cause of daytime cough q Angiotensin-converting enzyme inhibitors: cause dry cough q Coughing during or after swallowing liquids: suggests neuromuscular disease of the oropharynx 5/8/12 q Occupational asthma and exposure to
q

WHAT DO I ASK THE PATIENT ABOUT?

1.What is the frequency of cough? 2.What is the severity of cough? 3.Does it occur on some special time of day or night? 4.Is the cough precipitated under some special circumstances? 5.Is cough accompanied with wheeze? 6.Is cough accompanied with hoarseness? 5/8/12

COUGH WITH SPUTUM

What is SPUTUM?
Expectorated respiratory secretions. Four main types Serous Mucoid Purulent Rusty HAEMOPTYSIS: the Presence 5/8/12 of blood in sputum

AMOUNT

SOLID MATERIAL

WHAT DO I ASK THE PATIENT ABOUT?

COLOUR

TASTE/SMELL
5/8/12

1- AMOUNT
How much phlegm do you cough out each day? - Small (Teaspoon) - Large (Tablespoon) What does it tell you?

Regular coughing of large volumes Bronchiectasis Sudden production of large amounts on a single ocassion - Rupture of a 5/8/12 abcess lung or empyema into the bronchial tree

2- COLOUR
What is the colour of the phlegm? What does it tell you?

Clear, watery, pink, frothy (Serous) Pulmonary oedema, Alveolar cell cancer Clear, grey, white, viscid (Mucoid) Chronic bronchitis/COPD, Asthma Yellow, green (Purulent) Bronchopulmonary
5/8/12

3- TASTE/ SMELL
How does it taste? What does it tell you?

Foul/ Smelling Anaerobic bacterial infection : Bronchiectasis, Lung abscess, empyema

5/8/12 Change in sputum taste Infective

4- SOLID MATERIAL
Is there any solid material in the phlegm? What does it tell you?

Asthma Bronchopulmonary aspergillosis Necrotic tumour Food, teeth, tablets

5/8/12

ROLE-PLAY Doctor: Fatimah AlGhamdi Patient2: Razan AlHadlaq

5/8/12

:SYMPTOMS

Breathlessnes s
21/8/5

BREATHLESS NESS

5/8/12

BREATHLESS NESS
Wha t? Breathlessness (dyspnoea) is an undue
awareness of breathing. It is a natural consequence of strenuous physical exercise. Patients may refer to it as shortness of breath or difficulty in getting enough air.
5/8/12

BREATHLESS NESS
Sign s: Breathlessness may be associated with
a feeling of light-headache, dizziness, tingling in the fingers and around the mouth, chest tightness and rarely syncope.
5/8/12

BREATHLESS NESS
q

How are the causes of breathlessness presented??

5/8/12

Cause # 1
- Lying flat (orthopnoea): present with left ventricular failure and respiratory muscle weakness. However, this can be a feature of sever lung disease
5/8/12

Cause # 2
- Paroxysmal nocturnal dyspnoea: due asthma and left ventricular failure, that wakes patient from sleep. Waked from 3-5a.m.with wheezing
5/8/12

Cause # 3

- (COPD) Chronic obstructive pulmonary disease. If its worse first thing in the morning, and feels better with coughing up sputum.

5/8/12

Cause # 4

Exercise induced asthma: breathlessness continue to worsen for 5-10 min after stopping activity.

If suspected (asthma) ask directly about:

exposure to any allergens (animals, hoovering, mowing the lawn ) Irritant with smoke , perfumes, fumes, cold air or drugs(e.g. Aspirin) 5/8/12

Cause # 5

Occasional asthma: breathlessness that improve at weekend or holidays/extrinsic allergic alveolitis.

5/8/12

SEVERITY OF BREATHLESSNESS

5/8/12

WHAT DO I ASK THE PATIENT ABOUT?

1.

Mode on onsets, duration, progression, variation, aggravating, relieving factors, severity and associated symptoms. When does it occur? At exercising ? at sleep ? or at rest? How long does it remain? Is it episodic or not? Let the patient describe the pain. 5/8/12

2.

3.

4.

ASSOCIATED SYMPTOMS

Cough Sputum Haemoptysis Chest pain And wheeze

5/8/12

THANK YOU
21/8/5