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MEDICINE I | History Taking | Grand OSCE Reviewer

IMPORTANT FEVER
- Introduce yourself - Temperature > 38C measured rectally
- Speak in Tagalog o Fever of unknown origin: lasting greater than
- If FEMALE, ensure OB history is taken two weeks without cause determined through
history, physical exam and diagnosis
TAKING THE HISTORY o Heat stroke/hyperthermia: greater than 42C
- Must obtain General Data - Pathophysiology
- Chief Complaint o Raised hypothalamic set point
- HPI Infection
- Characterize symptoms Vascular disease
o Onset Malignancy
o Location o Excess heat production
o Duration Salicylate overdose
o Character Hyperthyroid
o Aggravating/Associated Factors Environmental heat
o Relieving Factors Malignant hyperthermia
o Temporal Factors o Defective heat loss
o Severity of Symptoms Ectodermal dysplasia
- Associated active medical, surgical, psychiatric Heatstroke
problems that influence chief complaint Anticholinergic overdose
- Past experience with symptoms - Differential diagnoses
o Prior treatment o Infection
o Medications given Viral
Dose Bacterial
Frequency o Inflammatory
Route Kawasaki
Duration IBD
Compliance Juvenile rheumatoid arthritis
Response o Drug use or toxins
o Data from past charts o Neoplasm
o What patient has done about the symptoms ALL
- Significant positives and negatives Lymphoma
- Common cases assigned - History of Present Illness
o Fever o Onset
o Abdominal Pain When did the fever begin?
o Diarrhea o Duration
o Headache How long has the fever lasted?
o Chest Pain o Characteristics
- Review of Systems Pattern of fever
o Must choose at least three to five systems for Temperature, was it measured and if
ROS that are related or that can be related to it was, what method was used?
the chief complaint o Associated/Aggravating symptoms
o One of these symptoms will always be the Is there associated cough, abdominal
general survey pain, chest pain?
Weight change Think about possible system
Fever involvement here
Chills o Relieving factors
Malaise Was anything done for the fever?
Change in appetite Medications taken
Change in sleep pattern Did the medication work?
o The other two to four symptoms will depend o Temporal
on the chief complaint Ask about travel time
- Remember Note the season of the year
o Past medical history Influenza
o Current health status Dengue
o Risk factors Respiratory infection
o Family history o Severity of symptoms
o Personal and social history How much is the patient
- At the end of the interview inconvenienced by the fever?
o SUMMARIZE YOUR FINDINGS Are they still able to go about their
Make sure you ask your patient if daily activities?
what you are saying is correct - Review of systems
o Ask if the patient has anything to add to your o General status
summary Malaise
o Ask the patient if there is any other complaint Lethargy
at the time Chills
o THANK THE PATIENT FOR THEIR TIME Change in appetite
Change in sleep pattern
Weight change

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o CNS o Tumor
Infection like meningitis or other o Immune deficiency
pathologic pathway that can cause - History of Present Illness
fever in this patient o Onset of diarrhea
Inflammatory process o Duration of diarrhea
o Respiratory How long as it been going on?
Respiratory infection, sometimes o Characteristics of diarrhea
fever is the presenting issue in these Appearance of the stool
patients Consistency
Ask about cough, any dyspnea, any Odor
discharge, color of discharge, etc. Amount
If the patient states that there is o Associated or aggravating factors
sputum or mucus, must note the Did they notice if they ate anything?
amount, character, color Do they have a fever or any
o Genitourinary abdominal pain?
Possible UTI that has progressed in o Relieving factors
this case Did they take any medication?
Ask about urinary frequency, Did the medication work?
urgency, hesitancy, dribbling, How often have they taken the
incontinence, hematuria, dysuria medication and at what dose?
o Gastrointestinal Have they done anything else
Infection of inflammatory process as nonpharmacological or otherwise
with IBD to help relieve the symptoms?
Ask about nausea, vomiting, o Temporal factors
retching, hematemesis, melena, Recent travel
hematochezia, indigestion, food Season of the year
tolerance or any abdominal pain o Severity of symptoms
Also ask about diarrhea or - Review of systems
constipation, change in stool color or o General status
continence Malaise
Jaundice can also be asked here Lethargy
o Musculoskeletal Chills
Inflammatory process as with Change in appetite
arthritis Change in sleep pattern
Ask about Weight change
Joint stiffness o Gastrointestinal
Pain Nausea
Swelling Vomiting
Muscle cramps Retching
Muscle weakness Abdominal pain or distention
Muscle wasting o Genitourinary
Abnormal posture In older adults, UTI can manifest as
o Dermatologic diarrhea
Possible entry point of infection Ask about
Ask about Hesitancy
Any itchiness Frequency
Any visible skin lesions Dribbling
Color change Dysruria
Rash or eruptions Urinary incontinence
Texture changes o Endocrine
DIARRHEA Diabetes mellitus
- Increased active anion secretion Hyperthyroidism
- Decreased absorption of water and electrolytes Increased basal metabolic
o Inhibited or defective rate can cause diarrhea in
o Luminal presence of osmotically active agents these patients
o Increased propulsive motor activity causing ABDOMINAL PAIN
decreased contact time - Initial assessment
o Decreased absorptive surface area o Ensure the patient is comfortable enough to
- Differential diagnoses continue with the interview
o Infectious o Ensure it is not a medical emergency
Viral o Refrain from administering too many pain
Bacterial medications because it could make the patient
Giardia lethargic or drowsy
Food poisoning - History of present illness
Travelers o Onset
o Drugs Sudden
o Pseudo-membranous colitis Torsion
o Functional/irritable colon Rupture
o Malabsorption Stone
o IBD obstruction
o Diabetes/hyperthyroid Gradual
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o Location CHEST PAIN
RUQ - Risk factors
LUQ o Dyslipidemia
Epigastric o Hypertension
RLQ o Diabetes
LLQ o Family history
Suprapubic o Smoking
o Duration - Types
How long does the pain last? o Stable
How long have you been o Unstable
experiencing the pain? o Prinzmetal
Is there a pattern? - Differential
o Character o Cardiac
Stabbing Angina
Aching MI
Dull Pericarditis
Sharp Endocarditis
All in one area Dissection
Diffusely all over Prinzmetal
Have the patient POINT to the point o Respiratory
of maximal intensity Pneumonia
o Aggravating or alleviating factors Pneumothorax
What alleviates the pain or makes it Pulmonary embolus
better? o Musculoskeletal
What makes the pain worse? Costochondritis
o Radiation Fractures
Does the pain radiate to any other o Gastrointestinal
areas? GERD
Does it move? PUD
o Symptoms associated Spasm, achalasia
Gastrointestinal symptoms Gastritis
Genitourinary o CNS
Gynecologic (if female) Herpes zoster
- Review of systems Neoplasm
o General status o Psychiatric
o Gastrointestinal Panic attack
Jaundice - History of present illness
Nausea, vomiting o Onset
Diarrhea When did it start?
Indigestion What were you doing when it
Food tolerance started?
Constipation How did it start?
Obstruction/presence of abdominal o Location
mass or if there is a sensation of Where is the pain located?
heaviness in the abdominal region o Duration
o Urinary How long did the pain last?
Urgency o Characteristics
Frequency Have the patient describe the pain to
Hesitancy you and how it felt.
Dribbling Was it heavy? Did it feel sharp or
Incontinence dull?
Flank or suprapubic pain o Alleviating or aggravating factors
Stone passage Change in position
Appearance of the urine Exertion or rest
Any discharge o Relieving factors
Hernia Medication
o Reproductive o Temporal
Abdominal mass Did it return?
o Respiratory How long did it last?
Especially if pain is noted in the LUQ Has there been a previous pattern?
can have to do with the lung - Review of systems
Ask about difficulty in breathing o General status
o Cardiovascular o Cardiac
Possible myocardial infarction/AAA Easy fatigability
Chest pain Paroxysmal nocturnal dyspnea
Easy fatigability Orthopnea
PND Palpitations
Orthopnea Syncope
Palpitations Leg edema
Syncope o Respiratory
o Musculoskeletal Dyspnea
Abdominal muscle pain Cough/secretions
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o Musculoskeletal Application of ice or heat
Joint stiffness Whether or not the interventions
Pain worked
Swelling o Temporal factors
Muscle pain Do the headaches follow a pattern?
Cramps or muscle weakness How often do they occur?
Muscle wasting o Severity of symptoms
Rating on a scale of one to ten
Abnormal posture
FOR ALL CASES
o Gastrointestinal
PAST MEDICAL HISTORY
Possibility of GERD/PUD
- Birth and developmental history (where applicable)
Nausea - Childhood illnesses or hospitalizations
Vomiting - Adult illnesses or hospitalizations
Retching - Surgeries
Hematemesis - Injuries or accidents
Melena - Transfusions and reactions, if any
Hematochezia - Allergies
Indigestion o Nondrug related
Food tolerance Food
Abdominal pain Dye
Esophageal spasm Seasonal
o CNS Environmental
Headache o Drug related
Loss of consciousness Class of medication
Motor dysfunction or weakness Reaction or symptoms observed
Tremors - Obstetric or gynecologic history
o Gynecologic
o Psychiatric
LMP
Anxiety
Average number of days in cycle
Depression
History of dysmenorrhea
Agitation o Obstetric
Tension Obstetrical number
Sleep disturbance Births
HEADACHE Complications
- There are different types History of gestational diabetes
o Sporadic known as migraines Preeclampsia history
o Every day or continuous headaches are usually o Family planning method
tension headaches CURRENT HEALTH STATUS/RISK FACTORS
o Many headaches and then they disappear and - Health screening
return a few years later are known as cluster o Blood chemistries
headaches o Ancillary procedures
o Can be related to disease pathology - Nutrition and dietary habits
- History of present illness - Sleep pattern
o Onset - Smoking
Acute - Exercise
- Alcohol
Gradual
- Environmental exposure
o Location
- Medication data
Where is the headache located on
o Self-prescribed or over the counter
the head? o Doctor-prescribed drugs
Occipital o Herbal medications
Temporal o Allergies to drugs
Frontal o Illegal drug or substance abuse
Parietal - Immunizations
o Duration o When was the patient immunized
How long do the headaches last? o What immunizations
o Characteristics FAMILY HISTORY
Characteristics of the pain - Current health conditions of parents, siblings and children
Sharp - Determine pattern of disease within family
- Deaths
Dull
o Cause
Stabbing
o Date
Aching o Age at death
Diffuse PERSONAL AND SOCIAL HISTORY
Localized - Marital status
o Alleviating or aggravating factors/associated - Where patient was born and raised and by whom
symptoms - Living arrangement and condition
Nausea - Family structure and background
Vomiting - Interpersonal relationships
Aura - Support/secondary gains
Photophobia - Employment history and job satisfaction
Sonophobia - Sexual history and function
o Relieving factors - Significant life events
Medication taken to help relieve o Death
headache o Divorce
o Financial hardship
BINSOL | UST A MED 2019

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