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.Greet patient and introduce your selfidentify patientconfirm agenda and take consent for discussion by saying.. I have a letter from GP ?you have it is alright to discuss this issue today
DD
DD
Causes
Risk factors
Association
Complicati
PRESENT HISTORY
Ask about all DDREVIEW OF OTHER SYSTEMGit GG CCC HLES Period Psychatric Trauma
PAST HISTORYFAMILY HISTORYDRUG HISTORY ,,,, HERBAL ,,,, VITAMINE ,,,,, OCPSOCIAL HISTORY
Alchol
Smoking
Recreational
drugs
With
who
m
you
lives
Income
Daily
activity
Travel
history
in
fever
Vaccination
Sexual
history
HISTORY SHEET
:END OF HISTORY
I will summarize for you now the important point if you still have anything that .we have not discussed and you are worried about it tells me
ASK ABOUT PATIENT CONCERN From what we have discussed, it is possible your symptoms could be duo to . After I examine you, we might consider doing
Basic investigationadmision
..Confirm diagnosis
Search for etiology and complication
.........................HISTORY
GeneralWeight, any recent change in your weight, how many Kg, over how many
days
Appetite, any change in your appetite .
.Fever any change in body temp .
Fatigue, any undue fatigue .
Swelling, any lump or bumps in your body.
Sleep any change in sleeping hours.
GastroenterologyAre you have any mouth sore, it is painful, any problem with teeth .
There is any difficult of swallowing, sensation of food sticking in your .
throat, where does it seems to stick, and it worse by fluid or solid
Any pain during swallowing.
Any feeling sick, retching or regurgitation of clear tasteless fluid.
Did you getting sick, it is color, how many time, related to pain. Related .
to food, what relive, what exacerbate, does it contain any trace of blood,
any indigestion, can you describe your indigestion to me, any heart burn,
.can you describe to me
Did you have any tummy pain and analysis pain.
Did you have any wind, does it pass downward or upward.
Ask about normal bowel habit , how many times in normal, and now .
how many times, what color , there is blood , slime, what is about odor,
associated with abdominal pain, it is difficult to flush away, does it smell
or float, there is incontinent of stool, when you try to opening bowels,
you have sensation of needing to go without evacuation
?Did you have any discolorations of your eyeball or skinGenitourinaryAny problem with your water work.
Any pain during or immediately after passing urine.
Strangury, inability to pass urine with suprapubic pain and repeated .
desire to micturation
Pain in the side of back.
Frequency, pass the urine with repeated time without no change in .
volume
Urgency, sudden need to pass urine.
Unsteadiness, in the dark and during walkGaitWater work and back passageDid you have any change in your mood, concentration, memory or ?behaviors
Hematology
Any bleeding spot under skin, from teeth, gums or from noseLocomotors
Joint pain, stiffness, swelling and deformity
Skin
,Skin rash, colour, size, shape, itching, discharge
Hair loss of hair or abnormal growth of hair
Sweating
Past medical history (PATMIS)
Procedure, admission and blood transfusionMedical examination for check upImmunizationSerious illness
Allergy
Drugs
Family history
Similar conditionAny illness runs in your familySocial
Alcohol, smoking and recreational drugsMarital statusSexual historyJob and financeLives withTravel, vaccination and diet historyDaily activity-
After end of consultation tell the pt is there is anything that we have not discussed and you are worried about it
From what we have discussed, it is possible your symptoms could be duo to . After I examine you, we might consider doing
During discussion I will request
Basic investigation
Confirm diagnosis
Search for aetiology and complication
Management plan
Symptoms controlmanaged underling disease processGeneral management?How you can practice history taking
Introduction-1
Open question................. I have a letter from GP that you -2
have ............... It is alright to discuss that today
Tell pt can you tell me more about that-3
Analysis complain....... In details -4
Focused history according to complain ........ As if the complain is -5
cough so ask about chest symptoms
Ask about the DD in details every DD ask about causes , risk factor, -6
symptoms, complication ,,,,,,,,,,,,, ask about everything even if symptoms
in past or family history
Review of other system and please don't repeat the question again-7
Past history including drug history-8
Family history-9
Social history-10
DD INABILITY TO WAHK
WITHOUT SENSORY LEVEL -1
A- FLACID (LMNL)
Muscle disease congenital as myopathy
inflammatory as polymyositis and dermatomyositis
Drugs as steriod and statin
Metabolic as hypokalemia and hyperkalemia
Endocrine as cushing, hypothyrodism, thyrotoxicosis
Paraneoplastic syndrome
Preipheral nerve Motor preipheral neuropathy
Neuro musculare junction as mythenia gravis and botulismpoliomylitiesB- Spastic( UMNL)
Hereditary spastic paraplegiaTropical spastic paraplegiacerebral palsyParasagital meningomaMultiple sclerosisMotor neuron disease-
Causes of collapse
CNS,,,,, as stroke, Parkinson, epilepsy, and disequilibrium
CVS,,,,,,, as ACS, valve stenosis, arrhythmia, vasovagal, carotid
hypersensitivity syndrome, HOCM
Hypotension (especially with autonomic neuropathy)
hypoglycemia
Situational syncope
Alcohol related falls
Drugs causes hypotension
Addison
Dehydration
Hemorrhage
Hyperventilation and anxiety
Ask if attack happened during supine
Ask about color during syncope and during recovery
Ask about symptoms before, during and after attack
Ask about if he seat down, and what is the response
Ask about the bite his tongue and pass urine, or injured him self
Ask about alcohol and drug intake
Ask about the driving( most important question )
Ask about consciousness, what is the time he taken to regain conscious
drsaied78@yahoo.com
Shortness of breathing and chest pain
Headache
Acute as SAH, Meningitis, GCA, carotid dissection, pituitary apoplexy,
acute angel glaucoma and cerebral vein thrombosis
Intermittent migraine, cluster. Trigeminal neuralgia, tension, paroxysmal
hemicrania
Chronic analgesic misuse headache, space occupying lesion, BIH,
pituitary affection, normal pressure hydrocephalus and co poisoning
Ask about affection of sleep
Ask about effect of cough, sneezing
Ask about head trauma
Ask about eye, teeth, ear, and nose symptoms
Ask about facial pain
Ask about relation to work, stress, and food
Ask about photophobia, neck pain, fever
Ask about pain at tempomandibular joint pain with eating or alone
Ask about visual filed and galactorrhea
Ask about HIV
Ask about psychiatric history
Ask about APCKD
Ask about bleeding disorder
Ask about family history for thrombosis, migraine, and SAH
Hirsutism
Cushing disease and Cushing syndrome
PCO
Simple obesity
Pregnancy
Ovarian and androgen secreting neoplasm
Drugs as phynetoin and steroid, OCP
Ask about manifestation of pituitary tumor as headache and vision
affection and manifestation of other hormone deficit
Ask about manifestation of Cushing as skin bruises, recurrent infection
Ask about drug history
Ask about malignancy
Ask about sexual life
Ask about skin rash and darkening of skin specially areola and axilla
Ask about Bp
Polyuria
-DM-1
DI--2
A- Neurogenic as trauma, infection HIV TB, infiltrations as Sarcodosis,
hemochromatosis, histocytosis and malignancy post surgery, post
radiotherapy and head trauma
B-Nephrogenic as hereditary, hypokalemia, hypercalcemia or drugs as
lithium
-C-Psychogenic Polyuria polydepsia
D-Paraneoplastic syndrome
Ask about amount of urine, colour, and nocturia
Ask about muscle cramps duo to electrolyte disturbance
Ask about dry eye, dry mouth
Ask about polydepsia and how much fluid intake
Ask about pituitary dysfunction symptoms
Ask about weight and galactorrhea
Bloody diarrhea
Infection
UC
Cronhs
HIV
Behcet
Malignancy
Ischemic colitis
Superior mesenteric artery occlusion
Vascular malformation
Local anal causes as piles, fissure
Diverticulitis
TB
Collagen disorder leads to Vasculitis
Purpuric rash
Increase destruction
ITP history of URTI in last 10 days
Hypersplenism
Bone marrow suppression
Infection as CMV, EBV
Drugs as methotrexate
Aplastic anemia
Megaloplastic anemia
Metastases
Vascular
SLE
HSP
HCV
Cryoglobulinemia
Drugs as anticoagulant, thiazids, penicillin
Vitamin c deficiency
Blood transfusion
HIV
TTP
HUS
DIC
ASK ABOUT
BLANCHING
Abdominal pain, joint pain, renal colic
Skin rash
LN
Diet and fruits
Alcohol
Trauma and bleeding related to it
Ask about family history
My rolePt nameProblem of pt
DD
Take consent to start the consultationTell him, your GP has written to me explaining that you have some trouble with youre ., I would like to ask you some question, so I can
decide the plan of management
Tell him I need to write few notes in may paper, so if I am writing thing down, I still will be listening to you
ComplainROSGGG CCC HELS
ROS
GeneralWeight, any recent change in your weight, how many Kg, over how
many days
Appetite, any change in your appetite .
.Fever any change in body temp .
Fatigue, any undue fatigue .
Swelling, any lump or bumps in your body.
Sleep any change in sleeping hours.
GastroenterologyAre you have any mouth sore, it is painful, any problem with teeth .
There is any difficult of swallowing, sensation of food sticking in your .
throat, where does it seems to stick, and it worse by fluid or solid
Any pain during swallowing.
Any feeling sick, retching or regurgitation of clear tasteless fluid.
Did you getting sick, it is color, how many time, related to pain. Related .
to food, what relive, what exacerbate, does it contain any trace of blood,
any indigestion, can you describe your indigestion to me, any heart burn,
.can you describe to me
Did you have any tummy pain and analysis pain.
Did you have any wind, does it pass downward or upward.
Ask about normal bowel habit , how many times in normal, and now .
how many times, what color , there is blood , slime, what is about odor,
associated with abdominal pain, it is difficult to flush away, does it smell
or float, there is incontinent of stool, when you try to opening bowels,
you have sensation of needing to go without evacuation
?Did you have any discolorations of your eyeball or skinGenitourinaryAny problem with your water work.
Any pain during or immediately after passing urine.
Strangury, inability to pass urine with suprapubic pain and repeated .
desire to micturation
Pain in the side of back.
Frequency, pass the urine with repeated time without no change in .
volume
Neurological
Headache, eye affection, photophobia, neck pain, confusion, fever and drowsiness
Faint or blackoutFunny turns or fitsWeakness or numbness, tingling sensation (pin and needle in limbs)Special sense, smell, hearing, taste, eye, and swallowing
Unsteadiness, in the dark and during walkGaitWater work and back passageDid you have any change in your mood, concentration, memory or ?behaviors
Hematology
Any bleeding spot under skin, from teeth, gums or from noseLocomotors
Joint pain, stiffness, swelling and deformity
Skin
,Skin rash, colour, size, shape, itching, discharge
Hair loss of hair or abnormal growth of hair
Sweating
Past medical history (PATMIS)
Procedure, admission and blood transfusionMedical examination for check upImmunizationSerious illness
Allergy
Drugs
Family history
Similar conditionAny illness runs in your familySocial
Alcohol, smoking and recreational drugsMarital statusSexual historyJob and financeLives withTravel, vaccination and diet historyDaily activityAfter end of consultation tell the pt is there is anything that we have not discussed and you are worried about it
From what we have discussed, it is possible your symptoms could be duo to . After I examine you, we might consider doing
During discussion I will request
Basic investigation
Confirm diagnosis
Search for aetiology and complication
Management plan
Symptoms controlmanaged underling disease processGeneral management-
Abdominal swelling
DD 1- AscitesObesity -2
pregnancy-3
flatus-4
Causes of AscitesLiver diseasesViral hepatitis, alcoholic, drugs, biliary, autoimmune, metabolic,
malignancy (asbestosis) and vascular
Non hepatic causes Heart failure
Nephritic syndrome and renal failure
Constrictive pericardities
Local abdominal causes as infection, malignancy, pancreatitis
Asymptomatic hypertension
Essential HTNSecondary HTN Renal APCKD, RAS, CKD, GN, interstitial nephritis
Endocrine as cons, Cushing, pheochromocytoma, MENS 2, ACROMEGALY
Anxiety and panic disorder
Pregnancy induced HTN
Drugs as steroids and liquorices
OCP
Coarctation of aorta
Ask if previous pregnancy induced HTN
Discus other risk factors of vascular affection
Discus the life style change as alcohol, smoking, diet, exercise, coffee and teaPlan as blood test including renal profile and electrolyte and image on heatCheck for complications eye, heart, and kidney Back pain
Causes
Mechanical as lumber disc
Trauma
Infection as TB, Brucellosis, and osteomylitis
Inflammatory as seronegative arthropathy
Tumor primary or secondary specially MM
Osteoporosis, osteomalicia
Renal colic
Pancreatitis
Ask about the neurological manifestation and pathological fracture
Ask about refer of pain to lower limb and at any level
Ask about the relation of pain to walk and what is about affection of rest on it
Ask if pain relived by sitting forward (spinal canal stenosis)
Ask about night pain, gait affection, sphincter affection
Any join affection; ask about skin rash, hair, eye, proximal muscle, and nail.
Raynaudes, bowel change, STDs and diet history for celiac and osteomalicia
Ask if there is change in weight or height
Ask about relation of pain with cough and sneezing
Ask about risk factors of osteoporosis as early menopause, oophorectomy, smoking,
nutrition, family history, corticosteroids therapy, HRT, OCP, Thyrotoxicosis and
collagen disorder
Drug history and HRT
Plan of careBasic investigation like CBC, LFT, RFT, electrolytes and x ray of spine
DEXA, isotopic bone scan for metastases and MRI
Causes of collapse
CNS as stroke, Parkinson, epilepsy, and disequilibrium
CVS as ACS, valve stenosis, arrhythmia, vasovagal, carotid
,
hypersensitivity syndrome, HOCM
Hypotension (especially with autonomic neuropathy) and hypoglycemia
Situational syncope
Alcohol related falls
Drugs
Addison
Dehydration
Hemorrhage
Hyperventilation and anxiety
Confusion
Causes
Dementia asAlzheimer disease
Lowey body dementia
Multi infarction dementia
Parkinson and Parkinson related syndrome
Picks dementia
Hydrocephalus
Hypothyroidism and vit. B12 deficiency
Creutzfeldt jakobe and syphilis
Wernicks encephalopathy
Post trauma
HIV
Syphilis
Subdural hematoma
Hydrocephalus
Brain tumor
Acute confusionInfection
Hepatic encephalopathy
Uremia
Drugs
Alcohol, Wernicks and delirium tremens
Polypharmacy
Subdural hematoma
Fecal impaction
Urinary retention
Electrolyte disturbance
MI and PE
HIV
Ask about the fluctuation of conscious
Ask about if he easily distracted
Ask if the pt has insight to his symptoms
Ask about memory recent ant retrograde
Ask about behavior
Ask about language
Ask about he can make plan
Ask about hallucination
Ask about problem in concentration
Ask about the personal hygiene, incontinence
Ask about trauma, drug intake and alcohol history
Ask about depression
Ask about social risk as driving, cooking alone, boiling water
Bed ridden
SLE
Non specific symptoms as fever, skin rash, LN, chest pain, Reynauds and
polyartharalgia
Bloody diarrhea
Infection
UC
Cronhs
HIV
Behcet
Malignancy
Ischemic colitis
Superior mesenteric artery occlusion
Vascular malformation
Local anal causes as piles, fissure
Diverticulitis
TB
Collagen disorder leads to Vasculitis
Jaundice
Hemolytic as sickle cell, thalassemia, and G6PD deficiency and autoimmune specially
drug induced
Cholestasis
Medically as PBC, PSC, autoimmune liver disease, drugs, OCP, hepatitis A B C ,
alcohol, anesthesia and vascular
Obstruction
Pancreatitis
Painful jaundice as, alcohol, infection, drugs, budd chiari, Wilson, pancreatitis
Painless as hemolysis, gilberts, pancreatic malignancy, cirrhosis, primary biliary
cirrhosis
Ask about risk for hepatitis as blood contact, sharing needle, sex, and for hepatitis A
ask about exposure to sewage or food intake or water
Ask about drugs and alcohol
Ask about herbal medication
Ask about pain, fever, loss of weight, anorexia, colour of urine and stool, itching,
vomiting, abdominal swelling, confusion and sleep affection
Ask about other autoimmune disease
Ask about liptospirosis
Ask about recent anaesthesia
Ask about history of preeclampsia in women
Amenorrhea
Pregnancy and OCP
Anorexia nervosa
Hyperthyroidism and hypothyroid
Addison
Pituitary causes
Hysterectomy
ASK about headache, vision affection, galactorrhea and libido
Ask about hypercalcemia, gastric ulcer
Ask about family history
Ask about diet and exercise
Cough, no sputum
Bronchial asthma and precipitating factors
GERD and relation to food
ILD and causes including collagen and drugs
Drugs
Postnasal discharge, allergic rhinitis, sinusitis
Infection including TB
Job
Foreign body
Externisc allergic alvolitis
Ask about URT symptoms as nasal discharge, nasal congestion
Ask about hoarseness of voice
Ask about complication of cough as hernia, incontinence of urine, syncope
Ask about exposure to animal
Ask about exposure to asbestoses
double vision
Multiple sclerosis
Myasthenia gravis
Botulism
Miller fisher
Graves
Mitochondria dystrophy
Progressive external ophthalmoplegia
Increase ICT
Wernicks encephalopathy
Pituitary apoplexy
Ask about it unilateral, bilateral
Ask about what site of diplopia is worse
Ask about two images site by site or above each other
Ask if double vision always same or variable
Relation of diplopia to fatigue
Ask about drug history specially penicillamine and aminoglycosid
Ask about visual acuity, night vision, headache, ptosis, diplopia, sequint, and filed of
vision
Facial swelling
Angioneuretic edema
Systemic illness as thyrotoxicosis, lymphoma, SLE
Hereditary
Drugs as ACEi
Ask about the precipitating factors as trauma, stress, pollen, food as peanut, extreme
cold or hot, jeweler or contact with animal
Ask about history of atopy or bronchial asthma
Ask about skin rash, itching, abdominal pain and skin after resolution of
attack
Ask about symptoms suggestive laryngeal edema
Hypoglycemia
Iatrogenic as hypoglycemic drugs and qunin
Addison
Panhypopitutarism
Renal and hepatic failure
Malignancy
Insulinoma
Reactive hypoglycemia
Lack of food intake, injection site, exercise
Weight loss
Intentional as diet, anorexia nervosa, exercise, drugs as laxative, diuretics, eltorexine
Endocrinal as Thyrotoxicosis, and diabetes mellitus (patient has good appetite)
Poor appetite
Anxiety and depression
Gastrointestinal as malabsorption, celiac, and cancer
,Addison
Malignancy
As lymphoma, Myloproliferative disorder
Chronic illness and infection as TB, HIV
IBD
Macrocytic anemia
Megaloplastic
Vitamin B 12 deficiency ask about diet and celiac disease other autoimmune disease
Folic acid deficiency other iliocecal disease like Whipple, Cronhs, and cancer
Non Megaloplastic
Drugs as phynetoin, methotrexate and trimethprim
MDS
Alcohol
Hypothyroidism
Liver disease
Ask about symptoms of anemia as fatigue daily activity and mental status
Ask about other causes of vit B12 deficiency as celiac, ileal disease and bacterial
overgrowth
Neck lump
Infection as TB, CMV, IMN and HIV
Sarcodosis
Lymphoma
Metastases
Myloproliferative disorder
Drugs as phynetoin, allopurinol
Collagen as SLE, still disease
Ask about the contact at work
Ask about contact with animal cat scratch disease
Ask about toxoplasmosis
Ask about relation with alcohol
Ask about tiredness, joint pain, and headache, tenderness over head, jaw claudicating
and blurring of vision
Ask about morning stiffness
Ask about tenderness
Ask about muscle weakness, sensation and muscle wasting
Ask about fever weight loss
Ask about pain or weakness, stiffness
Ask if pain at shoulder or arm
Ask about sensory affection
Ask about history of trauma
Palpitation
Ask about anxiety disorder
Ask about caffeine and tea
Ask about drugs ask salbutamol inhaler
Ask about illicit drugs
Ask about hyperthyroidism
Ask about trigger factors as stress, coffee, tea and emotion change
,Ask about what is mean by palpitation, it is slow or fast
Ask if any things can terminate it
Ask about systemic causes as Thyrotoxicosis, pheochromocytoma, anemia
Ask about family history or sudden cardiac death
Personality change
Hepatic encephalopathy ask about precipitating factors
Acute alcohol intoxication
Wernicks encephalopathy
Subdural hematoma
Hypoglycemia
Meningitis
Polyuria
-DM
DINeurogenic as trauma, infection HIV TB, infiltrations as Sarcodosis,
hemochromatosis, histocytosis and malignancy post surgery, post radiotherapy and
head trauma
Nephrogenic as hereditary, hypokalemia, hypercalcemia or drugs as lithium
Psychogenic Polyuria
-polydepsia
Paraneoplastic syndrome
Ask about amount of urine, colour, and nocturia
Ask about muscle cramps duo to electrolyte disturbance
Ask about dry eye, dry mouth
Ask about polydepsia and how much fluid intake
Ask about pituitary dysfunction symptoms
Ask about weight and galactorrhea
Pruritus
Scabies
PBC
Thyrotoxicosis
Lymphoma
Renal failure
Liver cell failure
Exposure to fiberglass, washing powder
Hemochromatosis
DM
HIV
Polycythemia
Psychological history
Drugs as phynetoin
Malignancy
Ask about other member of family
Ask if Pruritus affected by food, drugs, and stress
Ask about skin rash
Ask about skin injury and bleeding
Ask about eye sore and mouth affection
Ask about Pruritus of vulvae
Purpuric rash
Increase destruction
ITP history of URTI in last 10 days
Hypersplenism
Bone marrow suppression
Infection as CMV, EBV
Drugs as methotrexate
Aplastic anemia
Megaloplastic anemia
Metastases
Vascular
SLE
HSP
HCV
Cryoglobulinemia
Drugs as anticoagulant, thiazids, penicillin
Vitamin c deficiency
Blood transfusion
HIV
TTP
HUS
DIC
ASK ABOUT
BLANCHING
Abdominal pain, joint pain, renal colic
Skin rash
LN
Diet and fruits
Alcohol
Trauma and bleeding related to it
Ask about family history
Pyrexia
Infection as hepatitis, TB, HIV, malaria, brucellosis, infective endocardites
Collagen
Drugs
Malignancy
IBD
Factious
IBS
Thyrotoxicosis
Ask about
Fever, weight loss, sweating, drench bed sheet
Ask about diet intake for HAV, brucellosis
Ask about sexual history
Risk for hepatitis specially HAV
Ask about backache, depression, joint pain, fever, night sweat
Haematuria
Trauma and vigorous exercise
APCKD
Renal stone
Renal cyst
Sickle cell disease
Hydronephrosis
Infection as TB
BPH
IgA nephropathy, post strep. GN, alport
Drug as anticoagulant, cyclophosphamid
Blood disease as hemolysis, congenital or acquired or thrombocytopenia
Vasculitis as HCP, PAN, WG, GPS, MP
Ask about at start, at end or all
Ask about catheter insertion
Ask about job as working in dye, rubber, benzene
Ask about history of biliharzasis
Ask about nocturia, frothy urine, and stone passage
Tiredness
Fibromyalgia
Chronic fatigue syndrome
Myasthenia
gravis
Hypothyroidism
Psychiatric illness
Drugs like anexiolytics
Alcohol
Anemia
OSA asks about snoring, nocturia, restlessness at night, morning headache, and
reduced libido
Ask about sleep in front of TV, or at work
Ask about accident by car
Ask about chronic diseases
,Ask about history of URTI
Ask about coffee, tea, alcohol
Tremors
Parkinson and Parkinson plus syndrome and causes, dementia and control of urine
Benign essential tremors
Intention tremors
Anxiety
Drugs as lithium, B2 agonist
Alcohol
Throtoxicosis
Pheochromocytoma
Ask about shaking of hand
Unilateral or bilateral, symmetrical or asymmetrical
During rest or during all movemoment or during intention to touch subject or
sustained posture
Ask about symptoms of Parkinson as tingling, coldness, and rigidity, and slow
movement, inability to roll over bed, dribbling of saliva or blepharospasm
Ask about tremors at head and legs and if affect elbow or wrist
Ask about voice change
Visual disturbance
DM
GCA
CRAO
CRVO
TIAs
Migraine
Hypoglycemia
Postural hypotension
MS
Macular degeneration
,Ask about headache, pain, filed, acuity, movement, ptosis, colour vision, night vision
Weight gain
Simple obesity
PCO
Cushing, psudocushing
Hypothyroidism
Acromegaly
Insulinoma
Hypothalamus disorder as Sarcodosis, neoplasm
Drugs like steroid, OCP, antiepileptic, HRT, atypical antipsychotic, anabolic steroid
Nicotine withdrawal
Pregnancy
Fluid as in RF, LCF, HF, nephritic syndrome
ask about central obesity, straia, hair growth, thinning of skin, easy bruising, low
mood, recurrent infection, facial acne, back pain, proximal muscle weakness and
period change and ask about alcohol
Ask about diet history
Ask about at any site there obesity
Seizure
Congenital as tuberous sclerosis
Infection as TB, meningitis
Space occupying lesion
Vascular as AVM, stroke
Metabolic as hypoglycemia, hypokalemia, hyponatermia, hypocalcemia
Trauma
Drug withdrawal as benzodiazepine
Alcohol withdrawal
Drugs as lithium, ciprofloxacin
Ask about strange sensation, abd pain, fatigue, sleep deprivation, pallor, sweaty, and
hallucination
Ask about past history of trauma, febrile convulsion, and birth injury
Ask to differentiate epilepsy from psudoepilepsy
Anemia
Tell that sometimes of anemia is settle, decrease daily activity, lack of concentration,
headache, and palpitation
Explore about BM failure
Explore of hemolytic anemia, pain and attack of jaundice
Ask about menses
Ask about diet
Ask drugs
Ask about family history of cancer
Ask about malignancy
Ask about bleeding from orifice or under skin
Ask about chronic illness, CKD and collagen
Past history of operation
Ask about sinster symptoms and signs
Night sweat
TB
HIV
Thyrotoxicosis
Brucellosis
Lymphoma
Malaria
Hypoglycemia
sarcodosis
TIAs
Cardiac, AF, MS, cardiomyopathy and paradoxical embolism
Vasculitis
Blood disease as thyrombocytosis, polycythemia, PAN
Ask about past history of rheumatoid
Family history of stroke
Family history of death by stroke
Family history of APCKD
Risk of blood clots
Long flight
Pregnancy
Drugs as tamoxifine
After surgery
Long immobility
Family history
Constipation
Hypercalcemia
Hypothyroidism
Depression
Parkinson
Diverticulitis
Spinal surgery
Sexual abuse
Local anal causes
Cancer bowel
Ask about normal bowel habit
Ask about character of stool
Ask about straining
Ask about if he hart himself during defecation
Ask about blood in stool
Ask about flatus or wind
?Did you need to evacuate the rectum by your hand
There is any over flow diarrhea
Ask about diet history
Diarrhea
Infection
Celiac
Bacterial overgrowth
Tropical sprue
Crohns
UC
HIV
Tumor
DM autonomic
Throtoxicosis
Carcinoid
VIPOma
Drugs as laxative and thyroxin
Radiation
Hirsutism
Cushing disease and Cushing syndrome
PCO
Simple obesity
Pregnancy
Ovarian and androgen secreting neoplasm
Drugs as phynetoin and steroid
OCP
Ask about manifestation of pituitary tumor as headache and vision affection and
manifestation of other hormone deficit
Ask about manifestation of Cushing as skin bruises, recurrent infection
Ask about drug history
Ask about malignancy
Ask about sexual life
Ask about skin rash and darkening of skin specially areola and axilla
Ask about Bp
Uncontrolled DM
Ask about hemochromatosis
Acromegaly
Incompliant to medication
Incompliant with life style
Ask about skin rash, erectile dysfunction, bony pain, cardiomyopathy, darkening of
skin, hypogonadal dysfunction as hair loss, loss of libido