History

PREPARATION FOR PACES
HISTORY
BY
Dr: AHMED MAHER ELIWA

-My role
-Pt name
-Problem of pt DD risk factor, association and complication
-Take consent to start the consultation
-Tell him, your GP has written to me explaining that you have some
trouble with you’re ……., 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
-Complain
-ROS
GGG CCC HELS

ROS
-General
Weight, 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
-Gastroenterology
.Are 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 skin?
-Genitourinary
.Any 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

.Urge incontinence, involuntary to pass urine when an urgent need to
micturate cannot be resistant
.Stress incontinence, leakage of urine in response to increase intra
abdominal pressure
.Hesitancy delay in initiation of urine flow
.Poor urinary stream and dribbling of urine after micturation
.Polyuria, pass amount of urine more than normal, it is associated with
increase drink of water, passes urine at night
.Coloure of urine
.I want to ask you some rather personal questions is that ok?
.Have you a regular sexual partner, male or female, are you practicing safe
sex, are you worried about that you might have picked anything from
sexual intercourse
.Any change in sexual desire or ability
Ask about scrotal pain, swelling
Ask about anal discharge, rectal bleeding
Ask about ulcer at penis, rash, wart
.Ask about menses, purities valve, sores, dysparunia, post coital bleeding
Cardiovascular system
-Chest pain, shortness of breath, orthopnea, paroxysmal dyspnea
-Ankle swelling
-Awareness of heart beat
-Blackout
-Leg pain (Claudiacation(
Chest
-Cough, phlegm, haemoptysis
-Shortness of breath
-Noisy chest
-Chest pain
-Sleep affection, snore during sleep
-Change the voice character
Neurological

-Headache, eye affection, photophobia, neck pain, confusion, fever and
drowsiness
-Faint or blackout
-Funny turns or fits
-Weakness or numbness, tingling sensation (pin and needle in limbs(
Special sense, smell, hearing, taste, eye, and swallowing
-Unsteadiness, in the dark and during walk
-Gait
-Water work and back passage
-Did you have any change in your mood, concentration, memory or
behaviors?
Hematology
-Any bleeding spot under skin, from teeth, gums or from nose
Locomotors
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 transfusion
-Medical examination for check up
-Immunization
Serious illness
Allergy
Drugs
Family history

-Similar condition
-Any illness runs in your family
Social
-Alcohol, smoking and recreational drugs
-Marital status
-Sexual history
-Job and finance
-Lives with
-Travel, vaccination and diet history
-Daily 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 control
-managed underling disease process
-General management
Abdominal swelling

-DD 1- Ascites
2-Obesity
3-pregnancy
4-flatus
-Causes of Ascites
-Liver diseases
Viral 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
Shortness of breathing and chest pain
-cardiac 1-ACS
2-Constrictive pericardities
3-Vave lesion
-Chest 1- pleurisy
2-Pnumothorax
3-Pleural effusion
4-pnumonia
5-Bronchial asthma exacerbation, occupation, exercise, cold, home pets and
history of allergy
6-Pulmonary embolism
7-Interstitial lung diseases ask about collagen specially scleroderma
8-Pulmonary hypertension primary or secondary, ask about HIV and appetite
suppression drugs
9-Drugs
-GIT
GERD
Asymptomatic hypertension

-Essential HTN
-Secondary 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 tea
-Plan as blood test including renal profile and electrolyte and image on heat
-Check 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 care
Basic investigation like CBC, LFT, RFT, electrolytes and x ray of spine
DEXA, isotopic bone scan for metastases and MRI
Joint pain with fever
Still disease
Rheumatic heart disease
Sarcodosis
SLE
Crystal arthropathy
Ask about trauma
Ask if pain affection joint and surrounding tissue
Ask about deformity and swelling
Ask if there is sign of inflammation
Ask about hair, muscle, skin, Reynaud’s, nails, bowel habit, eye and orogental ulcer
Ask about relation to alcohol or drugs as in gout
Ask about diet history if suspect gout

Fever with headache
Meningitis viral as HIV, HS
Bacterial as TB, meningococcal, pneumococcal, listeria
Fungal as cryptococcal
SLE
Ask about skin rash
Ask about neck pain photophobia
Ask about head trauma
Ask about traveler history
Ask about vaccination
Ask about splenectomy
Ask about diet as unpasteurized milk that leads to neurobrucellosis and listeria
Ask about vaccination history
Ask about HIV, TB history
Bronchial asthma with increase symptoms
-Search about the trigger factors as pollen, dust mite, cat dander, cold air, smoke,
exercise, pets, aspirin and occupational (isocynate, platinum(
-History of allergic rhinitis and topic eczema
-History of drug allergy
-Inhaler technique and embarrassment of using inhaler
-Previous use predisolone
-GERD
-Post nasal discharge
-Allergic pulmonary aspergillus's
-Carcinoid
-charge Strauss, GPS, and WG
Ask about day symptoms, affection of sleep, interfere with daily activity
Ask about relation with exercise, and cold exposure
Ask if there is other medication than used for treatment of asthma
Ask about did he use salbutamol more than before
Ask about there is previous anesthesia
Tell plan for annually influenza vaccine and 5 years pneumococcal vaccine

Abdominal pain
Postprandial pain, GB, DU, mesenteric ischemia
AIP
FMF
PAN
DKA
MI
Renal failure
Adrenal insufficiency
Lead poising
Drugs
Pancreatitis
IBS
Malingering
Any pain should be score
Ask about alarm sign
Ask about diet history in details for celiac
Ask about bowel
Ask about other symptoms suggestive IBS as anxiety, coffee and tea
Ask about HIV
Ask about IBD
Ask about previous surgery
Ask about tingling and numbness during attack of pain
Ask what increase pain as alcohol?
Ask about psychtic illness
Ask about drugs for depression
Ask about skin rash and sensitivity to rash

Burning of the feet
Causes
-Alcoholic and amylodosis
-Vitamin b12 deficiency and folic acid deficiency
-Paraneoplastic syndrome
-Vasculities
-Drugs as INH, amiodarone
-infection as HIV and syphilis
-Diabetes mellitus
-Trauma
-Endocrinal as hypothyroidism, acromegaly, pregnancy
-ask about renal failure
-Collagen disorder
Ask about back pain
Ask about history of peripheral vascular disease
Ask about foot ulcer
Ask about the autonomic dysfunction as impotence, arrhythmia, and hypotension
Ask about sensation and history of falls in the dark area
Ask about gait
In the plan of care should treat the other risk factors
Cold and painful finger
Causes
Collagen disorder as scleroderma, SLE, dermatomyositis,
Peripheral vascular diseases
Drugs as BB
Job
Trauma
Cervical disc and syringomyelia
Blood diseases as polythycemia, waldenstorm, vasculities, cryoglobulinemia,
myloproliferative disorder
Primary
Ask about family history
Ask about same change in hand, feet and hair lobules
Ask about smoking
Ask about history of trauma

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
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
Ask about consciousness, what is the time he taken to regain conscious
Causes of dizzy spell
CNS Parkinson plus syndrome, epilepsy, ataxia, stroke and vestibular neuritis
CVS carotid hypersensitivity syndrome, valve lesion, arrhythmia,
Hypoglycemia ask about diet, exercise, injection technique and any lumps also
search about other causes of hypoglycemia as hypopiutarism, Addison, sarcoma liver
and renal disease
Postural hypotension
Situational syncope as micturation, cough, vasovagal syncope
Osteoarthritis
Drugs like diuretics and antihypertensive medication
Anemia
Ear disease, BBV
Multiple sclerosis, relation of vertigo with hot bath
Ask about attack what happened before, during and after
Ask if attack occurred while sitting or lying down
Ask about history of falls
Ask about loudness, facial pain

Confusion
Causes
-Dementia as
Alzheimer 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 confusion
Infection
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
Ask about gait
Ask about abnormal movement
Ask about mood

Rheumatoid arthritis
Ask about bone protection from long use of steroid
Ask about contraindication of infliximab and methotrexate
Ask about carpal tunnel syndrome
Ask about affection of daily activity and
job
Ask about weakness and sensory affection
Ask about skin nodules, nail, hair, eye, bowel, stiffness,
Ask about trauma
Ask drug history as thiazids, hydralazine, and procainamid
Diabetes mellitus
Check eye, heart, stroke, peripheral vascular disease, renal, foots, peripheral nerve,
NASH, impotence, unsteadiness and autonomic dysfunction
Ask about job specially driving
Ask about other risk factors of cardiovascular disease
Ask about life style
Ataxia and difficult to walk
Alcohol
Vascular
Congenital
Paraneoplastic
Malignant
Space occupying lesion
Drugs
Hypothyroidism
Trauma
Demylinated disorder
Miller fisher syndrome
Ask about history of falls
Risk factors for DVT and PE
Long flight
OCP
Family history
Malignancy
SLE
Antiphospholipid
Life style
Bed ridden

SLE
Non specific symptoms as fever, skin rash, LN, chest pain, Reynaud’s 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
Ask if mixed with stool
Ask about tensmus, urgency, and pain during defecation
Ask if mass protruded from the anus
Ask about bowel habit
Ask about if fresh blood, dark red, mixed with stool, or present in toilet paper
Ask about nocturnal diarrhea
Ask about alarm sign
Ask about drug as anticoagulant and NSAID
Ask about family history of cancer
Ask about skin papules after taking blood sample
Ask about fever, rigors, and sweating
Ask about serositis as pleurisy
Ask about oral, genital ulcer

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 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
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
Ask about bulbar symptoms and respiratory affection
Ask about other autoimmune diseases
Ask about history of APCKD

Dysphagia
Neurological causes bulbar and psudobalbar
Local as FB, GERD, drugs, infection as fungus, scleroderma, cancer and achalasia
Drugs as nitrate CCB, bisphosphonate
HIV
Globus hystericus
Ask if there is pain between meals
Ask if swallowing easier with different position
Ask about cough, choking when pt lying flat
Ask about recurrent chest infection
Ask about type of food
Ask about nocturnal symptoms
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
Surgery as gastric bypass surgery
Alcohol excessive intake
Ask about awareness if he is unaware, no driving

Haemoptysis
Cancer
Bronchiactesis
PE
Infection as TB or pneumonia
ABPS
MS
Carcinoid
HIV Kaposi sarcoma
Laryngeal causes
Drugs as anticoagulant
Vasculitis as WG, GPS, MP
Hereditary hemorrhagic telangecetesia
Bleeding disorder
Thoracic endometriosis
Ask to DD between hematemesis and hemoptysis
Ask about asbestosis
Ask about TB
Explain need for bronchoscope
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

Hoarseness of voice
Overuse voice
Laryngitis
Fungal infection in pt use steroid inhalation
Upper respiratory tract infection
GERD
Inhalation of smoke
Lung cancer
Laryngeal cancer
Bulbar palsy
Ortener syndrome from mitral stenosis
Thyroid enlarged
Tell pt, you will refer him to ENT
Hypercalcemia
Hyperparathyroidism
MEN 1and MEN 2
Acromegaly
Thyrotoxicosis
Addison
Familial hypercalcemia hypocalceuria
Sarcodosis
Milk alkali syndrome
Malignancy as multiple myeloma
Drugs as thiazids diuretics and lithium
Vitamin D over dose
Immobility
Hypercalcemia with increase PTH, 1ry and tertiary hyperparathyroidism, lithium and
hypocalceuria hypercalcemia
Hypercalcemia symptoms as fatigue, depression, anorexia, nausea, vomiting,
constipation, renal colic and peptic ulcer

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
Ask about the weight before and similar attack
Ask about diet history
Ask about any teeth problem
Ask about travel history
Ask about drugs that lead to weight loss as SSRIs, metformin and illicit drugs
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
Ask about manifestation of vit B 12 deficiency as neuropathy and glossiest
Ask about past history of surgery
Ask about steatorrhea
Ask about other autoimmune disease

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
Painful shoulder with proximal muscle weakness
Inflammatory as polymyositis and dermatomyositis
PMR
GCA
Fibromyalgia
Endocrine as Cushing, acromegaly, thyrotoxicosis
Collagen as rheumatoid
Drugs as steroid and statin
Electrolyte disturbance
Paraneoplastic syndrome
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
Subdural hematoma
Hypoglycemia
Meningitis

Polyuria
DM-
-DI
Neurogenic 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
Lower limb edema
Heart failure
Cor pulmonal
PPH and secondary PH
Liver cell failure
Renal failure
Hypoalbuminemia
Hypothyroidism
Drugs as OCP, ca channel blocker and steroid
Lymphoedema
Ask about bite of sting
Ask about trophic change of skin

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

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
Ask about effect of alcohol on tremor
Ask about thyrotoxicosis
Ask about respiratory, liver failure
Treatment of BET is BB, thalamotomy, deep brain stimulation

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 at any site there obesity
Ask about trials of weight loss
Ask about complication of obesity as IHD, DM, OSA, HTN,
Ask about symptoms of hypothalamus disorder as headache, vomiting, Polyuria

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 sister symptoms and signs

Night sweat
TB
HIV
Thyrotoxicosis
Brucellosis
Lymphoma
Malaria
Hypoglycemia
sarcodosis
Ask about frequency, feels hot or cold
Ask about appetite, thrush in mouth, dyspahgia, loss of weight
Ask about skin rash
Ask about travel history
Did you feels any flushing pain with alcohol
Ask about intimated relationship
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
All of above should be assessed in pt complain from
Dyspnea, collapse, chest pain, hemoptysis, stroke, pain at lower limbs and
collapse

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
Diarrhea
Infection
Celiac
Bacterial overgrowth
Tropical sprue
Crohns
UC
HIV
Tumor
DM autonomic
Throtoxicosis
Carcinoid
VIPOma
Drugs as laxative and thyroxin
Radiation
Ask about night diarrhea
Ask about oral ulcer
Ask about history of antibiotic in last 2 months or hospital admission
Ask about history of bowel surgery
Ask if stool float in the pan

Inability to walk with sensory affection
HSMN
GBS
MFS
Local spinal causes as malignancy, TB, disc prolapsed
MS
Botulism
CIPD
Ask about trauma
Ask about sphincter affection
Ask about recent vaccination, TB and surgery
Ask about recent URTI, or gastroenteritis
Ask about breathing in pt suspected be GBS
Ask about travel, vaccination and sexual history
Bone pain and pathological fracture
Multiple myeloma
Osteoporosis
Osteomalicia
Primary hyperparathyroidism
Tertiary hyperparathyroidism
Paget disease
Bone neoplasm either primary or secondary
Osteoarthritis
Ask about Reynaud’s phenomenon
Ask about hypercalcemia symptoms
Ask about risk of osteoporosis and osteomalicia
Ask about height and weight

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

Sweating and anxiety
Hypoglycemia
Hyperthyroidism
Pheochromocytoma
Menopausal symptoms
Psychological condition
Ask about period and OCP
Ask about HRT
Ask about blood pressure
Ask about heart rate
Ask about drugs
Ask about menopausal symptoms
Ask about relation of sweating to weather
Ask about feeling cold during sweating
Ask about temperature at this time
Intermittent episode of inability to move
Hypokalemia periodic paralysis
Thyrotoxicosis associated with hypokalemia periodic paralysis
Myasthenia graves
Narcolepsy and cataplexy
Psychologically stress
Proximal muscle weakness
Ask about fatigue
Ask what relation to exercise is
Ask about relation to food
Ask about symptoms related to MG
Ask about variability of symptoms
Ask about Thyrotoxicosis symptoms
THANKS

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