Medical History

Question 1

Clinical Skills

What percent of the time does an exceptional history-taking indicate the correct diagnosis?

Answer 1

75%

(the review of systems is then confirmatory)

Question 2

Clinical Skills

What are the initial steps in establishing a rapport with a patient before beginning to take their history?

Answer 2

Introduce yourself (your role and purpose in talking to them) and acknowledge their fear and/or pain;

make sure the surrounding area is private and quiet; sit down at eye level;

ask family members to step out if necessary;

do NOT interrupt for at least 30 seconds;

be conscious of their comfort level and ability to express their needs (consider any necessary language and cultural adaptations)

Question 3

Clinical Skills

What is the first part of a successful history? (1/5 and 2/5)

Answer 3

1. Chief complaint
2. History of present illness

Question 4

Clinical Skills

Which mnemonic is useful in taking a history of present illness?

Answer 4

FAR COLDER

Question 5

Clinical Skills

What is the second part of a successful history? (3/5)

(after chief complaint and HPI)

Answer 5

3. Medical history

(including medications (doses and indications) and allergies)

Question 6

Clinical Skills

Which mnemonic is useful in taking a past medical history?

Answer 6

I³ SAM

Illnesses, Injuries, Immunizations Screening, Allergies, Medications

Question 7

Clinical Skills

What is the final part of the history taking process before beginning the review of systems? (4/5 and 5/5)

(after CC, HPI, and medical history)

Answer 7

4. Family history
5. Social history

Question 8

Clinical Skills

Which mnemonic is useful in taking a social history?

Answer 8

LEO-DSST

Living situation, Education, Occupation, Diet/exercise, Substance use, Sexual history, Travel

Question 9

Clinical Skills

What are the main two parts of a chief complaint?

Answer 9

Symptom(s) + duration

Question 10

Clinical Skills

What mnemonic is useful in establishing a complete history of the present illness? For what does it stand?

Answer 10

FAR COLDER

Frequency

Associated symptoms

Radiation

Character

Onset

Location

Duration

Exacerbating factors

Relieving Factors

Question 11

Clinical Skills

Outline the ‘FAR’ in the FAR COLDER mnemonic regarding HPIs.

Answer 11

Frequency

Associated symptoms

Radiation

Question 12

Clinical Skills

Outline the ‘COLDER’ in the FAR COLDER mnemonic regarding HPIs.

Answer 12

Character

Onset

Location

Duration

Exacerbating factors

Relieving Factors

Question 13

Clinical Skills

What is the mnemonic FAR COLDER?

Answer 13

A S/Sy outline for the history of present illness

(Frequency, associated symptoms, radiation, character, onset, location, duration, exacerbating factors, relieving factors)

Question 14

Clinical Skills

What type of questions are most useful in gaining a patient’s side of the story and making them feel validated?

Answer 14

Open-ended questions

Question 15

Clinical Skills

What is the F in the FAR COLDER mnemonic for HPIs?

Answer 15

Frequency

Question 16

Clinical Skills

What is the A in the FAR COLDER mnemonic for HPIs?

Answer 16

Associated symptoms

Question 17

Clinical Skills

What is the R in the FAR COLDER mnemonic for HPIs?

Answer 17

Radiation

Question 18

Clinical Skills

What is the C in the FAR COLDER mnemonic for HPIs?

Answer 18

Character

Question 19

Clinical Skills

What is the O in the FAR COLDER mnemonic for HPIs?

Answer 19

Onset

Question 20

Clinical Skills

What is the L in the FAR COLDER mnemonic for HPIs?

Answer 20

Location

Question 21

Clinical Skills

What is the D in the FAR COLDER mnemonic for HPIs?

Answer 21

Duration

Question 22

Clinical Skills

What is the E in the FAR COLDER mnemonic for HPIs?

Answer 22

Exacerbating factors

Question 23

Clinical Skills

What is the second R in the FAR COLDER mnemonic for HPIs?

Answer 23

Relieving factors

Question 24

Clinical Skills

How should the chief complaint be recorded?

Answer 24

In the patient’s own words

Question 25

**​Clinical Skills** What 4 factors make up the main family history?

Answer 25

**1.** Mother **2.** Father **3.** Siblings **4.** Genetic pedigrees (if warranted)

Question 26

**​Clinical Skills** What is the general order of the medical interview?

Answer 26

Chief Complaint \> History of Present Illness \> Medical history \> Social history \> Family history \> Review of systems

Question 27

**​Clinical Skills** Identify what percentage of the time is the diagnosis made by each of the following steps in the patient experience: **The medical interview** **Review of systems** **Lab results**

Answer 27

The medical interview - 75-80% Review of systems - 10-15% Lab results - 5-10% (I.e., the review of systems and lab results are generally confirmatory in nature as to any particular diagnosis)

Question 28

**​Clinical Skills** How should you wrap up a medical interview with a patient?

Answer 28

Recap everything that was discussed to make sure you're not missing anything

Question 29

**​Clinical Skills** How can you make the illicit substances and sexual history portions of the medical interview easier for the patient?

Answer 29

Before beginning these portions, remind them of the confidentiality they have with you and the attending AND remind them they don't have to answer any questions, but it is in their best interest to give you a clear understanding of who they are

Question 30

**​Clinical Skills** What is a simple way to help patients feel that their opinion is valued during the medical interview?

Answer 30

Ask them what they think the cause of their chief complaint is / get their input --\> this also helps us see their perspective on the issue

Question 31

**​Clinical Skills** What are the main topics to be covered in ascertaining the patient's medical history? **PAMSAS**

Answer 31

**P**ast diagnoses **A**ccidents / injuries **M**edications **S**urgical Hx **A**llergies (to medications and not) **S**creenings / Immunizations (also, travel, hx of transfusion, etc.)

Question 32

**​Clinical Skills** What 5 factors make up the main social history? **1.** \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ **2.** \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ **3.** Education / occupation **4.** Diet / exercise **5.** Sexual History

Answer 32

**1. _Family / living environment_** **2. _Alcohol / Tobacco / Drugs_** **3.** Education / occupation **4.** Diet / exercise **5.** Sexual History

Question 33

**​Clinical Skills** What 5 factors make up the main social history? **1.** Family / living environment **2.** Alcohol / Tobacco / Drugs **3.** \_\_\_\_\_\_\_\_\_\_\_\_\_ **4.** \_\_\_\_\_\_\_\_\_\_\_\_\_ **5.** Sexual History

Answer 33

**1.** Family / living environment **2.** Alcohol / Tobacco / Drugs **3. _Education / occupation_** **4.** **_Diet / exercise_** **5.** Sexual History

Question 34

**​Clinical Skills** What 5 factors make up the main social history? **1.** \_\_\_\_\_\_\_\_\_\_\_\_\_ **2.** Alcohol / Tobacco / Drugs **3.** Education / occupation **4.** Diet / exercise **5.** \_\_\_\_\_\_\_\_\_\_\_\_\_

Answer 34

**1.** **_Family / living environment_** **2.** Alcohol / Tobacco / Drugs **3.** Education / occupation **4.** Diet / exercise **5. _Sexual History_**

Question 35

**​Clinical Skills** In taking a patient history, what questions should be asked about medications?

Answer 35

- Over-the-counter Rx - Prescription Rx - Allergies

Question 36

**​Clinical Skills** What is an appropriate way to ask a patient's sexual orientation in clear, easily understood terms?

Answer 36

Are you sexually active with men, women, or both?