Topic Progress:
 
need to engage with a patient – (sp In adalocents – ) explain confidentiality if needed 
need to see them alone
Be non judgemental  
do a HEADASS 
 
in certain circumstances – you may first have to say 
eg –  STD, Depression history 
1) Confidentiality – ( exceptions, if the patient or someone else is at danger of death ) 
2) Why I ask these questions ( to asses the risk and decide on
3) Some questions may be personal 
4 ) normalize things by saying, i ask all my patients these questions – 
 
P/C –
 
History of presenting complaint – 
Pain
Lump 
 
CSV
Respiratory
Gastro 
Urinary
CNS and endocrine 
joint
Haematology  – 
 infections, inflammatory iatrogenic, idiopathic 
 
skin – 
type of skin – do you get burnet very easily or tan – as burning patients get more melanoma 
 
RASH – 
where did is start and where to did it spread 
How long 
Itchy ? ( mild – takes long time to see doc, severe- would wake up in night due to this and has excoriation ) 
what have you applied – treatment so far 
 
Reproductive history – ?
      • At what age did you have menarche 
      • were the cycles reguler
      • any symptoms with the cyclesmid cycle pains)
      • When did the first intercourse happen 
      • Have you had kids, pregnancies, abortion or miscarriage
      • are you sexually active 
      • any issues with sex  -( loss of libido, disparonea, bleeding )  
      • history of STD
      • Do you have contraception, have you used emergency contraception , do you use withdrawal method as contraception ) 
      • are you planning pregnacy and what would you feel if you become pregnent 
      • have you had HPV vaccination ( if young ) 
      • is PAP up to date  
      • are you in menopause – symptoms of menopause 
Sexual – 
Reproductive –  Consider the 5 ‘P’s: partners, practices, protection from STIs, past history of STIs and prevention of pregnancy.1
In regard to pregnancy – 
      •  when was the LMP
      • any missed pills 
      • vaginal bleeding – and any possibility of pregnancy – 
in regard to STD – 
      • about sexual partners and when she had them 
      • protection from STD and pregnancy – condoms 
      • last STD check 
      • history of STD and pregnancy 
 
Sexual history – 
      • Are you sexually active ?
      • Age of partner – important in ATSI specially 
      • When is the last time you had sex
      • when did the last time you had a different partner and do you have multiple partner  – important in ATSI specially 
      • Is your partenr a male / female or do you have sex with both  (if HIV positive – know 1) is he on ART, 2) viral load detectable, 3) is he/you circumcised)
      • are you top or bottom – and did he cum inside you 
      • are you circumcised 
      • Did you have sex overseas or have your partner traveled overseas recently or is he from overseas
      • Is you partner having multiple sexual partners, IV drug abuse or has STD –  important in ATSI specially 
      • What sort of sex do you have – anal / vaginal / oral – if homosexual – giver or the taker 
      • do you use condoms and for what acts
      • is sex consensual – important in ATSI specially 
      • Have you had tatoos / IV drugs – important in ATSI specially 
      • Have you had STD ?
      • ask MSM high-risk questions 
Symptoms of STD ? 
Any discharge – Urethral discharge or vaginal discharge 
dysuria
itchiness 
Pain – dyspareunia ( superficial or deep )  
anal symptoms of itchiness and discharge
throat symptoms 
systemic symptoms of fever, joint swelling, rash 
lumps 
ulcers or fishers 
Menstrual history – 
 
Reproductive history – ?
      • Have you had kids, pregnancies, abortion or miscarriage
      • Do you have contraception
      • are you planning pregnancy and what would you feel if you become pregnant 
      • have you used emergency contraception 
      • do you use withdrawal method as contraception 
      • is PAP up to date  
OBS – 
Several questions can be posed to assess the relevant family history of both the woman and her partner. These include:
      • Are there any conditions in your family that have affected more than one family member?
      • Has anyone been born with a health or learning problem?
      • Has anyone in your family had more than 3 miscarriages?
      • Has anyone had a stillbirth or a baby who has died?
      • Has anyone in your family attended special schools or been in a special class at school?
      • Is there anything you are especially worried about? (While not specifically an assessment of family history, it may remind the patient about something not mentioned or uncover any other concerns).
Psychiatry 
 
Young person – psychological intervier ( adolosents ) – 
HEADSS – home, education and employment, Activities, Drugs, Sex , Suicide 
be nonjudgemental – “ many people at your age has started experimenting sex . Have you done that as well ? “ 
HEADSS and maturity ++ intelligence are good methods of checking GILLICK competence as well
PTSD – 
      • flashbacks
      • avoidance 
      • hypervigilance 
      • Anxious and agitated + irritable lately 
Eating disorder  – SCOFF questions 
      • do you make your self sick after meals because you feel uncomfortable 
      • do you think you have lost control of how much you eat 
      • have you lose over one stone over 3 months of body weight 
      • do you consider your self fat when others say you are thin 
      • do you think food dominates your life 
Sleep 
LOW / LOA 
Night sweats 
 
PMhx
Past history should consider previous similar episodes, how they ( rash/ STD  ) were treated and responded.
Past history of immunisation ( e.g. – salmonella if the patient has a diarrhoea ) 
past history of melanoma – ( increases risk of melanoma by 10 fold ) or other skin cancers ( increases risk by 4 fold) 
past history of rashes –  asthma / skin rashes / eczyma 
 
surgical history 
 
Drug history and allergies 
medications related to a patient with diarrheoa 
  • antibiotics are associated with Clostridium difficile infection
  • proton pump inhibitors (PPI) increase the risk of infectious diarrhoea
  • immunosuppressants increase the risk of cytomegalovirus (CMV) and parasitic infections14
  • absorption of some medications may be reduced (eg combined oral contraceptive pill)
  • medications more likely to cause adverse effects in the presence of dehydration include non-steroidal anti-inflammatory drugs (NSAIDs), angiotensin converting enzyme inhibitors (ACEIs), angiotensin II receptor blockers, diuretics, digoxin, warfarin, metformin, lithium
pst medications that may cause skin rash – medication ADR 
 
Any drugs used or has any creams modified teh rash 
 
Immunisation history – ( Immunisation for diphtheria in sore throat) 
 
Family history
–  of Ca – prostate – prostate before the age of 65 or familial breast Ca  ( puts in high risk – but no need to screen ) 
             – Colon – i first degree relative 
pst family history of skin cancer 
Family history of eczyma and Asthma – allergic tendency 
Family history of rashes 
 
Social History 
Alcohol ( CAGE – cut down, annoyed, guilty, eye-opener)
Smoking – asess – 5As 
Diet 
 
over working – women often juggle with work – over work, – hours of work 
 
contact history – diarrhoea / rash 
 
Contact history 
occupation 
food from out
pst contact of skin rash – did you use some one’s cloths 
exposed to any thing different recently 
 
Travel history –  ( until one year of a travel, travel related illness should be considered in any presentation ) 
exact itinerary, travel dates in each destination, date of return to Australia, specific exposures, pre-travel vaccinations and, if appropriate, whether antimalarial medication was prescribed and taken as directed. 
consumption of other potentially contaminated foods and fluids (eg raw foods)?
 exposure to fresh water,? animal bites?, contact with farm animals? and Bats? birds ? 
the use of personal protective measures against insects? , insect bites noted,?
Any sexual contacts?, 
fellow travellers had been sick either on the trip or after returning to Australia
Take a detailed travel history from patients with an influenza-like illness, because international travel is an important vehicle for the rapid spread of these viruses. The management of novel strains of influenza virus depends on local epidemiology and the characteristics of the strain. If a novel strain is suspected, notify the local health department.
 
Diarrheoa – 
      • Occupation ( to see contact and the time off ) 
      • medications – ( as they can cause – clos dif or can reduce – efficacy ( OCP ) – or can cause ADR – NSAID/ diuretics ) 
      • Travel  – food from out, contact with fresh water and farm animals 
      • change of diet – Eg – milk 
      • contact history – and day care attendance 
Rash – 
contacts 
any cloths 
travel 
job – 
 
IN any case of infection – 
ask for exposure with an index case
travel is a good question 
 
if the patient has had any antibiotics/ medication s- always ask compliance 
           
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