GENERAL SURGERY BLOCK LECTURES for proper histroy taking

GOOD HISTORY TAKING – “WHAT
IS WRONG WITH THE PATIENT?”
BY
PROFESSOR BONIFACE MWAMBA
KAWIMBE

Raison d’^etre
• Is a French expression which means the most
important reason for somebody’s or
something’s existence.
• Our raison d’^etre as a medical profession is
the PATIENT.
• Without the PATIENT we are all out of work.

RAISON D’ ETRE
THE REASON OUR PROFESSION EXISTS

HIPPOCRATIC OATH - Highlights
• Respect for ones teachers [30-40% unwritten]
• Obligation to pass on medical knowledge
• Never to do harm [ignorance]
• Never to use ones skills and knowledge to kill
• Need to leave operations to specialists
• Guard against 3W = Wine/Women/Wealth
• Never breach confidentiality

INFORMED CONSENT
• PATIENTS HAVE RIGHTS
• AT THE MOMENT THE PRACTICE IS THAT WE
GET BLANKET PERMISSION TO TREAT PATIENTS
• BUT THE STANDARD OF CARE IS TO OBTAIN
INFORMED CONSENT FOR EACH PROCEDURE

CLINICAL THINKING
• IS THE PROCESS THAT HAS BEEN DEVELOPED
BY THEMEDICAL PROFESSION OVER
THOUSANDS OF YEARS BY WHICH WE TRY TO
ANSWER THE QUESTION “WHAT IS WRONG
WITH THE PATIENT?”

STEPS IN CLINICAL THINKING
1. HISTORY TAKING – provides subjective data
2. PHYSICAL EXAMINATION – provides objective
data
3. INVESTIGATIONS – provide objective data
4. ASSESSMENT – tries to make sense of the
above data
5. PLAN AND TREATMENT

LEVELS OF DIAGNOSIS
1. HISTORY DIAGNOSIS
2. PHYSICAL EXAMINATION DIAGNOSIS
3. RADIOLOGICAL DIAGNOSIS
4. LABORATORY DIAGNOSIS
5. HISTOPATHOLOGICAL DIAGNOSIS
6. POST MORTEM DIAGNOSIS

LEVELS OF DIAGNOSIS
LEVEL
• HISTORY DIAGNOSIS
• EXAMINATION DIAGNOSIS
• RADIOLOGICAL DIAGNOSIST
• LABORATORY DIAGNOSIS
• HISTOPATHOLOGICAL DX
• POSTMORTEM DIAGNOSIS
EXAMPLE
• ANGINA PECTORIS
• INGUINAL HERNIA
• FRACTURE
• HYPERKALEMIA
• CANCER
• TB MENINGITIS

DEFINITION OF HISTORY TAKING
• IS THE PROCESS OF TALKING TO THE PATIENT,
CAREGIVER, OR PATIENT’S FAMILY OR FRIENDS

A PRE-REQUISITE FOR HISTORY TAKING IS
• DEVELOPMENT OF GOOD COMMUNICATION
SKILLS AND GOOD BEDSIDE MANNERS

IMPORTANT PRE-REQUISITE FOR GOOD
COMMUNICATION
• IS SHARED OR COMMON MEDIUM OF
COMMUNICATION:-
1. SAME SPOKEN LANGUAGE
2. SAME WRITTEN LANGUAGE
• IN A MULTI-LINGUAL SOCIETY LIKE OURS
• FIND A GOOD INTERPRETER
• EACH HOSPITAL SHOULD HAVE A LIST OF
INTERPRETERS WHO SHOULD BE PAID FOR
THEIR SERVICES.

WHAT IS THE MOST IMPORTANT PRE-
REQUISITE FOR RECEIVING INFORMATION ?
•IS TO LISTEN WELL

WHAT IS THE MOST IMPORTANT PRE-
REQUSITES FOR GIVING INFORMATION?
1.THINK WELL
2.SPEAK WELL
3.WRITE WELL

BEFORE TALKING TO THE PATIENT
1. DRESS WELL WITH CLEARLY DISPLACED I.D.
2. HAVE A PEN AND PAPER
3. INTRODUCE YOURSELF TO THE SISTER –IN-
CHARGE OF THE WARD
4. HAVING BEEN CLEARED BY THE OWNERS OF
THE PATIENTS
5. REVIEW THE PATIENT’S HOSPITAL RECORDS

LIKE A GOOD TV PRESENTER OR
INTERVIEWER
• PREPARE THE QUESTIONS
YOU ARE GOING TO ASK

KEY TOPICS OR AREAS COVERED IN HISTORY
TAKING
• SOURCE:-
1. PATIENT
2. FAMILY MEMBER
3. CAREGIVER
4. EMERGENCY PERSONNEL – POLICE, TAXI DRIVER, FIREFIGHTER
• GET THE PHONE NUMBER OF YOUR SOURCE
• THIS WILL ALLOW YOU TO GET ADDITIONAL
INFORMATION TO QUESTIONS THAT MAY ARISE
AFTER YOUR SOURCE HAS LEFT THE HOSPITAL

HISTORY TAKING IS NOT A ONE TIME
ACTIVITY
• FOR INSTANCE YOUR FINDINGS ON PHYSICAL
EXAMINATION MAY PROVOKE FURTHER
QUESTIONING. E.G. SURGICAL SCAR
• FOR INSTANCE THE BLOOD TEST MAY REVEAL
THAT A FEMALE PATIENT IS ANAEMIC? THIS
MAY PROVOKE QUESTIONS ON HOW
MENSTRUAL PERIODS.

KEY AREAS OF HISTORY TAKING INCLUDE:-
1. PERSONAL DETAILS OF THE PATIENT
2. PRESENTING COMPLAINT[S]
3. DEVELOPMENT OF SYMPTOMS
4. REVIEW OF SYSTEMS [Beginning with the
system[s] affected by the presenting
complaints]
5. PAST MEDICAL HISTORY AND
HOSPITALIZATIONS

KEY POINTS OF HISTORY TAKING CONTINUED
6. PAST SURGICAL HISTORY, ACCIDENTS AND
INJURIES
7. TETANUS IMMUNIZATION
8. FAMILY HISTORY OF ILLNESS:-
 Nuclear family – spouse – significant other – children –
dependants
 Extended family – parents – brothers – sisters – uncles
– aunties – cousins
 DM, TB, MI, ASTHMA, ALLERGIES, CANCER, ANAEMIA,
MENTAL ILLNESS

8. ALLERGIES TO FOODS AND MEDICATIONS –
the nature or severity of allergic reaction is
important.
9. MEDICATIONS AND OVER THE COUNTER
DRUGS
10.ALCOHOL, DRUGS
11.TOBACCO [MARIJUANA]
12.EDUCATION AND OCCUPATION[S]

13.IMPORTANT LIFE EVENTS – births – deaths –
illnesses – marriages – divorces – separations
– job losses
14.SCREENING TESTS – HIV – pap smear –
mammography – colonoscopy – breast self
examination – prostate specific antigen
15.RELIGIOUS BELIEFS – relevant to health,
illness, and treatment

16.IMMUNIZATIONS
17.HOBBIES
18.TRAVEL
19.DIET
20.PLEASE EDIT YOUR HISTORY!

HISTORY DIAGNOSIS
ARE YOU ABLE TO REACH
A HISTORY DIAGNOSIS
AFTER TAKING A
COMPLETE HISTORY?

SEVEN IMPORTANT ATTRIBUTES OR
FEATURES OF A SYMPTOM
• LOCATION - RADIATION
• QUALITY
• QUANTITY
• TIMING
• SETTING
• AGGREVATING/ALLEVIATING FACTORS
• ASSOCIATED MANIFESTATIONS

AIDS TO HISTORY TAKING
GREET THE PATIENT BY NAME AND
PROPER TITLE
• INTRODUCE YOURSELF:-
1. Describe your relationship
with pt’s doctors
2. State your mission
3. Ask for permission to
proceed
POSSIBLE OPENING LINES
• I am a medical student, my name
is Boniface Kawimbe, I work with
your doctor Prof. Bowa
• I would like to ask you some
questions about your health and
examine you. Do I have your
permission. Is this a good time?
Would you like me to come back
later? Since this will take some
time would you like to use the
bath room before we start?

HISTORY TAKING
PATIENT
DETAILS
POSIBLE OPENING LINES
• tell me about yourself?
• what are all your names?
• what is your cellphone number?
• Names of spouse or significant other
and their phone numbers?
• When do you celebrate your birthday?
• How old are you?
• Names of your children and their sexes
and ages?
• Where did you go to school?
• What was your first job when you
finished school?

HISTORY TAKING
[listen and encourage the patient to talk]
PRESENTING
COMPLAINT[S]
• What brings you to
the hospital?
• Tell me about your
health?
• Of all your many
complaints which
one is bothering you
the most?

HISTORY TAKING
DEVELOPMENT OF SYMPTOMS
DEVELOPMENT
OF SYMPTOMS
• When were you
last well?
• What went
wrong first?
• What happened
next?

REVIEW OF SYSTEMS
Begin with general symptoms
NON-SPECIFIC
SYMPTOMS
• Body weight – loss or gain
• Fever which is abnormal
elevation in body
temperature. [rigors, chills,
night sweats
• Fatigue is a sense of
weariness or loss of energy
• Weakness is loss of muscle
power

HISTORY TAKING
SKIN
SKIN
• Have you noticed
any changes in your
skin?...Your hair? Or
Nails? Any
rashes?....Any
sores?....Any lumps
or itching?

HISTORY TAKING
HEADACHES?
• Other causes of
headache include:-
• Ears [otitis]
• Sinuses [sinusitis]
• Eyes [refractory
errors]
• Teeth [dental
abscess]
• Where is the
discomfort?
• Bilateral or one sided?
• Steady or recurrent?
• New or chronic?
• Timing?
• Any associated nausea
or vomiting?

HISTORY TAKING
EYES
EYES
• How is your vision?
• Do you have trouble
with close work
[hyperopia] far
sightedness or
• Presbyopia trouble
with near sightedness.
• Do you wear glasses.

HISTORY TAKING
EARS
EARS
• How is your hearing?
• Have you ever had trouble with
your ears?
• One side or both?
• Sudden or gradual onset?
• Any discharge from the ears?
• Any pain?
• TINNITUS is perceived sound
without external stimulus.
• VERTIGO is false perception that
patient or environment is rotating
or spinning.

HISTORY TAKING
SENSE 0F SMELL
NOSE
• RHINORRHOEA – watery
nasal discharge.
• STUFFINESS is a sense of
nasal obstruction.
• Itching?
• Sneezing?
• Watery eyes?
• EPISTAXIS – bleeding from
the nose?

HISTORY TAKING
MOUTH
MOUTH
• BLEEDING
GUMS
• SORE TONGUE
• ALTERED TASTE
OF FOOD

HISTORY TAKING
VOICE CHANGES
THROAT
• Sorethroat?
• HOARSENESS is altered quality
of the voice and may be
described as husky, rough or
harsh.
• Have you noticed any swollen
glands or lumps in your neck?
• GOITRE is an enlarged thyroid
gland.
• Pain?
• Stiffness of the neck?

HISTORY TAKING
BREAST LUMPS
BREASTS
• Have you ever examined
your own breasts?
• How often?
• Pain or discomfort?
• Lumps?
• DISCHARGE from the
nipple:-
• On squeezing
• Spontaneously

HISTORY TAKING
CHEST PAIN
CHEST
POSSIBSLE OPENING LINES
• Do you have pain or unpleasant felling in
your chest?
• Chest pain may originate from:-
• Myocardium = ANGINA PECTORIS,
MYOCARDIAL INFARCTION
• Oarta = DISECTING AORTIC ANEURYSM
• Trachea/bronchi = TRACHEOBRONCHITIS
• Parietal pleura = PLEURISY, PERICARDITIS
• Oesophagus = GASTROESOPHAGEAL
REFLUX DISEASE
• Chest wall = COSTOCHONDRITIS, HERPES
ZOSTER

HISTORY TAKING
CHEST SYMPTOMS
CHEST
• PALPITATIONS = are unpleasant
awareness of ones heartbeat, racing,
skipping, fluttering, pounding or stopping.
• DYSPNOEA = non painful but
uncomfortable awareness of breathing
that is inappropriate to the circumstances.
• Are you short of breath? [SOB]
• Are you having difficulties in breathing?
• ORTHOPNOEA = is dyspnoea that occurs
when the patient lies down and improves
upon sitting up. Number of pillows that
the patient sleeps on is an indication of
the severity of orthopnoea.

HISTORY TAKING
CHEST SYMPTOMS
CHEST
• PAROXYMAL NOCTURNAL
DYSPNOEA=shortly after going to bed
pt suddenly becomes dyspnoeic and
sits up or stands or goes to the
window for fresh air.
• WHEEZING = musical respiratory
sounds
• OEDEMA = accumulation of excessive
fluid.
• Are the feet swelling?
• Are the rings tight?
• Are the shoes tight?
• Puffy eyelids?

HISTORY TAKING
CHEST SYMPTOMS
CHEST
• [phlegm]
• HAEMOPTYSIS = coughing
up or spitting up blood
[blood streaked or frank
blood]

HISTORY TAKING
GASTROINTESTINAL TRACT
• APPETITE
• ANOREXIA
• NAUSEA
• VOMITING
• HAEMATEMESIS
• How is your appetite?
• =loss of appetite must be
differentiated from food
intolerance due to
anticipated discomfort
• =feeling sick to ones stomach
• =forceful expulsion of gastric
contents
• =vomiting blood

HISTORY TAKING
• REGURGITATION
• DYSPHAGIA
• =raising of oesophageal or
gastric contents in the absence
of nausea or retching.
• =difficult in swallowing, sense
of food or drink sticking,
“wont go down”.
• Dysphagia for solids suggests
mechanical obstruction
• Dysphagia for both solids and
liquids suggests muscle
disorder

HISTORY TAKING
• ODYNOPHAGIA
• HEARTBURN[INDIGESTION]
• EXCESSIVE GAS
• FLATUS
• =Sharp burning pain on swallowing
suggests inflammation.
• While squeezing or cramping pain
on swallowing suggests muscle
origin
• =burning or warm sensation
radiating form the epigastrium to
the neck.
• May manifest itself as frequent
belching, abdominal bloating or
distension.
• =passage of gas per rectum

HISTORY TAKING
TYPES OF
ABDOMINAL PAIN
• VISCERAL PAIN – is usually
midline in location and
when severe is associated
with pallor, nausea,
vomiting, restlessness and
sweating.
• PARIETAL PAIN – is more
severe than visceral pain.

HISTORY TAKING
• BOWEL MOVEMENTS
• INCONTINENCE
• REFERED PAIN pancreas and
duodenum refer their pain to
the back
• How often do you move your
bowels?
• Has there been a change in
pattern?
• Do you any difficulties when
you move your bowels?
• = INVOLUNTARY LOSS OF
STOOL

HISTORY TAKING
• CONSTIPATION
• OBSTIPATION
• DIARRHOEA
• TENESMUS
• =reduced frequency from normal
pattern.
• Hard?
• Painful stool?
• Straining hard?
• Sense of incomplete evacuation?
• =absence of both stool and gas.
• =increased frequency of usually
liquid stool. Nocturnal diarrhea
suggest an organic cause.
• =intense urge to defeacate but with
little or no result.

HISTORY TAKING
• JAUNDICE [ICTERUS]
• = yellow discolouration of
the skin and eyes by
bilirubin.
• What is the colour of the
urine?
• What colour is the stool?
• Ask about pruritis/itching of
the skin?

HISTORY TAKING
URINARY SYSTEM
• KIDNEY PAIN
• URETERAL PAIN
• ACUTE BLADDER DISTENSION
while
• CHRONIC BLADDER DISTENSION
• DYSURIA
• Is visceral
• Is severe coliky pain this
was formerly known as
RENAL COLIKY PAIN.
• Is agonizingly painful.
• Relatively painless
• =pain on urination

HISTORY TAKING
URINARY TRACT
• INCONTINENCE
• STRESS INCONTINENCE
• HAEMATURIA
• ASK ELDERLY MEN
• =involuntary loss of urine.
• Do you ever leak urine?
• =involuntary loss of urine as a result of
sudden coughing, sneezing or laughing.
• =passing blood in the
urine[microscopic/macroscopic]
• Do you have trouble getting your stream
started?
• Do you stand closer to the toilet than
before?
• Do you have to strain in order to void?
• Do you hesitate or stop in the middle of
voiding?
• Do you dribble after you are through?

HISTORY TAKING
FEMALE GENITAL SYSTEM
• MENARCHE
•
•
• =age at which menstrual periods
began
• Last menstrual period [LMP]?
• How often?[24 to 32 days]
• How regular/irregular?
• How long do they last?[3-7 days]
• How heavy are they?
• How many pads or tampons do you
use per day?
• Do you bleed between period?
• Or after intercourse or after
douching?

HISTORY TAKING
• DYSMENORRHOEA
• AMENORRHOEA
•
•
• OLIGOMENORRHOEA
•
• POLYMENORRHOEA
• MENORRHOEA
• =painful periods
• = absence of period. It is
primary if the patient has never
had periods and it is secondary
if patient has had periods
before.
• abnormally reduced frequency
of periods
• =abnormally frequent periods
• =refers to increased duration
and amount of menstrual flow

HISTORY TAKING
• SEX
• Are you sexually active?
• Do you have more than one
partner?
• Do you have sex with men or
women or both?
• Are you satisfied sexually?
• Ask about anal or oral sex?
• Is your partner sexually satisfied?
• How often do you have sex?
• Are you interested in getting
pregnant?
• Are you using any contraceptive?

HISTORY TAKING
• METRORRHOEA
•
• POSTCOITAL BLEEDING
• DYSPARUNIA
• = occurs in between periods
and refers to intermenstrual
bleeding
• =is bleeding that occurs
after sexual intercourse
• =is painful sexual
intercourse

HISTORY TAKING
• SEX
• DO NOT FORGET TO ASK
ABOUT VAGINAL
DISCHARGE!!
• Are you worried about the
AIDS virus or other sexually
transmitted diseases?
• What precautions do you
take?
• Do you have any concerns
about your sexual function?

HISTORY TAKING
MALE GENITAL SYSTEM
• DISCHARGE FROM THE
PENIS
• SCROTUM
• Do you have any discharge
from the penis?
– Amount
– Colour
– consistence
• Any staining of the
underwear?
• Any sores or growths on the
penis?
• Any swelling or pain in the
scrotum?

HISTORY TAKING
MALE GENITAL SYSTEM
• SEX
• ORAL/ANAL SEX
• Are you sexually active?
• Do you have more than one
partner?
• Do you have sex with men,
women or both?
• Sexually transmitted diseases
can involve any body
opening where you have sex.
It is important that you tell
me which openings you use?

HISTORY TAKING
MALE GENITAL SYSTEM
• ERECTILE DYSFUNCTION
• How are your erections?
• With your spouse or regular
partner?
• With other partners?
• Do you experience early morning
erections?
• Are your ejaculations premature or
out of control?
• Are you satisfied sexually?
• Is your partner sexually satisfied?
• How often do you have sex?
•

HISTORY TAKING
PERIPHERAL VASCULAR
SYSTEM
• PAIN in the arm and legs
may be due to:-
• INTERMITTENT
CLAUDICATION
1. Venous insufficiency is associated with swelling
of the feet and legs
2. =arterial insufficiency is associated with
coldness and numbness
3. Infection [redness, swelling, warmth & pain]
4. Nervous causes
5. Skin conditions
6. Referred pain from the myocardium
•
•
•
•
• =is leg pain that comes on after walking a
distance and goes away on resting.
• How far can you walk without stopping to rest?

HISTORY TAKING
MUSCULOSKELETAL SYSTEM
• PAIN
• Any pain in your joints?
• Any stiffness in your joints?
• How long do your legs take
to loosen up after your
wake up in the morning?
• Ask about backache and
neckache

HISTORY TAKING
• [TENDERNESS
• WARMTH
• REDNESS]
• ATHRALGIA
• MYALGIA
• Signs of inflammation
•
•
• =painful joints without
objective evidence of
swelling, tenderness or
warmth.
• =pain in the muscles

HISTORY TAKING
• LOOK OUT FOR SYSTEMIC
SYMPTOMS
•
• Weakness
• Fever
• Chills
• Fatigue
• Anorexia
• Weight loss

HISTORY TAKING
• LOOKOUT FOR THE
FOLLOWING CONDITIONS
• Butterfly rash on the cheeks
indicative of systemic lupus
erythromatosis
• Scaly rash and pitted nails
indicative of psoriasis
• Clubbing of the fingers
indicative of hypertrophic
osteoarthropathy
• Preceeding sorethroat indicative
of acute rheumatic fever or
• Gonocccal arthritis

HISTORY TAKING
CENTRAL NERVOUS SYSTEM
• SYNCOPE
• NEAR SYNCOPE
• =temporary loss of
consciousness that occurs
when blood flow to the
brain becomes insufficient.
This may occur +/- clonic
movements and or +/-
urinary incontinence.
• =weakness, lightheadness
without actual loss of
consciousness.

HISTORY TAKING
• SEIZURE
• = is a paroxysmal disorder
that may or may not involve
loss of consciousness and
may involve abnormal
sensation, movements,
feelings or thought processes.
It is caused by a sudden,
excessive electrical discharge
in the cerebral cortex or
underlying structures.

HISTORY TAKING
• GRAND MAL SEIZURE
•
• PARALYSIS
• PARASTHESIA
• DYSESTHESIA
• =fully developed tonic-clonic
seizures with faecal incontinence .
• =inability to move a part in
absence of pain, tenderness or
tendon injury.
• =are peculiar sensations of various
kinds that have no obvious
stimulus. Like when the leg goes
to sleep after nerve compression.
• =distorted sensation in response
to a stimulus and may last longer
than the stimulus

HISTORY TAKING
• DO NOT FORGET TO ASK
THE WITNESSES TO A
SEIZURE
• ALSO ASK ABOUT
• What did the patient look
like before, during and after
the seizure.
• Tremors
• Involuntary movements
• Headache
• Numbness
• Pins and needles
• Tingling

HAEMATOLOGICAL SYSTEM
• BLEEDING TENDENCY
•
•
•
•
•
•
•
•
• MEDICATIONS
• Do you bleed or bruise easily?
• Did you bleed a lot after a tooth
was pulled?
• An operation?
• Or injury?
• Was bleeding localized or
generalized?
• DO YOU HAVE A FAMILY HISTORY
BLEEDING?
• Are you on blood thinners?
• Or NSAIA

HISTORY TAKING
ENDOCRINE SYSTEM
• CUSHINGS SYNDROME
• =adrenocortical
hyperfunction characterized
by:-
• Obesity
• Fatigue
• Easy bruisability
• Ankle oedema
• Oligomerrhoea or
amenorrhoea

HISTORY TAKING
ENDOCRINE SYSTEM
• ADDISON’S DISEASE
• =adrenocortical
hypofunction characterized
by:-
• Weakness
• Weight loss
• Nausea
• Vomiting
• Darkened skin
• Postural hypotension

HISTORY TAKING
ENDOCRINE SYSTEM
• DIABETES MELLITUS
• =insulin deficiency characterized
by:-
• POLYURIA =passing large amounts
of urine frequently
• POLYDYSIA = increased fluid intake
• THIRST
• POLYPHAGIA = eating a lot
• Weakness
• Fatigue
• Weight loss
• Blurred vision

HISTORY TAKING
ENDOCRINE SYSTEM
• THYROID GLAND
• Do you prefer cold or hot
weather?
• Do you dress more warmly
or less warmly than other
people?
• Do you use more blankets
or less than other people?
• Do you sweat more or less
than other people?

HISTORY TAKING
MENTAL STATUS
• HAS ITS OWN CHAPTER
AND BRANCH OF MEDICINE
CALLED PSYCHIATRY
MENTAL ILLNESSES
• AFFECT OUR EMOTIONS,
THINKING OR BEHAVIOUR
OR A COMBINATION OF
THESE + SUBSTANCE ABUSE
• 50% BEGIN BY AGE 14 YRS
• 75% BY THE AGE OF 24 YRS
• TREATABLE
• LOOK OUT FOR EARLY SIGNS

WARNING SIGNS OF MENTAL ILLNESSES
SIGN - SYMPTOMS
• PERSONAL CARE
• SLEEP
• APPETITE
• MOOD
DEFINITION
• LOOK OUT FOR DECLINE IN
PERSONAL CARE
• DRAMATIC DECLINE
[INSOMIA] OR INCREASE
• DRAMATIC DECLINE OR
INCREASE
• DRAMATIC SHIFTS IN
EMOTIONS OR DEPRESSED

WARNING SIGNS OF MENTAL ILLESSES
SIGN / SYMPTOM
• WITHDRAWAL
• DROP IN FUNCTION
• PROBLEMS THINKING
WHAT TO LOOK OUT FOR
• FROM FAVOURITE
ACTIVITIES
• SOCIAL WITHDRAWAL
• AT SCHOOL, WORK OR
HOME
• CONCENTRATION,
MEMORY, LOGICAL
THINKING AND SPEECH

SIGN / SYMPTOM
• INCREASED SENSITIVITY
• APATHY
• FEELING DISCONNECTED
WHAT TO LOOK OUT FOR
• TO SOUNDS, SIGHTS,
SMELL, TOUCH, AVOIDANCE
OF OVERSTIMULATING
SITUATIONS
• LOSS OF INIATIVE OR DESIRE
TO PARTICIPATE IN ANY
ACTIVITY
• FROM ONESELF AND ONES
SURROUNDINGS

SIGN / SYMPTOMS
• ILLOGICAL THINKING
• NERVOUSNESS
• UNSUAL BEHAVIOUR
• SUICIDAL THOUGHTS OR
INTENT
WHAT TO LOOK FOR
• EXAGGERATED BELIEFS
ABOUT PERSONAL POWERS
OR “MAGICAL” THINKING
TYPICAL OF A CHILD IN AN
ADULT
• FEAR OR SUSPICIOUS OF
OTHERS
• ODD, UNCHARACTERISTIC,
PERCULIAR BEHAVIOUR

LEVEL OF DIAGNOSIS
• HISTORY DIAGNOSIS
• EXAMPLES:-
1. MYOCARDIAL ISCHAEMIA – ANGINA
PECTORIS – DUE TO ATHEROSCLEROTIC
CORONARY HEART DISEASE
2. INTERMITTENT CLAUDICATION – LOWER
LIMB ISCHAEMIA DUE TO ATHEROSCLEROTIC
PERIPHERAL VASCULAR DISEASE

CONFIRMING A HISTORY DIAGNOSIS
• CONFIRMING A HISTORY DIAGNOSIS OF
ANGINA PECTORIS
1. STRESS/TRADEMILL ECG
2. CORONARY ANGIOGRAPHY

GENERAL SURGERY BLOCK LECTURES for proper histroy taking

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