Exercises:

1. Study the case notes. Write the questions the doctor asked to obtain the numbered information. Look at Appendix IV to help you.

SURNAME Dates		FIRST NAMES Allison
ADDRESS Acredales, Bridgethorpe
D. O. B. 30/4/79	SEX f		MARITAL STATUS married
OCCUPATION bank clerk
Presenting complaint C/o severe, boring in nature, mainly in and around R eye. Can radiate to forehead. Comes on at time and can vary in duration 1-2 hts. No precipitating or relieving factors. Has noticed haloes around lights with some blurry vision in R eye.

2. Read the continuation of the case notes for the patient in C. Write the doctor's questions.

PMH similar headaches 10 yrs, coming every 3 mths. Aggravated by eating chocolate; relieved by lying in dark room. Can have visual aura, blurred vision, nausea.

Doctor: Can you tell me what the problem is?

Patient: I've got a terrible headache.

Doctor: (1) ………………………………………………………………………………?

Patient: Just here.

Doctor: (2) ……………………………………………………………………………... ?

Patient: Well, it's really bad. And it throbs.

Doctor: Have you had anything like this before?

Patient: Yes, about every three months. I've had them for the last ten years or so.

Doctor: (3) ………………………………………………………………………………?

Patient: Usually one or two days. This one started yesterday morning.

Doctor: (4) ………………………………………………………………………………?

Patient: They usually start just after I eat chocolate. I'm not sure.

Doctor: (5) …………………………………………………………………………… ...?

Patient: If I lie down in a dark room it helps. Light makes them worse.

Doctor: (6) ………………………………………………………………………………?

Patient: If I move my head, it gets more painful.

Doctor: Apart from the headache, (7) …………………………………………………...?

Patient: Yes, my eye feels strange. Sometimes I can't see clearly, things get blurred. I feel sick.

3. Complete the sentences. Look at Appendix to help you.

1. Gastric ulcers are associated with a ………,..……pain.

2. Patients with a peptic ulcer may say they have a ………….. pain.

3. Recurrent abdominal pain (RAP) may be described as ……………or ……………pain.

5. People with osteoarthritis often complain of a deep ……………centred in the joint.

6. Kidney stone pain is sudden, severe and …………..

7. Angina is usually described as a crushing or heavy or …………..pain.

Lesson 2

Drug history

Here is an extract from a medical textbook.

It is essential to obtain full details of all the drugs and medications taken by the patient. Not infrequently patients forget to mention, or forget the name of, drugs they take. Some may be over-the-counter remedies unknown to the general practitioner. The significance of others, such as herbal remedies may not be appreciated by the patient.

It is necessary to determine the precise identity of the drug, the dose used, the frequency of administration and the patient's compliance or lack of it.

It is important to ask about known drug allergies or suspected drug reactions and to record the information on the front of the notes to be obvious to any doctor seeing the patient. Failure to ask the question or to record the answer properly may be lethal.

To find out about drug history, doctors ask:

Details of drugs and medications

• Which tablet do you take?

• Are you taking any medication at the moment?

• Do you use any over-the-counter remedies or herbal or homeopathic medicines?

Frequency of administration Compliance

■ How many times a day? ■ Do you always remember to take it?

Side-effects and allergies

■ Do you get any side effects? ■ Do you know if you are allergic to any drug?

If the answer is Yes: What symptoms do you get after taking it?

Family history

Note the age, health or cause of death of parents, siblings (brothers and sisters), spouse (husband or wife), and children. To find out about family history, doctors ask:

Do you have any brothers and sisters? Do you have any children? Are all your close relatives alive? Are your parents alive and well? Is anyone taking regular medication?

How old was he when he died? Do you know the cause of death? / What did he die of? Does anyone in your family have a serious illness?

Social and personal history

Record the relevant information about occupation, housing and personal habits including recreation, physical exercise, alcohol and tobacco and, in the case of children, about school and family relationships. Typical questions in taking a social and personal history are:

What kind of house do you live in? Do you live alone? Who shares your home with you? How old are your children? Are any of them at nursery or school? What's your occupation? Do you have any problems at work? Do you have any hobbies or interests? What about exercise?

Do you smoke? How many a day? Have you tried giving up? What about alcohol? Can you give up alcohol when you want? How much do you drink in a week? Are you aware of any difference in your alcohol consumption over the past five years?