Medical history taking

Some new work has been done here which shows the effects of solvents exposure. A new study illustrates a simple method of detoxification using heat chamber depuration (sauna), and raises awareness in the practice of medicine of the importance of taking an environmentally oriented historical approach. The connection between symptoms of chronic degenerative diseases and environmental and/or nutritional factors is missed in many cases due to lack of obtaining an environmentally oriented medical history. Taking such a history and dealing with the cause of illness using avoidance and/or appropriate therapy is preventive and cost-effective for both the patient and society (Krop, 1998). 

DW, a 78-year-old Caucasian man, presents to the emergency room with complaints of a headache persisting over the last 3 days. Repeated blood pressure measurements average 200/11 0 mm Hg. He reports no other symptoms and physical examination and laboratory tests are unremarkable as is his past medical history with the exception of hypertension diagnosed in his early 60s. DW reports that he is struggling on a fixed retirement income with no prescription coverage and takes "what I can afford." Blood pressure medications are carvedilol 25 mg twice daily, amlodipine 10 mg once daily, torsemide (Demadex )... 

Conduct a medication history (prescription, over-the-counter, and dietary supplements) to determine conditions or causes of hypertension. Does the patient take any medications, supplements, herbal products, or foods that may elevate SBP or DBP Does the patient have drug allergies ... 

Assuming KK continues to take the prescription and over-the-counter medications listed in her medication history obtained during her hospitalization, should any of these medications be discontinued or changed If changed, what alternative therapy would you recommend ... 

Interview the patient and/or caregivers to obtain a complete medical history, which should include family medical history, current and past prescription and nonprescription medications, and dietary intake. Determine whether the patient is taking medication/supplements that could interfere with the therapy. 

RC, a 22-year-old woman, presents to your clinic requesting information on contraception. You begin to take a history and determine that the patient is currently sexually active and is not using any method of birth control. Her past medical history is significant only for acne, and she takes no medications except occasional ibuprofen for menstrual cramps. On further questioning, you discover that she has a positive family history for hypertension and coronary artery disease. As you begin to discuss various contraceptive options with the patient, it is clear that she has a preference for an oral contraceptive agent. 

Formulate a drug therapy plan, taking into consideration the patient s medical history, concomitant medications, and previous use of medications. 

A 22-year-old female college student with no remarkable medical history notes shortness of breath when she takes her daily 5-mile run, which has worsened progressively over the past 3 weeks. On review of systems, it is discovered that she has experienced intermittent sensations of chest tightness over the past 2 months that she ascribed to pollen allergies, and 3 days prior to presentation she experienced an episode of hemoptysis. Her only medication is oral contraceptives, and she reports no known drug allergies. A chest x-ray is remarkable for a 10 x 12 cm mediastinal mass. 

Take a thorough medication history with particular attention to over-the-counter and herbal medications. 

Statistical data can provide general information about how common a condition is, how many people have the condition, or how likely it is that a person will develop the condition. Statistics are not personalized, however—they offer estimates based on groups of people. By taking into account a person s family history, medical history, and other factors, a genetics professional can help interpret what statistics mean for a particular patient. 

A genetic consultation provides information, offers support, and addresses a patient s specific questions and concerns. To help determine whether a condition has a genetic component, a genetics professional asks about a person s medical history and takes a detailed family history (a record of health information about a person s immediate and extended family). The genetics professional may also perform a physical examination and recommend appropriate tests. 

Physical examination and follow-up Take a complete medical history and physical examination prior to the implantation or re-implantation of levonorgestrel implants and at least annually during its use. Carefully monitor women with a strong family history of breast cancer or who have breast nodules. 

Seizures An increased incidence of seizures has been reported in patients with a history of epilepsy who received the related drug amantadine. In clinical trials, the occurrence of seizure-like activity was observed in a small number of patients with a history of seizures who were not receiving anticonvulsant medication while taking rimantadine. If seizures develop, discontinue the drug. 

A 47-year-old man is evaluated for a 12-hour history of nausea, vomiting and, more recent, difficulty breathing. His past medical history is unremarkable, and he takes no medications. However, he is a farmer who has had similar episodes in the past after working with agricultural chemicals in his fields. Just yesterday he reports applying diazinon, an organophosphate insecticide, to his sugar beet field. 

Acute pain is a warning signal and it is necessary to take a medical history and make the appropriate investigations to make a diagnosis and to give causal treatment. In pain of a more chronic nature an analysis of the origin of the pain and its character must be made in order to give the correct treatment (Table 1). 

A 55-year-old patient has been referred to you. She complains about a skin rash and a cough. In the course of history taking, she tells you that she takes high blood pressure medication but she doesn t remember the name. You suspect a drug toxicity. Which of the following antihypertensive agents is the patient most likely taking ... 

Next, the physician rules out medical causes for the depressive syndrome through further history taking, a physical examination, and laboratory tests. 

A physician reported that a 60-year-old male started sildenafil 50 mg while he was also taking 600 mg of St. John s wort daily for depression. When the patient increased the dose of St. John s wort to 1200 to 1800 mg daily for unknown reasons, the sildenafil was reported to be partially effective. Patient increased the dose of sildenafil to 100 mg but it was completely ineffective. The physician suspected that a drug interaction caused the adverse events. No other significant medical history was noted. 

A 59-year-old woman presents to an urgent care clinic with a 4-day history of frequent and painful urination. She has had fevers, chills, and flank pain for the last 2 days. Her physician advised her to immediately come to the clinic for evaluation. In the clinic she is febrile (38.5°C [101.3°F]) but otherwise stable and states she is not experiencing any nausea or vomiting. Her urine dipstick test is positive for leukocyte esterase. Urinalysis and urine culture are also ordered. Her past medical history is significant for three urinary tract infections in the past year. Each of these episodes was uncomplicated, treated with trimethoprim-sulfamethoxazole, and promptly resolved. She also has osteoporosis for which she takes a daily calcium supplement. The decision is made to treat her with oral antibiotics for a complicated urinary tract infection with close follow-up. Given her history what would be a reasonable empiric antibiotic choice Depending on the antibiotic choice are there potential drug interactions she should be counseled on ... 

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