History of the present illness (Anamnesis morbi)
This section is dedicated to the chronology and dynamics of the development of the current pathology. Elucidating the Anamnesis morbi requires the physician to carefully study the following aspects:
- Onset and Course: Exact start time (from what moment the person considers themselves ill), initial symptoms, frequency and duration of relapses, and changes in symptomatology over time.
- Patient's Perspective: Potential causes of exacerbation (triggers), such as hypothermia, dietary indiscretions, infections, or sun exposure.
- Previous Interventions: Analysis of old medical records, examination results, as well as the efficacy and tolerability of previously prescribed medications.
- Social Factor: Presence of a disability status and the time elapsed since it was established.
Note: If the diagnosis remains unclear, one must return to this section to identify any missed details.
Personal history (Anamnesis vitae)
This section includes biographical data, socio-living status, education, and lifestyle. The main goal is to assess the background against which the disease developed. Previously suffered illnesses are of immense importance: it is essential not only to list them but also to understand the specifics of their course, as they may have a pathogenetic connection to the current illness (if an old pathology caused the current presentation, it is moved to the Anamnesis morbi).
The medical history must include facts regarding surgical interventions, stays in unusual climatic zones (risk of parasitic infestations), and answers to five strictly mandatory questions:
- Allergies (with an emphasis on medications).
- Tuberculosis (whether a diagnosis was ever established).
- Hepatitis (even if the patient denies hepatitis, one must ask about episodes of "jaundice" and rule out parenteral drug use).
- Blood Transfusions (hemotransfusions carry the risk of hepatitis B and C transmission).
- Sexually Transmitted Infections (this questioning requires special delicacy).
Family and occupational history
Heredity forms a predisposition to diseases, which is realized under the influence of external factors. When taking a family history, the health of relatives and the causes of their death are ascertained. A particularly alarming sign is the death of parents at a young age from cardiovascular catastrophes (CHD, stroke). The presence of diabetes mellitus, oncology, tuberculosis, depression, and sex-linked diseases (e.g., hemophilia) among relatives is also clarified.
The assessment of occupational history is based on three aspects:
- Epidemiological: whether colleagues have similar symptoms.
- Specific: contact with dust (asbestos, silicon dioxide), heavy metals, solvent vapors, vibration.
- Preventive: use of protective equipment and undergoing medical examinations.
Bad habits and alcohol screening
Data regarding psychoactive substances vary in reliability. Patients report smoking history quite accurately, downplay alcohol volumes, and completely conceal drug use (dissimulation).
To identify hidden alcohol dependence, alongside objective signs of target-organ damage, the CAGE questionnaire is used. It consists of four questions:
- C (Cut down): Have you ever felt you should cut down on your drinking?
- A (Annoyed): Have people annoyed you by criticizing your drinking?
- G (Guilty): Have you ever felt bad or guilty about your drinking?
- E (Eye-opener): Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover?
A positive response to 3 or 4 questions strongly confirms alcohol dependence.
Reproductive function and socio-living status
Interviewing women includes analyzing the menstrual cycle, obstetric history, and contraceptive methods (especially oral contraceptives, which carry vascular risks). The term "climacteric" is considered obsolete; instead, the concept of the perimenopausal period is used. Clarifying its symptoms helps differentiate climacteric cardialgia from true angina pectoris. In men, sexual dysfunctions that can cause severe stress are delicately inquired about.
Social and living history assesses:
- Living conditions: dampness and cold provoke pulmonary diseases (COPD, asthma).
- Diet: solitary elderly individuals often experience nutritional deficiencies due to financial constraints or frailty.
- Finances: determine compliance (adherence to treatment)—whether the patient will be able to consistently purchase prescribed medications.
- Physical activity: necessary for assessing exercise tolerance.
Briefly: answers to topical questions
How do main complaints differ from additional ones?
Main and additional complaints differ in their subjective significance for the patient and the method by which they are elicited.
| Criterion | Main complaints | Additional complaints |
|---|---|---|
| Subjective significance | Have the greatest subjective significance for the patient, causing the most distress. | These are symptoms that the patient might have forgotten or grown accustomed to. |
| Method of elicitation | Identified during the analysis of the patient's complaints as the most significant. | Elicited by the physician through active questioning. |
| Diagnostic value | In typical cases, detailed analysis of the main complaints is crucial for the diagnosis. | Active questioning helps identify additional symptoms, including general nonspecific manifestations: weakness, fever, chills, headaches, irritability, changes in appetite, thirst, and body weight. |
Logic of the CAGE questionnaire: C (Cut down) — desire to reduce the dose; A (Annoyed) — annoyance at criticism; G (Guilty) — feeling of guilt; E (Eye-opener) — desire to drink in the morning for recovery.
Class and exam questions
Why is it important to ask about jaundice if the patient already denies having hepatitis?
Patients often do not associate the medical term "hepatitis" with a childhood history of "Botkin's disease" or episodes of skin yellowing of a different etiology, so the question must be asked in easily understandable everyday language.
How does a patient's financial situation affect their treatment?
It directly determines compliance. The physician must take into account the cost of medications so that the patient can purchase them on an ongoing basis rather than taking them intermittently.
Why is it necessary to specify stays in other climatic zones in the geographical history?
This is necessary to assess epidemiological risks, primarily to rule out parasitic infestations after traveling to tropical regions.
What else to study on this topic
- Specifics of interviewing patients with hyper- and hyporeactions to illness
- Differential diagnosis of climacteric cardialgia and true angina pectoris
- Identification of physical signs (stigmata) of alcohol abuse
- Rules for documenting answers to mandatory screening infection questions
- Interview tactics when drug addiction concealment (dissimulation) is suspected
Master the entire topic in the "Propaedeutics" course
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Other topics in the section «Patient Examination Methods»
Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.