Lesson 2.6: Medical History Add-Ons by System
Add these targeted questions on top of the standard history when the presenting complaint points to a specific system.
Cardiovascular
Always screen for cardiac risk factors: hypertension, diabetes, hypercholesterolaemia, smoking, family history of early heart disease (men under 55, women under 65).
- "How far can you walk on the flat before you have to stop?
- "Do you get breathless when you lie flat? How many pillows do you sleep with? Any ankle swelling?
- "Any palpitations — heart racing or beating irregularly? Have you ever fainted or felt like you were about to?"
Respiratory
For cough: duration (acute under 3 weeks, subacute 3–8 weeks, chronic over 8 weeks), productive or dry, sputum colour, any blood. Worse at night or morning?
- Occupation / environment: dust, asbestos, chemicals, grain, birds?
- Atopy: personal or family history of asthma, eczema, hay fever?
- TB contacts or travel to high-prevalence area?
- ACE inhibitor cough: taking ramipril or lisinopril? (causes dry cough in 10–15%)
Gastrointestinal
Abdominal pain: relationship to eating and bowel habit. In women of reproductive age: relationship to menstrual cycle.
- Bowel habit: usual frequency, any change, blood or mucus in stool, consistency.
- Dysphagia: solids only (mechanical) or liquids too (motility)? At throat or chest level?
- Nausea and vomiting: timing relative to meals, content (blood = haematemesis; coffee-ground = old blood).
- Jaundice: dark urine, pale stools, itch?
- Alcohol history essential in any GI presentation with risk factors.
Neurological
Headache: onset (thunderclap = subarachnoid until proved otherwise), nausea/vomiting/photophobia/neck stiffness, aura.
Limb symptoms: weakness (proximal vs. distal), sensory changes (distribution), coordination, balance.
- Speech: slurred (dysarthria) or wrong words (dysphasia)?
- Seizures: aura, loss of consciousness, tongue biting, incontinence, postictal confusion. Does the patient drive?
Musculoskeletal
- Which joints? Symmetrical or asymmetrical? Small (hands, feet) or large (knees, hips)?
- Morning stiffness: over 1 hour = inflammatory; under 30 minutes = osteoarthritis.
- Back pain cauda equina red flags: bladder/bowel dysfunction? Saddle anaesthesia? Leg weakness? → Same-day emergency MRI.
- Systemic features: rash, mouth ulcers, eye problems alongside joint symptoms?
Endocrine
Diabetes: polyuria, polydipsia, unexplained weight loss, recurrent infections, foot numbness.
Hyperthyroid: heat intolerance, weight loss, palpitations, tremor, diarrhoea, anxiety, eye changes.
Hypothyroid: cold intolerance, weight gain, constipation, fatigue, dry skin, hair thinning, low mood, heavy periods.
Renal and Urology
| Type | Symptoms | Common Causes |
|---|---|---|
| Voiding (outlet) | Hesitancy, poor stream, straining, incomplete emptying, terminal dribbling | BPH, urethral stricture |
| Storage | Frequency, urgency, urge incontinence, nocturia | Overactive bladder, UTI |
| Pain on urination | Dysuria | UTI, STI, urethritis |
Haematuria in any patient over 50: investigate for malignancy until proved otherwise.
Dermatology
- Where did the rash start? How has it spread? How has it changed?
- Itchy, painful, or blistering?
- Contact triggers: new soap, washing powder, perfume, jewellery, plants, new medications.
- Pigmented lesion — ABCDE: Asymmetry, Border irregularity, Colour variation, Diameter over 6mm, Evolution.