History of the presenting complaint

When did the problem start?

Where did it start?
Where is affected now?
How have things changed since?
Is it a continuous or intermittent problem?
Is it evolving (if so, how?) or stable?
Is there any discharge or bleeding?
Is there pain, itch, or altered sensation?
Is there dryness or itching?
Are there any obvious factors which trigger or exacerbate the problem?
Possibilities include: Sunlight Extremes of temperature (itching is often
worsened by heat) Contact with certain substances (e.g. latex, rubber, metals,
hair dye) Work (e.g. occupational allergy or wet work leading to irritant contact
dermatitis).
Does anything relieve the symptoms? e.g. sunlight, topical treatments,
systemic drugs.
What treatments have been tried? What was effective or ineffective?
Are there any systemic symptoms such as fever, malaise, joint pain, weight loss,
or sore throat?
Past medical history Previous skin problems? Ask also about diabetes,
connective tissue disease, inflammatory bowel disease, atopy (eczema, especially
as a baby, asthma, hayfever)?
Allergies Remember to ask about the nature of any allergic reaction claimed.
Drug history Which drugs is the patient taking and for how long? See Box 4..
If a drug reaction is possible, ask about recent courses of drugs not taken
regularly (e.g. antibiotics, over-the-counter analgesics).
Bear in mind that there may be a delay of a few days to months before a drug
eruption occurs Immunosuppression can increase the risk of skin cancer.

Family history
Ask especially about atopic diseases, psoriasis, skin cancer.
Social history
Occupation (consider wet work, sun exposure, exposure to chemicals or plants).
Hobbies.
Pets (including pets of close friends and relatives).
Living conditionshow many share the house/living space?
Recent travel? Were appropriate vaccinations taken before leaving?
Insect bites?
Risk factors for sexually transmitted diseases? Take a full sexual history if
relevant. 0 Be delicate.
Psychosocial impact
Ask about how the condition is affecting the patient.
Physical symptoms such as pain or worsening in sunlight might curtail usual
activities.
Self-consciousness and embarrassment in a physically asymptomatic condition
can still lead to enormous social handicap.

Respiratory system
1. Are you ever short of breath? Has this come on suddenly?Pulmonary embolism
2. Have you had any cough?
3. Is yourcough associated with shiversand shakes (rigors)and breathlessnessand
chest pain?Pneumonia
4. Do you cough up anything?
5. Have you coughed up blood?Bronchialcarcinoma
6. What type ofwork have you done?Occupationallung disease
7. Do you snoreloudly? Do you fallasleep easily during the day? When? Have you
fallen asleep while driving?(Sleep history)
8. Do you ever have wheezingwhen you areshort of breath?
9. Have you had fevers?
9. Have you had fevers?
10. Do you have nightsweats?
11. Have you ever had pneumonia or tuberculosis?
12. Have you had arecentchest X-ray?
13. Have you had any bleeding or dischargefromyour breasts or feltany lumps
there? Carcinoma ofthe breast

Gastrointestinal system
1. Are you troubled by indigestion?
2. Do you have heartburn?
3. Have you had any difficulty swallowing?Oesophagealcancer
4. Have you had nausea or vomiting, or vomited blood?Gastrointestinal bleeding
5. Have you had pain or discomfort in yourabdomen?
6. Have you had any abdominal bloating or distension?
7. Has your bowel habitchanged recently?Carcinoma ofthecolon
8. Howmany bowelmotionsa week do you usually pass?
9. Have you lostcontrol of your bowels or had accidents (faecalincontinence)?
10. Have you seen blood in your motions or vomited blood?Gastrointestinal
bleeding
11. Have your bowelmotions been black?Gastrointestinal bleeding
12. Have you lost weight recentlywithout dieting?Carcinoma ofthecolon
13. Have youreyes or skin ever been yellow?
14. Have you ever had hepatitis, peptic ulceration,colitis, or bowelcancer?
15. Tellmeabout your diet recently.