History Taking list (in English)
***1. General complaints ******************************
8. Are you feeling ill?
10. Restlees? Irritable?
11. What part of the day?
12. Are you feeling tired?
13. What part of the day?
14. Do you have fever?
16. What temperature
18. During what time?
19. Did the temperature change?
15. Is it attended by chills?
17. How often do you have chills?
20. How long ago did you have them?
21. How long did it last this time?
22. Have you been having fever before?
23. Did you have any change in appetite?
24. Excessively thirsty?
25. Attended with usual, smaller or larger quantity of urine?
26. Was there any change in your weight?
27. How many kilos?
28. Excessive perspiration?
29. Itching?
30. Are you more susceptible to infections?
***2. Circulatory Tract ******************************
32. Shortness of breath?
33. While at rest?
34. While excercising? To what extent?
35. At a certain time of the day?
36. While lying down?
38. On how many pillows do you sleep?
39. Do you have swollen ankles?
40. When?
41. Do you urinate during the night?
42. How often?
43. Pain at the chest?
44. How often?
46. Localization?
47. Pain of what kind?
48. Radiation to other parts?
49. How long does the pain last?
50. While excercising?
51. Gone when at rest?
52. Gone after taking nitroglycerine?
53. How long after taking the nitro?
54. Is it connected with coughinh? breathing? swallowing? stooping?
cold? lying down? emotions?
55. Connected with breathing?
56. Connected with coughing?
57. Did you have pain on the chest in the past?
58. Palpitations?
59. How often?
60. Regular or irregular heartbat?
61. How many beats per minute?
62. Do they start and stop suddenly?
63. When do they occur?
64. Attended with increased or diminished urine production?
65. A slow heartbeat?
66. A skipped beat?
67. Have you ever fainted (black-out)?
68. How long does this last? How often? How long ago? Evoked by what?
69. Do you have pain in the calfs while walking?
70. After what distance?
71. Does it pass over when you stop?
72. Cold hands or feet?
73. Attended with a change of colour?
74. Attended with pain?
75. Swollen and painful legs?
76. Pain at this moment?
77. How long ago?
78. Swollen painful legs before?
79. Sore legs at this time or in the past?
80. High blood pressure?
81. How long ago was it noticed?
31. Having a diet during pregnancies?
***3. Respiratory tract ******************************
82. Cough? Dry or productive?
83. What part of the day? What is it provoked by?
84. Attended by wheezing and humming on at the chest?
85. Influence of season?
86. Spit mucus?
87. How much?
88. What does it look like?
89. Does the sputum change in any way?
90. Does the sputum smell?
91. Do you cough up blood?
92. How long ago?
93. How much?
94. Wheezing?
95. During inspiration or expiration?
96. Shortness of breath?
99. Shortness of breath in attacks?
100. What is the attack evoked by?
102. How long ago?
103. Shortness of breath in earlier days?
104. Often a severe cold?
105. Hay-fever?
106. Severe angina in the past?
107. Hoarseness? Pain on the chest? How long ago? Where is it localised? Attended with breathing? Attended with coughing? Pain on the chest in the past?
***4. Digestive tract ******************************
108. Smelling breath?
109. Painful corners of the mouth?
110. Inflammation of teeth or roots of the teeth?
111. Quickly bleeding gums?
112. Swellings in the mouth?
113. Wounds in the mouth?
114. Painfull tongue?
115. Thickenings in the tongue?
116. Dry mouth?
117. Sore throat?
118. Difficulties with opening your mouth?
119. Complaints with swallowing?
120. Lumps in the throat?
121. Doyou often choke?
122. Impaired passage of food?
123. Where does it get stuked?
124. With solid or liquid food?
125. What is it decreased by?
126. Pain while swallowing?
127. Where localised?
128. Hiccups?
129. Pain in the belly?
131. During what period?
132. What part of the belly?
133. Does it radiate?
134. Where does it radiate to?
135. How could you describe the pain (character of the pain)?
136. What part of the day?
137. What makes it worse?
138. What relieves it?
130. How long ago?
139. Did you have pain in the belly in the past?
140. Do you suffer from heartburn?
141. What part of the day?
142. What is it evoked by?
143. What is it relieved by?
144. Excessive salivation?
145. Burping? * Decreased appetite? * Change of weight?
146. Food-intolerance?
147. Nausea?
148. Vomiting?
149. How often?
150. What part of the day?
151. What is it evoked by?
152. Forceful vomiting?
153. In what quantity?
154. What does it look like?
155. How long after the meal?
156. Constipation?
157. Diarrhoea?
158. Defecation?
159. With what frequences?
160. Attended with gripes?
161. Is the defecation painful?
162. How is the consistency?
163. What quantity of faeces at a time?
164. Of what colour?
165. Is it mixed with blood or mucus?
166. Does the defecation smell unpleasant?
167. Hemorrhoids?
168. Yellowish skin and sclera? Itching?
***5. Urogenital tract ******************************
169. Urinating.....
170. How many times a day do you urinare?
171. How long ago for the last time?
172. Pain while urinating?
173. Changes in the pattern - urinating at night?
174. Are you able to hold your urine?
175. Difficult micturtion?
176. Forcefull urination?
177. Weak flow of urine?
178. Dripping after words?
179. Sudden cease of micturation; interrupted flow of urine?
180. Lost precognition of micturation?
181. Strange colour of the urine?
182. Unpleasant smelling of the urine?
183. Blood in the urine?
184. How long ago?
185. Had it how many times? -Pain in the belly?
186. Pain in the side?
187. How long ago?
188. Does or did it radiate?
189. Where does it radiate to?
190. Character of the pain? -What kind of pain?
191. Attended with urinating?
192. How many times/how often?
193. Have you had pain in the side in the past?
189. Where does it radiate to?
190. Character of the pain? -What kind of pain?
191. Attended with urinating?
192. How many times/how often?
193. Have you had pain in the side in the past?
194.
195. At what age first menstruation?
196. At what age did the menstruation finally stop?
197. Did occasional loss of blood occur after wards?
198. Within how many days did the menses occur/how frequent?
199. Extent of blood loss from vagina at a time?
200. Vaginal discharge?
201. What does it look like?
202.
203. How many children do you have?
204. How many were born alive?
205. How many died within one month?
206. Miscarriages?
207. Did you give birth to any heavy children?
208. Impotent?
***6. Locomotory tract ******************************
209. Pain in the joints?
211. Where is it localised?
212. Are the joints concerned red?
213. Are the joints concerned swollen?
214. Are the joints concerned warm?
215. Is there impaired movement in the joints concerned?
216. Do the complaints migrate to other joints?
217,
218,
219. Stiffness.....
217. Are the joints stiff?
218. Does the pain disappear when the joints are used?
219. How long does it take before it disappears while using the joints?
210. How long ago did you have pain?
220. Have you been having pain in the past?
221. Pain in the neck?
222. Pain in the back?
223. Where is it localised?
224. Does it radiate?
225. Where does it radiate to?
226. By what is it worsened?
227. Impairment of movement of the back?
228. Crooked back?
229. Pain in arms?
230. Pain in legs?
231. Loss of power in arms or legs?
232. Where is it localised?
233. Pain in the bones?
234. Where is it localised?
***7. Hemopoetic tract ******************************
235. Pale skin colour?
236. Red skin colour?
237. Bruises, hemorrhages bleedings of skin or mucus membrane?
238. Develop spontaneously?
239. On what spots?
240. Small wounds keep bleeding?
241. Wounds keep bleeding after teethextraction or confinement?
242. Swelling of glands?
244. On what spot?
243. How long ago?
245. What is this pain evoked by?
246. Painfull glands?
247. Swellings on the glands in the past?
* Excessive sweating (tract 1)
* Itching (tract1)
* See tract 1-30
More susceptible to infectious?
***8. Endocrine tract ******************************
23. (tract 1)
24. (tract 1)
26. (tract 1)
28. (tract 1)
29. (tract 1)
30. (tract 2)
31. (tract 5)
207.
249. Swelling in frontpart of the neck?
250. Chillness?
251. Intolerance of warmth?
252. Nervousness?
253. Cryingspells? * Palpitations?
254. Trembling hands?
255. Excessive loss of hair?
256. On special spots?
257.Excessive hairgrowth?
258. On special spots?
259. Changed pitch of voice?
260. Changed size of gloves, shoes? Menstruation?
See also tract 5.
***9. Nervous tract ******************************
261. Deminishing eyesight?
262. How is the right eye?
263. How is the left eye?
264. Difficulties with the sight far away or nearby?
265. Do you see black spots?
266. Double sight (diplopia)?
267. Whilst looking in a certain direction?
268. Pain in both eyes?
270. Deminishing hearing?
271. At which ear?
272. Pain in the ear?
273. Is it attended with discharge in the ear?
274. Do you have ringing in your ear?
275. Diminished sense of taste?
276. Dizziness?
277. Of what kind?
278. Especially when rising from a lying down or seating position?
279. Headache?
280. Where is it localized?
281. During which part of the day? * Less of consciousness (tract 2)?
282. Somnolence?
283. Paralysis?
285.Where is it localized?
284. How long ago?
286. Have you been having paralysis in the past?
287. Disturbances in the sense of touch (tactile sense)?
288. How long ago?
289. Where is it localized?
290. Have you had disturbances in the past?
291. Numbness in hands or feet?
292. Where is it localized?
293. Parasthesis in hands or feet (prickling feeling)?
294. Where is it localized?
295.Cramps in hands or feet?
296. Where is it localized?
297. Uncontrolled movements?
298. Where is it localized?
299. During which part of the day?
231. Loss of power in arms or feet (tract 6)?
300. Speech disturbances?
301. Of what kind?
119. (Tract 4)
229. (Tract 6)
302. Convulsions in the past?
303. How long ago?
304. How often have you been having them?
305. Disturbances of sleep?
306. Of what kind?
307. Dreaminess?
308. During what part of the day?
253. (Tract 8)
***10. Skin deformities ******************************
309. Skin deformities?
310. How long ago?
311. On which part of the body?
312. How does it look like?
313. How many are there/were there?
314. Which colour?
315. Changing form or colour?
316. What did the deformity look like at first?
317. Did this change simultaneously?
318. Was there moist discharge?
319. What did this moisture look like?
320. Was it attended by itching?
321. Were they painfull?
322. Did they develop after the use of mediction or contact with a specific substance?
323. Have you been having skin deformaties in the past?
***11. Supplementary information ******************************
324.
326. Nutrition habits? What do you eat during the day?
327. Do you smoke? Do you inhale?
328. Hove you been smoking in the past?
329. How long ago for the last time?
330. How much a day?
331. How much and what kind of alcoholics do you drink?
332. Do you use analgetics (c.q. aspirine)?
333. Are you being checked on your trombosis regularly?
334. Do you use the contraceptive pill?
1009. Do specific diseases occur in the family?
1006. What medication do you use?
1010. How do you respond to these?
1013. What are your hobbies?
1011. How is your family composed?
1012. How is your housing?
1007. What is your profession?
1008. What are your previous diseases?
1014. Allergies? Pets?
***End of history taking question list.
Basisreferenties o.a.
Min, F.B.M. en K.H. Ephraim
Computer assisted instruction voor het leren overzien van de anamnese. Proceedings Medisch Informatica congres '79 (red. J.L. Willems), Acco Leuven, Antwerpen 117-122 (1979)
Min, F.B.M.
Anamnese Training; een computersimulatieprogramma. Instituut voor Nucleaire Geneeskunde, Rijksuniversiteit Utrecht, interne uitgave (1978)
Formijne en Mandema
Anamnese en fysische diagnostiek. (19...)