Significance of Past History in

Case Taking

Prepared By: Vivek Jariwala

Guided By: Dr. Mukesh
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Past medical history may be relevant to the presenting
symptoms: for example, previous migraine in a patient with
headache, or haematemesis and multiple minor injuries in a
patient with suspected alcohol abuse.

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These questions will elicit the key information in most
patients:
• What illnesses have you seen a doctor about in the past?
• Have you been in hospital before or attended a clinic?
• Have you had any operations?
• Do you take any medicines regularly?
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Past medical history Enquire about any current
or previous physical health problems, including
operations. Note childhood operations or chronic
childhood illness which can be etiological factors
in somatoform disorders.
•
Past medical history Taking the full medical
history must not be overlooked. It may give
invaluable clues as to the aetiology and
pathogenesis of pain.
PAST HISTORY : History of relevant past illness like,
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Rheumatic fever
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Tuberculosis
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Malaria
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Kala- azar
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Jaundice
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STD(sexually transmitted diseases) like gonorrhea, syphilis,AIDS etc.
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Systemic hypertension
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Diabetes mellitus
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Trauma or injury
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‘H/O contact’ with persons suffering from tuberculosis or any contagious
disease.
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‘H/O exposure’ (sexual) to STD.
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Any illness which demanded ‘blood transfusion’ (e.g., accidents or any
operation).
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Childhood illness (e.g., eruptive fevers).
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Past hospital admissions.
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Any other major medical or psychiatric illness in the past. .
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H/O travel (abroad or disease-prone areas).
 Respiratory system
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Most patients with respiratory disease will
present with
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Breathlessness
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Cough
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excess sputum
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Haemoptysis
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Wheeze
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chest pain.
Tuberculosis

Tuberculosis, a disease that is becoming more common in all parts

of the world, requires specialized techniques of laboratory
microscopy and culture to identify the responsible organisms, and if
the diagnosis is suspected, these tests must be specifically
requested.

Chest X-ray showing right apical scarring and tracheal deviation (detectable clinically) from
previous tuberculosis, and hyperinflation of the lungs due to chronic obstructive pulmonary
disease in a 66-year-old long-term smoker with 5 years of increasing breathlessness.
 Cardiovascular system
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This should define the nature of the symptoms, initially
through open questioning: –
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Chest pain: site, radiation, character, duration, provoking and
relieving factors, associated symptoms?
•
Breathlessness: paroxysmal nocturnal dyspnoea, ankle
swelling, cough, wheeze, haemoptysis?
•
Palpitation: sudden onset and offset, ‘thumps’ or ‘pauses’,
presyncope or syncope?
•
Dizziness/syncope: provoking factors, warning, duration,
recovery?
Past medical history (PMH)
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Stroke or transient ischaemic attack (TIA),
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renal impairment,
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rheumatic fever,
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peripheral vascular disease,
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Other Operations, hospital clinic attendances.
 Gastrointestinal system
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The patient usually presents with acute
abdominal pain.
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As for any pain its
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site, severity, radiation, character, time and
circumstances of onset and any aggravating or
relieving features are all important.
JAUNDICE
Jaundice is a yellowish discoloration of the skin, sclerae
and mucous membranes caused by hyperbilirubinaemia.
There is no absolute level at which jaundice is clinically detected
but, in good light, most clinicians will recognise jaundice when
bilirubin levels exceed 50 μmol/L (2.92 mg/dL).

Ask about:
• associated symptoms: abdominal pain, fever, weight loss,
itching
• colour of stools (normal or pale) and urine (normal or dark)
• alcohol intake
• travel history and immunisations
• use of illicit or intravenous drugs
• sexual history
• previous blood transfusions
• recently prescribed drugs.
 Nervous system
History Of:
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Falls
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Loss of sense of smell
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Loss of taste
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Loss of vision
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Difficulty with speech
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Difficulty swallowing
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Impairment of control of limbs
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Altered sensation
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pain