Family History Social History

Question 1

family history

Answer 1

-one of the critical pieces of social and psychological information
-attention to preventable or treatable diseases with a known inheritable component
-family tree of all known relatives may reveal a genetically determined pattern of illness

Question 2

why family history

Answer 2

-inform diagnosis
-promote risk assessment and stratification
-change managements
-build rapport with patients

Question 3

eliciting and summarizing family history information can

Answer 3

-help the patient understand the condition in question
-clarify patient misconceptions
-help the patient recognize the inheritance pattern of the disorder
-demonstrate variation in disease expression (such as different ages at onset)
-provide visual reminder of who in the family is at risk for the condition
-emphasize the need to obtain medical documentation on affected family members

Question 4

family history method must

Answer 4

-be reasonably accurate
-be updated easily
-allow for pattern detection and interpretation
-provide clear communication between healthcare providers

Question 5

organizing the family history

Answer 5

-pedigree- uses standard symbols and terminology to represent a large amount of information in a diagram
-preferred method of organizing and displaying family history
-benefits:
-organize a great deal of information
-visualize inheritance patterns and familial clustering

Question 6

family history pedigree

Answer 6

-what should always be included:
-date obtained and name of person collecting information
-a legend or key of symbols and disorders
-3 generations (with roman number heading)
-first name or initials of relatives
-age of family member, or age at death
-whether individual is living or deceased
-cause of death if known below symbol
-affected individuals

Question 7

drawing your pedigree

Answer 7

-start in the middle of the page
-male partner are to the left of female partners
-siblings are drawn from oldest to youngest (oldest on the left)
-generations are down top to bottom (older generations above younger generations)
-if there are multiple disorders use quadrants or different shading/colors

Question 8

3 functions of family interviewing

Answer 8

-build the relationship
-assess and understand the pt and family
-collaborate to manage

Question 9

effects of family on health

Answer 9

-family changes can affect health
-stressful life events such as martial breakdown and divorce, death of spouse etc. increase risk of sickness for other family members

Question 10

effect of chronic disease or death

Answer 10

-role changes- if wife gets sick or dies the husband has to adjust (or vice-versa)
-economic pressures- family member stops work to care for the sick, patient is unable to work, medical bills become high

Question 11

delivering information to family

Answer 11

-often bring family together to five important medical information (Bad news)
-family members important source of support
-family can help interpret information and correct misconceptions

Question 12

social history helps to reveal

Answer 12

-environment
-social support
-social stressors
-literacy and language
-health beliefs and expectations

Question 13

components of social history

Answer 13

-occupation
-education
-living environment
-significant other
-sources of stress
-important life experiences
-tobacco / alcohol / and illicit drug use (may be included separately with medications and allergies)
-diet
-activity / exercise
-religious affiliation
-insurance and financial situation

Question 14

how to make social history concise

Answer 14

-alcohol intake- specify type, quantity, frequency, duration
-cigarette smoking- determine the number of packs smoked per day and the number of years -> multiply them to get pack years
-note when person quit smoking
-drug use- specify type, frquency, duration
-home- who the pt lives with, living environment, access to care
-marital/relationship- status, intimate partner violence
-sexual history- orientation, types of activity, history of STIs
-work history- type, duration, exposures
-other- travel, pets, hobbies
-health care maintenance- age and sex appropriate cancer screens, vaccinations
-military history- particular if working at VA hospital

Question 15

48 year old Hispanic male
Pt chief complaint: “I got lightheaded and felt too weak to walk”

Answer 15

Patient is a high school graduate, working as an electrician, living with his wife of 25 years and 2 dogs. Patient feels safe and well-cared for in his home. He works as an electrician, a job with daily physical exertion that requires climbing ladders and the lifting of heavy objects. These aspects of his job have been impacted with his lightheadedness and muscle pain and weakness. Patient is concerned about having to miss additional work due to his illness. Patient denies any history of smoking. Patient reports previously drinking alcohol socially -1-2 beers, 1-2 times per month - however has ceased alcohol intake since the onset of symptoms 4 months ago. Patient denies any recreational drug use. Patient denies any exercise, though he feels that physically exerted every day at his job. Patient reports a well-rounded non-vegetarian diet of mostly home cooked meals of meat and vegetables. Patient is sexually active with his wife and reports a happy and monogamous relationship.