History

Question 1

What are the 5 aspects of a smoking history?

Answer 1

Q: quantity
C: context
D: dependence
C: cessation
C: consequences

Question 2

What questions do you need to ask to determine quantity of smoking?

Answer 2

1. What do you smoke?
2. How much? (per day)
3. How often?
4. How long for?

Question 3

What questions do you need to ask to determine context of smoking?

Answer 3

3 W’s:

1. Who with?
2. When?
3. Why?
4. Motivations - have they always been the same?

Question 4

What questions do you need to ask to determine dependance on smoking?

Answer 4

1. Do you think you’re addicted?
2. What time of day crave 1st cigarette?
3. How long can you go without?
4. Any withdrawal symptoms?
5. How do you cope when you can’t smoke?

Question 5

What questions would you ask re. cessation of smoking?

Answer 5

1. Have you tried to quit?
2. Was this successful?
3. Motivation to quit
4. Who advised to quit
5. Methods used to quit
6. How long quit for?
7. What triggered you to start smoking again?

Question 6

What questions would you ask re. consequences of smoking?

Answer 6

2 categories:

1. Physical - e.g cough, SOB, cancer
2. Social - relationships, work, money

Question 7

What do you need to ask in the past medical history?

Answer 7

1. Past sig illnesses (1 mark)
2. Operations (1 mark)
3. Hospitalisations (1 mark)
4. Deliberate questions (2 marks)
   a. Related to current symptom – e.g. for palpitations (chest problems, heart or thyroid conditions)
   b. Things patient might forget - e.g. asthma, diabetes

Question 8

How would you ask about family history?

Answer 8

1. Signpost that you wish to talk about family history of illness
2. Are you parents still with you?
   a. No – Sorry to hear that, find out cause and other sig illnesses
   b. Yes – Any sig illnesses?
3. Do you have any siblings?
   a. Yes – Any sig illnesses?
4. Any sig illnesses in other family members (e.g. aunts and uncles, grandparents)
5. Specific things relating to topic/condition
   e. g. presence of cardiac risk factors in family if patient’s symptoms have suspected cardiac cause, family history of bowel cancer if patient present with diarrhoea, constipation.

Question 9

How would you ask about social/occupational history?

Answer 9

1. Home situation
   • e.g. Who do you live with?
   • Can then follow this up by asking about social supports
2. Work
3. Hobbies
   How do work and hobbies affect illness AND how does illness affect work and hobbies