History Flashcards
PC
Nature
Site
Duration
Can use OATES here again
Symptoms
Pain Itch Bleeding Discharge Blistering Systemic symptoms – fever / malaise / weight loss / arthralgia
Q’s to ask for PC/HPC:
Onset
Course
Intermittent or continuous
Location/distribution
Exacerbating and relieving factors
Associated features
Onset:
When did the skin problem start?
Was the onset acute or gradual?
Course – has the rash/skin lesion changed over time?
Intermittent or continuous – is the skin problem always present or does it come and go?
Duration of the symptom if intermittent – minutes/hours/days/weeks/months/years
Location/distribution:
Where is the skin problem?
Number of lesions?
Is it spreading?
Precipitating factors – are there any obvious triggers for the symptom?
Relieving factors – does anything appear to improve the symptoms (e.g. steroid cream)?
Associated features – are there other symptoms that appear associated (e.g. fever/malaise)?
Q’s to ask for PC/HPC:
Previous episodes
Previous / current treatment
Contact history
Sun exposure
Previous episodes – has the patient experienced this problem previously?
When?
How long for?
Was it the same or different than the current episode?
Previous or current treatment for this skin problem (did it work?):
Prescribed medication
Over the counter medication
Contact history – has the patient been in contact with an infectious skin problem (e.g. chickenpox)?
Sun exposure (including sunbed use)
Pain - what to ask?
Site – where is the pain?
Onset – when did it start? / sudden vs gradual?
Character – sharp / dull ache / burning
Radiation – does the pain move anywhere else?
Associations – other symptoms associated with the pain?
Time course – worsening / improving / fluctuating / time of day dependent
Exacerbating / Relieving factors – does anything make the pain worse or better?
Severity – on a scale of 0-10, how severe is the pain?
PMH
Skin cancer
Atopy – eczema / hay fever / asthma
Other dermatological conditions
Diabetes
Inflammatory bowel disease
Drug history
Skin treatments – creams / ointments / UV therapy / antibiotics / biologics
Regular medication – including length of treatment (paying particular attention to those started around the time of the skin problem)
Antibiotics
OTC drugs
Cosmetics
Herbal remedies
ALLERGIES (a common cause of rashes)
FHx
Skin conditions – e.g. psoriasis / hereditary hemorrhagic telangiectasia
Skin cancer
Atopy – eczema / asthma / hay fever
SHx:
Occupation
Smoking
Alcohol
Recreational drug use
Living situation
AODL
Occupation:
Are the skin problems worse at work?
Do the skin problems improve when the patient is off from work?
Is the patient exposed to any skin irritants or other hazardous substances?
Smoking – How many cigarettes a day? How many years have they smoked for?
Alcohol – How many units a week? – type / volume / strength of alcohol
Recreational drug use – e.g. cellulitis from IV drug injection sites
Living situation:
Own home/care home – adaptations / stairs?
Who lives with the patient? – is the patient supported at home?
Any carer input? – what level of care do they receive?
Any recent changes at home that could be related to skin problems (e.g. new detergent causing allergic reaction to clothing)
Activities of daily living:
Is the patient independent and able to fully care for themselves?
Can they manage self-hygiene/housework/food shopping?
Extra thing to ask in this history that is important
Travel history
Where did the patient travel to?
How long was the patient there?
Is the patient aware of any exposure to infectious disease?
Sun exposure – was the skin problem worsened by sun exposure? (e.g. facial rash in lupus)
Mnemonic to check everything:
6S+3B
Scabby Scaly Scrunched - lichenification Split - ulcer, erosion, excoriation Scarred Smooth
Blood - pink, purple
Black - necrosis, may also be green and yellow
Brown - melanin, haemosiderin
