History taking

Approach to History Taking

You will have pencil and paper
A. Greet the patient and introduce yourself (Hello. I am Mahmoud Bazeed one
of the exam candidate).
B. Confirm patient name and age (May I confirm your name and age) except for
hospitalized persons like confusion and depression.
C. Get verbal consent (Today I’ve been asked to ask you few questions regarding
your condition, are you OK with this?).
D. Ask for chaperon in impotence station, offer analgesia and switch off light in
Headache station.
E. Open Question, Patient statement: How can I help you today? What seems
to be your problem? (Don’t interrupt the patient).
F. Analysis of patient complain: onset, course, duration, severity, aggravating
and relieving factors and associated factors (for differential diagnosis most
important). (Interrupt the patient if you have to).
G. Past medical or surgical history
1. Have you ever visited your GP for any other medical problems?
2. Have you ever had surgeries?
H. Drug history: Doses and allergy.
1. Do you take any prescribed or over the counter medications?
2. Do you have any allergy against any drug?
I. Family history.
Is there anyone else in the family has had a similar problem?
J. Social history (May I ask personal question?)
1. Occupation
2. Home situation (Who is at home with you?).
3. Mobility (do you have any difficulties using stairs?).

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4. Smoking (do you smoke? How many packets per day? Have you
considered quitting? ).
5. Alcohol (Do you drink Alcohol? How many units per week? Have you
considered quitting?).
K. Ideas, concerns and expectations: Before I go any further could I ask
1. Idea: What do you think the cause is?
2. Concern: What are you the most concerned about?
3. Expectations: What are you hoping us to do for you?
L. Other system review.
Respiratory: cough Dyspnea wheezes
Cardiovascular: chest pain, orthopnea
Urinary: Dysuria
M. Anything else you want to add.
N. Thank the patient.
O. Present your case including provisional and differential diagnosis and
investigations.
P. Answer the examiner questions.

Try to practice history taking at least four times.

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 History taking

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 History taking

 Two history stations in the exam.

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 History taking

 Each station is 20 marks station.

 Each station lasts for ten minutes.
 You will have one minute to read the stem on the door of
station.
 Six minutes to take history from the patient.
 Three minutes to present your case and answer the
examiner questions.
 The patient is always an actor.
 Two examiners present in each history station:
1. Surgeon examiner responsible for 15 of 20marks and he will
evaluate you on three main items history taking from the
patient, presentation and knowledge.
2. Layman examiner responsible for 5 of 20 marks and he will
evaluate you on the following items body language including
head nodding and eye to eye contact, rapport to the patient
(how can I help you sir, so sorry to hear that), use of layman
language not medical one (tummy for abdomen, bleeding for
hemorrhage) and end of conversation (answer patient
questions, anything else I have missed and thank your patient)

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 History taking

Positive findings
Symptom Provisional diagnosis Differential Diagnosis
(also you have to
consider)
Bleeding per rectum Cancer colon 1.IBD
(Bleeding per rectum, 2.Anal causes (fissure,
disturbed bowel habits, hemorrhoids)
Positive family history) 3. Diverticular disease.
4. Bleeding tendency.
5. Sever gastroenteritis.
6. Diverticular disease.
Dysphagia Cancer Esophagus 1. Achalasia.
(Dysphagia to solids 2. GORD.
then solids and fluids, 3. Goiter.
hematemesis, 4. Pharyngeal pouch.
unintentional weight 5. Esophagitis.
loss, heavy smoker and 6. Autoimmune disease
alcohol drinker) (Myasthenia Gravis,
(past history of cancer Scleroderma).
testis on chemotherapy, 7. Neurological
Hip replacement on disorders (UMNL).
NSIADs).

Abdominal pain and IBD (Crohn's disease). 1. IBS.

Diarrhea 2. Cancer colon.
(Abdominal pain and 3. Gastroenteritis.
diarrhea associated with 4. Diverticular disease.
mucous discharge
Pain increased by
passing stool, weight
loss and extra intestinal
manifestation erythema
nodosum )

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 History taking

Female with neck 1. Toxic multinodular

swelling goiter.
(neck swelling, increase 2. Simple multinodular
in size, positive goiter.
compression and toxic 3. Thyroid neoplasm.
symptoms)
Chronic Lower Limb Chronic Ischemia 1. Spinal canal stenosis.
Claudication 2. Disc prolapse
(Claudication calf pain (Sciatica).
increase by cold
weather and walking
and decrease by rest)
Hematuria Bladder Cancer 1. UTI, Stones.
(painless total 2. Bleeding Tendency.
hematuria ,weight loss, 3. Traumatic.
anorexia and work in 4. BPH.
dye factory ) 5. Cancer prostate.
6. Renal cell carcinoma.

Chronic Urine Retention BPH 1. Cancer Prostate.

(urine retention and use 2. Urethral stricture.
of nasal spray containing 3. UTI, stones.
alpha blocker) 4. Neurological (UMNL
LMNL).
5.Bladder cancer

Back Pain (female ) Mechanical pain 1. Disc Prolapse.

(long standing history of 2. Ankylosing
Social stress
back pain ,worse in the spondylitis.
last 3 years ,MRI mild 3. TB.
degenerative changes, 4. Metastatic.
Disabled husband, work 5. Osteoporosis.
commitment, increase 6. Cauda equine.
by activity and decrease
by rest)

Back Pain (Male) Cauda equine 1. Disc Prolapse.

(sudden pain, red flags)

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2. Ankylosing
spondylitis.
3. TB.
4. Metastatic.
5. Osteoporosis.
6. Mechanical pain.
Chest Pain Pulmonary Embolism 1. Chest infection.
(sudden chest pain 2. Chest malignancy.
,stabbing ,increase by 3. MI.
breathing ,sever and no 4. Musculoskeletal Pain.
history of trauma)
Knee Pain Post traumatic 1. Cruciate Ligament
(history of trauma, and Osteoarthritis Injury.
operation , can’t play 2. Meniscal Injury.
football now, pain 3. Septic arthritis.
increase at night 4. Referred from the
,crepitus) back.
5. Extra intestinal
manifestation of IBD.

Groin swelling Inguinal hernia 1. Lymph node.

(Gym trainer referred 2. Abscess.
from GP with groin 3. infected
swelling typical of pseudoanurysm.
inguinal hernia, past
history of genitourinary
infection, stoma tonics,
patient will ask question
about hernia and
surgery)
Groin Swelling Infected femoral 1. Groin Abscess.
(referred from GP with pseudoaneurysm. 2. Lymph nodes.
groin abscess) 3. Inguinal Hernia.

Unilateral tonsillar 1. Infective Causes.

enlargement 2. Neoplastic causes.
3. Asymmetrical tonsils.

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Headache Subarachnoid 1. Meningitis.

(headache with hemorrhage. 2. Brain tumor.
photophobia, polycystic
kidney , positive family
history of brain
aneurysm)
Depression Reactive post-operative
(feeling down after Depression.
gastrectomy)
Seizures Brain tumors 1. Epilepsy.
(focal seizures, Rt arm 2. Meningitis.
shaking, not 3. Encephalitis.
generalized, late onset, 4. Head trauma.
no post ictal 5. TIAs.
manifestation negative
past history of epilepsy)
Impotence 1. Psychogenic.
(Social stress, atenolol 2. Drug induced.
,smoker and 3. Organic.
hypertensive)
Abdominal Pain IBS 1. Biliary colic.
(abdominal pain 2. IBD.
relieved by passing stool 3. Cancer colon.
or flatus ,bloating ,social 4. Gastroenteritis.
history and past history
of gall bladder stones)
Abdominal Pain Acute Pancreatitis 1. Acute Cholecystitis.
(female patient, smoker 2. perforated peptic
alcohol drinker, past ulcer.
history of peptic ulcer 3. MI.
on lansoprazole 4.MVO
presented with
epigastric pain after
drinking in wedding)
Abdominal Pain Chronic Pancreatitis 1. Pancreatic
(chronic epigastric pain pseudocyst.
addict to alcohol, 2. Peptic ulcer disease.
patient take morphine
for pain)

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Preoperative Confusion Dementia Other causes.

(Old female patient
prepared for THA ,nurse
noted confusion)

Anxiety
Shortness of Breath 1. Chest infection.
(prepared for lap 2. Chest malignancy.
cholecystectomy and 3. MI.
she has been 4. Musculoskeletal Pain.
investigated before for
SOB and free)

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 History taking

Bleeding per rectum

Hello. I am Mahmoud Bazeed one of the exam candidate
May I confirm your name and age please?
Nice to meet you Mr. …. Today I’ve been asked to ask you few questions
regarding your condition, are you OK with this?
How can I help you today?
I am so sorry to hear that.
(Onset, course, duration, severity, aggravating and relieving factors and
associated factors)
Did this started suddenly or gradually?
When you did first noted this?
Does this bleeding comes and goes. Does it get previously worse?
What is the color of the blood? , how much blood you notice every time?
Streaks?
Teaspoon? More? Is that bleeding is painful when you pass stool?
Is there anything makes this bleeding stops
Is there anything makes that bleeding increases?
(Associated factors for differential diagnosis)
1. Cancer Colon
Do you have any disturbances regarding bowel habits?
How has your appetite been?
Have you noticed any unintentional weight loss?
2. IBD:
Have you noticed any slime or discharge? Or pain in your tummy especially with
bowel opening?
Have you had any mouth ulcers? Fever? Painful red eye? Joint or back pain? Or
skin problems?

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3. Bleeding tendency:
Have you noticed bleeding from any other orifices?
4. Anal causes:
Have you noticed itching around your back passage? Or any swelling?
5. Gastroenteritis:
Have you been abroad recently? If so, where?
Do you have the urge to pass stool in spite of passing little amount?
6. Diverticular disease.
Do you have long standing history of constipation?
(Past medical or surgical history, Drug history, Family history, Ideas, concerns
and expectations, other system review)
Do you have any other medical conditions, see your GP for anything, ever had
surgeries?
Do you take any medications? Dose? Do you have any allergy against any drug?
Do you mind if I ask personal questions?
What is your occupation?
Who is at home with you?
Do you have any difficulty with the stairs?
Do you smoke? How many packs/ day
Do you drink alcohol? How many units/ week
Is there anyone else in the family has had a similar problem?
Before I go any further, could I ask?
What do you think the cause is?
What are you the most concerned about?
What are you hoping us to do for you?
resp., cvs: is there any chest pain, SOB, cough
Urinary: any problems in passing urine?

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Rheumatic: any muscle or joint pain?

Anything else you want to add?
Thank you
(Order of questions)
Hello. I am Mahmoud Bazeed one of the exam candidate
May I confirm your name and age please?
Nice to meet you Mr. …. Today I’ve been asked to ask you few questions
regarding your condition, are you OK with this?
How can I help you today?
I am so sorry to hear that.
Did this started suddenly or gradually?
When you did first noted this?
Does this bleeding comes and goes. Does it get previously worse?
What is the color of the blood? , how much blood you notice every time?
Streaks?
Teaspoon? More? Is that bleeding is painful when you pass stool?
Is there anything makes this bleeding stops
Is there anything makes that bleeding increases?
Do you have any disturbances regarding bowel habits?
Have you noticed any slime or discharge? Or pain in your tummy especially with
bowel opening?
Do you have the urge to pass stool in spite of passing little amount?
Do you have long standing history of constipation?
Have you noticed itching around your back passage? Or any swelling?
How has your appetite been?
Have you noticed any unintentional weight loss?

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 History taking

Have you had any mouth ulcers? Fever? Painful red eye? Joint or back pain? Or
skin problems?
Have you been abroad recently? If so, where?
Do you have any other medical conditions, see your GP for anything, ever had
surgeries?
Do you take any medications? Dose? Do you have any allergy against any drug?
Do you mind if I ask personal questions?
What is your occupation?
Who is at home with you?
Do you have any difficulty with the stairs?
Do you smoke? How many packs/ day
Do you drink alcohol? How many units/ week
Is there anyone else in the family has had a similar problem?
Before I go any further, could I ask?
What do you think the cause is?
What are you the most concerned about?
What are you hoping us to do for you?
resp., cvs: is there any chest pain, SOB, cough
Urinary: any problems in passing urine?
Rheumatic: any muscle or joint pain?
Anything else you want to add?
Thank you
Positive findings:
(Bleeding per rectum, disturbed bowel habits, Positive family history)

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Questions
What is the most important investigation to carry out?
As I am suspecting colorectal cancer, the most important investigation is a
colonoscopy +/- biopsy to examine the whole colon.
If immediately available in clinic, a rigid sigmoidoscopy may be carried out in the
first instance
• Hematology: FBC (anaemia, leucocytosis of infective colitis, inflammatory
bowel disease, ischemic colitis), low platelets (bleeding disorder), clotting
screen, group and save / cross match for transfusion.
• Biochemistry: U&Es, LFTs (hepatic failure with variceal bleed, malignancy)
• Arterial blood gases: Raised lactate (ischemia), metabolic acidosis.
• ECG: Mesenteric ischaemia, atrial fibrillation (emboli).
• Endoscopy: OGD (to exclude upper gastrointestinal cause), sigmoidoscopy /
proctoscopy (haemorrhoids, anorectal lesion, distal colitis, rectal ulcer) and
colonoscopy (malignancy, diverticular disease, colitis, angiodysplasia).
• Mesenteric angiography (CT or invasive) / Technetium scan / Labelled red cell
scan, if source not identified by endoscopy (looking for angiodysplasia / Meckel’s
diverticulum).
• Radiology: AXR (obstruction, toxic megacolon of inflammatory bowel disease)
and US scan / CT (if suspected malignancy, for liver metastases and staging).
• Microbiology: Stool cultures (infective colitis).

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Dysphagia
Hello. I am Mahmoud Bazeed one of the exam candidate.
May I confirm your name and age please?
Nice to meet you Mr. …. Today I’ve been asked to ask you few questions
regarding your condition, are you OK with this?
How can I help you today?
I am so sorry to hear that.
(Onset, course, duration, severity, aggravating and relieving factors and
associated factors)
Did this started suddenly or gradually?
When you did first noted this?
Is there anything makes this difficulty stops?
Is there anything makes that difficulty increases?
Do you experience this difficulty of swallowing to solid or to liquid foods or both?
Have you vomited at all? If so, was there any blood?
(Associated factors for differential diagnosis)
1. Cancer esophagus
Have you vomited at all? If so, was there any blood? (Already been asked)
How has your appetite been?
Have you noticed any unintentional weight loss? How many kilos over how long?
2. Goiter:
Have you noticed any neck swelling?
3. Pharyngeal pouch:
Does the food get stuck in your throat when swallowing?
Have you noticed having bad-smelling breath recently?
Do you ever feel a lump in your throat?
Do you ever notice gurgling or a wet voice after swallowing?

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4. GORD:
Do you ever taste acid at the back of your mouth? Heartburn? Pain in your
tummy?
5. Achalasia:
Have you noticed that difficulty more to fluids than solids?
6. Esophagitis:
Have you noticed pain during swallowing?
7. Autoimmune disease (Myasthenia Gravis, Scleroderma):
Do you suffer with painfully cold hands? Dry eyes or mouth?
8. Neurological disorders (UMNL):
Have you noticed any weakness anywhere? Any problems walking?
(Past medical or surgical history, Drug history, Family history, Ideas, concerns
and expectations, other system review)
Do you have any other medical conditions, see your GP for anything, ever had
surgeries?
Do you take any medications? Dose? Do you have any allergy against any drug?
Do you mind if I ask personal questions?
What is your occupation?
Who is at home with you?
Do you have any difficulty with the stairs?
Do you smoke? How many packs/ day
Do you drink alcohol? How many units/ week
Is there anyone else in the family has had a similar problem?
Before I go any further, could I ask?
What do you think the cause is?
What are you the most concerned about?
What are you hoping us to do for you?

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 History taking

resp., cvs: is there any chest pain, SOB, cough

Urinary: any problems in passing urine?
Rheumatic: any muscle or joint pain?
Anything else you want to add?
Thank you.
(Order of questions)
Hello. I am Mahmoud Bazeed one of the exam candidate
May I confirm your name and age please?
Nice to meet you Mr. …. Today I’ve been asked to ask you few questions
regarding your condition, are you OK with this?
How can I help you today?
I am so sorry to hear that.
Did this started suddenly or gradually?
When you did first noted this?
Is there anything makes this difficulty stops?
Is there anything makes that difficulty increases?
Do you experience this difficulty of swallowing to solid or to liquid foods or both?
Have you noticed that difficulty more to fluids than solids?
Have you noticed pain during swallowing?
Have you vomited at all? If so, was there any blood?
Do you ever taste acid at the back of your mouth? Heartburn? Pain in your
tummy?
Have you noticed any neck swelling?
Does the food get stuck in your throat when swallowing?
Have you noticed having bad-smelling breath recently?
Do you ever feel a lump in your throat?
Do you ever notice gurgling or a wet voice after swallowing?

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 History taking

How has your appetite been?

Have you noticed any unintentional weight loss? How many kilos over how long?
Do you suffer with painfully cold hands? Dry eyes or mouth?
Have you noticed any weakness anywhere? Any problems walking?
Do you have any other medical conditions, see your GP for anything, ever had
surgeries?
Do you take any medications? Dose? Do you have any allergy against any drug?
Do you mind if I ask personal questions?
What is your occupation?
Who is at home with you?
Do you have any difficulty with the stairs?
Do you smoke? How many packs/ day
Do you drink alcohol? How many units/ week
Is there anyone else in the family has had a similar problem?
Before I go any further, could I ask?
What do you think the cause is?
What are you the most concerned about?
What are you hoping us to do for you?
resp., cvs: is there any chest pain, SOB, cough
Urinary: any problems in passing urine?
Rheumatic: any muscle or joint pain?
Anything else you want to add?
Thank you.
Positive findings:
(Dysphagia to solids then solids and fluids, hematemesis, unintentional weight
loss, heavy smoker and alcohol drinker)(Past history of cancer testis on
chemotherapy, hip replacement on NSIADs).

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Questions
Investigations:
- Full clinical examination checking for lymphadenopathy
- Bloods –FBC, U&Es, LFTs and clotting and bone profile
- Chest X-ray
- Esophageal manometry: achalasia, GORD
- Barium swallow
- Endoscopy and biopsy
- Esophageal end luminal US, also for staging of carcinoma.
- Video fluoroscopy –assessing for aspiration
- Staging CT scan, depending on what the previous investigations reveal
Treatment:
Operable cases: oesphagectomy + chemo radiotherapy
Non-operable cases: palliation: self-expanding metallic stent, palliative
chemotherapy and radiotherapy, feeding jeujnosomy.

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 History taking

Abdominal pain and Diarrhea

Hello. I am Mahmoud Bazeed one of the exam candidate
May I confirm your name and age please?
Nice to meet you Mr. …. Today I’ve been asked to ask you few questions
regarding your condition, are you OK with this?
How can I help you today?
I am so sorry to hear that.
(Site, Onset, course, duration, character, radiation, timing, severity,
aggravating and relieving factors and associated factors)
(SOCRATES) analysis of pain
Where did you feel that pain? Could please point to the site?
Does it move anywhere?
When did you first notice that pain?
Did it start suddenly or gradually?
Did it come and go? Has this changed recently?
Is there any specific time during the day that the pain increase?
Is there anything makes this pain stops?
Is there anything makes that pain increases?
Could please describe that pain for me? Is it colicky, cramping, or stabbing?
How badly is this affecting your day-to-day life?
If you had to rate the pain from 1 to 10, with 10 being the worst pain you can
imagine, how would you rate it?
Analysis of diarrhea
How many motions per day?
What are the stools like? Are they watery, semi-solid or solid? Can be easily
flushed? Is there any blood?

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 History taking

(Associated factors for differential diagnosis of abdominal pain)

1. IBD:
Have you noticed any slime or discharge? Or pain in your tummy especially with
bowel opening?
Have you had any mouth ulcers? Fever? Painful red eye? Joint or back pain? Or
skin problems?
2. Cancer Colon
Do you have any disturbances regarding bowel habits?
How has your appetite been?
Have you noticed any unintentional weight loss?
3. Gastroenteritis:
Have you been abroad recently? If so, where?
Do you have the urge to pass stool in spite of passing little amount?
4. Diverticular disease.
Do you have long standing history of constipation?
5. IBS
Did the tummy pain relieved by passing stool?
Did it increase by social stress?
(Past medical or surgical history, Drug history, Family history, Ideas, concerns
and expectations, other system review)
Do you have any other medical conditions, see your GP for anything, ever had
surgeries?
Do you take any medications? Dose? Do you have any allergy against any drug?
Do you mind if I ask personal questions?
What is your occupation?
Who is at home with you?
Do you have any difficulty with the stairs?

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 History taking

Do you smoke? How many packs/ day

Do you drink alcohol? How many units/ week
Is there anyone else in the family has had a similar problem?
Before I go any further, could I ask?
What do you think the cause is?
What are you the most concerned about?
What are you hoping us to do for you?
resp., cvs: is there any chest pain, SOB, cough
Urinary: any problems in passing urine?
Rheumatic: any muscle or joint pain?
Anything else you want to add?
Thank you.
(Order of questions)
Hello. I am Mahmoud Bazeed one of the exam candidate
May I confirm your name and age please?
Nice to meet you Mr. …. Today I’ve been asked to ask you few questions
regarding your condition, are you OK with this?
How can I help you today?
I am so sorry to hear that.
Where did you feel that pain? Could please point to the site?
Does it move anywhere?
When did you first notice that pain?
Did it start suddenly or gradually?
Did it come and go? Has this changed recently?
Is there any specific time during the day that the pain increase?
Is there anything makes this pain stops?

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HISTORY TAKING
 History taking

Is there anything makes that pain increases?

Did the tummy pain relieved by passing stool or increased?
Did it increase by social stress?
Could please describe that pain for me? Is it colicky, cramping, or stabbing?
How badly is this affecting your day-to-day life?
If you had to rate the pain from 1 to 10, with 10 being the worst pain you can
imagine, how would you rate it?
How many motions per day?
What are the stools like? Are they watery, semi-solid or solid? Can be easily
flushed? Is there any blood? Have you noticed any slime or discharge?
Do you have the urge to pass stool in spite of passing little amount?
Do you have long standing history of constipation?
How has your appetite been?
Have you noticed any unintentional weight loss? How many kilos over how long?
Have you had any mouth ulcers? Fever? Painful red eye? Joint or back pain? Or
skin problems?
Have you been abroad recently? If so, where?
Do you have any other medical conditions, see your GP for anything, ever had
surgeries?
Do you take any medications? Dose? Do you have any allergy against any drug?
Do you mind if I ask personal questions?
What is your occupation?
Who is at home with you?
Do you have any difficulty with the stairs?
Do you smoke? How many packs/ day
Do you drink alcohol? How many units/ week
Is there anyone else in the family has had a similar problem?

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HISTORY TAKING
 History taking

Before I go any further, could I ask?

What do you think the cause is?
What are you the most concerned about?
What are you hoping us to do for you?
resp., cvs: is there any chest pain, SOB, cough
Urinary: any problems in passing urine?
Rheumatic: any muscle or joint pain?
Anything else you want to add?
Thank you.
(Positive findings)
(Abdominal pain and diarrhea associated with mucous discharge Pain increased
by passing stool, weight loss and extra intestinal manifestation erythema
nodosum)
Questions
Investigations:
-Abdominal examination including DRE
-Routine bloods – FBC, U&E, CRP, LFTs, calcium, magnesium, phosphate,
Coagulation screen, -
Group and Save. (Looking for raised inflammatory markers, dehydration,
electrolyte disturbance
Secondary to diarrhea, albumin as a guide of nutritional status, coagulation
defects.)
-Stool sample
-Faecal occult blood test
-Abdominal Radiograph - assess for toxic megacolon
-+/-CT or MRI abdomen and pelvis if concerning features on examination and for
pre-operative planning if surgery is indicated - Colonoscopy
Treatment:

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 History taking

Medical: mesalazine, prednisolone, immunomodualtors (infliximab)

Conservative: dietary control (low residue diet)
Surgical: in toxic megacolon, IO, malignant transformation, fistulation,
refractory cases

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 History taking

Abdominal pain
Female referred from her GP as chronic calcular
cholecystitis
Hello. I am Mahmoud Bazeed one of the exam candidate
May I confirm your name and age please?
Nice to meet you Mr. …. Today I’ve been asked to ask you few questions
regarding your condition, are you OK with this?
How can I help you today?
I am so sorry to hear that.
(Site, Onset, course, duration, character, radiation, timing, severity,
aggravating and relieving factors and associated factors)
(SOCRATES) analysis of pain
Where did you feel that pain? Could please point to the site?
Does it move anywhere?
When did you first notice that pain?
Did it start suddenly or gradually?
Did it come and go? Has this changed recently?
Is there any specific time during the day that the pain increase?
Is there anything makes this pain stops?
Is there anything makes that pain increases?
Could please describe that pain for me? Is it colicky, cramping, or stabbing?
How badly is this affecting your day-to-day life?
If you had to rate the pain from 1 to 10, with 10 being the worst pain you can
imagine, how would you rate it?
(Associated factors for differential diagnosis of abdominal pain)
1. IBS
Did the tummy pain relieved by passing stool?

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HISTORY TAKING
 History taking

Did it increase by social stress?

Do you have bloating?
2. IBD
Have you noticed any slime or discharge? Or pain in your tummy especially with
bowel opening?
Have you had any mouth ulcers? Fever? Painful red eye? Joint or back pain? Or
skin problems?
3. Cancer Colon
Do you have any disturbances regarding bowel habits?
How has your appetite been?
Have you noticed any unintentional weight loss? How many kilos over how long?
4. Gastroenteritis:
Have you been abroad recently? If so, where?
Do you have the urge to pass stool in spite of passing little amount?
5. Biliary colic:
Does the pain move to your RT shoulder?
Have you noticed that the pain increase by fatty meal?
Have you noticed yellowish discoloration of your eyes?
(Past medical or surgical history, Drug history, Family history, Ideas, concerns
and expectations, other system review)
Do you have any other medical conditions, see your GP for anything, ever had
surgeries?
Do you take any medications? Dose? Do you have any allergy against any drug?
Do you mind if I ask personal questions?
What is your occupation?
Who is at home with you?
Do you have any difficulty with the stairs?

27

HISTORY TAKING
 History taking

Do you smoke? How many packs/ day

Do you drink alcohol? How many units/ week
Is there anyone else in the family has had a similar problem?
Before I go any further, could I ask?
What do you think the cause is?
What are you the most concerned about?
What are you hoping us to do for you?
resp., cvs: is there any chest pain, SOB, cough
Urinary: any problems in passing urine?
Rheumatic: any muscle or joint pain?
Anything else you want to add?
Thank you.
(Order of questions)
Hello. I am Mahmoud Bazeed one of the exam candidate
May I confirm your name and age please?
Nice to meet you Mr. …. Today I’ve been asked to ask you few questions
regarding your condition, are you OK with this?
How can I help you today?
I am so sorry to hear that.
Where did you feel that pain? Could please point to the site?
Does it move anywhere? Does the pain move to your RT shoulder?
When did you first notice that pain?
Did it start suddenly or gradually?
Did it come and go? Has this changed recently?
Is there any specific time during the day that the pain increase?
Is there anything makes this pain stops?

28

HISTORY TAKING
 History taking

Is there anything makes that pain increases?

Did the tummy pain relieved by passing stool or increased?
Did it increase by social stress?
Have you noticed that the pain increase by fatty meal?
Could please describe that pain for me? Is it colicky, cramping, or stabbing?
How badly is this affecting your day-to-day life?
If you had to rate the pain from 1 to 10, with 10 being the worst pain you can
imagine, how would you rate it?
Do you have any disturbances regarding bowel habits?
Have you noticed any slime or discharge?
Do you have the urge to pass stool in spite of passing little amount?
How has your appetite been?
Have you noticed any unintentional weight loss? How many kilos over how long?
Have you had any mouth ulcers? Fever? Painful red eye? Joint or back pain? Or
skin problems?
Have you noticed yellowish discoloration of your eyes?
Have you been abroad recently? If so, where?
Do you have any other medical conditions, see your GP for anything, ever had
surgeries?
Do you take any medications? Dose? Do you have any allergy against any drug?
Do you mind if I ask personal questions?
What is your occupation?
Who is at home with you?
Do you have any difficulty with the stairs?
Do you smoke? How many packs/ day
Do you drink alcohol? How many units/ week
Is there anyone else in the family has had a similar problem?

29

HISTORY TAKING
 History taking

Before I go any further, could I ask?

What do you think the cause is?
What are you the most concerned about?
What are you hoping us to do for you?
resp., cvs: is there any chest pain, SOB, cough
Urinary: any problems in passing urine?
Rheumatic: any muscle or joint pain?
Anything else you want to add?
Thank you.
(Positive findings)
(Abdominal pain relieved by passing stool or flatus, bloating, social history and
past history of gall bladder stones)
Questions
Investigations: abdominal ultrasound, AXR, colonoscopy, stool analysis, FBC
Treatment: fibre diet, antispasmodics, antidepressants

30

HISTORY TAKING
 History taking

Abdominal Pain
Hello. I am Mahmoud Bazeed one of the exam candidate
May I confirm your name and age please?
Nice to meet you Mr. …. Today I’ve been asked to ask you few questions
regarding your condition, are you OK with this?
How can I help you today?
I am so sorry to hear that.
(Site, Onset, course, duration, character, radiation, timing, severity,
aggravating and relieving factors and associated factors)
(SOCRATES) analysis of pain
Where did you feel that pain? Could please point to the site?
Does it move anywhere?
When did you first notice that pain?
Did it start suddenly or gradually?
Did it come and go? Has this changed recently?
Is there any specific time during the day that the pain increase?
Is there anything makes this pain stops?
Is there anything makes that pain increases?
Could please describe that pain for me? Is it colicky, cramping, or stabbing?
How badly is this affecting your day-to-day life?
If you had to rate the pain from 1 to 10, with 10 being the worst pain you can
imagine, how would you rate it?
(Associated factors for differential diagnosis of abdominal pain)
1. Acute pancreatitis
Does the pain move to your back?
Does the pain relieved by leaning forward?

31

HISTORY TAKING
 History taking

2. Acute cholecystitis:
Does the pain move to your RT shoulder?
Have you noticed that the pain increases by fatty meal?
Have you noticed yellowish discoloration of your eyes?
3. Perforated peptic ulcer:
Did you throw up? Is there blood?
Do you ever taste acid at the back of your mouth? Heartburn?
4. MI:
Have you noticed chest pain?
Have you been investigated before for any cardiac problems?
5. Mesenteric vascular occlusion:
Have you noticed blood in the stool?
(Past medical or surgical history, Drug history, Family history, Ideas, concerns
and expectations, other system review)
Do you have any other medical conditions, see your GP for anything, ever had
surgeries?
Do you take any medications? Dose? Do you have any allergy against any drug?
Do you mind if I ask personal questions?
What is your occupation?
Who is at home with you?
Do you have any difficulty with the stairs?
Do you smoke? How many packs/ day
Do you drink alcohol? How many units/ week
Is there anyone else in the family has had a similar problem?
Before I go any further, could I ask?
What do you think the cause is?
What are you the most concerned about?

32

HISTORY TAKING
 History taking

What are you hoping us to do for you?

resp., cvs: is there any chest pain, SOB, cough
Urinary: any problems in passing urine?
Rheumatic: any muscle or joint pain?
Anything else you want to add?
Thank you.
(Order of questions)
Where did you feel that pain? Could please point to the site?
Does it move anywhere? Does the pain move to your back or to your RT
shoulder?
When did you first notice that pain?
Did it start suddenly or gradually?
Did it come and go? Has this changed recently?
Is there any specific time during the day that the pain increase?
Is there anything makes this pain stops? Does the pain relieved by leaning
forward?
Is there anything makes that pain increases? Have you noticed that the pain
increase by fatty meal?
Could please describe that pain for me? Is it colicky, cramping, or stabbing?
How badly is this affecting your day-to-day life?
If you had to rate the pain from 1 to 10, with 10 being the worst pain you can
imagine, how would you rate it?
Have you noticed chest pain?
Did you throw up? Is there blood?
Do you ever taste acid at the back of your mouth? Heartburn?
Have you noticed blood in the stool?
Have you noticed yellowish discoloration of your eyes?

33

HISTORY TAKING
 History taking

Have you been investigated before for any cardiac problems?

Do you have any other medical conditions, see your GP for anything, ever had
surgeries?
Do you take any medications? Dose? Do you have any allergy against any drug?
Do you mind if I ask personal questions?
What is your occupation?
Who is at home with you?
Do you have any difficulty with the stairs?
Do you smoke? How many packs/ day
Do you drink alcohol? How many units/ week
Is there anyone else in the family has had a similar problem?
Before I go any further, could I ask?
What do you think the cause is?
What are you the most concerned about?
What are you hoping us to do for you?
resp., cvs: is there any chest pain, SOB, cough
Urinary: any problems in passing urine?
Rheumatic: any muscle or joint pain?
Anything else you want to add?
Thank you
(Positive findings)
(Female patient, smoker alcohol drinker, past history of peptic ulcer on
lansoprazole presented with sudden sever epigastric pain radiated to the back
after drinking in wedding)

34

HISTORY TAKING
 History taking

Abdominal Pain
40 year. Old divorced male with chronic epigastric pain radiating to the back for
the past 1 year, with steatorrhea, takes 5 glasses of beer/ day, previously
admitted for acute pancreatitis. Takes 30 mg of morphine / day to numb the
pain, depressed
Hello. I am Mahmoud Bazeed one of the exam candidate
May I confirm your name and age please?
Nice to meet you Mr. …. Today I’ve been asked to ask you few questions
regarding your condition, are you OK with this?
How can I help you today?
I am so sorry to hear that.
(Site, Onset, course, duration, character, radiation, timing, severity,
aggravating and relieving factors and associated factors)
(SOCRATES) analysis of pain
Where did you feel that pain? Could please point to the site?
Does it move anywhere?
When did you first notice that pain?
Did it start suddenly or gradually?
Did it come and go? Has this changed recently?
Is there any specific time during the day that the pain increase?
Is there anything makes this pain stops?
Is there anything makes that pain increases?
Could please describe that pain for me? Is it colicky, cramping, or stabbing?
How badly is this affecting your day-to-day life?
If you had to rate the pain from 1 to 10, with 10 being the worst pain you can
imagine, how would you rate it?

35

HISTORY TAKING
 History taking

(Associated factors for differential diagnosis of abdominal pain)

1. Chronic Pancreatitis:
Does the pain move to your back?
Does the pain relieved by leaning forward?
Have you noticed that the stool is difficult to flush?
Have you noticed that the pain increase by fatty meal?
2. Pancreatic pseudocyst:
Have been feverish or being ill?
Have you noticed any lump in your tummy?
3. Peptic ulcer disease:
Did you throw up? Is there blood?
Do you ever taste acid at the back of your mouth? Heartburn?
(Past medical or surgical history, Drug history, Family history, Ideas, concerns
and expectations, other system review)
Do you have any other medical conditions, see your GP for anything, ever had
surgeries?
Do you take any medications? Dose? Do you have any allergy against any drug?
Do you mind if I ask personal questions?
What is your occupation?
Who is at home with you?
Do you have any difficulty with the stairs?
Do you smoke? How many packs/ day
Do you drink alcohol? How many units/ week
Is there anyone else in the family has had a similar problem?
Before I go any further, could I ask?
What do you think the cause is?
What are you the most concerned about?

36

HISTORY TAKING
 History taking

What are you hoping us to do for you?

resp., cvs: is there any chest pain, SOB, cough
Urinary: any problems in passing urine?
Rheumatic: any muscle or joint pain?
Anything else you want to add?
Thank you.
(Order of questions)
Hello. I am Mahmoud Bazeed one of the exam candidate
May I confirm your name and age please?
Nice to meet you Mr. …. Today I’ve been asked to ask you few questions
regarding your condition, are you OK with this?
How can I help you today?
I am so sorry to hear that
Where did you feel that pain? Could please point to the site?
Does it move anywhere? Does the pain move to your back?
When did you first notice that pain?
Did it start suddenly or gradually?
Did it come and go? Has this changed recently?
Is there any specific time during the day that the pain increase?
Is there anything makes this pain stops? Does the pain relieved by leaning
forward?
Is there anything makes that pain increases? Have you noticed that the pain
increase by fatty meal?
Could please describe that pain for me? Is it colicky, cramping, or stabbing?
How badly is this affecting your day-to-day life?
If you had to rate the pain from 1 to 10, with 10 being the worst pain you can
imagine, how would you rate it?

37

HISTORY TAKING
 History taking

Have you noticed that the stool is difficult to flush?

Have been feverish or being ill?
Have you noticed any lump in your tummy?
Did you throw up? Is there blood?
Do you ever taste acid at the back of your mouth? Heartburn?
Do you have any other medical conditions, see your GP for anything, ever had
surgeries?
Do you take any medications? Dose? Do you have any allergy against any drug?
Do you mind if I ask personal questions?
What is your occupation?
Who is at home with you?
Do you have any difficulty with the stairs?
Do you smoke? How many packs/ day
Do you drink alcohol? How many units/ week
Is there anyone else in the family has had a similar problem?
Before I go any further, could I ask?
What do you think the cause is?
What are you the most concerned about?
What are you hoping us to do for you?
resp., cvs: is there any chest pain, SOB, cough
Urinary: any problems in passing urine?
Rheumatic: any muscle or joint pain?
Anything else you want to add?
Thank you.
(Positive findings)
(Chronic epigastric pain addict to alcohol, patient take morphine for pain)

38

HISTORY TAKING
 History taking

(Questions)
What do you think about the history of taking 30 mg of morphine, what should
be the normal dose?
15-30 mg /4hours as needed
Investigations:
- Secretin stimulation test
- Serum amylase and lipase (elevated)
- Serum trypsinogen
- CT scan (pancreatic calcifications)
- MRCP: identify the presence of biliary obstruction and the state of the
pancreatic duct
- Endoscopic ultrasound
Treatment:
Medical treatment of chronic pancreatitis:
1- Treat the addiction: ■ Help the patient to stop alcohol consumption and
tobacco smoking
■ Involve a dependency counsellor or a psychologist
2-Alleviate abdominal pain:
■ Eliminate obstructive factors (duodenum, bile duct, pancreatic duct)
■ Escalate Analgesia in a stepwise fashion
■ Refer to a pain management specialist
■ for intractable pain, consider CT/EUS-guided coeliac axis block
3- Nutritional and digestive measures:
■ Diet: low in fat and high in protein and carbohydrates
■ Pancreatic enzyme supplementation with meals
■ Correct malabsorption of the fat-soluble vitamins (A, D, E, K) and vitamin B12

39

HISTORY TAKING
 History taking

■ Medium-chain triglycerides in patients with severe fat malabsorption (they

are directly absorbed
By the small intestine without the need for digestion)
■ reducing gastric secretions may help Treat diabetes mellitus
4- Treat DM
The role of surgery is to overcome obstruction and remove mass lesions

40

HISTORY TAKING
 History taking

Hematuria
Hello. I am Mahmoud Bazeed one of the exam candidate
May I confirm your name and age please?
Nice to meet you Mr. …. Today I’ve been asked to ask you few questions
regarding your condition, are you OK with this?
How can I help you today?
I am so sorry to hear that.
(Onset, course, duration, severity, aggravating and relieving factors and
associated factors)
When you did first noted this?
Is it only when you pass urine? Is there any chance it could be coming from
elsewhere? What colour is it? Have you recently eaten any beetroot?
Did this started suddenly or gradually?
Does this bleeding comes and goes. Does it get previously worse?
Is there anything makes this bleeding stops?
Is there anything makes that bleeding increases?
Is there always blood in your urine or does it come and go? Have you had this
before?
Is the blood present at the start of urination, the end or throughout?
Do you pass any clots?
(Associated factors for differential diagnosis)
1. Bladder cancer:
How has your appetite been?
Have you noticed any unintentional weight loss? How many kilos over how long?
Any pain in your tummy or back?

2. UTI / stones

41

HISTORY TAKING
 History taking

Do you have any pain when you pass urine? Any pain in your tummy or back? If
so, SOCRATES
(SOCRATES) analysis of pain
Where did you feel that pain? Could please point to the site?
Does it move anywhere?
When did you first notice that pain?
Did it start suddenly or gradually?
Did it come and go? Has this changed recently?
Is there any specific time during the day that the pain increase?
Is there anything makes this pain stops?
Is there anything makes that pain increases?
Could please describe that pain for me? Is it colicky, cramping, or stabbing?
How badly is this affecting your day-to-day life?
If you had to rate the pain from 1 to 10, with 10 being the worst pain you can
imagine, how would you rate it?
How many times do you go to toilet to pass urine during daytime?
Do you get sudden irrepressible urges to pass water?
Have you been unwell recently, or had any fever or chills?
3. Bleeding tendency
Have you noticed bleeding from any other orifices?
4. Trauma:
Have you had any trauma to your tummy or groin recently?
5. BPH:
How often do you get up at night to pass urine?
Do you have difficulty getting the stream started?
Is there prolonged dribbling at the end?
Is your stream powerful or weak?

42

HISTORY TAKING
 History taking

(Past medical or surgical history, Drug history, Family history, Ideas, concerns
and expectations, other system review)
Do you have any other medical conditions, see your GP for anything, ever had
surgeries?
Do you take any medications? Dose? Do you have any allergy against any drug?
Do you mind if I ask personal questions?
What is your occupation?
Who is at home with you?
Do you have any difficulty with the stairs?
Do you smoke? How many packs/ day
Do you drink alcohol? How many units/ week
Is there anyone else in the family has had a similar problem?
Before I go any further, could I ask?
What do you think the cause is?
What are you the most concerned about?
What are you hoping us to do for you?
resp., cvs: is there any chest pain, SOB, cough
Rheumatic: any muscle or joint pain?
Anything else you want to add?
Thank you
(Order of questions)
Hello. I am Mahmoud Bazeed one of the exam candidate
May I confirm your name and age please?
Nice to meet you Mr. …. Today I’ve been asked to ask you few questions
regarding your condition, are you OK with this?
How can I help you today?
I am so sorry to hear that.

43

HISTORY TAKING
 History taking

When you did first noted this?

Is it only when you pass urine? Is there any chance it could be coming from
elsewhere? What color is it? Have you recently eaten any beetroot?
Did this started suddenly or gradually?
Does this bleeding comes and goes. Does it get previously worse?
Is there anything makes this bleeding stops?
Is there anything makes that bleeding increases?
Is there always blood in your urine or does it come and go? Have you had this
before?
Is the blood present at the start of urination, the end or throughout?
Do you pass any clots?
Have you noticed bleeding from any other orifices?
Do you have any pain when you pass urine? Any pain in your tummy or back? If
so, SOCRATES
(SOCRATES) analysis of pain
Where did you feel that pain? Could please point to the site?
Does it move anywhere?
When did you first notice that pain?
Did it start suddenly or gradually?
Did it come and go? Has this changed recently?
Is there any specific time during the day that the pain increase?
Is there anything makes this pain stops?
Is there anything makes that pain increases?
Could please describe that pain for me? Is it colicky, cramping, or stabbing?
How badly is this affecting your day-to-day life?

44

HISTORY TAKING
 History taking

If you had to rate the pain from 1 to 10, with 10 being the worst pain you can
imagine, how would you rate it?
How many times do you go to toilet to pass urine during daytime?
Do you get sudden irrepressible urges to pass water?
Have you been unwell recently, or had any fever or chills?
How often do you get up at night to pass urine?
Do you have difficulty getting the stream started?
Is there prolonged dribbling at the end?
Is your stream powerful or weak?
Have you had any trauma to your tummy or groin recently?
How has your appetite been?
Have you noticed any unintentional weight loss? How many kilos over how long?
Do you have any other medical conditions, see your GP for anything, ever had
surgeries?
Do you take any medications? Dose? Do you have any allergy against any drug?
Do you mind if I ask personal questions?
What is your occupation?
Who is at home with you?
Do you have any difficulty with the stairs?
Do you smoke? How many packs/ day
Do you drink alcohol? How many units/ week
Is there anyone else in the family has had a similar problem?
Before I go any further, could I ask?
What do you think the cause is?
What are you the most concerned about?
What are you hoping us to do for you?
resp., cvs: is there any chest pain, SOB, cough

45

HISTORY TAKING
 History taking

Rheumatic: any muscle or joint pain?

Anything else you want to add?
Thank you
(Positive findings)
(Painless total hematuria, weight loss, anorexia and work in dye factory)
(Questions)
Management:
- Urine dipstick to confirm hematuria, assess infection, send a sample for
cytology
- Bloods: FBC, U&E, clotting screen, PSA
- Cystoscopy and biopsy
- U/s, CT
Treatment:
Depends on the stage and the grade of the tumor
- Surgical: TURBT, Radical cystectomy
- Non- surgical: chemotherapy and radiotherapy and immunotherapy

46

HISTORY TAKING
 History taking

Chronic Urine Retention

Hello. I am Mahmoud Bazeed one of the exam candidate
May I confirm your name and age please?
Nice to meet you Mr. …. Today I’ve been asked to ask you few questions
regarding your condition, are you OK with this?
How can I help you today?
I am so sorry to hear that.
(Onset, course, duration, severity, aggravating and relieving factors and
associated factors)
Did this started suddenly or gradually?
When you did first noted this?
Is there anything makes this difficulty stops?
Is there anything makes that difficulty increases?
(Associated factors for differential diagnosis)
1. BPH:
How often do you get up at night to pass urine?
Do you have difficulty getting the stream started?
Is there prolonged dribbling at the end?
Is your stream powerful or weak?
2. Prostatic cancer:
How has your appetite been?
Have you noticed any unintentional weight loss? How many kilos over how long?
Have you noticed back pain?
Do you have any problems with erections recently?
3. Bladder cancer:
Any redness or blood in your urine? If present

47

HISTORY TAKING
 History taking

When you did first noted this?

Is it only when you pass urine? Is there any chance it could be coming from
elsewhere? What color is it? Have you recently eaten any beetroot?
Did this started suddenly or gradually?
Does this bleeding comes and goes. Does it get previously worse?
Is there anything makes this bleeding stops?
Is there anything makes that bleeding increases?
Is there always blood in your urine or does it come and go? Have you had this
before?
Is the blood present at the start of urination, the end or throughout?
Do you pass any clots?
4. UTI /stones:
Do you have any pain when you pass urine? Any pain in your tummy or back? If
so, SOCRATES
(SOCRATES) analysis of pain
Where did you feel that pain? Could please point to the site?
Does it move anywhere?
When did you first notice that pain?
Did it start suddenly or gradually?
Did it come and go? Has this changed recently?
Is there any specific time during the day that the pain increase?
Is there anything makes this pain stops?
Is there anything makes that pain increases?
Could please describe that pain for me? Is it colicky, cramping, or stabbing?
How badly is this affecting your day-to-day life?
If you had to rate the pain from 1 to 10, with 10 being the worst pain you can
imagine, how would you rate it?

48

HISTORY TAKING
 History taking

How many times do you go to toilet to pass urine during daytime?

Do you get sudden irrepressible urges to pass water?
Have you been unwell recently, or had any fever or chills?

5. Neurological causes:
Have you noticed numb leg? Weak legs?
6. Urethral stricture:
Same questions as BPH
(Past medical or surgical history, Drug history, Family history, Ideas, concerns
and expectations, other system review)
Do you have any other medical conditions, see your GP for anything, ever had
surgeries?
Do you take any medications? Dose? Do you have any allergy against any drug?
Do you mind if I ask personal questions?
What is your occupation?
Who is at home with you?
Do you have any difficulty with the stairs?
Do you smoke? How many packs/ day
Do you drink alcohol? How many units/ week
Is there anyone else in the family has had a similar problem?
Before I go any further, could I ask?
What do you think the cause is?
What are you the most concerned about?
What are you hoping us to do for you?
resp., cvs: is there any chest pain, SOB, cough
Rheumatic: any muscle or joint pain?
Anything else you want to add? Thank you

49

HISTORY TAKING
 History taking

(Order of questions)
Hello. I am Mahmoud Bazeed one of the exam candidate.
May I confirm your name and age please?
Nice to meet you Mr. …. Today I’ve been asked to ask you few questions
regarding your condition, are you OK with this?
How can I help you today?
I am so sorry to hear that.
Did this start suddenly or gradually?
When you did first noted this?
Is there anything makes this difficulty stops?
Is there anything makes that difficulty increases?
How often do you get up at night to pass urine?
Do you have difficulty getting the stream started?
Is there prolonged dribbling at the end?
Is your stream powerful or weak?
Any redness or blood in your urine? If present

When you did first noted this?

Is it only when you pass urine? Is there any chance it could be coming from
elsewhere? What color is it? Have you recently eaten any beetroot?
Did this started suddenly or gradually?
Does this bleeding comes and goes. Does it get previously worse?
Is there anything makes this bleeding stops?
Is there anything makes that bleeding increases?
Is there always blood in your urine or does it come and go? Have you had this
before?
Is the blood present at the start of urination, the end or throughout?
Do you pass any clots?

50

HISTORY TAKING
 History taking

Where did you feel that pain? Could please point to the site?
Does it move anywhere?
When did you first notice that pain?
Did it start suddenly or gradually?
Did it come and go? Has this changed recently?
Is there any specific time during the day that the pain increase?
Is there anything makes this pain stops?
Is there anything makes that pain increases?
Could please describe that pain for me? Is it colicky, cramping, or stabbing?
How badly is this affecting your day-to-day life?
If you had to rate the pain from 1 to 10, with 10 being the worst pain you can
imagine, how would you rate it?
How many times do you go to toilet to pass urine during daytime?
Do you get sudden irrepressible urges to pass water?
Have you been unwell recently, or had any fever or chills?
Do you have any problems with erections recently?
Have you noticed back pain?
How has your appetite been?
Have you noticed any unintentional weight loss? How many kilos over how long?
Have you noticed numb leg? Weak legs?
Do you have any other medical conditions, see your GP for anything, ever had
surgeries?
Do you take any medications? Dose? Do you have any allergy against any drug?
Do you mind if I ask personal questions?
What is your occupation?
Who is at home with you?
Do you have any difficulty with the stairs?

51

HISTORY TAKING
 History taking

Do you smoke? How many packs/ day

Do you drink alcohol? How many units/ week
Is there anyone else in the family has had a similar problem?
Before I go any further, could I ask?
What do you think the cause is?
What are you the most concerned about?
What are you hoping us to do for you?
resp., cvs: is there any chest pain, SOB, cough
Rheumatic: any muscle or joint pain?
Anything else you want to add?
Thank you
(Positive findings)
(Urine retention and use of nasal spray containing alpha blocker)
(Questions)
Management:
Investigations:
- Full clinical examination including DRE
- Bloods: PSA, Urine analysis, U&E
- Imaging: abdominal u/s, Trans rectal u/s
Treatment:
Medical:
- Tamsulin (1alpha adrenergic blocker)
- Finasteride (5 alpha reductase inhibitor)
Surgical:
TURP

52

HISTORY TAKING
 History taking

Impotence
Hello. I am Mahmoud Bazeed one of the exam candidate
May I confirm your name and age please?
Nice to meet you Mr. …. Today I’ve been asked to ask you few questions
regarding your condition including personal questions, I am here to help you and
everything you will tell me will be confidential, are you OK with this?
Ask for chaperon. Look for the examiner and say: Can I have a chaperon here?
How can I help you today?
I am so sorry to hear that.
(Onset, course, duration, severity, aggravating and relieving factors and
associated factors) and specific questions for organic causes:
Do you have difficulty obtaining an erection?
Did this started suddenly or gradually?
When you did first noted this?
Is there anything makes this difficulty improve?
Is there anything makes that difficulty getting worse?
Do you experience nocturnal/ morning erections?
Is the erection suitable for penetration?
Can the penetration be maintained until partner has achieved orgasm?
Does ejaculation occur & if yes, is it premature?
Do both partners experience sexual satisfaction?
Is their associated pain/ discomfort - if yes, were, etc.?
Is penile curvature a problem?
Psychological history:
Have you noticed any episodes of feeling down?
Have you had any difficulties in getting to sleep?
Have you been feeling overly tired?

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Have you noticed a change in your appetite?

Have you noticed a change in your libido?
Is there any problems/ tension in sexual relationship? Any stress from work/
other sources like Family or social pressures?
Any anxiety related to performance?
Sexual history
Are you married?
When was your last sexual contact?
Do you use contraceptive?
Was there any previous sexual contacts in the last3months?
(Past medical or surgical history, Drug history, Family history, Ideas, concerns
and expectations, other system review)
Do you have any other medical conditions, see your GP for anything, Any history
of pelvic surgery/ trauma, previous prostate surgery, irradiation to prostate?
Any past history of:
Thyroid dysfunction, Hypertension, Rheumatic, Epilepsy, Asthma, Diabetes,
Stroke, MI, Jaundice ever had surgeries?
Do you take any medications? Antihypertensive, anti-ulcer (e.g. PPI), lipid
lowering, 5a-reductaseAntidepressants, testosterone anabolic steroids Dose?
Do you have any allergy against any drug?
What is your occupation?
Who is at home with you?
Do you have any difficulty with the stairs?
Do you smoke? How many packs/ day
Do you drink alcohol? How many units/ week
Is there anyone else in the family has had a similar problem?
Before I go any further, could I ask?
What do you think the cause is?

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 History taking

What are you the most concerned about?

What are you hoping us to do for you?
Cardiovascular
Chest pain, Sob, orthopnea, palpitations, dizziness, ankle swelling
Respiratory
Sob, exercise tolerance, PND, wheeze, chest pain, cough, hemoptysis,
Hoarseness
Gastrointestinal
Change in appetite/ diet, Kg loss, dysphagia, odynophagia, change in bowels
Urogenital
Abdominal pain, F of micturition, dysuria, urgency, polyuria, hematuria
CNS & PNS
Fits, faints, headache, LoC, tremor, m. weakness, paralysis, sensory changes
MSK
Muscle/ bone/ joint pain, deformity, swelling, stiffness, limb weakness
Metabolic system
Change in BMI/ appetite, alteration in build/ appearance?
Anything else you want to add?
Thank you
Positive findings
(Social stress, atenolol, smoker and hypertensive)
(Questions)
Investigations:
- Hematology: FBC, erythrocyte sedimentation rate, hematinic, clotting screen,
group & save. -
- Glycated hemoglobin (cardiovascular risk assessment).

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 History taking

- • Biochemistry: U&Es, LFTs, CRP, lipid profile.

- • Prostate specific antigen (if relevant history).
- • Serum free testosterone.
- • Serum prolactin.
- • Serum FSH / LH.
- • ACTH (synacthen) stimulation test.
- • Urinalysis: Microscopy to exclude a genitourinary cause.
- • Radiology: –Duplex ultrasonography to assess vascular function of the penis.
Ultrasonography of the testes to exclude any abnormality.
- –Trans rectal ultrasonography to exclude any pelvic or prostatic abnormality.
- Angiography: It can be useful for planning vascular procedures /
reconstruction, particularly following trauma.
- Injection of prostaglandin E1: This outpatient investigation includes the
injection of prostaglandin
E1 directly into the corpora cavernosa and to assess rigidity after ten minutes.
While it can help to evaluate the vasculature, a positive result may still be found
with mild vascular disease. It can also be utilized to assess penile deformities to
aid planning of surgical correction.
Treatment:
- Risk factor modification by controlling lipidaemia and diabetes, weight loss,
smoking cessation, increase exercise.
- Phosphodiesterase-5 inhibitor therapy (sildenafil)
- Intercavernous injection therapy (alprostadil)
- Placement of a penile prosthesis which may take the form of either a semi rigid
or inflatable implant.

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 History taking

Depression
You have been asked to take history from depressed patient hospitalized due
to gastrectomy due to bladder cancer, so you will not ask for name or age or
Past medical or surgical history, Drug history, Family history, Ideas, concerns
and expectations, other system review.
Hello Mr.…. I am Mahmoud Bazeed one of the exam candidate. How have you
been feeling recently?
Core symptoms of depression (depression, anhedonia and fatigue)
In the past days during your hospital stay have you.

Felt down, depressed or hopeless?

Found that you no longer enjoy, or find little pleasure in life?
Been feeling overly tired?
Biological symptoms of depression:
Sleep cycle:
How has your sleep pattern been recently?
Have you had any difficulties in getting to sleep?
Do you find you wake up early, and find it difficult to get back to sleep?
Mood:
Are there any particular times of day that you notice your mood is worse?
Does your mood vary throughout the day?
Do you find that your mood gradually worsens throughout a day?
Appetite:
Have you noticed a change in your appetite?
What is your diet like at the moment?
What are you eating in a typical day?
Libido:
Have you noticed a change in your libido?

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 History taking

Since you have been feeling this way, have you noticed a difference in your sex
drive?
Past psychiatric History:
Previous episodes of depression or dysthymia:
Have you ever felt like this before?
Have you ever had any other periods of feeling particularly low?
In the past, have you had any problems with your mental health?
Have you had any counselling for any issues before?
Have you ever been admitted to hospital because of your mental health? If so,
obtain details –time, method of admission, result.
Positive finding
(Positive core and biological symptoms of depression)
(Questions)
Management:
Mild:
- Regular exercise
- Advice on sleep hygiene (regular sleep times, appropriate environment)
- Psychosocial therapy –CBT
Moderate to severe:
- Regular exercise, advice on sleep hygiene,
- CBT
- Medication –SSRIs
- High-intensity psychosocial intervention (CBT or interpersonal therapy)
- Immediate and considerable high risk to themselves or others: Admit to
psychiatric ward (use Mental Health Act if necessary)

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 History taking

Dementia
You have been asked to take history from female patient hospitalized due to
THA, nurse noted confusion, so you will not ask for name or age or Past
medical or surgical history, Drug history, Family history, Ideas, concerns and
expectations, other system review.
Hello, I’m Mahmoud Bazeed One of exam candidate, how are you today?
-Would you mind if I asked you some questions to test your memory?
Abbreviated mental test scoring:
How old are you?
What time is it to the nearest hour?
Can you remember this address? 24 West St. I will ask you this at the end
What year is it?
What is the name of this place?
What is my job? And what is the job of this person (e.g. a nurse)?
What is your date of birth?
When did WW2 end?
Who is the current prime minister?
Can you count backwards from 20-1?
What was that address I asked you to remember?
Positive findings
Score < 6 suggests dementia or delirium to complete my assessment of the
patient I will do MMSE (mini mental state examination).
The patient has acute confusion with het AMTS SCORE of 2/10 which suggests
delirium or dementia

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 History taking

(Questions)
What is your differential diagnosis?

Management:
Observations:
• Early Warning Scores can be useful
• BP / Pulse – ↓BP ↑Pulse may indicate sepsis / dehydration
• Temperature, respiratory rate and oxygen sats are all important diagnostic
clues.
CT head:
• Ischemic stroke
• Intracranial bleeds (from trauma or spontaneous)

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 History taking

• Space occupying lesions

Bloods:
• FBC – white cells for signs of infection, anemia, increased MCV (macrocytic
anemia can be caused by B12 or folate deficiency which can have a variety of
origins: leukemias, alcohol use, lack of intake, lack of absorption (i.e. post-
gastrectomy), pernicious anaemia; hypothyroidism, liver disease.)
• U&E – deranged electrolytes can cause confusion (consider sodium, but
relative to what is normal for the patient).
• LFTs – confusion can be caused by liver failure, malnutrition or be based on
the background of alcohol abuse.
• INR – can be useful to know if the patient is on Warfarin & you are concerned
about intracranial bleeding
• TFTs – confusion is more common in hypothyroid states.
• Calcium – Hypercalcemia often causes confusion/delirium – Bones, moans,
psychotic groans
• B12 + folate/hematinic – macrocytic anemias, and B12/folate deficiency can
compound confusion
• Glucose – hypoglycemia is a common cause of confusion
CXR – As part of a sepsis screen to identify infection source –? Pneumonia
Blood cultures if appropriate – as part of sepsis screen
Urine dipstick/culture – UTI is a very common cause of delirium in the elderly
History: take history from the patient (as possible), from the notes, from her
relatives
Fitness for the operation?
Not fit for giving a consent, as she cannot retain information and she cannot
make an informed decision
Should the operation go ahead?
No. The operation is non urgent, therefore it can be postponed until the cause
of the confusion has resolved. I would talk to my consultant and the anesthetist

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in charge of the case to inform them of the confusion and ask their advice before
cancelling it.
If the cause of confusion was only senile dementia, how you will consent for
the operation?
As the patient lack capacity, consent should be recorded using consent form 4
with 2 consultant signatures

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 History taking

Seizures
Hello. I am Mahmoud Bazeed one of the exam candidate
May I confirm your name and age please?
Nice to meet you Mr. …. Today I’ve been asked to ask you few questions
regarding your condition, are you OK with this?
How can I help you today?
I am so sorry to hear that
Analysis of seizures
1. Description
Can you talk me through what happened exactly?
Where and when?
What were you doing at the time?
Did anyone witness the episode? How did they describe the episode?
Did you trip over anything or slip?
2. Date of first seizure (early for epilepsy or late for brain tumors)
When did you first experience you first seizure?
3. Aura
How did you feel immediately before the episode? Chest pain, anxious or
Fearful? Did you have any warning that something was about to happen?
4. Ictal manifestation
Did you lose consciousness? How long for?
Did you hit your head?
Did your whole body shake or only part of it?
Did you bite your tongue?
Did you wet or soil yourself?

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Have you noticed head or eye deviation toward one side? (Frontal lobe),
excessive eye blinking (occipital lobe) or lip smacking (temporal lobe)
5. Post ictal
How did you feel immediately after the fall/when you regained consciousness?
Were you confused? Drowsy? Aching muscles? Unable to speak?
6. Previous episodes
Has something like this ever happened before? If yes, can you describe exactly
what happened those times?
7. Diurnal variation (morning for epilepsy late for frontal lobe)
Did it occur in morning time or night time?
8. Triggering factors
Have you noticed that those fits occurs with events like sleep disturbance.
Alcohol consumption, having a fever or with certain medications?
9. Frequency
How frequent do you experience your fits?
How many times per week?
11. past medical history:
Have been investigated before for of CNS infections (meningitis, encephalitis),
head injuries, brain tumors or cerebrovascular disease?
12. Signs of brain tumors
Have you had any arm or leg weakness?
Any visual disturbances?
Any other sensory disturbance?
Did you throw up?
How has your appetite been?
Have you noticed any unintentional weight loss? How many kilos over how long?

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(Past medical or surgical history, Drug history, Family history, Ideas, concerns
and expectations, other system review)
Do you have any other medical conditions, see your GP for anything, ever had
surgeries?
Do you take any medications? Dose? Do you have any allergy against any drug?
Do you mind if I ask personal questions?
What is your occupation?
Who is at home with you?
Do you have any difficulty with the stairs?
Do you smoke? How many packs/ day
Do you drink alcohol? How many units/ week
Is there anyone else in the family has had a similar problem?
Before I go any further, could I ask?
What do you think the cause is?
What are you the most concerned about?
What are you hoping us to do for you?
resp., cvs: is there any chest pain, SOB, cough
Rheumatic: any muscle or joint pain?
Anything else you want to add?
Thank you
(Order of questions)
Hello. I am Mahmoud Bazeed one of the exam candidate
May I confirm your name and age please?
Nice to meet you Mr. …. Today I’ve been asked to ask you few questions
regarding your condition, are you OK with this?
How can I help you today?
I am so sorry to hear that

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 History taking

Can you talk me through what happened exactly?

Where and when?
What were you doing at the time?
Did anyone witness the episode? How did they describe the episode?
Did you trip over anything or slip?
When did you first experience you first seizure?
How did you feel immediately before the episode? Chest pain, anxious or
Fearful? Did you have any warning that something was about to happen?
Did you lose consciousness? How long for?
Did you hit your head?
Did your whole body shake or only part of it?
Did you bite your tongue?
Did you wet or soil yourself?
Have you noticed head or eye deviation toward one side? (Frontal lobe),
excessive eye blinking (occipital lobe) or lip smacking (temporal lobe)
How did you feel immediately after the fall/when you regained consciousness?
Were you confused? Drowsy? Aching muscles? Unable to speak?
Has something like this ever happened before? If yes, can you describe exactly
what happened those times?
Did it occur in morning time or night time?
Have you noticed that those fits occurs with events like sleep disturbance.
Alcohol consumption, having a fever or with certain medications?
How frequent do you experience your fits?
How many times per week?
Have been investigated before for of CNS infections (meningitis, encephalitis),
head injuries, brain tumors or cerebrovascular disease?
Have you had any arm or leg weakness?

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Any visual disturbances?

Any other sensory disturbance?
Did you throw up?
How has your appetite been?
Have you noticed any unintentional weight loss? How many kilos over how long?
Do you have any other medical conditions, see your GP for anything, ever had
surgeries?
Do you take any medications? Dose? Do you have any allergy against any drug?
Do you mind if I ask personal questions?
What is your occupation?
Who is at home with you?
Do you have any difficulty with the stairs?
Do you smoke? How many packs/ day
Do you drink alcohol? How many units/ week
Is there anyone else in the family has had a similar problem?
Before I go any further, could I ask?
What do you think the cause is?
What are you the most concerned about?
What are you hoping us to do for you?
resp., cvs: is there any chest pain, SOB, cough
Rheumatic: any muscle or joint pain?
Anything else you want to add?
Thank you
(Positive finding)
(Focal seizures, RT arm shaking, not generalized, late onset, no post ictal
manifestation negative past history of epilepsy)

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(Questions)
Investigations
- Blood glucose
- CBCD
- Electrolytes, BUN, creatinine, calcium, magnesium, anion gap, lactate,
prolactin (will be elevated after seizure, sometimes used if not sure if event was
a seizure)
- ABG, U/A, LP
- CT head if trauma, suspected intracranial hemorrhage, suspected structural
lesion in first time seizure, prolonged altered mental status, focal neurological
deficit, anticoagulated patient, HIV/Cancer patients
- If infection – may require full septic w/u (LP, cultures, etc)
- EEG – most likely to be done as an outpatient
- MRI – in consultation with neurology
Treatment
- If the patient is seizing
Move to safe place
Turn to side (recovery position) if possible
Observation for specific activity and progression and duration
Prepare to assess/monitor once seizure subsides (ABC’s)
Consider treatment if patient is in status
Postictal
Seizure precautions
ABC’s and monitors, O2
Benzodiazepines may be used to prevent further seizures
Consider anticonvulsant therapy
Phenytoin (Dilantin) 300-600mg PO tid

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Phenobarbital 60-200mg PO daily

Valproic acid (Epival) 15-60mg/kg daily divided bid or tid
Carbamazepine (Tegretol) 400-1200mg daily divided tid/qid
Status epilepticus – 30+min of active seizing or no recovery/consciousness
between
IV line, O2, monitors
Consider intubation
Benzodiazepines (diazepam 10-20mg IV, or lorazepam 4-8mg IV)
Phenytoin 18-20mg/kg IV @ 25mg/min
- Stereotactic biopsy and resection or debunking of brain tumors

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Headache
Hello. I am Mahmoud Bazeed one of the exam candidate
May I confirm your name and age please?
Nice to meet you Mr. …. Today I’ve been asked to ask you few questions
regarding your condition, are you OK with this?
(Patient can’t speak because of the headache and photophobia)
Do you need analgesic?
Do you want me to switch off the light? So sorry to see you like that.
How can I help you today?
I am so sorry to hear that.
(Site, Onset, course, duration, character, radiation, timing, severity,
aggravating and relieving factors and associated factors)
(SOCRATES) analysis of pain
Where did you feel that pain? Could please point to the site? Frontal, occipital,
temporal, unilateral, all over
Does it move anywhere?
When did you first notice that pain?
Did it start suddenly or gradually?
Did it come and go? Has this changed recently?
Is there any specific time during the day that the pain increase?
Is there anything makes this pain stops?
Is there anything makes that pain increases?
Could please describe that pain for me? Is it colicky, cramping, or stabbing?
How badly is this affecting your day-to-day life?
If you had to rate the pain from 1 to 10, with 10 being the worst pain you can
imagine, how would you rate it?

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(Associated factors for differential diagnosis)

1. Subarachnoid hemorrhage
Have you banged your head, had a fall recently?
Are you sensitive to light?
Do you have any neck stiffness?
2. Meningitis
Have you noticed a rash anywhere?
Have you been feeling ill or had a fever?
3. Brain tumors
Have you ever had seizures or blacked out?
Have you ever lost consciousness?
Have you had any arm or leg weakness?
Any visual disturbances?
Any other sensory disturbance?
Did you throw up?
How has your appetite been?
Have you noticed any unintentional weight loss? How many kilos over how long?
(Past medical or surgical history, Drug history, Family history, Ideas, concerns
and expectations, other system review)
Do you have any other medical conditions, see your GP for anything, ever had
surgeries?
Do you take any medications? Dose? Do you have any allergy against any drug?
Do you mind if I ask personal questions?
What is your occupation?
Who is at home with you?
Do you have any difficulty with the stairs?
Do you smoke? How many packs/ day

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Do you drink alcohol? How many units/ week

Is there anyone else in the family has had a similar problem?
Before I go any further, could I ask?
What do you think the cause is?
What are you the most concerned about?
What are you hoping us to do for you?
resp., cvs: is there any chest pain, SOB, cough
Rheumatic: any muscle or joint pain?
Anything else you want to add?
Thank you
(Order of questions)
Hello. I am Mahmoud Bazeed one of the exam candidate
May I confirm your name and age please?
Nice to meet you Mr. …. Today I’ve been asked to ask you few questions
regarding your condition, are you OK with this?
Do you need analgesic?
Do you want me to switch off the light? So sorry to see you like that.
How can I help you today?
I am so sorry to hear that.
Where did you feel that pain? Could please point to the site? Frontal, occipital,
temporal, unilateral, all over
Does it move anywhere?
When did you first notice that pain?
Did it start suddenly or gradually?
Did it come and go? Has this changed recently?
Is there any specific time during the day that the pain increase?
Is there anything makes this pain stops?

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Is there anything makes that pain increases?

Could please describe that pain for me? Is it colicky, cramping, or stabbing?
How badly is this affecting your day-to-day life?
If you had to rate the pain from 1 to 10, with 10 being the worst pain you can
imagine, how would you rate it?
Are you sensitive to light?
Do you have any neck stiffness?
Have you ever had seizures or blacked out?
Have you ever lost consciousness?
Have you had any arm or leg weakness?
Any visual disturbances?
Any other sensory disturbance?
Have you noticed a rash anywhere?
Have you been feeling ill or had a fever?
How has your appetite been?
Have you noticed any unintentional weight loss? How many kilos over how long?
Did you throw up?
Have you banged your head, had a fall recently?
Do you have any other medical conditions, see your GP for anything, ever had
surgeries?
Do you take any medications? Dose? Do you have any allergy against any drug?
Do you mind if I ask personal questions?
What is your occupation?
Who is at home with you?
Do you have any difficulty with the stairs?
Do you smoke? How many packs/ day
Do you drink alcohol? How many units/ week

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 History taking

Is there anyone else in the family has had a similar problem?

Before I go any further, could I ask?
What do you think the cause is?
What are you the most concerned about?
What are you hoping us to do for you?
resp., cvs: is there any chest pain, SOB, cough
Rheumatic: any muscle or joint pain?
Anything else you want to add?
Thank you
(Positive findings)
(Headache with photophobia, polycystic kidney, positive family history of brain
aneurysm)
(Questions)
Management:
I would manage him in an ABC manner, ensuring that he is stable and arrange
appropriate bloods and a plain CT head.
Investigations:
- CT BRAIN
- CSF Tapping
Treatment:
- I would refer this patient to a neurosurgical unit.
- Bed rest, 3L of IV fluids /24h.
- Oral nimodipine 60mg every 4 hours, and laxatives
- Attempt to coil the aneurysm is made
- Burr holes
- Craniotomy
- Discuss in neurovascular MDT

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 History taking

Chest pain
Hello. I am Mahmoud Bazeed one of the exam candidate
May I confirm your name and age please?
Nice to meet you Mr. …. Today I’ve been asked to ask you few questions
regarding your condition, are you OK with this?
How can I help you today?
I am so sorry to hear that.
(Site, Onset, course, duration, character, radiation, timing, severity,
aggravating and relieving factors and associated factors)
(SOCRATES) analysis of pain
Where did you feel that pain? Could please point to the site?
Does it move anywhere?
When did you first notice that pain?
Did it start suddenly or gradually?
Did it come and go? Has this changed recently?
Is there any specific time during the day that the pain increase?
Is there anything makes this pain stops?
Is there anything makes that pain increases?
Could please describe that pain for me? Is it colicky, cramping, or stabbing?
How badly is this affecting your day-to-day life?
If you had to rate the pain from 1 to 10, with 10 being the worst pain you can
imagine, how would you rate it?
(Associated factors for differential diagnosis)
1. Pulmonary embolism
Have you noticed a cough? Do you bring anything up? Any blood?
Do you get breathless?
Have you had a recent surgery?

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Have you noticed painful legs?

2. Chest infection
Have you been ill or having a fever?
Do you get wheezy chest?
3. Chest malignancy
How has your appetite been?
Have you noticed any unintentional weight loss? How many kilos over how long?
4. MI
Do you ever get breathless when lying flat?
How many pillows do you sleep with at night?
Do you ever wake up gasping for breath?
5. Musculoskeletal
Is the pain worse on movement? Does it hurt to press on the area?
(Past medical or surgical history, Drug history, Family history, Ideas, concerns
and expectations, other system review)
Do you have any other medical conditions, see your GP for anything, ever had
surgeries?
Do you take any medications? Dose? Do you have any allergy against any drug?
Do you mind if I ask personal questions?
What is your occupation?
Who is at home with you?
Do you have any difficulty with the stairs?
Do you smoke? How many packs/ day
Do you drink alcohol? How many units/ week
Is there anyone else in the family has had a similar problem?
Before I go any further, could I ask?
What do you think the cause is?

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 History taking

What are you the most concerned about?

What are you hoping us to do for you?
Urogenital Abdominal pain, F of micturition, dysuria, urgency, polyuria,
hematuria
Rheumatic: any muscle or joint pain?
Anything else you want to add?
Thank you
(Order of questions)
Hello. I am Mahmoud Bazeed one of the exam candidate
May I confirm your name and age please?
Nice to meet you Mr. …. Today I’ve been asked to ask you few questions
regarding your condition, are you OK with this?
How can I help you today?
I am so sorry to hear that.
Where did you feel that pain? Could please point to the site?
Does it move anywhere?
When did you first notice that pain?
Did it start suddenly or gradually?
Did it come and go? Has this changed recently?
Is there any specific time during the day that the pain increase?
Is the pain worse on movement? Does it hurt to press on the area?
Is there anything makes this pain stops?
Is there anything makes that pain increases?
Could please describe that pain for me? Is it colicky, cramping, or stabbing?
How badly is this affecting your day-to-day life?
If you had to rate the pain from 1 to 10, with 10 being the worst pain you can
imagine, how would you rate it?

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Have you noticed a cough? Do you bring anything up? Any blood?
Do you get breathless?
Have you been ill or having a fever?
Do you get wheezy chest?
Do you ever get breathless when lying flat?
How many pillows do you sleep with at night?
Do you ever wake up gasping for breath?
How has your appetite been?
Have you noticed any unintentional weight loss? How many kilos over how long?
Have you had a recent surgery?
Have you noticed painful legs?
Do you have any other medical conditions, see your GP for anything, ever had
surgeries?
Do you take any medications? Dose? Do you have any allergy against any drug?
Do you mind if I ask personal questions?
What is your occupation?
Who is at home with you?
Do you have any difficulty with the stairs?
Do you smoke? How many packs/ day
Do you drink alcohol? How many units/ week
Is there anyone else in the family has had a similar problem?
Before I go any further, could I ask?
What do you think the cause is?
What are you the most concerned about?
What are you hoping us to do for you?
resp., cvs: is there any chest pain, SOB, cough

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Urogenital Abdominal pain, F of micturition, dysuria, urgency, polyuria,

hematuria
Anything else you want to add?
Thank you
(Positive findings)
(Sudden chest pain, stabbing, increase by breathing, sever and no history of
trauma)
(Questions)
Management:
Investigations:
- CTPA
- V/Q scan
- CXR
- ECG
- ABG
Treatment:
- ABC PROTOCOL
- Non massive: heparin until APTT 50-60 sec.
- Massive: thrombolysis/ embolectomy

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Shortness of breath (SOB)

In pre-admission clinic Lady planning for cholecystectomy, SOB for few
minutes, increasing in frequency 6 weeks after being scheduled for operation
Hello. I am Mahmoud Bazeed one of the exam candidate
May I confirm your name and age please?
Nice to meet you Mr. …. Today I’ve been asked to ask you few questions
regarding your condition, are you OK with this?
How can I help you today?
I am so sorry to hear that.
(Site, Onset, course, duration, character, radiation, timing, severity,
aggravating and relieving factors and associated factors)
When did you first notice that breathlessness?
Did it start suddenly or gradually?
Did it come and go? Has this changed recently?
Is there any specific time during the day that the breathlessness increase?
Does anything help you get your breath back? If you rest for a while, does it
improve? Do inhalers help?
Does anything make it worse?
How far can you walk before the breathlessness stops you? Can you climb a flight
of stairs in one go? If not, how many can you manage?
Do you suffer from chest pain? If so
(SOCRATES) analysis of pain
Where did you feel that pain? Could please point to the site?
Does it move anywhere?
When did you first notice that pain?
Did it start suddenly or gradually?
Did it come and go? Has this changed recently?

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Is there any specific time during the day that the pain increase?
Is there anything makes this pain stops?
Is there anything makes that pain increases?
Could please describe that pain for me? Is it colicky, cramping, or stabbing?
How badly is this affecting your day-to-day life?
If you had to rate the pain from 1 to 10, with 10 being the worst pain you can
imagine, how would you rate it?
(Associated factors for differential diagnosis)
1. Pulmonary embolism
Have you noticed a cough? Do you bring anything up? Any blood?
Do you get breathless?
Have you had a recent surgery?
Have you noticed painful legs?
2. Chest infection
Have you been ill or having a fever?
Do you get wheezy chest?
3. Chest malignancy
How has your appetite been?
Have you noticed any unintentional weight loss? How many kilos over how long?
4. MI
Do you ever get breathless when lying flat?
How many pillows do you sleep with at night?
Do you ever wake up gasping for breath?
Are you aware of your heart beats?
5. Musculoskeletal
Is the pain worse on movement? Does it hurt to press on the area?

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6. Anxiety
Do you only get breathless when you are anxious?
(Past medical or surgical history, Drug history, Family history, Ideas, concerns
and expectations, other system review)
Do you have any other medical conditions, see your GP for anything, ever had
surgeries?
Do you take any medications? Dose? Do you have any allergy against any drug?
Do you mind if I ask personal questions?
What is your occupation?
Who is at home with you?
Do you have any difficulty with the stairs?
Do you smoke? How many packs/ day
Do you drink alcohol? How many units/ week
Is there anyone else in the family has had a similar problem?
Before I go any further, could I ask?
What do you think the cause is?
What are you the most concerned about?
What are you hoping us to do for you?
Urogenital Abdominal pain, F of micturition, dysuria, urgency, polyuria,
hematuria
Rheumatic: any muscle or joint pain?
Anything else you want to add?
Thank you
(Order of questions)
Hello. I am Mahmoud Bazeed one of the exam candidate
May I confirm your name and age please?

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 History taking

Nice to meet you Mr. …. Today I’ve been asked to ask you few questions
regarding your condition, are you OK with this?
How can I help you today?
I am so sorry to hear that.
When did you first notice that breathlessness?
Did it start suddenly or gradually?
Did it come and go? Has this changed recently?
Is there any specific time during the day that the breathlessness increase?
Does anything help you get your breath back? If you rest for a while, does it
improve? Do inhalers help?
Does anything make it worse?
How far can you walk before the breathlessness stops you? Can you climb a flight
of stairs in one go? If not, how many can you manage?
Do you only get breathless when you are anxious?
Do you suffer from chest pain?
Where did you feel that pain? Could please point to the site?
Does it move anywhere?
When did you first notice that pain?
Did it start suddenly or gradually?
Did it come and go? Has this changed recently?
Is there any specific time during the day that the pain increase?
Is there anything makes this pain stops?
Is there anything makes that pain increases?
Could please describe that pain for me? Is it colicky, cramping, or stabbing?
How badly is this affecting your day-to-day life?
If you had to rate the pain from 1 to 10, with 10 being the worst pain you can
imagine, how would you rate it?

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Have you noticed a cough? Do you bring anything up? Any blood?
Do you get breathless?
Have you been ill or having a fever?
Do you get wheezy chest?
Do you ever get breathless when lying flat?
How many pillows do you sleep with at night?
Do you ever wake up gasping for breath?
How has your appetite been?
Have you noticed any unintentional weight loss? How many kilos over how long?
Have you had a recent surgery?
Have you noticed painful legs?
Do you have any other medical conditions, see your GP for anything, ever had
surgeries?
Do you take any medications? Dose? Do you have any allergy against any drug?
Do you mind if I ask personal questions?
What is your occupation?
Who is at home with you?
Do you have any difficulty with the stairs?
Do you smoke? How many packs/ day?
Do you drink alcohol? How many units/ week
Is there anyone else in the family has had a similar problem?
Before I go any further, could I ask?
What do you think the cause is?
What are you the most concerned about?
What are you hoping us to do for you?
Urogenital Abdominal pain, micturition, dysuria, urgency, polyuria, hematuria

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Anything else you want to add? Thank you

(Positive findings)
(Prepared for lap cholecystectomy and she has been investigated before for SOB
and free)
(Questions)
Management:
- I should contact the GP to get hold of all the notes regarding investigation of
the patient’s chest pain.
- I would examine the patient and ensure that we repeat the patient’s bloods,
ECG, CXR and get a baseline ABG on room air.
- I would want to ensure she had a recent echo and angiogram and discuss these
with a cardiologist.
- I would reassure the patient that she is going to be well looked after, and ask
her is there was anything we could do to allay her fears.
- I would also suggest that we involve her close relatives or friends so that she
has an adequate support network in place before and after the operation
Can the operation go ahead?
As long as we have no documented evidence that there is no cardiac or resp.
Illness, the operation should go ahead

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 History taking

Female with hyperthyroidism

Hello. I am Mahmoud Bazeed one of the exam candidate
May I confirm your name and age please?
Nice to meet you Mr. …. Today I’ve been asked to ask you few questions
regarding your condition, are you OK with this?
How can I help you today?
I am so sorry to hear that.
(Site, Onset, course, duration, character, radiation, timing, severity,
aggravating and relieving factors and associated factors)
When did you first notice that lump?
Did it start suddenly or gradually?
Did it come and go? Has this changed recently?
Is there any specific time during the day that lump increase in size?
Is there anything makes that lump increase in size?
Is there anything makes that lump decrease in size?
(Associated factors for differential diagnosis)
1. Compressive symptoms
Have you noticed a change in your voice recently?
Do you have difficulty during swallowing?
Have you noticed breathlessness?
2. Toxic symptoms
Have you noticed a change in the size of your eyes?
Have you noticed a change in your vision?
Do you menstruate regularly?
Are you aware of your heart beats?
Do you have difficulty getting sleep? Do you get up urself from squatting?

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Does your mood change through the day?

Have you noticed heat or cold intolerance?
Have you noticed changes regarding your bowel habits? How many motions per
day?
3. Malignancy
How has your appetite been?
Have you noticed any unintentional weight loss? How many kilos over how long?
Have you noticed a change in your voice?
4. Thyroiditis
Is that swelling painful?
(Past medical or surgical history, Drug history, Family history, Ideas, concerns
and expectations, other system review)
Do you have any other medical conditions, see your GP for anything, ever had
surgeries?
Do you take any medications? Dose? Do you have any allergy against any drug?
Do you mind if I ask personal questions?
What is your occupation?
Who is at home with you?
Do you have any difficulty with the stairs?
Do you smoke? How many packs/ day
Do you drink alcohol? How many units/ week
Is there anyone else in the family has had a similar problem?
Before I go any further, could I ask?
What do you think the cause is?
What are you the most concerned about?
What are you hoping us to do for you?

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 History taking

Urogenital Abdominal pain, F of micturition, dysuria, urgency, polyuria,

hematuria
Rheumatic: any muscle or joint pain?
Anything else you want to add?
Thank you
(Order of questions)
Hello. I am Mahmoud Bazeed one of the exam candidate
May I confirm your name and age please?
Nice to meet you Mr. …. Today I’ve been asked to ask you few questions
regarding your condition, are you OK with this?
How can I help you today?
I am so sorry to hear that.
When did you first notice that lump?
Did it start suddenly or gradually?
Did it come and go? Has this changed recently?
Is there any specific time during the day that lump increase in size?
Is there any specific time during the day that lump decrease in size?
Is that swelling painful?
Have you noticed a change in your voice recently?
Do you have difficulty during swallowing?
Have you noticed breathlessness?
Have you noticed a change in the size of your eyes?
Have you noticed a change in your vision?
Do you menstruate regularly?
Are you aware of your heart beats?
Do you have difficulty getting sleep?
Does your mood change through the day?

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Have you noticed heat or cold intolerance?

Have you noticed changes regarding your bowel habits? How many motions per
day?
How has your appetite been?
Have you noticed any unintentional weight loss? How many kilos over how long?
Do you have any other medical conditions, see your GP for anything, ever had
surgeries?
Do you take any medications? Dose? Do you have any allergy against any drug?
Do you mind if I ask personal questions?
What is your occupation?
Who is at home with you?
Do you have any difficulty with the stairs?
Do you smoke? How many packs/ day
Do you drink alcohol? How many units/ week
Is there anyone else in the family has had a similar problem?
Before I go any further, could I ask?
What do you think the cause is?
What are you the most concerned about?
What are you hoping us to do for you?
Urogenital Abdominal pain, F of micturition, dysuria, urgency, polyuria,
hematuria
Rheumatic: any muscle or joint pain?
Anything else you want to add?
Thank you

(Positive findings)
(Neck swelling, increase in size, positive compression and toxic symptoms)

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 History taking

(Question)
Management:
Triple easement:
. Full clinical examination
. Ultrasound imaging
. FNAC
Other investigations: radioisotope scan
Possible causes of sudden enlargement:
- hemorrhage inside a cyst.
- Malignant: papillary, follicular, medullary carcinoma
Treatment: thyroidectomy (hemi, near total or total) with such compressive
symptoms

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 History taking

Unilateral tonsillar swelling

Hello. I am Mahmoud Bazeed one of the exam candidate
May I confirm your name and age please?
Nice to meet you Mr. …. Today I’ve been asked to ask you few questions
regarding your condition, are you OK with this?
How can I help you today?
I am so sorry to hear that.
(Site, Onset, course, duration, character, radiation, timing, severity,
aggravating and relieving factors and associated factors)
When did you first notice that lump?
Did it start suddenly or gradually?
Did it come and go? Has this changed recently?
Is there any specific time during the day that lump increase in size?
Is there anything makes that lump increase in size?
Is there anything makes that lump decrease in size?
(Associated factors for differential diagnosis)
1. Neoplastic (SCC or NHL)
Have you noticed that the lump rapidly increase in size?
Have you noticed a change in your voice?
How has your appetite been?
Have you noticed any unintentional weight loss? How many kilos over how long?
Have you or your partner noticed snoring while sleeping?
Do you have difficulty during swallowing?
Have you noticed breathlessness?
Have you noticed night fever?

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2. Infective (follicular tonsillitis, quinsy, glandular fever)

Is swallowing painful?
Have you been ill or having fever recently?
Have you noticed wheezy chest?
Do you get breathless?
Have you noticed cough? Do you bring anything? Is there blood?
Have you noticed tummy pain or swelling?
Have you been abroad recently?
3. Asymmetrical anatomic position
(Past medical or surgical history, Drug history, Family history, Ideas, concerns
and expectations, other system review)
Do you have any other medical conditions, see your GP for anything, ever had
surgeries?
Do you take any medications? Dose? Do you have any allergy against any drug?
Do you mind if I ask personal questions?
What is your occupation?
Who is at home with you?
Do you have any difficulty with the stairs?
Do you smoke? How many packs/ day
Do you drink alcohol? How many units/ week
Is there anyone else in the family has had a similar problem?
Before I go any further, could I ask?
What do you think the cause is?
What are you the most concerned about?
What are you hoping us to do for you?
Urogenital Abdominal pain, F of micturition, dysuria, urgency, polyuria,
hematuria

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Rheumatic: any muscle or joint pain?

Anything else you want to add?
Thank you
(Order of questions)
Hello. I am Mahmoud Bazeed one of the exam candidate
May I confirm your name and age please?
Nice to meet you Mr. …. Today I’ve been asked to ask you few questions
regarding your condition, are you OK with this?
How can I help you today?
I am so sorry to hear that.
When did you first notice that lump?
Did it start suddenly or gradually?
Did it come and go? Has this changed recently?
Is there any specific time during the day that lump increase in size?
Is there anything makes that lump increase in size?
Is there anything makes that lump decrease in size?
Have you noticed that the lump rapidly increase in size?
Have you noticed a change in your voice?
Have you or your partner noticed snoring while sleeping?
Do you have difficulty during swallowing?
Have you noticed breathlessness?
Is swallowing painful?
Have you noticed wheezy chest?
Have you noticed cough? Do you bring anything? Is there blood?
Have you noticed tummy pain or swelling?
Have you been ill or having fever recently?

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Have you noticed night fever?

How has your appetite been?
Have you noticed any unintentional weight loss? How many kilos over how long?
Have you been abroad recently?
Do you have any other medical conditions, see your GP for anything, ever had
surgeries?
Do you take any medications? Dose? Do you have any allergy against any drug?
Do you mind if I ask personal questions?
What is your occupation?
Who is at home with you?
Do you have any difficulty with the stairs?
Do you smoke? How many packs/ day
Do you drink alcohol? How many units/ week
Is there anyone else in the family has had a similar problem?
Before I go any further, could I ask?
What do you think the cause is?
What are you the most concerned about?
What are you hoping us to do for you?
Urogenital Abdominal pain, F of micturition, dysuria, urgency, polyuria,
hematuria
Rheumatic: any muscle or joint pain?
Anything else you want to add?
Thank you
(Questions)
Management:
Investigations:
- Tonsillectomy for biopsy

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- Biopsy with flowcytometry

- CT or PE -CT to rule out lymphoma
- Panendoscopy: examination of the upper aerodigestive tract (pharynx, larynx,
upper trachea and oesophagus).
-FBC: looking for raised WCC associated with infection
-U+E’s: looking for renal impairment if patient has had decreased oral intake
-LFT’s: derangement may indicate glandular fever or metastasis
-Monospot test (detecting glandular fever)
Treatment:
- Staging: MRI neck, CT neck, u/s liver
- Discuss in MDT
- Block neck dissection (radical, modified radical, selective)
- Radiotherapy

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Inguinal hernia
Worried gym trainer with inguinal hernia. You
have to interrupt the patient to save time.
Hello. I am Mahmoud Bazeed one of the exam candidate
May I confirm your name and age please?
Nice to meet you Mr. …. Today I’ve been asked to ask you few questions
regarding your condition, are you OK with this?
How can I help you today?
I am so sorry to hear that.
(Site, Onset, course, duration, character, radiation, timing, severity,
aggravating and relieving factors and associated factors)
When did you first notice that lump?
Did it start suddenly or gradually?
Is it on RT side or LT side or both?
Did it come and go? Has this changed recently?
Is there any specific time during the day that lump increase in size?
Is there anything makes that lump increase in size?
Is there anything makes that lump decrease in size?
(Associated factors for differential diagnosis)
1. Inguinal hernia
What were you doing when you first noticed the bulge?
Is there straining while passing stool or urine?
Have you noticed that the lump increase with size with straining while passing
urine or stool, or with cough?
Have you noticed that the lump decrease in size when you lie down?
Have you noticed redness or hotness in the overlying skin?

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Is that lump painful? If so

(SOCRATES) analysis of pain
Where did you feel that pain? Could please point to the site?
Does it move anywhere?
When did you first notice that pain?
Did it start suddenly or gradually?
Did it come and go? Has this changed recently?
Is there any specific time during the day that the pain increase?
Is there anything makes this pain stops?
Is there anything makes that pain increases?
Could please describe that pain for me? Is it colicky, cramping, or stabbing?
How badly is this affecting your day-to-day life?
If you had to rate the pain from 1 to 10, with 10 being the worst pain you can
imagine, how would you rate it?
Have you noticed that the lump decrease in size even with lying down?
Do you have tummy pain?
Did you throw up?
Do you have distension or bloating?
2. Abscess
Have you been ill or having a fever?
Is there wound or sore over the bulge?
Did the lump bring anything? (Discharge)
3. Lymph node (inflammatory or neoplastic)
How has your appetite been?
Have you noticed any unintentional weight loss? How many kilos over how long?

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(Past medical or surgical history, Drug history, Family history, Ideas, concerns
and expectations, other system review)
Do you have any other medical conditions, see your GP for anything, ever had
surgeries?
Do you take any medications? Dose? Do you have any allergy against any drug?
Stamina tonic: what are the components of it? Is it contains any steroids
Visit of the GUM clinic, foreign travel: did you make test for HIV, when you came
back, did you repeat it?
Do you mind if I ask personal questions?
What is your occupation?
Who is at home with you?
Do you have any difficulty with the stairs?
Do you smoke? How many packs/ day
Do you drink alcohol? How many units/ week
Is there anyone else in the family has had a similar problem?
(Answer patient questions)
How does a hernia happen?
With straining like you do, there will be muscle tearing, and some gut will
protrude through the defect.
Could it be better?
It usually needs a surgical operation for repair, the operation may be in open
fashion or keyhole surgery.
Where to get back to work?
Few weeks
Urogenital Abdominal pain, F of micturition, dysuria, urgency, polyuria,
hematuria
Rheumatic: any muscle or joint pain?
Anything else you want to add? Thank you

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 History taking

(Order of questions)
Hello. I am Mahmoud Bazeed one of the exam candidate
May I confirm your name and age please?
Nice to meet you Mr. …. Today I’ve been asked to ask you few questions
regarding your condition, are you OK with this?
How can I help you today?
I am so sorry to hear that
When did you first notice that lump?
Did it start suddenly or gradually?
What were you doing when you first noticed the bulge?
Is it on RT side or LT side or both?
Did it come and go? Has this changed recently?
Is there any specific time during the day that lump increase in size?
Is there anything makes that lump increase in size?
Is there straining while passing stool or urine?
Have you noticed that the lump increase with size with straining while passing
urine or stool, or with cough?
Is there anything makes that lump decrease in size?
Have you noticed that the lump decrease in size when you lie down?
Have you noticed redness or hotness in the overlying skin?
Is that lump painful? If so
Where did you feel that pain? Could please point to the site?
Does it move anywhere?
When did you first notice that pain?
Did it start suddenly or gradually?
Did it come and go? Has this changed recently?
Is there any specific time during the day that the pain increase?

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 History taking

Is there anything makes this pain stops?

Is there anything makes that pain increases?
Could please describe that pain for me? Is it colicky, cramping, or stabbing?
How badly is this affecting your day-to-day life?
If you had to rate the pain from 1 to 10, with 10 being the worst pain you can
imagine, how would you rate it?
Is there wound or sore over the bulge?
Did the lump bring anything?
Do you have tummy pain?
Did you throw up?
Do you have distension or bloating?
Have you been ill or having a fever?
How has your appetite been?
Have you noticed any unintentional weight loss? How many kilos over how long?
Do you have any other medical conditions, see your GP for anything, ever had
surgeries?
Do you take any medications? Dose? Do you have any allergy against any drug?
Stamina tonic: what are the components of it? Is it contains any steroids
Visit of the GUM clinic, foreign travel: did you make test for HIV, when you
came back, did you repeat it?
Do you mind if I ask personal questions?
What is your occupation?
Who is at home with you?
Do you have any difficulty with the stairs?
Do you smoke? How many packs/ day
Do you drink alcohol? How many units/ week
Is there anyone else in the family has had a similar problem?

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How does a hernia happen?

With straining like you do, there will be muscle tearing, and some gut will
protrude through the defect.
Could it be better?
It usually needs a surgical operation for repair, the operation may be in open
fashion or keyhole surgery.
Where to get back to work?
Few weeks
Urogenital Abdominal pain, F of micturition, dysuria, urgency, polyuria,
hematuria
Rheumatic: any muscle or joint pain?
Anything else you want to add?
Thank you
(Positive findings)
(Gym trainer referred from GP with groin swelling typical of inguinal hernia, past
history of genitourinary infection, stoma tonics, and patient will ask question
about hernia and surgery)

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 History taking

Infected pseudoaneurysm
Referred from GP as groin abscess
Hello. I am Mahmoud Bazeed one of the exam candidate
May I confirm your name and age please?
Nice to meet you Mr. …. Today I’ve been asked to ask you few questions
regarding your condition, are you OK with this?
How can I help you today?
I am so sorry to hear that.
(Site, Onset, course, duration, character, radiation, timing, severity,
aggravating and relieving factors and associated factors)
When did you first notice that lump?
Did it start suddenly or gradually?
Is it on RT side or LT side or both?
Did it come and go? Has this changed recently?
Is there any specific time during the day that lump increase in size?
Is there anything makes that lump increase in size?
Is there anything makes that lump decrease in size?
(Associated factors for differential diagnosis)
1. Infected pseudo aneurysm
Is it painful? If so
(SOCRATES) analysis of pain
Where did you feel that pain? Could please point to the site?
Does it move anywhere?
When did you first notice that pain?
Did it start suddenly or gradually?
Did it come and go? Has this changed recently?

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 History taking

Is there any specific time during the day that the pain increase?
Is there anything makes this pain stops?
Is there anything makes that pain increases?
Could please describe that pain for me? Is it colicky, cramping, or stabbing?
How badly is this affecting your day-to-day life?
If you had to rate the pain from 1 to 10, with 10 being the worst pain you can
imagine, how would you rate it?
Did you notice any blood coming out from the swelling?
Did you have any recent injection or trauma in your groin?
Do you feel that this swelling is having pulses? Is it beating?
Do you feel any limb pain or coldness or colour changes or limb swelling?
Do you have any limb numbness?
2. Groin abscess
Have you been ill or having a fever?
Is there wound or sore over the bulge?
Did you notice any discharge from the Lump?
3. Lymph node (inflammatory or neoplastic)
How has your appetite been?
Have you noticed any unintentional weight loss? How many kilos over how long?
4. Inguinal hernia
Is there straining while passing stool or urine?
Have you noticed that the lump increase with size with straining while passing
urine or stool, or with cough?
Have you noticed that the lump decrease in size when you lie down?
Have you noticed redness or hotness in the overlying skin?
Have you noticed that the lump decrease in size even with lying down?
Do you have tummy pain?

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Did you throw up?

Do you have distension or bloating?
(Past medical or surgical history, Drug history, Family history, Ideas, concerns
and expectations, other system review)
Do you have any other medical conditions, see your GP for anything, ever had
surgeries?
Do you take any medications? Dose? Do you have any allergy against any drug?
Do you mind if I ask personal questions?
What is your occupation?
Who is at home with you?
Do you have any difficulty with the stairs?
Do you smoke? How many packs/ day
Do you drink alcohol? How many units/ week
Is there anyone else in the family has had a similar problem?
Before I go any further, could I ask?
What do you think the cause is?
What are you the most concerned about?
What are you hoping us to do for you?
Urogenital Abdominal pain, F of micturition, dysuria, urgency, polyuria,
hematuria
Rheumatic: any muscle or joint pain?
Anything else you want to add?
Thank you
(Order of questions)
Hello, I am Mahmoud Bazeed one of the exam candidate.
May I confirm your name and age please?

104

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 History taking

Nice to meet you Mr. …. Today I’ve been asked to ask you few questions
regarding your condition, are you OK with this?
How can I help you today?
I am so sorry to hear that.
When did you first notice that lump?
Did it start suddenly or gradually?
Is it on RT side or LT side or both?
Did it come and go? Has this changed recently?
Is there any specific time during the day that lump increase in size?
Is it painful? If so
Where did you feel that pain? Could please point to the site?
Does it move anywhere?
When did you first notice that pain?
Did it start suddenly or gradually?
Did it come and go? Has this changed recently?
Is there any specific time during the day that the pain increase?
Is there anything makes this pain stops?
Is there anything makes that pain increases?
Could please describe that pain for me? Is it colicky, cramping, or stabbing?
How badly is this affecting your day-to-day life?
If you had to rate the pain from 1 to 10, with 10 being the worst pain you can
imagine, how would you rate it?
Did you notice any discharge from the Lump?
Did you notice any blood coming out from the swelling?
Did you have any recent injection or trauma in your groin?
Do you feel that this swelling is having pulses? Is it beating?
Is there wound or sore over the bulge?

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Is there straining while passing stool or urine?

Have you noticed that the lump increase with size with straining while passing
urine or stool, or with cough?
Have you noticed that the lump decrease in size when you lie down?
Have you noticed redness or hotness in the overlying skin?
Have you noticed that the lump decrease in size even with lying down?
Do you have tummy pain?
Did you throw up?
Do you have distension or bloating?
Have you been ill or having a fever?
How has your appetite been?
Have you noticed any unintentional weight loss? How many kilos over how long?
Do you have any other medical conditions, see your GP for anything, ever had
surgeries?
Do you take any medications? Dose? Do you have any allergy against any drug?
Do you mind if I ask personal questions?
What is your occupation?
Who is at home with you?
Do you have any difficulty with the stairs?
Do you smoke? How many packs/ day
Do you drink alcohol? How many units/ week
Is there anyone else in the family has had a similar problem?
Before I go any further, could I ask?
What do you think the cause is?
What are you the most concerned about?
What are you hoping us to do for you?

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Urogenital Abdominal pain, F of micturition, dysuria, urgency, polyuria,

hematuria
Rheumatic: any muscle or joint pain?
Anything else you want to add?
Thank you
(Positive findings)
(Referred from GP with groin abscess and turn to be infected pseudo aneurysm)
(Questions)
Investigations:
- Duplex ultrasonography
- CT angiography
Treatment:
- Ligation of the involved artery with delayed revascularization.
- Non operative treatment: Duplex ultrasound-guided compression and
percutaneous thrombin injection
- Define pseudo aneurysm: is a collection of blood that forms between the two
outer layers of an artery, the tunica media and the tunica adventitia. It is usually
caused by a penetrating injury to the vessel, which then bleeds, but forms a
space between the above two layers, rather than exiting the vessel. It may be
pulsatile and can resemble a true aneurysm
- True aneurysm: involves all three layers of the blood vessel

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Back pain
Hello. I am Mahmoud Bazeed one of the exam candidate
May I confirm your name and age please?
Nice to meet you Mr. …. Today I’ve been asked to ask you few questions
regarding your condition, are you OK with this?
How can I help you today?
I am so sorry to hear that.
(Site, Onset, course, duration, character, radiation, timing, severity,
aggravating and relieving factors and associated factors)
Where did you feel that pain? Could please point to the site?
Does it move anywhere?
When did you first notice that pain?
Did it start suddenly or gradually?
Did it come and go? Has this changed recently?
Is there any specific time during the day that the pain increase?
Is there anything makes this pain stops?
Is there anything makes that pain increases?
Could please describe that pain for me? Is it colicky, cramping, or stabbing?
How badly is this affecting your day-to-day life?
If you had to rate the pain from 1 to 10, with 10 being the worst pain you can
imagine, how would you rate it?
(Associated factors for differential diagnosis)
1. Disc prolapse (cauda equine)
Does the pain travel down your legs?
Have you had any strange sensations down your legs or buttocks?
Have your legs been feeling weaker than usual?
Have you had any problems with your waterworks? Bowels?

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Have you had any difficulty in gaining an erection?

2. Ankylosing spondylitis
Is your back stiff in the morning? If so, how long does that last for?
3. TB
Have you been ill or having a fever especially at night?
Do you suffer night sweat?
Do you have any neck swelling?
Do you cough? Do you bring anything? Is there blood?
4. Metastatic
Have you noticed any significant weight loss over the past few months?
How is your appetite?
5. Osteoporosis
Did you have any bone fractures that occur easily than usual?
6. Trauma
Have you had trauma to your back recently?
7. Non spinal causes
Do you have tummy pain? Or tummy swelling
(Past medical or surgical history, Drug history, Family history, Ideas, concerns
and expectations, other system review)
Do you have any other medical conditions, see your GP for anything, ever had
surgeries?
Do you take any medications? Dose? Do you have any allergy against any drug?
Do you mind if I ask personal questions?
What is your occupation?
Who is at home with you?
Do you have any difficulty with the stairs?
Do you smoke? How many packs/ day

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Do you drink alcohol? How many units/ week

Is there anyone else in the family has had a similar problem?
Before I go any further, could I ask?
What do you think the cause is?
What are you the most concerned about?
What are you hoping us to do for you?
Urogenital Abdominal pain, F of micturition, dysuria, urgency, polyuria,
hematuria
Rheumatic: any muscle or joint pain?
Anything else you want to add?
Thank you
(Order of questions)
Hello. I am Mahmoud Bazeed one of the exam candidate
May I confirm your name and age please?
Nice to meet you Mr. …. Today I’ve been asked to ask you few questions
regarding your condition, are you OK with this?
How can I help you today?
I am so sorry to hear that.
Where did you feel that pain? Could please point to the site?
Does it move anywhere? Does the pain travel down your legs?
When did you first notice that pain?
Did it start suddenly or gradually?
Did it come and go? Has this changed recently?
Is there any specific time during the day that the pain increase?
Is there anything makes this pain stops?
Is there anything makes that pain increases?
Could please describe that pain for me? Is it colicky, cramping, or stabbing?

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How badly is this affecting your day-to-day life?

If you had to rate the pain from 1 to 10, with 10 being the worst pain you can
imagine, how would you rate it?
Is your back stiff in the morning? If so, how long does that last for?
Did you have any bone fractures that occur easily than usual?
Have you had trauma to your back recently?
Have you had any strange sensations down your legs or buttocks?
Have your legs been feeling weaker than usual?
Have you had any problems with your waterworks? Bowels?
Have you had any difficulty in gaining an erection?
Have you been ill or having a fever especially at night?
Do you suffer night sweat?
Do you have any neck swelling?
Do you cough? Do you bring anything? Is there blood?
Have you noticed any significant weight loss over the past few months?
How is your appetite?
Do you have tummy pain? Or tummy swelling
Do you have any other medical conditions, see your GP for anything, ever had
surgeries?
Do you take any medications? Dose? Do you have any allergy against any drug?
Do you mind if I ask personal questions?
What is your occupation?
Who is at home with you?
Do you have any difficulty with the stairs?
Do you smoke? How many packs/ day
Do you drink alcohol? How many units/ week
Is there anyone else in the family has had a similar problem?

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 History taking

Before I go any further, could I ask?

What do you think the cause is?
What are you the most concerned about?
What are you hoping us to do for you?
Urogenital Abdominal pain, F of micturition, dysuria, urgency, polyuria,
hematuria
Rheumatic: any muscle or joint pain?
Anything else you want to add?
Thank you
(Positive findings)
First scenario (female patient, long standing history of back pain ,worse in the
last 3 years ,MRI mild degenerative changes, Disabled husband, work
commitment, increase by activity and decrease by rest) Mechanical low back
pain.
Second scenario (male patient, sudden pain and red flags) cauda equina.
(Questions)
My main differential diagnosis will be:
- Functional back pain (Mechanical lower-back pain):
.localized pain that worsens with movement and changes in posture
.history of heavy lifting
. History of previous similar episodes over a number of years
. No features of systemic illness, nor neurological symptoms
- I have also to rule out organic pathology: Prolapsed intervertebral disc, spinal
mets, Seronegative spondyloarthropathy (ankylosing spondylitis),Spinal canal
stenosis, Non-spinal causes of back pain( AAA, fibromyalgia, pancreatitis, renal
calculi)
Cauda equina:
- Urinary and faecal incontinence

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- Sensory numbness of buttocks and backs of thighs and weakness of legs

Investigations:
- A full examination is required, particularly looking for perianal sensory loss and
anal tone.
- I would carefully check for a reduction in power and decreased reflexes.
- Back examination and lower-limb neurological examination

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- Bloods –FBC, LFTs, U&Es, CRP and ESR Chest X-ray and QuantiFERON-TB Gold
if TB suspected
- MRI (not needed if the history suggests uncomplicated mechanical back pain)
- Urgent MRI/CT scan if cord compression or cauda equina is suspected
- X-ray and a subsequent DEXA scan if a crush fracture is suspected
Management:
Simple back pain (including prolapsed intervertebral disc):
- Advise to stay active and avoid prolonged bed rest Physiotherapy, regular
analgesia and consider short-course muscle relaxants
- Serious pathology or red-flag symptoms: Cord compression –dexamethasone
and urgent surgery; radiotherapy in malignancy
- Cauda equina syndrome –urgent surgery
- refer to social worker

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Knee pain
Footballer, had right knee injury 30 years ago, had knee
operation that he has no idea about, developed worsening
right knee pain 4 months ago

Hello. I am Mahmoud Bazeed one of the exam candidate

May I confirm your name and age please?
Nice to meet you Mr. …. Today I’ve been asked to ask you few questions
regarding your condition, are you OK with this?
How can I help you today?
I am so sorry to hear that.
(Site, Onset, course, duration, character, radiation, timing, severity,
aggravating and relieving factors and associated factors)
Where did you feel that pain? Could please point to the site?
Does it move anywhere?
When did you first notice that pain?
Did it start suddenly or gradually?
Did it come and go? Has this changed recently?
Is there any specific time during the day that the pain increase?
Is there anything makes this pain stops?
Is there anything makes that pain increases?
Could please describe that pain for me? Is it colicky, cramping, or stabbing?
How badly is this affecting your day-to-day life?
If you had to rate the pain from 1 to 10, with 10 being the worst pain you can
imagine, how would you rate it?
(Associated factors for differential diagnosis)
1. Osteoarthritis
Does the pain present all the day and increase at night?

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Did you notice any changes in the shape of your knee?

Was there any history of trauma?
2. ACL injury
Did you experience giving away when walking?
3. Meniscus injury
Did you experience locking of your knee?
4. Rheumatoid arthritis
Have you noticed any stiffness in your joint(s) when you wake up in the
morning? How long does that last for?
5. Septic arthritis
Have you noticed swelling of your knee? Or redness?
Is there any discharge?
6. Referred from the back
Have you noticed weak or numb legs?
Do you have back pain?
7. Extra intestinal manifestation of IBD
Have you noticed any rashes anywhere on your body?
Have you had any diarrhea?
Have you had painful or red eyes?
8. Malignancy
Have you noticed any significant weight loss over the past few months?
How is your appetite?
(Past medical or surgical history, Drug history, Family history, Ideas, concerns
and expectations, other system review)
Do you have any other medical conditions, see your GP for anything, ever had
surgeries?
Do you take any medications? Dose? Do you have any allergy against any drug?

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Do you mind if I ask personal questions?

What is your occupation?
Who is at home with you?
Do you have any difficulty with the stairs?
Do you smoke? How many packs/ day?
Do you drink alcohol? How many units/ week
Is there anyone else in the family has had a similar problem?
Before I go any further, could I ask?
What do you think the cause is?
What are you the most concerned about?
What are you hoping us to do for you?
Urogenital Abdominal pain, F of micturition, dysuria, urgency, polyuria,
hematuria
Rheumatic: any muscle or joint pain?
Anything else you want to add?
Thank you
(Order of questions)
Hello. I am Mahmoud Bazeed one of the exam candidate
May I confirm your name and age please?
Nice to meet you Mr. …. Today I’ve been asked to ask you few questions
regarding your condition, are you OK with this?
How can I help you today?
I am so sorry to hear that.
Where did you feel that pain? Could please point to the site?
Does it move anywhere?
When did you first notice that pain?
Did it start suddenly or gradually?

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Did it come and go? Has this changed recently?

Is there any specific time during the day that the pain increase?
Does the pain present all the day and increase at night?
Is there anything makes this pain stops?
Is there anything makes that pain increases?
Could please describe that pain for me? Is it colicky, cramping, or stabbing?
How badly is this affecting your day-to-day life?
If you had to rate the pain from 1 to 10, with 10 being the worst pain you can
imagine, how would you rate it?
Did you notice any changes in the shape of your knee?
Did you experience giving away when walking?
Did you experience locking of your knee?
Have you noticed swelling of your knee? Or redness?
Have you noticed any stiffness in your joint(s) when you wake up in the
morning? How long does that last for?
Do you have back pain?
Have you noticed weak or numb legs?
Have you noticed any rashes anywhere on your body?
Have you had any diarrhea?
Have you had painful or red eyes?
Have you noticed any significant weight loss over the past few months?
How is your appetite?
Do you have any other medical conditions, see your GP for anything, ever had
surgeries?
Do you take any medications? Dose? Do you have any allergy against any drug?
Do you mind if I ask personal questions?
What is your occupation?

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Who is at home with you?

Do you have any difficulty with the stairs?
Do you smoke? How many packs/ day
Do you drink alcohol? How many units/ week
Is there anyone else in the family has had a similar problem?
Before I go any further, could I ask?
What do you think the cause is?
What are you the most concerned about?
What are you hoping us to do for you?
Urogenital Abdominal pain, F of micturition, dysuria, urgency, polyuria,
hematuria
Rheumatic: any muscle or joint pain?
Anything else you want to add?
Thank you
(Positive findings)
(History of trauma, and operation, can’t play football now, pain increase at
night, crepitus) secondary OA.
(Questions)
My main differential will be:
- OA (traumatic)
- RA
- Referred pain from hip or spine pathology
Investigations:
- Knee x- ray (standing and weight bearing): a-p, lateral views

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Treatment:
Conservative
• Maintain or achieve a healthy weight i.e. aim to decrease weight, and
therefore force, going through a joint
• Regular exercise, with particular attention to strengthening the muscles
around the joint. For example in OA of the knee, cycling is beneficial
• Analgesia: care to be taken with NSAID's with relation to gastric irritation
• Heat application to the joint may offer relief
• Physiotherapy
• Intra-articular steroids
Surgical:
. Arthroscopy and arthrocentesis
• Realignment osteotomy
• Total or partial knee replacement
Will the patient be likely to play soccer in 9 months? No

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Lower limb claudication

Hello. I am Mahmoud Bazeed one of the exam candidate
May I confirm your name and age please?
Nice to meet you Mr. …. Today I’ve been asked to ask you few questions
regarding your condition, are you OK with this?
How can I help you today?
I am so sorry to hear that.
(Site, Onset, course, duration, character, radiation, timing, severity,
aggravating and relieving factors and associated factors)
Where did you feel that pain? Could please point to the site?
Does it move anywhere?
When did you first notice that pain?
Did it start suddenly or gradually?
Did it come and go? Has this changed recently?
Is there any specific time during the day that the pain increase?
Is there anything makes this pain stops?
Is there anything makes that pain increases?
Could please describe that pain for me? Is it colicky, cramping, or stabbing?
How badly is this affecting your day-to-day life?
If you had to rate the pain from 1 to 10, with 10 being the worst pain you can
imagine, how would you rate it?
(Associated factors for differential diagnosis)
1. Chronic lower limb ischemia
Is it relieved by rest?
Is it made worse if you walk faster or up a hill?
Does cold weather affect it?
Have you noticed any skin breech in your legs or feet?

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How far can you walk before stopping?

2. Spinal canal stenosis
Do you have any numb or weak legs or feet?
Do you have any back pain?
(Past medical or surgical history, Drug history, Family history, Ideas, concerns
and expectations, other system review)
Do you have any other medical conditions, see your GP for anything, ever had
surgeries?
Do you take any medications? Dose? Do you have any allergy against any drug?
Do you mind if I ask personal questions?
What is your occupation?
Who is at home with you?
Do you have any difficulty with the stairs?
Do you smoke? How many packs/ day?
Do you drink alcohol? How many units/ week
Is there anyone else in the family has had a similar problem?
Before I go any further, could I ask?
What do you think the cause is?
What are you the most concerned about?
What are you hoping us to do for you?
Urogenital Abdominal pain, F of micturition, dysuria, urgency, polyuria,
hematuria
Rheumatic: any muscle or joint pain?
Anything else you want to add?
Thank you
(Order of questions)
Hello. I am Mahmoud Bazeed one of the exam candidate

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May I confirm your name and age please?

Nice to meet you Mr. …. Today I’ve been asked to ask you few questions
regarding your condition, are you OK with this?
How can I help you today?
I am so sorry to hear that.
Where did you feel that pain? Could please point to the site?
Does it move anywhere?
When did you first notice that pain?
Did it start suddenly or gradually?
Did it come and go? Has this changed recently?
Is there any specific time during the day that the pain increase?
Is there anything makes this pain stops?
Is it relieved by rest?
Is there anything makes that pain increases?
Is it made worse if you walk faster or up a hill?
Does cold weather affect it?
Could please describe that pain for me? Is it colicky, cramping, or stabbing?
How badly is this affecting your day-to-day life?
If you had to rate the pain from 1 to 10, with 10 being the worst pain you can
imagine, how would you rate it?
How far can you walk before stopping?
Have you noticed any skin breech in your legs or feet?
Do you have any back pain?
Do you have any numb or weak legs or feet?
Do you have any other medical conditions, see your GP for anything, ever had
surgeries?
Do you take any medications? Dose? Do you have any allergy against any drug?

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Do you mind if I ask personal questions?

What is your occupation?
Who is at home with you?
Do you have any difficulty with the stairs?
Do you smoke? How many packs/ day?
Do you drink alcohol? How many units/ week
Is there anyone else in the family has had a similar problem?
Before I go any further, could I ask?
What do you think the cause is?
What are you the most concerned about?
What are you hoping us to do for you?
Urogenital Abdominal pain, F of micturition, dysuria, urgency, polyuria,
hematuria
Rheumatic: any muscle or joint pain?
Anything else you want to add?
Thank you
(Positive findings)
Claudication pain in calf increased by col and walking and decreased by rest
Chronic ischemia.
(Questions)
How to diff. between spinal and vascular claudication:
Peripheral vascular disease:
- Claudication pain is a cramping pain in the calf, thigh or buttocks
- Brought on by exercise and relieved by rest (patients often pretend to ‘window-
shop’ until the pain disappears)
- Exacerbated by walking faster or up hills and also by cold weather

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- Risk factors/associated factors for atherosclerosis: Diabetes

Hypercholesterolemia Stroke
- Rest pain may indicate critical limb ischaemia
Spinal claudication:
- Often relieved when walking up a hill
- Often has associated limb numbness
Sciatica:
- Shooting pain down the back of a leg to the feet
- History of lower-back pain
Investigations:
- Full peripheral vascular, cardiovascular and neurological examination
- Assess gait and balance
- Arterial duplex
- CT angiography (if surgical intervention was needed)
- MR Angiography
Treatment:
- optimize blood sugar, cholesterol, blood pressure
- Antiplatelet agents: aspirin, clopidogrel
- Antilipemic agents: simvastatin
- Surgical treatment: endovascular stenting, surgical bypass, amputation

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