GOOD AFTERNOON MR. MRS… , I AM DR.

FADY SHO OF … CLINIC / DEPARTMENT

PLEASE HAVE A SEAT , MAY I SIT BESIDE YOU?

IF U DON’T MIND I WOULD LIKE TO TAKE SOME NOTES FOR THE PURPOSE OF THE INTERVIEW WHICH WILL BE
STRICTLY CONFIDENTIAL

SO YOU ARE … YEARS OLD RIGHT? (check information)

I HAVE RECEIVED A LETTER FROM UR GP STATING U HAVE .. , ..RIGHT?

WOULD U LIKE TO TELL ME MORE ABOUT THIS ? (leave her to speak 2 min. with no interruption)

I `D LIKE TO GO THROUGH THE STORY AGAIN CLARIFYING SOME DETAILS WHAT DO U MEAN BY FUNNY TURNS ,
MIGRAINE ….? (check pseudomedical words) ABOUT THIS CHEST PAIN ..

FOR HOW LONG HAVE U BEEN FEELING IT? HAS IT STARTED SUDDENLY OR GRADUALLY? IS IT GETTING BETTER OR
WORSE?

DO U HAVE IT ALL THE TIME? WHEN DO U HAVE IT MOSTLY? WHAT MAKES IT BETTER? AND WHAT MAKES IT
WORSE?

IS IT ACCOMPANIED BY ANY OTHER FEELINGS? SUCH AS LIGHT HEADEDNESS, RACING OF THE HEART , SWEATING ,
FEELING SICK?

WHERE EXACTLY DO U FEEL THIS PAIN? ,DOES IT GO ANYELSE WHERE?

CAN U DESCRIBE HOW IT FEELS LIKE? IS IT BURNING ? STABBING? DULL ACHING ? HEAVINESS?

IS IT RELATED TO FOOD , LYING FLAT OR EXERTION? (these questions are asked for every other symptom plus other
specific questions for each symptom)

SO THERE ARE SOME MORE QUESTIONS I WOULD LIKE TO ASK ? OK? DO U FEEL UR HEART IS RACING OR
THUMPING? CAN U TAP IT OUT?

DO U HAVE ANY SHORTNESS OF BREATH ? AFTER HOW MANY METERS OR FLIGHT OF STAIRS U FEEL IT? HAVE U
BEEN IN CONTACT WITH ANY BODY WITH LONG STANDING CHEST INFECTION (T.B)?

DO U FEEL SHORT OF BREATH ON LYING FLAT ? HAVE U RAISED UR PILLOWS LATELY? HOW MANY?

DO U WAKE UP AT NIGHT SHORT OF BREATH? WHEN EXACTLY? IMMEDIATELY AFTER SLEEP OR EARLY MORNING?

DO U COUGH? DO U BRING UP ANY PHLEGM? WHAT COLOR IS IT? HOW MUCH? DOES IT SMELL?

HAVE U EVER COUGHED UP ANY BLOOD? HOW MANY TIMES? IS IT FRANK OR JUST A TINGE?
DO U FEEL UR LEGS ARE SWOLLEN?

DO U FEEL ANY CRAMPS DURING WALKING/ AFTER HOW MANY METERS?

HAVE U EVER HAD ANY FITS , FAINTS OR BLACK OUTS? HOW MANY TIMES? WHAT WERE U DOING? WHAT DID U
FEEL EXACTLY BEFORE IT? DID U LOSE

CONSCIOUSNESS ? ANY WITNESSES ? DID U BITE UR TONGUE OR WET URSELF? HOW LONG BEFORE U REGAINED
CONSCIOUSNESS? DO THESE ATTACKS HAPPEN IN THE MORNING WHEN U GET UP OF BED (postural hypotension) ?
HAVE U EVER HAD ANY HEAD INJURIES?

DO U HAVE ANY FEVERS? SHIVERING?

DO U HAVE ANY RUNNY NOSE , SORE THROAT ? DO U SNORE?

DO U FEEL UR CHEST IS NOISY? DO U FEEL BETTER ON HOLIDAYS WHEN U ARE AWAY OF WORK?

ANY PROBLEMS WITH UR VOICE OR SPEECH (Mediastinal $ & Inhalers)?

HAVE U EVER HAD ANY CHEST OR HEART PROBLEMS?

HAVE U LOST OR GAINED WT.? HOW MUCH KILOS IN HOW MUCH TIME?IS IT INTENTIONAL? ARE U ON A SPECIAL
DIET? WHAT TYPED OF DO U EAT? WHAT ABOUT UR APPETITE? WHERE EXACTLY DID U GAIN THIS WEIGHT?

ARE U FEELING THIRSTIER , DRINKING MORE THAN USUAL?

HAVE U NOTICED UR EYE WHITE TURNED YELLOW?

DO U HAVE DIFFICULTY OR PAINFUL SWALLOWING? IS IT MORE FOR SOLIDS OR LIQUIDS? DO U FEEL THAT FOOD
STICKS IN UR THROAT ? WHERE IN UR THROAT? ARE U TROUBLED BY INDIGESTION OR HEART BURN?

DO U FEEL SICK? DO U THROUGH UP? HOW MANY TIMES? HOW MUCH? WHAT COLOR IS IT , IS IT LIKE COFFEE?

HAVE U EVER THROUGHN UP ANY BLOOD? HOW MANY TIMES?

DO U HAVE ANY TUMMY PAINS? IS IT RELATED TO FOOD? IS IT RELIEVED BY OPENING UR BOWEL?

DO U HAVE ANY LOSE MOTIONS OR FEELING CONSTIPATED? HOW MANY TIMES DO U OPEN UR BOWEL ? IS IT
OFFENSIVE , FLOATING ON WATER SURFACE AND DIFFICULT TO FLUSH (Malabsorption)? WHAT COLOR IS IT ? IS IT
PALLER (obstructive jaundice) OR DARKER (Melena)? DO U NEED TO WAKE UP DURING NIGHT FOR UR BOWEL
(Organic bowel ds)?

HAVE U NOTICED ANY BLOOD OR SLIME? IS IT COATING OR JUST A TINGE? DO U FIND ANY BLOOD WHEN U WIPE
URSELF? ANY PAIN WITH UR BACK PASSAGE? CAN U CONTROL AND HOLD UR BOWEL MOTIONS?
HAVE U EVER HAD ANY PROBLEM WITH UR BOWEL?

WHAT ABOUT UR WATER WORKS? ANY BURNING OR PAIN?

CHANGE IN COLOR? WHAT COLOR IS IT (Darker in obstructive or HCC jaundice , Red in hematuria)? IS IT FROTHY
(PROTIENURIA) ? HAVE U NOTICED ANY GRAVELS PASSING WITH UR WATER?

ARE U PASSING MORE /LESS WATER MORE THAN U USED TO? HOW MANY TIMES U GO FOR UR WATER WORKS? ,
ABOUT HOW MANY LITRES U PASS A DAY? DO U NEED TO WAKE UP DURING NIGHT FOR UR WATER WORKS
(Obstructive Uropathy , Chronic renal disease)?

HAVE U NOTICED ANY DISCHARGE OF UR PRIVATE AREAS? HAVE U EVER HAD ANY WATER INFECTION or PROBLEMS?

MALE: HAVE U NOTICED ANY DIFFICULTY TO START OR DRIBBLING AT THE END? ANY PROBLEM WITH UR INTIMATE
RELATIONS?

FEMALE : WHAT ABOUT UR PERIODS? REGULAR? EVERY HOW MANY DAYS U

HAVE IT? FOR HOW MANY DAYS IT STAYS WITH U? HOW MANY PADS U NEED TO CHANGE IN A DAY? DO U USE ANY
METHOD OF CONTRACEPTION? DO U TAKE THE PILL ? WHEN WAS THE 1 ST DAY OF UR LMP? ANY MISCARRIAGES?
ANY POSSIBILITY U R PREGNANT?

CAN U CONTROL AND HOLD UR WATER WORKS?

DO U HAVE ANY HEADACHES? DO U HAVE ANY PAIN IN FACE , NECK , SINUSES? ANY WATERING AND REDNESS OF
EYES OR NASAL BLOCKAGE (cluster headache)? ANY PAIN IN UR HEAD? ANY CRAMPS IN UR JAW DURING CHEWING
FOOD (GCA)? ANY HEAD INJURIES? ANY UNUSUAL SENSATIONS BEFORE THIS HEADACHE , DO U GET AFRAID OF
LOUD NOISE OR BRIGHT LIGHT (Migraine)?

ANY PROBLEMS OR CHANGES WITH UR FACE? CAN U DESCRIBE IT?

ANY PROBLEMS WITH EYES OR VISION? CAN U DESCRIBE IT? DO U SEE THINGS DOUBLE? CAN U SEE THE SIDES OF
THE ROADS (piruitary tumours)?

ANY PROBLEMS WITH EARS OR HEARING? CAN U DESCRIBE IT? ANY HAND SHAKES? IS IT WITH REST OR WHEN U
MOVE UR HANDS?

ANY PROBLEMS WITH WALKING? DESCRIBE IT? WALKING ON COTTON (P.N.)?Do U LOOSE BALANCE WHEN U WALK
IN DARK (P.N or Dorsal column)?

DO U HAVE ANY WEAKNESS OR CLUMSINESS ?WHERE? WEAKNESS WITH CLIMBING STAIRS OR COMBING HAIR
(PROXIMAL)? DO THINGS DROP OF UR HAND (DISTAL) ?
ANY NUMBNESS , SENSE OF PINS AND NEEDLES? WHERE? ANY PAIN IN UR BACK?

DO U FEEL DOWN , DEPRESSED OR LOW MOOD? DO U THINK LIFE IS NOT WORTH LIVING? HAVE U THOUGHT ABOUT
ENDING UR LIFE? DID U MAKE ANY PLANS? DO U FEEL ANXIOUS , IRRITABLE? DO U WORRY ABOUT MINOR THINGS
WHERE OTHER PEOPLE WONT? DO U HAVE PERSISTENT THOUGHTS?

WHAT ABOUT SLEEP ? DO U SLEEP MORE OR LESS THAN USUAL? ANY NIGHT MARES?

DO U FEEL WEAKER OR FATIGUED?

ANY PROBLEMS WITH MEMORY OR CONCENTRATION? DO U HEAR VOICES?

DO U HAVE ANY PAIN , STIFFNESS OR SWELLINGS OF UR JOINTS? WHERE?WHICH JOINTS? HOW LONG THE STIFFNESS
LASTS? BOTH HANDS/LEGS? WORSE IN MORNING ,EVENING OR SAME ALLTHROUGH THE DAY?

ANY DEFORMITY OR DISFIGUREMENT IN UR JOINTS? DID U INJURE URSELF RECENTLY?

WHAT ABOUT UR JOINTS MOVEMENTS DO THEY MOVE FREELY? WHAT ABOUT SHOE AND RING SIZE ? DO THEY FIT?

WHAT ABOUT UR SKIN? ANY CHANGE IN COLOR?

ANY RASH? WHERE? HOW IT LOOKS LIKE? HAS IT CHANGED SINCE ONSET? IS IT ITCHY , PAINFUL? ANY DISCHARGE?

HAVE U NOTICED ANY LUMPS OR BUMPS? WHERE? HOW DID U NOTICE IT? IS IT PAINFUL? ANY OTHER LUMPS OR
BUMBPS IN OTHER PARTS OF UR BODY?

ANY SORES IN UR MOUTH OR BODY? WHERE?

HAVE U NOTICED ANY EXCESSIVE SWEATING? WHEN EXACTLY?

DO U FEEL THE HOT OR COLD WHETHER MORE THAN U USED TO? ANY LOSS OF HAIR?

ANY PROBLEMS WITH UR NAILS?

DO U BLEED FROM ANY PART OF UR BODY?

SO THERE ARE SOME DISEASES THAT WE ROUTINELY ASK ABOUT..OK? HAVE U DONE ANY RECENT TESTS? BLOOD
TESTS OR IMAGING? HAVE U EVER BEEN DIAGNOSED WITH ANY MEDICAL CONDITION?

DO U HAVE HIGH BLOOD PRESSURE/ HIGH BLOOD SUGAR? FOR HOW LONG? WHAT MEDICATIONS ARE U TAKING
FOR IT?WHAT WAS UR LAST CHECK? ARE U TROUBLED BY ANY COMPLICATIONS?/ DID U CHECK?

HEART PROBLEMS? KIDNEY PROBLEMS? LIVER PROBLEMS ?CHEST PROBLEMS? HAVE U EVER BEEN ADMITTED TO
HOSPITAL?
HAVE U EVER HAD ANY SURGERIES? OR MINOR OPERATIONS , PROCEDURES? TOOTH EXTRACTION OR OPENING
ABSCESS? (fever cases)?

HAVE U EVER HAD ANY BLOOD TRANSFUSION? DO U HAVE ANY SORT OF ALLERGIES?

DO U CURRENTLY TAKE ANY MEDICATION , OVER THE COUNTER OR HERBAL REMIDIES? FOR WHAT? AT WHAT
DOSAGE? ARE U CONTROLLED? ARE U TROUBLED BY ANY SIDE EFFECTS?

DID U TAKE ANY MEDICATIONS IN THE PAST? FOR WHAT? DID U NOTICE ANY SIDE EFFECTS?

ANY SIMILAR CONDITIONS IN UR FAMILY?

IS THERE ANY ILLNESS OR DISEASE THAT RUNS IN UR FAMILY? DO U HAVE ANY SIBLINGS? HOW ARE THEY?

HOW ARE YOUR PARENTS? WHAT DID THEY DIE OF?

DO U SMOKE? HOW MUCH? FOR HOW LONG ? (NO. OF PACK/DAY X YEARS = PACK/YEAR)

DO U DRINK ALCOHOL? HOW MUCH? HAVE U EVER THOUGHT TO CUT DOWN? ARE U TROUBLED BY PEOPLE
CRITICIZING UR WAY OF DRINKING? DO U FEEL GUILTY ABOUT DRINKING? DO U NEED TO DRINK FIRST THING IN THE
MORNING AS EYE OPENER?

DO U USE ANY DRUGS THAT ALLEVIATE THE MOOD? WHAT? HOW? DO U SHARE NEEDLES?

WHAT DO U DO FOR LIVING? CAN U TELL ME MORE ABOUT UR JOB ?ARE U COPING WELL OR U ARE ON SICK
LEAVES? ANY PREVIOUS JOBS?

WHAT ARE UR DAILY ACTIVITIES? ARE U COPING WELL? DO DRIVE?

HOW ARE THINGS AT HOME? HOW MANY FLIGHT OF STAIRS U NEED TO CLIMB? DO U HAVE A LIFT? WHO IS THE
ONE TAKING CARE OF U?

IM SORRY TO ASK U PRIVATE QUESTION?

ARE U MARRIED? ANY KIDS? DO U HAVE ANY PARTNERS ? MAY I ASK MALES OR FEMALES? DO U PRACTICE SAFE SEX
METHODS?

HAVE U BEEN ABROAD RECENTLY?

DO U HAVE ANY PETS?

SO IS THERE ANYTHING ELSE WE MIGHT NOT HAVE DISCUSSED?

AND WHAT ARE UR THOUGHTS ABOUT WHAT IS HAPPENING FOR U?

SO WHAT ARE UR CONCERNS MR…?

CONCERN:

Diagnosis INV TTT Admition Referral Adivce Driving

The concern itself