Step 2 Cs Hx Questions

Front 1

Fever

Back 1

1. Do you have a fever?
2. How long have you had a fever?
3. How high did it get?
4. Was it continuous or intermittent?
5. Did you have any associated chills or sweating?

Front 2

Cough

Back 2

1. Do you have a cough
2. Is it dry or productive?
a. What color?
b. Any blood?
c. Foul smelling?
d. How much(tsp, tbl, cup)?
3. Do you have a chronic cough?
a. HIV and TB status?
b. Drug Use
c. ACE-Inhibitors**

Front 3

SOB

Back 3

1. Any problems breathing?
2. Any wheezing?
3. How far can you walk without troubles?
a. Do you ever stop to catch your breath?
3. Do you have attacks of breathlessness at nigh(PND)?
4. Do you need to sit up in order to fall asleep?

Front 4

Nausea/Vomiting

Back 4

1. Do you feel nauseated?
2. Have you been vomiting or throwing up?
3. How much, and what did it look like?
4. Was there any blood in it?
5. How fast did it come out?(Projectile)

Front 5

Headaches

Back 5

1. Do you have headaches?
2. How severe?
3. Location/distribution

Front 6

Edema

Back 6

1. Have you ever had swelling in your arms or legs?
2. Ankle swelling?
3. Where did you first notice the swelling?
4. Do they swell more in the day or the night time?

Front 7

Thyroid

Back 7

1. Have you ever had any problems adjusting to the temperature?
2. Any voice changes recently?(Hoarseness in Hypo)
3. Any change in bowel movements?(Constipation Hypo, Diarrhea Hyper)
4. Any unintentional weight changes recently?

Front 8

PMH

Allergies

Back 8

1. Do you have any allergies?(Intial)
c/o allergies
2. Are you allergic to specifics(pets, drugs, foods, plants, dust)?
3. If yes then describe the Problem?
a. How often?
b. Any medications for it?
c. What type of rxn is it?

Front 9

Past Medical Problems by System

Back 9

CNS - Strokes? Migraines? Seizures?
CVS - Heart problems like heart attacks or heart failure?
RS - Ever had TB? Hx of Asthma? Ever had any lung issues?
GIT - Ever had stomach problems or ulcers? Ever had any problems with your Gall Bladder or Liver?
Renal - Any hx of kidney infections? Any Hx of stones? Any prostate problems?
Thyroid problems?
Cancer Hx

Front 10

Hospitalizations

Back 10

1. Ever been hospitalized before?
2. For what? When?
3. Ever had any surgery before?
4. Ever been in a serious accident? Broken bones? Serious head injuries?

Front 11

Urinary questions - past any problems or troubles?

Back 11

1. H/o burning?
2. H/o urgency?
3. H/o frequency?
4. H/o hesitancy?
5. H/o hematuria?
6. H/o pyuria(pus)
7. H/o straining?
8. H/o changes in urine stream?
9. H/o incomplete emptying?
10. H/o incontinence?

Front 12

GI questions - past any problems with your bowel movements?

Back 12

1. How often do you move your bowels?
2. Have your bowel movements changed?
3. Are they hard or soft? What consistency? What color?
4. Any black or tarry colored stools?

Front 13

Sleep problems

Back 13

1. Any problems sleeping?
2. Falling asleep?
3. Staying asleep?
4. Early waking?
5. Dreams or nightmares?

Front 14

Family Hx

Back 14

1. Anyone have similar problems?
2. Are your parents living?
a. Yes, how is their health?
b. No, I'm sorry may I ask how they passed?

Front 15

OB/GYN Hx

Back 15

1. I am going to ask about your GYN health, is that ok?
1. LMP?
2. Are cycles regular?

If GYN case
1. Age of 1st menstrual period?
2. Are periods regular?
3. Ever bleed between cycles?
4. Do you have abdominal cramping and pain with your period?
5. How many pads do you use on a heavy day?
6. Ever notice any bleeding after intercourse?
7. When was your last pap smear?

Front 16

Vaginal Discharge

Back 16

1. Do you have any discharge?
2. Color? Odor? Feminine itching?
3. Have you had any sores or infections around your vagina?

Front 17

Pregnancy?

Back 17

1. Ever been pregnant? Any miscarriages or Abortions?
2. How many? Which month/week? Do you know the reason?
3. Ever had any problems or complications during your pregnancies?
4. How were the births? Were there any delivery complications?

Front 18

Sexual Hx?

Back 18

Transition - I would like to ask a few questions about your sexual hx. This will be confidential between you and I, please try to be as honest as possible.
1. Are you sexually active?
a. Yes. Who? More than one? Birth control methods? Men, women or both? Are you satisfied?
b. No. Do you have any problems in your sexual life? Any loss of interest in sex? Able to reach orgasm?
2. Do you use contraception?
a. Yes - what type?
3. High Risk
a. Ever been checked for STDs?
b. Ever been checked for HIV?

Front 19

Social Hx

Appetite?
Diet?
Weight?

Back 19

1. How is your appetite?

1. Please tell me about your diet?
2. What does your diet mainly consist of?
3. Are you on a special diet?
4. Menopausal - Do you take any calcium supplements?

1. Any weight changes recently?
2. How much? How long?

Front 20

Social Hx

Smoking?
Alcohol?
Drugs?

Back 20

1. Do you use tobacco? Smoke?
a. No - have you ever?
b. Yes - How much per day? How long?
2. Ever thought about quitting?

1. Do you consume alcoholic beverages?
a. No - did you ever?
b. Yes - What type? # per day? How long?
2. CAGE
a. Cut down?
b. Annoyed?
c. Guilty?
d. Eye opener?

1. Do you take OTC meds? Prescription?
2. Recreational drugs? What kind? How long? Injectable?

Front 21

Social Hx

Occupational Exposure?

Back 21

1. Do you work?
2. What type?
3. Is it stressful?
4. Exposure to any health hazards at work or personal life?
5. Unsafe working conditions?
6. Does your job involve prolonged sun exposure?(Rash)
7. Exposure to loud noises at work(Hearing loss)?

Front 22

Travel

Back 22

1. Have you traveled outside the US in recent years?
2. When?
3. Where?

Front 23

Psychiatric Hx

Back 23

1. What the patient thinks the problem could be due to?
2. Anyone to talk to when they are in distress?
3. Any unusually traumatic episodes in the past few months or remote past?
4. Any changes in appetite?
5. Any changes in sleep patterns?
6. Any weight loss or gain?
7. Describe a typical daily routine?
8. Do they have any interests or hobbies? Have they been giving the same type of pleasure as before?
9. What's your mood most of the day?
10. Duration of the symptoms?
11. Are they frequently forgetting things or feel like they are losing their memory?
12. General attitude towards daily life, positive or negative frame of mind?
13. Patient's sexual life?
14. Have you ever considered ending your life?
15. Do you have a plan to end your life?
16. Any pills or guns at home?
17. How is your family life and how do you feel towards your family members?
18. Any excessive caffeine intake?
19. Any delusions or hallucinations?
20. Any heat or cold intolerance?
21. MMSE
22. Do you realize you have a problem and are you willing to get help?