Key Points in Patient Inquiry

Common Symptoms Inquiry Key Points 【Seven Elements of Present Illness Inquiry】

1. Onset of Illness: Speed, location, range, severity, and frequency related to the duration of the illness.
2. Main Symptoms Characteristics: Location, nature, duration, and severity; factors that relieve or exacerbate symptoms.
3. Etiology and Triggers: Any past related diseases or similar symptoms.
4. Progression and Evolution of the Condition.
5. Accompanying Symptoms.
6. Treatment History: Medications, dosages, duration, and efficacy.
7. General Condition During Illness: Changes in mental state, physical strength, appetite, food intake, weight, sleep, and bowel and urinary habits.

【Fever】

1. Onset Time, Season, and Situation: Speed, course, severity (high or low fever), frequency (intermittent or continuous), and triggers.
2. Presence of chills, shivering, profuse sweating, or night sweats.
3. Should include multi-system symptom inquiries: whether accompanied by cough, sputum, hemoptysis, chest pain, abdominal pain, vomiting, diarrhea, frequent urination, urgency, dysuria, rash, bleeding, headache, muscle and joint pain, etc.
4. General condition since onset: mental state, appetite, weight changes, sleep, and bowel and urinary habits.
5. Treatment history: medications, dosages, efficacy, especially for antibiotics, antipyretics, corticosteroids, cardiac drugs, anti-tuberculosis drugs, etc.
6. History of contact with infectious diseases, exposure to contaminated water, surgical history, history of miscarriage or childbirth, medication history, occupational characteristics, etc., can provide important clues for related disease diagnosis.

【Headache】

1. Onset Time, Speed, Course, Location and Range, Nature, Severity, Frequency: Intermittent or continuous, triggering or relieving factors.
2. Presence of accompanying symptoms such as insomnia, anxiety, severe vomiting (whether projectile), dizziness, vertigo, syncope, sweating, convulsions, visual disturbances, sensory or motor abnormalities, mental disturbances, drowsiness, consciousness disorders, etc.
3. History of infection, hypertension, arteriosclerosis, cranial trauma, tumors, mental illness, epilepsy, neuroses, and diseases of the eyes, ears, nose, and teeth.
4. Occupational characteristics, exposure to toxins.
5. Treatment history and effects.

【Edema】

1. Time of onset, presence of triggers and prodromal symptoms.
2. Initial location and progression: whether affected by body position; whether there is edema in the face, lower limbs, and sacral area.
3. Speed of edema development: nature of edema; whether it is pitting edema; presence of pleural or abdominal effusion.
4. Presence of signs of infection and allergy; nutritional status.
5. History of treatment with corticosteroids, testosterone, estrogen, and other medications.
6. Accompanying symptoms: local skin color, temperature, tenderness, rash, and thickness; systemic symptoms such as palpitations, shortness of breath, cough, and sputum indicative of cardiopulmonary disease; changes in urine color; presence of hypertension; normal renal function tests; gastrointestinal manifestations; liver disease; jaundice and bleeding tendencies; changes in appetite, weight, cold intolerance, sluggishness, and constipation.
7. For female patients, inquire about the relationship between edema and menstruation, body position, and weather, as well as diurnal variations.

【Obesity】

1. Dietary habits: composition of diet.
2. Family history.
3. For adult patients, inquire about menstruation, sexual function, and reproductive status.
4. Time of onset of obesity, accompanying symptoms, significantly affected body areas, and triggers for changes.

【Weight Loss】

Similar to obesity, with special attention to personality type, work, and life stress.

【Anemia】

1. Time of onset of anemia, course, and various symptoms of anemia.
2. Presence of acute or chronic bleeding, melena, and dark urine history; whether women have heavy menstrual bleeding.
3. Nutritional status: presence of picky eating, weight loss; presence of digestive system diseases such as peptic ulcers, gastric cancer, and hemorrhoids.
4. History of exposure to chemical toxins, radioactive substances, or specific medications; if so, inquire about the concentration of harmful substances, exposure methods, duration, protective measures, and names, dosages, and duration of medications.
5. Family history of anemia; whether parents are consanguineous; whether there was childhood anemia; past similar episodes.
6. For children and rural patients, also inquire about parasitic infections such as hookworm and roundworm infections.
7. History of chronic inflammation, infection, liver and kidney diseases, connective tissue diseases, and malignant tumors.

【Skin and Mucosal Bleeding】

1. Age of onset: bleeding from childhood suggests congenital bleeding disorders, while adult onset is often due to acquired factors.
2. Gender: in hereditary bleeding disorders, hemophilia is almost exclusively seen in males, while von Willebrand disease can affect both genders. Young females with recurrent purpura are often seen in simple purpura.
3. Triggers, locations, distribution, and characteristics: inquire about the location, size, distribution, duration, regression, and frequency of skin and mucosal bleeding.
4. Accompanying symptoms: presence of proteinuria, hematuria, arthritis, rash, and multi-system damage.
5. Past medical history: inquire about past diagnoses and treatment history, which is important for diagnosing acquired bleeding; whether there is a history of infection, snake bites, malignant tumors, shock, etc.; whether there has been anticoagulant treatment or other medication history; for female patients, whether there has been heavy menstrual bleeding or postpartum hemorrhage.
6. Personal history: dietary habits, nutritional status, living environment, occupation; whether there has been exposure to radioactive substances and toxins; whether there is a family history of similar initial patients.

【Cough and Sputum】

1. Age of onset: duration and rhythm of cough; whether acute or chronic; whether sudden or gradual; whether there is a difference in daytime and nighttime cough; if it is a long-term chronic cough, what is its relationship with seasonal climate.
2. Cough severity, tone, and influencing factors: is the cough severe or mild; is it intermittent or continuous, paroxysmal; what is the tone and quality of the cough; does it worsen with different stimuli; whether there has been wheezing, chest pain, and fever in the past six months.
3. Whether the cough is accompanied by sputum: color, nature, quantity, any special odor; whether there is blood in the sputum; whether the amount of sputum is large; whether different positions affect the cough; whether sputum shows layering when collected and allowed to settle.
4. History of special occupations: exposure to dust, chemicals, bird droppings, and animal contact; consider silicosis, berylliosis, asbestosis, or farmer’s lung.
5. Whether the patient smokes: cigarette smoke is a toxic gas; patients who cough due to smoking are at risk for bronchitis and lung cancer; passive smoking, especially in children, is also a risk factor. Chronic smokers should be cautious of congenital heart disease, emphysema, pulmonary fibrosis, or pulmonary embolism. Pay attention to body temperature and limb temperature.
6. History of related diseases: whether there is a history of cyanosis or exposure to drugs, chemicals, or spoiled vegetables; sulfonamides and coal tar products can lead to methemoglobinemia and sulfhemoglobinemia.
7. Generalized, localized, or unilateral cyanosis: deep shock can cause generalized cyanosis; circulatory disorders and Raynaud’s disease can cause limb cyanosis; arterial embolism or venous thrombosis can cause unilateral cyanosis.

【Palpitations】

1. Triggers, time, frequency, characteristics of episodes, and course.
2. Presence of precordial pain, fever, dizziness, headache, syncope, convulsions, dyspnea, weight loss, excessive sweating, insomnia, anxiety, and other related symptoms.
3. History of heart disease, endocrine disorders such as hyperthyroidism, pheochromocytoma, respiratory diseases such as emphysema, blood disorders such as anemia, and neuroses.
4. Use of certain medications: such as adrenaline, ephedrine, caffeine, atropine, thyroid hormones, aminophylline, calcium channel blockers (e.g., nifedipine).
5. Habits of consuming strong tea, coffee, alcohol; history of mental stimulation.

【Nausea and Vomiting】

1. Onset of vomiting: whether there is a definite cause or trigger; whether it is acute or gradual; relationship with food intake; past abdominal surgery history; menstrual history for female patients.
2. Time of vomiting: morning or nighttime; intermittent or continuous; relationship with diet, activity, etc.
3. Characteristics of vomitus: nature and odor of vomitus.
4. Triggers for episodes: such as position, food intake, throat irritation, etc.
5. Accompanying symptoms: as mentioned above, which help determine the cause.
6. Treatment history: whether X-ray barium meal, gastroscopy, abdominal ultrasound, blood glucose, urea nitrogen, etc., have been performed.

【Dysphagia】

1. Onset of dysphagia: whether there is a cause or trigger, such as ingestion of corrosive agents, chemical drugs, or foreign bodies; lesions in the oral cavity, pharynx, esophagus, or stomach.
2. Course and progression of dysphagia: a long course with no progressive worsening is often benign, while a short course with progressive worsening is often malignant.
3. Relationship between dysphagia and food types: solid or liquid foods are more difficult to swallow.
4. Location of obstruction: patients usually indicate the location of the obstruction, which generally corresponds to the lesion location.
5. Other accompanying symptoms and general condition: such as chest pain, drooling, abnormal voice, hoarseness, anemia, weight loss, etc.

【Dyspepsia】

1. Inquire about the patient’s exact symptoms and symptom clusters: clarify the meaning of “dyspepsia”; different regions, ethnicities, and cultural backgrounds may express it differently; after inquiring about the patient’s exact feelings, analyze and summarize whether it is dyspepsia. For example, if the patient describes a feeling of “fullness” in the upper abdomen, “nausea”, or “noisy stomach”, only by integrating their exact feelings can it be determined; if the patient mentions dyspepsia along with gastric retention, vomiting, or an upper abdominal mass, then a deeper understanding of these symptoms and signs becomes more important.
2. Onset and duration of symptoms: if it starts after age 45, is persistent, and progressively worsens, various organic causes should be taken seriously; for younger patients, even if the course is long, if symptoms are intermittent, functional causes should be considered more.
3. Causes and triggers of episodes: if there are various upper digestive tract irritants, such as food or medications, and if there are pre-existing upper digestive tract diseases, more attention should be paid to organic causes; if caused by mental or psychological factors, work stress, or living conditions, functional causes should be considered.
4. Ways to relieve symptoms: if antacids or eating can relieve symptoms, it is often a high-acid secretion disease; both organic and functional causes can apply; if eating worsens with weight loss and poor appetite, various organic diseases with impaired secretion should be particularly noted.
5. Presence of warning symptoms: those with warning symptoms should be examined promptly.
6. General condition after illness: changes in hyperthyroid conditions can indicate the severity of the disease and organic damage.

【Abdominal Pain】

1. Onset of abdominal pain: whether there are dietary or surgical triggers; in addition to noting causes and triggers, special attention should be paid to relieving factors.
2. Nature of abdominal pain: usually start with general questions about how it hurts; if satisfactory answers cannot be obtained, use choice questions: is it burning, cramping, knife-like, dull, or bloated?
3. Location of pain: clearly indicate the most painful area, especially at the onset, to help determine the disease location; those who can accurately point out the pain location have greater diagnostic significance than those who cannot; the former is often organic disease, while the latter should pay more attention to the role of mental and psychological factors.
4. Severity of pain: can be judged based on the patient’s statements; also observe the patient’s complexion, expression, sweating, and posture.
5. Time of pain: especially its relationship with food intake, activity, and position.
6. Accompanying symptoms: as mentioned above, are very important for establishing the nature and severity of the disease.

【Hematemesis】

1. Determine whether it is hematemesis: pay attention to exclude nasal or pharyngeal bleeding and hemoptysis.
2. Triggers for hematemesis: whether there is a history of irregular diet, excessive alcohol consumption, ingestion of toxins or specific medications.
3. Color of hematemesis: can help infer the bleeding site and speed; for esophageal lesions, bleeding is often bright red or dark red; for gastric lesions, it is often coffee ground-like.
4. Volume and nature of hematemesis: can serve as a reference for estimating the amount of bleeding; however, some bleeding may remain in the gastrointestinal tract, so the overall response should be accurately assessed.
5. General condition of the patient: is most important for estimating blood loss; symptoms such as thirst, dizziness, blackouts, palpitations, sweating, etc., as well as whether there are changes in heart rate or fainting when changing positions.
6. Past history of upper abdominal pain, acid reflux, belching, dyspepsia; whether there is a history of liver disease and long-term medication use; pay attention to medication names, dosages, and reactions.

【Melena】

1. Causes and triggers of melena: whether there is a history of irregular diet, excessive consumption of raw, cold, spicy, or irritating foods; whether there is a medication history or collective illness.
2. Color of melena and its relationship with stool: helps infer the bleeding site, speed, and possible causes.
3. Volume of melena: can serve as a reference for estimating blood loss; however, due to the influence of stool volume, it is necessary to combine the patient’s overall response to accurately estimate blood loss.
4. Accompanying symptoms: such as abdominal pain, urgency, masses, obstruction, and systemic bleeding.
5. Changes in the patient’s general condition.
6. Past history of diarrhea, abdominal pain, hemorrhoids, anal fissures, and gastrointestinal surgery.

【Diarrhea】

1. Onset of diarrhea: whether there is a history of unclean food, travel, gatherings, or collective illness; whether it is related to the intake of fatty foods or related to tension and anxiety.
2. Frequency of diarrhea and stool volume: helps determine the type of diarrhea and the site of the lesion.
3. Nature and odor of stool: whether there is fatty diarrhea or purulent blood stools; as mentioned above, this is also very helpful for determining the type of diarrhea.
4. Factors that worsen or relieve diarrhea: such as the relationship with food intake, greasy foods, and the effects of fasting or antibiotics.
5. Accompanying symptoms: whether there is fever, abdominal pain, urgency, anemia, edema, malnutrition.
6. Changes in general condition after illness: whether there is dehydration, weight loss, fatigue, or limb convulsions.
7. Pay attention to regional and family incidence to make timely judgments about epidemics, endemic diseases, and hereditary diseases.

【Constipation】

1. Inquire about the patient’s exact meaning of constipation: frequency and shape of stool, amount of stool, and whether it is difficult to pass, to determine whether it is constipation.
2. Onset and course of constipation: whether it occurred after diarrhea, whether it is persistent or intermittent, whether it is triggered by mental stress or work pressure, and whether there have been changes in diet and lifestyle.
3. Whether there has been long-term use of laxatives: types of medications, names, duration, and effects; whether there is a history of abdominal or pelvic surgery.
4. Accompanying symptoms: as mentioned above, whether there is nausea, vomiting, abdominal distension, cramping abdominal pain, and a feeling of heaviness. If there are symptoms such as abdominal masses, bowel sounds, hematochezia, or anemia, consider organic constipation and systemic diseases, especially be alert to the possibility of intestinal tumors.
5. Other diseases and medication history: such as metabolic diseases, endocrine diseases, chronic lead poisoning, etc.; pay special attention to the use of sedatives, analgesics, antidepressants, anticholinergic drugs, and calcium channel blockers.
6. Changes in general condition after illness: such as changes in weight, diet, and mental state.

【Jaundice】

1. Determine whether there is jaundice: the patient’s description of yellowing should be distinguished from pale skin, conjunctival fat, and carotinemia. Pay attention to changes in urine color for verification.
2. Onset of jaundice: whether it is acute or gradual; whether there is a history of group illness, travel, medication use, long-term alcohol abuse, or liver and gallbladder diseases.
3. Duration and evolution of jaundice: helpful for distinguishing obstructive from hepatocellular jaundice, as well as distinguishing between stone and cancerous obstruction.
4. Accompanying symptoms: whether there are gastrointestinal symptoms, skin itching, visual disturbances, and the relationship between jaundice, fever, and abdominal pain.
5. Treatment history: results of certain special tests, changes in liver function, and treatment outside the hospital.
6. Impact of jaundice on overall health: the depth of hepatocellular jaundice is positively correlated with the degree of liver function damage; congenital bilirubin metabolism disorders generally have better overall conditions.
7. Past history of jaundice, liver, gallbladder, and pancreatic diseases, and surgical history; history of parasitic infections.

【Hematuria】

1. Medical history: determine whether it is due to the following causes of false hematuria: 1) food factors, such as chili, beet, artificial coloring; 2) drug factors, such as rifampicin, phenolphthalein, phenazopyridine, rhubarb; 3) porphyrin metabolism disorders or damage leading to myoglobinuria; 4) contamination from vaginal or rectal bleeding.
2. After confirming true hematuria, inquire when the patient first noticed visible blood in urine; whether there is an increase in blood at the beginning, middle, or end of urination; whether there is a primary or secondary coagulation disorder.
3. Presence of bleeding in other areas: such as hemoptysis, gastrointestinal bleeding, skin and mucosal bleeding, and heavy menstrual bleeding, often indicating primary or secondary coagulation disorders.
4. History of kidney, urinary tract, and prostate diseases: including hypertension, edema, proteinuria, and renal dysfunction.
5. Presence of urinary tract irritation symptoms, urinary interruption, renal colic, and abnormal urine volume.
6. Medication history: whether there has been long-term or excessive use of sulfonamides, antibiotics (such as aminoglycosides), analgesics, anticancer drugs, and anticoagulants.
7. History of intense exercise, abdominal or lumbar trauma, or urinary tract instrumentation.
8. Family history of kidney disease, hematuria, deafness, and polycystic kidney disease.

【Frequent Urination, Urgency, and Dysuria】

1. Time of onset of frequent urination, urgency, and dysuria.
2. Frequency of urination, number of nighttime urinations, and volume of each urination.
3. Location, nature, time, and radiation of dysuria.
4. Presence of accompanying symptoms: such as fever, lumbar pain, hematuria, pyuria, difficulty urinating, and discharge from the urethra.
5. Recent history of catheterization, urinary tract instrumentation, or abortion.
6. Past history of related diseases: such as tuberculosis, urinary tract infections, stones, pelvic diseases, pelvic surgery, central nervous system damage, and mental illness.
7. For suspected sexually transmitted diseases causing lower urinary tract infections, inquire about the patient or their partner’s history of unprotected sexual intercourse.

【Oliguria, Anuria, and Polyuria】

1. Oliguria and anuria: 1) time of onset of oliguria, specific urine volume (collect 24-hour urine volume if necessary), urine color, etc.; 2) whether urination is accompanied by dysuria, frequency, urgency, urinary interruption, or difficulty; 3) whether there has been use of nephrotoxic drugs, chemicals, or consumption of raw fish bile, poisonous mushrooms, etc.; 4) whether there has been a history of massive bleeding, shock, heart failure, renal colic, high fever, etc.; 5) whether there has been a history of respiratory infections or pharyngitis; whether there is a history of chronic nephritis, urinary tract stones, or prostate enlargement.
2. Polyuria: 1) time of onset of polyuria, specific urine volume (collect 24-hour urine volume if necessary), whether there is increased nighttime urination; 2) whether polyuria is accompanied by thirst (specific daily water intake), increased food intake but significant weight loss; whether there are symptoms such as bone pain, easy fractures, periodic paralysis, and hypertension; 3) whether there has been a history of significant oliguria or anuria; 4) whether diuretics or medications with diuretic effects are being used; 5) whether there is a habit of consuming excessive water-rich foods or high-salt diets, or a habit of drinking large amounts of water or beverages; 6) whether there is a family history of chronic kidney disease, such as Fanconi syndrome, Bartter syndrome, etc.

【Urinary Incontinence】

1. Time of onset of urinary incontinence: whether it is intermittent or continuous.
2. Triggers for each episode.
3. Severity of urinary incontinence: frequency of episodes, amount of urine overflow each time.
4. Past history of trauma, pelvic and perineal surgery, recurrent urinary tract infections; whether currently suffering from diabetes, prostate enlargement, neurological diseases, pelvic, and urinary reproductive system diseases.
5. Whether there has been a sudden change in urination habits or environment; whether medications that may cause functional urinary incontinence are being used.

【Difficulty in Urination】

1. Time and degree of difficulty in urination: such as distance, force, duration of urination, frequency (including nighttime urination), and volume of each urination.
2. Whether difficulty in urination is accompanied by dysuria, urgency, frequency, sudden interruption of urine flow, bifurcation, thinning, and systemic symptoms such as fever, fatigue, weight loss, etc.
3. History of trauma, surgery, or infection of the brain, spinal cord, or urinary system.
4. History of diabetes, peripheral neuropathy, or radiation therapy in the pelvic perineal area.
5. Whether medications that may cause difficulty in urination are being used, such as anticholinergic drugs, antidepressants, antihistamines, and opioid analgesics.

【Low Back Pain】

1. Onset speed, presence of triggers, pain location: whether it is continuous or intermittent, whether there is a pattern.
2. Is it worse at night or during the day, does it improve after rest, or worsen after activity?
3. Presence of systemic symptoms: such as fever, fatigue, weight loss, rash, and morning stiffness.
4. Presence of other joint swelling, pain, deformity, and functional impairment.
5. Past history of similar episodes, previous examinations, and treatment history.
6. Family history of similar diseases.

【Joint Pain】

1. Onset speed, presence of triggers.
2. Location of joint pain: whether it affects large joints, small joints, or both.
3. Number of joints affected: whether it is a single joint, few joints, or symmetrical multiple joints.
4. Severity of joint pain: whether it has a pattern, whether it is continuous or intermittent, whether it is migratory joint pain.
5. Presence of joint redness, swelling, heat; presence of morning stiffness and joint deformity; whether it worsens or improves after activity.
6. Presence of systemic symptoms: such as fever, fatigue, weight loss, rash, etc.
7. Family history; past treatment history.