History of Cough & URTI:

Character:
WIPP
• Whopping vs Barking

• Intrusive vs trying to clear throat

• Painful vs painless

• Productive vs Non-Productive

- Frequency

- Amount

- Color

- Content (blood? - If hemoptysis: when did it start? Amount of blood? Bright vs dark?)

- Consistency

Associated Symptoms:
Chronic Cough:
• Wheeze (asthma)

• Change in voice (laryngeal cause)

• Heartburn (GERD)
• Secretions go back to your throat - itchy throat (PND)
Acute Cough:
• Headache

• Sinus & nose congestion

• Runny nose

• Loss of smell & taste

• Sore throat

• Change in voice

• SOB (if present ask about POPE)

Exacerbating & Relieving Factors:

• Worse when breathing or exercising

• GERD: spicy food & position (flat)

• Asthma: season, pet, irritants

Past Medical History:

• Similar disease: Atopy [asthma, allergic rhinitis, eczema]

• Recent History of Infection: contact with TB patient?

Drug History:
• ACE Inhibitors

• Inhalers

• Vaccines: Flu, COVID-19, Pneumococcal Vaccine

Depression:
Onset:
• When did it start?

• Sudden or gradual?

• Continuous or intermittent?

• Was there any trigger for those feeling?

• Do these feelings suddenly come before your menstrual cycle begins?

Associated Symptoms:
Depression:
MISGECAPS
• Mood is depressed

• Interest loss

• Sleep disturbance

• Guilt

• Energy decline

• Concentration difficulties

• Appetite or weight changes

• Psychomotor abnormalities

• Suicidal ideation - If yes:

- Did you prepare a plan?

- Have you had any previous attempts?

5/9 symptoms must be present for 2 weeks (M or I must be present).

PAMM:
Psychosis:
• Hallucinations: “Have you ever heard voices speaking when there’s no-one around?”

• Delusions: “Have you ever felt that someone is able to put thoughts into your head?”

• Paranoia: “Do you fear that people are out to get you?”

Anxiety: “Have you felt more anxious lately”

Mania: “Have you experienced periods where you feel euphoric/energetic?”

Medical Conditions:
• Cold intolerance, dry skin, weight gain (Hypothyroidism)

• Dyspnea, fatigue, palpitations (Anemia)

Exacerbating & Relieving Factors:

• Worse with life-stressors (marital dispute, social life, financial stress)

• Relieved by self-harm / self-destructive behavior (cutting wrists or thighs)

Past Medical History:

• Chronic Diseases: Hypothyroidism & Anemia

• Similar disease: Psychiatric disorders

• Is it associated with the onset of your menstrual cycle?

Social History:
• Food: Caffeine intake

• Stressors

Dysuria:
Site:
• Is what you’re experiencing pain or discomfort while urinating?

• Where exactly is the problem?

Onset:
• When did it start?

• Sudden (cystitis) or gradual (urethritis)?

• Continuous or intermittent?

• Does it occur before the onset of menses (vulvovaginitis)?

Character:
1. Character of the pain (sharp, burning, …)

2. Initial vs Terminal pain?

3. FACC-O

- Frequency

- Amount

- Color (frothy or cloudy?)

- Content (blood or stones?)

- Odor

Radiation:
• Abdominal pain? (Suprapubic abdominal pain)

• Flank pain?

Associated Symptoms:
UTI Symptoms:
Males:
• Pain or swelling in the testicles

• Urethral discharge

Females:
• Painful sexual intercourse

• Vaginal discharge

LUTS:
Voiding Symptoms: SHEDD

• Stream changes

• Hesitancy

• Emptying problems (strain to urinate)

• Dribbling

• Dysuria

Storage Symptoms: FUNI

• Frequency

• Urgency

• Nocturia

• Incontionence

Past Medical History:

• Investigations: Kidney biopsy

• Hospitalizations: Foley catheter

• Surgeries: Renal transplant & stone extraction

• Trauma: History of trauma to the pelvis

• Similar disease: CKD, UTI, Stones (BHP/Prostate cancer in males)

• Infections: Stept throat, STD

Drug History:
DAAAC

• Diuretics

• Alpha-Blockera

• ACE Inhibitors

• Anelgesics

• Chemotherapy

Social History:
• Unprotected sex

• Extramarital relationships

Past Medical History (All Histories):

• Any Previous:
- Have you had any previous investigations regarding your symptoms?

- Have you had any previous hospitalizations?

- Have you had any previous procedures, surgeries, or blood transfusions?

- Have you had any previous trauma or prolonged immobilization?

• Have You Ever Been Diagnosed:

- Have you ever been diagnosed with any chronic diseases? (DM, HTN, Autoimmune,
Cancer)

- Have you recently been diagnosed with any infections or came into contact with sick
patients (TB or Hepatitis)?

- Have you ever been diagnosed with any (related system) disorder, such as:

Gastrointes*nal CVS Respiratory

IBD, IBS, GERD, PUD, Celiac/ HTN, DLP, IHD, Asthma, COPD, PE, DVT, CF,
lactose intolerance, HH, liver Any early age sudden TB, STD, or any recent
disease. death in your family? Infec*ons
Renal Endocrine Rheumatology & Skin
Recurrent UTI, Hypo/ hyperthyroidism,
SLE, RA, OA, any joint
stones, Cushing, AI, DM or its
replacement? Gout, hyper/
PCKD, kidney transplant, CKD, complica*ons,
Hypopigmenta*on, mobility
deafness, BPH, prostate dx, Osteoporosis,
aids
Osteoporosis amenorrhea, acromegaly,

Drug, Allergy, & Immunization History:

• Are you currently on any medications? (If yes, ask about: frequency, dose, compliance, SE)
• Do you have any allergy (food / drugs / chemicals/ irritants/ perfumes F)?

• Have you been immunized against HepB, Hep A, pneumococcal, influenza, Covid-19,
tetanus vaacine/malaria? (if yes, When? What type? Any complications?)

Family History:
• Are your parents 1st degree relatives?

• Does any family member have a similar presentation as you do?

• Has Any Family Member Ever Been Diagnosed:

- Has any family member ever been diagnosed with any chronic diseases? (DM, HTN,
Autoimmune, Cancer)

- Has any family member recently been diagnosed with any infections or came into contact
with sick patients (TB or Hepatitis)?

- Has any family member ever been diagnosed with any (related system) disorder, such as:..

Social History: (Home, Diet, Work, Activity, Risky Behaviors) TAKE PERMISSION FIRST!!!

Home:
• Are you married? You have any children?

• Where do you live? (Villa or apartment - which floor?)

• Do you live alone? Do you need support at housekeeping?

• Do you have pets? Do you smoke at home? Do you use ‫

?بخور‬
Diet:
• How would you describe your diet? Healthy (home-cooked) vs non-healthy (fast food)?

• Do you eat fibers and drink enough water? (How many bottles?)

• Do you eat a lot of red meat and sea food? (GOUT)

• Think of other food related to the complaint (Thyroid: seaweed & goiterogenic food like
peanuts - Hematuria: beetroot)

• Recent history of eating outdoor then getting sick (food poisoning & gastroenteritis) or
ingestion of raw milk & animal contact or insect bites / undercooked meat/ Undercooked
eggs/ unwashed vegetable & fruits / unclean water.

Work:
WHACS

• What do you do for a living

• How do you do it?

• Active job or sedentary?

• Colleagues with similar presentation?

• Stress level of their job?

Activity & Depression Screening:

• Active or sedentary lifestyle? (How many days per week do you exercise?)

• Recent history of traveling overseas + vaccination prior to traveling? If they visited any rural
areas with dirty water or swam in unclean swimming pools?

• Have you noticed any change in your mood or loss of interest, hopelessness, increase or
decrease in sleep and energy in the past 2 weeks?

Risky Behavior:
• Do you drink alcohol? (How much, for how long?)

• Do you smoke? Does anyone at home smoke? (How many packs, for how many years?)

⚠ If the patient is a smoker, ask whether the symptoms were the same before he/she started
smoking?

• Any recent history of insect bites or contact with animals?

• History of unprotected Sex, IVDU ,working in health field, Tattos and piercing?

Counseling:
Dyslipidemia Lifestyle Counseling:
• WIPPPE

• ICEE

• Female = Family

CRRAAPP

Clarification:
1. What are Lipids?
• Lipids = Fat in the blood

• Lipoproteins = Lipids + Proteins

• Three kinds: HDL, LDL, VLDL

• LDL accumulates in blood vessels and clogs them (causing strokes & MI)

2. Symptoms of Dyslipidemia
• Asymptomatic

• First sign may be a stroke or MI

3. Normal Cholesterol Levels

• Total Cholesterol < 200 mg/dL

• LDL < 130 mg/dL

• If LDL levels go > 130 the risk of MI/stroke becomes very high

4. What Causes Dyslipidemia

• Eating high-fat food

• Inherited disorders

• Medical conditions (hypothyroidism, alcoholism, CKD…)

• Medications (OCPs, steroids, BP meds, …)

Reassurance:
Very common + easily manageable with lifestyle modifications and medications.

Red Flags:
Go to the ER if you experience chest pain or any signs of a stroke (neurological deficits)

Assess:
• Comorbidities (HTN, DM, Obesity)

• Risky Behaviors (Smoking & Alcohol)

Advice:
The best way to manage your dyslipidemia is by:

1. Losing Weight

2. Eating Less Fat

• Meat, Chicken, Eggs, Fried Food
- Meat: buy lean meat + remove any visible fat before cooking

- Chicken: remove skin + don’t fry

- Eggs: do not eat the yolk

- Avoid fried food

• Dairy Products
- Low-fat or skimmed milk, yogurt, cheese…

- Avoid full-fat

• Increase Fiber Intake

- Eat 3-5 servings of fruits & vegetables a day

3. Exercise
• 150 mins/week (30 mins/day - 5 days/week)

• Aerobic Exercises: walking, swimming, cycling

• This will help lower your cholesterol, BP, and help you lose weight

Prescribe:
1. Medications

2. Allergies

3. Adherence

- Following those lifestyle modifications might bring your cholesterol levels back to our
target; however, if this approach doesn’t work, we might need to start you on medications

Positive Reinforcement

Opportunistic Prevention

Depression Screening
Diabetes Lifestyle Counseling:
• WIPPPE

• ICEE

• Female = Family

CRRAAPP

Clarification:
1. What is Diabetes?
• Decreased insulin production

• High Blood glucose

• If not managed properly, it can affect your eyes, kidneys, and heart

2. Symptoms of Diabetes
• Hyperglycemia: Polyuria, polydipsia, polyphagia

• Hypoglycemia: Perspiration, Palpitations, Pre-syncope

3. Normal Blood Sugar Levels

• Fasting Blood Glucose: 80-130

• Post-Prandial: <180

• HbA1c: <7

4. What Causes Diabetes?

• It’s caused by a combination of genetic & environmental causes.

• Some contributing factors include: obesity, sedentary lifestyle, high sugar or high carb
diet.

Reassurance:
Very common + easily manageable with lifestyle modifications and medications.

Red Flags:
Go to the ER if you experience severe hypoglycemia or hyperglycemia symptoms

Assess:
• Comorbidities (HTN, DM, Obesity)

• Risky Behaviors (Smoking & Alcohol)

• Family History of DM

Advice:
The best way to manage your diabetes is:

1. Weight:
• Normal BMI (20-25)

• A your weight increases, insulin resistance & risk of complications increase.

2. Diet
• Low Glycemic Index Food (BRAM)

• 10 Fs

• 12 S

3. Exercise:
• 150 mins/week (30 mins/day - 5 days/week)

• Aerobic Exercises: walking, swimming, cycling (Moderate Intensity)

• This will help you lose weight + increase insulin sensitivity

Prescribe:
1. Medications

2. Allergies

3. Adherence

- Following those lifestyle modifications might prevent the need of more medications or
insulin

Prevention:
Prevent complications by:
1. Weight Loss

2. Foot Care

Opportunistic Prevention

Depression Screening
Asthma Counseling:
• WIPPPE

• ICEE

• Female = Family

CRRAAPP

Clarification:
1. What is Asthma?
• Tubes (airways) become smaller making it difficult to for air to go in and difficult to berth

2. Symptoms of Asthma
• Cough, chest tightness, wheezing, SOB

• These symptoms come & go when exposed to certain triggers

3. What Causes Asthma?

• Unknown cause

• Some factors make it more likely that you’ll get it:

- Family Hx of Asthma

- Having other allergies

• There are certain triggers for asthma: pets, smoke, dust…

Reassurance:
Very common + easily manageable with lifestyle modifications and medications.

Red Flags:
Go to the ER if you experience worsening of your symptoms and they don’t improve after
taking your inhaler. This is called an asthma attack.

Assess:
• Comorbidities (HTN, DM, Obesity)

• Risky Behaviors (Smoking & Alcohol)

• Asthma Control: DINA

Advice:
The best way to manage your Asthma is to:

1. Avoid Triggers:
• Remove dust, remove rugs, remove pets, stay indoors when dusty, smoking cessation

2. Exercise:
• Do NOT stop exercising due to SOB - take inhaler 20 mins before exercising

3. Asthma Attacks:
• Always keep your inhaler on you

Prescribe:
1. Medications

2. Allergies

3. Adherence

Reliever Inhaler:
• Most common is Ventolin (blue inhaler)

• Relieves symptoms by quickly relaxing the airways

• If used >3 days/week it means your asthma is not controlled

• SE: Increased HR, tremor, headache

Controller Medication:
• Helps on the long-term to decrease inflammation

• They must take it every day - even if they feel well

• SE: wash mouth after use to prevent oral candidiasis

Steps to use the inhaler

Peak Flow Meter:

• Helps monitor symptoms

• Only used if medications changed or if pt has exacerbation

• Used twice a day (morning & night) 3 times each

• How to use it

Positive Reinforcement

Opportunistic Prevention

Depression Screening

Done By:
Noura Abuthiyab & Noura Alzaid