How to Take a History—Syndromes

First we try to figure out WHAT the problem is.

Begin with the chief complaint of your patient. (The author is a neurosurgeon, so examples from the neurological realm will abound in these pages. Get used to it. )

Begin with an open-ended question to elicit the chief complaint:

Q: What is bothering you, Mr. Wilson?

A: Well, doc, my right arm is numb.

This (these) chief complaint will form the foundation of your inquiry.

At this point, you must stop and think of various patterns of disease presentation which this chief complaint can fit into.

These clinical syndromes, for that is what they are, then suggest a list of questions for your history of present illness queries.

To take our above example, right arm numbness can occur as part of many different medical problems.

Syndrome associated with R arm numbness	Additional History	Typical PE findings
L cerebral hemisphere lesion	R face and leg numbness R hemiparesis spatial disorientation	R decreased stereognosis R pronator drift R side hyperreflexia
L brainstem lesion	R cranial nerve deficit	R cranial nerve deficit
R spinal cord lesion	L arm & leg numbness R arm & leg weakness	R Brown-Sequard syndrome
R cervical radiculopathy	R arm/hand weakness R arm/shoulder pain	root-distribution signs
R peripheral nerve lesion	R arm/hand weakness R arm/hand numbness	nerve-distribution signs

But you have to know these syndromes first, don't you? Aah, so that was what the 1st and 2nd years of med school were for! Yes. But now you are challenged to take that mass of raw data and package it into a form where you can access and use it out on the firing line. Thus 3rd and 4th year of med school, plus the rest of your life.

So you take the chief complaint(s), list the syndromes that they are associated with, and ask questions to rule in/rule out these syndromes. Now we're getting somewhere.

But wait, there's more...ANATOMY