Notes on History of Present Illness

Jul 30, 2024

History of Present Illness (HPI)

Key Aspects of HPI

  • Critical component of history taking
  • Consists of three main elements, known as the Three C's:
    • Case: Identify the system involved (e.g., cardiac, respiratory, gastrointestinal, CNS, renal, endocrine, hematological)
    • Cause: Determine the specific disease causing the symptoms
    • Complications: Assess for any complications arising from the disease

Understanding the Three C's

  1. Case

    • Identifying the System:
      • Example: Breathlessness
      • Main systems involved:
        • Cardiac
        • Respiratory
    • Cardinal Features to Assess:
      • Cardiac Features:
        • Paroxysmal nocturnal dyspnea
        • Orthopnea
        • Palpitations
        • Chest pain
        • Syncope
        • Pedal edema
      • Respiratory Features:
        • Preceding cough and sputum
        • Hemoptysis

  2. Cause

    • Mnemonic: VITAMIN CD (used to identify potential causes of disease)
      • Vascular
      • Infectious
      • Traumatic
      • Autoimmune
      • Metabolic
      • Idiopathic
      • Neoplastic
      • Congenital
      • Drugs and toxins
    • Example of Features Based on Cause:
      • Vascular: Pulmonary embolism
      • Infectious: Pneumonia, lung abscess, bronchitis, pleural effusion
      • Traumatic: Pneumothorax
      • Autoimmune: Interstitial lung disease
      • Allergic: Asthma
      • Neoplastic: Lung tumor
      • Congenital: Cystic fibrosis, congenital diaphragmatic hernia
      • Toxins: Chronic smoking

  3. Complications

    • Importance of understanding potential complications for management:
      • For COPD:
        • Acute exacerbations
        • Multifocal lateral tachycardia
        • Respiratory failure type 2
        • Cor pulmonale
    • History to Ask for Complications:
      • History of acute attacks (fever, purulence)
      • Palpitations
      • Morning headache
      • Altered behavior/sensorium
      • Edema, jaundice, distended veins

Conclusion

  • Comprehensive evaluation using Three C's leads to effective HPI taking
    • Steps to Take:
      • Identify what system is involved by asking about cardinal features of symptoms
      • Use VITAMIN CD to check all possible causes
      • Evaluate for complications that arise from the potential disease
  • Efficient history taking allows for ruling out negative history for more accurate diagnosis and management decisions.