History of Common Surgical Symptoms
Abdominal pain
- SOCRATES:
 Site {RIF, RUQ & Epigastric ...}
 Onset , Character & Radiation :
o Suddenly > perforation\rupture > start as
localize then diffused …. Gradually >
inflammatory > constant …. Gradually
>obstruction >intermittent.
 Associations :
 GI {N&V ,hematemesis ,jaundice ,itchy ,bowel
habits (( diarrhea , constipation , alternate in b\w
, pale ,melena , bleeding)), dysphagia , heartburn
, mouth ulcer , mass}
 RS & CVS { chest pain , SOB , hemoptysis ,
palpitation , cough}
 GU {dysuria , hematuria , testicular swelling ,
vaginal bleeding , period irregularity , dark urine
} surgery , DM , IBD , anal fissure ,hemorrhoid , TB
 Constitutional symptoms { anorexia , fever ,
weight loss , night sweat ,fatigue , bone pain }
 Timing { at night , at morning ,all the day ,
Duration}
 Execrating & reliving { defecation , vomiting ,
flatus , urination , M.period , movement ,
coughing , sneezing , food }
 Severity {1-10 or similar to ..}
- PMHx {trauma , previous attack , surgery , UTI
,mumps , blood transfusion , lymph node
enlargement , strock&IHD (mesenteric ischemia),
kidney stone , endoscope , HTN ,DM
,hyperlipidemia}
- FHx {PU, Ca stomach ,gallstone ,FMF ,HTN}
- Drugs{NSAID,aspirin,diuretics,steroid ,H2 blocker}
- Sox {smoking , alcohol }
Jaundice
- Duration , onset , progression , charcot's triad {
RUQ pain , fever , jaundice} , itchy ,yellow sclera .
- GI ,GU ,CVS ,RS & constitutional
- PMHx { contact with other same iliness , previous
attack , hepatitis immunization , HF , gallstone ,
blood transfusion }
- FMHx { hepatitis A or E , jaundice , liver disease}
- Drugs { acetaminophen , isoniazid , sulfonamide ,
NSAID ,}
- SOX { IV drugs abuse , travel , alcohol }
Intestinal Obstruction
- Duration , onset , central abd.pain ,partial or
complete , flatus ,vomiting
- GI , Constitutional symptoms , Diet
- PMHx { abd.surgery ,spinal surgery ,anal fissure
,gallstone , TB contact }
- FMHx {colorectal ca , lymphoma }
- Drugs { anticoagulant , anticholinergic }
- Sox { smoking}
Ano-rectal Pain
- SOCRATES :
1- Fissure (suddenly after defecation , tearing)
2- Hemorrhoid ( suddenly & may not painful)
3- Abscess ( throbbing )
- GI , Constitutional
- PMHx { trauma , PNS , scrotal changes , anal
, immunocompromized }
- FMHx { colorectal ca }
- Sox {smoking}
Bleeding per rectum ( Hematochezia )
- Onset ,duration , frequency , how noticed ,
amount , character { color , clots , mucus , mixed
with stool } , relation to defecation {painful ,
tenesmus , itchy , incomplete empty ,} , bleeding
from other site {hematuria , hematemesis ,
hemoptysis ,epistaxis , bruising }
- GI , constitutional , CVS , Diet
- PMHx {hemorrhoid ,fissure ,anal trauma ,
colonoscopy , PUD , DM ,HTN ,IBD,diverticula
,abd.surgery , liver disease , esophageal varicose,
prolapse , bleeding disorder ,blood transfusion}
- FMHx { PUD , hemorrhoid , CHD , liver & renal
diseases ,bleeding disorders}
- Drugs { anticoagulant , NSAID , Radiation}
- Sox { smoking , alcohols }
Diarrhea
- Duration ,frequency >3\d , consistency
{loose\watery} , volume {small\large} ,character {
fatty ,mucus ,melena ,bloody} ,persistence on
fasting , eaten before 24 hr ,other family
members same illness , relived by defecation .
- GI , MS ,ENDO ,constitutional
- PMHx { IHD ,peripheral vascular disease >>
ischemic colitis , infections}
- Drugs { laxative , magnesium antacid ,antibiotics ,
digitalis , colchicine }
- Sox { stress , travel , alcohol }
Constipation
- Duration ,onset , frequency , consistency
,character {color ,bullet-shape} ,tenesmus ,
episode of diarrhea , gas
- GI , GU , ENDO , constitutional , Diet
- PMHx { pregnancy , abd,surgery , anal fissure ,
hemorrhoid , DM , hypothyroid , IBD , sleep
disturbance , depression }
- FMHx {colorectal ca }
- Drugs { ca+ channel blocker , codeine , narcotic
- Sox { alcohol , smoking , stress}
Dark stool (melena )
- Duration ,character { true (black tarry sticy stool
with strong odor ) … false ( ingestion of certain
substance)} , bleeding other sites { hematemesis ,
coffee ground vomitus , hemoptysis , hematuria ,
epistaxis }
- Association { heart pain , fainting & sweating ,
early satiety , stomach pain , loss appetite , weight
loss}
- PMHx { upper GI bleeding , PU , GERD , bleeding
disorder , stomach ca , colorectal ca }
- FMHx { stomach ca , colorectal ca , PUD , bleeding
disorder}
- Drugs { iron , NSAID , anticoagulant , steroid}
- Sox { alcohol , smoking}
Dysphagia
- Duration , character { intermittent , progression} ,
To { fluid\solid} , level of stuck , halitosis ,
aspiration , skin tightness , neck mass
- GI , RS ,CVS ,constitutional
- PMHx {GERD,PUD ,DM ,HIV , anemia, Cardiac
problem , CVA , NGT}
- FMHx {CVA , DM , PUD}
- Drugs {anticholinergic , antihistamine , steroid ,
radiation}
- Sox { alcohol , smoking}
Abdominal Swelling
- Duration ,site , how noticed , progression ,
disappear\ reappear , any other swelling ,
symptoms related {pulsatile ,painful ,reducible ,
SOB}
- GI , GU , Constitutional
- PMHx { blood transfusion , contact with hepatitis
,bleeding disorder ,gallstone , jaundice , HTN ,DM
,TB ,mumps ,anemia }
- FMHx {polycystic ovarian\kidney , stomach ca
,ovarian\breast ca , sudden death}
- Drugs { medication abuse}
- Sox { travel , alcohol , smoking}
Jaw Pain & Swelling
- SOCRATES , UNI\BI ,trauma ,can open mouth
,relation to eat , paraesthesia jaw ,stress\clench
- HEENT{Eye ,throat} ,CVS , constitutional
- PMHx {DM ,face fracture , HZV , Radiation ,smoking}
Fecal incontinence
- Onset , duration , food relation
- GI , constitutional
- PMHx { pelvic trauma , IBD , prostate \ obstetric
surgery , colonoscopy , DM , HX of constipation
\sever diarrhea , colorectal ca }
- Drugs { laxative abuse , radiation }
- Sox { smoking , alcohol}
Hematemesis
- Onset , duration , character { bright blood , coffee
ground } , amount { hypovolemic (SOB , cool
extremities , pale skin)},frequency , proceeded by
nausea or sever vomiting , charcot's traid
,bleeding other sites { hemoptysis , epistaxis ,
bruising , melena ,hematuria }
- GI , constitutional
- PMHx { previous attack , anemia , burn , trauma ,
PUD , liver disease}
- FMHx { PUD stomach ca , bleeding disorder }
- Drugs { NSAID , aspirin , warfarin }
- Sox { alcohol , smoking , coffee}
Hemoptysis
- Duration , amount , character { color ,clots,
sputum , aspiration food} , bleeding other sites
{hematemesis , hematuria , epistaxis ,melena}
- RS , constitutional
- PMHx { leg pain\swelling , DVT , contact with TB ,
post-bronchoscopy , CXR\CT ,HF}
- FMHx { bleeding disorder , lung ca }
- Drugs { Aspirin , anticoagulant}
- Sox { travel , smoking , alcohol}
Nausea & Vomiting
- Duration , frequency ,volume, character { color
taste , food , bile , blood , projectile}, abdominal
pain ,LMP .
- CNS ,RS ,GI ,GU, constitutional
- PMHX { contact with Ill patient , DM ,cardiac
problem ,PU , past test (x-ray , endoscopy) }
- Drugs { contraceptive , change in medication}
- Sox { smoking , alcohol}
Headache
- SOCRATES
- Association : { aura , jaw claudication , visual
disturbance , photophobia , hx influenza
,exarbation with sneez ,food ,smoking ,alcohol
,neck stiffness , droesiness , N&V ,constitutional ,
drugs like nitrate\ nifedipine}
Facial swelling
- Duration ,site , how noticed , progression ,
disappear\ reappear , any other swelling
,generalized\localized , mask cream ,insect bite ,
trauma , previous attack , food relation , chewing
execration , pain
- HEENT {nose} ,constitutional
- PMHx { contact with mump, sinusitis , central
venous cannula , acromegaly , DM , renal disease ,
pregnancy }
- FMHx { mumps}
- Drugs {Allergy , steriod}
Axillary swelling
- Duration ,site , how noticed & onset , progression
, disappear\ reappear , any other swelling
,generalized\localized
- Association { tender , supergicial , redness ,
hotness , discharge ,firm\soft , pulsatile , any site
of infection}
- Constitutional , PMHx { TB , breast ca ,DM }
Foot Pain
- SOCRATES ,trauma , heavy walk , puncture wound
, insect bite , redness , swelling ,joint pain
,deformitiy , pain in wearing shoes, rest pain ,
plantar wart , ulcer , backache .
- Constitutional
- PMHx {gout , DM , Ulcer , intermittent
claudication , backache }
Leg Swelling
- Duration ,site , how noticed & onset , progression
, disappear\ reappear , any other swelling
,generalized\localized ,Bi\Uni , trauma , insect bite
, paralysis
- Association { joint pain , malnutrition , skin
infection , ENDO , constitutional }
- PMHx { abd\pelvic surgery ,pregnancy ,HF , RF, LF ,
varicose , hypothyroidism }
- SOX { travel , smoking , alcohol}
Neck Pain
- SOCRATES ,trauma , equipment (central line ,
endoscope ) , stiffness , nuchal rigidity , lymph
node swelling
- Association { arm& hand pain & weakness in
muscles , bladder problem , joint pain & swelling ,
shoulder pain , headache radiate to neck ,
constitutional }
- PMHx{ Rh.A ,TB contact , malignancy , cervical rib}
Arm Swelling & Pain
# Swelling :
- Duration ,site , how noticed & onset , progression
, disappear\ reappear , any other swelling
,generalized\localized
- Association { trauma , cut wound , hotness ,
redness ,fly bite ,pain , edema ,discoloration ,
excessive use }
- PMHx { breast ca ,IV injection ,previous attack }
- FMHx { malignancies of pancreas ,stomach , lung ,
lymphoma}
- Drugs { radiation , chemotherapy }
# Pain :
- SOCRATES
- Association { trauma, neck stiffness , muscle
wasting , hair & sweating loss for arm
,paraesthesia ,swelling , discoloration , excessive
use }
- CVS , constitutional
- PMHx {HTN ,DM ,RF ,LF , vit.B12 deficiency }
- SOX { smoking , alcohol}
Leg Pain
- SOCRATES ,Uni\Bi ,trauma ,puncture wound
,hotness\coldness , redness ,itchy ,swelling ,
deformity , lump behind knee , backache .
- MSS , constitutional
- PMHx { RhA ,gaut , infection ,IHD , hyperlipidemia
, RF , surgery , DVT ,}
- Drugs { steroid , contraceptive }
Popliteal Swelling
- Duration ,site , how noticed & onset , progression
, disappear\ reappear , any other swelling
,generalized\localized , bi\uni , pulsatile ,
firm\soft ,hotness ,redness , movement limitation
, discharge , pain (calves , leg , joint) , infection
- RS , constitutional
- PMHX { varicose , vascular disease , Rh.A}
Neck Lump
- Duration ,site , how noticed & onset , progression
, disappear\ reappear , any other swelling
,generalized\localized ,uni\bi ,trauma , infection ,
occur during mastication \after eating ,move with
swallowing , pulsatile
- Association { dizziness , headache , chocking ,
claudication\numbness of upper limb ,RS, ENDO
,GI ,MSS ,constitutional }
- PMHx {cervical rib , HIV , TB , malignancy }
- Drugs { radiation , steriod}
- SOX { pet scratch , travel, smoking}
Thyroid
- Duration ,site , how noticed & onset , progression
, disappear\ reappear , any other swelling
,generalized\localized , painful (SOCRATES)
,uncomfortable \movement with swallowing ,
hoarseness , limitation movement , SOB
- Constitutional , ENDO :
1- Hyper {nervousness , tremor , palpitation ,
chest pain , diarrhea , muscle wasting ,
heat intolerance , sweating , amenorrhea }
2- Hypo { inc weight ,cold intolerance , slow
action , loss hair , muscle fatigue , dry skin
, constipation , eye changes }
- PMHx { pregnancy , HTN , DM , HYPO\HYPER-
thyroids , infection }
- Drugs { iodine , radiation}
Penile Lesion
- Duration , site (glans\foreskin) ,painful , swelling
,redness , hotness , vesicles , wart , trauma , ulcer ,
discharge , deformity (opening) , painful
intercourse , erectile dysfunction
- GU , constitutional
- PMHx { sexual Hx , catheter , DM , HTN}
- Drugs & SOX {smoking}
Hematuria
- Duration , color (micro\macro) ,clots , frequency ,
dysuria , pain , vigorous exercise , stone passage ,
trauma , at begging \terminal \total , bleeding
other (hemoptysis , epistaxis , bruising , melena)
- Association { joint pain , rash , menstruation ,
constitutional , GU , Diet (fava beans , dyes)}
- PMHx { previous attack , precious sore throat , skin
infection , TB ,UTI , kidney disease , foley catheter , - FMHX { HTN ,DM , CRF}
stone , G6PD}
- FMHx {hematuria , bleeding disorder , G6PD}
- Drugs { warfarin , aspirin , rifampicin ,
cyclophosphamide}
- Sox{ smoking ,travel}
Scrotal Problem
# Pain
- SOCRATES ,trauma , vigorous exercise ,torsion ,
groin swelling , abd.pain , heaviness
- Skin (swelling , color , hotness , itchy , ulcer
,vesicles , loss sensation , discharge ), GU ,
constitutional
- PMHx { mumps , urethral catheter , UTI }
- Sox { smoking}
# Swelling
- Duration ,site , how noticed & onset , progression
, disappear\ reappear , any other swelling
,generalized\localized ,bi\uni , trauma , groin
swelling , tender , hotness , redness , discharge ,
reducible , varicocle , absence testis , pulsatile
- GU , GI , Constitutional
- PMHx { TB contact (hemoptysis ), sexual hx ,
subfertility ,mumps , DM , HTN }
- Sox {smoking}
Urologic Pain
- S(flank, suprapubic , lower abd , back)OCR(flank ,
penis , scrotum\labia )ATES
- Constitutional , GU :
1- Irritant {frequency , urgency ,nocturia ,
dysuria , urine color (hematuria , dark ,
amount , peumaturia , at begin \ terminal
\ total )}
2- Obstructive { hesitancy , intermittency ,
dripping , poor stream (caliber , number ,
shape , strength ) , straining to void ,
feeling incomplete . inconstancy }
- PMHX ,FMHX ,DRUGS ,SOX
Proteinuria
- Onset ( frothy urine , urine analysis ) , previous
febrile illness , sore throat , trauma
- Association { fever , facial rash , hemoptysis ,
swelling (eye , abdomen , ankle , legs , arms ,
genitalia , joints ) , abdominal pain , N&V , GU }
- PMHX { pregnancy , SLE , DM , CRF , HTN , CHF ,
Rh.A }
- Drugs { penicillamine , gold}
- SOX { smoking }
Polyuria AND Frequency
- Duration , frequency , amount , nocturia ,
drinking excess amount of fluid , excessive thirst
& appitite , weight loss , bone pain , dysuria ,
hematuria , numbness & infected feet
- ENDO , constitutional
- PMHX { DM , glucose test Hx , hyperthyroid , CRF ,
DI , UTI , head surgery }
- FMHX { DM }
- drugs {NSAID ,Lithium }
- SOX{smoking , alcohol , caffeine }
Urinary incontinence
- Duration , Timing (all day\at night) , Pads ( number
, socked , bed or cloth wetting ) , ureteric & renal
colic ,Types :
1- Stress { stress , cough , multiple birth }
2- Overflow { after period of retintion}
3- Urge { strong desire to urinate}
4- Anatomical { since underwent pelvic
surgery }
- GU , constitutional
- PMHx { prostatectomy , urethral catheter , DM ,
head injury , CVA , pelvic surgery , spinal
injury\surgery , bladder tumor , TB }
- Drugs {pelvic radiotherapy}
- Sox { somking}
Urethral Discharge
- Duration , character ( bloody , purulent , smell ,
viscosity ) , genitalia (pain , swelling , redness ,
hotness , ulcer , trauma) , groin swelling ,
dyspareunia , change of soap , back pain , abd.pain
, constipation\diarrhea , multipartner
- GU , constitutional
- PMHx {stone , urethral catheter , TB}
- Sox {smoking , travel}
Breast Mass
- Duration ,site ,bi\uni , how noticed & onset ,
progression , disappear\ reappear , any other
swelling ,generalized\localized , shape ,
fixed\mobile , consistency (solid\soft) ,pain , skin
changes (peud oranges, infection ) , nipples
(inversion \retraction , discharge(color\bloody) ),
LN enlargement , relation to menstruation , age of
menarche , lactation , trauma
- Association { hemoptysis , chest pain , SOB ,
jaundice , headache , bone pain , constitutional }
- FMHx { ovarian ca , breast ca}
- Drugs { oral contraceptive }
Done by Dr.Salem Mohammad AL-ma’aiteh - Orthopedic surgeon
Urinary Retention
- Duration , hesitancy , poor stream , intermittency
, incomplete empty , dripping , strain to void ,
trauma , constipation , anxiety
- GU , constitutional
- PMHx { UTI , stone , BPH , urethral catheter ,
pregnancy , urological surgery , neurological
disease }
- Drugs { atropine , antidepressant }
Ulcers problem
- Onset , duration , site ,size ,shape ,trauma ,
insect\animal bite , exposure(chemical,UV-light) ,
pigmentation , discharge , itchy , vesicles ,
previous ulcers
- Constitutional
- PMHx { IBD , DM , IHD , hyperlipidemia , varicose
\DVT , TB , Rh.A , syphilis , surgery }
- Drugs { radiation , chemotherapy}
- Sox { smoking ,travel}
Regurgitation
- Duration , content ( acid , bitter , food , fluid ) ,
worse with ( big meal , horizontal posture ,
bending , belching , at night when sleep ) , wake
pt at night
- Association { heart burnig , water brush ,cough ,
hoarseness , waking bad taste mouth , dysphagia
(solid\fluid) , weight loss ,thinking & tightening of
skin , constitutional }
- PMHx {GERD , SLE , scleroderma , pregnancy ,
obesity ,ca ,}
- Drugs { NSAID ,narcotic , theophylline , tricyclic
antidepressant ,}
- SOX { smoking , alcohol , caffeine ,}
Breast Pain AND Nipples discharge
- Duration , uni\bi , relation to period , hotness ,
discoloration , swelling , trauma , LMP ,
pregnancy , lactation , nipple discharge (duration ,
character [color , bloody , mucus ,smell , viscosity
] , uni\bi ,swelling , axillary LNE )
- Constitutional , menstruation
- FMHx { breast ca }