Davao Medical School Foundation, Inc

ARTS AND SCIENCE OF MEDICINE 2

Patient Presenting with Chest Pain

Name of Student: _____________________________________________ Date:

__________

Legend: 3 points = Done COMPLETELY and CORRECTLY

2 points = Done CORRECTLY but INCOMPLETE
1 point = Done INCORRECTLY and INCOMPLETE
0 point= NOT DONE

ESTABLIHING
A. ESTABLISHING RAPPORT RAPPORT IS REMARKS
AND ASKS FOR CHIEF GRADED AS 1
COMPLAINT POINT OR 0(ZERO)

1. Greets the patient politely

2. Introduces self

3. Asks for the identifying data:

NAME, AGE, OCCUPATION,
RELIGION, ADDRESS

4. Tells the patient the purpose of

the interview, assures patient to
maintain confidentiality and
secures consent

5. Asks the CHIEF COMPLAINT

B. CHESTPAIN. ASKS ABOUT THE FOLLOWING:

History Of Present Illness:
3 2 1 0 REMARKS

1. Onset of CHESTPAIN
“When did your chestpain start?”
2. LOCATION of CHESTPAIN
*Can you point to me exactly where the
pain is?
3. RADIATION * Pain radiates to
or does not radiate
4. Duration of CHESTPAIN
e.g: During an episode of
CHESTPAIN, how long will it
last? Is it persistent?

5. CHARACTER/QUALITY of
CHEST PAIN
Can you describe to me your chest
pain, ex Sharp pain?
6. AGGRAVATING FACTORS

Is there any factor, which can

increase the CHESTPAIN?
7. ALLEVIATING FACTORS

e.g: Did you take any

medication for CHESTPAIN? Or
what medication did you take?
Or What factors can relieve your
CHESTPAIN or make it subside
8. ASSOCIATED SYMPTOMS

e.g: Aside from CHESTPAIN

what other symptoms do you
have? Difficulty in breathing,
shortness of breathing,
palpitations,
orthopnea,Paroxysmal
Nocturnal Dyspnea
9. TIMING
When is the chest pain most
prominent, or is there any
specific time in a day that you
experience chest pain?
10. SEVERITY

Use of Pain scale

Medical History
REMARKS

1. PAST MEDICAL HISTORY

Asks about co morbidities
Hypertension,
Diabetes mellitus,
Dyslipidemia

if present asks if co morbidities

are controlled or uncontrolled
( asks for date or years of
diagnosis, medications,
compliance to medications,
latest BP levels or lab results)
Previous history of Illness
recent or previous history of Fever
History of Upper respiratory
complaints/symptoms
Childhood febrile illness, Rheumatic
fever
Previous OPD Consultations
previous Hospitalizations
2. FAMILY HISTORY
Asks about family members
 with chest pain or any cardiac
conditions
3. PERSONAL /SOCIAL
HISTORY
Asks about drug allergies
Asks smoking history
Asks about alcohol use
4. OB GYNE HISTORY
Asks about menarche,
Menstrual cycle ,
gravidity,Parity

5. REVIEW OF SYSTEMS
Asks about other possible
symptoms experiences:

Name and Signature of Preceptor__________________________________

Date__________