What questions should be asked to diagnose a patient's condition?

Diagnostic Questions for Common Medical Conditions

Ménière's Disease

To diagnose Ménière's disease, physicians should ask specific questions about vertigo episodes, hearing symptoms, and their temporal relationship.

• Ask about the nature of dizziness, specifically whether the patient experiences a sensation of spinning or rotation (true vertigo) 1
• Inquire about the duration of vertigo episodes (typically lasting 20 minutes to 24 hours in Ménière's disease) 1
• Ask about the frequency of vertigo attacks 1
• Determine if hearing loss occurs with dizziness episodes, and whether it fluctuates 1
• Ask about tinnitus (ringing, buzzing, or other noises in the ear) during or between attacks 1
• Inquire about aural fullness (ear feeling plugged) during episodes 1
• Ask if symptoms have caused falls 1
• Determine if headaches or light sensitivity occur during dizzy spells (to rule out vestibular migraine) 1
• Ask about family history of similar symptoms 1

Allergic Rhinitis

When evaluating a patient for allergic rhinitis, focus questions on symptom patterns, triggers, and impact on quality of life.

• Determine the pattern of nasal symptoms (seasonal, perennial, or combined) 1
• Ask about specific nasal symptoms: congestion, rhinorrhea, sneezing 1
• Inquire about the onset, frequency, and characteristics of symptoms 1
• Identify potential triggers that precipitate or worsen symptoms (pollen, animals, irritants) 1
• Ask about associated symptoms: throat soreness, post-nasal drip, cough, ocular symptoms 1
• Determine the severity and impact on quality of life, including work/school performance and sleep 1
• Ask about previous treatments and their effectiveness 1
• Inquire about willingness to modify exposures if allergens are identified 1

Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis

For suspected SJS/TEN, ask detailed questions about medication history, symptom progression, and mucosal involvement.

• Ask about prodromal symptoms (fever, malaise, upper respiratory symptoms) 1
• Determine the date when the rash first appeared and document progression 1
• Ask about pain associated with the rash 1
• Inquire about involvement of mucosal sites (eyes, mouth, nose, genitalia) 1
• Ask about respiratory symptoms: cough, dyspnoea, bronchial hypersecretion, haemoptysis 1
• Inquire about gastrointestinal symptoms: diarrhoea, abdominal distension 1
• Record all medications taken over the previous 2 months, including over-the-counter and complementary therapies 1
• Document when medications were started, dose changes, and when they were stopped 1
• Ask about previous history of drug allergies and reaction types 1

Alzheimer's Disease and Related Disorders

When evaluating for cognitive impairment, ask questions about changes in memory, function, and behavior.

• Inquire about changes in cognitive abilities over the previous year 1
• Ask about difficulties with complex instrumental activities of daily living (managing finances, using technology, traveling to unfamiliar areas) 1
• Determine if there are problems with basic self-care activities (bathing, dressing, toileting) 1
• Ask about changes in behavior or personality 1
• Inquire about neuropsychiatric symptoms: apathy, depression, anxiety, irritability, agitation 1
• Ask about sleep disturbances 1
• Determine if there is a family history of dementia 2
• Use open-ended questions to explore the patient's understanding of their symptoms 3
• Consider using validated assessment tools like the AD8, ECog, or CFI 1

Overactive Bladder

For diagnosing overactive bladder, focus questions on urinary urgency, frequency, and associated symptoms.

• Ask if the patient experiences a sudden, compelling desire to pass urine that is difficult to defer (urgency) 1
• Determine the number of urination episodes during waking hours (frequency) 1
• Ask about nocturia (waking at night to urinate) and the number of episodes 1
• Inquire about urgency urinary incontinence (leakage associated with urgency) 1
• Ask about the duration of symptoms 1
• Determine if symptoms are bothersome to the patient 1
• Review current medications that might affect bladder function 1
• Ask about co-morbid conditions, especially neurologic diseases 1
• Inquire about the impact of symptoms on quality of life 1

General Approach to Diagnostic Questioning

Use open-ended questions initially, followed by focused inquiries to gather comprehensive information efficiently.

• Begin with open-ended questions like "What brings you in today?" or "What can I do for you?" to allow patients to describe their concerns freely 4, 5
• Ask about the onset and chronology of symptoms 2
• Inquire about the location of symptoms and if they radiate 2
• Ask patients to describe how symptoms feel (quality) 2
• Determine the severity of symptoms and their impact on daily activities 2
• Ask about the duration of symptoms 2
• Identify activities or situations when symptoms occur or worsen 2
• Ask what makes symptoms better or worse 2
• Inquire about associated symptoms 2
• Use the question "What is your understanding of your illness?" to explore patients' perspectives 3
• Ask patients what specific needs they hope to address during the visit 6
• Allow sufficient time for patients to express their concerns before moving to focused questions 1

Documentation and Follow-up

Document pertinent positive and negative findings to support diagnostic reasoning.

• Record both the presence and absence of key symptoms relevant to the suspected diagnosis 2
• Document the patient's description of symptoms in their own words when possible 7
• Note the impact of symptoms on the patient's quality of life and daily functioning 7
• Consider using standardized assessment tools or symptom questionnaires when appropriate 1
• Ask patients about their expectations regarding diagnosis and treatment 7, 6
• Provide patients with written information about their condition after diagnosis 1