Step 1: Take a History

Objective :

Bone pain in the absence of trauma, in a patient over 40, is suspicious for metastatic disease.

A 53 year old Caucasian woman, who recently emigrated from Eastern Europe, presents to the Emergency Room with severe right hip pain:

You ask her to tell you more about it.

Tip 1

Open ended questions establish which symptoms are most important to the patient and promote good rapport. More direct questions can follow later.

Close

She tells you:

  • She has had right groin pain for 2 months
  • The pain has been getting worse in the last week
  • She hasn’t been able to walk since she rolled over in bed and heard a crack
  • She has been very tired lately and has lost weight
  • She is otherwise healthy
Tip 2

Pain from the hip joint is often felt in the groin, and can radiate down the anterior thigh. Her inability to weight bear is very concerning. Volunteering that she heard a crack is very ominous!

Close

You want to know more, so you ask her about...

...Any night sweats?

Tip 3

She says she often wakes up at night in a sweat that is soaking the sheets.

Close

...Any lumps or bumps, such as in her breasts?

Tip 3

She says she hasn’t noticed anything, but she doesn’t really check.

Close

...Having a cough with blood, or passing bloody stool?

Tip 3

She denies any other symptoms of primary malignancies.

Close

...Any previous surgery?

Tip 3

She had a Caesarian section 22 years ago. Asking this question can help prompt patients about serious illnesses they may not be focusing on right now.

Close

...Medication and drug history?

Tip 3

She takes no medication, has no allergies, does not smoke or drink alcohol.

Close
More Info Next Step

In cancer patients, systemic non-specific symptoms are often referred to as type B symptoms. These include night sweats, weight loss, tiredness, nausea, etc. These are very worrisome that she has a malignancy somewhere. Added to the inability to weight bear and hearing a crack, it is very likely this is something serious.