3. Dizziness. Experienced any dizziness? (Determine exactly what the person means by dizziness). Was it a feeling of lightheadedness or of falling Or was it a spinning sensation?
Rationale: Dizziness is a lightheaded, swimming sensation or a feeling of falling. True vertigo is true rotational spinning owing to neurologic dysfunction (labyrinthinevestibular apparatus, vestibular nuclei in brain stem). When vertigo is objective, the perception is that the room spins. When vertigo is subjective, the perception is that the person spins.
* Onset. Abrupt or gradual? After a change in position, such as sudden standing?
* Associated factors. Any nausea and vomiting, pallor, immobility, decreased hearing acuity, or tinnitus along with the dizziness?
4. Neck pain. Any neck pain?
* Onset. How did the pain start: injury, automobile accident, after lifting, from a fall? Or with fever? Or did it have a gradual onset?
Rationale: Acute onset of stiffness along with headache and fever occurs with meningeal inflammation.
* Location. Does pain radiate? To the shoulders, arm?
* Associated symptoms. Any limitations to range of motion, numbness or tingling in shoulders, arms, or hands?
* Precipitating factors. What movements cause pain? Do you need to lift or bend at work or home? Does stress seem to bring it on?
Rationale: Pain creates a vicious circle. Tension increases pain and disability, which produces more anxiety.
* Coping strategies. Able to do your work, to sleep?
5. Lumps or swelling. Any lumps or swelling in the neck? Any recent infection? Any tenderness? For a lump that persists, how long have you had it? Has it changed in size?
Rationale: Tenderness usually indicates acute infection. A persistent lump should arouse suspicion of malignancy. For persons over 40 years, suspect malignancy until proven otherwise.
* Any history of prior irradiation of head, neck, upper chest?
Rationale: Increased risk for salivary and thyroid tumors.