* Any difficulty swallowing?
Rationale: Dysphagia
* Do you smoke? For how long? How many packs a day? Do you chew tobacco?
Rationale: Smoking and chewing tobacco increase risk of oral and respiratory cancer.
* When was your last alcohol drink? How much alcohol do you drink a day?
Rationale: Smoking and large alcohol consumption together increase the risk of cancer.
* Ever had a thyroid problem? Overfunctioning or underfunctioing? How was it treated: surgery, irradiation, any medication?
6. History of head or neck surgery. Ever had surgery of the head or neck? For what condition? When did the surgery occur? How do you feel about results?
Results: Surgery for head and neck cancer often is disfiguring and increases risk of body image disturbance.
ADDITONAL HISTORY FOR INFANTS AND CHIDLREN
1. Did the mother use alcohol or street drugs during pregnancy? How often? How much was used per episode?
Rationale: Alcohol increases the risk of fetal alcohol syndrome, which has distinctive facial features. Cocaine use causes neurologic, development, and emotional problems.
2. Was delivery vaginal or by cesarean section? Any difficulty? Use of forceps?
Rationale Forceps may increase the risk of caput succedaneum, cephalhematoma, and Bell’s palsy.
3. What were you told about the baby’s growth? Was it on schedule? Did the head seem to grow and fontanels close on schedule? At what age (in month) did the baby achieve head control?
ADDITIONAL HISTORY FOR THE AGING ADULT
1. If dizziness is a problem, how does this affect your daily activities? Are you able to drive safely, maneuver about the house safely?
Rationale: Assess self-are. Assess potential for injury.
2. If neck pain is a problem, how does this affect your daily activities? Are you able to drive, perform at work, do housework, sleep, look down when using stairs?