Zbieranie wywiadu z zakresu układu odpornościowego | Taking an Immune System History

Tooltip .tooltip { position: relative; cursor: pointer; text-decoration: none; border-bottom: 1px dashed rgba(0, 0, 0, 0.6); } .tooltip::before { content: attr(data-tooltip); position: absolute; top: -40px; /* Trochę niżej nad słowem */ left: 50%; /* Wyśrodkowanie */ transform: translateX(-50%); background-color: rgba(255, 255, 255, 0.9); color: #333; padding: 6px 12px; border-radius: 8px; white-space: nowrap; opacity: 0; visibility: hidden; transition: opacity 0.3s ease, visibility 0.3s ease; font-family: ‘Arial’, sans-serif; font-size: 14px; box-shadow: 0px 4px 8px rgba(0, 0, 0, 0.1); z-index: 10; } .tooltip:hover::before { opacity: 1; visibility: visible; } document.addEventListener(‘DOMContentLoaded’, function () { const wordsToTooltip = { “immune system”: “układ odpornościowy”, “innate immunity”: “odporność wrodzona”, “adaptive immunity”: “odporność nabyta”, “Chief Complaint”: “Główna skarga”, “recurrent infections”: “nawracające infekcje”, “immune dysregulation”: “dysregulacja układu odpornościowego”, “autoimmune conditions”: “choroby autoimmunologiczne”, “sinusitis”: “zapalenie zatok”, “bronchitis”: “zapalenie oskrzeli”, “pneumonia”: “zapalenie płuc”, “skin infections”: “infekcje skóry”, “urinary tract infections”: “zakażenia dróg moczowych”, “immunodeficiency”: “niedobór odporności”, “chronic fatigue”: “przewlekłe zmęczenie”, “chronic fatigue syndrome”: “zespół przewlekłego zmęczenia”, “lupus”: “toczeń”, “rheumatoid arthritis”: “reumatoidalne zapalenie stawów”, “chronic inflammatory conditions”: “przewlekłe stany zapalne”, “unintentional weight loss”: “niezamierzona utrata masy ciała”, “immune-related cancers”: “nowotwory związane z układem odpornościowym”, “lymphomas”: “chłoniaki”, “joint pain”: “ból stawów”, “joint swelling”: “obrzęk stawów”, “immune system attacks”: “ataki układu odpornościowego”, “redness and warmth”: “zaczerwienienie i ocieplenie”, “rashes”: “wysypki”, “vasculitis”: “zapalenie naczyń”, “pigment changes”: “zmiany pigmentacyjne”, “immune dysfunction”: “dysfunkcja układu odpornościowego”, “persistent fever”: “utrzymująca się gorączka”, “chronic inflammation”: “przewlekłe zapalenie”, “swollen lymph nodes”: “powiększone węzły chłonne”, “enlarged lymph nodes”: “powiększone węzły chłonne”, “anemia”: “niedokrwistość”, “blood disorders”: “zaburzenia krwi”, “thrombocytopenia”: “małopłytkowość”, “immune thrombocytopenic purpura”: “samoistna plamica małopłytkowa”, “allergic reactions”: “reakcje alergiczne”, “sensitivities”: “nadwrażliwości”, “environmental allergens”: “alergeny środowiskowe”, “food allergies”: “alergie pokarmowe”, “medication allergies”: “alergie na leki”, “anaphylaxis”: “anafilaksja”, “intermittent fever”: “przerywana gorączka”, “systemic symptoms”: “objawy ogólnoustrojowe”, “blood cancers”: “nowotwory krwi”, “autoimmune diseases”: “choroby autoimmunologiczne”, “immunodeficiency disorders”: “zaburzenia odporności”, “chronic inflammatory disorders”: “przewlekłe zaburzenia zapalne”, “chronic obstructive pulmonary disease”: “przewlekła obturacyjna choroba płuc”, “chronic allergies”: “przewlekłe alergie”, “inflammatory bowel disease”: “zapalenie jelit”, “splenectomy”: “splenektomia”, “spleen dysfunction”: “dysfunkcja śledziony”, “corticosteroids”: “kortykosteroidy”, “immunosuppressive treatments”: “leczenie immunosupresyjne”, “chemotherapy”: “chemioterapia”, “immunological memory”: “pamięć immunologiczna”, “hypersensitivity reactions”: “reakcje nadwrażliwości”, “severe combined immunodeficiency”: “ciężki złożony niedobór odporności”, “common variable immunodeficiency”: “pospolity zmienny niedobór odporności”, “helper T cells”: “limfocyty T pomocnicze”, “cytotoxic T cells”: “limfocyty T cytotoksyczne”, “primary immunodeficiencies”: “pierwotne niedobory odporności”, “secondary immunodeficiencies”: “wtórne niedobory odporności”, “HIV/AIDS”: “HIV/AIDS”, “antiretroviral therapy”: “terapia antyretrowirusowa”, “methotrexate”: “metotreksat”, “biologics”: “leki biologiczne”, “JAK inhibitors”: “inhibitory JAK”, “antivirals”: “leki przeciwwirusowe”, “antifungals”: “leki przeciwgrzybicze”, “drug allergies”: “alergie na leki”, “environmental allergies”: “alergie środowiskowe”, “chemical exposure”: “ekspozycja na chemikalia”, “industrial cleaners”: “środki czyszczące przemysłowe”, “high-stress situations”: “sytuacje wysokiego stresu”, “physical strain”: “obciążenie fizyczne”, “nutrient deficiencies”: “niedobory składników odżywczych”, “zinc deficiency”: “niedobór cynku”, “vitamin D deficiency”: “niedobór witaminy D”, “gut-associated lymphoid tissue”: “tkanka limfatyczna związana z jelitami”, “microbiota disruption”: “zakłócenie mikrobioty”, “immune cell processing”: “przetwarzanie komórek odpornościowych”, “immune cell function”: “funkcja komórek odpornościowych”, “immune compromise”: “osłabienie odporności”, “immune checkpoints”: “punkty kontrolne układu odpornościowego”, “immune tolerance”: “tolerancja immunologiczna”, “cytokine production”: “produkcja cytokin”, “T cell activity”: “aktywność limfocytów T”, “chronic immune suppression”: “przewlekłe tłumienie odporności”, “antibody deficiencies”: “niedobory przeciwciał”, “neutrophil function”: “funkcja neutrofili”, “hormonal imbalances”: “zaburzenia hormonalne”, “humoral immune deficiencies”: “niedobory odporności humoralnej”, “selective IgA deficiency”: “wybiórczy niedobór IgA”, “phagocytic defects”: “wady fagocytozy”, “bacteremia”: “bakteriemia”, “bronchiectasis”: “rozstrzenie oskrzeli”, “secondary immune compromise”: “wtórne osłabienie odporności”, “seasonal immune variations”: “sezonowe zmiany odporności”, “routine vaccinations”: “rutynowe szczepienia”, “immunoglobulin levels”: “poziomy immunoglobulin”, “excessive alcohol intake”: “nadmierne spożycie alkoholu”, “smoking and lung health”: “palenie i zdrowie płuc”, “nutrient density”: “gęstość odżywcza”, “chronic stress”: “przewlekły stres”, “cortisol levels”: “poziomy kortyzolu”, “herd immunity”: “odporność zbiorowa”, “white blood cell counts”: “liczba białych krwinek”, “exposure to infectious agents”: “ekspozycja na czynniki zakaźne”, “hospitalization”: “hospitalizacja”, “intravenous antibiotics”: “antybiotyki dożylne”, “respiratory tract”: “drogi oddechowe”, “gastrointestinal tract”: “przewód pokarmowy”, “night sweats”: “nocne poty”, “appetite changes”: “zmiany apetytu”, “energy levels”: “poziomy energii”, “low-grade fever”: “niskiego stopnia gorączka”, “immune suppression”: “tłumienie odporności”, “sepsis”: “sepsa”, “immune cell activation”: “aktywacja komórek odpornościowych”, “immunological assessment”: “ocena immunologiczna”, “fever”: “gorączka”, “lymph node biopsy”: “biopsja węzła chłonnego”, “immune surveillance”: “monitorowanie immunologiczne”, “lymphoma”: “chłoniak”, “bruising”: “siniaki”, “malignancy”: “złośliwość”, “chronic”: “przewlekły”, “inflammatory state”: “stan zapalny”, “malignancies”: “nowotwory złośliwe”, “autoimmune disorders”: “zaburzenia autoimmunologiczne”, “immunity”: “odporność”, “immune deficiency”: “niedobór odporności”, “immunosuppressive”: “immunosupresyjny”, “chronic illnesses”: “przewlekłe choroby”, “abscesses”: “ropnie”, “complications”: “powikłania”, “IV antibiotics”: “antybiotyki dożylne”, “asthma”: “astma”, “eczema”: “egzema”, “multiple sclerosis”: “stwardnienie rozsiane”, “immunosuppressants”: “leki immunosupresyjne”, “antibiotics”: “antybiotyki”, “vaccines”: “szczepionki”, “pollen”: “pyłki”, “dust”: “kurz”, “pet dander”: “sierść zwierząt” }; // Normalize keys in the dictionary const normalizedWordsToTooltip = {}; for (const [key, value] of Object.entries(wordsToTooltip)) { const cleanedKey = key.replace(/(.*?)/g, ”).trim(); // Remove anything in parentheses normalizedWordsToTooltip[cleanedKey.toLowerCase()] = value; } function processNode(node) { if (node.nodeType === Node.TEXT_NODE && node.nodeValue.trim()) { let content = node.nodeValue; // Regex to match only the main words (ignores parentheses) const regex = new RegExp( `\b(${Object.keys(normalizedWordsToTooltip).join(‘|’)})\b`, ‘gi’ ); if (regex.test(content)) { const wrapper = document.createElement(‘span’); wrapper.innerHTML = content.replace(regex, (match) => { const tooltip = normalizedWordsToTooltip[match.toLowerCase().trim()]; return `${match}`; }); node.replaceWith(wrapper); } } else if (node.nodeType === Node.ELEMENT_NODE) { Array.from(node.childNodes).forEach(processNode); } } document.querySelectorAll(‘body *:not(script):not(style)’).forEach((element) => { Array.from(element.childNodes).forEach(processNode); }); });Podświetlanie tekstu z notatkami body { margin: 0; padding: 0; font-family: Arial, sans-serif; } .highlight { background-color: #cce7ff; /* Highlight color without notes */ position: relative; display: inline; } .highlight.with-note { background-color: #ffeb3b; /* Highlight color with notes */ } .note-box { position: absolute; background-color: #f9f9f9; color: #333; font-size: 14px; line-height: 1.6; padding: 10px 15px; border: 1px solid #ddd; border-radius: 5px; box-shadow: 0 2px 5px rgba(0, 0, 0, 0.2); max-width: 250px; z-index: 1000; white-space: normal; text-align: left; display: none; /* Hidden by default */ } .note-controls { position: absolute; top: -30px; right: -30px; display: flex; gap: 10px; z-index: 10; opacity: 0; pointer-events: none; transition: opacity 0.3s; } .note-controls.visible { opacity: 1; pointer-events: all; } .note-controls span { cursor: pointer; background-color: gray; color: white; padding: 5px 10px; border-radius: 5px; font-size: 16px; font-weight: bold; } .note-controls span:hover { background-color: darkgray; } document.addEventListener(“DOMContentLoaded”, () => { /** * Checks if an element is a header. */ const isHeaderElement = (node) => { while (node) { if (node.nodeType === 1 && node.tagName.match(/^H[1-5]$/)) { return true; } node = node.parentNode; } return false; }; /** * Checks if an element is inside a table cell. */ const isInsideTable = (node) => { while (node) { if (node.tagName === “TD” || node.tagName === “TH”) { return node; } node = node.parentNode; } return null; }; /** * Checks if an element belongs to the same list item. */ const isWithinSameListItem = (selection) => { if (selection.rangeCount === 0) return false; const range = selection.getRangeAt(0); const startContainer = range.startContainer; const endContainer = range.endContainer; const getClosestListItem = (node) => { while (node) { if (node.nodeType === 1 && node.tagName === “LI”) { return node; } node = node.parentNode; } return null; }; const startListItem = getClosestListItem(startContainer); const endListItem = getClosestListItem(endContainer); // Ensure selection is within the same list item return startListItem === endListItem; }; /** * Validates the selection. * Ensures the selection is within a single header, table cell, or list item. */ const isSelectionValid = (selection) => { if (selection.rangeCount === 0) return false; const range = selection.getRangeAt(0); const startContainer = range.startContainer; const endContainer = range.endContainer; const startInHeader = isHeaderElement(startContainer); const endInHeader = isHeaderElement(endContainer); // Block selection spanning headers if (startInHeader !== endInHeader) { return false; } const startCell = isInsideTable(startContainer); const endCell = isInsideTable(endContainer); // Block selection spanning table cells if (startCell && endCell && startCell !== endCell) { return false; } // Block selection spanning multiple list items if (!isWithinSameListItem(selection)) { return false; } return true; }; /** * Highlights the selected text. */ const wrapTextWithHighlight = (range) => { const fragment = range.extractContents(); const highlight = document.createElement(“span”); highlight.className = “highlight”; highlight.appendChild(fragment); range.insertNode(highlight); const noteControls = document.createElement(“div”); noteControls.className = “note-controls visible”; const editNote = document.createElement(“span”); editNote.textContent = “✎”; editNote.title = “Edit note”; noteControls.appendChild(editNote); const removeHighlight = document.createElement(“span”); removeHighlight.textContent = “x”; removeHighlight.title = “Remove highlight”; noteControls.appendChild(removeHighlight); highlight.style.position = “relative”; highlight.appendChild(noteControls); let noteBox = null; const updateNotePosition = () => { const rect = highlight.getBoundingClientRect(); if (noteBox) { noteBox.style.top = `${rect.height}px`; noteBox.style.left = `${rect.width / 2}px`; } }; const hideControlsAndNoteAfterDelay = () => { setTimeout(() => { noteControls.classList.remove(“visible”); if (noteBox) noteBox.style.display = “none”; }, 3000); }; // Show controls for 3 seconds after highlighting hideControlsAndNoteAfterDelay(); highlight.addEventListener(“click”, () => { noteControls.classList.add(“visible”); if (noteBox) noteBox.style.display = “block”; hideControlsAndNoteAfterDelay(); }); editNote.addEventListener(“click”, () => { const noteText = prompt(“Add or edit a note:”, noteBox?.textContent || “”); if (noteText) { if (!noteBox) { noteBox = document.createElement(“div”); noteBox.className = “note-box”; highlight.appendChild(noteBox); } noteBox.textContent = noteText; noteBox.style.display = “block”; highlight.classList.add(“with-note”); updateNotePosition(); hideControlsAndNoteAfterDelay(); } }); removeHighlight.addEventListener(“click”, () => { const parent = highlight.parentNode; while (highlight.firstChild) { parent.insertBefore(highlight.firstChild, highlight); } parent.removeChild(highlight); if (noteBox) noteBox.remove(); }); }; /** * Handles the mouseup event to validate and apply highlighting. */ document.body.addEventListener(“mouseup”, () => { const selection = window.getSelection(); if (selection.rangeCount > 0 && selection.toString().trim()) { if (!isSelectionValid(selection)) { alert(“Zaznaczenie musi być w obrębie jednego akapitu, komórki tabeli lub punktu listy!”); selection.removeAllRanges(); return; } const range = selection.getRangeAt(0); wrapTextWithHighlight(range); selection.removeAllRanges(); } }); });
Szacowany czas lekcji: 18 minut
.lesson-duration-container { background-color: #f0f4f8; /* Szarawe tło dopasowane do reszty strony */ padding: 8px 15px; /* Wewnętrzny odstęp */ border-radius: 8px; /* Zaokrąglone rogi */ font-family: ‘Roboto’, Arial, sans-serif; /* Czcionka Roboto, jeśli dostępna */ font-size: 16px; /* Rozmiar tekstu */ color: #6c757d; /* Ciemny szary kolor tekstu */ display: inline-block; /* Wyświetlanie jako element blokowy */ margin-bottom: 20px; /* Odstęp na dole */ border: none; /* Bez obramowania */ } .lesson-duration-label { font-weight: 700; /* Pogrubienie dla etykiety */ color: #6c757d; /* Ciemny szary kolor dla etykiety */ margin-right: 5px; /* Odstęp od wartości */ } .lesson-duration-value { color: #6c757d; /* Ciemny szary kolor dla wartości */ font-weight: 700; /* Pogrubienie dla wartości */ }Podświetlanie tekstu z notatkami body { margin: 0; padding: 0; font-family: Arial, sans-serif; } .highlight { background-color: #cce7ff; /* Highlight color without notes */ position: relative; display: inline; } .highlight.with-note { background-color: #ffeb3b; /* Highlight color with notes */ } .note-box { position: absolute; background-color: #f9f9f9; color: #333; font-size: 14px; line-height: 1.6; padding: 10px 15px; border: 1px solid #ddd; border-radius: 5px; box-shadow: 0 2px 5px rgba(0, 0, 0, 0.2); max-width: 250px; z-index: 1000; white-space: normal; text-align: left; display: none; /* Hidden by default */ } .note-controls { position: absolute; top: -30px; right: -30px; display: flex; gap: 10px; z-index: 10; opacity: 0; pointer-events: none; transition: opacity 0.3s; } .note-controls.visible { opacity: 1; pointer-events: all; } .note-controls span { cursor: pointer; background-color: gray; color: white; padding: 5px 10px; border-radius: 5px; font-size: 16px; font-weight: bold; } .note-controls span:hover { background-color: darkgray; } document.addEventListener(“DOMContentLoaded”, () => { /** * Checks if an element is a header. */ const isHeaderElement = (node) => { while (node) { if (node.nodeType === 1 && node.tagName.match(/^H[1-5]$/)) { return true; } node = node.parentNode; } return false; }; /** * Checks if an element is inside a table cell. */ const isInsideTable = (node) => { while (node) { if (node.tagName === “TD” || node.tagName === “TH”) { return node; } node = node.parentNode; } return null; }; /** * Checks if an element belongs to the same list item. */ const isWithinSameListItem = (selection) => { if (selection.rangeCount === 0) return false; const range = selection.getRangeAt(0); const startContainer = range.startContainer; const endContainer = range.endContainer; const getClosestListItem = (node) => { while (node) { if (node.nodeType === 1 && node.tagName === “LI”) { return node; } node = node.parentNode; } return null; }; const startListItem = getClosestListItem(startContainer); const endListItem = getClosestListItem(endContainer); // Ensure selection is within the same list item return startListItem === endListItem; }; /** * Validates the selection. * Ensures the selection is within a single header, table cell, or list item. */ const isSelectionValid = (selection) => { if (selection.rangeCount === 0) return false; const range = selection.getRangeAt(0); const startContainer = range.startContainer; const endContainer = range.endContainer; const startInHeader = isHeaderElement(startContainer); const endInHeader = isHeaderElement(endContainer); // Block selection spanning headers if (startInHeader !== endInHeader) { return false; } const startCell = isInsideTable(startContainer); const endCell = isInsideTable(endContainer); // Block selection spanning table cells if (startCell && endCell && startCell !== endCell) { return false; } // Block selection spanning multiple list items if (!isWithinSameListItem(selection)) { return false; } return true; }; /** * Highlights the selected text. */ const wrapTextWithHighlight = (range) => { const fragment = range.extractContents(); const highlight = document.createElement(“span”); highlight.className = “highlight”; highlight.appendChild(fragment); range.insertNode(highlight); const noteControls = document.createElement(“div”); noteControls.className = “note-controls visible”; const editNote = document.createElement(“span”); editNote.textContent = “✎”; editNote.title = “Edit note”; noteControls.appendChild(editNote); const removeHighlight = document.createElement(“span”); removeHighlight.textContent = “x”; removeHighlight.title = “Remove highlight”; noteControls.appendChild(removeHighlight); highlight.style.position = “relative”; highlight.appendChild(noteControls); let noteBox = null; const updateNotePosition = () => { const rect = highlight.getBoundingClientRect(); if (noteBox) { noteBox.style.top = `${rect.height}px`; noteBox.style.left = `${rect.width / 2}px`; } }; const hideControlsAndNoteAfterDelay = () => { setTimeout(() => { noteControls.classList.remove(“visible”); if (noteBox) noteBox.style.display = “none”; }, 3000); }; // Show controls for 3 seconds after highlighting hideControlsAndNoteAfterDelay(); highlight.addEventListener(“click”, () => { noteControls.classList.add(“visible”); if (noteBox) noteBox.style.display = “block”; hideControlsAndNoteAfterDelay(); }); editNote.addEventListener(“click”, () => { const noteText = prompt(“Add or edit a note:”, noteBox?.textContent || “”); if (noteText) { if (!noteBox) { noteBox = document.createElement(“div”); noteBox.className = “note-box”; highlight.appendChild(noteBox); } noteBox.textContent = noteText; noteBox.style.display = “block”; highlight.classList.add(“with-note”); updateNotePosition(); hideControlsAndNoteAfterDelay(); } }); removeHighlight.addEventListener(“click”, () => { const parent = highlight.parentNode; while (highlight.firstChild) { parent.insertBefore(highlight.firstChild, highlight); } parent.removeChild(highlight); if (noteBox) noteBox.remove(); }); }; /** * Handles the mouseup event to validate and apply highlighting. */ document.body.addEventListener(“mouseup”, () => { const selection = window.getSelection(); if (selection.rangeCount > 0 && selection.toString().trim()) { if (!isSelectionValid(selection)) { alert(“Zaznaczenie musi być w obrębie jednego akapitu, komórki tabeli lub punktu listy!”); selection.removeAllRanges(); return; } const range = selection.getRangeAt(0); wrapTextWithHighlight(range); selection.removeAllRanges(); } }); });.frame { max-width: 750px; margin: 15px auto; padding: 15px; background-color: #fdfdfd; border: 1px solid black; border-radius: 8px; box-shadow: 0 3px 6px rgba(0, 0, 0, 0.1); font-size: 0.9em; line-height: 1.4; background-image: linear-gradient(120deg, #f0f7fc, #e9f7ff, #d6effa, #e3f2fd, #f0f7fc); /* Subtelne odcienie niebieskiego */ } .frame h3 { color: #000; margin-bottom: 10px; font-weight: normal; font-size: 1em; } .frame ul { padding-left: 15px; list-style-type: disc; } .frame ul li { margin-bottom: 8px; font-size: 0.9em; }

Opening Consultation

Before starting, review the patient’s medical records for relevant musculoskeletal history if available.

Confirm the patient’s identity politely.

Teraz ty powiedz:

  • Mr. Jones? This way, please.
  • Ms. Jones? Please come in.
  • Could I please confirm your full name and date of birth?
  • Just to confirm, your name and date of birth?
  • Your full name and date of birth, please.

Introduce yourself warmly, stating your name and role.

Teraz ty powiedz:

  • Hello, I’m Dr. Jones. How can I help you today?
  • Good morning/afternoon, I’m Dr. Jones. What brings you in today?
  • Hi, I’m Dr. Jones. What would you like to discuss today?

Chief Complaint (CC)

The Chief Complaint (CC) refers to the primary concern or symptom that has brought the patient to seek medical consultation. In the context of the immune system, patients may present with symptoms related to immune dysregulation, recurring infections, or autoimmune conditions. Here are some common complaints associated with immune system disorders:

ComplaintDescription
Frequent InfectionsPatients with weakened or compromised immune systems often experience recurrent infections. These can range from respiratory infections (such as sinusitis, bronchitis, or pneumonia) to skin infections and urinary tract infections. If infections are frequent or severe, immunodeficiency may be suspected.
Chronic FatigueFatigue that persists and is disproportionate to physical activity or rest could indicate an immune system issue, such as chronic fatigue syndrome (CFS), autoimmune diseases (e.g., lupus or rheumatoid arthritis), or chronic inflammatory conditions.
Unexplained Weight LossSignificant, unintentional weight loss may be associated with chronic infections, autoimmune diseases, or immune-related cancers, such as lymphomas. Persistent weight loss should prompt further investigation into metabolic and immune-related causes.
Joint Pain and SwellingJoint pain or swelling is often linked to autoimmune diseases, such as rheumatoid arthritis or lupus, where the immune system attacks the body’s tissues. Joint involvement can vary in severity and frequency, and pain may be accompanied by redness and warmth.
Rashes or Skin ChangesAutoimmune diseases can present with skin symptoms like rashes, patches, or pigment changes. Conditions like lupus can cause characteristic facial rashes, while vasculitis may result in small red or purple spots on the skin. Skin infections may also be recurrent in those with immune dysfunction.
Persistent FeverA low-grade or intermittent fever that persists may indicate chronic inflammation or infection. This could be due to immune dysregulation or an underlying autoimmune condition, especially if accompanied by other systemic symptoms.
Swollen Lymph NodesEnlarged lymph nodes may be associated with infections or immune-related cancers, like lymphoma. While lymph nodes typically swell in response to infections, persistent or painful swelling may warrant further investigation.
Anemia and Other Blood DisordersBlood cell abnormalities, such as anemia or thrombocytopenia (low platelet count), can occur in autoimmune conditions like lupus or immune thrombocytopenic purpura (ITP). Patients may experience fatigue, easy bruising, or bleeding.
Allergic Reactions and SensitivitiesAn overactive immune system may result in heightened sensitivities or allergic reactions to environmental allergens, foods, or medications. Symptoms can range from mild (itchiness, sneezing) to severe, such as anaphylaxis.

History of Present Illness

Frequent infections can signal immune system deficiencies or chronic health conditions, particularly when infections recur or present atypical severity. Employing the OLD CARTS framework ensures a thorough history, focusing on factors such as the onset, duration, and characteristics of infections to determine underlying causes or risks.

OLD CARTS Assessment of Frequent Infections

  • O – Onset: Sudden onset often suggests an acute immune challenge, such as exposure to a new pathogen. In contrast, a gradual increase in infection frequency may indicate an underlying immunodeficiency, malignancy, or chronic inflammatory state impairing immune function

Teraz ty zapytaj – Onset:

  • When did you start noticing an increase in infections?
  • Did these infections begin suddenly, or have they developed gradually over time?
  • Was there a particular illness or incident that occurred before the onset of frequent infections?
  • Have you experienced similar episodes of frequent infections in the past?
  • L – Location: Identifying infection sites provides insight into possible immune vulnerabilities. Recurrent respiratory infections (e.g., sinusitis, pneumonia) might suggest conditions like antibody deficiencies, while frequent skin or soft tissue infections may indicate defects in neutrophil function or skin barrier issues.

Teraz ty zapytaj – Location:

  • Where do these infections tend to occur (e.g., respiratory tract, skin, gastrointestinal tract)?
  • Are certain areas more frequently affected than others?
  • Do you tend to have infections in multiple areas at the same time?
  • D – Duration: T Persistent infections that fail to resolve with standard treatment raise concerns for immunodeficiency or resistant pathogens. Short-lived but recurrent episodes may reflect fluctuating immune suppression, potentially related to stress or underlying hormonal imbalances.

Teraz ty zapytaj – Duration:

  • How long does each infection episode typically last?
  • Do the infections resolve with treatment, or are they persistent?
  • Have you noticed changes in the duration of infections over time?
  • C – Character: Frequent bacterial infections may suggest humoral immune deficiencies (e.g., selective IgA deficiency), while viral infections could point toward cellular immune dysfunction. Fungal infections, particularly those that are recurrent or severe, often indicate a deeper immune compromise, such as HIV/AIDS or specific phagocytic defects.

Teraz ty zapytaj – Character:

  • What types of infections do you typically experience (bacterial, viral, fungal)?
  • Do these infections differ in severity compared to infections you had in the past?
  • Are the infections resistant to standard treatments?
  • A – Associated Symptoms: Symptoms such as unexplained weight loss, chronic fatigue, night sweats, or persistent low-grade fever may suggest systemic involvement, including malignancies (like lymphomas) or autoimmune disorders, warrant additional investigation for conditions that might compromise immunity.

Teraz ty zapytaj – Associated Symptoms:

  • Are you experiencing any other symptoms like weight loss, fatigue, or night sweats?
  • Have you noticed any changes in appetite or energy levels?
  • Do you have persistent low-grade fever or unexplained aches?
  • R – Radiation: While infections don’t “radiate” like pain, examining whether infections spread or affect multiple systems is essential. For example, skin infections that extend to the bloodstream (bacteremia) or recurrent respiratory infections leading to bronchiectasis might indicate an ongoing immune deficiency or structural lung issue.

Teraz ty zapytaj – Radiation:

  • Do the infections tend to spread from one area to another?
  • Are multiple systems often affected simultaneously (e.g., respiratory and gastrointestinal)?
  • T – Timing: Seasonal patterns, such as infections worsening in winter, could suggest environmental triggers or seasonal immune variations. Additionally, increased infections during periods of high stress or after starting immunosuppressive medication could imply secondary immune compromise.

Teraz ty zapytaj – Timing:

  • Do infections seem to worsen during specific seasons or times of the year?
  • Are there patterns in timing, such as infections worsening with stress?
  • Have you noticed changes in infection frequency over time?
  • S – Severity: Infections requiring hospitalization, intravenous antibiotics, or resulting in complications (e.g., abscesses, sepsis) strongly suggest significant immunodeficiency or chronic illnesses.

Teraz ty zapytaj – Severity:

  • On a scale of 0 to 10, how severe are these infections in terms of impact on your daily life?
  • Have any of the infections required hospitalization or IV antibiotics?
  • Are the infections impacting your work or personal life significantly?

Past Medical History

Understanding a patient’s past medical history is essential for identifying underlying immune system issues or conditions that may be impacting current health:

  • Autoimmune Diseases – A history of autoimmune diseases, such as lupus or rheumatoid arthritis, may suggest an overactive immune system prone to self-targeting, affecting organs and tissue.
  • Frequent or Severe Infections – Repeated infections or prolonged recovery times can indicate an underlying immunodeficiency or compromised immune system.
  • Chronic Inflammatory Disorders – Conditions like inflammatory bowel disease or chronic obstructive pulmonary disease (COPD) indicate ongoing immune activity and inflammation that can strain immune resources.
  • Cancer and Immunosuppression – A history of cancer, particularly blood cancers like leukemia or lymphoma, or treatments such as chemotherapy, may significantly weaken immune function.
  • Allergic Conditions – Chronic allergies or conditions such as asthma can indicate a hypersensitive immune response, leading to recurrent inflammatory issues.
  • Splenectomy or Spleen Dysfunction – Removal of the spleen or issues with spleen function impair immune cell processing, affecting the body’s ability to fight infections effectively.

Teraz ty zapytaj – Past Medical History:

  • Have you been diagnosed with any autoimmune diseases, like lupus or rheumatoid arthritis?
  • Do you experience frequent or severe infections, such as respiratory or skin infections?
  • Are there any chronic inflammatory conditions in your history, like COPD or Crohn’s disease?
  • Have you had cancer, especially blood cancers, or undergone immunosuppressive treatments?
  • Do you have chronic allergies or asthma that affect your breathing or skin?
  • Have you had your spleen removed or experienced spleen-related health issues?

Family History

Family history can reveal hereditary predispositions to immune disorders and provide insight into the patient’s risk of developing similar conditions:

  • Autoimmune Diseases – A family history of autoimmune diseases can increase the likelihood of similar conditions, given the genetic predisposition to immune system overactivity.
  • Primary Immunodeficiency Disorders – Conditions like severe combined immunodeficiency (SCID) or common variable immunodeficiency (CVID) may run in families.
  • Allergic Conditions – A family history of severe allergies, asthma, or eczema can indicate a predisposition to hypersensitive immune reactions.

Teraz ty zapytaj – Family History:

  • Does anyone in your family have an autoimmune disease, like lupus or multiple sclerosis?
  • Are there any known immunodeficiency disorders in your family?
  • Is there a family history of severe allergies, asthma, or eczema?

Social History

Social history offers insights into lifestyle and environmental factors that may affect immune health:

  • Exposure to Infections – Frequent travel, crowded work environments, or contact with young children can increase exposure to infectious agents.
  • Diet and Nutrition – A diet low in essential vitamins (e.g., A, C, D) and minerals (e.g., zinc) can weaken immune responses.
  • Smoking – Tobacco weakens lung defenses, making infections more likely and exacerbating immune-related conditions.
  • Alcohol Use – Excessive alcohol intake suppresses immune cell function, increasing infection risk and interfering with chronic condition management.
  • Stress Levels – Chronic stress elevates cortisol levels, which can suppress immune function and increase susceptibility to infections.

Teraz ty zapytaj – Social History:

  • Are you frequently exposed to infections through travel, work, or contact with children?
  • How would you describe your diet in terms of nutrient density and balance?
  • Do you smoke, or have you smoked in the past?
  • How often do you consume alcohol?
  • Do you feel that chronic stress affects your health or immune resilience?

Medications

Understanding current and past medications helps reveal treatment history and any drug-related immune impacts:

  • Immunosuppressants – Medications like corticosteroids, methotrexate, or biologics for autoimmune conditions weaken immune function.
  • Antibiotic Use – Repeated or long-term antibiotic use can disrupt natural microbiota, impacting immune health and resistance to infections.
  • Antivirals or Antifungals – These may be prescribed for recurrent infections, which can signal immune compromise.

Teraz ty zapytaj – Medications:

  • Are you currently taking any immunosuppressants, like corticosteroids or methotrexate?
  • Have you had repeated courses of antibiotics, or do you take them regularly?
  • Are you using any antivirals or antifungals for chronic or recurrent infections?

Allergies

Identifying allergies is crucial to avoid immune-triggering substances and plan appropriate management:

  • Drug Allergies – Allergies to immunosuppressants, antibiotics, or vaccines can complicate treatment options.
  • Environmental Allergies – Exposure to allergens like pollen, dust, or pet dander can lead to frequent immune responses, impacting daily function and quality of life.

Teraz ty zapytaj – Allergies:

  • Are you allergic to any medications, especially antibiotics, immunosuppressants, or vaccines?
  • Do you have any known environmental allergies, such as pollen, dust, or pet dander?

Environmental and Occupational Exposures

Environmental and occupational exposures can influence immune health, particularly in patients with a history of immune compromise:

  • Chemical Exposure – Regular exposure to chemicals, such as pesticides or industrial cleaners, can weaken immune function over time.
  • Physical Demands at Work – High-stress or physically demanding jobs can impact immune function by elevating stress hormones and reducing resistance to infections.

Teraz ty zapytaj – Environmental and Occupational Exposures:

  • Are you regularly exposed to chemicals, like pesticides or cleaning agents, in your work or home?
  • Does your job involve high-stress situations or physical strain that may impact your immune health?

Closing the Consultation

Summarize the main points discussed during the history-taking to confirm understanding and ensure no details were missed.

Teraz ty powiedz:

  • Let me summarize what we’ve discussed so far to make sure I have everything correct.
  • To confirm, you’ve mentioned [key symptoms or points]. Does that sound accurate?
  • Is there anything important that we haven’t covered?
  • Before we proceed, is there anything else you’d like to add or clarify?
  • Thank you for sharing all these details; it will help us plan the next steps effectively.

Ask the patient if they have any remaining questions or concerns before moving forward with the examination.

Teraz ty powiedz:

  • Do you have any other questions or concerns before we start the examination?
  • Is there anything else you’d like to discuss before we begin the physical exam?