Family history FH

As with other aspects of history-taking, ii is preferable to begin with an open inquiry - 'tell me about any illnesses that run in your family'. The nature of the reply may provide grounds for asking further questions. Often closed questions should be asked regarding particular diseases or specific relatives.

The extent of enquiry will probably be constrained by lime, and the clinician has to judge the relevance of deter mining how detailed a family history is required. Plainly this element is most important with potentially inherited di sorders.

The symbols used in the construction of a family tree (pedigree chart) are illustrated in Figure 1.7.

The genetic basis is most striking in disorders which are autosomal dominant, e.g. Huntington's disease, or sex-linked. e.g. haemophilia. The pattern of inheritance in autosomal recessive conditions is less apparent as siblings only have a I in 4 chance of developing the disorder.

In many common disorders such as coronary artei7 disease the mode of inheritance is more complex and variable, and there may be additional environmental influences such as diet and smoking. Apparently unrelated illness may be associated through a common pathological process, such as atheroma, with one relative presenting with a heart attack and another with a stroke or with intermittent claudication. Environmental factors may emerge through family proximity; for instance a lifelong non-smoking woman with a bronchogenic carcinoma may have had a husband who smoked heavily before he died of a smokmg-related illness. It is necessary also to consider the implications of diseases: for instance a patient presenting wilh a depressive illness may (truthfully) say that no member of the family has had a similar illness yet further inquiry may reveal that several relatives committed suicide.

Finally, it may be important to establish if the patient or a close relative has been adopted.

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