Have you ever been diagnosed with Epstein-Barr virus (EBV)?
Don't know
No, tests were negative
Yes, doctor suggested it but no testing was done
Yes, tests confirmed previous infection only
Yes, tests confirmed current active infection
723.
Have you had vaginal yeast infections? Symptoms may include itching, burning or a "cottage cheese" discharge.
Don't know
No
In the past, but none for at least a year
Currently 1 to 3 per year
Chronic problem / more than 3 per year
724.
Have you had vaginal infections which were not caused by yeast? Symptoms, if any, may include discharge, irritation and itching.
Don't know
No
In the past, but none for at least a year
Currently 1 to 3 per year
Chronic problem / more than 3 per year
725.
Have you had fungal or yeast infections (such as Candida) anywhere, other than vaginal?
No / don't know
Minor in the past only, now resolved
Major in the past only, now resolved
Current minor problem
Current major problem
726.
Have you had Coccidioidomycosis (Valley Fever)?
Don't know
No, tested negative
In the past only
Current problem, only lungs involved
Current problem, disseminated
727.
Do you have a history of infections, for example skin, ear, bladder, respiratory etc.?
No / almost never
Average - occasionally / don't know
Often - one or two per year
Very often - more than two per year
728.
Have you ever been diagnosed with Lupus (SLE, Systemic Lupus Erythromatosis)?
Don't know
No, it has been ruled out
Past episodes, now resolved
Current minor problem
Current major problem
729.
Have you ever been diagnosed with Lyme disease?
Don't know
Tests for Lyme were negative
Past episode now resolved
Current minor problem
Current major problem
730.
Do you live in an area where you are exposed to ticks known to carry the bacteria that causes Lyme's disease? Or, have you visited an area where exposure was likely?
Have you been diagnosed with ALS (amyotrophic lateral sclerosis)?
Don't know
No, doctors don't think I have it.
Has been suggested as a possibility
Yes, onset less than 3 years ago
Yes, onset less over 3 years ago
733.
Do you generally have poor wound healing?
No / don't know
Moderate - healing takes longer than it should
Severe - healing takes weeks/months
734.
Have you suffered from Postviral Syndrome - a viral infection where symptoms persist for a long time?
Never had it / don't know
Probably/minor episode now resolved
Major episode now resolved
Current minor problem
Current major problem
735.
Do you have Sarcoidosis?
Don't know
No
Yes, but now symptom free
Yes, a single organ problem
Yes, a multiple organ problem
736.
Have you been diagnosed with scleroderma?
Never had it / don't know
Probably/minor episode now resolved
Major episode now resolved
Current minor problem
Current major problem
737.
Have you had Shingles, also known as Varicella Zoster?
Never had it / don't know
Probably/minor episode now resolved
Major episode now resolved
Current minor problem
Current major problem
738.
Have you been diagnosed with Sjogrens?
Don't know
No
Past only / It is suspected
Mild / moderate case
Severe case
739.
Have you had inflammation of the thyroid gland - Thyroiditis? This means elevation of antithyroid antibodies like TBII, anti-Tg or anti-TPO (antithyroid peroxidase / antimicrosomal antibody).
Never had it / don't know
Probably/minor episode now resolved
Major episode now resolved
Current minor problem
Current major problem
740.
Have you had tumors that were benign, or non-ovarian cysts?
Enter any additional information here for the questions above:
Please mention the question number(s) if possible.
SYMPTOMS: SKIN: GENERAL
742.
Do you have calluses on your heels and, if so, are they cracked?
No / don't know
Light callus without significant cracking
Light callus with cracking
Thick callus without significant cracking
Thick callus, cracked
743.
Do you have a problem with cracking skin, typically on the fingers, toes or in skin creases? Do not include cracked heel calluses.
No / don't know
Occasionally / moderate
Often / severe
744.
Do you have small bumps on the backs of your arms?
No / don't know
Yes, some/minor
Diagnosed with keratosis pilaris
Yes, many/definite
745.
What is your skin color prior to suntan, compared to others of your race, or family members?
Significantly lighter/paler
A little lighter/paler
Average / don't know
A little darker/redder
Significantly darker/redder
746.
What is your facial coloring prior to suntan, compared to others of your race, or family members?
Noticeably pale
Slightly pale
Average / don't know
Slightly dark
Noticeably dark, pink, flushed or ruddy
747.
Not counting blushing during embarrassing situations, do you experience facial blushing, flushing or redness more frequently or intensely than would be considered normal?
Don't know / I think I'm average
No, definitely not
Mild / occasionally
Moderate / sometimes
Major / often
748.
Does your skin seem to have a more yellowish (jaundiced) tone than previously? It may help to look at untanned areas.
Don't know
No
Probably
Definitely
749.
Skin moistness. Without moisturizer, is your skin...?
Very dry
A bit dry
Average / don't know
A bit oily/moist
Definitely oily/moist
750.
Does your skin tend to itch often, perhaps worse at night?
No / don't know
Moderately
Severely
751.
Do you have a burning sensation on your skin?
Don't know
No, definitely not
Mildly / occasional
Moderately / sometimes
Severely / frequently
752.
Do you have a sensation of bugs crawling under or on top of your skin?
Do you have palms and fingertips that are more red than average?
No / don't know
Somewhat
Definitely
758.
Is your skin temperature . . . ?
Very cold
Colder than average
Average / don't know
Warmer than average
Very warm
759.
Is your skin thickness . . . ?
Very thin / fragile
Thinner than average
Average / don't know
Thicker than average
Very thick / tough
760.
Is your skin yellow-tinged?
No / don't know
Somewhat
Definitely
761.
Beyond the questions already asked, do you have ANY skin problems? This would include diagnosed conditions like acne, eczema, psoriasis, dandruff, polyps, spots, rashes, infections, MRSA, etc..
Don't know
No
Yes More questions later...
Enter any additional information here for the questions above:
Please mention the question number(s) if possible.
SYMPTOMS: HAIR
762.
What is your body hair quantity? This question refers to 'normal' female hair patterns i.e. underarm, pubic or leg hair but not chest or upper lip.
Don't know
Little / none
Less than average
Average
Abundant, more than average
763.
Do you have any hair growth pattern that is usually seen in males? This means increased hair on the chest/nipples, above the pubic area toward the navel, or on the chin or upper lip.
Don't know
No
Very minor
Somewhat / one or two areas
Very noticeable / in several areas
764.
Have you had a recent change in body hair quantity?
Much recent loss
Some recent loss
No / don't know
Some recent gain
Much recent gain
765.
Do you have an urge or habit of pulling or plucking hairs from your body beyond the removal of selected hairs for cosmetic reasons?
Don't know
No
Yes, from time to time
Yes, I habitually pull hairs out
Yes, I habitually pull hairs out and eat them
766.
Do you have less pubic or underarm hair growth than previously?
I can't tell / don't know
No, quantity is the same
Yes, the quantity has decreased somewhat
Yes, the quantity has decreased substantially
767.
Do you have male pattern hair loss? Male pattern hair loss (MPHL) is a common condition in which men, and sometimes women, experience a receding hairline and/or balding on the top of the head.
No / don't know
Mildly / frontal loss only
Moderately / partial loss on top only
Moderately / complete loss on top only
Severely / nearly or totally bald
768.
Is your scalp hair falling out?
Don't know
Normal loss
History of heavy loss / alopecia areota
Moderate loss
Much loss
769.
How oily is your hair?
Dry
Average / not applicable / don't know
Oily
770.
Apart from graying, what color tone is or was the hair on your head?
Very light
Light
Average / not applicable / don't know
Dark
Very dark
771.
If you have gray hair, choose the answer that best describes the graying process in your case. Hair graying is both genetic and age-related.
I have no hair / no gray hair / don't know
It retained its natural color longer than expected
It has grayed normally for my age and race
Somewhat prematurely (over half gray before 45)
Very prematurely (over half gray before 35)
772.
How dense is the hair on your head?
Very sparse
Somewhat sparse
Average / not applicable / don't know
Dense/abundant
773.
How strong are individual hairs from your head?
Brittle / break easily
Somewhat brittle
Normal / durable / don't know
774.
How thick are individual hairs on your head?
Thin / fine
Average / don't know
Thick
775.
How fast does your scalp hair grow? Hair normally grows about 1/2 inch (1.25cm) per month or 6 inches (15cm) per year.
Very slowly
Slowly
Average / don't know
Quickly
Very quickly
776.
How wavy is your hair naturally?
It is straight
"Average" / don't know
It is wavy / curly
Enter any additional information here for the questions above:
Please mention the question number(s) if possible.
SYMPTOMS: NAILS
777.
Do your fingernails have white spots on them that are not due to nail trauma/injury?
No / don't know
A few
Several
778.
Do you have any white areas (not spots) on your nails that are not due to nail injury/trauma?
No / don't know
Pink at the base, turning white towards the ends
80% or more of nail beds are white, including base
White lines from side to side, do not move
White lines from side to side, move as nails grow
779.
Are (parts of) your nails any unusual color other than white?
No / don't know
Green
Blue and brown
Black / somewhat brown
780.
Do you experience inflamed cuticles (the skin over the base of your nails)?
No / don't know
Occasionally / moderately
Often / severely
781.
Do you suffer from hangnails/agnails (painful swelling around the fingernails or toenails) or ragged cuticles (occurring when cuticle or skin surrounding the nail is damaged or torn)?
No / don't know
Occasionally / moderate
Often / severe
782.
Are your fingernails brittle - do they chip, peel or break easily?
Don't know
No
Somewhat
Very
783.
Do your fingernails have ridges or grooves across them (from side to side)?
No / don't know
A few / minor
Many / pronounced
784.
Do your fingernails curve backward like little spoons?
Don't know
No
A little
Definitely
785.
Do you have increased roundness of finger and toe tips and nails that look like upside down spoons? This is called clubbing and can be seen here.
Don't know
No
Possibly
Definitely with some digits
Definitely, both fingers and toes
786.
How fast do your fingernails grow? Normal growth is 0.8 inches (2cm) per year but this can be hard to estimate.
Very slowly
Slowly
Average / don't know
Quickly
Very quickly
787.
Are your toenails distorted/deformed?
No / don't know
Probably/minor episode now resolved
Major episode now resolved
Current minor problem
Current major problem
Enter any additional information here for the questions above:
Please mention the question number(s) if possible.
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GLOSSARY
Acne: A chronic skin disorder due to inflammation of hair follicles and sebaceous glands (secretion glands in the skin).
Antibody: A type of serum protein (globulin) synthesized by white blood cells of the lymphoid type in response to an antigenic (foreign substance) stimulus. Antibodies are complex substances formed to neutralize or destroy these antigens in the blood. Antibody activity normally fights infection but can be damaging in allergies and a group of diseases that are called autoimmune diseases.
Bacteria: Microscopic germs. Some bacteria are "harmful" and can cause disease, while other "friendly" bacteria protect the body from harmful invading organisms.
Benign: Literally: innocent; not malignant. Often used to refer to cells that are not cancerous.
Bruise: Injury producing a hematoma or diffuse extravasation of blood without breaking the skin.
Cancer: Refers to the various types of malignant neoplasms that contain cells growing out of control and invading adjacent tissues, which may metastasize to distant tissues.
Candidiasis: Infection of the skin or mucous membrane with any species of candida, usually Candida albicans. The infection is usually localized to the skin, nails, mouth, vagina, bronchi, or lungs, but may invade the bloodstream. It is a common inhabitant of the GI tract, only becoming a problem when it multiplies excessively and invades local tissues. Growth is encouraged by a weakened immune system, as in AIDS, or with the prolonged administration of antibiotics. Vaginal symptoms include itching in the genital area, pain when urinating, and a thick odorless vaginal discharge.
Clubbing: A broadening and thickening of the fingers or toes (distal phalanx) with increased lengthwise curvature and curvature of the tip of the nail, with flattening of the angle between the cuticle and nail.
Clubbing is associated with a wide number of diseases, although it is most often noted in diseases of the heart and lungs that cause decreased blood oxygen and skin blueness (cyanosis) or lung cancer. Clubbing can also be associated with other diseases such as diseases of the liver and the gastrointestinal tract. It may also occur in families without signifying an underlying disease.
Cysts: A closed pocket or pouch of tissue; a cyst may form within any tissue in the body and can be filled with air, fluid, pus, or other material. Cysts within the lung generally are air filled, while cysts involving the lymph system or kidneys are fluid filled. Cysts under the skin are benign, extremely common, movable lumps. These may develop as a result of infection, clogging of sebaceous glands, developmental abnormalities or around foreign bodies.
Cytomegalovirus: (CMV): A member of the herpes virus family which may induce the immune-deficient state or cause active illness, such as pneumonia, in a patient already immune-deficient due to chronic illness, such as cancer or organ transplantation therapy.
Eczema: Swelling of the outer skin of unknown cause. In the early stage it may be itchy, red, have small blisters, and be swollen, and weeping. Later it becomes crusted, scaly, and thickened.
Epstein Barr virus: (EBV): A virus that causes infectious mononucleosis and that is possibly capable of causing other diseases in immunocompromised hosts.
Immune System: A complex that protects the body from disease organisms and other foreign bodies. The system includes the humoral immune response and the cell-mediated response. The immune system also protects the body from invasion by making local barriers and inflammation.
Metabolism: The chemical processes of living cells in which energy is produced in order to replace and repair tissues and maintain a healthy body. Responsible for the production of energy, biosynthesis of important substances, and degradation of various compounds.
Multiple Sclerosis: Demyelinating disorder of the central nervous system, causing patches of sclerosis (plaques) in the brain and spinal cord, manifested by loss of normal neurological functions, e.g., muscle weakness, loss of vision, and mood alterations.
Polyp: A usually nonmalignant growth or tumor protruding from the mucous lining of an organ such as the nose, bladder or intestine, often causing obstruction.
Psoriasis: An inherited skin disorder in which there are red patches with thick, dry silvery scales. It is caused by the body making too-many skin cells. Sores may be anywhere on the body but are more common on the arms, scalp, ears, and the pubic area. A swelling of small joints may go along with the skin disease.
Shingles: A severe infection caused by the Varicella-Zoster virus (VZV), affecting mainly adults. It causes painful skin blisters that follow the underlying route of brain or spinal nerves infected by the virus. Also know as herpes zoster.
Thyroid: Thyroid Gland: An organ with many veins. It is at the front of the neck. It is essential to normal body growth in infancy and childhood. It releases thyroid hormones - iodine-containing compounds that increase the rate of metabolism, affect body temperature, regulate protein, fat, and carbohydrate catabolism in all cells. They keep up growth hormone release, skeletal maturation, and heart rate, force, and output. They promote central nervous system growth, stimulate the making of many enzymes, and are necessary for muscle tone and vigor.
Virus: Any of a vast group of minute structures composed of a protein coat and a core of DNA and/or RNA that reproduces in the cells of the infected host. Capable of infecting all animals and plants, causing devastating disease in immunocompromised individuals. Viruses are not affected by antibiotics, and are completely dependent upon the cells of the infected host for the ability to reproduce.
Yeast: A single-cell organism that may cause infection in the mouth, vagina, gastrointestinal tract, and any or all bodily parts. Common yeast infections include candidiasis and thrush.
I'm a great believer in luck, and I find the harder I work, the more I have of it. - Thomas Jefferson
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