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MALE QUESTIONNAIRE - PAGE 8  You are on page 8 of 9 >     FAMILY HISTORY 893.  Do you have any knowledge of diseases/conditions that your parents, grandparents, brothers or sisters have had? Answer 'no' if, for example, you were adopted or simply have no idea. No, I can't answer questions about close relatives Yes, I can answer questions about close relatives More questions later... CHILDHOOD 894.  Have you ever had chicken pox? Don't know Definitely not Yes 895.  Did you have allergies or signs of allergy such as an "allergic crease" across the nose, runny nose or bags under the eyes? No / don't know Yes, but insignificant Yes, a few minor ones Yes, one or two severe Yes, several severe 896.  Did you experience growing pains? No / don't know Minor Moderate Serious Severe 897.  Have you suffered from Osgood-Schlatter Disease (growing pains at the knee)? No / don't know Mildly in past Significantly in the past Currently mildly Currently significantly 898.  Did you have Osteochondrosis or Leg-Hip Perthes Disease? No / don't know Yes, but good recovery Severely - lasting skeletal damage 899.  Was your hair sensitive to brushing or combing (pulling, manipulation), or was it painful to remove something from your hair? No / don't know Yes 900.  Did your head sweat easily or at night? No / don't know Yes 901.  Did you roll your head on the mattress, or tend to rock back and forth? No / don't know Yes 902.  Were you inappropriately physically punished / abused as a child? Do not include sexual abuse here. No / don't know Mildly - an occasional smack Moderately - regular light physical punishment Occasional severe physical punishment/abuse Severely - frequent hard physical punishment/abuse 903.  Were you ever molested / sexually abused / raped as a child? Only include incidents that occurred up until the age of 18. No / can't remember / don't know There was occasional molestation Frequent molestation and/or isolated serious abuse Occasional serious abuse over a long period Frequent serious abuse over a long period 904.  Did your legs get tired easily; did you want to be carried a lot? No / don't know Yes 905.  Were you a hyperactive child? No / don't know Somewhat - I was more active than most children Definitely - I was a 'real handful' Severely - I was out of control 906.  Have you had some or all of the 'required' vaccinations? Don't know I have not been vaccinated at all I have had vaccinations but will not have any more I have had vaccinations and may have more Yes, and I am careful about keeping up-to-date 907.  At what age was puberty onset, based on first physical signs (usually pubic hair development)? 10 or younger 11 12 / don't know 13 14 or older Add any additional information here for the questions above: Please mention the question number(s) if possible.     GLOSSARY Allergic Salute (Allergic Crease) When the itchy, runny or blocked nose is being wiped in an upwards direction. This movement helps to open up the nasal airways but can lead to an Allergic Crease - a horizontal crease or pale line that develops across the lower part of the nose as a consequence of frequent upward wiping of the nose. Allergy (Allergies) Hypersensitivity caused by exposure to a particular antigen (allergen), resulting in an increased reactivity to that antigen on subsequent exposure, sometimes with harmful immunologic consequences. Chicken Pox An acute, highly infectious illness, principally of young children, caused by the chicken pox-herpes zoster virus and marked by fever and successive eruptions of clear blisters over the body. Chicken pox may enter latency in the deep nerve ganglia and reactivate years later in the form of herpes zoster. Growing Pains Unexplainable pain, usually in the legs, that occurs in growing children and is not accompanied by swelling or any other symptoms. Treatment includes massage and rest. The problem is distinguishing this pain from that caused by more serious problems: even physicians often have difficulty knowing how many laboratory and X-ray tests to perform. Osgood-Schlatter Disease One of the most common causes of knee pain in young athletes. It causes swelling, pain and tenderness just below the knee, at the top of the shin bone (tibia). It occurs mostly in boys who are having a growth spurt. One or both knees may be affected. Osteochondrosis The osteochondroses, also called Epiphyseal Ischemic Necrosis, are a relatively common group of orthopedic disorders of children, which are poorly understood. In an osteochondrosis, the epiphysis (growing end) of a bone dies and then is gradually replaced over a period of years, resulting in abnormal bone growth and deformity. The immediate cause of bone death is loss of blood supply, but why this occurs remains unclear. Perthes Disease Also known as Legg-Calvé-Perthes Disease (capital femoral epiphysis). The most common osteochondrosis, which occurs in the head of the thighbone, which dies and is then gradually replaced over a period of years. It occurs in youngsters aged 3-13 and is much more frequent in boys than in girls. Persistent pain is the most prominent symptom. Uncorrected severe cases lead to arrest of growth, deformity, and arthritic changes in the hip joint.

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