Which OPQRST-I element covers "When and how did the symptom begin?"

• A. Onset
• B. Time
• C. Quality
• D. Provocation

Answer: (A)

Onset is the part of the history that answers when the symptom first began and how it started. It captures the timing and the manner of initiation (for example, whether it started suddenly or gradually, and what event or trigger brought it on). This helps you gauge acuity and potential causes—for instance, a sudden onset of chest pain after heavy lifting suggests a different urgent concern than chest pain that develops gradually with activity. Other elements describe what makes symptoms worse or better (provocation), what the symptom feels like (quality), where it radiates, how long it lasts or its pattern over time (time), and how severe it is, but the question about when and how it began specifically targets onset.