1.01 - Surgical History Taking

Question 1

What are the differentials for a patient present with acute right lower abdominal pain?

Answer 1

?UTI
?testicular torsion (M only)
?acute appendicitis
?ectopic pregnancy (F only)

Question 2

Which bedside investigation should always be carried out for a patient presenting with acute right lower abdominal pain?

Answer 2

Urinalysis - will exclude UTI and ectopic pregnancy.

Question 3

What is the pain character of acute appendicitis?

Answer 3

An acute onset of periumbilical pain (visceral pain) that migrates to the right iliac fossa (somatic pain).

Question 4

Give the scoring system and the respective criteria used to make a clinical diagnosis of acute appendicitis.

Answer 4

Alvarado score

MANTRELS (see image attached)

A score ≥5 is sufficient to make a clinical diagnosis of acute appendicitis.

Question 5

Define anorexia.

Answer 5

The loss of appetite and/or loss of interest in food.

This can subsequently lead to weight loss, which is usually the result of reduced energy intake as opposed to increased energy expenditure.

Question 6

A patient who has zero calorie intake will lose how much weight per week?

Answer 6

Approx. 2kg/wk

Question 7

What are the differentials for a patient presenting with a ‘painful mouth’?

Answer 7

• inflammatory bowel disease
• gluten enteropathy
• iron deficiency
• vitamin B deficiency
• vitamin C deficiency

Question 8

Give the characteristics of heart burn.

Answer 8

A retrosternal burning pain / discomfort, which radiates upwards. The patient may also describe a sour taste in their mouth and water brash (hypersalivation).

This is indicative of gastro-oesophageal reflux disease.

Question 9

What is dyspepsia?

Answer 9

Pain or discomfort centred in the upper abdomen.

Question 10

Give the characteristics of the following types of dyspesia:

a) reflux-like dyspepsia

b) ulcer-like dyspepsia

c) dysmotility-like dyspepsia

Answer 10

a) heart burn predominant pain in the upper abdomen.

b) epigastric pain relieved by foods or antacids.

c) nausea, belching, bloating and premature satiety.

Question 11

What is odynophagia?

Answer 11

Pain on swallowing

Question 12

Odynophagia that is precipitated by drinking hot liquids is suggestive of what diagnosis?

Answer 12

Oesophagitis

Question 13

A sudden onset of severe and generalised abdominal pain is suggestive of which pathologies?

Answer 13

• bowel perforation
• ruptured abdominal aorta
• mesenteric infarction

Question 14

Inflammation usually produces:

a) constant

or

b) intermittent

pain?

Answer 14

a) constant

Question 15

Give the pain characteristics of acute pancreatitis.

Answer 15

Central abdominal pain with back radiation, which is relieved by leaning forwards.

Question 16

Give the pain characteristics of gall stone disease.

Answer 16

Right hypochondrial pain that radiates to the right shoulder.

Question 17

Give the differentials for severe vomiting without significant pain.

Answer 17

• gastric outlet obstruction
• proximal small-bowel obstruction

Question 18

Give the differentials of feculent vomiting.

Answer 18

Late feature of:
- distal small-bowel obstruction
- colonic obstruction

Question 19

What questions should be asked when exploring past surgical history?

Answer 19

• previous operations
• dates
• complications

Question 20

What questions should be asked when exploring drug history?

Answer 20

• medications
• indication
• dose
• how long has been taking for

Question 21

What question can be asked to elicit a full past medical history?

Answer 21

“Have you ever had any medical problem or been to the hospital for anything?”

Question 22

Give the topics that should be explored in a cardiovascular systematic enquiry.

Answer 22

• chest pain
• effort dyspnoea
• orthopnoea
• nocturnal dyspnoea
• palpitations
• swollen ankles
• claudication

Question 23

Give the topics that should be explored in a respiratory systematic enquiry.

Answer 23

• dyspnoea
• cough (?sputum ?haemoptysis)
• wheeze

Question 24

Give the topics that should be explored in a gastro-intestinal systematic enquiry.

Answer 24

• weight loss
• loss of appetite
• nausea or vomiting
• dysphagia
• heart burn
• abdominal pain
• bleeding per rectum
• changes in bowel habit (diarrhoea / constipation)

Question 25

Give the topics that should be explored in a genito-urinary systematic enquiry.

Answer 25

• abnormal discharge
• last menstrual period
• dysuria
• haematuria
• frequency
• offensive or dark coloured urine
• incontinence
• post-mictruition dribble

Question 26

Give the topics that should be explored in a social history, that are relevant to surgery.

Answer 26

• at what time did they last eat or drink?
• who will look after the patient following discharge?
• smoking & alcohol history