Approaches Flashcards
Ankle / Leg Swelling
History and Key Questions
PC - Site, onset, duration, redness, warmth, pain, rash. trauma, bite / sting
Systemic - N&V, fever, sweating, weight loss
PMH - recent surgery, immobility, fractures, IHD, DM, Stroke, bowel disease / GU, thyroid
DH - COCP / HRT, steroids, amlodipine, allergies
SH - smoking, alcohol, long-distance travel
Examination and Special Tests
Examine the limb - site, size, shape, colour, tender, temperature, ulcers (between toes)
Systemic exam led by history - heart, lungs, GI, vascular
Differential Diagnosis & Supporting Features
Lymphoedema - non-pitting, malignancy, FH, obesity
DVT - unilateral, red, tender, risk factors
Venous Insufficiency - bursting/throbbing, relieved by elevation, worse on standing, prev DVT or thrombophlebitis
Investigations
Simple - Wells score to determine DVT risk, dipstix
Bloods - FBC, CRP, U&Es, ?D-dimer & ABG if PE susp.
Imaging - Doppler USS
Others -
Management
Conservative -
Lymphoedema - exercise, weight loss, elevate limb, massage
DVT - modify risk factors
Medical -
Lymphoedema - compression bandaging, Abx
DVT - Enoxaparin, Warfarin
Venous - compression if ABPI >0.8
Surgical -
Venous - varicose vein removal
Abdo pain
History and Key Questions
PC - pain/tenderness, N&V, swelling, stool, blood, habit, GU, weight loss, surgery, jaundice, eating
PMH - DM, IBD, IHD, jaundice, gallstones, parcreatitis, GORD
DH&SH - NSAIDs, alcohol, travel
Examination and Special Tests
Don’t forget Flap, Nodes or Ankles
Murphy’s for cholecystitis
Shifting dullness for ascites
Hernias
PR
Differential Diagnosis & Supporting Features
Obstruction - pain, dist, N&V, const, tinkling bowel sounds
Appendicitis - perium-RIF, anorexia, N&V
Strangulated Hernia - sudden onset, prev hernia
GORD/Ulcer - dyspepsia, heartburn, anorexia, NSAIDs
Gastroenteritis - rapid, V, Diarr, inc Temp, epigastric tend
IBD - weight loss, mouth ulcers, PR blood/mucus, tender
Diverticulitis - diarrhoea, const, PR blood, tender/peritoniti
Renal colic - colicky flank pain, groin, N&V, restlessness
HPB - constant or colicky RUQ, +- Jaundice
O&G - lower abdo, PV blood, period change,
Acute - Perforation, Pancreatitis, AAA Rupture, Testicular Torsion
Investigations
Simple - dipstix, MSU, ßHCG in women, ?ECG
Bloods - FBC, CRP, U&Es, LFTs, amylase, Ca(low in pancreatitis), glucose, clotting, ?C&S, ?Trops, ABG if unwell
Imaging - Erect CXR, plain AXR, USS liver, CT KUB
_Others - _
Management
Acute
ABCDE approach
Analgesia & antiemetic
?O2, NG tube, catheter
IVT if shocked
NBM
Senior review
Chronic Depends on cause
Conservative -
Medical -
Surgical -
Abdo mass / swelling
History and Key Questions
Examination and Special Tests
Differential Diagnosis & Supporting Features
Investigations
_Simple - _
Bloods -
_Imaging - _
_Others - _
Management
Acute
_Chronic _
Conservative -
Medical -
Surgical -
Back pain
History and Key Questions
Examination and Special Tests
Differential Diagnosis & Supporting Features
Investigations
_Simple - _
Bloods -
_Imaging - _
_Others - _
Management
Acute
_Chronic _
Conservative -
Medical -
Surgical -
Altered bowel habit
History and Key Questions
Examination and Special Tests
Differential Diagnosis & Supporting Features
Investigations
_Simple - _
Bloods -
_Imaging - _
_Others - _
Management
Acute
_Chronic _
Conservative -
Medical -
Surgical -
Breast Lump
History and Key Questions
Examination and Special Tests
Differential Diagnosis & Supporting Features
Investigations
_Simple - _
Bloods -
_Imaging - _
_Others - _
Management
Acute
_Chronic _
Conservative -
Medical -
Surgical -
SoB
History and Key Questions
Examination and Special Tests
Differential Diagnosis & Supporting Features
Investigations
_Simple - _
Bloods -
_Imaging - _
_Others - _
Management
Acute
_Chronic _
Conservative -
Medical -
Surgical -
Change in appetite and body weight
History and Key Questions
Examination and Special Tests
Differential Diagnosis & Supporting Features
Investigations
_Simple - _
Bloods -
_Imaging - _
_Others - _
Management
Acute
_Chronic _
Conservative -
Medical -
Surgical -
Chest Pain
History and Key Questions
Examination and Special Tests
Differential Diagnosis & Supporting Features
Investigations
_Simple - _
Bloods -
_Imaging - _
_Others - _
Management
Acute
_Chronic _
Conservative -
Medical -
Surgical -
Collapse
History and Key Questions
Examination and Special Tests
Differential Diagnosis & Supporting Features
Investigations
_Simple - _
Bloods -
_Imaging - _
_Others - _
Management
Acute
_Chronic _
Conservative -
Medical -
Surgical -
Confusion
History and Key Questions
Examination and Special Tests
Differential Diagnosis & Supporting Features
Investigations
_Simple - _
Bloods -
_Imaging - _
_Others - _
Management
Acute
_Chronic _
Conservative -
Medical -
Surgical -
Delirium
History and Key Questions
Examination and Special Tests
Differential Diagnosis & Supporting Features
Investigations
_Simple - _
Bloods -
_Imaging - _
_Others - _
Management
Acute
_Chronic _
Conservative -
Medical -
Surgical -
Cough
History and Key Questions
Examination and Special Tests
Differential Diagnosis & Supporting Features
Investigations
_Simple - _
Bloods -
_Imaging - _
_Others - _
Management
Acute
_Chronic _
Conservative -
Medical -
Surgical -
Difficult micturition & dysuria
History and Key Questions
Examination and Special Tests
Differential Diagnosis & Supporting Features
Investigations
_Simple - _
Bloods -
_Imaging - _
_Others - _
Management
Acute
_Chronic _
Conservative -
Medical -
Surgical -
Dizziness, syncope & falls
History and Key Questions
Examination and Special Tests
Differential Diagnosis & Supporting Features
Investigations
_Simple - _
Bloods -
_Imaging - _
_Others - _
Management
Acute
_Chronic _
Conservative -
Medical -
Surgical -
Dyspepsia
History and Key Questions
Examination and Special Tests
Differential Diagnosis & Supporting Features
Investigations
_Simple - _
Bloods -
_Imaging - _
_Others - _
Management
Acute
_Chronic _
Conservative -
Medical -
Surgical -
Dysphagia
History and Key Questions
Examination and Special Tests
Differential Diagnosis & Supporting Features
Investigations
_Simple - _
Bloods -
_Imaging - _
_Others - _
Management
Acute
_Chronic _
Conservative -
Medical -
Surgical -
Fever
History and Key Questions
Examination and Special Tests
Differential Diagnosis & Supporting Features
Investigations
_Simple - _
Bloods -
_Imaging - _
_Others - _
Management
Acute
_Chronic _
Conservative -
Medical -
Surgical -
Gait disturbance
History and Key Questions
Examination and Special Tests
Differential Diagnosis & Supporting Features
Investigations
_Simple - _
Bloods -
_Imaging - _
_Others - _
Management
Acute
_Chronic _
Conservative -
Medical -
Surgical -
Haemoptysis
History and Key Questions
Examination and Special Tests
Differential Diagnosis & Supporting Features
Investigations
_Simple - _
Bloods -
_Imaging - _
_Others - _
Management
Acute
_Chronic _
Conservative -
Medical -
Surgical -
Haematemesis
History and Key Questions
Examination and Special Tests
Differential Diagnosis & Supporting Features
Investigations
_Simple - _
Bloods -
_Imaging - _
_Others - _
Management
Acute
_Chronic _
Conservative -
Medical -
Surgical -
Melaena
History and Key Questions
Examination and Special Tests
Differential Diagnosis & Supporting Features
Investigations
_Simple - _
Bloods -
_Imaging - _
_Others - _
Management
Acute
_Chronic _
Conservative -
Medical -
Surgical -
Hearing loss
History and Key Questions
Examination and Special Tests
Differential Diagnosis & Supporting Features
Investigations
_Simple - _
Bloods -
_Imaging - _
_Others - _
Management
Acute
_Chronic _
Conservative -
Medical -
Surgical -
Hoarseness
History and Key Questions
Examination and Special Tests
Differential Diagnosis & Supporting Features
Investigations
_Simple - _
Bloods -
_Imaging - _
_Others - _
Management
Acute
_Chronic _
Conservative -
Medical -
Surgical -
Incontinence
History and Key Questions
Examination and Special Tests
Differential Diagnosis & Supporting Features
Investigations
_Simple - _
Bloods -
_Imaging - _
_Others - _
Management
Acute
_Chronic _
Conservative -
Medical -
Surgical -
Infection
History and Key Questions
Examination and Special Tests
Differential Diagnosis & Supporting Features
Investigations
_Simple - _
Bloods -
_Imaging - _
_Others - _
Management
Acute
_Chronic _
Conservative -
Medical -
Surgical -
Inguinal swelling
History and Key Questions
Examination and Special Tests
Differential Diagnosis & Supporting Features
Investigations
_Simple - _
Bloods -
_Imaging - _
_Others - _
Management
Acute
_Chronic _
Conservative -
Medical -
Surgical -
Tremor
History and Key Questions
Examination and Special Tests
Differential Diagnosis & Supporting Features
Investigations
_Simple - _
Bloods -
_Imaging - _
_Others - _
Management
Acute
_Chronic _
Conservative -
Medical -
Surgical -
Itch
History and Key Questions
Examination and Special Tests
Differential Diagnosis & Supporting Features
Investigations
_Simple - _
Bloods -
_Imaging - _
_Others - _
Management
Acute
_Chronic _
Conservative -
Medical -
Surgical -
Jaundice
History and Key Questions
Examination and Special Tests
Differential Diagnosis & Supporting Features
Investigations
_Simple - _
Bloods -
_Imaging - _
_Others - _
Management
Acute
_Chronic _
Conservative -
Medical -
Surgical -
Joint pain
History and Key Questions
Examination and Special Tests
Differential Diagnosis & Supporting Features
Investigations
_Simple - _
Bloods -
_Imaging - _
_Others - _
Management
Acute
_Chronic _
Conservative -
Medical -
Surgical -
Joint swelling
History and Key Questions
Examination and Special Tests
Differential Diagnosis & Supporting Features
Investigations
_Simple - _
Bloods -
_Imaging - _
_Others - _
Management
Acute
_Chronic _
Conservative -
Medical -
Surgical -
Loin pain
History and Key Questions
Examination and Special Tests
Differential Diagnosis & Supporting Features
Investigations
_Simple - _
Bloods -
_Imaging - _
_Others - _
Management
Acute
_Chronic _
Conservative -
Medical -
Surgical -
Lymphadenopathy
History and Key Questions
Examination and Special Tests
Differential Diagnosis & Supporting Features
Investigations
_Simple - _
Bloods -
_Imaging - _
_Others - _
Management
Acute
_Chronic _
Conservative -
Medical -
Surgical -
Memory problems
History and Key Questions
Examination and Special Tests
Differential Diagnosis & Supporting Features
Investigations
_Simple - _
Bloods -
_Imaging - _
_Others - _
Management
Acute
_Chronic _
Conservative -
Medical -
Surgical -
Menstrual / menopausal symptoms
History and Key Questions
Examination and Special Tests
Differential Diagnosis & Supporting Features
Investigations
_Simple - _
Bloods -
_Imaging - _
_Others - _
Management
Acute
_Chronic _
Conservative -
Medical -
Surgical -
Mood disturbance
History and Key Questions
Examination and Special Tests
Differential Diagnosis & Supporting Features
Investigations
_Simple - _
Bloods -
_Imaging - _
_Others - _
Management
Acute
_Chronic _
Conservative -
Medical -
Surgical -
N&V
History and Key Questions
Examination and Special Tests
Differential Diagnosis & Supporting Features
Investigations
_Simple - _
Bloods -
_Imaging - _
_Others - _
Management
Acute
_Chronic _
Conservative -
Medical -
Surgical -
Neck Pain
History and Key Questions
Examination and Special Tests
Differential Diagnosis & Supporting Features
Investigations
_Simple - _
Bloods -
_Imaging - _
_Others - _
Management
Acute
_Chronic _
Conservative -
Medical -
Surgical -
Neck swelling
History and Key Questions
Examination and Special Tests
Differential Diagnosis & Supporting Features
Investigations
_Simple - _
Bloods -
_Imaging - _
_Others - _
Management
Acute
_Chronic _
Conservative -
Medical -
Surgical -
normal pregnancy
History and Key Questions
Examination and Special Tests
Differential Diagnosis & Supporting Features
Investigations
_Simple - _
Bloods -
_Imaging - _
_Others - _
Management
Acute
_Chronic _
Conservative -
Medical -
Surgical -
Nutritional Disorders
History and Key Questions
Examination and Special Tests
Differential Diagnosis & Supporting Features
Investigations
_Simple - _
Bloods -
_Imaging - _
_Others - _
Management
Acute
_Chronic _
Conservative -
Medical -
Surgical -
Pallor
History and Key Questions
Examination and Special Tests
Differential Diagnosis & Supporting Features
Investigations
_Simple - _
Bloods -
_Imaging - _
_Others - _
Management
Acute
_Chronic _
Conservative -
Medical -
Surgical -
Palpitations
History and Key Questions
Examination and Special Tests
Differential Diagnosis & Supporting Features
Investigations
_Simple - _
Bloods -
_Imaging - _
_Others - _
Management
Acute
_Chronic _
Conservative -
Medical -
Surgical -
Paraesthesiae
History and Key Questions
Examination and Special Tests
Differential Diagnosis & Supporting Features
Investigations
_Simple - _
Bloods -
_Imaging - _
_Others - _
Management
Acute
_Chronic _
Conservative -
Medical -
Surgical -
Perceptual abnormalities
History and Key Questions
Examination and Special Tests
Differential Diagnosis & Supporting Features
Investigations
_Simple - _
Bloods -
_Imaging - _
_Others - _
Management
Acute
_Chronic _
Conservative -
Medical -
Surgical -
Photophobia
History and Key Questions
Examination and Special Tests
Differential Diagnosis & Supporting Features
Investigations
_Simple - _
Bloods -
_Imaging - _
_Others - _
Management
Acute
_Chronic _
Conservative -
Medical -
Surgical -
Polyuria
History and Key Questions
Examination and Special Tests
Differential Diagnosis & Supporting Features
Investigations
_Simple - _
Bloods -
_Imaging - _
_Others - _
Management
Acute
_Chronic _
Conservative -
Medical -
Surgical -
Rectal blood loss
History and Key Questions
Examination and Special Tests
Differential Diagnosis & Supporting Features
Investigations
_Simple - _
Bloods -
_Imaging - _
_Others - _
Management
Acute
_Chronic _
Conservative -
Medical -
Surgical -
Dyspareunia
History and Key Questions
Examination and Special Tests
Differential Diagnosis & Supporting Features
Investigations
_Simple - _
Bloods -
_Imaging - _
_Others - _
Management
Acute
_Chronic _
Conservative -
Medical -
Surgical -
Shock
History and Key Questions
Examination and Special Tests
Differential Diagnosis & Supporting Features
Investigations
_Simple - _
Bloods -
_Imaging - _
_Others - _
Management
Acute
_Chronic _
Conservative -
Medical -
Surgical -