Common Medical Presentations Flashcards
ACS presentation?
Central crushing chest pain Radiates to Neck/left arm Assoc. Nausea, SOB, Sweating CVD risk factors Brought on at rest
Unstable angina: crescendo angina
Angina presentation?
Cardiac-type chest pain
Present of exertion
Relieved on rest
Aortic dissection presentation?
Tearing chest pain
Very sudden onset
Radiates to back
Pain may be in other sites such as arms, legs, back and head
Pericarditis presentation?
Retrosternal/pleuritic chest pain
Relieved by sitting forward
May radiate to shoulder
Cardiac chest pain differentials?
ACS
Angina
Aortic dissection
Pericarditis
Pulmonary embolism presentation?
Pleuritic chest pain
SOB +/- haemoptysis
R/Fs inc. Long haul flight, recent surgery, immobilisation, malignancy
Signs include: Raised RR, low sats, tachycardia and tachypnoea.
Pneumothorax presentation?
Sudden onset chest pain
SOB if large enough
R/Fs tall/thin, marfans, COPD/Asthma
Respiratory chest pain presentations?
Pulmonary embolism
Pneumothorax
GORD presentation?
Retrosternal burning chest pain
Related to meals, lying and straining
Water brash
Anxiety/Panic attack presentation?
Tight chest pain, SOB, sweating, dizziness, palpitations, feeling of impending doom.
Anxious personality/GAD/PD
Chest pain Hx SR?
SOCRATES
General
- Fevers
- Weight loss
- Lethargy
- Eating & Sleeping
- Waterworks & Bowel
Cardiorespiratory
- Palpitations
- SOB/wheeze
- Cough +/- production
- Haemoptysis
- Leg swelling
MSK chest pain presentation?
Sharp chest pain
Exacerbated by movement and inspiration
Can point to where it is worse
Exacerbated by pressure over that area
Breathlessness Hx inc. SR?
OPERATE
Onset (sudden or gradual) Progression Exacerbating Relieving factors Associated symptoms Timing (intermittent or continuous Ever happened before?
Breathlessness
- Normal vs current exercise tolerance
- Orthopnoea
- Paroxysmal nocturnal dyspnoea
- Diurnal/season variation
General SR
- Fevers
- Night sweats
- Weight loss
- Lethargy
- E&D?
Cardiorespiratory SR
- Chest pain
- Palpitations
- Cough +/- production (inc. haemoptysis)
- Leg swelling
Chest pain Ddx?
MI Angina Aortic Dissection Pericarditis Pulmonary embolism Pneumothorax GORD Anxiety/Panic MSK
Breathlessness Ddx?
MI HF Pneumonia Asthma COPD Pneumothorax Pulmonary Embolism Pulmonary Fibrosis
HF presentation?
SOB Orthopnoea Paroxysmal nocturnal dyspnoea Pink frothy sputum Peripheral oedema Cardiac Hx
Pneumonia presentation?
Acute SOB, cough and sputum
Systemic symptoms e.g. fever
Asthma presentation?
Intermittent wheeze
Diurnal presentation
Nocturnal cough
Exacerbating factors: pets, exercise
COPD presentation?
Chronic SOB
Sig. smoking Hx
Chronic sputum production
Pulmonary fibrosis presentation?
Progressive SOB over long period on exertion (exertional dyspnoea)
Dry cough
Abdo pain Hx?
SOCRATES
General SR
- Fever
- Weight loss
- Night sweats
- Lethargy
- E&D
GI
- Dysphagia
- N&V
- Dyspepsia
- Odynophagia
- Bowel habit
- Blood/mucus
- Waterworks
Gynaecological/Menstrual
Appendicitis presentation?
Younger
Periumbilical pain, moves to RIF
Anorexia
Pain on movement, staying very still
Gallstones presentation?
Biliary colic
- intermittent RUQ pain
- Worse with food
Cholecystitis
- Continuous RUQ pain
- Fevers
- Murphys sign
Cholangitis
- Jaundice
- Fevers/Rigors
- RUQ pain
Pancreatitis presentation?
Severe epigastric/central pain
Radiates to the back
Relieved by sitting forward
Vomiting
Gastritis/Peptic ulcer presentation?
Epigastric pain Related to meals Nausea Heartburn - possibly R/Fs - NSAIDS, Alcohol, Spicy foods
Diverticulitis presentation?
Elderly LIF pain Pyrexia Tachycardia N&V Change in bowel habit
Bowel obstruction presentation?
Vomiting,
Abdo distension,
Constipation
Colicky pain
Renal colic presentation?
Spasms of loin to groin pain
Nausea and vomiting
Cannot lie still
Ectopic pregnancy presentation?
Iliac fossa (either side) increasing (shoulder tip pain)
Amenorrhoea/pregnancy
Spotting
Gastroenteritis presentation?
Nausea and Vomiting Fever Diarrhoea Dehydration Recent travel/dodgy food
Abdo pain common Ddx?
Appendicitis Gallstones (and related disease) Pancreatitis Gastritis/PUD Diverticulitis Bowel obstruction Renal colic Ectopic pregnancy IBD Gastroenteritis
Change in bowel habit Ddx?
Colon Ca Gastroenteritis IBD IBS Coeliac disease Thyrotoxicosis Hypothyroidism Bowel obstruction Diverticulitis Overflow constipation
Change in Bowel habit Hx?
OPERATE
Onset Progression Exacerbating Relieving Associated Symptoms Timing Ever happened before?
Stool
- How much
- How often
- Consistency, colour, blood/mucus
GI SR
- Weight loss, Night sweats, Lethargy
- Fever
- E&D
- Dysphagia
- Odynophagia
- Dyspepsia
- N&V
- (BH)
- Waterworks
- Abdo pain
- Abdo distension
Colon Ca. Presentation?
Elderly
Blood in stool
Weight loss & Anaemia
Change in BH
Gastroenteritis presentation?
Acute Diarrhoea
N&V
IBD Presentation?
Blood/Mucus in stool
Abdo Pain
Weight loss
Diarrhoea Mostly
IBS Presentation?
Fluctuates between Diarrhoea and Constipation
Associated with stress/anxious personality
Crampy abdo pain and bloating. Abdo pain reliveed of defecation
Coeliac disease presentation?
Diarrhoea/Steatorrhoea
Anaemia symptoms
Abdo discomfort
Hyperthyroidism presentation?
Diarrhoea Heat intolerance Irritability Tremor Oligo/menorrhoea
Hypothyroidism presentation?
Constipation
Cold intolerance
Lethargy
Menorrhagia
Rectal bleeding Hx?
OPERATE
- Bleeding - fresh, on tissue
- Mucus
General SR
- Weight loss, Night sweats, Lethargy
- Fever
- E&D
GI
- Dyspahgia
- Odynophagia
- Dyspepsia
- Nausea & Vomiting
- Abdo pain
- Abdo distension
- BH
- Waterworks
Rectal bleeding Ddx?
Anal fissure Haemorrhoids Diverticular haemorrhage Distal polyp/malignancy Inflammatory bowel disease Haemorrhagic infective Gastroenteritis Angiodysplasia Proximal polyp or malignancy Haemorrhagic peptic ulcer/gastritis Oesophageal varices
Anal Fissure presentation?
Bleeding on defecation
Bright red on paper
Intense pain
Constipation
Haemorrhoids presentation?
Bleeding on defecation
Bright red on paper
Constipation
Pruritis
Diverticular haemorrhage presentation?
Sudden painless rectal bleeding
Elderly
Distal polyp/maignancy
- Alternating bowel habit
- Weight loss
- Urgency/Tenesmus
- Anal discomfort /pruritis
Inflammatory Bowel Disease presentation?
- Blood mixed with stool
- Mucus
- Diarrhoea
- Abdo pain
- Weight loss
Haemorrhagic infective gastroenteritis presentation?
- Acute diarrhoea and vomiting
2. Hx of high risk food intake
Angiodysplasia presentation?
- Elderly
- Painless
- Subtle
Proximal polyp/malignancy presentation?
- Weight loss
2. Anaemia symptoms
Haemorrhagic peptic ulcer/gastritis presentation?
- Gastritis symptoms
- Haematemesis
- R/Fs: NSAIDS, Alcohol, Spicy food
Oesophageal Varices presentation?
- Hx of liver disease/alcoholism
- Encephalopathy of alcohol withdrawal
- Haematemesis
Haematemesis Ddx?
- Oesophageal varices
- Mallory-Weiss tear
- Peptic ulcer haemorrhage/haemorrhagic gastritis or oepsophagitis
Mallory Weiss Tear presentation?
- Multiple vomits before haeamatemesis
2. Typically before drinking
Peptic ulcer haemorrhage, gastritis/oesophagitis haemorrhage presentation?
- Prev. gastritis
2. R/Fs e.g. NSAIDS alcohol, spicy foods
