SOCRATES General - Fevers - Weight loss - Lethargy - Eating & Sleeping - Waterworks & Bowel Cardiorespiratory - Palpitations - SOB/wheeze - Cough +/- production - Haemoptysis - Leg swelling

SOCRATES General SR - Fever - Weight loss - Night sweats - Lethargy - E&D GI - Dysphagia - N&V - Dyspepsia - Odynophagia - Bowel habit - Blood/mucus - Waterworks Gynaecological/Menstrual

Common Medical Presentations Flashcards by leo Olney

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

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Angina presentation?

Cardiac-type chest pain
Present of exertion
Relieved on rest

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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

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Pericarditis presentation?

Retrosternal/pleuritic chest pain
Relieved by sitting forward
May radiate to shoulder

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Cardiac chest pain differentials?

ACS
Angina
Aortic dissection
Pericarditis

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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.

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Pneumothorax presentation?

Sudden onset chest pain
SOB if large enough
R/Fs tall/thin, marfans, COPD/Asthma

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Respiratory chest pain presentations?

Pulmonary embolism

Pneumothorax

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GORD presentation?

Retrosternal burning chest pain
Related to meals, lying and straining
Water brash

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Anxiety/Panic attack presentation?

Tight chest pain, SOB, sweating, dizziness, palpitations, feeling of impending doom.

Anxious personality/GAD/PD

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Chest pain Hx SR?

SOCRATES

General

Fevers
Weight loss
Lethargy
Eating & Sleeping
Waterworks & Bowel

Cardiorespiratory

Palpitations
SOB/wheeze
Cough +/- production
Haemoptysis
Leg swelling

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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

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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

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Chest pain Ddx?

MI
Angina
Aortic Dissection
Pericarditis
Pulmonary embolism 
Pneumothorax 
GORD
Anxiety/Panic
MSK

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Breathlessness Ddx?

MI
HF
Pneumonia 
Asthma
COPD
Pneumothorax
Pulmonary Embolism
Pulmonary Fibrosis

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HF presentation?

SOB
Orthopnoea
Paroxysmal nocturnal dyspnoea
Pink frothy sputum
Peripheral oedema 
Cardiac Hx

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Pneumonia presentation?

Acute SOB, cough and sputum

Systemic symptoms e.g. fever

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Asthma presentation?

Intermittent wheeze
Diurnal presentation
Nocturnal cough
Exacerbating factors: pets, exercise

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COPD presentation?

Chronic SOB
Sig. smoking Hx
Chronic sputum production

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Pulmonary fibrosis presentation?

Progressive SOB over long period on exertion (exertional dyspnoea)
Dry cough

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Abdo pain Hx?

SOCRATES

General SR

Fever
Weight loss
Night sweats
Lethargy
E&D

Dysphagia
N&V
Dyspepsia
Odynophagia
Bowel habit
Blood/mucus
Waterworks

Gynaecological/Menstrual

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Appendicitis presentation?

Younger
Periumbilical pain, moves to RIF
Anorexia
Pain on movement, staying very still

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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

1. Alternating bowel habit 2. Weight loss 3. Urgency/Tenesmus 4. Anal discomfort /pruritis

Inflammatory Bowel Disease presentation?

1. Blood mixed with stool 2. Mucus 3. Diarrhoea 4. Abdo pain 5. Weight loss

Haemorrhagic infective gastroenteritis presentation?

1. Acute diarrhoea and vomiting | 2. Hx of high risk food intake

Angiodysplasia presentation?

1. Elderly 2. Painless 3. Subtle

Proximal polyp/malignancy presentation?

1. Weight loss | 2. Anaemia symptoms

Haemorrhagic peptic ulcer/gastritis presentation?

1. Gastritis symptoms 2. Haematemesis 3. R/Fs: NSAIDS, Alcohol, Spicy food

Oesophageal Varices presentation?

1. Hx of liver disease/alcoholism 2. Encephalopathy of alcohol withdrawal 3. Haematemesis

Haematemesis Ddx?

1. Oesophageal varices 2. Mallory-Weiss tear 3. Peptic ulcer haemorrhage/haemorrhagic gastritis or oepsophagitis

Mallory Weiss Tear presentation?

1. Multiple vomits before haeamatemesis | 2. Typically before drinking

Peptic ulcer haemorrhage, gastritis/oesophagitis haemorrhage presentation?

1. Prev. gastritis | 2. R/Fs e.g. NSAIDS alcohol, spicy foods