Comms 4 (Symptoms)

Question 1

What is the problem with the way we learn medicine?

Answer 1

It tends to be based around diseases.

Patients do not present with a diagnosis they present with symptoms.

Question 2

How do we convert symptoms into diagnosis?

Answer 2

Create and test hypotheses
Rule out red flags
Create a plan for you and the patient

Question 3

How can we structure our thinking in coming to a diagnosis?

Answer 3

Systems - what kind of symptom is this?
Time of onset
Severity
We should not base it on ease of investigations

Question 4

How should we structure our questioning?

Answer 4

Open Questions: establish the facts to develop a hypothesis
Closed Questions: start to test your hypotheses and sense check
Remember the absence of a symptom may be as important as no symptom

Question 5

What are red flags?

Answer 5

These symptoms may suggest a more serious underlying illness which needs to be diagnosed and treated early.
Fortunately the vast majority of these ‘red flag’ symptoms when investigated, are often of no significance.

Question 6

What to look out for with a cough?

Answer 6

Foreign travel (atypical pneumonia/TB)
Weight loss/hoarse voice in a smoker
Haemoptysis
Suspect inhaled foreign body in children when no signs of infection
Unresponsive to treatment

Question 7

What to look out for in single joint pain?

Answer 7

Very hot, painful and systemic illness possible septic arthritis
Very swollen after trauma possible haemarthrosis
Be careful in rheumatoid arthritis which can mask symptoms
Young male with monoarthritis may have Reiters