Core Presentations Flashcards
What are your differentials for Chest pain:
M.I
- central chest pain
- radiates to left arm
- crushing
Pleuritic chest pain
- sharp
- localised
- pneumonia
Pericarditis
- Central pain worse on breathing in and leaning back
GORD
- Burning
- dyspepsia
Cholecystitis
What will the Central ScvO2 be during cardio/ hypovolemic shock and how does this differ to sepsis or anaphylaxis?
Much lower than normal, due to increased extraction of oxygen as flow is impeded.
- oxygen extraction exceeds delivery
Sepsis may be reduced as oxygen simply can’t extracted as easily.
Differentials for cough:
URTI COPD Bronchiectasis Lung cancer Interstitial disease GORD LEft ventricular heart failure
Common causes of haemoptysis:
Bronchitis Pneumonia Bronchial carcinoma Pneumonia Bronchiectasis Left heart failure
List some causes of acute and chronic breathlessness:
Acute:
- P.E
- Pneumothorax
- Asthma attack
- Metabolic acidosis
- Pneumonia
- Anxiety
Chronic:
- COPD
- Lung cancer
- Interstitial lung disease
- Anaemia
- Chronic heat failure
What investigations do you want into a chronic cough? >6 weeks
CXR
Spirometry
CT
24 hour pH monitoring
What are some differentials for weight loss:
Malignancy
G.I disease:
- Crohn’s
- Coeliac
Biliary tract disease
- Chronic pancreatitis
- chronic obstruction
Endocrine disease:
- Thyrotoxicosis
- Diabetes
Chronic inflammation
- vasculitis
- RA
Alcohol abuse
What are some causes of constipation:
Low fibre
In activity
Drugs
- Opioids
Colorectal cancer
Hypercalcaemia
Hypothyroidism
What are your immediate investigation into acute diarrhea:
Bloods:
- FBC
- CRP
Orifices:
- Stool Culture
- C.Diff toxin
X-ray:
- Abdominal x-ray
What investigations are wanted into chronic diarrhea?
Bloods:
- FBC
- ESR
- LFTs - albumin level
- TFTs
- Coeliac screen
Orifices:
- stool cultures, microscopy
- Ova eggs and parasites
- Faecal elastase
X-rays:
- AXR
- Endoscopy
- Colonoscopy
What investigations do you want in a large PR bleed?
Bloods:
- FBC
- U&Es - urea level
- Coagulation studies
- Cross match
Orifices:
- flexible sigmoidoscope
X-rays:
- Mesenteric Angiography
- Abdominal x-ray - may show inflammation
Investigations into dyspepsia:
Bloods:
- FBC
- ESR
- U&Es
Orifices:
- Endoscopy
- 24 hour pH monitoring
X-rays:
- barium swallow
Special tests:
- H.Pylori testing
In transudate causes of ascites, what other signs may be seen?
Peripheral oedema
Raised JVP
Pleural effusions
What is the definition of polyuria?
> 3L a day
Causes for polyuria:
Diabetes mellitus
Polydipsia
Hypercalcaemia
Diabetes insipidus
Diuretic use
What are some differentials for sweating and anxiety state:
Anxiety
Thyrotoxicosis
Pheochromocytoma
Tachyarrhythmias
Lymphoma
- night sweats
What are the most common causes of a fever of unknown origin?
Abscess
Endocarditis
Lymphoma
Solid tumours
Vasculitis
Key question to ask in a fever of returning traveler?
Duration and nature of symptoms?
Countries visited?
When were they visited?
Activities?
- water contact
Sexual contact?
Anti-malarial prophylaxis?
What are some causes of a fever in a returning traveler?
Malaria Hepatitis Leptospirosis Typhoid Dengue fever
What key investigations should be done in a patient with a fever that has recently returned from traveling?
Malarial thick films
Blood cultures
FBC
- look for eosinophilia - schistosomiasis, liver flukes
HIV test
Serology
In new onset back pain in a >55 year old or <20 year old what investigations do you want to do?
Bloods:
- FBC - WCC?
- ERS/ CRP
- Bone profile - Ca2+/ Alk phos
- Protein electrophoresis
- Blood cultures
Orifices:
- electrophoresis
X-rays
- spinal x-ray
- MRI
What are some causes of pruritus:
Primary skin conditions:
- Eczema
- Dermatitis herpetiformis
- Angioedema
Drugs:
- Opioids
- ACE inhibitors
Systemic disease:
- Anaemia
- Leukemia
- Polycythemia vera `
What are some causes for constipation:
Medical:
- Opioids
Low fibre diet
Hypercalcemia
Hypokalemia
Autonomic dysfunction
Poor mobility
