DDx KP and Qs

Question 1

Bowel CA Qs

Answer 1

LOW, LOA, L&Bs, Tiredness
Blood in your stools?
Dark Stools?
Vomited any Blood?
Changes in your Bowel Habits?
Family Hx of bowel CA?
(If >50 y/o) Have you done your National Bowel Screening?

Question 2

Abdominal Pain GI DDx Qs

Answer 2

Bowel CA

Inflammatory Bowel Disease (Rheuma Qs)
- Bloody Diarrhea?
- Rash? BOV? Joint pain? Mouth Ulcer?

Irritable Bowel Syndrome Qs
- Social Hx – Stress - Home, Occupation
- Better with passing bowel motion?

Gastro Enteritis Qs - Travel Qs, Occupation?

Alcohol? (Pancreatitis)
Surgeries?
Medications? (NSAID Induced)
GORD and PUD Qs (if Upper Pain)

Question 3

GORD/ PUD Qs

Answer 3

GORD - Heartburn? Acidic Taste in mouth? Water Brash?

PUD - Pain Related to eating

Key points - If (+)
How long after eating does the pain start?
- Immediately (Peptic Ulcer)
- Few hours (Duodenal Ulcer)
Specific food?
PUD RF
- Alcohol?
- Medications? (Steroid and NSAID)
- Spicy food?
- Coffee or Tea?

Question 4

Abdominal Pain KUB DDx Qs

Answer 4

Dysuria – Burning or pain on passing urine?
Frequency – Have you been passing urine more frequently?
Blood in your urine? (Renal Colic, Renal CA, Trauma)

Question 5

Abdominal Pain Genital/Pelvic DDx Qs

Answer 5

Hernia
Have you noticed any swelling or lumps in your groin

(Female) - Pelvic Qs
(Male) - Groin Qs (Testicular Torsion, Epidydimo-Orchitis)
- Pain and Swelling in the scrotum

Question 6

Abdominal Pain Pelvic Qs

Answer 6

Menstruation and STI’s

Symptoms
-Vaginal Bleeding or Vaginal Discharge?

Period Hx (Endometriosis, EP, Pregnancy)
- LMP**
- Heavy Periods or Irregular Bleeds?

Sexual Hx (PID)
- Are you Sexually Active?
- Safe Sex? Condoms?
- Multiple Partners
- Pain or bleeding during and after Intercourse?

Question 7

Abdominal Pain Others Qs

Answer 7

DKA - Polyuria, Polydypsia,
Mesenteric Ischemia - Funny Racing of the Heart? (AF)
Rash? (Shingles, Celiac D, IBD)

Question 8

Abdominal Pain Format

Answer 8

Explore Abdominal Pain
General Symptoms
GI Qs
Upper Abdomen
KUB Qs
Genital/ Pelvic Qs
Other Causes Qs
SADMA, PMHx, Fhx

Question 9

Abdominal Pain Upper Abdomen DDx Qs

Answer 9

Liver and GB - Jaundice, Itchiness, Dark urine and pale stools, Fever and Travel?

ACS and Lower Lobe Pneumonia - Chest pain or SOB?, Cough?

Question 10

Pancreatitis KP Qs

Answer 10

A – Alcohol
B – Biliary Obstruction (Tumor, Gallstones)
C – Cholesterol (Lipids, HyperTAG)
D – Drugs (Steroids, Tetracycline, Gliptin)
E – ERCP (Procedure)
F – Flu-like (Mumps
G - Gallstones

Question 11

Additional Abdo Pain DDx for Young

Answer 11

Celiac Disease
- Greasy Stool
- Stool Hard to flush? Stick to the pan

Lactose intolerance
- Abdominal Pain after taking dairy products

DKA
- Polydipsia - Inc Thirst
- Polyuria - Increase frequency of urine

Question 12

Back Pain Red Flags

Answer 12

LOW, LOA, L&Bs
Neurological Deficit - Weakness or Numbness of the Legs
Urinary Leakage

Question 13

Abdominal Pain + Back Pain DDx

Answer 13

CA with Mets
Inflammatory Bowel Disease
A/E of Endone use (Constipation)
Ankylosing Spondylitis

Question 14

Renal Colic Qs

Answer 14

• Dysuria and Fever (UTI Qs)
• Frequency, Hematuria
• Dribbling
• Family Hx of Kidney Stones
• RF - Medications, Drinking enough Water, High salt Diet?

Question 15

Dark Urine KUB Qs

Answer 15

Cancer - LOW, LOA, L&B, Tiredness, Night sweats

IGA nephropathy & PSGN
- Any Recent Sore throat or flu-like symptoms?
- Antibiotic or Medication?
- Swelling in legs?
- Puffiness face or other parts?

UTI - Dysuria, Frequency, and Fever

Renal Colic
- Flank pain or Abdominal Pain
- PMHx or Fhx of kidney stones

Traumatic Injury - Trauma to your abdomen?

Excessive Exercise
Medication (Statins)

Pseudo hematuria - Medication? Beetroots?

Liver Qs - (2-3 Qs)

Question 16

Dark Urine Liver Qs

Answer 16

Hepatitis
- Jaundice, Itchiness?
- Abdominal Pain? N/V?
- RF of Hepatitis – ABP FIT No Sick Sex

Cancers - LOW, LOA, L&B

GB Stones - Pain in RUQ after heavy fatty meals?

Cholangitits - Fever? Abdominal Pain? Jaundice

Previous Surgeries? Medications?

KUB Qs (2-3Qs)

Question 17

RF of Hepatitis

Answer 17

A BP FIT No Sick Sex

A - Alcohol, Antibiotics
B - Blood Transfusion
P - Piercing and Tatooing
F - Food – Street Food and unbottled water
I - IV drug Use
T - Travel
N – Needle stick Injury,
O – Occupation
Sick – Contact with Sick people
Sex – Sex Hx

Question 18

Fatty Liver Qs

Answer 18

Cholesterol Medication
Lifestyle - Alcohol Diet and Excercise
Hemochromatosis Qs
Bowel CA Qs

Question 19

Hypercalcium Qs

Answer 19

Have you ever been told you have high CA in the Blood?
GP ever investigated it?

Symptoms
- Bone Pain
- Tiredness
- Weakness in muscles
- Nausea

Question 20

Hemorrhoids Qs

Answer 20

Felt any lumps around back passage?

(if Yes)
Is it always there? Or does it go back in?

RF of Hemorrhoids
- Long term constipation?
- High fiber Diet? Drink enough water?
- Chronic Cough? Lifting Heavy?
- Liver Disease – Yellowish discoloration of the skin?

Question 21

Per-Rectal Bleeding Format Qs

Answer 21

Timing Qs, A&A, CCVO
General Symptoms
Bowel CA Qs
Anal Fissure
- Pain on passing bowel motions?
Hemorrhoid Qs
IBD Qs
Acute Abdomen
- Diverticulitis - Abdominal Pain
- Mesenteric Ischemia - Funny racing of the heart
Gastroenteritis
Infective Proctitis (STD)
- Discharge form the back passage?
- Sexually Active?
- Safe Sex? Condoms
- Ever been dx with STIs?
Bleeding d/o, Blood Thinners

Question 22

GORD RF Qs

Answer 22

Red Flags - Dysphagia, Melena, LOW

Smoking and Alcohol
Spicy food and fatty food (take away)
Coffee tea, Energy drink and Soft drink
Medications (ASA, NSAIDS, Steroids, Alendronate)
Recent weight gain? Exercise?
Stress

Question 23

Hyponatremia Qs

Answer 23

Symptoms of Hyponatremia (CNS Qs) - Confused or Dizzy? HA? Seizures?
PMHx of the Patient
1st - r/o Pseudohyponatremia - BSL, Lipid Profile
2nd - Volemia
Hypovolemia - V/D? Intake? Diuretics?
Hypervolemia - Heart, Liver, Kidney Failure Qs
Euvolemic
- Thyroid Qs
- SIADH Qs -
– Medications (SSRI or Anticonvulsant),
– Malignancy Qs,
– Respiratory Qs - Cough or SOB
– Cerebral - Falls? or Head injury?

Question 24

Buttocks Pain DDx Qs

Answer 24

Anal Fissure
- Bleeding passing bowel motion
- Blood on the tissue
- Recent Constipation

Hemorrhoids - Lump in the back passage?

Perianal Abscess - Lump? Fever and Chills?

Pilonidal Abscess and Boil and Fistula
- Discharge on your underwear?
- Swelling or redness on the skin?

Prostatitis (Urinary Qs) - Dysuria, Hematuria, Polyuria STI Qs

Proctitis (Infection)
- Pain passing on bowel motion
- STI Qs - Unsafe and Prev Dx?
- IBD Qs

Question 25

Ovarian CA Qs

Answer 25

Period Hx - LMP? Any spotting or abnormal Vaginal bleeding?

Routine Screening >50 y/o –
Mamogram and CST

FHx of Breast or ovarian CA

Early Satiety – Do you feel full after eating a small amount of food?

Urinary - Freq and Urgency
- Passing urine more frequently
- Do you get sudden urge to pass urine?

SOB, Tiredness

Question 26

Inc. Thirst DDx Qs

Answer 26

Timing Qs
A&A
DM and DI - Polyuria, Polyphagia
Multiple Myeloma - Tiredness, Recurrent Infections
Brain Tumor
Malignancy Qs (HyperCA)
Thyrotoxicosis - Pref weather, Heat intolerance, Palpitations
Medication Hx
Lifestyle Qs - Diet, Coffee, Tea, Alcohol, Excercise
Hyper CA Qs