F&C Histories

Question 1

Peadiatric Vomiting History in infant Differentials

Answer 1

GORD - common in 1st year. Regurgitation
Pyloric Stenosis - projectile vomiting, first 2 months
Intussusception - up to 2 years age, colicky pain, blood in stool
Coeliac disease - fatty stools, failure to thrive
Meningitis - fever, irritable, lethargic, non blanching pupuric rash
Gastroenteritis - diarrhoea, fever

Question 2

Paediatric Failure to Thrive Differentials

Answer 2

Constitutionally small child - no symptoms, parents small
Inadequate feeding - not eating enough
Intake issues - cleft palate, GORD or vomiting after feeds
Cows milk intolerance - diarrhoea, blood in stool
Cystic fibrosis - URTI, fatty stools
Coeliac disease - occurs after solids introduced, diarrhoea, abdominal distension

Question 3

Paediatric Developmental Delay Differentials (e.g, delayed walking)

Answer 3

Cerebral palsy - early hand dominance, abnormal tone, history of birth trauma
Duchene Muscular dystrophy - boys, gowers sign
Global developmental delay (downs, tuberous sclerosis) - delay in other areas of development as well as motor
Normal variation - diagnosis of exclusion

Question 4

Paediatric Acute Abdominal Pain Differentials

Answer 4

Intussusception - up to 2 years, bloody stool, colicky pain 
Gastroenteritis - assoacited diarrhoea 
Appendicitis - nausea, RIL pain 
Strangulated inguinal hernia - mass felt
DKA - with associated vomiting

Question 5

Paediatric Neonatal Jaundice Differentials

Answer 5

Preterm labour - RBCs not matured so haemolysis
Breast milk jaundice
Haemolysis - G6PD deficiency, spherocytosis
Septicaemia - infection causing RBC breakdown

Question 6

Paediatric Seizures Differentials

Answer 6

Febrile Convulsions - up to 6 years, high temp and viral infection, <5 mins
Reflex anoxic seizures - triggered by pain anxiety, < 1min
Breath holding - during crying episode, pallor and collapse
Epilepsy - birth trauma risk factor, post ictal state
Meningitis - rash, unwell prior

Question 7

Paediatric Rash in Children Differentials

Answer 7

Viral induced rash - blanching, not sore or itchy, preceding illness
HSP - on Lower limbs, abdo pain, preceding viral illness
Meningococcal - purpuric, lethargic, irritable, headache, neck
Measles - widespread, fever, cough and flu prior
Chicken pox - itchy rash, starts on face and spreads
Rubella
Scarlet fever - sandpaper like rash, strawberry tongue, flushed cheeks

Question 8

Paediatric Cough Differentials

Answer 8

Bronchiolitis - less than 1 year, fever
Asthma - chronic, worse in winter, dry cough, wheeze
LRTI - productive cough, viral illness, cystic fibrosis
Viral illness - coryzal symptoms, no red flags
Croup - barking cough, first 2 years of life
Pertussis - whooping cough, dry, intense bouts

Question 9

Paediatric Fever Differentials

Answer 9

URTI - coryzal symptoms
Otitis Media - pulling on ear
Tonsillitis - sore throat, tonsils enlarged
Meningitis - irritable, drowsy, photophobia, rash
UTI - dysuria, strong smelly urine, irritability, poor feeding
Bronchiolitis - 1st year of life, cough, wheeze, coryzal symptoms
Croup - barking cough, first few years
Kawasakis disease - fever >5 days, strawberry tongue, conjunctival infection, cervical lymphadenopathy

Question 10

Peadiatric Difficult Behaviour Differentials

Answer 10

ADHD - inattention, hyperactivity, impulsiveness. Present for >6 months in 2 different environments
Autism - difficulty interactive and sharing, communication difficulties, likes routines
Conduct disorders - violent child, problems at school, disobedience, problems at home may precipitate

Question 11

Gynaecology Menorrhagia Differentials

Answer 11

Fibroids - heavy periods, no change in pain
Endometrial Polyp - heavy periods, no change in pain
Endometriosis - periods are more painful
Endometrial ca - might also have intermenstural bleeding
Cervical ca - might have post coital bleeding
PCOS - weight gain, hirtuism, irregular periods
Hypothyroidism - cold intolerance, constipation, weight gain
Bleeding Disorders - Von villabrands, haemophilia

Question 12

Gynaecology Postcoital Bleeding Differentials

Answer 12

Cervical ca - multiple partners, lack of HPV vaccine, may have intermenstural bleeding also
Cervical ectropian - benign, may be on COCP
Cervical polyp - may have intermenstural bleeding also
STI - if painful sex, chlamydia?

Question 13

Gynaecology Post Menopausal Bleeding Differentials

Answer 13

Endometrial ca - obesity, unopposed oestrogen
Endometrial hyperplasia - unopened oestrogen, pre cancerous
Endometrial polyp
Atrophic vaginitis - dry, itchy vagina, dyspareunia, recurrent UTIs

Question 14

Gynaecology Intermenstural Bleeding Differentials

Answer 14

Pregnancy - spotting, could they be pregnant, ectopic?
STIs - have they been tested
Ca - endometrial or cervical may present with intermenstural bleeding
Contraception - have they started new one?
Menopause - symptom of early menopause
PCOS - other symptoms
Fibroids - heavy periods

Question 15

Gynaecology Amenorrhea Differentials

Answer 15

Pregnancy - check when LMP was
PCOS - irregular periods, weight gain, hirtuism
Hyperthyroidism - heat intolerance, weight loss, diarrhoea
Hypothyroidism - cold intolerance, weight gain, constipation
Hypogonadotrophic Hypogonadism - e.g, in exercise or starvation this can cause periods to stop
Menopause - suspect if over 40 years of age and other symptoms
Pituitary tumour - excess prolactin can interfere with menstruation, check for headaches, and visual disturbances

Question 16

Gynaecology Pelvic Pain Differentials

Answer 16

Endometriosis - cyclical pain around periods 
PID - history of STIs or unsafe sex 
Cyclical period pain - painful periods 
Ectopic pregnancy - if acute setting 
UTI - urinary symptoms

Question 17

Gynaecology Vaginal Discharge Differentials

Answer 17

Normal - clear/cream, can increase during arosal or COCP
Trichomonas - green/yellow discharge
Gonorrhoea - yellow/green discharge
Thrush - thick white, itchy, tender vulva, painful urination
Bacterial vaginosis - grey/white, malodour
PID - associated pelvic pain, dyspareunia, vaginal bleeding
Cervical ca - if blood in discharge
Foreign body - is tampon stick there and cause toxic shock syndrome

Question 18

Gynaecology Subfertility Differentials

Answer 18

General causes - lack of sex, prem ejaculation
Lifestyle - obesity, smoking, alcohol, drugs
PCOS - irregular periods, weight gain, hirtusim
Amenorrhoea causes - thyroid, premature menopause, hypergondotrophic hypogonadsim, hyperprolactinaemia
STIs - ask about history of these
Women pathology - endometriosis, fibroids
Male factors - mumps, STIs, Hx of testicular ca

Question 19

Gynaecology Urinary Incontinence Differentials

Answer 19

Prolapse - dragging feeling, feel a lump, previous surgery
Stress incontinence - previous pregnancy, cough and sneeze
Urge incontinence - can’t get to toilet in time
UTI - rule out pain, blood, frequency
Constipation - ask about bowels

Question 20

Obstetrics Bleeding early Pregnancy Differentials

Answer 20

Ectopic pregnancy - associated abdominal pain, shoulder tip pain, rectal pain
Miscarriage - can have pain, passing clots?
STIs - check sexual history
Cervical ca - post coital bleeding, ask smear history

Question 21

Obstetrics Antepartum Haemorrhage 3rd trimester Differentials

Answer 21

Placental Abruption - painful bleeding, bleeding may be concealed if light
Placenta Praevia - intermittent painless bleeding, ask about placental location
Cervical ectropian - more common in pregnancy
Cervical polyp - post coital bleeding
Cervical cancer - post coital bleeding, ask about last smears