Histories

Question 1

18yo male
P/C: diarrhoea 3/52
- initially B/O 6 times/day, now 3 times/day
- bright red blood + mucus in stool
- lower abdomen pain
- incontinence X2
- urgency

recent trip to Ibiza 2/52 ago, Sx started 2/7 before return to UK

• ate same food as friends
• consumed +++ alcohol
• no nausea or vomiting
• no fever
• no dec. appetite
• no weight change

PMH: 6/12 lower back pain, possible sports injury, worse in mornings, often resolving throughout day

Drug Hx: NKDA
Ibuprofen when back pain ++

Social Hx: non-smoker
drinks socially, but +++ in Ibiza
no illicit drugs

Family Hx: grandfather died of colon cancer (aged 82yrs)

What are your differentials, diagnosis, investigations and management?

Answer 1

Ddx: Crohn’s disease, infectious colitis

Dx: Ulcerative colitis

Investigations/Management:
Routine bloods: FBC, U+E, LFTs, CRP, cultures
Stool microscopy + culture
Urine microscopy, sensitivities and cultures w/ dipstick
Gastroenterology referral (outpatient), colonoscopy + biopsy for histological diagnosis

Question 2

35yo female
P/C: intense pain in whole left side of head
-no radiation to neck/neck stiffness
-described as throbbing and intense ache
-no recent alcohol intake
-no recent head trauma
-onset: 5hrs ago
-exacerbated by bright lights
-general weakness and fatigue
-vomited X2
-taken 1g of paracetamol but no improvement

PMH: 5 similar episodes previously, last one >10 years ago

Drug Hx: NKDA, no regular medications

Social Hx: non-smoker 
social drinker 
no recent travel 
stress at work
recent split with partner 

Family Hx: sister diagnosed by GP with migraines

What are your differentials, diagnosis and management for this patient?

Answer 2

DDx: tension headache, cluster headache

Dx: migraines

Mx: full clinical exam, routine obs and bloods
medication may include antiemetics, analgesics, possibly triptans
advise to avoid codeine phosphate or any triggers appearing to cause migraines