Histories

Question 1

What is the basic differential diagnosis for diarrhoea?

Answer 1

Infectious

IBD

Malignancy

Coeliac

Drugs (c.dif?)

Ischaemic

Thyrotoxicosis

Question 2

What might cause bloody diarrhoea?

Answer 2

Shigella, Salmonella, Campylobacter

IBD

Colorectal Carcinoma

Question 3

What are the common causes of weight loss?

Answer 3

With appetite maintained - DM, Hyperthyroidism, Malabsorption, Phaeochromocytoma

Without appetite - Malignancy, Cardio/Resp Failure, Gut Failure, Depression, HIV

Question 4

What are the causes of acute pancreatitis?

Answer 4

I – Idiopathic (most common)
G – Gallstones
E – Ethanol
T – Trauma
S – Steroids
M – Mumps
A – Autoimmune (eg. PAN)
S – Scorpion Venom – black Trinidadian scorpion (tityus trinitatis)
H – Hyperlipidaemia, Hypercalcaemia
E – ERCP
D – Drugs (azathioprine, thiazides, valproate, asparaginase, allopurinol)
And Pregnancy

Question 5

What is the scoring system for pancreatitis?

Answer 5

Glasgow score for severity
Includes Oxygen, age, neutrophils, calcium, renal function, LDH/AST, albumin and BMs

Question 6

What are the complications of acute pancreatitis?

Answer 6

Early:
Shock
Acute kidney injury
Acute respiratory distress syndrome
DIC
Sepsis
Hypocalcaemia
Hyperglycaemia
Pancreatic necrosis
Late:
Pancreatic necrosis
Pancreatic pseudocyst
Pancreatic fluid in lesser sac
Fluid in lesser sca
Presents > 6 weeks later
Abdominal mass may be present
May need internal (via stomach) or external drainage
Abscess
Thrombosis – splenic/gastroduodenal arteries
Fistulae

Question 7

How are migraines managed?

Answer 7

Acute episode
* 1st: Paracetamol + metoclopramide / domperidone * 2nd: NSAID (e.g. ketoprofen) + M/D
* 3rd: Rizatriptan

Prophylaxis
* Avoid triggers
* 1st: Propanolol, topiramate
* 2nd: Valproate, pizotifen (↑ wt.), gabapentin

Question 8

What can trigger migraines

Answer 8

2) What are some of the triggers?
* CHOCOLATE
* CHeese
* OCP
* Caffeine
* alcohOL
* Anxiety
* Travel
* Exercise

Question 9

What are the main compications of migraines to be aware of?

Answer 9

3) Complications?
* Status migrainous
* Migrainous infarction
* Seizures
* Depression

Question 10

What are the features of raised ICP?

Answer 10

Signs and Symptoms
a. * Headache
b. * n/v
c. * Seizures
d. * Drowsiness → coma
e. * Cushing’s reflex: ↑BP, ↓HR, irregular breathing
f. * 6th CN palsy (may be false localising)
g. * Cheyne-Stokes respiration
h. * Pupils: constriction → dilatation
i. * Papilloedema, loss of venous pulsation @ disc

Question 11

What can cause raised ICP?

Answer 11

• • Haemorrhage
• • Tumours
• • Infection: meningitis, encephalitis, abscess
• • Hydrocephalus
• • Status
• • Cerebral oedema

Question 12

Systems Review - Cardio

Answer 12

Chest pain
SoB
Palpitations
Syncope
Leg swelling, orthopnoea, PND
N&V, sweaty, clammy
Claudications

Question 13

Systems Review - Resp

Answer 13

SoB
Cough/sputum/haemoptysis
Chest pain

Question 14

Systems Review - GI

Answer 14

Waterbrash
Dysphagia
Heartburn
Indigestion
N&V/haematemesis
Abdo pain
CIBH - constipation/diarrhoea or blood, mucus, colour, smell, not flushing, frequency
Pain on defecation

Question 15

Systems review - Neuro

Answer 15

Headaches
Visual disturbance
Dizziness
Fainting/LoC
Altered sensation
Fits
Weakness
Recent trauma
Raised ICP: N&V, confusion, rash, photophobia

Question 16

Systems Review - Endo

Answer 16

Changes in appearance
Weight loss
Mood changes
Period changes
Sleep disturbance
Heat/cold intolerance
Sweating
Bowel habits
Palpitations
Difficulty swallowing
Changes in voice

Question 17

Systems Review - Rheum

Answer 17

Joint pain, stiffness, swelling
Skin rashes, ulcers, Raynauds
Nail changes
Hair loss
Eye redness, dryness
Dry mouth
IBD Sx
GU Sx

Question 18

Systems review - Musc

Answer 18

Pain
Instability
Stiffness/locking
Swelling/deformity
NV status
Functional status

Question 19

Systems Review - Urology

Answer 19

Storage: frequency, urgency, nocturia, volume
Infective: dysuria, haematuria
Prostate/voiding: hesitancy, poor flow, dribbling, feeling incomplete, terminal dribbling

Question 20

Differentials - Headache

Answer 20

Cluster
Migraine
Tension
Raised ICP
SOL
Post-Epidural
Venous Sinus Thrombosis
GCA
Meningitis
Sinusitis

Question 21

Differentials - Chest Pain

Answer 21

Cardiac - ACS, HF, Pericarditis, Myocarditis, Tamponade, angina,
Resp - PE, Asthma, COPD, PO, Pneumonia, Pneumothorax,
GI - Dyspepsia, Dysphagia, PUD, GI Bleed
Anxiety, Pancreatitis, Cholecystitis
Costochondritis,

Question 22

Differentials - SOB

Answer 22

PE
ACS
Asthma, COPD
Fibrosis
Pretty much all pulmonary stuff

HF, Tamponade, Silent MI, SVC syndrome

Anaemia, Anaphylaxis, Anxiety

Question 23

Differentials - Cough

Answer 23

Acute - Pneumonia, Asthma/COPD, PE, Pneumothorax

Subacute - Post-infectious cough

Chronic - Smoking, Post-nasal drip, GORD, Asthma, Eosinophilic bronchitis

Other - Cancer, Bronchitis, Bronchiectasis, HF, FB Aspiration, TB,

Question 24

Differentials - Constipation

Answer 24

Colorectal Cancer
Diverticular Disease
Poor diet
Opioid Use
IBS
Bowel Obstruction
issue with peristalsis (lots of neuro stuff)

Question 25

Which questions should you ask about discharge/bleeding etc

Answer 25

Colour Amount Smell Mixed with anything? When? Investigated before?

Question 26

Which qs should you ask in drug history?

Answer 26

Current meds Recently stopped Meds Recently started Meds? Herbal meds/OTC meds? Vaccines? Relevant meds to symptom, ie. Ulcer - NSAID

Question 27

Which qs should you ask in a social history?

Answer 27

Work, old jobs Smoking, alcohol, drugs Live with? Anyone they know with similar symptoms? Sexual history Diet Travel Impact on life

Question 28

PMHx questions?

Answer 28

Regular issues Past admissions to hospital Past surgeries Allergies When were diagnoses made. Specific history of differentials

Question 29

Rheum history?

Answer 29

SOCRATES Which joints Symmetrical? Effect on function? extra-articular features?

Question 30

Specific weight loss qs?

Answer 30

Over how long, how much weight, clothes looser? Change in appetite/diet? Change in exercise? Intentional? Red flags

Question 31

Weight loss differentials?

Answer 31

Cancer Hyperthyroidism Diabetes Addison's GI Inflammation/Ulceration Phaeochromocytoma HIV TB Hepatitis HF Neurological GCA Rheumatological Psych

Question 32

Diarrhoea differentials?

Answer 32

Infectious Meds IBD/IBS Overflow Cancer Endocrine (Thyroid, addisons) Diabetes Surgical history? Bacterial overgrowth of small intestine

Question 33

Jaundice differentials?

Answer 33

Pre Hepatic - G6PD, MAHA, SCD, Spherocytosis, Elliptocytosis, Gilbert's, Criggler-Najjar Hepatic - HCC, Infectious Hep, Autoimmune Hep, Cirrhosis, Alcohol, NAFLD, Hereditary Haemochromatosis, A1AT def. Post-Hepatic - Obstruction, Pancreatic cancer, Gallstones, Cholangiocarcinoma, Abdominal lymphoma Drug-Induced (can be mix of the above)

Question 34

Things not to forget when taking a history from a young woman

Answer 34

Pregnant? Any chance? Contraception? Obstetric history Sexual History Gynae History

Question 35

Assessing fever in a returning traveller?

Answer 35

When? Other sx? Chills, shakes, night sweats, weight loss, fatigue, anorexia Travel? Purpose, where, accommodation, food/drink, sanitation, medical precautions, bites/exposure to potential infection sources (dead animals, wild animals, etc) Exposure to ill people

Question 36

Fever in a returning traveller differentials?

Answer 36

Malaria TB Dengue Typhoid Yellow Fever Ebola STD Pneumonia Leptospirosis Amoebiasis Schistosomiasis

Question 37

How would you investigate fuo?

Answer 37

CXR malaria blood films x3 Blood cultures x3 Sputum MC&S Serology Viral throat swab Urine MC&S HEP/HIV/Syphyllis screen Biopsy of any lesions

Question 38

Which conditions might come up in the DM/Endo station?

Answer 38

T1DM T2DM MODY Thyroid - Graves', Hashimoto's, Subacute, Toxic multinodular thyroid Adrenals - Addison's, Cushing's, Conn's, Acromegaly Paget's Disease of the bone

Question 39

List some causes of erythema nodosum

Answer 39

IBD Sarcoidosis Behcet's