Histories Flashcards
What is the basic differential diagnosis for diarrhoea?
Infectious
IBD
Malignancy
Coeliac
Drugs (c.dif?)
Ischaemic
Thyrotoxicosis
What might cause bloody diarrhoea?
Shigella, Salmonella, Campylobacter
IBD
Colorectal Carcinoma
What are the common causes of weight loss?
With appetite maintained - DM, Hyperthyroidism, Malabsorption, Phaeochromocytoma
Without appetite - Malignancy, Cardio/Resp Failure, Gut Failure, Depression, HIV
What are the causes of acute pancreatitis?
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
What is the scoring system for pancreatitis?
Glasgow score for severity
Includes Oxygen, age, neutrophils, calcium, renal function, LDH/AST, albumin and BMs
What are the complications of acute pancreatitis?
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
How are migraines managed?
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
What can trigger migraines
2) What are some of the triggers?
* CHOCOLATE
* CHeese
* OCP
* Caffeine
* alcohOL
* Anxiety
* Travel
* Exercise
What are the main compications of migraines to be aware of?
3) Complications?
* Status migrainous
* Migrainous infarction
* Seizures
* Depression
What are the features of raised ICP?
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
What can cause raised ICP?
- Haemorrhage
- Tumours
- Infection: meningitis, encephalitis, abscess
- Hydrocephalus
- Status
- Cerebral oedema
Systems Review - Cardio
Chest pain
SoB
Palpitations
Syncope
Leg swelling, orthopnoea, PND
N&V, sweaty, clammy
Claudications
Systems Review - Resp
SoB
Cough/sputum/haemoptysis
Chest pain
Systems Review - GI
Waterbrash
Dysphagia
Heartburn
Indigestion
N&V/haematemesis
Abdo pain
CIBH - constipation/diarrhoea or blood, mucus, colour, smell, not flushing, frequency
Pain on defecation
Systems review - Neuro
Headaches
Visual disturbance
Dizziness
Fainting/LoC
Altered sensation
Fits
Weakness
Recent trauma
Raised ICP: N&V, confusion, rash, photophobia
Systems Review - Endo
Changes in appearance
Weight loss
Mood changes
Period changes
Sleep disturbance
Heat/cold intolerance
Sweating
Bowel habits
Palpitations
Difficulty swallowing
Changes in voice
Systems Review - Rheum
Joint pain, stiffness, swelling
Skin rashes, ulcers, Raynauds
Nail changes
Hair loss
Eye redness, dryness
Dry mouth
IBD Sx
GU Sx
Systems review - Musc
Pain
Instability
Stiffness/locking
Swelling/deformity
NV status
Functional status
Systems Review - Urology
Storage: frequency, urgency, nocturia, volume
Infective: dysuria, haematuria
Prostate/voiding: hesitancy, poor flow, dribbling, feeling incomplete, terminal dribbling
Differentials - Headache
Cluster
Migraine
Tension
Raised ICP
SOL
Post-Epidural
Venous Sinus Thrombosis
GCA
Meningitis
Sinusitis
Differentials - Chest Pain
Cardiac - ACS, HF, Pericarditis, Myocarditis, Tamponade, angina,
Resp - PE, Asthma, COPD, PO, Pneumonia, Pneumothorax,
GI - Dyspepsia, Dysphagia, PUD, GI Bleed
Anxiety, Pancreatitis, Cholecystitis
Costochondritis,
Differentials - SOB
PE
ACS
Asthma, COPD
Fibrosis
Pretty much all pulmonary stuff
HF, Tamponade, Silent MI, SVC syndrome
Anaemia, Anaphylaxis, Anxiety
Differentials - Cough
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,
Differentials - Constipation
Colorectal Cancer
Diverticular Disease
Poor diet
Opioid Use
IBS
Bowel Obstruction
issue with peristalsis (lots of neuro stuff)
Which questions should you ask about discharge/bleeding etc
Colour
Amount
Smell
Mixed with anything?
When?
Investigated before?
Which qs should you ask in drug history?
Current meds
Recently stopped Meds
Recently started Meds?
Herbal meds/OTC meds?
Vaccines?
Relevant meds to symptom, ie. Ulcer - NSAID
Which qs should you ask in a social history?
Work, old jobs
Smoking, alcohol, drugs
Live with? Anyone they know with similar symptoms?
Sexual history
Diet
Travel
Impact on life
PMHx questions?
Regular issues
Past admissions to hospital
Past surgeries
Allergies
When were diagnoses made.
Specific history of differentials
Rheum history?
SOCRATES
Which joints
Symmetrical?
Effect on function?
extra-articular features?
Specific weight loss qs?
Over how long, how much weight, clothes looser?
Change in appetite/diet?
Change in exercise?
Intentional?
Red flags
Weight loss differentials?
Cancer
Hyperthyroidism
Diabetes
Addison’s
GI Inflammation/Ulceration
Phaeochromocytoma
HIV
TB
Hepatitis
HF
Neurological
GCA
Rheumatological
Psych
Diarrhoea differentials?
Infectious
Meds
IBD/IBS
Overflow
Cancer
Endocrine (Thyroid, addisons)
Diabetes
Surgical history?
Bacterial overgrowth of small intestine
Jaundice differentials?
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)
Things not to forget when taking a history from a young woman
Pregnant? Any chance?
Contraception?
Obstetric history
Sexual History
Gynae History
Assessing fever in a returning traveller?
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
Fever in a returning traveller differentials?
Malaria
TB
Dengue
Typhoid
Yellow Fever
Ebola
STD
Pneumonia
Leptospirosis
Amoebiasis
Schistosomiasis
How would you investigate fuo?
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
Which conditions might come up in the DM/Endo station?
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
List some causes of erythema nodosum
IBD
Sarcoidosis
Behcet’s
