Histories differentials Flashcards
Weight loss
ENDO: T1DM, diabetes insipidus, hyperthyrod, addison’s
GI: Chron’s, UC, coeliac, malnutrition
Infectious: TB, IV
CANCER (anywhere)
DEPRESION
weight gain
Pregnancy
Endo: Hypothyroid, Cushing’s, PCOS
Steroid tx
what questions can you ask for Cushing’s
stretch marks
easy bruising
weakness in hips or shoulders
difficulty getting up from chair
what questions for PCOS
hirsutism (unusual hair growth on body)
oligo/amenorrhoea
acne
oily hair
what questions for hypothyroidism
always cold? tired constipated menorrhagic appetite loss, weight gain
neck swelling / neck lump?
differentials for chest pain
CARDIAC – RESP – GASTRO – MSK
Cardiac: ACD, stable angina, aortic diss, pericarditis
Resp: PE, pneumonia, pneumothorax
GI: peptic ulcer, pancreatitis
MSK: costochondritis
presentation of ACD
central crushing pain
radiates to arm jaw neck epig
sweating pallor nausea
lasts >20 mins
presentation of aortic diss
tearing pain (retrosternal/intrascap) collapse, dizziness, weakness, parasthesia
presentation of pericarditis
central pleuritic pain
RELIEVED SITTING FORWARD
which types of chest pain are relieved by sitting forqard
pancreatitis
pericarditis
causes of pleuritic pain
pericarditis
PE
pneumothorax
assoc sx to ask about with cardiac pain
nausea vomitng sweating
dizziness collapse
fever? pericarditis
assoc sx to ask if resp related chest pain
SOB cough haemoptysis
leg swelling / leg pain (PE)
assoc sx for GORD related pain
associated with eating worse lying down post prandial regurgitation / heartburn anaemia sx (peptic ulcer)
diiffs for palpitations
Cardiac (AF, SVT)
Endo (hypethyroidism, phaeo, hypoglyucaemia)
Drugs, alcohol, caffeine, anxiety
causess of acute SOB
Cardiac: MI, angina, pulm oedema, aortic diss, arrythmia, acute pericarditis
Resp: PE, pneumothorax, COPD IE, Asthma, ANAPHLAXIS
Endo: DKA
causes of chronic SOB
Cardiac: HF
Resp: COPD, bronchiectasis, interstitial lung disease, malignancy
Anaemia
Respiratory sx to ask about
SOB (+ orthopnoea + PND) Cough Sputum Blood Chest pain, pleuresis
red flag respiratory sx
FLAWS
haemoptysis
hoarseness
dysphagia
RF to ask about in resp hx
smoking asbestos exposure / occupation animals dusts hx of atopy if suspecting asthha
diffs haemoptysis
RESP:
- PE
- pneumonia
- TB
- lung cancer
Rheum:
- Wegener
- SLE
headache differentials
RED FLAGS: Vascular: SAH, Subdural, extradural Infection: meningitis, encephalitis Vision threatening: Temporal arteritis, acute glaucoma SOL (raised ICP)
Benign: migraine, cluster, tension, medication overuse
Trigeminal neuralgia
how does SAH present
sudden onset back of head
worse headache ever
meningism
sx of meningism
neck stiffnness
photophobia
N/V
sx SDH
gradual onset confusion and headache
alcoholic or elderly
sx extradural haemorrhage
head trauma.: LOC > resume consciousness > rapid deterioration
sx meningitis
gradual onset headache, neck stiffness, photophobia malaise, fever, RASH N/V irrtability seizures, focal neuro deficit, confusion
TRAVEL HX
OTHER UNWELL PEOPLPE
triigem neuralgia sx
facial pain
triggers (wind, vinration, brushing hair)
GCA sx
gradual headache vision blurring drop in visual acuity scalp tendenes jaw pain
differentials for neck lump
Midline:
- thyroid (graves, Hashimoto, toxic multinod etc – benign: thyroglossal cyst, thyroid nodule)
- non thyroid: lipoma, dermoid cyst, ABSCESS
MUMPS
LYMPHOMA
how do you categorise causes of dysphagia
neuro
GI
neuro cause of dysphagia
stroke PD myasthenia MS MND
GI causes of dysphagia
achalasa
CREST
oesophageal cancer
peptic stricture from GORD
what can you ask to characterise the dysphagia
WORSE WITH SOLID OR LIQUID?
- worse with solid = mechanical obstruction e.g. stricture
- worse with liquid = motlity disorder (achalasia or neuromusc)
differentials for constipaton
GI: IBD, colorectal CA, adhesions Pt not pushing: haemorrhoid,anal fissure Drugs: opiates, iron tablets, CCB Metabolic: Hypothyroid, hypercalcaema Neuro: DM, spinal colrd compression, MS
DIarrhoea differentials
GI: coeliac, IBD, lactose intolerance, ingection
Hyperthyroidism
questions to ask about stool
Characterise stool: colour, consistency, quantity Bloody, mucoid Foul smelling, floating Pale, greasy Nocturnal diarrhoea Urgency Incontinence, Tenesmus
Constant or variaable’
Assoc: FLAWS, FLATUS
Top to bottom: N/V, dysphagia, abdo pain,
Infecrtive urinary s x
FUND (storage)
Freq
urgency
Noct
Dysuria
voiding urinary sx
Hesitancy (difficulty in starting to urinate)
Intermittent stream (start - stop)
Poor stream (weak)
Terminal dribbling
other sx for urinary hx
pain in abdo
lumps in abdo
blood in urine, urine colour (clear or cloudy)
discharge from pens, rashes, spots on genital
differentials for fatigue
Anxiety / obstructve sleep appnoea / environmental /depression or prychosocial – HOW HAVE YOU BEEN SLEEPING? WHAT DOES YOUR PARTNER SAY?
Endo: hypothyroid, DM, addisons
Haem: anaemia
Malignancy screen
