History Pack 1 Flashcards
A 25 year old female presents to GP with constipation. What are your differentials for constipation?
GI abnotmalities:
- Abdo hernia
- appendicitis
- Colon cancer
- colon obstruction
- diverticulitis
- toxic megacolon
- adbo sepsis / peritonitis
- intestinal motility disorder
Infective:
-Chagas disease
IBD:
Crohn’s
UC
IBS
Drugs:
-codeine (opiates)
Social / lifestyle :
-decreased fibre in diet
psycological:
- anxiety
- depression
Endocrine:
- hypothyroid
- hyperparathyroid
- diabetes mellitus (constipation due to diabetic neuropathy)
Autoimmune:
- Lupus
- scleroderma
A 50 yr old bus driver presents with chest pain - what are your differentials?
Cardiovascular:
- Ischaemic heart disease (angina / MI)
- infective endocarditis
- pericarditis
- aortic stenosis
- aortic dissection
- aortic aneurysm
Respiratory:
- Pleuritic chest pain
- costochondritis
- pneumothorax
- PE
- pneumonia
- lung cancer
Breast disease
- hormonal breast pain
Gi:
- GORD
- oesophageal spasm
- peptic ulcer
- cholecystitis
- pancreatitis
Skin:
-herpes zoster
Psycho:
- anxiety
- depression
A 50 yr old bus driver presents with pain in chest (dull, heaviness in centre of chest) on exertion. Normally the pain goes away after a couple of minutes. However whilst playing football the pain was worse, he felt anxious, cold, sweaty and SOB.
what is your differential?
Ischaemic heart disease
A 26 year old presents at GP after a collapse on 3 occasions.
what are your differentials for collapse?
Cardiovascular:
- arrhythmia
- postural hypotension ( GI bleed, venous bleeding, varicose veins)
- aortic stenosis
- ruptured AAA
Neuro:
- epilepsy
- vasovagal
- stroke / TIA
- intracranial haemorrhage
Drug overdose / toxicity
Alcohol
Mechanical fall (trip)
hypoglycaemia
leg weakness
virtigo (feels room is spinning)
What questions should you ask when suspecting epilepsy or seizure as cause of collapse?
- tongue biting
- deja vu before attack (aura)
- headache
- feel tired / fatigued / aching after attack
- become vacant?
- duration (lasts 1-2 mins)
What questions would you ask when suspecting stroke or TIA as a cause of collapse?
- sudden onset
- slurred speech
- limb / facial weakness (one sided)
- loss of vission of half of field in one eye (homonymous hemianopia)
- sensory loss
-risk factorse e.g. hypertension, smoking, DM, AF, vascular disease
What questions should you ask for an alcohol history?
- alcohol in units per week (now and previously)
- what do they drink? (narrowing of repertoire)
(tolerance / hangover?) - Compulsion to drink (unable to control / hard to stop)
- CAGE (Cut down, Annoyed anyone, Guilty, Eyeopener)
- tried to cut down and why? why have you started again?
- Withdrawal symptoms? relief of symptoms by drinking?
- missed work or commitments because of alcohol
A 43 yr old lady presents to GP feeling faint, dizzy and has weight loss.
- what are your differential diagnosis?
1) Addisons disease
2) postural hypotension
3) Hyperthyroid (weight loss)
A pt presents with dizziness, feeling faint, lethargy, low mood, nausea, vomiting , increased skin pigmentation and irregular periods - what is your differential diagnosis?
- Addison’s disease
How would a patient with rheumatoid arthritis present to GP?
- Joint pain and swelling of small joints of hands and feet.
- symmetrical distribution
- pain / stiffness worse in morning or after activity lasts around 1 hour +
(osteoarthritis pain/stiffness gone after 30mins)
-rheumatoid nodules
- tired/no energy
- weight loss
- dry eyes
- chest pain
-low mood due to lack of independance
how does Multiple sclerosis present?
- disturbed balance
- fatigue
- loss of sensation .
- numbness / tingling
- muscle weakness
- decreased co-ordination
- vision - blurred, hazy , double
- eye pan
a pt presents with regular headaches for months. Feeling agitated and irritable.
Poor sleep
Lacking concentration.
feeling hot and sweaty
What is your provisional diagnosis?
What other symptoms are associated with this?
Hyperthyroid
Other associated symptoms:
- increased appetite
- weight loss
- change in bowels - loose stool
- light periods
- dizziness
- palpitations, tachycardia, arrhythmia.
A 70 yr old presents with an ulcer on his right leg, above ankle on lateral side.
it is small (size of 10p coin) and 4mm deep. It is painfull all the time (6 out of 10 ) but 8 when lying down or leg up.
What is your provisional diagnosis? what is the cause and what further questions would you ask?
Arterial ulcer (as it is it a punched out ulcer, painful)
Caused by peripheral arterial disease.
Ask about:
- cold peripheries
- hairloss
- numb toes?
- swelling in affected leg
- bleeding / smell/ oozing (indicates diabetic ulcer)
- intermittent claudication
What are the typical signs and symptoms of a venous ucler ? -location - size - condition of skin - pain? -
Location:
- below knee often on inner part of ankle
Pain:
-usually painless unless infected
condition of skin:
- surrounded by mottled brown staining, itchy, reddened.
- thickened skin
- scaling
- Swelling
- OOZING, fissuring
- associated with varicose veins
Size - can be large
what are the usual signs and symptoms of arterial ulcers?
Location:
- feet, heels, toes
Pain - at night, legs elevated
Ulcer looks punched out
Cold, white/bluish, shiny feet
hairloss on leg
intermittent claudication
