History points Flashcards
Haematuria
SOCRATES
Progression
Intermit/continuous
Quantify bleeding Clots or discoloured urine ?catheter Hx FLAWS \+ joints, rashes
Uro Hx: freq/urgency, nocturia, dysuria, prostatic (hestitancy, poor flow, incomplete emptying), discharge
DDX: benign/malignant
site - renal, ureter, bladder, prostate, urethra
!! Urothelial cancer (painless haematuria, RFs = occupational exposure, smoking, FHx, schisto)
Urethral trauma
UTI/urethritis
Calculi (loin to groin)
Others - glomerulonephritis, prostate Ca, RCC, PCKD, TB, schistosomiasis
coagulation disorder, infective endocarditis
Ix: Bedside - urine dip, MSU Bloods - FBC, U&Es, CRP, coag ?G&S Imaging - upper? CT urogram with contrast lower? urinary tract USS - flexi cystoscopy
2WW!!
visible haem w/o UTI
non-visible in >60yo + dysuria/raised WCC
? 3 way catheter
Frequency/dysuria
DDx: UTI/cystitis Urethritis Pyelonephritis BPH
?overactive bladder
prostatitis
pregnancy
diuretics
Incontinence
SOCRATES - pattern of incontinence can you feel when you need to urinate? - any constipation? - fluid intake, drugs - other Uro Sx
Stress ~ incompetent sphincter - small losses with effort
RFs: pregnancy, menopause
Urge ~ detrusor instability (idiopathic, cystitis, stone) OR hyperreflexia
- urge –> uncontrolled bladder emptying
? MIXED
Overflow ~ BPH, stricture/stone - prostate Sx, dribbling
Fistula between bladder and outlet = continuous leak
Ix: full examination, perianal sensation
Bedside - urine dip
Assessing pelvic floor
Urodynamics incl flow rate
Rx: affect on quality of life
Retention
SOCRATES
Constipation?
Uro Sx
DDx: prostate hypertrophy, urethral stricture (Hx of trauma or catheter), bladder neck obs (tumour, calculus), UTI
Constipation, prostatitis, clot retention
Neuro - MS, cord compression
Drugs - anticholinergic
Polyuria
SOCRATES
Quantify is poss + fluid intake
Other Sx
FLAWS, rashes, joints
Uro Sx (storage, infection, prostate)
DDX: Endo - DM, DI CKD Psychogenic Drugs (diuretics, lithium, ETOH)
Abdo pain
SOCRATES FLAWS GI Sx: dysphagia, N&V, heartburn, diarrhoea or constipation, blood or mucus in stool Uro Sx: storage, infection Gynae Sx: PPPP
Don’t forget
- vascular
- renal
- gynae incl PID, endometriosis
- non-abdo i.e. MI, pneumonia, DKA
Change in bowel habit
SOCRATES
Stool - how much, how often, consistency
Colour/content (mucus, blood)
FLAWS
GI Sx as before *blood in stool
+ bloating
? gynae Sx
DDx:
GI - CRC, gastroenteritis, IBD, IBS, coeliac
Endo - hyper/hypo thyroid
Other - drugs, diverticulitis, overflow, lactose intolerance
*ovarian Ca
Rectal bleeding
SOCRATES Bleeding - fresh / altered / melaena - timing Stool - mucus? - how much /how often / consistency
FLAWS
GI Sx as before
DDx: (fresh/distal to melaena/prox) Fissure Haemorrhoid Diverticular disease Polyps/cancer IBD Gastroenteritis Vascular bowel Peptic ulcer/gastritis Varices
Haematemesis
DDx: Peptic ulcer
Varices
Mallory-Weiss tear
Gastritis
Leg pain
SOCRATES
Assoc *signs of DVT/infection/CLI, skin changes, weakness
Exac *up stairs (spinal stenosis)
Relieving *leaning forward (spinal stenosis)
Can you walk through the pain?
beta blockers worsen claudication
DDx:
- vascular (embolic, atherosclerotic)
- infection
- inflammation (vasculitis, ruptured Baker’s cyst, OA)
- neurogenic (sciatica, spinal stenosis, peripheral neuropathy)
Dysphagia
*STOP* Solids or liquids? Timing Onset Progression - RED FLAG *FLAWS* \+ Sx of anaemia
GI Sx: dysphagia, N&V, heartburn/reflux, odynophagia, diarrhoea or constipation, blood or mucus in stool
Where does it feel the food gets stuck?
Cough (+blood)? Breathing problems?
Lump in your throat?
Change in your voice?
PMHx: stroke, MS, cancer, GORD
Rheum Sx i.e. tight skin, cold hands, dry eyes
DHx: NSAIDs/steroids
SHx: Smoking, ETOH
DDx: motility - neurological (stroke, MG, bulbar palsy) - oesophageal spasm - achalasia
mechanical
- intraluminal (foreign body)
- intramural - inflammation = stricture, malignancy, Plummer-Vinson web
- extramural
(goitre, lymph node, bronchial malignancy, thoracic aneurysm, hiatus hernia)
RED FLAGS ?alarm
2WW - dysphagia OR >55 + wt loss + upper abdo pain / reflex / dyspep
Ix: bloods - FBC, U&E, LFTs imaging - CXR, barium swallow upper GI - endoscopy + biopsy *further depends on the DDx i.e. manometry for achalasia CT for staging
Rx: upper GI cancer MDT - oesophagectomy \+ feeding jej !! Dietician input Palliative - referral to palli care, +/- stenting, radiotherapy, chemo
Pancreatic Hx
FLAWS
>40yo + jaundice = 2WW
Urgent CT >60yo wt loss + diarrhoea/steatorrhoea,
pain/painless + N&V + new onset diabetes
Complications - shock
necrosis/infection/abscess
psuedocyst
