Mixed history pack 9 Flashcards
A 46 yr old lady presents with a hoarse voice - what differentials are you thinking of?
1) Laryngitis
- acute —> viral URTI , vocal strain.
- Chronic —-> alcohol, smoking, vocal chord strain.
- GORD
2) Recurrent laryngeal nerve
- tumour pressing (lung)
- goitre
- injury from surgery
3) Hypothyroid
A 46 yr old lady presents with hoarse voice, weight gain, constipation, and heavy periods —> what is your differential diagnosis?
Hypothyroid
What symptoms should you ask about when suspecting hypothyroid?
1) feeling cold
2) constipation
3) heavy periods
4) weightloss
5) hoarse voice
6) poor appetite
7) tired / lethargy
8) low mood
9) other autoimmune conditons
A 24 year old female presents with discomfort passing urine - what are your differential diagnoses?
1) UTI
- cystitis
- acute pyelonephritis (fever)
2) STI
- chlamydia, herpes simplex
3) Vaginitis
- candida albicans
4) Renal calculi
What questions should you ask a patient presenting with dysuria?
1) frequency
2) urgency
3) quantity of urine
4) appearance of urine
5) smell
6) abdo pain
7) blood clots / red blood in urine
8) fever / nausea
9) fluid intake
10) ever had this before
A 45 year old man presents at the GP with pain in his foot - what are your differential diagnosis?
1) Trauma (fracture, sprain)
2) Arthritis
3) Gout
4) peripheral neuropathy
5) ingrown toenail
A 45 year old man presents to the GP with a swollen, red , hot toe - what are your differentials?
1) SEPTIC Arthritis
2) Gout
3) trauma
A 45 year old man presents to the GP with pain in his toe, you suspect gout - what questions should you ask him?
1) SOCRATES
2) has he been systemically unwell recently (rule out septic arthritis)
3) can you weight bear
4) alcohol / red meat?
A 34 year old presents at the GP with lethargy and weakness - what are your differentials?
1) Invective (EBV)
2) sleep deprived
3) anaemia
4) Neuro –> Multiple Sclerosis
5) metabolic –> hypothyroid, diabetes, alcohol/cirrhosis
6) Metastatic disease
7) inherited –> haemochromatosis, muscular dystrophy,
9) Inflammatory –> mypoathies
A 34 year old presents with lethargy and weakness along with increased clumsiness, restless jerky legs, fatigue worsening throughout day, headaches, difficulty expressing self, blurred vision, loss of control of foot.
Multiple Sclerosis
What questions should you ask in a patient whom you suspect multiple sclerosis?
1) weakness - unilateral or bilateral.
2) headache
3) tremor
4) dyspraxia
5) sleep disturbance
6) continence?
7) blackouts
8) dizziness
9) altered taste, vision, hearing
10) poor concentration
A 52 year old woman presents with cough, chest pain and SOB - what are your differential diagnoses?
1) Chest infection (LRTI -pneumonia, TB)
2) Heart failure
3) Lung cancer
4) Asthma / COPD / bronchiectasis
5) Pulmonary Embolism
6) Sickle cell crisis
What questions should you ask someone presenting with cough, chest pain and SOB/
1) SOCRATES for chest pain (MI?, Pleuritic? GORD?)
2) Cough - productive - BLOOD?
3) SOB - how many pillows? on excertion?, any trigger?
4) Oedema (CCF)
5) Fever?
A 43yr presents to GP with a Painful right elbow - what are your differentials?
1) Tennis elbow (lateral epicondylitis)
2) Golfer’s elbow (medial epicondylitis)
3) bursitis
4) Arthritis
5) Trauma –> dislocation? fracture?
6) Skin —> cellulitis?
7) trapped nerve
a 65yr old man presents with a painful wound on his leg, that is taking a while to heal - what are your differential diganoses?
- Arterial Ulcer (punched, out well defined, deep, small, severe pain, no exudate, covered with slough and necrotic tissue)
- Venous Ulcer (sloping, gradual, shallow, large, minimally painful, Oozing (exudate), covered with slough.
Other DDx of poor wound healing:
- Cushing’s syndrome
- Pressure ulcer
- malnutrition
