PC: Weight Loss

Question 1

what questions would you want to ask to further explore the symptom of weight loss

Answer 1

how much
over how long
associated symptoms

Question 2

in the systems review what GI questions

Answer 2

weight: appetite change 
work down the body;
- dysphagia, 
- N&V
-  indigestion/heartburn 
- abdominal pain 
- bowel habit change
- blood/mucus in stool

(consider full systems review if diagnosis is unclear

Question 3

name some key differentials for weight loss

Answer 3

malignancy of any kind 
GI
- colon cancer 
- IBD
- coeliac disease 
Endocrine 
- thyrotoxicosis 
psychological 
- anorexia 
- depression 
- stress
others 
- diet changes/malnutrition 
- substance misuse
- end organ failure 
- type 1 diabetes 
- HIV/AIDS
- chronic infection 
- chronic inflammatory diseases

Question 4

what clues would help you think of any malignancy (give specific cancers with signs)

Answer 4

breast lump 
Haemoptysis (lung)
prostatic symptoms 
change in bowel habits (bowel) 
haematuria (TCC)
jaundice (head of pancreas)
post-menopause bleeding (uterine)

Question 5

what clues would help differentiate colon cancer

Answer 5

elderly
blood/melaena PR
change in bowel habit

Question 6

what clues would help differentiate IBD

Answer 6

abdominal pain

blood/mucus in stool

Question 7

what clues would help differentiate coeliac disease

Answer 7

diarrhoea, steatorrhoea
anaemia symptoms (due to issues with absorption)
abdominal discomfort
ask about foods

Question 8

what clues would help differentiate thyrotoxicosis

Answer 8

diarrhoea 
heat intolerance 
irritability 
tremor 
oligomenorrhoea/amenorrhoea

Question 9

what clues would help differentiate anorexia/bulimia nervosa

Answer 9

BMI less than 17.5
binge eating in bulimia
effort to loose weight (gym, vomitting and laxatives)
menstrul cycle disturbance

Question 10

what clues would help differentiate depression

Answer 10

core: low mood, anhedonia
biological: poor sleep, lack of energy
future: hopelessness, suicidal thoughts

Question 11

what clues would help differentiate type 1 diabetes

Answer 11

polyuria and polydipsia

Question 12

what differential are you thinking if you hear these symptoms;
elderly
blood/melaena PR
change in bowel habit

Answer 12

colon cancer

Question 13

what differential are you thinking if you hear these symptoms;
abdominal pain
blood/mucus in stool

Answer 13

IBD

Question 14

what differential are you thinking if you hear these symptoms;
diarrhoea, steatorrhoea
anaemia symptoms (due to issues with absorption)
abdominal discomfort
ask about foods

Answer 14

coeliac

Question 15

what differential are you thinking if you hear these symptoms;
diarrhoea 
heat intolerance 
irritability 
tremor 
oligomenorrhoea/amenorrhoea

Answer 15

thyrotoxicosis

Question 16

what differential are you thinking if you hear these symptoms;
BMI less than 17.5
binge eating in bulimia
effort to loose weight (gym, vomitting and laxatives)
menstrul cycle disturbance

Answer 16

anorexia/ bulimia nervosa

Question 17

what differential are you thinking if you hear these symptoms;
polyuria and polydipsia

Answer 17

type 1 diabetes

Question 18

what differential are you thinking if you hear these symptoms;

core: low mood, anhedonia
biological: poor sleep, lack of energy
future: hopelessness, suicidal thoughts

Answer 18

depression