Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

CAM202 Clinical > Presenting complaint > Flashcards

Presenting complaint Flashcards

1
Q

Upper abdominal pain ddx

A

Gastrointestinal

  • gastritis
  • peptic ulcer
  • reflux esophagitis
  • pancreatitis
  • cancer (gastric, pancreatic)
  • Booerhaarve’s disease (esophageal rupture)
  • dyspepsia
  • irritable bowel syndrome

Pain from nearby areas

  • abdominal: central, RUQ pain
  • cardiac: e.g. myocardial infarction, pleuritis
  • pulmonary: e.g. pneumonia, pleurisy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Right upper abdominal pain ddx

A

Gall bladder

  • biliary colic
  • cholecystitis
  • cholangitis

Liver

  • hepatitis
  • hepatomegaly (e.g. liver congestion in right heart failure)
  • hemorrhage into hepatic tumour
  • trauma
  • hepatic or subdiaphragmatic abscess
  • Fitz-Hugh-Curtis syndrome (periphepatitis due to PID)

Other gastrointestinal

  • appendicitis with high appendix (e.g. pregnancy)
  • perforated or penetrating duodenal ulcer
  • colon cancer

Pain from nearby areas

  • abdominal: epigastric, central, RIF, loin, groin pain
  • right lower lobe pneumonia, pleurisy or other lung disease
  • subphrenic abscess
  • acute pyelonephritis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Left upper abdominal pain ddx

A
  • pancreatitis
  • subphrenic abscess
  • diverticulitis
  • ruptured spleen
  • acute pyelonephritis
  • leaking aneurysm of the splenic artery
  • acute gastric distention
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Right iliac fossa pain

A

Gastrointestinal

  • appendicitis
  • crohns disease
  • inflamed meckels diverticulum
  • cholecystitis with low gall bladder
  • mesenteric adenitis
  • epiploic appendagitis
  • colon cancer
  • constipation
  • irritable bowel syndrome

Reproductive (female)

  • ectopic pregnancy
  • acute ovarian event (cyst rupture, hemorrhage, torsion)
  • Mittelschmerz (ovulation pain mid-cycle)
  • Pelvic inflammatory disease
  • Endometriosis

Reproductive (male)

  • seminal vesiculitis
  • undescended testicle pathology

Urinary

  • renal colic
  • UTI

Pain from nearby areas

  • abdominal: RUQ, central, groin pain
  • hip pathology
  • psoas abscess
  • rectus sheath hematoma
  • right lower lobe pneumonia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Suprapubic abdominal pain ddx

A
  • urinary retention
  • cystitis
  • uterine in origin (e.g. PID, fibroid, menstruation)
  • origin from RIF and/ or LIF causes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Flank abdominal pain ddx

A

Renal tract

  • infection e.g. pyelonephritis
  • obstruction, e.g. renal colic
  • renal carcinoma
  • renal vein thrombosis
  • polycystic kidney disease
  • adrenal hemorrhage

Other

  • retroperitoneal hemorrhage
  • retroperitoneal infection
  • vertebral pathology
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Referred abdominal pain ddx

A
  • Herpes zoster
  • Pneumonia
  • Thoracic spine disease
  • AMI
  • Pericarditis
  • Testicular torsion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Abdominal pain hx

A
  • Age
  • Pain HX (SOCRATES)
  • Associated (GIT history symptoms): focus on nausea, vomiting, bowel motion changes
  • Constitutional symptoms
  • PMHx (surgery especially)
  • Medications
  • FHx (colon Ca, diabetes, HTN, IBD)
  • SHx (alcohol, travel, occupation)
  • Menstrual history (if appropriate)
  • Sexual history (if appropriate)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

General abdominal pain ddx

A
  • Uraemia
  • Hypercalcaemia
  • Diabetic ketoacidosis
  • Sickle cell disease
  • Pb poisoning
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Abdominal pain examinations

A
  • Full GIT examination, plus relevant CVS/Resp/renal
  • PR
  • Vaginal
  • Urine analysis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

General examinations for abdominal pain

A

FBC, ESR

Low Hb can show peptic ulcer, malignancy. High WCC indicates infection/inflam. High ESR can indicate Crohn’s or TB.

U&Es

Urea and Creatinine up will provide insight into uraemia.

LFTs

Thinking cholangitis and hepatitis or acute cholecystitis.

Serum amylase

Pancreatitis. Perforated peptic ulcer or bowel infarct can raise also.

MSU

Blood, protein, culture epositive in pyelonephritis. Red cells in ureteric colic. Must think of glomerular disease also.

CXR

Perforated viscus (gas under diaph.) or lower lobar pneumonia.

AXR

Obstruction (dilated loops of bowel). Local ileus (sentinel loop) – pancreatitis, acute appendicitis. Toxic dilation of UC or Crohn’s. Renal calculi. Calcified aorta aneurysm. Radio-opaque gallstones.

US

Abscesses (appendix, diverticular). Fluid in peritonitis. Aortic aneurysm. Ectopic pregnancy. Gallstones. Kidney cysts/tumours.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Specific examinations for abdominal pain

A
  • Blood glucose (diabetic ketoacidosis)
  • ABGs (metabolic acidosis)
  • Beta HCG (pregnancy)
  • ECG (AMI, or electrolyte/K disturbance)
  • IVP (Kidney stones)
  • CT (aneurys, pancreatitis, malignancy)
  • Barium enema (colon Ca, obstructions)
  • Colonscopy (tumours, diverticular, colitis)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Constipations differential diagnosis

A

Congenital

  • Hirschsprung’s disease

Obstruction

  • Colonic Ca
  • Diverticular disease
  • Extrinsic compression - Pregnancy, tumours

Anal pain

  • Anal fissure
  • Perianal abscess
  • Haemorrhoids
  • Post surg.

Adynamic bowel

  • Paralytic ileus
  • Ischaemic colitis
  • Senility
  • Spinal injury

Endocrine

  • Diabetic autonomic neuropathy
  • Hyperparathyroidism

Drugs

  • Codeine
  • Morphine
  • Atropine
  • Tricyclic antidepressants

Other

  • IBS
  • Diet
  • Anxiety
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Relevant history constipation

A

Age

Explore timing, relieving/excacerbating and previous episodes

? Pain Hx (SOCRATES)

Associated (GIT history symptoms)

  • Focus on nausea, vomiting, bowel motion changes in past

Constitutional symptoms

PMHx (surgery and trauma especially)

Medication

FHx (colon Ca, diabetes, HTN, IBD)

Menstrual history (if appropriate)
Sexual history (if appropriate)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Examinations constipation

A
  • Full GIT examination, plus relevant CVS/Resp/renal
  • PR
  • Vaginal
  • Urine analysis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

General investigations for constipation

A

FBC, ESR

Hb low can be anaemia with Ca, WCC high can be diverticular disease. High ESR can be Ca

U&E

High urea with dehydration

Sigmoidoscopy

Tumour or Hirschsprung disease

AXR

Obstruction

17
Q

Diarrhoea ddx

A

Infective enteritis

  • Bacterial (Escherichia coli, Shigella spp., Vibrio cholera, Clostridium difficile, Campylobacter spp., Salmonella spp., Staphylococci, Yersinia enterocolitica)
  • Viral

Inflammatory

  • UC
  • Crohn’s

Malabsorption

  • Coeliac disease
  • Radiation

Neoplastic

  • Ca
  • Non-neoplastic polyps

**Pancreatic **

  • Chronic pancreatitis
  • Cystic fibrosis
  • Ca

Drug

  • Abx
  • Laxatives
  • Mg antacids
  • Chemo

Other

  • Diverticular disease
  • IBS
  • Ischaemic colitis
  • Anxiety
  • Diet
18
Q

History for diarrhoea

A
  • Age
  • Pain Hx (SOCRATES)
  • Associated (renal/GIT): focus on nausea, vomiting, cramping
  • Constitutional symptoms (fever, dehydration)
  • PMHx (surgery and trauma especially)
  • Medication
  • SHx (travel)
  • FHx (colon Ca, diabetes, HTN, IBD)
  • Menstrual history (if appropriate)
  • Sexual history (if appropriate)
19
Q

Examinations for diarrhoea

A
  • Full GIT examination, plus relevant CVS/Resp/renal
  • Vitals for infection
  • PR
  • Vaginal
  • Urine analysis
20
Q

Investigations for diarrhoea

A

FBC, ESR

  • Hb low can be anaemia with Ca bleeding or other cause. High PCV in dehydration. WCC high from infection or diverticular disease. High ESR can be Ca or inflam.

Stool culture and microscopy

  • Infectious causes

U&E

  • High urea with dehydration, low K in dehydration

LFTs

  • Liver mets. from colon Ca ALP will be high

Sigmoidoscopy

  • Tumour, IBD, pseudomembranous colitis

Colonscopy

  • Tumours, colitis, diverticular

Barium enema

  • Tumours, colitis, diverticular disease
21
Q

Specific investigations for diarrhoea

A

Duodenal/jejunal biopsy

Coeliac disease

22
Q

Jaundice differential diagnosis

A

Preheptic

  • Congenital
    • Gilbert’s disease
  • Haemolysis
    • Hereditary spherocytosis
    • Sickle cell disease
    • Thalassaemia
    • Malaria
    • Incompatible blood transfusion
    • Autoimmune
    • Haemolytic disease of newborn

Hepatic

  • Acute hepatic disease
    • Viral hepatitis (A, B, C, EBV, CMV)
    • Drugs (paracetamol)
    • Toxins
  • Chronic hepatic disease
    • Chronic viral hepatitis
    • Autoimmune hepatitis
    • ESLD (alcohol, cirrhosis, haemochromatosis, Wilson’s disease)
    • HCC

Posthepatic

  • Lumen
    • Gallstones
    • Infection infestation
  • In the wall
    • Congenital biliary atresia
    • Cholangiocarcinoma
    • Stricture
    • Cholangitis (ascending)
  • Outside the wall
    • Ca of pancreas
    • Chronic pancreatitis
23
Q

History for jaundice

A

Age

? Pain Hx (SOCRATES)

Associated (GIT history symptoms)

  • Focus on nausea, vomiting

Constitutional symptoms (weight loss, malaise)

PMHx

Medication

FHx (Liver disease)

SHx (Alcohol, travel and occupation)

24
Q

Examination for jaundice

A
  • Full GIT examination, plus relevant CVS/Resp/renal
  • Vitals for infection
  • PR
  • Vaginal
  • Urine analysis
25
Q

General investigations for jaundice

A

FBC, ESR

  • Hb low can be anaemia due to malignancy, haemolysis. WCC high from infection (hepatitis, cholangitis). High ESR can be Ca or inflam.

Reticulocyte count

  • Haemolysis

LFTs

  • VITAL (see table below)

Viral antibodies

  • Viral hepatitis

US

  • Gallstones, dilated bilary tree, cirrhosis.

CT

  • Ca of pancreas, liver mets.
26
Q

Specific investigations for jaundice

A

Specialty serum tests for specific markers

  • Iron and copper (haemochromatosis and Wilsons + others)
27
Q

Differential diagnosis chest pain

A

Cardiovascular

  • Angina (stable/unstable)
  • AMI
  • Acute aortic dissection
  • Pericarditis

GIT

  • Oesophageal reflux
  • Peptic ulcer
  • Gastritis

Respiratory

  • Pneumonia
  • PE
  • Pneumthorax

Musculoskeletal

  • Trauma
  • Herpes zoster
28
Q

Relevant history chest pain

A

Age

Pain HX (SOCRATES)

  • Character of pain

Associated (CVS history symptoms)

  • Focus on palpitations, pain Hx

Constitutional symptoms

PMHx

Medications

FHx (colon Ca, diabetes, HTN, IBD)

SHx (alcohol, travel, occupation)

29
Q

Examination for chest pain

A
  • Full CVS and/or respiratory examination, plus relevant GIT
  • Vitals very important
30
Q

General examinations chest pain

A

FBC

  • WCC high in infection

Cardiac enzymes

  • AMI

ECG

  • Angina or AMI

CXR

  • Pneumonia, pneumophorax, PE, aortic dissection, trauma
31
Q

Specific investigations chest pain

A

V/Q scan

  • Mismatch (PE)
32
Q

Differential diagnosis dyspnoea

A

Sudden

  • Pneumothorax
  • Pulmonary oedema
  • PE
  • Aspiration
  • Anaphylaxis
  • Anxiety
  • Trauma

Acute

  • Asthma
  • Pneumonia
  • Tumours
  • Pleura effusion
  • Metabolic acidosis

Chronic

  • COPD/Emphysema
  • Heart failure
  • Anaemia
  • Arrhythmia
  • Valvular heart disease
  • Cystic fibrosis
  • Pulmonary HTN

Interstitial diseases

33
Q

Relevant history for dyspnoea

A

Age

Explore the Hx: Onset, precipitating factors, relieving factors, happened before

Associated (Resp. history symptoms)

  • Focus cough, wheeze, chest pains

Constitutional symptoms

PMHx

Medications

FHx

SHx (SMOKING AND OCCUPATION)

34
Q

Examination dyspnoea

A

Full respiratory and/or CVS examination, plus relevant GIT. JVP important. Percussion and auscultation vital.

Vitals very important

35
Q

General investigations dyspnoea

A

FBC

  • Low Hb for anaemia as primary cause

Peak expiratory flow rate

  • Asthma or COPD

CXR

  • Hyperinflation in emphysema, asthma. Consolidation in pneumonia. Fibrosis in interstitial disease. Heart failure with cardiomegaly. Lung collapse. Pneumothorax. Masses: Ca

ECG

  • Angina or AMI or arrhythmias or PE

ABGs

  • Severity and metabolic acidosis. Respiratory failure.
36
Q

Specific investigations for dyspnoea

A

Cardiac enzymes

  • AMI?

V/Q scan

  • Mismatch (PE)

Serum and blood cultures

  • Pneumonia?

Spirometry

  • Restrictive or obstructive disease and severity. Obstructive: reduced FEV1 to FVC ratio with normal VC (asthma, COPS, bronchiectasis, CF) FVL will show plateau in expiration. Restrictive: normal FEV1 to FVC ratio with reduced VC (pulmonary fibrosis, infiltrative lung disease)

Bronchoscopy

  • Foreign body aspiration or biopsy for pneumonia or Ca

CT thorax

  • Only if unsure

Echocardiogram

  • Heart failure of valvular pathology. PE: RSHF and elevated pulmonary a. pressures. Elevated pulmonary a. pressures can also be pulmonary HTN.
37
Q

Differential diagnosis for vomiting

A

Central vomiting (direct vomiting centre stimulation)

  • Drugs (narcotic analgesics and chemo)
  • Acute infections (children)
  • Pregnancy
  • Diabetic ketoacidosis
  • Addison’s
  • Intracranial pressure
  • Motion sickness
  • Psychiatric disorders (bulimia)
  • Offensive sights/smells

Reflex vomiting (afferent fibres to vomiting centre)

Inflammation

  • Appendicits
  • Cholecystitis
  • Pancreatitis
  • Peptic ulcers
  • Biliary colic

Obstruction

  • Pyloric stenosis
  • Small/colon obstruction

Irritants

  • Bacteria (Campylobacter and Salmonella)
  • Drugs (NSAIDS, Fe, abx)
  • Alcohol
  • Poisons
  • Emetics

Other

  • AMI
  • Severe pain
  • Irradiation
  • Coughing attack
38
Q

Haematemsis/melaena ddx

A

Swallowed blood

Oesophagus

  • Varices
  • Reflux oesophagitis
  • Oesophageal Ca
  • Mallory Weiss tear

Stomach

  • Peptic ulcer
  • Gastritis erosions
  • Ca

Small intestine

  • Merckel’s diverticulum
                Bleeding disorders

                              Liver disease associated

                              Thrombocytopenia

                              Haemophilia

            Drugs

                              Anticoagulants

                              Asprin

                              NSAIDS

                              Steroids
39
Q

Left hypochondrium pain

A

Gastrointestinal

  • diverticulitis
  • colitis
  • colon cancer
  • constipation
  • irritable bowel syndrome

Reproductive (female)

  • ectopic pregnancy
  • acute ovarian event (cyst rupture, hemorrhage, torsion)
  • Mittelschmerz (ovulation pain mid-cycle)
  • Pelvic inflammatory disease
  • Endometriosis

Reproductive (male)

  • seminal vesiculitis
  • undescended testicle pathology

Urinary

  • renal colic
  • UTI

Pain from nearby areas

  • abdominal: LUQ, central, groin pain
  • hip pathology
  • psoas abscess
  • rectus sheath hematoma
  • left lower lobe pneumonia

CAM202 Clinical (9 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions