presenting complaints

Question 1

Abdominal pain differentials- RLQ

Answer 1

• appendicitis
• diverticulitis
• PID
• endometriosis
• ectopic pregnancy
• rupture of ovarian cyst
• renal calculus

Question 2

Abdominal pain differentials- pelvic/ hypogastric region

Answer 2

• cystitis
• PID
• ectopic pregnancy
• diverticulitis
• strangulated hernia
• endometriosis
• appendicitis
• ovarian cyst
• ovarian torsion
• testicular torsion
• bladder distesion
• prostatitis
• malignancy
• AAA

Question 3

Abdominal pain differentials- LLQ

Answer 3

• diverticulitis
• intestinal obstruction
• colitis
• strangulated hernia
• IBD
• gastroenteritis
• pyelonephritis
• aortic aneurysms
• volvulus
• PID

Question 4

red flags for acute abdominal pain

Answer 4

• hypotension/ shock / dehydration
• confused
• rigid abdomen/ pt very still
• absent/ altered bowel sounds
• involuntary guarding
• rebound tenderness
• testicular pathology
• hx of haematemesis/ Malena

Question 5

red flags for chronic abdominal pain

Answer 5

• age > 60
• unexplained weight loss
• anorexia
• masses
• organomegaly

Question 6

types of abdominal pain

Answer 6

Colicky - renal colic/ biliary colic/ intestinal obstruction

tearing- aortic dissection/ rupture

constant sharp - peritonitis

constant dull - inflammation > appendicitis / diverticulitis.

Question 7

key to ask in abdominal pain hx

Answer 7

• associated N+V / bloating
• vomit colour, character, relation to food
• does it wake at night (severity)
• appetitie?
• weight loss?
• opening bowels regularly?
• diarrhoea/ constipation?
• stools > formed? hard to flush? colour?

Question 8

Abdominal pain differentials- RUQ

Answer 8

• cholecystitis
• fatty liver
• congested liver (secondary to heart failure)
• cholangitis
• hepatitis
• gastritis
• pancreatitis
• pneumonia
• fitz hugh curtis syndrome

Question 9

Abdominal pain differentials- epigastric

Answer 9

• gastritis
• Pelvic ulcer disease
• pancreatitis
• gastroenteritis
• intestinal obstruction
• MI
• aortic aneuyrsm

Question 10

Abdominal pain differentials- LUQ

Answer 10

• peptic ulcer disease
• gastritis
• GORD
• PE
• pancreatitis
• splenomegaly
• left lower lobe pneumonia

Question 11

menorrhagia differentials

Answer 11

Polyps
Adenomyosis
Leiomyoma
Malignancy

Coagulophathy
Ovulatory dysfunction
Endometrial
Iatrogenic
Not classified

PALM COEIN

Question 12

menstrual hx

Answer 12

• age of firsts period?
• regular/ irreg?
• heavy/ light?
• pain? how long?
• LMP
• menopause symptoms

Question 13

obstetric hx

Answer 13

• conceived in past?
• did you go to term?
• heavy bleed?
• ever terminated pregnancy?

Question 14

ammenorhea key questions

Answer 14

• any radio/ chemo > premature ovarian filure
• any thyroid problems? > hypo/hyperthyroidism
• overweight? facial hair? deep voice? >PCOS
• nipple dischage? vision disturbance? headache? > pituitary tumour
• abdo swelling/ bloating? > ovarian tumour
• general health? cough? fever? tired? > systemic illness
• any recent weight loss? diet? > anorexia/ bulimia
• use pill? > post pill amenorrhea
• stress?
• substance misuse?
• pregnancy?!
• when did mum reach menopause? > perimenopausal/ primary ovarian failure

Question 15

differential diagnosis - secondary amenorrhea

Answer 15

• hypothyroidism
• pregnancy
• PCOS
• stress
• eating disorders
• weight loss/ XS exercise
• hyperprolactinaemia
• galactorrhea (secondary due to meds - phenothiazines/ OCP) “(primary due to pituitary adenoma)