Presenting Complaints

Question 1

Headache - Sinister Causes

Answer 1

Vasular - subarachnoid haemorrhage, haematoma, cerebellar infarct
Infection - meningitis, encephalitis
Vision-threatening - temporal arteritis, acute glaucoma,
Intracranial pressure - space-occupying lesion, hydrocephalus, malignant hypertension
Dissection - carotid dissection

Question 2

Unilateral headache

Answer 2

Migraine, cluster headache, temporal arteritis

Question 3

Nausea and vomiting with headache

Answer 3

Suggestive of raised ICP

Question 4

Visual disturbance with headache

Answer 4

Migraine, intracranial lesion, bleeding, stroke

Question 5

Photophobia with headache

Answer 5

Raised ICP, meningitis

Question 6

Neck stiffness, fever and rash with headache

Answer 6

Meningitis

Question 7

Sleep disturbance with headache

Answer 7

Concerned about raised ICP

Question 8

Temporal region tenderness with headache

Answer 8

Consider temporal arteritis

Question 9

Neurological deficits with headache

Answer 9

Space occupying lesion, intracranial bleeding, stroke

Question 10

Painless neck lump

Answer 10

Lymphoma, thyroid malignancy, goitre

Question 11

Midline neck lump

Answer 11

Goitre, thyroglossal cyst, solitary adenoma, dermatoid cyst, abscess, lymphoma

Question 12

Presents with haematemesis

Answer 12

Oesophagitis, duodenitis, gastritis, bleeding peptic ulcer, oesophageal varices, mallory-weiss tear, oesophageal cancer, gatric cancer

Question 13

Dysphagia

Answer 13

Stroke, parkinson’s, myasthenia gravis, cancer, achalasia, stricture

Question 14

Acute dry cough

Answer 14

Asthma, sinusitis, URTI, drug induced, smoke inhalation, pulmonary oedema, lung cancer

Question 15

Acute productive cough

Answer 15

LRTI, COPD, TB

Question 16

Chronic dry cough

Answer 16

Asthma, GORD, post-nasal drip, smoking, lung cancer, drug induced, COPD, pulmonary oedema, pulmonary fibrosis

Question 17

Chronic productive cough

Answer 17

Bronchiectasis, TB, lung cancer,

Question 18

Blood-streaked sputum

Answer 18

Infection, bronchiectasis, lung cancer

Question 19

Pink and frothy sputum

Answer 19

Pulmonary oedema

Question 20

Frank blood in sputum

Answer 20

TB, lung cancer, PE, bronchiectasis, rarer causes e.g. goodpastures

Question 21

Haematemesis

Answer 21

TB, bronchitis, pneumonia, lung abscess, lung cancer, LV failure, Goodpasture’s syndrome, SLE, iatrogenic, wounds, bronchiectasis, warfarin

Question 22

Chest pain

Answer 22

ACS, stable angina, PE, pleurisy, musculoskeletal, oesophagitis, anxiety, pneumothoax, peptic ulcer, aortic dissection,

Question 23

Shortness of breath

Answer 23

COPD, asthma, lung cancer, pulmonary fibrosis, pneumothorax, lung collapse, GBS, pulmonary oedema, pneumonia, PE, anaemia, HF, shock, DKA, hyperventilation, aortic stenosis, MI

Question 24

Epigastric pain

Answer 24

Acute pancreatitis, gastritis, duodenitis, peptic ulcer disease, perforated peptic ulcer, biliary colic, acute cholecystits, pneumonia, ruptured AAA, ascending cholangitis, MI, GORD

Question 25

Nausea and vomiting

Answer 25

Motion sickness, vertigo, medications, alcohol, hormones, toxins, pain, raised ICP, meningitis, GI obstruction, GI infection, inflammation of the diaphragm, inflammation of HPB

Question 26

Jaundice

Answer 26

Haemolytic anaemia, liver pathology, primary sclerosing cholangitis, CBD obstruction, gallstones, liver cancer, pancreatic cancer, Budd-Chiari syndrome, haemochromatosis,

Question 27

RUQ pain

Answer 27

Biliary colic, cholecystitis, duodenal ulcer, pancreatitis, basal pneumonia, ascending cholangitis, gastric ulcer, SBO, appendicitis, pyelonephritis, hepatits

Question 28

RIF pain

Answer 28

Appendicitis, gastroenteritis, ureteric colic, acute pancreatitis, testicular torsion, diverticulitis, SBO, inguinal hernia, bowel cancer, ectopic

Question 29

LIF pain

Answer 29

Acute diverticulitis, constipation, IBD, ischaemic colitis, AAA, locally perforated sigmoid carcinoma, pyelonephritis, UTI, IBS

Question 30

Flank pain

Answer 30

Muscular pain, ureteric colic, AAA, pyelonephritis, perforated peptic ulcer, renal cancer

Question 31

Constipation with abnormal bowel peristalsis

Answer 31

IBS, medications (opiates, iron supplements and Ca channel blockers), hypothyroidism, hypercalcaemia, hypokalaemia, MS, Parkinson’s, diabetic neuropathy, bowel obstruction

Question 32

Constipation with hard faeces

Answer 32

Lack of dietary fibre, dehydration

Question 33

Constipation with bowel obstruction

Answer 33

Colorectal adenocarcinoma, sigmoid volvulus

Question 34

Constipation due to pain

Answer 34

Haemorrhoids, anal fissure, pelvic floor dysfunction

Question 35

Diarrhoea

Answer 35

Gastroenteritis, IBS, coeliac disease, Crohn’s disease, ulcerative colititis, medications (antibiotics, laxatives)

Question 36

Rectal bleeding - anorectal

Answer 36

Haemorrhoids, rectal tumour, anal tumour, anal fissure, anal fistula, solitary rectal ulcer, radiation proctitis, rectal varices

Question 37

Rectal bleeding - colonic

Answer 37

Diverticular disease, colitis, colonic tumour, iatrogenic (colonoscopy), vasculitis

Question 38

Rectal bleeding - ileo-jejunal

Answer 38

Peptic ulceration, Crohn’s disease, coeliac disease, small bowel tumours

Question 39

Upper GI - bleed

Answer 39

Peptic ulcer, gastritis, varices, tumour, MW tear

Question 40

Poor urinary output - pre-renal causes

Answer 40

Hypovolaemia, HF, reduced local perfusion of the kidneys, decreased systemic vascular resistance of the kidneys

Question 41

Poor urinary output - renal causes

Answer 41

Acute tubular necrosis, glomerulonephritis, interstitial nephritis, haemolytic uraemic syndrome, thrombocytic thrombocytopenic purpura, DIC, malignant hypertension, malaria

Question 42

Poor urinary output - post-renal causes

Answer 42

Abdominal pelvic mass, complication of pelvic surgery, neuropathic bladder, anticholinergic drugs, bladder stones or tumour, BPH, prostate cancer

Question 43

Polyuria

Answer 43

Diabetes mellitus, diuretics, diabetes insipidus, primary polydipsia, ATN

Question 44

Swollen calf

Answer 44

DVT, cellulitis

Question 45

Leg ulcer

Answer 45

Venous ulcer, arterial ulcer, neuropathic ulcer, pressure ulcer