Symptom histories and differentials Flashcards

Question

Drugs that cause GI symptoms

Answer 1

NSAIDs Metformin Colchicine Antibiotics Laxatives

Answer 2

Beta blockers (SOB) NSAIDs (SOB, cough) Methotrexate (SOB, cough) ACEI (cough) Amiodarone (cough, SOB)

Answer 3

Assess need for cardiopulmonary resus from severity Assess chronicity Determine frequency, volume, colour/floating Postprandial, and time after Night diarrhoea Consider general fatigue questions Infective history Drug history Cancer history Connective tissue disease history Malabsorptive history Endocrine history

Answer 4

Acute GI infection Acute genitourinary infection Upper GI pathology Lower GI pathology Ischaemic gut Renal calculi Myocardial infarct Pneumonia Ruptured AAA DKA Hypercalcaemia Ectopic pregnancy Cancer

Answer 5

Cholecystitis (febrile, RUQ tenderness, positive murphy's, NV and dehydration) Choledocholithiasis (Jaundice, biliary colic, positive murphy's) Cholangitis (fever, jaundice, RUQ tenderness, positive murphy's, NV and dehydration) Peptic ulcer (RUQ/epigastric tenderness, haematemesis, dehydration) Acute hepatitis (RUQ pain, fevers, malaise +/-, ascites, jaundice, asterixis, reduced GCS, peripheral oedema, bruising, hepatic faetor, NV and dehydration) Acute pancreatitis (central abdominal pain, lipase +, RUQ pain, low Ca, dehydrated, febrile, low BP) Myocardial infarct (ECG changes, troponin, prior reflux symptoms, CVD risk factors) Oesophageal ishaemia (Chest and epigastric pain, odynophagia/dysphagia, recent procedure, febrile, NV haematemesis, creps auscultation, SC crepitus) Oesophageal rupture (as ischaemia, low BP, crepitus, RR high, low sats)

Answer 6

Appendicitis Diverticulitis Small bowel obstruction Large bowel obstruction Bowel perforation Ischaemic gut AAA rupture peritonitis Abscess Renal calculus Pelvic inflammatory disease Bleeding renal cyst Retroperitoneal incarcerated hernia

Answer 7

Assess severity, site, time course Infective symptom history Cardiorespiratory history Menstrual cycle and sexual activity Previous surgeries/endoscopy Diet Alcohol history

Answer 8

Respiratory infection Pulmonary vascular pathology Cardiac failure Obstructive airways disease Interstitial lung disease Pneumothorax, pleural and chest wall pathology Metabolic disturbance

Answer 9

Previous DVT, PE History of cancer Previous surgery, immobility Current estrogen supplementation Recent long haul flights or car trips Family history of clotting disorders Calf pain or swelling Smoking

Answer 10

Pulmonary embolism Chronic thromboembolic pulmonary hypertension Pulmonary hypertension in setting of cardiac failure or COPD Idiopathic pulmonary hypertension Bronchopulmonary sequestration AVM

Answer 11

Pneumothorax Pleural effusion Empyema Phrenic nerve palsy Kyphoscloiosis/acute vertebral crush fracture Acute peripheral neuropathy Acute myopathy

Answer 12

Duration, frequency and rhythm Occurrence with activities (before, during, after) Associated dizziness, loss of conscious, lightheadness Associated shortness of breath or chest discomfort Nausea vomiting, chills, sweats, rigors, coryzal symptoms Hunger (at time of palpitations), tremor, heat intolerance, prior diarrhoea Menstrual history (last period/irregular cycles, vaginal dryness, irritability, sweats/flushes) Caffeine, alcohol intake, smoking Social stressors, anxiety Family history of sudden death, MI PHx dyslipidaemia, HTN, T2DM, long QT, COPD, heart failure Guilt, sadness, suicidal ideation

Answer 13

1) Cardiac electrical disturbance - AF, flutter - Supraventricular Tachycardia - Ventricular tachycardia/ectopics - HCOM 2) Systemic sympathetic disturbance - Caffeine, alcohol - Anxiety - Infection - Dehydration/hypovolaemia - Thyrotoxicosis - Hypoglycaemia - Phaechromocytoma

Answer 14

Nature, colour, amount, consistency Distinguish coughing from vomiting and vomiting without blood present, prior nausea Abdominal pain and discomfort prior, heartburn w/ acid brash Malaena, PR bleeding Dizziness, lightheadedness, shortness of breath Loss of weight, loss of appetite, night sweats, dysphagia Bleeding elsewhere - cough w/ haemoptysis, haematuria, epistaxis, easy bruising Liver symptoms - RUQ pain, jaudice/yellow skin, ankle, abdominal swelling Meds - NSAIDs, anticoagulants, bisphosphonates, steriods Recent ingestion of corrosive material Recent abdominal trauma Prior history of GORD, cirrhosis, aortic graft repair, hepatitis B,C, HIV, cancer, IVDU, overseas travel Prior endoscopies, CT scans FHx oesophageal cancer, gastric cancer

Answer 15

Bleeding gastric or duodenal ulcer NSAID/bisphosphonate/GCS/stress associated gastritis Oesophageal or gastric fundal varicies in setting of cirrhosis Mallory-Weiss Tear Oesophageal strangulation and rupture (Boerrhave's) Aortoenteric fistula Gastric/duodenal AVM Bleeding diathesis

Answer 16

Colitis - infective, ischaemic Inflammatory bowel disease - ulcerative colitis Colorectal cancer Proctitis - Radiation, infective, inflammatory, traumatic Upper GI bleed Haemorrhoids Divericular bleed Anal fissures Anal trauma, foreign bodies Anorectal prolapse and ulceration

Answer 17

Amount, mixed with stool/around stool, dripping, on toilet paper Colour - dark/bright Time course and duration Dizziness, lightheadedness, shortness of breath/fatigue Abdominal pain, back pain Diverticular bleed, haemorrhoids- Bowel habits, hard stools, constipation, use of laxatives, straining when going to toilet Anal fissure/ulcer - Anal pain Cancer, IBD - Tenesmus/faecal urgency New mass in rectum Faecal incontinence Chills/sweats rigors, nausea vomiting Recent sick contacts, take-away foods, BBQs, uncooked meat, unwashed salads/vegetables, overseas travel Arthralgias, rashes, eye pain, back pain, oral ulcers Loss of weight loss of appetite, night sweats PMHx - IBD, anorectal surgeries, radiotherapy, AF/IHD, constipation/diverticulitis, cancer, previous colonoscopies NSAIDs, anticoagulants Smoking, alcohol

Answer 18

Biliary disease (cholangitis, choledocholithiasis, gallstone pancreatitis, cholangiocarcinoma, pancreatic Ca, Biliary stenosis, primary sclerosing cholangitis) - RUQ pain, pale stools, dark urine, itch, nausea, vomiting, poor oral intake, loss of weight - PHx previous gallstones, cholecystectomy, previous endoscopies/stents Hepatitis/decompensated cirrhosis (Viral hepatitis, drug associated hepatitis, autoimmune hepatitis, biliary cirrhosis, acute fatty liver of pregnancy) - IVDU, hep B/C/HIV history, tattoos/piercings, foreign travel, needle stick injury, sexual partners - Arthralgia, rashes, eye pain/gritty eyes, vitiligo - Nausea, vomiting - abdominal distension, leg swelling Hepatic congestion (Right heart failure - TR, right MI, Budd-Chiari) - RUQ pain, history of blood clots, history of myeloproliferative disorders, MI Haemolytic anaemia (Autoimmune, mechanical/valve related, G6PD, congential cause, DIC/TMA) - chest pain on exertion/SOB, bruising, heart valves

Answer 19

Muscular strain/sprain (central palpation, vertebral movement, FABER) Facet joint osteoarthritis Vertebral disc prolapse Vertebral crush fracture (central palpation) Spondylolysthesis Sacroiliitis - Ankylosing spondylosis, IBD (Sacroiliac tenderness) Discitis/vertebral osteomyelitis (central palpation, febrile, flushed, tachycardic, loss of power and reflexes, lactate) Aortic dissection (radioradial and radiofemoral delay, abdominal tenderness, expansile mass, diastolic murmur at RUSE, low BP, lactate) Vertebral metastasis (central palpation, cachexia, lymphadenopathy, conjunctival pallor, abdominal mass/localised wheeze/breast lump, icterus) Renal calculi/pyelonephritis (Flank tenderness, lower abdominal tenderness, febrile) Colitis/diverticulitis/appendicitis/retroperitoneal incarcerated hernia (abdominal tenderness, peritonism, febrile, lactate) Kyphosis/scoliosis (Curvature of spine, reduced chest expansion)

Answer 20

Site - unilateral/bilateral, neck involvement Time of onset, duration, painfree periods; intermittent, continuous progressive Rapid onset - instant; worst severity experienced Exacerbating factors - worse early morning/evening, after bright lights, moving head/neck, touching scalp, with coughing Nausea, vomiting, loss of appetite Visual aura - spots/images before eyes Neck stiffness, rash, fevers/chills/rigors, photophobia Discomfort with chewing (temporal arteritis, trigeminal neuralgia), short duration (trigeminal neuralgia) Severe, pain around one eye, tears (cluster) Use of analgesics PHx cancer, migraines, smoking, alcohol, caffeine, hypertension FHx - berry aneurysms, malignancy

Answer 21

Primary headache (Tension headache, migraine, cluster headache, analgesic headache) Meningitis Haemorrhage (subarachnoid, intracranial) Temporal arteritis Trigeminal neuralgia Raised intracranial pressure (hydrocephalus, neoplasm) Ice-pick headache, benign sex headache Flu-like illness/upper respiratory tract infection

Answer 22

Cardioneurogenic reflex (vasovagal syncope, micrition syncope, carotid sinus hypersensitvity) Cerebral hypoperfusion (arrhythmia, aortic outflow stenosis, hypovolaemia) Seizure (tonic/clonic, atonic (drop attack), clonic, complex partial) Hypoglycaemia Basilar artery TIA, subclavian steal syndrome, posterior circulation giant cell arteritis

Answer 23

(Obtain collateral history) Events prior to, during and after event fall and subsequent pain and trauma, head trauma Footwear, use of gait aid, visual aids, lights on or off Symptoms of dizziness, lightheadedness, palpitations, shortness of breath (cardiac) Palpitations, chest pain (arrhythmia) Prior aura - epigastric sensation, de ja vu (generalised seizure) Sudden instability, weakness in limbs, double vision (posterior circulation insufficiency, atonic seizure/drop attack) Tongue bitten/bleeding, urinary/faecal incontinence (tonic/clonic seizure, syncope) Confused for 15-20mins following (generalised seizure, hypoglycaemia) tremor, hunger, lethargy (hypoglycaemia) Neck turning, shaving, neck extension (carotid sinus hypersensitivity, vertebral artery occlusion) Exercising (outflow stenosis, subclavian steal, posterior GCA) Dizziness on standing from sitting/lying (hypovolaemia/orthostatic hypotension) Appetite, prior nausea and vomiting, fever, chills, rigors, diarrhoea (hypovolaemia/sepsis) Headache, worse with coughing, worse in morning/when waking (Raised intracranial pressure) History of epilepsy, IHD, HTN, T2DM, on insulin, smoking, alcohol, stroke

Answer 24

Faintness/lightheadedness (Cerebrovascular insufficiency, anaemia, hypoglycaemia, arrhythmias) Vertigo (BPPV, labyrinthitis/vestibular neuronitis, vestibular migraine, medication toxicity, meniere's disease, brainstem infarct) Lateral instability (stroke, cerebellar disease, Parkinson's disease, sensory peripheral neuropathy, myasthenia gravis)

Answer 25

Allow patient to define dizziness - lightheadness, rotational, difficulty walking Time course and duration Worse with walking, lying/sitting, turning head Worse after exercise Hearing loss, tinnitus, nausea, vomiting Previous URTI, ear infections, pain from ear, blood from ear Headache, motor weakness, sensory weakness, visual disturbance, speech difficulties Chills, sweats and rigors, infective Hx PHx stroke, IHD, AS, heart failure Smoking, alcohol

Answer 26

Osteoarthritis Gout/pseudogout/hydroxyapetite crystal arthropathy Rheumatoid arthritis Infective arthritis Haemarthrosis Soft tissue injury Viral arthralgia,rheumatic fever SLE, jaccoud's arthropathy Seronegative arthritis - psoriatic arthritis, reactive arthritis, enteropathic arthritis Mixed connective tissue disease Haemachromatosis Relapsing costocondritis

Answer 27

Site, radiation, duration Worse with lying, sitting, standing, walking, coughing bending Use of analgesics Abdominal pain, groin pain, dysuria, flank pain (aortic dissection, renal calculi) Numbness/tingling down leg and calf (lumbar nerve compression) Bilateral numbness, tingling, weakness bilaterally, recent changes to bowel and bladder habits, anal tingling (spinal cord compression, conus medularis compression, lumbar nerve root compression) Pain at night, constant, night sweats, loss of weight, appetite (crush fracture, metastasis) IVDU, needlestick injury, fevers chills rigors (Osteomyelitis, discitis) Recent back trauma Abdominal pain, changes to bowel habit, PR bleeding (colitis, diverticulitis, appendicitis, retroperitoneal hernia) Smoker, alcohol, social circumstances

Answer 28

Site/sites of joints involved, swelling, redness Ability to move joint Recent trauma, injections, prostheses (septic arthritis) Chills/sweats/rigors, nausea, vomiting Loss of weight, malaise, fatigue, general unwell (chronic infection, connective tissue disease) Catching/locking or giving way (meniscal/ligamentous rupture) Morning stiffness Movement better/worse, better worse at beginning/toward end, improvement/worsening with rest, limitation of movement on ADLs Numbness, tingling at night, improved with hanging hand over bed (Carpal tunnel syndrome complication) Nodules, raynauds (Rheumatoid) Pitted nails, PHx psoriasis (psoriatic arthritis) Dry eyes and mouth (showgren's) Chronic diarrhoea, blood in stool, eye pain (IBD) Ulcers in mouth or genitals (RA, Bechet's) Chest pain, cough, shortness of breath on exertion (RA, CREST)

Answer 29

Hypotension Hypoxia Hypoactive delirium Hypoglycaemia/hyperglycaemia Acute intracranial haemorrhage Meningoencephalitis Non-convulsive status epilepticus Alcohol, benzodiazepine, opioid intoxication Hyperkalaemia/hypokalaemia, hypercalcaemia/hypocalcaemia Renal or liver failure Sleep disorder

Answer 30

Referred pain - MI, Renal calculi, AAA, radiculopathy, neuropathy Compartment syndrome Arterial insufficiency Necrotising fascitis/cellulitis Myonecrosis Septic arthritis DVT Abscess Gout Fracture/osteonecrosis Neuropathic pain