Systems Review Flashcards
1
Q
Upper Abdo Pain
A
- Acute Coronary Syndrome
- Pancreatitis
- RUQ- Cholecystitis, Ascending Cholangitis, Biliary Colic (USS if suspected)
- Flank Pain and Fever- Pyelonephritis
- Bloody Diarrhoea and weight loss- Crohn’s
- Gastroenterititis if crampy pain and vomiting
- Peptic Ulcer Disease
- Gastritis- if belching, recent history of NSAIDs/ Alcohol
2
Q
Lower Abdo Pain
A
- Pregnancy
- Appendicitis if mild fever, Also consider OVARIAN TORSION and CYST if sudden pain and do USS
- LLQ- Diverticulitis if Constipation and Old, IBD,
- Pelvic Inflammatory Disease if BILATERAL lower abdo and Fever- ask about discharge
- Mesenteric Ischaemia if Vascular Disease
- Consider Endometriosis if Dysmenorrhoea and Mittelschmirtz
3
Q
Acute Non Specific Abdo Pain in general
A
- Peritonitis
- Obstruction (if colicky pain and vomiting)
- Ischaemic Colitis- if vascular disease- CT Angiogram to assess this
- AAA if vascular disease
- Renal Tract obstruction- Colicky pain that radiates to the groin
- DIABETIC KETOACIDOSIS
4
Q
Chronic Abdo Pain
A
- Upper Alarm Signs
ALARM - Lower Alarm Signs
Bleeding, Weight loss, bowel habit, signs of anaemia - Jaundice
USS - KIDNEYs
Renal Cancer if ongoing flank pain and haematuria - Vaginal Pathology
Endometriosis, PID - Any palpable masses, jaundice or weight loss
IBD, Lymphoma, Chronic Pancreatitis, Chronic Mesenteric Ischaemic
5
Q
Breast Lump
A
- Breast Cancer
- Breast Abscess
- Fibroadenoma (mobile smooth lump)
- Fibrocystic changes
- Fat Necrosis (if after trauma)
6
Q
What do you ask about in a Breast Lump history?
A
- Breast Cancer
- Breast Abscess
- Fibroadenoma (mobile smooth lump)
- Fibrocystic changes
- Fat Necrosis (if after trauma)
7
Q
Chest Pain
A
- Acute Coronary Syndrome
- Aortic Dissection
- Pulmonary Embolism
- OESOPHAGEAL RUPTURE
- Pericarditis
- Musculoskeletal Pain
- Pneumothorax
- Malignancy- Changes to voice, Haemoptysis, Weight loss
- GORD- burning pain, provoked by lying down
- Asthma- ask about shortness of breath
- ANXIETY as well
8
Q
Altered Consciousness
A
- Hypoglycaemia- suspect if Diabetic Patient
- DKA- suspect if Diabetic patient and HHS
- Myxoedema Coma if Hypothyroidism
- Naloxone if OPIOID toxicity
- CNS INFECTION
- Head Injury if headache
- Uraemia if KIDNEY ISSUE
9
Q
Delirium/ Confusion
A
- Drugs
- Electrolyte Imbalance (like hypoglycaemia)
- Lack of Drugs (like Withdrawal)
- Infection
- Reduced sensory input (vision and hearing)
- Intracranial causes
- Urinary Retention and Fecal Impaction
- Myocardial and Pulmonary causes, and HEPATIC ENCEPHALOPATHY
10
Q
Chronic Cognitive Impairment
A
- Dementia (Alzheimers, Vascular, Lewy Body)
- Hypothyroidism
- Subdural Haemorrhage (So do a CT HEAD ANYWAY)
- NPH (if CANT PEE, WALK)
- Wilson’s
- ALWAYS ALWAYS CHECK for Psychosis signs
- Always be aware it may be DEPRESSION as well
11
Q
Diarrhoea
A
- IBD, Cancer, Gastroenteritis, Ischaemic Colitis- if BLOODY
- C Difficile? Hospital admission, antibiotics
- RECENT FOREIGN TRAVEL- Protozoa?
- If acute and does not meet any of this criteria then it is GASTROENTERITIS
- Hard Stool= OVERFLOW DIARRHOEA
- Steatorrhoea= Coeliac, Chronic Pancreatitis, Cystic Fibrosis
- Abdo red flag signs
- HYPERTHYROIDISM and HYPERCALCAEMA
12
Q
Dizziness
A
- Assess for Loss of Consciousness
- TIA if Focal Neurological Deficit
- Ask about spinning feeling (vertigo)- the room spinning is vertigo
- Ask about presyncope (feeling of going to faint)- assess as loss of consciousness if so
- Hypoglycaemia
- Orthostatic Hypotension
- Anxiety
- Visual Symptoms
- Cerebellar Disease
13
Q
Vertigo
A
- Red flags- sudden onset, hearing loss, inability to walk, neurological signs
- Vestibular Neuritis if recent illness, unilateral nystagmus, Viral labyrinthitis if hearing loss
- BPPV if changes in head position cause it
- If randomly occurring with hearing loss/ tinnitus= Meniere’s- AUDIOMETRY
- Could also be VERTEBROBASILAR TIAs (MR Angiography)
- Associated with migraine?
- Also ACOUSTIC NEUROMA
14
Q
Dysphagia
A
- Swallowing DIFFICULTY (in actually getting the food down)- Globus/ Odynophagia
- Make sure it is not an OROPHARYNGEAL CAUSE (it isn’t in the mouth and pharynx) and make sure it is an oesophageal cause
Pharyngeal Pouch
Stricture
Motility Disorder - Neurological Cause- Parkinson’s and Multiple Sclerosis, Pseudobulbar (Donald duck)/ bulbar palsy (nasal)
- Ask about fatiguability in other muscles, visual changes
- Also remember the red flags of Upper GI- Weight loss, changes to voice, PROGRESSIVE dysphagia
- Vomiting= Hiatus Hernia
15
Q
Short of Breath
A
- COPD/ Asthma
- Anxiety
- RTI
- Heart Failure
- DKA, Poisoning (ask about vomiting and abdominal pain)
- Pneumothorax
- Pulmonary Embolism
- Myocardial Infarction
- Lung CANCER RED FLAG SIGNS (haemoptysis, weight loss, clubbing, change of voice)
- Bronchiectasis
- Pulmonary Embolism Risk Factors
16
Q
Fatigue
A
- Drug causes- alcohol, steroids, antihtn, benzo, alcohol
- Heart and Lungs and Chronic Liver Disease- COPD, Heart Failure, Sleep Apnoea
- Fever, Night Sweats, Weight Loss- Cancer or Infection?
- Endocrine and Pregnancy
- Screen for Anaemia
- Depression and Chronic Fatigue (if >4 months)
- HIV if IV Drug user/ Unprotected Sex
17
Q
Fever
A
- Always say at the end that you would screen for sepsis
- Malignant Hyperthermia, Neuroleptic Malignant Syndrome
- Immunocompromised ?- Steroids/ HIV/ Chemotherapy/ Diabetes or Autoimmune condition
- Systemic Review for all systems (Head to toe)
18
Q
Haemetemesis
Ask about bleeding disorder/ blood thinner
A
Peptic Ulcer (if epigastric pain worsened by eating)
Gastritis (Epigastric pain and NSAID use)
Oesophagitis- heartburn, nausea
Mallory Weiss
Oesophageal Varices- Liver Disease (Jaundice)
Upper GI malignancy (Early satiety, weight loss)
19
Q
Rectal Bleeding
Ask about bleeding disorder/ blood thinner
A
Perianal Disorder (blood on tissue, red)
IBD
Cancer
GI Infection
Meckel’s Diverticulum and Intussusception in younger patients
Ischaemic Colitis
Diverticular Disease
20
Q
Haematuria
Bleeding disorder and Blood thinner
A
- Renal Colicky pain suggests kidney stone
- Bladder cancer- always screen for this (smoking, obstruction- dribbling of urine
- Renal cancer- loin pain, abdominal mass
- Also Screen for Prostate Cancer for all of these signs
- UTI- dysuria, cloudy urine, low grade fever,
- Ask about high blood pressure anyway- Nephritic Syndrome- and RECENT INFECTION for IgA/ PSGN
21
Q
Haemoptysis
Bleeding Disorder and Blood Thinner
A
- True haemoptysis?- Nose bleed associated?
- Pulmonary Embolism
- Lung Cancer
- Bronchiectasis
- Fever, Night Sweats, weight loss for Tuberculosis (ALWAYS ask about HIV)
- Rheumatic Fever because of Mitral Stenosis- ECG if dyspnoea
22
Q
Headache
A
- Migraine, tension headache, cluster headache
- Meningitis (photophobia, neurological symptoms, nausea, fever, RASH)
- TEMPORAL ARTERITIS
- Recent Head injury- SAH and other bleeds
- Glaucoma
- RED FLAGS- Ataxia, Change in personality, Headache worse in morning, VISUAL DISTURBANCE, Headache worse when bending forward
23
Q
Jaundice
A
- The RUQ pains (Cholecystitis, Cholangitis, Biliary Colic)
- Haemolysis
- Malignancy- Painless- Pancreatic or Cholangiocarcinoma
- Mirizzi’s- common hepatic duct obstruction due to stone lodged in the cystic (gallbladder) duct
- Alcoholic Hepatitis
24
Q
Swollen Joint
A
- Trauma- Screen for fracture
- Fever, unable to weight bear- Septic Arthritis?
- Over 1st MTP- Gout? (Ask about Alcohol and Red Meat)
- Other joints? For RA, OA, Psor A
- Recent GI/ GU infection- Reactive Arthritis
25
Q
Swollen Leg
A
- DVT
- Lymphoedema
- Cellulitis
- Gastrocnemius muscle rupture if recent sports
- COMPARTMENT SYNDROME- if paresthesia and pain and check with HIGH CK
- Venous Insufficiency-
- Oedema due to Nephrotic Syndrome/ Cardiac Failure (Ask about BREATHLESSNESS)
- Pelvic Cancers (Aks about Weight Loss, PV Bleeding, Difficulty urinating if male)- Rectal, Prostate, Vaginal Cancer
- DRUGs- CCB, Corticosteroids, NSAIDs
26
Q
Muscle Weakness
A
- Stroke/ TIA/ Space Occupying Lesion
- Multiple Sclerosis
- Myasthenia Gravis/ LEMS
- Guillain Barre
- Radiculopathy/ Spinal Cord Compression
- Ask about SENSORY SYMPTOMS
- Also screen for DRUG Causes (Alcohol, corticosteroids)
- Proximal weakness= DENIM, Distal= ABCDEG
Endocrine= Diabetes, Acromegaly, Cushing’s, Addison’s - MOTOR NEURON DISEASE
27
Q
Lower Back Pain
A
- Ankylosing Spondylitis
- Cauda Equina (if neurological features below lesion)
- Disc HERNATION- RADICULAR PAIN
- Trauma (Especially if Osteoporosis Risk Factors)
- Mechanical Back Pain
- Lumbar Spine Stenosis- if old, ongoing back pain made worse by standing for long periods of time and CLAUDICATION PAIN (Thigh Cramping pain)
- Red flags for cancer-
NIGHT Pain
Weight Loss
Fever, Night Sweats
28
Q
Falls
Assess for Polypharmacy and Dehydration
A
Cognitive Issues
Muscular Weakness
ENT Issues (Vertigo)
Cardiac issues
Dehydration
Brain lesion if GAIT ABNORMAL
Sensory Impairment?
Seizure/ Syncope
If still not sure, say you would screen for an acute cause of the fall
ALWAYS ask about chronic causes by asking about weight loss/ muscle wasting, hypoalbuminaemia
29
Q
Nausea and Vomiting
A
- Kidney (AKI)- Uraemic Encephalopathy
- GI Obstruction
- Infection (Gastroenteritis)
- Pregnancy
- ACS
- Gastritis
- Pancreatitis
- Peptic ulcer Disease
- DKA
- Adrenal Insufficiency and other hormonal causes
- Drug Causes- Toxicity
- Upper GI Cancer
- CNS DISORDER if they have any headaches
- Gastroparesis
30
Q
Palpitation
A
- Extra Systole (Jolt or Jump)- reassurance
- Monitoring
24 hours monitoring if paroxysmal
Otherwise ECG asap - Ask about the CHADSVAS Symptoms
- Anxiety (ask about trigger)
- Other Cardiac/ Respiratory Causes
- Shortness of Breath
- Chest Pain
31
Q
RASH FRAMEWORK
A
- Ask how their skin reacts to the sun
- Ask about allergies
- Ask if they’ve been in contact with anyone with similar symptoms
- Erythrodema (if more than 90% of body is affected)
- Blisters- SJS/ TEN if there is MUCOUS MEMBRANE INVOLVEMENT (Oral, Genital and Ocular)
SJS- rubbing skin causes blisters (Nikolsky’s sign)
TEN- IV IG - Blisters without mucosal involvement- Bullous Pemphigoid, HSV, VZV, Dermatitis Herpetiformis
BULLOUS PEMPHIGOID RX- Immunofluorescence for IgG and C3 and Manage with ORAL STEROIDS - Purpura
Meningococcus?
ITP/ TTP/ DIC
Vasculitis - HSP
- Polyarteritis Nodosa
- Pustular
- Wheals (Pale pink raised lesions (plaques?)
- Eczema
- GUTTATE PSORIASIS/ PITYRIASIS ROSEA
32
Q
Changes in Vision
A
- CHANGES to VISION
- Both eyes or only one
- Discharge
- Itchiness
- Keratitis, Iritis, Scleritis (if photophobia)
- Red flags
Sudden loss of vision
Photophobia
Eye pain (GLAUCOMA) - Haloes/ Distortion
- Temporal Arteritis
33
Q
Scrotal Swelling
A
- On the skin only= Cellulitis/ Fournier’s Gangrene
- Painful- Testicular Torsion/ Epididymo-Orchitis/ STRANGULTED HERNIA
Exclude Torsion ASAP- - N+V?
- High position of testes
- Testicular Cancer
- Inguinal Hernia- Dragging sensation
- Hydrocele if feels smooth- ultrasound to eliminate cancer. Hydroceles resolve by 1 year in babies
34
Q
Syncope/ Seizure
A
- Ask them to define what they mean by loss of consciousness (dizziness, fall, stroke)
- Cardiac? If it happened during EXERTION
- Hypoglycaemia (especially if Diabetic)
Syncope- TLOC after standing up/ coughing/ micturition/ venepuncture - Seizure- CNS Disease (ask about nuchal tenderness (neck pain), bleeding disorder, weakness, weight loss, change in personality, temperature)
- Precipitating factor (alcohol withdrawal, recreational drug use)
- Syncope- ECG= Arrythmia/ Ischaemia
- PE/ Aortic Dissection/ Occult Bleeding
- Standing- Postural Hypotension, Reflex Syncope- Evident cause (blood etc.)
35
Q
Urinary Incontinence
A
- MAKE SURE THERE IS no SPINAL PATHOLOGY- weakness/ lack of sensation
- UTI- Fever, Dysuria, Frequency- MSU for culture
- Post-void Residual Volume high= OVERFLOW INCONTINENCE- do a BLADDER ULTRASOUND SCAN
Causes= - Prostate Cancer
- Constipation/ Faecal impaction
- Neurological Cause
- Continuous leak- FISTULA (IV UROGRAM)
- Post Menopause= ATROPHIC VAGINITIS
- Urge/ Stress Incontinence
Urge- overactive bladder
Stress- muscles that support the bladder are weak
36
Q
Vaginal Bleeding
Blood Thinners and Bleeding Disorders
A
- Pregnant- Ectopic, Miscarriage, Placental Abruption, Placenta Praevia
- Post Menopausal- Atrophic Vaginitis, Endometrial Cancer, POLYPS
- Bleeding only during menstruation- MENORRHAGIA- Fibroids/ HOLB
- Post Coital- Cervical cancer/ ectropion
- STI? MITTELSCHMERZ
- PREGNANCY TEST!!!
37
Q
Weight Loss
A
- Diabetes
- Hyperthyroidism
- Hypercalcaemia
- Infection
- Drug Culprit (Diabetes Medications, Diuretics, Topiramate)
- Cancers- Screen for Resp, Colon, PSA, LDH (for hodgkins)
- Depression or EATING DISORDER
38
Q
Child with Joint Pain
A
SUFE
Perthes
Transient Synovitis
DDH
Septic Arthritis
- JIA
- Ewings Sarcoma
- Growing Pains
39
Q
ENT
A
earache, irritation
deafness
discharge
tinnitus
vertigo
sore throat
- Fever, Cough, (Lymphadenopathy, Cervical Tenderness, Tonsillar Exudate)
40
Q
A
