Weight Loss

Question 1

Sequence of events

Answer 1

Open question
Timeline

Question 2

Symptom analysis

Answer 2

Amount (when did they last weight themselves, if they couldn’t quantify, then ask about clothes, belts etc.)
Patients ideas- what do they think caused it
Intentional or not
Appetite
Exercise- more than unusual

Question 3

Systems review

Answer 3

RS- cough, sputum, blood, breathless

GIT- swallowing, abdominal pain, heartburn, vomiting, blood, bowel motion changes, blood in stools

GUT- waterworks, blood in urine, pain when passing urine, more frequently, how have periods been (postcoital, intermenstrual, post menopausal bleeding)

NS- weakness in any muscles, pins and needles or strange sensations, headaches, visual or other sensory problems

MS- pain in muscles, bone or joints, stiff in mornings

ENT- persistent sore throat, hoarse voice, neck lumps

haem- bruising, bleeding easily

Question 4

Patients perspective

Answer 4

Feelings and impact on life
ICE

Question 5

Background

Answer 5

PMH- recent illnesses, thyroid, chronic infections, IBD, previous cancer
DH- medications or allergies
FH- any cancers
SH- who cooks for you, what would you eat on a normal day

Question 6

Congenital/ failure to thrive

Answer 6

Paediatric

Question 7

Neoplasm

Answer 7

Primary or secondary malignancy

Question 8

Degenerative

Answer 8

COPD
MS

Question 9

Infection/inflammatory

Answer 9

Viral (HIV)
Bacterial
Other infections eg. TB
Inflammatory condition eg. CTD (SLE), RA, IBD, vasculitis (rashes, crusting, fevers etc.)

Question 10

Miscellaneous causes

Answer 10

Anorexia nervosa
Depression or other psychiatric diagnoses
Hyperthyroidism
Recent major surgery (gastrectomy)
Coeliac

Question 11

Investigations for weight loss

Answer 11

Physical exam of all systems
Bloods- FBC UE LFT glucose TFT CRP ER coeliac antibodies
Urinalysis
CXR
CT scan q