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Jan Stuff > Systems Review > Flashcards

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
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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
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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
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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
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5
Q

Breast Lump

A
  • Breast Cancer
  • Breast Abscess
  • Fibroadenoma (mobile smooth lump)
  • Fibrocystic changes
  • Fat Necrosis (if after trauma)
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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)
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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

Jan Stuff (6 decks)

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