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Finals Elliot > Histories > Flashcards

Histories Flashcards

1
Q

What is the basic differential diagnosis for diarrhoea?

A

Infectious

IBD

Malignancy

Coeliac

Drugs (c.dif?)

Ischaemic

Thyrotoxicosis

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2
Q

What might cause bloody diarrhoea?

A

Shigella, Salmonella, Campylobacter

IBD

Colorectal Carcinoma

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3
Q

What are the common causes of weight loss?

A

With appetite maintained - DM, Hyperthyroidism, Malabsorption, Phaeochromocytoma

Without appetite - Malignancy, Cardio/Resp Failure, Gut Failure, Depression, HIV

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4
Q

What are the causes of acute pancreatitis?

A

I – Idiopathic (most common)
G – Gallstones
E – Ethanol
T – Trauma
S – Steroids
M – Mumps
A – Autoimmune (eg. PAN)
S – Scorpion Venom – black Trinidadian scorpion (tityus trinitatis)
H – Hyperlipidaemia, Hypercalcaemia
E – ERCP
D – Drugs (azathioprine, thiazides, valproate, asparaginase, allopurinol)
And Pregnancy

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5
Q

What is the scoring system for pancreatitis?

A

Glasgow score for severity
Includes Oxygen, age, neutrophils, calcium, renal function, LDH/AST, albumin and BMs

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6
Q

What are the complications of acute pancreatitis?

A

Early:
Shock
Acute kidney injury
Acute respiratory distress syndrome
DIC
Sepsis
Hypocalcaemia
Hyperglycaemia
Pancreatic necrosis
Late:
Pancreatic necrosis
Pancreatic pseudocyst
Pancreatic fluid in lesser sac
Fluid in lesser sca
Presents > 6 weeks later
Abdominal mass may be present
May need internal (via stomach) or external drainage
Abscess
Thrombosis – splenic/gastroduodenal arteries
Fistulae

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7
Q

How are migraines managed?

A

Acute episode
* 1st: Paracetamol + metoclopramide / domperidone * 2nd: NSAID (e.g. ketoprofen) + M/D
* 3rd: Rizatriptan

Prophylaxis
* Avoid triggers
* 1st: Propanolol, topiramate
* 2nd: Valproate, pizotifen (↑ wt.), gabapentin

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8
Q

What can trigger migraines

A

2) What are some of the triggers?
* CHOCOLATE
* CHeese
* OCP
* Caffeine
* alcohOL
* Anxiety
* Travel
* Exercise

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9
Q

What are the main compications of migraines to be aware of?

A

3) Complications?
* Status migrainous
* Migrainous infarction
* Seizures
* Depression

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10
Q

What are the features of raised ICP?

A

Signs and Symptoms
a. * Headache
b. * n/v
c. * Seizures
d. * Drowsiness → coma
e. * Cushing’s reflex: ↑BP, ↓HR, irregular breathing
f. * 6th CN palsy (may be false localising)
g. * Cheyne-Stokes respiration
h. * Pupils: constriction → dilatation
i. * Papilloedema, loss of venous pulsation @ disc

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11
Q

What can cause raised ICP?

A
    • Haemorrhage
    • Tumours
    • Infection: meningitis, encephalitis, abscess
    • Hydrocephalus
    • Status
    • Cerebral oedema
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12
Q

Systems Review - Cardio

A

Chest pain
SoB
Palpitations
Syncope
Leg swelling, orthopnoea, PND
N&V, sweaty, clammy
Claudications

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13
Q

Systems Review - Resp

A

SoB
Cough/sputum/haemoptysis
Chest pain

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14
Q

Systems Review - GI

A

Waterbrash
Dysphagia
Heartburn
Indigestion
N&V/haematemesis
Abdo pain
CIBH - constipation/diarrhoea or blood, mucus, colour, smell, not flushing, frequency
Pain on defecation

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15
Q

Systems review - Neuro

A

Headaches
Visual disturbance
Dizziness
Fainting/LoC
Altered sensation
Fits
Weakness
Recent trauma
Raised ICP: N&V, confusion, rash, photophobia

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16
Q

Systems Review - Endo

A

Changes in appearance
Weight loss
Mood changes
Period changes
Sleep disturbance
Heat/cold intolerance
Sweating
Bowel habits
Palpitations
Difficulty swallowing
Changes in voice

17
Q

Systems Review - Rheum

A

Joint pain, stiffness, swelling
Skin rashes, ulcers, Raynauds
Nail changes
Hair loss
Eye redness, dryness
Dry mouth
IBD Sx
GU Sx

18
Q

Systems review - Musc

A

Pain
Instability
Stiffness/locking
Swelling/deformity
NV status
Functional status

19
Q

Systems Review - Urology

A

Storage: frequency, urgency, nocturia, volume
Infective: dysuria, haematuria
Prostate/voiding: hesitancy, poor flow, dribbling, feeling incomplete, terminal dribbling

20
Q

Differentials - Headache

A

Cluster
Migraine
Tension
Raised ICP
SOL
Post-Epidural
Venous Sinus Thrombosis
GCA
Meningitis
Sinusitis

21
Q

Differentials - Chest Pain

A

Cardiac - ACS, HF, Pericarditis, Myocarditis, Tamponade, angina,
Resp - PE, Asthma, COPD, PO, Pneumonia, Pneumothorax,
GI - Dyspepsia, Dysphagia, PUD, GI Bleed
Anxiety, Pancreatitis, Cholecystitis
Costochondritis,

22
Q

Differentials - SOB

A

PE
ACS
Asthma, COPD
Fibrosis
Pretty much all pulmonary stuff

HF, Tamponade, Silent MI, SVC syndrome

Anaemia, Anaphylaxis, Anxiety

23
Q

Differentials - Cough

A

Acute - Pneumonia, Asthma/COPD, PE, Pneumothorax

Subacute - Post-infectious cough

Chronic - Smoking, Post-nasal drip, GORD, Asthma, Eosinophilic bronchitis

Other - Cancer, Bronchitis, Bronchiectasis, HF, FB Aspiration, TB,

24
Q

Differentials - Constipation

A

Colorectal Cancer
Diverticular Disease
Poor diet
Opioid Use
IBS
Bowel Obstruction
issue with peristalsis (lots of neuro stuff)

25
Q

Which questions should you ask about discharge/bleeding etc

A

Colour
Amount
Smell
Mixed with anything?
When?
Investigated before?

26
Q

Which qs should you ask in drug history?

A

Current meds
Recently stopped Meds
Recently started Meds?
Herbal meds/OTC meds?
Vaccines?
Relevant meds to symptom, ie. Ulcer - NSAID

27
Q

Which qs should you ask in a social history?

A

Work, old jobs
Smoking, alcohol, drugs
Live with? Anyone they know with similar symptoms?
Sexual history
Diet
Travel
Impact on life

28
Q

PMHx questions?

A

Regular issues
Past admissions to hospital
Past surgeries
Allergies
When were diagnoses made.
Specific history of differentials

29
Q

Rheum history?

A

SOCRATES
Which joints
Symmetrical?
Effect on function?

extra-articular features?

30
Q

Specific weight loss qs?

A

Over how long, how much weight, clothes looser?

Change in appetite/diet?

Change in exercise?

Intentional?

Red flags

31
Q

Weight loss differentials?

A

Cancer
Hyperthyroidism
Diabetes
Addison’s
GI Inflammation/Ulceration
Phaeochromocytoma
HIV
TB
Hepatitis
HF
Neurological
GCA
Rheumatological
Psych

32
Q

Diarrhoea differentials?

A

Infectious
Meds
IBD/IBS
Overflow
Cancer
Endocrine (Thyroid, addisons)
Diabetes
Surgical history?
Bacterial overgrowth of small intestine

33
Q

Jaundice differentials?

A

Pre Hepatic - G6PD, MAHA, SCD, Spherocytosis, Elliptocytosis, Gilbert’s, Criggler-Najjar

Hepatic - HCC, Infectious Hep, Autoimmune Hep, Cirrhosis, Alcohol, NAFLD, Hereditary Haemochromatosis, A1AT def.

Post-Hepatic - Obstruction, Pancreatic cancer, Gallstones, Cholangiocarcinoma, Abdominal lymphoma

Drug-Induced (can be mix of the above)

34
Q

Things not to forget when taking a history from a young woman

A

Pregnant? Any chance?
Contraception?
Obstetric history
Sexual History
Gynae History

35
Q

Assessing fever in a returning traveller?

A

When? Other sx? Chills, shakes, night sweats, weight loss, fatigue, anorexia

Travel? Purpose, where, accommodation, food/drink, sanitation, medical precautions, bites/exposure to potential infection sources (dead animals, wild animals, etc) Exposure to ill people

36
Q

Fever in a returning traveller differentials?

A

Malaria
TB
Dengue
Typhoid
Yellow Fever
Ebola
STD
Pneumonia
Leptospirosis
Amoebiasis
Schistosomiasis

37
Q

How would you investigate fuo?

A

CXR
malaria blood films x3
Blood cultures x3
Sputum MC&S
Serology
Viral throat swab
Urine MC&S
HEP/HIV/Syphyllis screen
Biopsy of any lesions

38
Q

Which conditions might come up in the DM/Endo station?

A

T1DM
T2DM
MODY
Thyroid - Graves’, Hashimoto’s, Subacute, Toxic multinodular thyroid
Adrenals - Addison’s, Cushing’s, Conn’s,
Acromegaly
Paget’s Disease of the bone

39
Q

List some causes of erythema nodosum

A

IBD
Sarcoidosis
Behcet’s

Finals Elliot (12 decks)

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