Histories differentials

Question 1

Weight loss

Answer 1

ENDO: T1DM, diabetes insipidus, hyperthyrod, addison’s

GI: Chron’s, UC, coeliac, malnutrition

Infectious: TB, IV

CANCER (anywhere)

DEPRESION

Question 2

weight gain

Answer 2

Pregnancy

Endo: Hypothyroid, Cushing’s, PCOS

Steroid tx

Question 3

what questions can you ask for Cushing’s

Answer 3

stretch marks
easy bruising
weakness in hips or shoulders
difficulty getting up from chair

Question 4

what questions for PCOS

Answer 4

hirsutism (unusual hair growth on body)
oligo/amenorrhoea
acne
oily hair

Question 5

what questions for hypothyroidism

Answer 5

always cold? 
tired
constipated 
menorrhagic 
appetite loss, weight gain 

neck swelling / neck lump?

Question 6

differentials for chest pain

Answer 6

CARDIAC – RESP – GASTRO – MSK

Cardiac: ACD, stable angina, aortic diss, pericarditis

Resp: PE, pneumonia, pneumothorax

GI: peptic ulcer, pancreatitis

MSK: costochondritis

Question 7

presentation of ACD

Answer 7

central crushing pain
radiates to arm jaw neck epig
sweating pallor nausea
lasts >20 mins

Question 8

presentation of aortic diss

Answer 8

tearing pain (retrosternal/intrascap) 
collapse, dizziness, weakness, parasthesia

Question 9

presentation of pericarditis

Answer 9

central pleuritic pain

RELIEVED SITTING FORWARD

Question 10

which types of chest pain are relieved by sitting forqard

Answer 10

pancreatitis

pericarditis

Question 11

causes of pleuritic pain

Answer 11

pericarditis
PE
pneumothorax

Question 12

assoc sx to ask about with cardiac pain

Answer 12

nausea vomitng sweating
dizziness collapse
fever? pericarditis

Question 13

assoc sx to ask if resp related chest pain

Answer 13

SOB cough haemoptysis

leg swelling / leg pain (PE)

Question 14

assoc sx for GORD related pain

Answer 14

associated with eating 
worse lying down 
post prandial 
regurgitation / heartburn 
anaemia sx (peptic ulcer)

Question 15

diiffs for palpitations

Answer 15

Cardiac (AF, SVT)
Endo (hypethyroidism, phaeo, hypoglyucaemia)
Drugs, alcohol, caffeine, anxiety

Question 16

causess of acute SOB

Answer 16

Cardiac: MI, angina, pulm oedema, aortic diss, arrythmia, acute pericarditis
Resp: PE, pneumothorax, COPD IE, Asthma, ANAPHLAXIS
Endo: DKA

Question 17

causes of chronic SOB

Answer 17

Cardiac: HF
Resp: COPD, bronchiectasis, interstitial lung disease, malignancy
Anaemia

Question 18

Respiratory sx to ask about

Answer 18

SOB (+ orthopnoea + PND)
Cough 
Sputum 
Blood 
Chest pain, pleuresis

Question 19

red flag respiratory sx

Answer 19

FLAWS
haemoptysis
hoarseness
dysphagia

Question 20

RF to ask about in resp hx

Answer 20

smoking 
asbestos exposure / occupation 
animals 
dusts 
hx of atopy if suspecting asthha

Question 21

diffs haemoptysis

Answer 21

RESP:

• PE
• pneumonia
• TB
• lung cancer

Rheum:

• Wegener
• SLE

Question 22

headache differentials

Answer 22

RED FLAGS: 
Vascular: SAH, Subdural, extradural 
Infection: meningitis, encephalitis 
Vision threatening: Temporal arteritis, acute glaucoma 
SOL (raised ICP)

Benign: migraine, cluster, tension, medication overuse
Trigeminal neuralgia

Question 23

how does SAH present

Answer 23

sudden onset back of head
worse headache ever
meningism

Question 24

sx of meningism

Answer 24

neck stiffnness
photophobia
N/V

Question 25

sx SDH

Answer 25

gradual onset confusion and headache | alcoholic or elderly

Question 26

sx extradural haemorrhage

Answer 26

head trauma.: LOC > resume consciousness > rapid deterioration

Question 27

sx meningitis

Answer 27

``` gradual onset headache, neck stiffness, photophobia malaise, fever, RASH N/V irrtability seizures, focal neuro deficit, confusion ``` TRAVEL HX OTHER UNWELL PEOPLPE

Question 28

triigem neuralgia sx

Answer 28

facial pain | triggers (wind, vinration, brushing hair)

Question 29

GCA sx

Answer 29

``` gradual headache vision blurring drop in visual acuity scalp tendenes jaw pain ```

Question 30

differentials for neck lump

Answer 30

Midline: - thyroid (graves, Hashimoto, toxic multinod etc -- benign: thyroglossal cyst, thyroid nodule) - non thyroid: lipoma, dermoid cyst, ABSCESS MUMPS LYMPHOMA

Question 31

how do you categorise causes of dysphagia

Answer 31

neuro | GI

Question 32

neuro cause of dysphagia

Answer 32

``` stroke PD myasthenia MS MND ```

Question 33

GI causes of dysphagia

Answer 33

achalasa CREST oesophageal cancer peptic stricture from GORD

Question 34

what can you ask to characterise the dysphagia

Answer 34

WORSE WITH SOLID OR LIQUID? - worse with solid = mechanical obstruction e.g. stricture - worse with liquid = motlity disorder (achalasia or neuromusc)

Question 35

differentials for constipaton

Answer 35

``` GI: IBD, colorectal CA, adhesions Pt not pushing: haemorrhoid,anal fissure Drugs: opiates, iron tablets, CCB Metabolic: Hypothyroid, hypercalcaema Neuro: DM, spinal colrd compression, MS ```

Question 36

DIarrhoea differentials

Answer 36

GI: coeliac, IBD, lactose intolerance, ingection | Hyperthyroidism

Question 37

questions to ask about stool

Answer 37

``` Characterise stool: colour, consistency, quantity Bloody, mucoid Foul smelling, floating Pale, greasy Nocturnal diarrhoea Urgency Incontinence, Tenesmus ``` Constant or variaable' Assoc: FLAWS, FLATUS Top to bottom: N/V, dysphagia, abdo pain,

Question 38

Infecrtive urinary s x

Answer 38

FUND (storage) Freq urgency Noct Dysuria

Question 39

voiding urinary sx

Answer 39

Hesitancy (difficulty in starting to urinate) Intermittent stream (start - stop) Poor stream (weak) Terminal dribbling

Question 40

other sx for urinary hx

Answer 40

pain in abdo lumps in abdo blood in urine, urine colour (clear or cloudy) discharge from pens, rashes, spots on genital

Question 41

differentials for fatigue

Answer 41

Anxiety / obstructve sleep appnoea / environmental /depression or prychosocial -- HOW HAVE YOU BEEN SLEEPING? WHAT DOES YOUR PARTNER SAY? Endo: hypothyroid, DM, addisons Haem: anaemia Malignancy screen