Long Case Differentials/management Flashcards
(60 cards)
1
Q
Differentials for a neck lump
A
- branchial cyst
- salivary gland enlargmeent
- thyroid (goitre, multinodular goitre, graves, hashimotos, adenoma, carcinoma, subacute thyroiditis)
- subclavian aneurysm
- lymph node
2
Q
symptoms of thyroid malignancy
A
dysphonia
stridor
dysphagia
cough
haemoptysis
weight loss
3
Q
risk factors to ask for with neck lump?
A
- family hx: head and neck cancer
- family hx: thyroid disease
- smoking
- alcohol
- sick contacts: EBV etc.
- Cat scratch
- radiation to neck - malignancy
- other autoimmune disorders - points towards hashimotos
4
Q
Investigations of thyroid lump
A
- physical exam - signs of hypo/hyperthyroidism, movement of thyroid on swallowing, movement of thyroid when tongue out
- bloods- TFTs (T3, T4, TPO, TSH, calcitonin), blood film - for EBV, FBC for infection
- bedside - ultrasound of thyroid, ECG for arrhythmias
- Imaging - CT head and neck for malignancy, radionucelotide scan (hot or cold)
- special tests - Fine needle biopsy - malignancy
5
Q
management of neck lump
A
Cysts = surgical excision
EBV = supportive
hypothyroid = Levothyroxine
Hyperthyroid = carbamazepine or PTU, beta blocker or thyroidectomy
6
Q
Differentials for Polyuria
A
- diabetes mellitus (T1 or T2)
- diuretics (alcohol, caffeine, medication, lithium)
- heart failure
- hypercalcaemia
- hperthyroid
- hypokalaemia
- Diabetes Insipidus
7
Q
Polyuria specific questions to ask?
A
- blood in urine = UTI or stones
- fatigue/weight loss = DM
- recurrent infections = DM
- dribbling = BPH, prolapse
- Nocturia = BPH
- Increased thirst = DM/DI
- vasculitis?? = renal failure
- hypertension = Renal failure
- autoimmune conditions= Type 1 DM
- lithium prescription = DI
8
Q
What investigations for polyuria?
A
- Physical exam: PVD signs (T2DM) or peripheral neuropathy, fruity breath (T1DM), signs of dehydration (T2DM), prostate exam
- Bloods: aldosterone levels (DI), Plasma glucose (DM), sodium levels,
- U&E: sodium - DI
- Creatinine = renal failure
- TFTs = hyperthyroidism
- urine dipstick = UTI and osmolality
- Imaging = MRI pituitary - cranial DI
- special tests = water deprivation test
*
9
Q
Management of polyuria
A
- UTI = antibiotics
- Cranial DI = removal of tumour, or ADH replacement
- nephrogenic DI = carbamazepine
- primary polydipsia = refer to psychiatry and fluid restriction
- DKA = IV fluids, Insulin therapy
- DMT1 = insulin
- DMT2 = diet, exercise, metformin + second line agent like gliclazide
10
Q
differentials for haematuria/flank pain
A
- “SWITCH GPS”
- stones
- wegener’s vasculitis
- infection
- trauma/tumour
- cryoglobulinaemia
- HUS
- glomerulonephritis
- PCKD
- sickle cell/SLE
11
Q
specific questions for haematuria and flank pain?
A
- colour of urine (orange could be rifampicin, cloudy could indicate UTI)
- colicky pain?
- rigors/palpitations = stones or UTI
- fever
- history of UTIs
- dribbling = BPH = retention
- history of kidney disorders
- lump in flank?
- recent rash? SLE or HUS
- hypercoagulable state?
- Cough/haemoptysis = wegeners or goodpasture
- facial swelling = nephritic syndrome
- oedema/weight gain = nephritic syndrome
- recent URTI = IgA nephropathy
12
Q
Investigations for polyuria
A
Physical Exam: ballot kidneys for pain, cacexia (malignancy), dehydration, temperature, prostate exam (retention or mets)
Bloods: CRP/ESR (UTI, infection), FBC (WCC or anaemia), U&E (renal function), Calcium (Renal function), PSA (prostate cancer), Lactate (UTI/sepsis)
Bedside: urine dipstick ( haematuria and UTI), midstream culture = UTI, urine cytology (bladder cancer), renal ultrasound (stones, hydronephrosis, tumour)
Imaging: plain film X ray (stones), non contrast CT (stones, tumour), cystoscopy (bladder cancer), CT tap (staging).
Special Tests: transurethral biopsy (transitional cell cancer)
13
Q
management flank pain and haematuria
A
- stones = conservative (increase water), medical (anti-emetic, analgesia, alpha blocker), surgical (sock wave therapy, endoscopic stone retrival)
- neoplasm = medical (interferon, interleukin), surgical (nephrectomy partial or radial)
- Lower UTI = increase hydration and give antibiotics according to culture
- upper UTI = increase hydration, ciprofloxin 7 days
- nephritic syndrome = steroids + cyclophosphamide, renal transplant
14
Q
differentials for a breast lump
A
- Most common
- fibrocystic change
- fibroadenoma
- cyst
- carcinoma -
- DCIS
- LCIS
- Invasive ductal (most)
- invasive lobular
- medullary
- tubular
- less common
- fat necrosis
- mastitis
- abscess
- galactocele
- phyllodes tumour
- sarcoma
- lipoma
15
Q
what questions to ask about a breast lump?
A
- painful? Movable?
- ragged or smooth edges?
- skin changes
- changes to nipple
- discharge - colour or blood
- back pain
- fever?
- History or breast cancer
- recent trauma?
- weight loss?
- age at menarche and menopasue
- HRT use
- ovarian cancer hx
16
Q
Investigations for a breast lump?
A
- physical exam= symmetry, skin changes, nipple changes
- bloods = FBC (infection), U&E (renal function baseline), LFT (mets), calcium (mets)
- bedside = ultrasound of breast (if over 35 in addition to mammogram), ultrasound of liver (staging/liver mets)
- imaging = mammogram, MRI breast, CT breast (Staging), bone scan for mets
- Special tests = FNA, needle core biopsy (receptor status, invasiv vs. in situ),
17
Q
Management of breast lump
A
- Neoplasm (mostly DCIS)- dependent on receptor positive + chemotherapy + surgical excision (breast conserving or mastectomy + sentinel node)
- fibroadenoma = excision if symptomatic or >3cm
- cysts = aspirate if symptomatic
- reassurance, proper bra fitting, primrose oil help with breast pain,
- Breast infections/mastitis = antibiotics and aspiration of abscess if present
18
Q
Differentials for a blackout event
A
- Non-syncopal = intoxication, metabolic, psychogenic, narcolepsy, epilepsy
- syncope= vasovagal, cardiac, orthostatic hypotension, cerebrovascular perfusion, arrhythmia
- epilepsy = lesion cause or non-lesion epilepsy
19
Q
what questions should you ask about a blackout event?
A
- ask if someone witnessed the event?
- did you feel it coming on? Triggered? what was happening immediately before the episode
- recent head trauma?
- during episode: length of it, loss of continence, tongue biting, patterened movements
- after episode: spontaenous recovery? (non-metabolic), tiredness (epilepsy), confusion?
- risk factors: diabetes, epilepsy, anaemia, alcohol use, arrhythmia, sudden death of a relative, insulin therapy use? medications? blood thinners? beta blockers?
20
Q
Investigations for a blackout event?
A
- physical exam: carotid bruit? (stroke), BP standing and lying (orthostatic hypotension), focal neuro signs (stroke)
- bloods: eletrolytes (seizure) , FBC (anaemia), U&E (dehydration or hyponatraemia), tox screen (intoxication), TFT (arrhythmia), aldosterone levels (BP)
- bedside: ECG (heart block), glucometer (hypoglycaemia)
- imaging: CT brain (bleed), Echo, Carotid doppler
- Special tests: tild test (ANS failure or orthostatic hypotension), holder monider for cardiogenic syncope, EEG for signs of epilepsy
21
Q
Management of blackout event
A
- Cardiogenic
- sleep, diet, exercise limit stress
- antiarrhythmic medication if appropriate
- ICD if appropriate or Valve replacement
- Orthostatic hypotension
- increase fluid/salt intake
- avoid alcohol
- exercise
- take time when standing up
- stope medications that potentiate (diuretics etc.)
- Vasovagal
- increase fluid and salt
- SSRI
- Epilepsy
- avoid alcohol, stress, sleep deprivation
- avoid triggers
- need to bae 6 months seizure free to drive
- medical: sodium valproate , carbamazepine
*
22
Q
Differentials of headache
A
- sinister cause = VIVID
- vascular - subarachnoid haemorrhage
- infective- meningitis
- Vision - Giant cell arteritis
- ICP - oedema, hydrocephalus
- Dissection of carotids
- Non-sinister cause
- tension headache
- micraine
- sinusitis
- TMJ pain
- trigeminal neuralgia
- cluster headache
23
Q
what specific questions should you ask about headaches?
A
Red flags
- decreased consciousness
- head injury
- sudden onset
- seizures
- focal deficit
- scalp tenderness
- worse when lying down or in the mornning
- neck pain
- photophobia
- past malignancy
- impact on life
24
Q
Investigations for a headache?
A
- physical exam: eye movements, pupillary response, focal neuro signs, fundoscopy for papiloedema
- bloods: CRP for infection and Giant cell arteritis , FBC for infection, blood culture for meningitis
- bedside: lumbar puncture - meningitis, blood, opening pressure etc.
- imaging: CT brain - for bleed or space ocupying lesion, MRI
- Special tests: EEG
25
management of headache
* haemorrhage = coil insertion surgically
* migraine = paracetamol
* sinusitis = antibiotics
* tumour = chemo, radiation, sometimes ressection
* hydrocephalus = shunt
* meningitis = depends on viral or bacterial - steroids and ceftriaxone most common
* tension headaches = rest
26
Differentials for stroke
* Thrombus stroke
* large vessel atherosclerosis
* vasculitis
* atheroma of perforating arteries (lacunar infarct)
* emboli
* Afib
* valve disease
* septal defect
* carotid plaque
* Dissection
* carotid
* vertebral
* Hypoperfusion
* hypovolaemic shock
* haemorhagic
* hypertensive
* vascular malformation
* amyloid angiopathy
* recreational drugs
* anti-coagulant/antiplatelet drugs
27
what questions should you ask about a stroke?
- unilateral limb weakness
- paralysis
- sensory changes
- speech abnormality
- dysphasia?
- headache?
- urinary incontinence
- vertigo?
- impact on life since stroke?
28
in an acute stroke, what investigations should you do? How about after the acute phase?
acute
* physical exam: eye movements, pupillary response, focal neuro signs
* bloods: glucose (stroke mimic), coagulation screen (haemorrhagic stroke), FBC
* bedside: ECG (AFib), Blood pressure (hypertension)
* imaging: CT brain non-contrast, CT angio for large vessel occlusion, MRI brain
Post acute
* holter- Afib.
* Carotid doppler - carotid stenosis/plaque
* Echo - mural thrombus
29
what is the long term management for stroke?
non pharmalogical: smoking cessation, alcohol reduction, diet, weight reduction, exercise
medical: anticoagulated wtih heparin, aspirin therapy, statin, treat diabetes
surgical: carotid endarterectomy if stenosis is present
30
what are the differentials for MS ?
Degenerative
* MS
Infectious
* lyme
* syphilis
* HIV
Neoplastic
* tumour compressing brain
vascular
* vasculitis
* cerebral ischaemia
Inflammation
* SLE
* sarcoid
* vasculitis
31
what questions should you ask if you suspect MS?
limb numbness or tingling
visual loss
limb weakness
dyscoordination
worsening with heat?
decreased power?
intention tremor
change in sensation
Risk factors: young adult age, woman, autoimmune history
32
Investigations for suspected MS?
* physical exam
* increased tone
* decreased power
* increased reflexes
* clonus
* abnormal sensation
* intention tremor
* ataxia - lack of voluntary coordination
* nystagmus
* Bloods
* FBC - rule out infection
* CRP
* bedside
* lumbar puncture
* oligoclonal bands and high protein
* imaging: MRI brain
* Special tests
* EEG
* disseminations of lesions in time and space
33
management of MS?
acute relapse
- high dose steroids
Chronic
- interferons or Natalizumab
34
what are the differentials for movement disorders ?
1. Hypokinesia
1. parkinson's
1. idiopathic
2. parkinsons + lewy body, multiple system atrophy
3. drug induced
4. toxin induced
5. trauma
2. hyperkinesia
1. ataxia
2. tremor
3. dyskinesia
35
If someone presents with a resting tremor, what questions shoudl you ask them?
* site, onset character etc.
* associated symptoms: rigidity, instability, trouble with doorways, shuffling, difficulty turning in bed, slow movement, facial expression changes, blinking less, depression or anxiety, decreased sleep, orthostatic hypotension, bladder dysfunction, hallucinations (LEwy body dimentia)
* Risk factors: family history, head injury, occupational exposure to pesticides,
36
what investigations should you do for parkinsons?
* physical exam: pill rolling tremor, cogwheel rigidity, changes in posture, shuffling gait, reduced facial expression, vertical gaze palsy
* Bloods: FBC (inflammatory causes),
* Bedside : Levodopa administration - look for response
* imaging: MRI brain (vascular parkinsonism),
37
what is the management for Parkinsons disease?
Non-pharmacological: physio, exercise, OT
medical = levodopa + carbidopa
Surgical = Deep brain stimulation
38
what are your differentials for joint pain?
* trauma
* muscular
* tendon
* fracture
* inflammatory
* gout
* pseudogout
* septic arthritis
* synovitis
* osteoarthritis
* RA
* bursitis
* osteomyelitis
* bone malignancy
* Neuro
* nerve entrapment
* radiculopathy
*
39
what questions should you ask about joint pain?
* SOCRATES
* Red flags
* weakness
* altered sensation
* sphincter disturbance
* urinary retnetion
* systemic illness
* night pain
* trauma
* cancer history
* Multiple joints or single?
* symmetrical?
* small joint involvement?
* back pain?
* pain elsewhere?
* soreness after waking up?
* worsens with movement? Improves with rest?
* onset within hours?
* insidious onset
* chronic?
* relief with painkillers?
* frequent fractures
* Effect on life?
* tie shoes? Walk up stairs? Wash hair etc
* recent trauma
* hear a pop/crunch? Tendon rupture
* blood or exposed bone? risk of infection
* historical trauma? OA
* Fall?
* what happened before, after or during
* hit head?
* instability?
* Recent gonorrhea infection? - reactive arthritis
* skin changes (Psoriasis)
* steroid use (predisposed to fracture)
* mouth ulcers (crohns arthropathy
* shortness of breath
* loss of mobility
* fever, night sweats, malaise)
* gout risk factors: thiazide diuretics, alcohol, renal failure, chemo
* septic arthritis risk factors: immune suppression and prosthetic joints
40
investigations for joint pain?
* physical exam: look - swan neck deformity, nodes, etc, feel (heat), move (reduced ROM), special tests
* Bloods: FBC (septic arthritis), ESR/CRP (inflammation), RF, urate (gout), HLA B27 testing (seronegative spon), PTH \*hyperparathyroidism, Vitamin D levels
* bedside: ultrasound - ligamentous injury or capsular injury
* Imaging: plain film X ray of joint, MRI for soft tissue damage
* special tests: Arthrocentesis - for gout, septic arthritis, etc.
41
Management of joint pain?
* Gout = avoid alcohol and red meat, NSAIDS, and allopurinol
* Septic Arthritis = analgesia, joint aspiration and lavage
* tendonitis= rest/ice, analgesia
* reactive arthritis = avoidance of gonorrhea, antibiotics
* tendon rupture = RICE, physiotherapy, analgesia, tendon repair
* osteoarthritis = weight loss, physiotherapy, NSAIDS, total replacement, partial replacement
* RA = smoking cessation, exercise, DMARDS (methotrexate with folic acid), steroids, NSAIDS, joint fusion or replacement
* seronegative arthritis = smoking cessation, exercise, physio, NSAIDS or methotrexate
* Osteoporosis = smoking and alcohol cessation, exercise, bisphosphonates,
* Fracture = rest + immobilize, physio
42
Differential for abdominal pain
* Epigastric
* peritonitis - radiating to full abdomen, worse on movement, pleuritic pain 10/10
* perforated peptic ulcer - sudden onset
* gastritis - from epigastrium to chest - burning pain, self-limiting episode
* Peptic ulcer disease- burning pain, food alleviates duodenal ulcer but exacerbates a gastric ulcer,
* MI - can radiate then to jaw, neck, arm etc.
* ruptured AAA- radiates to back
* bowel ischaemia
* gastric cancer (rare)
* Right upper quadrant
* * biliary colic - self-limiting episode triggered by fatty food
* cholecystitis - over hours and radiates to the shoulder tip
* ascending cholangitis - over hours and presents with fever and signs of liver involvement
* duodenal cancer
* acute pancreatitis - deep pain radiating to back, relieved by sitting forward
* ulcer
* small bowel obstruction (colicky pain)
* gynae - cholestasis of pregnancy
* Right iliac fossa pain
* appendicitis
* gastroenteritis
* ureteric colic
* inguinal hernia
* orchitis
* diverticulitis (rare)
* pyelonephritis
* ectopic pregnancy
* PID
* testicular torsion
* rupture of ovarian cyst
* Left iliac fossa pain
* diverticulitis - 2-3 day history
* constipation
* IBD
* pylonephritis
* Flank pain
* stones - unilateral pain
* UTI
* muscular
* ruptured AAA
43
what questions should about abdominal pain?
* associated with foods?
* NSAID use
* cough?
* haematemesis
* recent vomiting
* pain getting worse or better?
* any jaundice
* any itchiness
* IBS
* diarrhea/constipation
* can you pass gas?
* risk factor for thromboembolism - ischaemic bowel
* meckels diverticulum/appendicitis?
* diverticulitis stuff?
* skin symptoms = crohns
* weight loss
* history of smoking
* gynae questions
* ovulation?
* period?
* chance of pregnancy
*
44
Investigations for acute abdominal pain?
* physical exam: guarding/rigidity/ rebound tenderness
* erythema nodosum (IBD)
* clubbing
* abscess
* pallor
* ascites
* jaundice
* bowel sounds
* murphys sign
* bloods:
* FBC
* CRP
* amyase/lipase
* AST/ALT
* GGT
* albumin
* creatinine
* glucose - pancreatitis induced lack of insulin
* troponin - MI
* bilirubin - elevated conjugated with jaundice
* pregnancy test
* bedside
* ultrasound
* ECG
* urinalysis - UTI
* Imaging
* erect CXR
* abdominal X ray
* CT
* SPecial tests
* endoscopy
* colonoscopy
45
what differentials do you have for haematemesis?
* esophagitis
* bleeding ulcer
* esophageal varices
* mallory weiss tear
* esophageal cancer
* gastric cancer
* trauma
* aorto-enteric fistula
46
what questions should you ask about haematemesis?
* how much blood
* any malaena
* forceful vomiting (mallory weiss tears)
* weight loss
* swallowing problems (malignancy)
* epigastric pain
* heartburn or reflux
* aortic repair in the past
* NSAID use
* excessive alcohol consumption
* liver failure symptoms: puffy ankles, easy bruising , distended abdomen, lethargy, methotrexate use, IVDuser(hep c)
47
What investigations would you perform for haematemesis?
* physical exam
* jaundice, scratch marks, spider naevi, palmar erythema, caput medusae
* abdominal scar (AA repair)
* cachectic = cancer
* any malaena
* bloods
* FBC (anaemia)
* albumin (liver disease)
* AST/ALT/GGT/ALP - liver function
* bilirubin
* INR - raised in liver failure
* hepatitis and HIV serology
* glucose
* tox screen, blood alcohol levels
* imaging
* chest X ray
* ultrasound liver
* fibro scan - liver cirrhosis
48
Differentials for rectal bleeding?
* anorectal
* haemorrhoids
* rectal/anal tumour
* anal fissure
* anal fistula
* rectal varices
* proctitis
* colon
* diverticular diseas
* colitis
* IBD
* tumour
* C.dif
* ileum/jejunum
* meckel's diverticulum,
* crohns
* celiac
* small bowel tumour
* upper GI
* PUD
* varices
* gastritis
* mallory weiss tears
* aorto-enteric fistula
49
what specific questions should you ask about rectal bleeding?
* color of blood
* how much blood
* with a bowel movement
* mucus (colitis)
* character of blood
* haematochezia (fissure and heamorroids)
* malaena (upper GI)
* on top of stool (sigmoid, anorectal)
* mixed in with stool (IBD, colitis, colon tumour)
* on toilet paper only (haemorrhoids)
* blood passed after stool (colitis, diverticular diseae, rectal tumour)
* pain
* prolapse
* tenesmus
* forceful vomiting
* recent weight loss
* SOB or fatigue (anaemia)
* light headedness, syncope (anaemia)
* recent colonoscopy
* coagulation disorder
50
what investigations shoudl you perform in rectal bleeding circumstance?
* physical: pulse and BP, anaemia signs, DRE (malaena, frank blood or palpable masses)
* bloods: FBC (anaemia and platelets), INR (clotting abnormality),
* imaging: proctoscopy and sigmoidoscopy, colonoscopy, mesenteric angiography , CT angio, upper GI endoscopy, video capsule endoscopy
51
what are your differentials for constipation ?
* lack of fiber
* dehydration
* IBS
* medication induced (opiates)
* colorectal carcinoma
* strictures
* hypothyroid
* neurologic - diabetic neuropathy, MS, PD
* haemorrhoids, anal fissure
* hypercalcaemia
52
what are your differentials for diarrhea?
* infectious
* inflammatory
* IBD, crohns, IC
* diverticular disease
* Motility
* hyperthyroid
* IBS
* Anxiety
* malabsorption
* celiac
* obstruction overflow
* medication
* laxatives
* meformin
* antibiotics
* thiazide diuretics
53
what questions should you ask when patient presents with a change in bowel habit?
* severe/persistent
* no stool or flatus (obstruction)
* rectal bleed
* tenesmus
* weight loss
* night sweats
* hard lumpy (diet), mucoid stool (salmonella), smelly/floating (celiac disease or biliary insufficiency), pale (obstruction of biliary duct),
* nocturnal diarrhea (IBS)
* nausea/vomiting (obstruction)
* pain? relieved by bowel movement = IBS
* signs of hypothyroidism - reduced appetite, feeling cold
* signs of hyperthyroidism - anxiety, sweating, palpitations
* bone pain?
* recent travel - gastroenteritis or salmonella
*
54
what investigations would you do for a change in bowel habit?
* physical: clubbing (crohns/UC), erythema nodosum (Crohn's), dermatitis herpetiforms (celiac), virchows node , anal cancer/fistula, abdominal mass, DRE for a mass
* bloods: FBC (anaemia), ESR/CRP (crohn's UC), celiac antibodies, TFTs for thryoid function, glucose (diabetic neuropathy), albumin (chronic diarrhea)
* bedside - fecal occult blood, feces for culture, feces for C.dif toxin
* imaging - abdominal x ray, colonoscopy/sigmoidoscopy,
55
What are your differentials for nausea and vomiting?
* Neuro
* vertigo, pain, raised ICP, meningitis
* Blood
* medication, alcohol, hormones/pregnancy, electrolyte imbalance, toxin, poisoning, DKA
* Viscera
* GI obstruction, gastroparesis, diaphragm inflammation, liver, pancreas, gallbladder formation, appendicitis, pregnancy
* Infectious
* viral, bacterial or parasitic
56
What questions should you ask about nausea/vomiting?
* what does the vomit consist of
* is it worse in the morning (raised ICP)
* new onset?
* during eating hours?
* early satiety?
* abdominal discomfort?
* pain?
* fever
* headache
* visual disturbances
* vertigo
* difficulty walking
* constipation
* sick contacts
* foreign ravel
* new medications
* alcohol
57
what investigations should you do for nausea/vomiting?
* physical: peritonitis, reduced consciousness, meningism, abdominal distention, jaundice
* bloods : FBC, CRP, LFT, amylase, glucose, ketones, tox screen
* bedside: pregnancy test, supine X ray, abdominal CT endoscopy, fundoscopy (signs of raised ICP)
* imaging: plain X ray, endoscopy, colonoscopy
58
What are your differentials for jaundice?
Prehepatic
* haemolysis
* G6PDH deficiency
* artificial heart valve lysis
* DIC
* malaria
* spherocytosis
* sickle cell
hepatic
* hepatitis (viral or autoimmune)
* neoplasia
* Gilbert's disease (enzyme insuficiency)
* paracetamol overdose
post-hepatic
* CBD obstruction
* gallstone ileus
* budd chiari syndrome
59
what specific questions should you ask in a patient presenting with jaundice?
* where are you from?
* Pregnant?
* pain/
* itching?
* fever?
* diarrhea
* steatorrhea
* dark urine
* pale stool
* weight loss
* night sweats
* worse with fatty food?
* tattoos/ IVDU
* alcohol consumption
* uprotectd sex
* foreign travel- malaria and hepatitis
60
what investigations should you perform on someone with jaundice?
physical: jaundice, spider naevi, palmar erythema, clubbing, brusiing, ascites
Bloods: FBC, reticulocyte, bilirubin, LFTs, amylase, haptoglobins, LDH, blood film, viral hepatitis screen, CMV screening,
bedside: urinalysis - bilirubin in urine = post-heaptic, pregnancy test, abdominal ultrasound - liver cirrhosis and obstruction
imaging - MRCP
