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
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
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
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
5
Q
Breast Lump
A
- Breast Cancer
- Breast Abscess
- Fibroadenoma (mobile smooth lump)
- Fibrocystic changes
- Fat Necrosis (if after trauma)
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)
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
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
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
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
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
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
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
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
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
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
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
Swollen Leg
- 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
Muscle Weakness
- 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
Lower Back Pain
- 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
Falls
Assess for Polypharmacy and Dehydration
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
Nausea and Vomiting
- 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
Palpitation
- 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
RASH FRAMEWORK
- 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
Changes in Vision
- 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
Scrotal Swelling
- 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
Syncope/ Seizure
- 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
Urinary Incontinence
- 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
Vaginal Bleeding
Blood Thinners and Bleeding Disorders
- 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
Weight Loss
- Diabetes
- Hyperthyroidism
- Hypercalcaemia
- Infection
- Drug Culprit (Diabetes Medications, Diuretics, Topiramate)
- Cancers- Screen for Resp, Colon, PSA, LDH (for hodgkins)
- Depression or EATING DISORDER
38
Child with Joint Pain
SUFE
Perthes
Transient Synovitis
DDH
Septic Arthritis
- JIA
- Ewings Sarcoma
- Growing Pains
39
ENT
earache, irritation
deafness
discharge
tinnitus
vertigo
sore throat
- Fever, Cough, (Lymphadenopathy, Cervical Tenderness, Tonsillar Exudate)
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