Documentos de Académico
Documentos de Profesional
Documentos de Cultura
DDs in Surgery
Dysphagia
1. Oesophageal stricture Could you by any chance have taken something corrosive in your
mouth?/ Swallowing substances that harm the lining of the esophagus, such as household
cleaners, lye (Caustic Soda), disc batteries, or battery acid
2. Strictures Are you on any antacid? Could lead to Barretts Oesophagus
3. GERD Did you have burning sensation in chest or under the breastbone after meals/ Feel-
ing that food is stuck behind the breastbone/ Increased by bending, stooping, lying
down, or eating/ More likely or worse at night/ Relieved by antacids/ Nausea after
eating
4. Achalasia Cardia Do you bring up water when you drink?
5. Pharyngeal Pouch How do you feel about your mouth odour/ pillow spoiling in the morning?
6. Myasthenia Gravis Do you have difficulty in swallowing at the end of the day?
7. Globus Hystericus Do you have a sensation of lump in your throat if young female
8. Post-procedural (Endoscopy) Have you recently been gone through any procedure?
9. Ca Oesophagus Swallowing difficulty for solids and liquids/wt loss/abnormal swellings/smoking history/racing of the heart?
10. Peptic esophagitis Mostly in immunocompromised.
Abdominal Pain
In Females
Ectopic Pregnancy Are you sexually active? /When was your last Menstrual Period? / Is it normal for you? / Could you be pregnant by any chance? / When did you
have your last intercourse/was it protected? /Do you always use safe sex? /Are you
on any contraceptives?
Pelvic Inflammatory Disease Fever/Change In discharge down below/pain goes to
back?
Ovarian Torsion Severe throbbing pain/ US history of fluid filled sacs
In Males Testicular torsion, Acute Epidydimo-orchitis
Haematuria
1. Renal Calculi - sudden onset of excruciating/cramping pain in low back /or side, groin, or abdomen/Changes in body position do not relieve this pain/ nausea and vomiting./worst pain
of their lives/even worse than the pain of childbirth or broken bones/ Kidney stones also
characteristically cause blood in the urine/If infection is present in the urinary tract along
with the stones, there may be fever and chills/difficulty urinating/urinary urgency/penile
pain/ or testicular pain may occur due to kidney stones.
2. Ureteric Calculi - severe colicky loin to groin pain /Pain may radiate into scrotum in men and
labia in women /May also cause frequency, urgency and dysuria
3. Urinary Bladder Calculi - lower tummy pain / how is your urine stream?/ In men, pain or discomfort in the penis/ Painful urination/ Frequent urination, especially during the night/ Difficulty urinating or interruption of urine flow/ Blood in your urine/ Cloudy or abnormally
dark-coloured urine
4. UTI Fever with lower tummy pain with burning sensation while passing urine/vomiting
5. Renal Ca. blood in urine/pain in the flanks/Mass in the flank/wt. loss/fatigue/loss of appetite/fever/night sweet/malaise /anaemia
6. Bladder Ca. blood in urine/urinary urgency/pain on urination/back or abdominal pain/loss
of appetite and weight/ask about profession/smoking has strong association
7. Schistosomiasis swimming in the lakes
8. Prostatitis - Increased urinary frequency and urgency during day and night /Fever, chills,
nausea and vomiting /Pain in the lower abdomen, lower back, pelvis and genital area /Blood
in urine /Pain with ejaculation /Pain with bowel movement /Pain or burning sensation when
urinating
9. Post-surgery/instrumentations Have you been gone through any instrumentation recently
10. Bleeding Disorders - Have you been diagnosed with any blood disorder/diseases?
11. Blood Thinners Are you on any blood thinning medications?
Urinary Obstruction
Important Differentials Diagnose for PLAB2 | 4/2/2012
/difficulty in starting or stopping the urine flow /inability to urinate /weak, decreased or interrupted urine stream /a sense of incompletely emptying the bladder /burning or pain during urination /blood in the urine or semen /painful ejaculation
5. U T I - Fever with lower tummy pain with burning sensation while passing urine/vomiting
6. STI - Discharge from the penis, vagina or anus /Pain or discomfort when urinating /Pain during sex /Abnormal or unusual vaginal bleeding /Lumps and bumps on the genitals /Genital
sores /genital itching /Genital irritation or pain /Rash on genitals
7. Post-procedural Urethral Stricture Have you gone through any procedure recently?
8. Drug Induced (Anticholinergic, Antidepressants) By any chance are you on any medication?
Treatment of UTI:
General measures
A high fluid intake is essential. Alkaline substances, such as citrates, taken in water might improve
symptoms.
Antibiotic therapy
Trimethoprim (e.g. Monotrim) is currently the first choice for lower UTI in the UK, because it's costeffective, well tolerated and works in 80 per cent of infections.
Cephalosporins, nitrofurantoin and norfloxacin are reserved as second line drugs in patients with
lower UTI. But they are the first choices in patients with signs of upper UTI or kidney infection.
A lithotripter machine in an operating room. Other equipment is seen in the background, including
an anesthesia machine and a mobile fluoroscopic system (or "C-arm").
Most stones less than 5 millimeters (0.20 in) pass spontaneously. Prompt surgery may, nonetheless,
be required with persons with only one working kidney, bilateral obstructing stones, a urinary tract
infection and thus, it is presumed, an infected kidney, or intractable pain. Beginning in the mid1980s, less invasive treatments such as Extracorporeal shock wave lithotripsy (ESWL), ureteroscopy,
and percutaneous nephrolithotomy began to replace open surgery as the modalities of choice for
the surgical management of urolithiasis.
Testicular Pain
Trauma what were you doing when you experienced this pain?
Epidydimo-orchitis Fever, redness, painful, discharge, history of temperature
Testicular Torsion recent onset of severe pain and stay same while lifting up testes
Bladder Calculi Does your urine stream suddenly stop when you go to loo?
U T I Have you noticed burning sensation while passing water with fever and possible nausea or vomiting?
6. Obstructed Inguinal Hernia Did you have a swelling in your groins which used to disappear
at its own but now it hasnt gone away for the last few days?
7. Ureteric Colic Do you feel a severe and restless pain which goes from your loin to groin/tip
of your penis or water pipe?
8. Orchitis due to Mumps Did you have redness of your cheeks and swelling of your face 4-6
weeks ago, either unilateral or bilateral/with fever?/Painful inflammation of the testicles/headache/ may affect either one of both testicles/
1.
2.
3.
4.
5.
***The testes usually get infected about 4-6 days after the mumps infection. The mumps
virus has a tendency to spread to other parts of the body and loves to go to the testes. The
typical features of a mumps virus induced orchitis include: - concurrent throat infection swelling of scrotum soon after the throat infection - swelling of one side of the scrotum
(70% of cases) - both testes affected (30% of cases) besides the mumps virus, numerous
other viruses can also cause orchitis. Rarely, mumps orchitis can occur after vaccination
with the mumps, measles and rubella vaccine.
*** Symptoms of epidydimo-orchitis usually develop quickly - over a day or so. The affected epididymis and testis swell rapidly, and the scrotum becomes enlarged, tender, and red.
It can be very painful.
Ulcer / Mole
1.
Malignant Melanoma Is it dark skin around with shiny & firm nodules/ Wt. loss with
anaemia may be or may be not?
Asymmetrical skin lesion/Border of the lesion is irregular/Color: melanomas usually have
multiple colors/Diameter: moles greater than 6 mm are more likely to be melanomas than
smaller moles/Enlarging: Enlarging or evolving /A change in an existing mole
A small, dark multi-coloured spot with irregular borders - either raised or flat - that
may bleed and form a scab
A cluster of shiny, firm dark bumps
Having a diameter larger than a pencil rubber
4.
5.
6.
7.
8.
9.
10.
Diabetic Ulcer - Have you been diagnosed with a condition called diabetes?
Venous Ulcer on medial malleolus/associated with varicose veins/ blue discolouration
Tubercular Ulcer Low grade fever/wt. loss/cough/Did you travel to TB rampant area?
Pressure sores Have you been immobile for a long period of time?
Post traumatic ulcers Did you hurt yourself where the ulcers are?
H I V Kaposis Sarcoma - Drug and sexual history?
Arterial Ulcer (v v v v v rare)
Management
1.
2.
3.
4.
5.
Management of BPH
Lifestyle
Patients should decrease fluid intake before bedtime, moderate the consumption of alcohol and caffeine-containing products, and follow timed voiding schedules.
Medications
The two main medications for management of BPH are alpha blockers and 5-reductase inhibitors.
Alpha blockers (technically 1-adrenergic receptor antagonists) are the most common
choice for initial therapy in the USA and Europe. Alpha blockers used for BPH include
doxazosin, terazosin, alfuzosin, tamsulosin, and silodosin. All five are equally effective
but have slightly different side effect profiles. Alpha blockers relax smooth muscle in the
prostate and the bladder neck, thus decreasing the blockage of urine flow.
The 5-reductase inhibitors finasteride and dutasteride are another treatment option.
These medications inhibit 5a-reductase, which in turn inhibits production of DHT, a
hormone responsible for enlarging the prostate.
Antimuscarinics such as tolterodine may also be used, especially in combination with
alpha blockers. They act by decreasing acetylcholine effects on the smooth muscle of
the bladder, thus helping control symptoms of an overactive bladder.
Sildenafil citrate shows some symptomatic relief, suggesting a possible common etiology with erectile dysfunction.
Herbal remedies
Saw palmetto extract from Serenoa repens is one of the most extensively studied. It showed promise
in early studies, though later trials of higher methodological quality indicated no difference from
placebo.
Minimally invasive therapies
Medication is often prescribed as the first treatment option; there are many patients who do not
achieve success with this line of treatment. transurethral microwave thermotherapy (TUMT) and
transurethral needle ablation (TUNA). Both of these procedures rely on delivering enough energy to
create sufficient heat to cause cell death (necrosis) in the prostate. The goal of the therapies is to
cause enough necrosis so that, when the dead tissue is reabsorbed by the body, the prostate shrinks,
relieving the obstruction of the urethra.
Surgery
If medical treatment fails, and the patient elects not to try office-based therapies or the physician
determines the patient is a better candidate for transurethral resection of prostate (TURP), surgery
may need to be performed. In general, TURP is still considered the gold standard of prostate interventions for patients that require a procedure. This involves removing (part of) the prostate through
the urethra.
Post-surgery care often involves placement of a Foley catheter or a temporary prostatic stent to
permit healing and allow urine to drain from the bladder.
DDs in Medicine
Hematemesis
*** (If there is lot of blood loss then questions about anaemia (racing of heart, fatigue, and cold &
pale peripheries)
Ask about bright colour or coffee colour vomits
1. Oesophageal Varices (Liver Disease) - alcohol history/Have you been drinking for long?
2. Ca. Oesophagus
- CA questions/wt. loss/abnormal swellings/racing of the heart?
3. Mallory Weisz Tear
- did you binge drink/did you have retching/ are you on painkillers
4. Ca. Stomach
- Fullness and loss of appetite
5. Oesophagitis
- Heart burn while lying down
6. Acid Peptic Disease
-Tummy pain associated with meals/Painkillers
7. Gastric Erosion
- Are you on any painkillers
8. Liver Disease
- Have you been diagnosed with liver disease?
9. Bleeding Disorders
- Have u been diagnosed or have family history
10. Blood Thinners
- Are you on blood thinners
11. Instrumentation
-Have you recently been gone through any procedure?
12. Smoking and family history of carcinoma By any chance do you smoke/What?/how long?
Chest Pain
1. Acromegaly
10
Dry Cough
*** Do you bring up any Phlegm? /How much phlegm do you bring? /Any specific smell or odour/
Have you noticed any blood
1. Asthma / Cardiac Asthma depending on age
- Have you been diagnosed with asthma
recently? Wheeze associated with cough?
Did you have asthma as a child? Cough
gets worse when you go to bed? Whistling
sensation in your lungs?
2. Smoking
- Do you smoke at all?
3. U R T I
- Runny nose with fever
4. H I V Pneumocystis Jerovecii
- Have you been diagnosed with HIV?
5. Atypical Pneumonia
- travel history/drug abuse/sexual history
6. Allergy
- By any chance are you allergic to anything?
7. Occupational
- What do you do for Living?
8. ACE-inhibitors (age)
- Medication history
9. Post nasal drip
- feeling of running something from nose
to your mouth/ trickling sensation behind
your throat
10. Interstitial lung disease
- Occupational/coalmine/shipyard worker
Authored by: Sarmad Kazmi 30/03/2011
Hoarseness of Voice
* Any loss of weight/racing of your heart/excessively tired/have you noticed any abnormal swellings
1. Smoking History v v v imp. How long and how much per day?
2. Vocal Abuse
-singer, teacher, football match/ concert
3. U R T I
- Runny nose, fever and cough?
4. Laryngitis
- pain in throat with fever
5. Trauma (Sec to instrumentation or post - surgery)
6. Hypothyroidism
- Three questions
7. Ca. Larynx
- Wt. loss, swelling and anaemia questions
8. Haematamesis
- Coughing blood
Sore Throat
1.
2.
3.
4.
5.
6.
7.
8.
9.
11
Mumps
Swelling and redness over the cheeks/low grade fever
Measles
Vomiting , diarrhoea and rashes on the body
Chicken Pox
Rashes on the body with slight lethargy/comes in crops/fever
Glandular Fever (Infectious mononucleosis) Painful swelling (glands on the neck, armpits and
groins) with fever, headache and weakness
Bacterial Tonsillitis due to streptococcus Severe pain on swallowing, redness in the throat,
high fever
Irritants Pollen, dust, change of weather, smoking have you been exposed to them?
Allergic conditions Hay fever Ask relevant questions?
Excessive use of voice singers & teachers
tumours Back of tongue, throat & Vocal cords
Ear Ache
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Trauma
Wax Impaction
Foreign Body
Mastoiditis
Otitis Externa
Otitis Media
Perichondritis
Ramsay Hunt Syndrome
Barotrauma
Boil and furuncle
Loss of Consciousness
1. Sub-arachnoid Haemorrhage - Sudden/ severe/ worse occipital pain/ with vomiting/Neck Stiffness
2. Trauma to head did you hurt yourself?
3. Meningitis
- Severe Headache/high grade fever/rash/shying away from light/neck stiffness
4. Epilepsy
- Have you been diagnosed with epilepsy?
5. Stroke
- Do you have weakness in your body and how long it last for?
6. T I A
- Do you have weakness in your body and it lasted for less than 24 hours?
7. Arrythmias
- Have you been diagnosed with heart conditions
8. Vasovagal Syncope Have you been standing for a long time? Did you go pale before you fall?
9. Hypotension
- Are you any hypertensive medication?/ ringing sensation with tunnel vision
10. Hypoglycaemia
- Diagnosed with diabetes/ Family history? / Excessively thirsty?
11. Diabetic Keto Acidosis fruity smell with dehydration
12. Alcohol did you drink too much?
13. Recreational Drugs Do you take recreation drugs?
Headache
12
1. Meningitis
- Shy away from light/ fever/ neck stiffness/ rash/ vomiting
2. Sub Arachnoid Hhage Sudden/ severe/ worse occipital pain/ with vomiting/Neck Stiffness
3. Giant Cell Arteritis
- Throbbing pain on the side of head/ visual impairment/ worse on
touching
4. Space Occupying Lesion worsening headache over time/ early morning sickness/ visual impairment/ weakness in the body? Get relieved when you puke?
5. Acute Congestive Glaucoma Headache in the back of the eyes? / Colourful rings Halos)? / Redness of eye? Get worse by Amytriptrypline?
6. Migraine Have you been diagnosed with migraine? / Aura/ painkillers
7. Cluster Headache Specific time? / Night? / Remissions/ relapses/ red eye/ unilateral tearing
8. Tension Headache Band like pain/ worst towards the end of the day/ stressful job?
9. Sinusitis Does the pain increase on bending forwards with fever?
10. Trauma Could you have hurt yourself?
11. Stressful Job Do you think that you have a busy and stressful job?
Red Eye
1.
2.
3.
4.
5.
6.
Trauma
- Did you hurt yourself?
Foreign Body
- Do you think something has gone in your eyes by chance/accident?
Conjunctivitis
- did you have matting of your eye/eyes when you woke up this morning?
Subconjunctival Hhage - Have you been diagnosed with high blood pressure?
Uveitis Bowl Habits and back pain either due to IBD or Ankylosing spondylitis
Acute Congestive Glaucoma- Severe headache/pain in the back of your eyes/nausea and vomiting/ Blurred vision and/or seeing haloes around lights (Haloes and blurred vision occur because
the cornea is swollen.)/ profuse tearing ***
7. Rheumatoid Arthritis Do you have pain in your joints early in the morning?
8. Cluster Headache Does your headache come after a certain time?
9. Systemic Lupus Erythematosis Have you noticed any butterfly rash on your face/body?
10. Ankylosing Spondylitis Does your pain go away as the day progresses? Young male patient.
11. Reiters Do you have pain in your joints with trouble passing urine?
12. Inflammatory Bowel Disease Have you noticed change in bowel habits with skin and joint
changes?
Back Ache
Remember DISCTOMA
1. Disc Prolapse Do you feel numbness in any part of your body? Did you hurt yourself?
2. Infections
3. Secondaries
4. Cauda Equina
5. Trauma
6. Osteoarthritis
7. Multiple Myeloma Anaemia/ back pain/fatigue
8. Ankylosing Spondylitis
9. Dysmenorrhoea / P I D
10. Dissecting Aneurysm
Fever
Did you measure your temperature? How is the pattern? Any associated symptoms?
1. Meningitis
2. Malaria Fever/ chills / rigors/did you travel to malaria rampant country at all?
3. Ear Infections 4. U R T I
5. Pneumonia
6. Tuberculosis
7. Gastroenteritis
8. Hepatitis
9. Pelvic Inflammatory Disease
10. Urinary Tract Infection
11. Epidydimo-orchitis
13
Calf Pain
Remember BBC DR SET And Do SOCRETES PDA
1. Bakers Cyst
2. Bergers Disease
3. Claudication
4. Deep Vein Thrombosis
5. Ruptured Achilles Tendon
6. Sciatica
7. Excessive Walking
8. Trauma
9. Sports Injury
10. Cellulitis
Haemoptysis
***Assess Anaemia
1. Pulmonary Embolism 2. Pneumonia 3. Tuberculosis 4. Bronchiectasis months of cupful of pus like sputum per day/crackles/finger clubbing/posture
related
5. Cystic Fibrosis repeated chest infections and diarrhoea
6. C O P D Long history of cough/breathlessness/wheeze with exacerbation over hours to days
with pursed lips
7. Ca. Bronchus 8. Bleeding Disorders 9. Blood Thinners 10. Instrumentation -
Knee Pain
**Remember GHRROSS
***Do SOCRETES PDA
1. Gout
2. Heamarthrosis
3. Reiters red eye and urethritis
4. Reactive Arthritis history of diarrhoea
5. Osteoarthritis
6. Septic Arthritis fever/ redness/tenderness/swelling
7. Sports Injury
Elderly Constipation
14
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
Acute Diarrhoea
1.
2.
3.
4.
5.
6.
Gastroenteritis
Infectious Diarrhoea
Food Poisoning
Pseudo Membranous Colitis
Medications (Alcohol/ Digoxin/ Laxative abuse)
Travellers Diarrhoea
Chronic Diarrhoea
1.
2.
3.
4.
5.
6.
7.
8.
9.
Malignancy
HIV
Inflammatory Bowel Disease
Irritable Bowel Syndrome
Malabsorption ( Celiac / Chr. Pancreatitis)
Parasitic diarrhoea tummy pain relieved on open bowl
Hyperthyroidism
Diabetes Neuropathy
Lactose intolerance
Weight Loss
15
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
Malignancy
Malnutrition
Malabsorption
Hyperthyroidism
Diabetes Mellitus
HIV
TB
IBS
IBD
Anorexia Nervosa
Bulimia Nervosa
Depression
Diplopia
Remember GM4C SHIRT
1. Inflammatory Orbital Myositis - fever/ swelling around eyes/ pain on moving your eyes
2. Refractory Error Do you wear glasses at all?
3. G C A Do you feel pain while combing your hair or either by touching your head?
4. Myasthenia Gravis Do you feel excessively tired towards the end of the day?
5. Multiple Sclerosis weakness/ coordination/ strength/loss of bladder and bowl control
6. Muscle Palsy Do you see double in a particular direction?
7. Malignancy Have you recently lost weight?/Have noticed any abnormal swellings?/any racing
of your heart?
8. Cataract (2o to DM or Steroids) Have you been diagnosed with a condition known as diabetes?
9. Space Occupying Lesion early morning heading worst in the morning and relived by puking?
10. Hyperthyroidism -Do you feel hot in the same environment where others are comfortable?
11. Trauma Did you hurt yourself by any chance?
Vomiting
***Assess Dehydration
***Feeling more thirsty/Low urine output/Dry lips
1. Pregnancy -*(If female patient)
2. Head Injury
3. Meningitis
4. S O L
5. Migraine
6. Antibiotics
7. Food Poisoning
8. Accidental Poisoning
9. Intestinal Obstruction
10. Gastroenteritis
11. Acute Pancreatitis
12. Diabetic Keto Acidosis
13. Ureteric Colic
14. U T I
1.
2.
3.
4.
5.
6.
16
Anaemia
Hypothyroidism
Myasthenia Gravis
Malignancy
Depression
Shift Workers
Palpitations
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
Hyperthyroidism
Hyperventilation
Hypoglycaemia
Cardiac Disorders
Arrhythmias
Excessive Alcohol
Caffeine
Stress
Fear
Anxiety
Pheochromocytoma
Salbutamol
Sore Throat
1.
2.
3.
4.
5.
6.
7.
8.
9.
Mumps
Measles
Chickenpox
Glandular fever
Streptococcus A
Hay Fever
Pollens/ Dust/ Change of weather/ Smoking
Ca. (Back of tongue, throat, vocal cords)
Excessive use of voice
Anaemia
1.
2.
3.
4.
5.
6.
7.
8.
Malnutrition
Malabsorption
Malignancy
Malaria
Bleeding/vomiting/cough/menstruation/bruises/delayed wound healing
Chronic renal failure
Rheumatoid Arthritis
Drugs Antacids/Steroids/Blood thinners
Vertigo
17
1.
2.
3.
4.
5.
6.
7.
8.
Menieres Disease
- Tinnitus/decreased hearing loss/fullness in ear
Acoustic Neuroma
- Numbness and change in facial features
Benign Positional Vertigo
Wax
Trauma
Vertibrobasilar Insufficiency- Due to hyperextension of the neck/shoulders
Cereobropontine angle tumour Ototoxicity - Gentamicin/Anticonvulsants
Hot Flushes
1. Natural Menopause 2. Premature ovarian failure age below 40/ history of surgery/radiotherapy/family history of
the same condition
3. Medullary Carcinoma Neck mass with weight loss
4. CA Pancreas Painless jaundice, dark coloured urine, pale stools, age>60
5. Brain tumours Headache, feeling sick worse by cough and sneeze
6. Pheocromocytoma Headache, palpitations, sweating, High Blood Pressure
Osteoporosis (Causes/DD)
1. Family history
2. Early Menopause
3. Steroids (Very Important)
4. Sedentary Life style
5. Smoking
6. Alcohol
7. Rheumatoid Arthritis
8. Thyroid disease
9. Cushing Disease/Syndrome
10. Primary Biliary Cirrhosis
18
Causes of Dysuria
UTI
BPH
Stones
DDs in OB-GYN
Dysmenorrhoea
1.
2.
3.
4.
5.
6.
7.
Menorrhagia
***Assess Anaemia
1. Pregnancy
2. Fibroids
3. Endometriosis
4. Polyps
5. Ca. Endometrium
- Weight Loss and HOVAC
6. Ca Cervix
- Cervical smear
7. I U C D, Instrumentation
8. Hypothyroidism
9. Bleeding Disorder
10. Medications (Blood Thinners)
11. Dysfunctional Uterine Bleeding
12. Ruptured ovarian cyst - Pain and past medical history
13. Vaginal Atrophy
- Painful intercourse
19
Amenorrhoea
1.
2.
3.
4.
5.
6.
7.
Pregnancy
Post-Pill Amenorrhoea.
Lactational Amenorrhoea
Uterine Ashermans
Ovarian P C O S, Ovarian Failure
Endocrine Cushings, Hyperthyroidism, Anorexia, Prolactinoma, Sheehans, Stress.
Imperforate Hymn
Infertility
MALE
1. Undescended Testes
2. Mumps/orchitis
3. Medications
4. Medical conditions / Surgeries
5. Tight underwear
6. Trauma
7. torsion of testis
8. hernia
9. UTI
FEMALE
1. P C O S
2. Endometriosis
3. Prolactinoma
4. Cushings
5. Hyperthyroidism
6. Sheehans
7. Ashermans any instrumentation/operations down below?
8. PID
9. Premature ovarian Failure
Hyper emesis
20
Incontinence
1.
2.
3.
4.
5.
6.
7.
8.
9.
True Fistula
Stress
Urge
Prolapse
UTI
Habitual
Medications Water tablet?
Medical conditions (DM)
Atrophic Vaginitis
Vaginal Discharge
Colour
Amount
Smell
Consistency
Pruritus
Any blood
Pain
Fever
Relation to cycles
Swelling in groin area
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
21
DDs in Paediatrics
Uncontrolled Epilepsy
1.
2.
3.
4.
5.
Meningitis
Head Injury
Non Accidental Injury
U R T I / U T I / Ear Infections
Hypoglycaemia
Excessive Crying
1.
2.
3.
4.
5.
6.
7.
8.
9.
Meningitis
Intussusceptions
U R T I / U T I / Ear Infections
Non Accidental Injury
Trauma
Hunger
Wet Diaper
Smoker around / Asthma / Irritation?
Infantile Colic
RASH
22
Head Injury
1.
2.
3.
4.
NAI
Accidental
Diabetes Mellitus
Epilepsy
Hypoglycaemic Fit
1.
2.
3.
4.
5.
Meningitis
Epilepsy
NAI
Accidental Injury
U R T I / U T I / Ear Infections does your child cry while passing wee?
Vomiting in Infant
*Any sunken part on his head/constipation/ dryness of mouth/ passing less urine than normal)
1.
2.
3.
4.
5.
6.
7.
8.
9.
Meningitis
Pyloric Stenosis
Duodenal Atresia
Intussusceptions
Head Injury
NAI
U R T I / U T I / Ear Infections
GERD
Over-feeding
*Assess dehydration first; (sunken eyes/constipation/ dryness of mouth/ passing less urine
23
than normal)
1. Meningitis
2. Intestinal Obstruction constipation/ wind passing
3. Diabetic Keto Acidosis fruity odour
4. Head Injury
5. N A I
6. Gastro-enteritis
7. Accidental Poisoning
8. U R T I / U T I / Ear Infections
Loss of Consciousness
1.
2.
3.
4.
5.
6.
7.
8.
Meningitis
Epilepsy
Diabetic Keto Acidosis
Head Injury
Non Accidental Injury
Accidental Poisoning
Vaso-vagal Syncope
Cyanotic Heart Disease
Celiac Disease
Cystic Fibrosis repeated chest infection with diarrhoea
Parasitic Infection
Lactose Intolerance
Long term medications
Toddlers Diarrhoea
Febrile Convulsions
24
1.
2.
3.
4.
5.
6.
Head injury
Meningitis
U T I / U R T I / Ear Infections
Pneumonia
Epilepsy
Hypoglycaemia
Neonatal Jaundice
Vaginal discharge
1.
2.
3.
4.
5.
6.
7.
8.
NAI
Foreign body
Trauma
Candidiasis common in extreme of ages
Poor hygiene
Diabetes
Immunocompromised Splenectomy or diabetes
possible infections
Cervical lymphadenopathy
25
Complications of Measles
1. Diarrhoea
2. Vomiting
3. Conjunctivitis
4. Laryngitis
5. Meningitis
6. Pneumonia
7. Bronchitis
8. Aseptic meningitis
9. Hepatitis
10. Otitis media
11. Sub Acute Sclerosing Encephalitis
Complications of Mumps
1.
2.
3.
4.
5.
6.
Orchitis
Pancreatitis
Encephalitis
Meningitis
Hearing Loss
Miscarriage
Growth retardation
Cataract
Deafness
Congenital Heart Defects
Mental retardation
Bracelets
SAD APE
S Steroids
A Asthma
D Diabetes
A Allergies
P Post Splenectomy
E Epilepsy
1.
2.
3.
4.
5.
6.
26
DDs in Psychiatry
Depression
1.
2.
3.
4.
5.
6.
7.
Drug Abuse
27
OR
Withdrawal - Do you get the same symptoms if you dont get it?
Dependence Do you feel the same without it?
Tolerance Do you feel as time passes by you need to increase
the amount you take to get the same effect?
OCD
Phobias
Panic attacks
GAD
Panic Attacks
1.
2.
3.
4.
5.
6.
28
Depression
Phobias
PTSD
GAD
OCD
Stress
*Include DD of Palpitations
Anorexia Nervosa
1.
2.
3.
4.
5.
6.
Diabetes mellitus
Malignancy
Malabsorption
Hyperthyroidism
Depression
HIV
Insomnia
1. Depression
2. Mania
3. GAD
4. PTSD
5. OCD
6. Stress
7. Panic Attack
8. Psychosis
9. Grief
10. Caffeine
11. Noise
12. Light
13. Medicine
14. Alcohol
15. Recreational drugs
16. Shift worker
17. Pain/Headache
18. Heart Burn
19. Shortness of Breath
20. Nocturia
21. Cough
29
Good advice
UTIs are rare in men, so all cases require investigation. Prostatitis, the infection or inflammation of the prostate (a gland beneath the bladder that produces some components of
semen), causes symptoms that can be mistaken for UTI in men.
30
The most important factor in maintaining the sterility of the urinary tract is emptying the
bladder completely and frequently.
The cause of most UTIs is bacteria that initially settle (colonise) around the urethra (urine
tube), and then ascend into the rest of the urinary tract.
Several factors can make this process more likely to occur.
Obstruction:
Enlarged prostate
Gland urethral stricture (narrowing)
Neurological conditions:
Spina bifida
Multiple sclerosis
Spinal cord injury
Foreign body:
instrumentation (i.e. during a procedure)
Catheters and stents
Underlying disease:
Diabetes
Steroid therapy.
UTIs are classified as either community acquired or hospital acquired. 70 per cent of infections are community acquired, usually caused by the bacteria Escherichia coli (E coli) from
the patient's own bowels.
Hospital acquired infections are usually E. Coli, but Pseudomonas and Staphylococci are important causes, particularly when a surgical instrument such as a catheter is used; instrumentation is the predisposing factor.
31
Hospital infections can often be due to multiple organisms, and antibiotic resistance is a
common problem.
The symptoms of upper urinary tract infection are the same as lower tract symptoms plus
loin (flank) pain, fever and chills. The patient is likely to be ill and might require hospital admission.
Antibiotic therapy
32
Recurrent UTI
If UTIs keep occurring, identification and treatment of the underlying cause is essential. Patients who
have the same infection coming back can be managed successfully by attending to 'bladder toilet'
(drinking 2 to 3 litres of fluid daily and always passing urine at bedtime and after sex).
Drinking 250 to 500ml of cranberry juice daily and avoidance of bubble baths may also help. If these
measures fail, six months of continuous therapy with low dose antibiotics is usually required.
2. Beta-adrenergic blockers
Timolol ophthalmic (Timoptic, Timoptic XE) /Carteolol ophthalmic (Ocupress)/Levobetaxolol
(Betaxon)/Levobunolol (AKBeta, Betagan)
3. Alpha-adrenergic agonists
Apraclonidine (Iopidine)/Brimonidine (Alphagan, Alphagan-P)
4. Corticosteroids
Prednisolone ophthalmic (AK-Pred, Econopred)
6. Hyperosmotics
Glycerin (Osmoglyn)/Isosorbide (Ismotic)/Mannitol (Osmitrol)
Ovarian Torsion
Definition
Ovarian torsion is the twisting of the ovary due to the influence of another condition or disease. This
results in extreme lower abdominal pain.
33
Description
Ovarian torsion occurs infrequently only in females. In can occur in women of all ages, but most
women that experience this are younger. Approximately 70-75% of cases occur in women under 30
years old. About 20% of all reported cases are in pregnant women. It is the fifth most common gynaecological emergency which can include surgical intervention.
Ovarian torsion usually arises in only one ovary at a time. They can occur in either normal or enlarged ovaries or fallopian tubes, and occasionally they develop in both.
The characteristic symptom of ovarian torsion is the sudden onset of extreme lower abdominal pain
that radiates to the back, side and thigh. Nausea, vomiting, diarrhoea, and constipation can accompany the pain. The patient may also experience tenderness in the lower abdominal area, a mild fever
and tachycardia.
Diagnosis
The diagnosis of ovarian torsions usually occurs in an emergency room due to the suddenness of extreme pain. Emergency room physicians may consult with another physician specializing in obstetrics
and gynaecology. Since 20% of ovarian torsions occur in pregnant women, physicians will order a
pregnancy test. Visualization with an ultrasound and CT scan (computed tomography) will help pinpoint the ovarian structures and allow physicians to diagnose. Diagnosis is often confirmed through
laparoscopy.
Treatment
Ovarian torsions need to be repaired. This is done through surgery, and for less severe cases laparoscopic surgery is used. Medications such as NSAIDs are given to control pain.
Prognosis
If ovarian torsions are diagnosed and treated early, then the prognosis is favourable. However, if
diagnosis is delayed, the torsions can worsen and cut off arterial blood flow into and venous blood
flow out of the ovary. This results in necrosis (death) of the ovarian tissue. Delayed diagnosis can
also result in problems when trying to conceive due to infertility.
Prevention
Currently, there are no known methods for prevention of ovarian torsion.
34
35
1. Isolation
Somebody present
Somebody nearby, or in visual or vocal contact
No one nearby or in visual or vocal contact
2. Timing
Intervention is probable
Intervention is not likely
Intervention is highly unlikely
3. Precautions against discovery/intervention
No precautions
Passive precautions (as avoiding other but doing nothing to prevent their
intervention; alone in room with unlocked door)
Active precautions (as locked door)
4. Acting to get help during/after attempt
Notified potential helper regarding attempt
Contacted but did not specifically notify potential helper regarding attempt
Did not contact or notify potential helper
5. Final acts in anticipation of death (will, gifts, insurance)
None
Thought about or made some arrangements
Made definite plans or completed arrangements
6. Active preparation for attempt
None
Minimal to moderate
Extensive
7. Suicide Note
Absence of note
Note written, but torn up; note thought about
Presence of note
8. Overt communication of intent before the attempt
None
Equivocal communication
Unequivocal communication
Self-Report
9. Alleged purpose of attempt
To manipulate environment, get attention, get revenge
Components of above and below
To escape, surcease, solve problems
10. Expectations of fatality
Thought that death was unlikely
Thought that death was possible but not probable
36
responsibility
Intentional intake of drug in order to facilitate implementation of attempt
15-19 Low Intent
20-28 Medium Intent
29+ High Intent
There is also a greater risk of repeated attempts the higher the intent rating
37
The risk of suicide in patients with mental disorders is higher than that for patients without
co-existent mental disorders. Although figures as high as 15% have been reported in people
with depression, the actual value is much lower. The original 15% represented in patients
with severe depression and the actual figure is probably more around 3%.
Suicide is a major cause of death in schizophrenic patients and it is thought that up to 1 in
10 patients with schizophrenia will eventually commit suicide.4
of the scale looks at the patient's thoughts and emotions at the time of the attempt
and the other questions are about the circumstances around the attempt.
The PATHOS score may be used to identify high risk patients after an overdose:
38
It is important to remember that scales of risk, although helpful, have a poor predictive value. Therefore, if you have a patient who you are worried about but they
score low, then still consider urgent referral for them.
39
6. Suicide note
None
Note torn up
Presence of note
7. Lethality
Thought would not kill
Unsure if lethal action
Believe would kill
8. Stated intent
Do not want to die
Unsure
Wanted to die
9. Premeditation
Impulsive
40