specific histories and differentials

general history tips

start with an open question

just some yes/no questions now

IV drug use

- ask do you share needles

- what drugs they use

- where they inject

ABDOMINAL PAIN causes

Gastrointestinal: oesophagitis, peptic ulcer (+/- perforation), gastroenteritis, splenic infarction/rupture, appendicitis, diverticulitis, bowel obstruction/ischaemia/perforation, IBD flare, hernia

Hepatobiliary and pancreatic: biliary colic, cholecystitis, cholangitis, acute hepatitis, acute pancreatitis

Genitourinary: UTI, prostatitis, pyelonephritis, testicular torsion, renal colic

Gynaecological: ectopic pregnancy, miscarriage, torsion of ovarian cyst, pelvic inflammatory disease, flare of endometriosis

Vascular: ruptured AAA

Other MI, DKA, malignancy of anything

abdominal pain history

think location (picture)

systems review:

- dysphagia

- vomiting, diarrhoea

- swollen abdomen

- blood in stool

- fever, night sweats, weight loss

drug history quite important

ask about diet

COUGH differentials

Acute

Upper respiratory tract infection (common cold)

Acute bronchitis

Pneumonia

Acute asthma exacerbation

COVID-19

Chronic

Chronic obstructive pulmonary disease (COPD)

Post-nasal drip

Gastroesophageal reflux disease (GERD)

Tuberculosis

Lung cancer

Other

ACE inhibitor use (persistent dry cough)

Heart failure (e.g., paroxysmal nocturnal dyspnea)

SHORTNESS OF BREATH differentials

*Respiratory*

* Asthma

* COPD exacerbation

* Pneumonia

* PE

* Pneumothorax

* Interstitial lung disease

* Lung cancer

❤️ *Cardiac*

* Congestive heart failure

* Acute coronary syndrome

* Arrhythmia (e.g. AF)

* Valvular heart disease

* Cardiac tamponade

* Pulmonary hypertension

*Hematologic*

* Anemia

*Metabolic*

* Diabetic ketoacidosis

* Sepsis (lactic acidosis)

* Renal failure (metabolic acidosis)

*Other*

* Anxiety/panic attack

CHEST PAIN differentials

- Cardiovascular; MI, Angina AAA, aortic dissection, Pericarditis,

- Pulmonary; Hyperventilation, Pneumonia, PE, Asthma

- GI; Peptic ulcer, Pancreatitis, Cholecystitis

- Musculoskeletal; Rib fractures, Cancer, Arthritis

- Others; Anxiety, Depression, Cocaine use

FEVER differentials

Infectious

Urinary tract infection (UTI)

Pneumonia

Gastroenteritis (viral, bacterial)

Sepsis (any source: UTI, pneumonia, skin, etc.)

Meningitis (esp. if neck stiffness, photophobia)

Endocarditis (with murmurs, risk factors like IV drug use)

Non-Infectious

Rheumatic fever (history of sore throat)

Autoimmune disease (e.g., lupus, vasculitis)

Malignancy (e.g., lymphoma, leukemia)

Drug fever (e.g., antibiotics, anticonvulsants)

HAEMATOCHEZIA differentials

Upper GI Bleeding

Peptic ulcer disease

Gastritis/duodenitis

Esophageal varices (in cirrhosis)

Lower GI Bleeding

Hemorrhoids

Anal fissure

Diverticular disease

Colorectal cancer

Inflammatory bowel disease (e.g., Crohn’s, ulcerative colitis)

Infectious colitis (e.g., Shigella, Campylobacter)

HAEMATURIA differentials

Renal Causes

Urinary tract infection (UTI)

Glomerulonephritis (e.g., post-streptococcal)

Nephrolithiasis (kidney stones)

(other things are related to trauma and bladder - more y5 stuff)

HEADACHE differentials

1. meningitis

2. trauma

3. GCA - scalp tenderness, loss of vision, jaw claudication

4. migraine

5. cluster headaches

6. tension type headache

7. subarachnoid haemorrhage

8. medication overuse

9. trigeminal neuralgia

10. normal pressure hydrocephalus

11. idiopathic intracranial hypertension

headache history

- ask about caffeine

- general lifestyle

- medication overuse

- triggers?

- how many headaches a week and how long do they last for

HEPATITIS questions

- travel

- sex

- lifestyle - alcohol, smoke,

-

FALLS causes

1. Environmental - not a problem due to health

2. Neuro - Parkinsons, stroke, anything visual

3. MSK - osteoporosis, arthritis

4. Cardiovascular - arrhythmias

5. UTIs - cause sudden movement

JAUNDICE differentials

🩸 Pre-hepatic (Increased Bilirubin Production – Hemolysis)

* Hemolytic anemia (autoimmune, hereditary spherocytosis, G6PD deficiency)

* Sickle cell disease

* Malaria

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🧫 **Hepatic (Liver Cell Dysfunction)**

* Viral hepatitis (A, B, C)

* Alcoholic hepatitis

* Drug-induced liver injury (e.g. paracetamol, anti-TB meds)

* Cirrhosis (e.g. alcoholic, NAFLD, hepatitis-related)

* Liver metastases or primary hepatocellular carcinoma

* Gilbert’s syndrome (benign, mild unconjugated hyperbilirubinemia)

---

🚧 **Post-hepatic (Obstruction to Bile Flow – Cholestasis)**

* Gallstones (especially choledocholithiasis)

* Pancreatic head or biliary tract cancer

* Primary sclerosing cholangitis (PSC)

* Primary biliary cholangitis (PBC)

* Biliary strictures or post-surgical obstruction

KNEE PAIN differentials

Mechanical/Orthopedic

Osteoarthritis (very common in older adults)

Ligament injury (ACL, MCL)

Meniscal tear

Patellofemoral pain syndrome (common in young adults)

Prepatellar bursitis

🔥 Inflammatory

Crystal arthritis (gout, pseudogout)

Rheumatoid arthritis (especially if bilateral, symmetrical)

🦠 Infectious

Septic arthritis

Reactive arthritis (post-infectious, often after GI/GU infection)

🧒 Paediatric/Other

Osgood-Schlatter disease (adolescents)

Slipped capital femoral epiphysis (referred pain in adolescents)

NECK PAIN DIFFERENTIALS

- meningitis, osteomyelitis, shingles

- malignancy

- trauma

- cervical disc prolapse

- degenerative cervical radiculopathy

- RA

- PMR

TIRED ALL THE TIME differentials

1. sleepiness: narcolepsy, obstructive sleep apnoea, insomnia, nocturia

2. mental health problems

3. endocrine: hypothyroidism, Addisons

4. malignancy

5. iron deficiency

6. rheum: SLE, RA

7. gastro related

8. cardiovascular/resp related

9. infective

TIRED ALL THE TIME history

what is the actual symptom

- sleepiness?

- exhaustion?

- weakness?

SR

- go through differentials

- hows sleep

- mood - hopeless, anhedonia

- periods

- fever, night sweats, weight loss

- joint/back pain

- change in bowel habit, changes in passing urine?

drug history

ask about lifestyle factors: caffeine, mood, *do you drive (important to notify dvla if diagnosed with obstructive sleep apnoea or narcolepsy)

VOMITING differentials

Gastrointestinal

Gastroenteritis (viral, bacterial)

Peptic ulcer disease

Gastritis

Bowel obstruction

Pancreatitis

Neurological

Increased intracranial pressure (e.g., brain tumor, meningitis)

Migraine

Metabolic

Diabetic ketoacidosis (DKA)

Renal failure (uremic vomiting)

Other

side effect of medication

WEIGHT LOSS differentials

Endocrine

Hyperthyroidism

Diabetes (uncontrolled)

Malignancy

Cancer (e.g., GI, lung, lymphoma)

Pancreatic cancer (often with jaundice)

Infections

Tuberculosis

Chronic HIV

Gastrointestinal

Malabsorption (e.g., coeliac disease, Crohn’s disease)

Peptic ulcer disease (with associated symptoms)

Psychiatric

Anorexia nervosa

Depression