Focused History PDF

Focused History Dr. Ahmed Laymouna  Hemoptysis 50-year-old man presented to the ER because of coughing of blood. What would you like to ask this patient regarding his symptom ?  Hemoptysis Differential diagnosis of hemoptysis: - Pulmonary embolism, pulmonary h...

Focused History Dr. Ahmed Laymouna  Hemoptysis 50-year-old man presented to the ER because of coughing of blood. What would you like to ask this patient regarding his symptom ?  Hemoptysis Differential diagnosis of hemoptysis: - Pulmonary embolism, pulmonary hemorrhage - Bleeding disorders and blood thinning drugs (anticoagulants, antiplatelets, thrombolytic drugs) - Infections - Lung malignancies - Trauma - Autoimmune diseases  Hemoptysis Introduce yourself, take permission Ask about age, occupation, smoking  Hemoptysis Analysis of complaint: - DD between hemoptysis and hematemesis Hemoptysis Hematemesis Colour Bright red and Dark red or frothy brown Consistency May be mixed May contain with sputum food particles Symptoms Accompanied May be by coughing preceded with nausea  Hemoptysis Analysis of complaint: - OCD, smoking - Amount of blood (need blood transfusion or hypotension) - Previous attacks - Associated symptoms  Hemoptysis Other chest/cardiac symptoms: - Shortness of breath - Palpitations - Syncope, dizziness - Lower limb swelling - Fever - Family history of bleeding disorders, malignancy  Hematemesis 52-year-old man presented to the ER because of vomiting of blood. What would you like to ask this patient regarding his symptom ?  Hematemesis Differential diagnosis of hematemesis: - Peptic ulcer disease - Malignancy - Arterial malformation - Trauma - Liver cirrhosis - Splenic vein thrombosis - Bleeding disorders - Blood thinning drugs  Hematemesis Introduce yourself, take permission Ask about age, occupation  Hematemesis Analysis of complaint: - DD between hematemesis and hemoptysis Hemoptysis Hematemesis Colour Bright red and Dark red or frothy brown Consistency May be mixed May contain with sputum food particles Symptoms Accompanied by May be coughing preceded with nausea  Hematemesis Analysis of complaint: - OCD - Amount (Need blood transfusion, fainting) - Colour - Previous attacks  Hematemesis Other symptoms: - Melena - Bleeding tendency elsewhere - Nausea - LL edema - Weight loss - Jaundice - Fever - Abdominal pain - Disturbed concious level  Hematemesis Risk factors: - History of HBV, HCV - Drugs - Bleeding tendency - Past history of liver cirrhosis, bleeding tendency, peptic ulcer disease - FH of bleeding disorders, hereditary GIT problems  Melena 65-year-old man presented to the ER because of vomiting of blood. What would you like to ask this patient regarding his symptom ?  Melena Differential diagnosis of melena: - Peptic ulcer disease - Malignancy - Arterial malformation - Trauma - Liver cirrhosis - Splenic vein thrombosis - Bleeding disorders - Blood thinning drugs  Melena Introduce yourself, take permission Ask about age, occupation  Melena Analysis of complaint: - OCD - Amount (Need blood transfusion, fainting) - Colour - Previous attacks  Melena Risk factors: - History of HBV, HCV - Drugs - Bleeding tendency - Past history of liver cirrhosis, bleeding tendency, peptic ulcer disease - FH of bleeding disorders, hereditary GIT problems  Melena Other symptoms: - Hematemesis - Bleeding tendency elsewhere - Nausea - LL edema - Weight loss - Jaundice - Fever - Abdominal pain - Disturbed conscious level  Chronic Cough 52-year-old man presented to the ER because of vomiting of blood. What would you like to ask this patient regarding his symptom ?  Chronic Cough Differential diagnosis of chronic cough: - Chronic bronchitis - GERD (gastro-esophageal reflux) - Bronchial asthma - Bronchiectasis - Interstitial pulmonary fibrosis - Drugs (ACEIs)  Chronic Cough Introduce yourself, take permission Ask about age, occupation, smoking  Chronic Cough Analysis of complaint: - OCD - Expectoration - Fever - Positional - Diurnal - Exposure to fumes or dust - Relieving factors (bronchodilators)  Chronic Cough Associated symptoms: - Dyspnea, orthopnea, PNDs - Palpitations - Wheezes - Chest pain - Cyanosis - Syncope - LL edema  Chronic Cough Risk factors: - Smoking, exposure to fumes or dust - GERD - Chronic sinusitis - Malignancy - Bronchial asthma - Past history of infections (TB), autoimmune disease (sarcoidosis), malignancy - FH of AI disease, malignancy, bronchial asthma  Jaundice 50-year-old man presented to the ER because he noticed recent discoloration of his eyes and skin. What would you like to ask this patient regarding his symptom ?  Jaundice Differential diagnosis: - Pre-hepatic: Hemolytic jaundice (autoimmune, drug-induced, infections, malignancy) - Hepatic: Liver cirrhosis, drugs, infections, malignancy - Post-hepatic: stones, pancreatic malignancy, cholangitis  Jaundice Introduce yourself, take permission Ask about age, occupation  Jaundice Analysis of complaint: - OCD - Previous attacks Associated symptoms: - Fever - Abdominal pain - LL edema - Abdominal distension - Hematemesis, melena - Disturbed concious level - Anemic manifestations (palpitations, dyspnea, dizziness, syncope) - Weight loss  Jaundice Risk factors: - Risk factors of liver cirrhosis (HBV, HCV, alcohol, AI hepatitis, cholangitis, drugs like methotrexate) - Travel history (malaria) - AI disease diseases (auto-immune hemolytic anemia) - Malignancy  Past history: gall bladder or pancreatic diseases FH: AI diseases, malignancies