CLUSTER QUESTIONING
CVS RESP
CCF SOB, SOBOE (exercise tolerance), Exac SOB
Orthopnea, PND, Ankle Oedema, Asthma/C Infectious – fever, cough, sputum
Peripheral Oedema OPD Non-infectious - ↑ SOB, need more
Fluid medication Ventolin; Hx of exac; smoker, ex-
smoker, baseline SOB/Ventolin use,
home O2? Steroids?
IHD Central, L sided chest pain, Pneumoni SOB
radiates to arm/neck/jaw/back a Fever, cough (productive vs non),
Pain worse w/ exertion vomiting, rigors
Associated N/V/SOB Chest pain
RF – HT, hypercholesterolaemia,
PHx, DM, FHx, Smoking, Indian,
Sri Lankan
Aortic Tearing, severe chest pain, Pulmonary SOBOE
Dissection radiates to back/shoulders Embolism Pleuritic chest pain
BP difference – pulsus paradoxus, RF - travel, surgery, past Hx, fam
radio-radial delay; hypertensive Hx, Ca, +/- fever; clear CXR, tender,
swollen calves
Rapid AF Hx of AF – Warfarin, sotalol, Pneumoth Chest pain
metoprolol, digoxin orax Younger
Dizzy Tall, thin Caucasian riding a bike
Chest tightness downhill; marijuana, ice, speed use
Triggers of infection
Pericardia Pleuritic chest pain, tachycardia, Arrhythmias Palpitations, unconscious collapse,
l Effusion SOBOE, hypotensive food/drink, dizziness, LOC, CP, SOB
or RF – young, concurrent viral type
Tamponad illness, pregnancy
e
GIT
Pancreatit Epigastric or central abdominal Biliary RUQ epigastric pain radiating to R
is pain radiating to back or in a Colic back +/- shoulder; constant w/
band around; severe pain exacerbations, PHx, FHx, female >
Hx of gallstones or EtOH in 72/24 male, obesity
GORD Epigastric pain w/ burning Cholecysti RUQ epigastric pain radiating to R
radiation up centre of chest tis back +/- shoulder; constant w/
Recent NSAID use exacerbations, PHx, FHx, female >
H pylori infection male, obesity
Chronic EtOH
Responds to pink lady, PPI, + Fever
rantidine
PUD Like GORD, but more severe +/- Cholangiti RUQ epigastric pain radiating to R
generalised abdominal pain s back +/- shoulder; constant w/
(perf); haematemesis, melaena exacerbations, PHx, FHx, female >
male, obesity
+ Fever + jaundice – Charcot’s Triad
AAA Epigastric or central abdominal Bowel Distended abdomen, but usually not
pain radiating to back; butt, lower Obstructio focally tender + BNO (bowels not
back n opened) + vomiting +/- Hx of surg,
Hypertensive Hx +/- hypotension, tympanic abdomen
tachycardia, abdo distention
Collapse – late sign Perforated – febrile, generally tender
to light touch
Appendici Central abdominal pain, localised Ascites Distended abdomen w/ increased
tis to RIF over 12-72 hrs weight
Fever, elevated CRP/WCC, normal +/- confusion, itchiness, jaundice,
FWT (full ward test of urine) EtOH, hep Hx, hepatic flap, dull
abdomen
Diverticul Hypogastric, LIF > RIF abdominal Spontaneo Ascites + fever + generally tender
osis pain, radiating to butt/lower back us to light touch
w/ fever in >40 y/o Bacterial
, Peritonitis
Ileocecal RIF abdominal pain + diarrhoea,
Crohns recurrent episodes +/- fever, +/-
FHx of Crohn’s
Stercocoli Focal opiate persistent tender
tis anywhere on abdomen w/
constipation
Oesophag Rare
eal Haematemesis + melaena
Rupture Hx of oesophageal Ca, surg,
strictures, dysphagia
Perforatio Haematemesis + melaena
n Febrile, tachycardia, hypotensive,
acute abdomen w/ generalised
peritonism
Haemorrh
oids
CRC
Anal
Fissures
IBD –
Crohns
IBD - UC
RHEUMATOLOGY
DDx – RA, OA, gout, pseudogout, PsA, viral arthritis, SLE, septic arthritis
Acute monoarthritis – Septic arthritis, gout, haemarthrosis, trauma, Baker’s cyst
Chronic monoarthritis – OA, PsA, reactive
Subacute/chronic polyarthritis – RA, SLE, OA, PsA, gout
OA –
Joint pain
Alleviating: Rest
Aggravating: Movement & weight bearing
Early morning stiffness <30min
Knees/hips
1st CMC
O/E – Bouchard’s Nodes (PIP), Heberdon’s Nodes (DIP), 1st CMC (squaring of thumb), DIP
involvement, collapse of CMS (inward facing thumb – advanced OA)
X-Ray – LOSS – Loss of joint space (eccentric), osteophytes (create nodes), subchondral
sclerosis, subchondral cysts
RA
Joint pain
Alleviating: Movement
Aggravating: Rest
Early morning stiffness > 1hr
Swelling
Raynaud’s/Carpal tunnel
O/E – Swan neck deformity, Boutinere deformity, Z thumb, deformities are irreversible/fixed,
ulnar deviation (at wrist or MCP joint), subluxation, interossei wasting, thenar and hypothenar
eminence wasting, DIP sparing, carpal tunnel (+ive Tinel’s/Phalen’s), Raynaud’s
X-Ray – eccentric joint space narrowing, erosions
SA
Fever, sweats, rigors
Swelling, erythema
RF – Hospital stays, skin breaches, prosthetic joints, recent procedures, DM, STI, IVDU
Gout
CVS RESP
CCF SOB, SOBOE (exercise tolerance), Exac SOB
Orthopnea, PND, Ankle Oedema, Asthma/C Infectious – fever, cough, sputum
Peripheral Oedema OPD Non-infectious - ↑ SOB, need more
Fluid medication Ventolin; Hx of exac; smoker, ex-
smoker, baseline SOB/Ventolin use,
home O2? Steroids?
IHD Central, L sided chest pain, Pneumoni SOB
radiates to arm/neck/jaw/back a Fever, cough (productive vs non),
Pain worse w/ exertion vomiting, rigors
Associated N/V/SOB Chest pain
RF – HT, hypercholesterolaemia,
PHx, DM, FHx, Smoking, Indian,
Sri Lankan
Aortic Tearing, severe chest pain, Pulmonary SOBOE
Dissection radiates to back/shoulders Embolism Pleuritic chest pain
BP difference – pulsus paradoxus, RF - travel, surgery, past Hx, fam
radio-radial delay; hypertensive Hx, Ca, +/- fever; clear CXR, tender,
swollen calves
Rapid AF Hx of AF – Warfarin, sotalol, Pneumoth Chest pain
metoprolol, digoxin orax Younger
Dizzy Tall, thin Caucasian riding a bike
Chest tightness downhill; marijuana, ice, speed use
Triggers of infection
Pericardia Pleuritic chest pain, tachycardia, Arrhythmias Palpitations, unconscious collapse,
l Effusion SOBOE, hypotensive food/drink, dizziness, LOC, CP, SOB
or RF – young, concurrent viral type
Tamponad illness, pregnancy
e
GIT
Pancreatit Epigastric or central abdominal Biliary RUQ epigastric pain radiating to R
is pain radiating to back or in a Colic back +/- shoulder; constant w/
band around; severe pain exacerbations, PHx, FHx, female >
Hx of gallstones or EtOH in 72/24 male, obesity
GORD Epigastric pain w/ burning Cholecysti RUQ epigastric pain radiating to R
radiation up centre of chest tis back +/- shoulder; constant w/
Recent NSAID use exacerbations, PHx, FHx, female >
H pylori infection male, obesity
Chronic EtOH
Responds to pink lady, PPI, + Fever
rantidine
PUD Like GORD, but more severe +/- Cholangiti RUQ epigastric pain radiating to R
generalised abdominal pain s back +/- shoulder; constant w/
(perf); haematemesis, melaena exacerbations, PHx, FHx, female >
male, obesity
+ Fever + jaundice – Charcot’s Triad
AAA Epigastric or central abdominal Bowel Distended abdomen, but usually not
pain radiating to back; butt, lower Obstructio focally tender + BNO (bowels not
back n opened) + vomiting +/- Hx of surg,
Hypertensive Hx +/- hypotension, tympanic abdomen
tachycardia, abdo distention
Collapse – late sign Perforated – febrile, generally tender
to light touch
Appendici Central abdominal pain, localised Ascites Distended abdomen w/ increased
tis to RIF over 12-72 hrs weight
Fever, elevated CRP/WCC, normal +/- confusion, itchiness, jaundice,
FWT (full ward test of urine) EtOH, hep Hx, hepatic flap, dull
abdomen
Diverticul Hypogastric, LIF > RIF abdominal Spontaneo Ascites + fever + generally tender
osis pain, radiating to butt/lower back us to light touch
w/ fever in >40 y/o Bacterial
, Peritonitis
Ileocecal RIF abdominal pain + diarrhoea,
Crohns recurrent episodes +/- fever, +/-
FHx of Crohn’s
Stercocoli Focal opiate persistent tender
tis anywhere on abdomen w/
constipation
Oesophag Rare
eal Haematemesis + melaena
Rupture Hx of oesophageal Ca, surg,
strictures, dysphagia
Perforatio Haematemesis + melaena
n Febrile, tachycardia, hypotensive,
acute abdomen w/ generalised
peritonism
Haemorrh
oids
CRC
Anal
Fissures
IBD –
Crohns
IBD - UC
RHEUMATOLOGY
DDx – RA, OA, gout, pseudogout, PsA, viral arthritis, SLE, septic arthritis
Acute monoarthritis – Septic arthritis, gout, haemarthrosis, trauma, Baker’s cyst
Chronic monoarthritis – OA, PsA, reactive
Subacute/chronic polyarthritis – RA, SLE, OA, PsA, gout
OA –
Joint pain
Alleviating: Rest
Aggravating: Movement & weight bearing
Early morning stiffness <30min
Knees/hips
1st CMC
O/E – Bouchard’s Nodes (PIP), Heberdon’s Nodes (DIP), 1st CMC (squaring of thumb), DIP
involvement, collapse of CMS (inward facing thumb – advanced OA)
X-Ray – LOSS – Loss of joint space (eccentric), osteophytes (create nodes), subchondral
sclerosis, subchondral cysts
RA
Joint pain
Alleviating: Movement
Aggravating: Rest
Early morning stiffness > 1hr
Swelling
Raynaud’s/Carpal tunnel
O/E – Swan neck deformity, Boutinere deformity, Z thumb, deformities are irreversible/fixed,
ulnar deviation (at wrist or MCP joint), subluxation, interossei wasting, thenar and hypothenar
eminence wasting, DIP sparing, carpal tunnel (+ive Tinel’s/Phalen’s), Raynaud’s
X-Ray – eccentric joint space narrowing, erosions
SA
Fever, sweats, rigors
Swelling, erythema
RF – Hospital stays, skin breaches, prosthetic joints, recent procedures, DM, STI, IVDU
Gout
