What are your differentials for this person’s low mood?
How would you evaluate?
DDx:
- Hypothyroid
- Anaemia
- Nutritional deficiency
- Renal failure
How would you investigate this person’s weight loss?
Normal appetite
- catabolic state
- malabsorption issues
- Endo -> DM / hyperthyroid
Decreased appetite
- psychiatric
- medical (malignancy, organ failures, chronic infection, chronic inflammation)
- drugs
How would you investigate this person’s SOB?
a
How would you investigate this person’s recurrent CP?
DDx:
- Cardiac -> IHD, pericarditis, aortic stenosis
- Resp -> PTx, infection, PE, COPD/asthma, cancer
- GIT -> GORD
- MSK -> costochondritis
- Psych -> anxiety
- Anaemia
Ix:
- Examination
- ECG
- Bloods: troponin, FBE, D-Dimer
- CXR
- CTPA
- Cardiac stress testing
- Consider echo
How would you investigate this person’s diarrhoea?
DDx:
- Infection
- Inflammatory
- Malabsorption
- Malignancy
Infective
○ Stool MCS + OCP
○ C.diff toxin if relevant, can check AXR for toxic megacolon
Malabsorptive ○ Faecal elastase ○ Coeliac serology ○ Fat soluble vitamins / iron ○ TFT
Inflammatory
○ Faecal calprotectin (high)
○ CRP / ESR
Malignant
○ CT
○ C’scope + biopsy
How would you investigate this person’s fatigue?
a
How would you investigate this person’s dizziness?
Neuro:
- Vertigo
- > central
- > peripheral
Cardiac:
- Postural hypotension
- arrhythmia
- valvular
Severe deconditioning
How would you investigate this person’s foot drop?
a
What are your differentials for ascites?
Liver -> portal hypertension Cardiac -> RHF Renal -> nephrotic syndrome Malignancy Infection -> TB
I would differentiate these based on ascitic fluid results, with cell count / cytology / culture
Serum to ascites albumin ratio will also determine if portal HTN is present (>11)
How will you evaluate this person’s peripheral neuropathy?
DDX
- Toxic -> Drugs, ETOH
- Metabolic -> DM, TFT, B12, uraemia, paraprotein
- Autoimmune -> CIDP, CTD, HIV
- Compressive -> radiculopathy
EMG / NCS -> determine axonal (reduced amplitude) / demyelinating (slow velocity) / myopathy
Consider spinal imaging
Consider LP in demyelinating pattern
How would you evaluate this person’s headache?
Tension Migraines SOL IIH Autonomic encephalgias Cerebral sinus thrombosis
How would you evaluate this myopathy?
DDx: CTD -> autoimmune myositis Toxins -> ETOH, steroids Endocrine -> thyroid, cortisol Malignant -> paraneoplastic
Ix:
CK
EMG
Muscle biopsy
How would you investigate this person’s weight loss?
Appetite increased?
- thyroid
- DM
- malabsorption
Decreased appetite?
- malignancy
- chronic inflammatory state / organ failure
- chronic infection
- psychiatric illness
How would you Ix Nausea?
Meds GI -> inflam -> infection -> GORD -> malignancy CNS Mood Metabolic
