STEP 2 CS symptoms and presentation

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1. COSTOCHONDRITIS 3. PLEURITIC PAIN

(TREITZ (PE,PNEUMOTHOTAX,PLEURAL
SYNDROME) EFFUSION,PNEUMONIA,PLEURISY)

HX:
HX: -localized sharp pain
-hx of pain on touching the spot -hx of chest pain with coughing/
-pain increases on mvmt and breathing inspiration
-assc. redness -breathlesness
-fever -h/o possible fever,cough,sputum -
PE: production,hemoptysis
-tenderness on local spot -h/o chronic smoker
-pain on movement of thorax or deep PE:
breathing -location;localized pain increased on
-redness deep inspiration or cough
-local warmth -quality sharp
-fever -breathlessness
2. GERD -fever
-no local tenderness
-restriction of chest movement on the
side of pain (inspection)
-tracheal deviation
4. MUSCULOSKELETAL
(RIBS/MYALGIA)

HX:
-hx of epigastric pain radiating to chest
-pain wosened by food intake-(late
night ,meals,caffeine)
-relieved by antacids
-regurgitation of food into mouth
-usually obese pt
-hoarsenss,sore throat,cough HX:
-pain in midchest -h/o injury/fall
PE: -hx of pain on touching the spot
epigastric tenderness -pain increase on mvmt n breathing
rebound tenderness+ -assc. redness
-warmth
PE:
-tenderness at local spot
-redness
-warmth
-swelling
5. PERICARDITIS 7. PULMONARY
EMBOLISM

HX:
-HX OF FEVER/RECENT INFECTION(URI)
HX:
-PAIN INCREASES WITH INSPIRATION
-hx of prolonged immobilization
-PATIENT FEELS RELIEVED OF PAIN ON
-hx of calf muscle pain
LEANING -FORWARD /SITTING UP
-sudden onset chest pain increased on
-INCREASE PAIN ON LYING DOWN FLAT
exertion and deep breath ,not relieved on rest
-sob
PE:
-cough with blood tinged sputum
-PRECORDIAL CHEST PAIN
-swelling on one leg/bluish discoloration
-SHARP STABBING CHEST PAIN
-LOW GRADE FEVER
PE:
-PERICARDIAL RUB
-breathlesness
6. AORTIC -tachycardia
DISSECTION -sweating
-signs of hypoxia
-swelling on one leg/bluish discoloration
8. ANEMIA
HX:
-known hypertensive
-sharp tearing pain down the spine/back
-syncopal attack(loc)
-sob
-sweating
-sudden loss of vision,weakness/paralysis of
one side of body like stroke
PE:
-hypotension
-unequal bp btw arm
-weak pulse in one arm compared to the
other
HX:
-racing of heart
-dizzy
-fatigue
-sob
PE:
-pale
-koilonychia
-tachypnea
9. HYPERTHYROIDISM 10. PANIC ATTACK

HX:
-heat intolerance
-sweating
-racing of heart HX:
-tremors discrete periods of intense fear or
-diarrhea discomfort
-visual disturbances abrupt and peak within 10 mins
-weight loss despite increase appetite + ≥4 -->
-fear of dying or "going crazy"
PE; -CP or chest discomfort
-exophthalmus -palpitations
-sweaty skin -SOB
-tremors of outstreched hand -dizziness
-sweating
-nausea
-abd. pain or discomfort
-trembling
-depersonalization

PE:
-anxious,
-tachycardia,
-tachypnea
11. PHEOCHRMOCYTOMA

HX:
-RAPID HR
-profound sweating
-abd pain
-sudden onset ha
-pale skin
-weight loss

PE:
HIGH BP
SWEATING
TENDERNESS ABDOMNE
PALE SKIN
12. CHF 14. LUNG HX
INFECTION -fever
-breathlessness
-palpitation
-restriction of movement of chest affected
site
-pain on deep inspiration
-h/o recent uri-sorethroat runny nose
PE:
-anxious,dyspnea pt,toxic looking
hx:
-tachycardia,tachypnea,fever
-proggresive breathlesness/exertional
-decrease chest expansion
dyspnea
-dullness on percussion
-h/o paroxysmal nocturnal dyspnea or
-bronchial breathing with/ without crepitation
orthopnea
-cough -frothy sputum +- blood 15. COPD HX;
-swelling of foot -EXERTIONAL DYSPNEA OR DYSPNEA AT
-fatigue REST
-h/o of existing heart/valvular disease, high -CHRONIC SMOKER
BP(know htn),IHD -HX OF CHRONIC COUGH WITH
-distension of abdomen EXPECTORATION
-PROLONG EXPIRATION(MAYBE ASS WITH
PE; WHEEZING)
-GENERAL EXAM:DYSPNEA/CYANOSIS -CYANOSIS(ADVANCED CASES)
/ELEVATED JVP
-VITALS: HIGH BP PE:
-FROTHY BLOOD TINGED SPUTUM -DYSPNEA,RR INCREASE,ACCESSORY
-SWELLING OF FEET -PITTING PEDAL MUSCLE IN USE
-LUNGS: CREPITATIONS BOTH LUNG BASES -CHEST EXPANDED IN AP DIAMETER
-HEART:EVIDENCE OF BOTH LUNF BASES (BARREL CHEST)
- HEPATOSPLENOMEGALY(RHF) ASCITES -hyperesonant percussion note(emphysema0
-sign of bronchitis/bronchospasm
13. PULMONARY HX:
(wheeze,few creps)
EMBOLISM -hx of prolonged immobilization
- cyanosis
-hx of CALF MUSCLE PAIN
-sudden onset chest pain increased on 16. ASTHMA HX:
exertion and deep breath , not relieved on -ACUTE EPISODIC BREATHLESNES
rest (PLEURITIC CP) -WHEEZING
-SOB -COUGH WITH EXPECTORANTS
-cough with blood tinged sputum -THICK WHITE PLUG LIKE SPUTUM
-swelling on one leg/bluish discoloration -TREMORS/SHAKINESS
(DVT)
PE: PE:
-breathlesness -DYSPNEA,USE OF ACCESORY MUSCLEOF
-tachycardia BREATHING
-sweating -LUNGS,WHEEZE(RHONCHI)
-signs of hypoxia
-swelling on one leg/bluish discoloration
17. ACUTE HX: 21. EPILEPTIC HX:
RESPIRATORY H/O FOREIGN BODY ASPIRATION SEIZURE -sudden onset
OBSTRUCTION (LARYNS/TRACHEA) -before loc may be has feeling of something
unusual eg lights sounds smells
PE: -positive hx of shaking movements
-STRIDOR witnessed by someone
-WHEEZE -loss of bladder control.,tongue biting
-DYSPNEA -confusion after regaining of consciousness
-CYANOSIS (postical state)
-MARKED RECESSION OF -may be ass with ha
INTERCOSTAL MUSCLE PE:
-RESTLESNESS -marks of tongue biting
-no specific findings in complete
18. PNEUMOTHORAX HX:
neurological & cardiac exam
-sudden onset dyspnea
-history of underlying lung disease eg:tb 22. STROKE HX:
emphysema,trauma -HA
-SPEECH DIFFICULTIES
PE: -WEAKNESS & NUMBNESS
-dyspnea -KNOWN HYPERTENSIVE
-pmi/tracheal shift,decrease chest
expansion on affected side during PE:
respiration -TROUBLE WITH WALKING
-percussion: tympanic -WEAKNESS IN ONE SIDE OF THE
-breath sound absent BODY(DECREASE MUSCLE POWER)
-NUMBNESS IN ONE SIDE OF BODY
19. VASOVAGAL HX:
-BLURRED VISION IN ONE EYE
SYNDROME -SUDDEN LOC
-DEVIATED MOUTH WITH SMILING(OR
-INITIATED BY SUDDEN PAIN OR
OTHER CN PALSIES)
EMOTIONAL UPSET/TIGHT COLLAR
-QUICK RECOVERY AFTER FALL 23. ARRHYTHMIA

PE:
FEEBLE PULSE?
COLD PERIPHERAL?
LOW BP?
BRADYCARDIA?
20. ORTHOSTATIC HX;
(postural) - sudden loc on standing from
HYPOTENSION recumbent position (decrease bp and
cerebral blood flow) HX
-h/o use of antihypertensive -RACING OF HEART
medication(eg prazosin) -DIZZYNESS
PE; -LOC/NEAR FAINTING
orthostatic vitals? -SOB
-CHEST PAIN

PE:
-ANXIOUS PATIENT
-TACHYPNEA
-TACHYCARDIA
24. HYPOGLYCEMIA 26. AORTIC HX:
STENOSIS -SUDDEN LOC
-CHEST PAIN
-SOB
-EX INTOLERANCE

PE:
HX; -DYSPNEA
-DIABETIC ON RX -LOW VOLUME PULSE
-SWEATY -SYSTOLIC MURMUR WITH THRILL BEST
-DIZZY/LOC HEARD IN AORTIC AREA A1(2ND
-PALPITATION INTERCOSTALS SPACE R SIDE)
-TREMOR/SHAKINESS
27. HEAD TRAUMA HX:
-HUNGER
-HX OF TRAUMA
-IRRITABILITY OR MOODINESS
-HJX OF HITTING HEAD
-HA
-ASS SYMPTOIMS (NAUSEA &VOMITING)
PE:
PE:
-SWEATING
-LOCALIZED TENDERNESS ON
-ALTERED SENSORIUM
PALPATION OF THE HEAD
-SWEATY SKIN
-BRUISES/LACERATION OF SCALP
-ANXIETY
-FOCAL NEUROLOGICAL
-TREMORS
SYMPTOMS(DECREASE MUSCLE POWER
25. MYOCARDIAC HX: OF DECREASED SENSORY FUNCTIONS)
INFARCTION -CHEST PAIN RELATED TO
28. SEVERE HX;
EXRTION/STRENOUS WORKterm-25
ANEMIA -racing of heart
-LOCATION: PRECORDIUM /LEFT ARM
-dizziness
RADIATING PAIN
-sob
-QUALITY OF PAIN\; CHRUSHING
-fatigue
SQUEEZING ,DUL/SORE
-h/o loss of blood in stool,excessive flow
-N&V
during periods, hemolysis,bleeding pud or
-SWEATING
use NSAIDs,cleeding piles,etc
-HIGH
CHOLESTEROLEMIA,HT,DM(PREDISPOSING)
PE
-MAY HAVE BREATHLESSNESS ,SYNCOPE
-PALLOR
ATTACK(LOC),PALPITATION
-KOILONYCHIA
-SOCIAL HX:CHRONIC SMOKER
-TACHYPNEA
,ALCOHOLIC,ILLICIR DRUGS USED EX
COCAIUNE(PREDISPOSE) 29. HYPOGLYCEMIA HX
-DM PATIENT ON INSULIN TREATMENT
PE: -PALPITATION
-NO LOCAL TENDERNESS -SWEATING
-SWEATING -TREMOR/SHAKINESS
-BREATHLESNMESS -LOC
-COLD PERIPHERAL/CYANOSIS -DIZZINESS
-ANXIOUSNESS= SENSE OF IMOPENDING -HUINGER
DOOM -IRRITABILITY OR MOODINESS
-VITALS SIGN: HIGH BLOOD PRESSURE(OR -HEADACDHE
KNOW HT)
PE:
SWEATING
ALTERED SENSORIUM
ANXIETY TREMORS
30. DRUG INDUCE HX: 35. PROLACTINOMA
LOC - KNOWN HYPERTENSIVE
-ON MEDICATION SUCH AS
PRAZOSIN ETC

PE;
-LOW BP
-SIGNS OF DEHYDRATION (DRY SKIN
,THROat)
31. ALCOHOL ABUSE HX
-HX OF ALCOHOL ABUSE HX;
-MILK DISCHARGE FROM NIPPLES
PE\; -HEADACHE
-BREAH SMELL OF ALCOHOL -VISUAL PROBLEMS(NEAR HITS WHILE
-SIGN OF ALCOHOL INTOXICATION DRIVING ,BUMPING INTO OBJECTS)

32. ACUTE BLOOD HX;

PE:
LOSS -HX OF TRAUMA,ACCIDENT(INTERNAL
-BILATERAL HEMIANOPSIA
AND EXTERNAL BLEEDING)
-TACHYCARDIA 36. PREMATURE
OVARIAN
PE; FAILURE
-LOW BP
-COLD AND CLAMPY PERIPHERALS
33. PREGNANCY HX
-SEXUALLY ACTIVE FEMALE WHO
HAVE UNPROTECTED SEX
-BREAST TENDERNESS AND FULLNESS
-FREQUENT URINATION
HX:
-MORNING SICKNESS
-VAGINAL DRYNESS/ITCHINESS
-FEMALE OF REPRODUCTIVE AGE
-HOT FLASHES
-NIGHT SWEATS
PE:
-DECREASE LIBIDO
--
-EARLY MENOPAUSE IN MOTHER (OR
34. (PCOS) 1ST DEGREE RELATIVES)
POLYCYSTIC
37. ASHERMAN
OVARIAN
SYNDROME
SYNDROME

HX:
-HIRSUTRISM
-EXCESS FACIAL ACNE
-DEEPENING VOICE HX:
-OBESITY(H/O INCREASE IN WEIGHT) -OB/GYN SURGICAL PROCEDURE IN
THE PAST
PE: -H/O DIFFICULTY CONCEIVING
-OBESE PT
-FACIAL HAIR PE: LOW ABD PAIN
-EXCESS FACIAL ACNE
38. ANXIETY/STRESS HX: 42. menorrhagia-
RELATED -EMOTIONAL/ANXIOUS/STRESSED 2 FIBROID

PE:
-ANXIOUS PT
-TACHYCARDIA
-TACHYPNEA
39. ANOREXIA
NERVOSA

HX;
-abdominal discomfort/bloating/mass
-frequent urination
-difficulty defecation
-excessive bleeding per rectum
43. menorrhagia
3
hypothyroidism

HX
-FEMALE SEX
-EXCESSIVE PHYSICAL ACTIVITY
/STARVATION
-INTENSIVE FEAR OF GAINING WT
HX:
-RAPID DRAMATIC DECREASE IN WT
-fatigue
-FATIGUE/DECREASED
-increase sensitivity to cold
LIBIDO/HAIRFALL/INSOMNIA
-constipation
-ABSENCE OF PERIODS
-dry skin
-unexplained weight gain/puffy face
PE:
-thinning hair
-LOW BODY WT
-hoarseness
40. THYROID HX -heavier than normal or iregular menstrual
PROBLEMS -thyroid disease in the past(hyper or periods
hypo)
-hot/cold intolerance PE:
-sweaty/dry skin -obese pt
-wt loss /wt gain -decrease hr (BRADYCARDIA)
-diarhea/constipation -slowed tendon reflex ( < DTR)
-anxiety/fatigue -dry skin -thinning hair

PE
-moist/dry skin
-hand tremors
-exophthalmos
-swelling in the front of the neck
-hair loss
41. MENORRHAGIA - HX:
1 DUB -INCREASED BLEEDING DURING
MENSES
-INCREASED PADS
-PASSING OF CLOTS DURING
MENSES
-INTERMENSTRUAL BLEEDING
44. MENORHAGIA 47. MENORHAGIA
4 coagulopathy 7 ENDOMETRIAL
POLYP

HX;
-INTERMENSTRUAL BLEEDING
HX;
-DYSMENORHEA
-f/h/o bleeding disoder
-increased bleeding time following 48. MENORHAGIA
minor injuries 8 CERVICAL
POLYPS
PE:
bruises
45. MENORHAGIA
5 ENDOMETRIAL
CANCER

HX;
-INTERMENSTRUAL BLEEDING
-BLEEDING AFTER INTERCOURSE
49. MENORHAGIA
9 PID
HX;
-AGE>40
-EARLY MENARCHE/DELAYED
MENOPAUSE
-NULLIPOROUS
-INTERMENSTRUAL BLEEDING
-WT LOSS
-LOSS OF APEITITE
46. MENORHAGIA
6 CERVICAL
HX;
CANCER
-FEVER
-LOWER ABD PAIN
-VAGINAL DISCHARGE
-MULTIPLE SEXUAL PARTNER
-PREVIOUS STD
50. MENORHAGIA HX;
10. DRUG USE OF ANTICOGULATION
INDUCED (WARFARIN)
HX;
- BLEEDING AFTER INTERCOURSE
- VAGINAL DISCHARGE
- POSITIVE SMOKING HX
- MULTIPLE SEXUAL PARTNER
- ABNORMAL PAP SMEAR
51. DYMENORHEA 54. dysmenorhea
1. 4endometrial
ENDOMETRIOSIS polyp

-intermenstrual bleed,postmenopausal
bleed
HX; -dysmenorhea
-DYSMENORHEA 55. dysmenorhea
-DYSPARENUNIA 5 fibroids
-PAINFUL DEFECATION
-CHRONIC PELVIC PAIN
-INFERTILITY
52. DYSMENORHEA
2. ADENOMYOSIS

hx;
-abdomnial discomfort/bloating mass
-frequent urination
-difficult defecation

HX; 56. dysmenorhea

-chronic pelvic pain 6pelvic
-dysmenorhea congestion
-infertility syndrome
53. dysmenorhea
3.PID

pain before menses and relieved after

mense
57. postmenopausal hx;
bleed -vaginal dryness/itching
1. atrophic -dysparenunia
vaginitis -post coital bleeding
58. postmenopausal hx;
bleed -postmenopausal bleeding
hx; 2. endometrial -dysmenorhea
-fever & chills polyps
-lower abd pain
-foul smelling vaginal discharge 59. postmenopausal HX:
-multiple sexual partner bleed -postmenopausal bleeding
-previous STDs 3. endometrial -early menarche/late menopause
cancer -nuliparous
-weight loss
-loss of appetite

PE:
-obese pt
60. postmenopausal HX: 68. dysparenunia hx;
bleed -PT ON HORMONE REPLACEMENT 3.trauma/surgery -hx of trauma to the groin area
4. ENDOMETRIAL THERAPY(HRT) -hx of previous surgery ex
HYPERPLASIA -POSTMENOPAUSAL BLEED episiotomy,hysterectomy etc
61. postmenopausal HX; 69. dysparenunia hx;
bleed -BLEEDING AFTER INTERCOURSE 3pelvic pathology -h/o pelvi mass,disoriented anatomy eg,
5. CERVIX -VAGINAL DISCHARGE fibroids, retroverted fistula, prolapsed
CANCER -ABNORMAL PAP SMEAR uterus/bladder
-MULTIPLE SEXUAL PARTNER -heaviness lower belly
-POSITIVE SMOKIGN HX
70. dysparenunia hx;
62. postmenopausal HX; 4. vaginismus -h/o pain intercourse
bleed -FEVER -h/o spasm of pelvic muscles and
6. PID -LOWER ABD PAIN attempted intercourse
-MULTIPLE SEXUAL PARTNER -no specific organic
-HX OF STD symptoms/pathology
-FOUL SMELLING VAGINAL
71. dysparenunia hx;
DISCHARGE
5. UTI -h/o painful /burning micturition
63. POSTCOITAL -itching
BLEED -increase frequency micturition
1. cervical polyps
72. dysparenunia hx:
6. PID -fever
-lower abd pain
-foul smeeling vaginal discharge
-multiple sexual partner
hx -hx of std
-intermenstrual bleeding
73. dysparenunia hx;
-menorhagia
7.psychological/emotional -h/o psychological trauma,sexual abuse
-vaginal discharge
factors in the past
64. postcoital bleed hx -h/o anxiety,stress,low self esteem
2.CERVICAL -WEIGHT LOSS
74. vaginal discharge
CANCER -LOSS OF APETITE
1 cervicitis
-POSITIVE SMOKING HX
-FATIGUE
-MULTIPLE SEXUAL PARTNER
-ABNORMAL PAP SMEAR
-INTERMENSTRUAL/POSTCOITAL
BLEED
65. POSTCOITAL HX;
BLEED -FOUL SMELLING VAGINAL
3. CERVICITIS DISCHARGE hx;
4.VAGINITS -DYSPARENUNIA -mucopurulent dischage
-MULTIPLE SEXUAL PARTNERS -painful urination/intercourse
-PREVIOUS STD -unpleasant odor
66. DYSPARENUNIA HX; -bledding post intercourse/btw
1. INSUFFICIENT -H/O PAINFUL INTERCOURSE periods,after menopause
LUBRICATION -NOT ENOUGH AROUSAL THROUGH -multiple sexual partner
FOREPLAY -hx of std
-PERIMENOPAUSAL AGE GROUP
pe;
67. DYSPARENUNIA HX;
-local tednernessru
2. LOCAL -H/O PAINFUL DURING INTERCOURSE
INFECTION -REDNESS,SWELLING,ITCHING IN
VAGINA EG ECZEMA AND INFECTION
75. vaginal 79. RUQ pain
discharge 1. cholecystitis
2.vaginitis

hx;
-change in color,amount.odor of discharge
from vagina
-vagina itching/irritation
-pain during urination/intercourse
-spotting
76. vaginal
discharge
3 candidiasis
hx;
-sudden severe RUQ pain
-refered pain to epigastric region,R
upper scapula /back
-pain aggravated by fatty food eg pizza
fried food pies
hx -fever/chills
-itching/irritation in vagina/introitus -may be ass with N&V,bloating
-thick white odor free vagina
discharge(cottage cheese appearance) pe:
-soreness/redness/swelling of -abdominal tenderness
vulva/vagina -murphy sign positive
-burning sensation during intercourse -guarding/rebound tenderness RUQ
77. vaginal -fever
discharge 80. choledocholithiasis
4.trichomoniasis

hx;
-profuse,often foul smelling vagina
discharge
-yellow/grey/green discharge
-genital redness
-burning/itching with urination and
intercourse hx:
-suuden severe,paroxysmal pain RUQ
78. vaginal HX
lasting several minutes-hours
discharge -fever
-pain radiated to epigastrium ,back or
5. PID -lower abd pain
shoulder blades
-foul smelling vaginal discharge
-anorexia,nausea,vomiting(somethign
-hx of std
bilious), diaphoresis
-multiple sexual partner
-jaundice often
-fatty food intolerance and frequent
indigestion
81. cholangitis 84. pneumonia/pleurisy
right lobe lung

hx;
fever,ruq pain,jaundice

pe;
fever ,jaundice ,hypotension hx;
82. hepatitis hx; -localized sharp pain
-fever -h/o chest pain on coughing /inspiration
-ruq pain -breathlessness
-anorexia,vomiting -h/o possible fever,cough,sputum
-jaundice production,hemoptysis
-h/o chronic alcoholism,blood -h/o chronic smoker
transufsion/STD PE:
-localized pain increased on
83. hepatic/subdiaphragmatic
cough/deep inspiration
abscess
-sharp quLity
-breathlessnes
-fever
-no local tenderness
-restriction of chest mvmt on the side
on pain(inspection)
-tracheal deviation (possibly in real pt)
85. carcinoma gall
hx; bladder
-ruq pain
-fever
-breathlesness

PE:
-fever/toxic pt
tachycardia,tachypnea

hx:
-h/o ruq pain/mass
-h/o weight /appetite loss
-jaundice
-frequnt urination
pe:
-ruq tenderness,mass
-jaundice
86. fitz hugh 91. ovarian cyst hx
curtis -incidental findings
syndrome -rupture pain\9pelvic\0
-iregular menstrual cycle.menorhagia
-abd bloating
-dysparenunia
HX; -PCOS syndrome
-ruq pain (hirsuitism.obesity,acne,infertility)
-fever pe:
-h/o STD (salpingitis-ascending -palpable mass per abdomen
chlamydia/gonorhea infection) -ascites
PE: -look for sign of rupture
-RUQ tenderness -peritonitis,sepsis,and CA
87. RLQ PAIN Hx; 92. testicular hx
appendicitis -May start as periumbilical pain and then torsion -u/l scrotal pain as with taruma,activity
localized to RLQ pain -rarely voiding difficulties
-nausea PE;
-vomiting after pain -swollen,tender,high riding testis
pe; -fixed scrotal skin
-Mc burney point tenderness -non transilluminant
-psoas sign -diminished cremasteric reflex(same side)
-tachycardia
93. ureteral stone hx
-rovsing sign
-loin to groin pain
88. ectopica hx -back pain (renal stones)
pregnancy -pain -burning micturition
-amenorhea pe;
-vaginal bleeding fever
-other symptoms or early pregnancy no specific exam findings
pe;
94. gastritis/gastric hx
-features of shock in case of ruptured
erosion -burning pain in epigastric region
ectopic pregbnancy with diffuse guarding
-indigestion after food/belching
-cervical motion tenderness
-feeling of fullness after food(bloating)
89. PID hx -n/v (blood +- coffee ground vomitus,ass
-fever with malena)
-lower abd pain -h/o use of nsaids
-foul smelling vaginal discharge -loss of appetite and weight
-multiple sexual partner pe:
previous std -epigastric tenderness
90. IBD hx 95. peptic ulcer Hx:
-RLQ /diffuse abd pain altered bowel habits -pain in upper abdomen burning or
-blood/mucus in the stool gnawing type
-systemic symptoms like weight -gastric- pain after meals duodenal pain-
loss,fatigue(anemia),growth retardation etc pain relieved with food
pe; -temporary relief by certain foods/anatcis
-fevre/chills -other;upper gi
-arthrtitis bleed/malena/anemia/dysphagia/weight
-skin-pyoderma gangrenosum changes/early satiety
-dehydration,tachycardia -h/o chronic NSAID use(for chronic
-pallor pain/fibromyalgia/RA)
-extra intestinal symptoms eg pe;
iritis/episcleritis -epigastric/RUQ tenderness
-guarding(perforation)
96. GERD hx: 100. smalll bowel
-midline burning pain,epigastric or obstruction
substernal(heartburn)
-pain worst when supine/with tight cloth
-pain relieved with antacids
-regurgitation of food/sour liquid(acid refulx)
-dysphagia
-atypical symptoms: chronic dry cough,chest
pain,asthma,sore throat
pe;
-obese pt hx;
97. pancreatitis hx; -colicky pain
-midline pain radiate to the back -bilious vomiting
-h/o alcoholism or gallstones -abdominal distension
-n/v -diarhea
-possible fever/weight loss -fever
/jaundice/dehydration -h/o colonic/ovarian ca
pe h/o abdominal surgery
-tenderness upper abdomen pe;
-tachycardia -distension abdomen
-possible fever/jaundice/weight loss -hyperactive bowel sounds
/dehydration -hypoactive bowel sounds(late stages

98. Myocardial hx: 101. gastroenteritis hx:

infarction -chest pain, sob,N&V -h/o consuming contaminated food or
-loc water
-sweating pe;
-radiation of pain to l arm -watery darhea
pe: -n&v
-anxious pt -muscle aches
-tachypnea +/- -fever
-weak peripheral pulse/cyanosis.cold -abd pain/cramps
peripheries 102. ruptured aortic hx;
99. mesentric hx aneurysm -midline pain,generally asymptomatic
ischemia -n &v until rupture
-postprandial crampy pain -midline palpable periumbilical pulsatile
-blody stools mass
pe; pe;
-features of shock in later stages(low -rupture-shock and pain
BP,tachycardia) -low bp,tachycardia
-no specific p/e findings 103. LUQ pain hx
splenic abscess -fever/chills
-luq pain
-N & V
pe;
pleuritic pain, kehr sign
104. splenic rupture HX:
-luq pain
-h/o trauma/acicdents
-symptoms of loss of blood eg pallor,dizziness
-abd distension
PE:
-LUQ tenderness
-guarding
-abd distension
-low bp
-tachycardia
105. Septic Arthritis -FEVER
(Gonococcal arthritis) -Joint pain for 1 to 4 days
-SYNOVITIS (e.g., knee and
-TenosynovitisHANDS OR WRISTS
-SINGLE JOINT pain (ASSYmetric MIGratory)
-DERMATITIS (e.g., pustules-sores are slightly raised, pink to red, and
may later contain pus or appear purple)
-Pain or burning during urination