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Common generalised histories

History taking > Common presenting complaints

Weight loss

Exploring symptom

  • How much
  • Over how long
  • Associated symptoms

Relevant system reviews

  • Gastrointestinal
    • Weight: appetite change
    • Work down body: dysphagia, nausea/vomiting, indigestion/heartburn, abdominal pain, bowel habit change, tenesmus, blood/mucus in stool
  • Full systems review
    • Consider full systems review if diagnosis unclear

Differential diagnoses and clues

Malignancy

Any malignancy

Symptoms of tumour, e.g. breast lump, haemoptysis (lung), prostatic symptoms, change in bowel habit (bowel), haematuria (TCC), jaundice (head of pancreas), post-menopausal bleed (uterine) etc.

Gastrointestinal

Colon cancer

  • Elderly

  • Blood/melaena PR

  • Change in bowel habit

Inflammatory bowel disease

  • Diarrhoea with blood / mucus

  • Abdominal pain

Coeliac disease

  • Diarrhoea, steatorrhoea

  • Anaemia symptoms, e.g. SOB, tiredness

  • Abdominal discomfort

Endocrinological

Thyrotoxicosis

  • Diarrhoea

  • Heat intolerance

  • Irritability/restlessness

  • Tremor

  • Oligomenorrhoea / amenorrhoea

Type 1 diabetes

  • Polyuria

  • Polydipsia

Psychological

Anorexia / bulimia nervosa

  • BMI <17.5 in anorexia

  • Binge eating in bulimia

  • Effort to lose weight (gym, vomiting, laxatives)

  • Menstrual cycle disturbance

Depression

  • Core: low mood, anhedonia

  • Biological: poor sleep, lack of energy

  • Future: hopelessness, suicidal thoughts

Stress

Organic stress

Others

  • Diet changes/malnutrition

  • Substance misuse

  • End organ failure

  • Chronic inflammatory diseases

  • Chronic infection (e.g. TB)

  • HIV

Tiredness

Exploring symptom

  • Timeframe
    • Duration
    • Onset (sudden or gradual)
    • Progression
    • Timing (intermittent or continuous)
  • Tiredness
    • What they mean by tiredness
    • Sleep pattern/quality
    • How it affects patient
  • Associated symptoms
    • Anaemia symptoms: breathlessness on exertion
    • Hypothyroidism symptoms: constipation, weight gain, cold intolerance etc.
    • Depression symptoms: mood
    • Diabetes symptoms: polydipsia, polyuria

Full systems review

  • Consider full systems review if diagnosis unclear

Differential diagnoses and clues

Haematological

Anaemia

  • Breathlessness on exertion

  • Weakness

  • May get palpitations, worsening angina, worsening claudication

Endocrinological

Hypothyroidism

  • Constipation

  • Cold intolerance

  • Weight gain

Diabetes

  • Polydipsia/thirst

  • Polyuria

  • Weight loss

  • Visual disturbance

Addison’s disease / adrenal insufficiency

  • Non-specific symptoms

  • Postural hypotension

Psychological

Depression

  • Core: low mood, anhedonia

  • Biological: poor sleep, lack of energy

  • Future: hopelessness, suicidal thoughts

Respiratory

Sleep apnoea

  • Loud snoring

  • Night time breathing interrupted by apnoeas / gasping / snorting

  • Excessive daytime sleepiness

  • Obesity is a risk factor

Others

Others

  • Stress

  • Post-viral fatigue

  • Organ failure

  • Drugs (e.g. recreational, Ξ²-blockers, diuretics)

  • Malignancy

  • Chronic inflammatory diseases (e.g. connective tissue diseases)

  • Chronic infection (e.g. TB)

Here are a few questions for you

A patient presents with weight loss and chronic diarrhoea. Which conditions would you include in your differential diagnosis? Please structure your answer.

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You see a patient who complains of tiredness and extreme fatigue. A workup excludes other causes and you think they may have chronic fatigue syndrome. Which features may suggest this diagnosis?

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Try some related OSCE stations

  1. Tiredness history
  2. Find more stations here

Common presenting complaints

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