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Presenting Exploding symptom Relevant system reviews Differential diagnoses Clues to differential
complaint Grouping Differentials
Abdominal Site General Gastrointestinal Appendicitis Young patient
pain Onset Fever, sweats Periumbilical pain
Character Moves to RIF
Radiation Gastrointestinal Anorexia
Associated symptoms Weight: loss, appetite change Gallstones Biliary colic
Timing Work down body: dysphagia, Intermittent RUQ pain
Exacerbating/relieving factors nausea/ vomiting, indigestion/ Exacerbated by fatty food
Severity heartburn, bowel habit change,
blood/ mucus in stool Cholecystitis
Continuous RUQ pain
Urological
Storage: frequency, volume, CBD stones
urgency/ nocturia Jaundice
Infection: dysuria, haematuria RUQ pain
2014 Dr Christopher Mansbridge at www.OSCEstop.com, a source of free OSCE exam notes for medical students finals OSCE revision
Rectal Timing Gastrointestinal Anal fissure Bleeding on defecation
bleeding When started Weight: loss, appetite change Fresh blood Bright red on tissue paper
Acute/ gradual onset Work down body: dysphagia, (distal) Intense anal pain
Duration nausea/ vomiting, indigestion/ Constipation history
Progression heartburn, abdominal pain, Haemorrhoids Bleeding on defecation
Intermittent or continuous bowel habit change, mucus in Bright red on tissue paper
stool Constipation history
Rectal bleeding Diverticular Sudden painless rectal bleeding
Blood: fresh/altered/melaena haemorrhage Elderly
When does it occur Distil polyp/cancer Alternating bowel habit
Weight loss
Stool Urgency/ tenesmus
Any mucus Inflammatory Blood mixed with stool
How much, how often, bowel disease Mucus
consistency Diarrhoea
Abdominal pain
Haemorrhagic Acute diarrhoea and vomiting
infective History of suspicious food intake
gastroenteritis
Angiodysplasia Elderly
Proximal polyp/ Weight loss
cancer Anaemia symptoms
Haemorrhagic Gastritis symptoms
peptic ulcer/ Risk factors e.g. NSAIDs, alcohol, spicy food
gastritis
Melaena Oesophageal History of liver disease/ alcoholism
(proximal) varicies May be encephalopathy or alcohol
withdrawal
Haematemesis
2014 Dr Christopher Mansbridge at www.OSCEstop.com, a source of free OSCE exam notes for medical students finals OSCE revision