Leg Pain

History Differentials

Site ● Unilateral (DVT), bilateral ● DVT - swelling, red, hot, Hx of immobility, chest
● Radiation pain (PE), coagulopathy risk Fx
● Intermittent Claudication - worse when walking,
Quality ● Aching, sharp, crampy Hx of CVD, relieved by rest
● Complete arterial obstruction - 6Ps (pain, cold,
Severity ● Quantify: out of 10 paresthesia, paralysis, pallor, pulselessness)
● Qualify: effect on movement, everyday ● MSK (pulled muscle) - Hx of injury, sore, sudden
activities, limping onset, tender point
○ How long to walk ● Varicose veins
(claudication distance)

Time Course ● onset/offset

● Progression
● Past occurrences

Context ● Long periods of immobility - surgery,

plane, travel, injury
● Injury
● Change in medication

Relieving ● Rest
● ibuprofen

Aggravating ● Movement

Associated ● Leg being warm/cold

● Chest pain
● Fever, malaise
● Breathlessness
● See differentials

Past history ● CVD risk factors

● Lifestyle
● Hospitalisations, operations
● Blood clotting factors
● Family Hx
● Meds: OCP

Red flags ● Fever, infection signs (sepsis)

● PE signs
● Complete arterial occlusion

Chest Pain
History Differentials

Site ● Central, left, right Cardiovascular

● Radiation ● Angina: centralised, w/ exertion, palpitations,
○ Left shoulder/arm (MI/angina) resolves under 20min
○ Stable: with exertion
Quality ● Pressure, crushing (MI) ○ Unstable: at rest
● Tearing ● MI: L shoulder arm pain (crushing), sweaty,
● Burning
Severity ● Pain scale nausea, epigastric pain (common in women),
● Limit to activities “acid reflux”, sense of doom women + diabetics
asymptomatic, >20min
Time course ● Onset/offset ● CHF: fatigue, SOB, oedema, paroxysmal noctural
● Duration of episode dyspnoea, orthopnea
● Frequency ● Pericarditis: recent viral illness, fever, sick
● Previous episodes contacts, positional pain relief, chest pain

Context ● Exertion - MI Respiratory

● Breathing in ● PE: sudden, sharp, pain with inhalation, risk
● Food factors for DVT, can happen at rest
● Pneumothorax: thin, tall, connective tissue
Relieving ● GTN (nitrates) disorders, trauma history
● Antacids ● Pleuritic chest pain: worse with deep breath,
● Rest sharp stabbing
● Costochondritis: anterior chest pain, worse with
Aggravating ● Physical exertion breathing, worse with applied force to area
● Breathing in ● Pneumonia: fever signs, resp signs (SOB)
● Physical position, sitting, lying, ○ TB (fever, weight loss, loss of
appetite, travel history or country of
Associated ● Fever
origin)
● Nausea
● Sweating
Gastrointestinal
● Palpitations
● GORD: epigastric pain, associated with eating,
● TLOC
worse when lying down, better with antacids and
● Impending sense of doom
milk, metal acidic
● Lethargy
● GI symptoms - nausea, diarrhoea, bloating
Psychological
● Panic attack: feeling like you're going to die
Past history ● Meds: OCP (the pill)
● CVD factors, Fam Hx
○ HTN
○ Cholesterol
○ Smoking
○ Diabetes
● Travel history/country of origin
● Sick contacts
● Immunocompromised (opportunistic
infections)

Red flags ● Cardiovascular risk factors ● MI

○ Major: smoking, HTN, ● AAA rupture: severe pain, tearing, sudden,
Diabetes, cholesterol more posterior,
● Aortic dissection

Oedema (legs)

History Differentials

Site ● Bilateral (general) vs unilateral (DVT, Cardio

lymph) ● CHF (increases hydrostatic pressure): fatigue,
underlying valve/heart pathology, TLOC,
Quality ● Pitting (mainly fluid) ● Peripheral vascular disease
● non pitting (other stuff)
Severity ● How far up the legs
● How swollen Resp
○ Indentation on feet/legs by ● Cor pulmonale (pulmonary hypertension)
socks, clothing ○ LHF
○ “Can’t put on/take off shoes” ○ COPD
● Functional impairment ○ Cystic fibrosis

Time Course ● On/off/progression Kidneys

● Worse at night/end of day ● Nephrotic syndrome (decreases oncotic
pressure): protein in urine
Context ● Underlying disease
● Change in medication Liver
● Liver cirrhosis and portal hypertension
Relieving ● Raising feet (decreases oncotic pressure, increases
● Better in the morning hydrostatic pressure)
● Hepatitis
Aggravating ● Standing for long periods
● Excessive fluid intake Skin and soft tissues
● Infections (increases vascular permeability):
Associated ● Chest pain
Hx of injury, pain/redness/hot
● Tightening of skin, particularly around the
feet, ankles and shins
Lymphatics
● Dyspnoea
● Post-surgery
Past history ● Kidney and liver disease
● Cardiovascular disease - MI, congestive
Other
heart failure
● Pregnancy
● Allergies
● Varicose veins
● DVT
● Anaphylaxis

Red flags

Dyspnoea

History Differentials

Site Resp
● Asthma - wheeze, brought on by exertion, cold
Quality ● Heavy or shallow breathing weather, environmental triggers, cough, chest
tightness, family history of atopy, relieved by
Severity ● Wake up in the middle of the night with or salbutamol, tightness in chest
because of SOB ● COPD - wheeze, history of smoking
● Number of pillows (vs normal) ● Restrictive pulmonary disorders
● How far you can walk (eg. around the ○ Interstitial lung disease:
house? Down the street?) ○ Sarcoidosis
● How many words you can say ○ Pulmonary fibrosis
○ Asbestosis
Time Course ● Onset ○ Tumour (Mesothelioma)
● Duration ● Pulmonary embolism - recent immobility/long
● Progression haul flight, chest pain, cough, pregnancy, OCP,
DVT
Context ● At rest vs exertion ● Infection (e.g. pneumonia) - fever, body aches,
● Exposure to allergens yellow or green coloured sputum, cough, recent
● Sick contacts sick contact\
● Overseas travel
 ● Occupational exposure ● Allergies/ anaphylaxis
● DVT risk factors - surgery, pregnancy, OCP, ● Angioedema
long flights ● Epiglottitis
● Pulmonary edema
Relieving ● Sitting up ● Pneumothorax
● Salbutamol Cardio
● Rest ● CHF - fatigue, oedema, tachycardia
● IHD: better with GTN, rest,
Aggravating ● Lying down ● AMI
● Exertion Psychological
● Anxiety
Associated ● Swelling of throat
● Wheeze, stridor
● Fever
● Night sweats, cachexia, LoA
● Haemoptysis
● Chest pain
● Barrel chest (hyperexpansion)

Past history ● Occupational Hx (exposure to asbestos)

● Coagulopathy Hhx
● Medication
○ ACE inhibitors
● Past Hx - allergies

Red flags Fever ● Epiglottitis

Haemoptysis ● Cancer
● Pneumothorax

TLOC

History Vasovagal syncope Cardiac Syncope Seizure

Before Precipitating ● Fasting ● Can occur on exertion ● Spontaneous

factors ● Dehydration ● Spontaneous ● May be triggered by
● Prolonged exertion/ sleep deprivation
standing
● Emotional event

Prodrome ● light-headedness and ● Not present ● May not be present

'wobbly' legs, vision ● Aura
going dim, noises
sounding distant.
● Remember start of
collapse

During Quality ● Loss of postural tone ● Loss of postural tone ● Tonic

○ Did you ● Convulsive movements ○ Stiffening of limbs
“Was anyone fall can occur, although with extension of
around you ○ Did you usually only a few jerks back and limbs,
when this have eyes deviate
happened?” trouble upwards, may cry
 standing out involuntarily
Did you up ● Clonic
actually have ● Convulsive movements ○ Generalised
TLOC can occur, although flexion
usually only a few jerks contractions of
muscles
alternating with
relaxation

Time course ● 30 secs ● 30 secs ● 1-2 mins

Context ● Usually doesn't occur
when sitting or lying
● Sitting on toilet
○ Straining
too hard
● Can occur when sitting ● Can occur when sitting
or lying or lying
● Can occur during sleep

Relieving ● Lying flat ● N/A - self limiting ● N/A - self limiting

Associated ● Pallor ● Pallor ● Tongue biting

● Sweaty ● Sweaty ● Head turning common
● Associated with ● Cyanosis - blue lips,
exertion or palpitations tongue
● Cry or moan at onset
● Frothing at mouth
● Incontinence
○ Did you
wet
yourself?

Headaches
No past history

After Period after ● Rapid recovery ● Rapid recovery ● Slow recovery

event ● Not confused after ● Not confused after ● Confusion
● Injury may occur ● Exhaustion
● May have cardiac
disease

Past history ● Past episodes

○ Context of past episodes
● Past medical history - CVD, neuro, metabolic, diabetes
● Family history - CVD, neuro
● Medication
● Malignancy
○ Hx
○ Risk factors

Differentials

● Vasovagal syncope (dehydration, POTS) - prodrome, standing, lying flat assists recovery, rapid
recovery, no soreness or confusion/disorientation, sweaty and pale before
● Cardiac syncope - no prodrome, can occur when sitting/lying, rapid recovery, loss of muscle tone
● Seizure/epilepsy - tonic/clonic, cry/moan at onset, tired and disoriented afterwards, tongue
biting/incontinence/frothing at mouth, slow recovery, convulsions

Concerning
● Injury prone
 ● Seizure symptoms
● Malignancy
● Cardiac symptoms
○ Heart block
○ Palpitations

Asthma Hx

History

Opening Reason for visit - change in symptoms, change in medication, etc.

Quality (usual ● Cough

asthma ● Wheeze
symptoms) ● Tightness in chest
● Hard to breathe, SOB
● Cyanosis (turning blue)
● Pain on breathing

Severity ● How bad is it

● Admitted to hospital?
○ ICU?
● Impact on everyday life
● Need for
○ Reliever - and how often
■ How do you take your reliever?
● Spacer? Head tilt?
○ Steroids? Preventor?
○ Adherence to meds?
● Compare to baseline
 ● If it wakes you up at night
● Interval symptoms
○ Symptoms in between acute asthma attacks
○ E.g. tightness in chest

Time course ● How long they’ve had asthma

● Frequency of symptoms
● Progression since diagnosis
● Progression since recent episode
● Previous episodes

Psycho-social ● Impact of asthma on lifestyle

context ● Impact of lifestyle on asthma
○ Healthy lifestyle?
○ Smoking?
○ Taking medication?
○ Activities make asthma worse
○ Pets
● Adherence to medication

Relieving ● Reliever/ventolin - can ask about technique

Aggravating ● Environmental, pollen

(triggers) ○ Seasonal (spring, summer)
● Pets
● Cold
● Exercise
● Stress, anxiety
● Infection
● Smoke/pollutants
● Change in medication

Associated ● Atopic
features ○ Eczema
○ Hay Fever
○ Allergies
● URTI symptoms
○ Fever
○ Runny nose
○ LoW, LoA
● Autoimmune disease

Past history ● Hospitalisation, ICU

● Need for prednisolone/steroids
● Family Hx - asthma, eczema, hay fever, allergies
● Autoimmune diseases
● Smoking, drugs

Smoking Hx
QCDCR “Quite commonly drugs cause reactions”
● Quantity
● Context
● Dependency
● Consequences
● Reduction
 History

Current/past ● Ask them

smoking ● What do they smoke? Tobacco, drugs?

Time course ● How long they’ve been smoking

Quantitative ● Pack years

assessment ○ 20 per pack
○ E.g. 2 pack a day for 15 years = 30 pack years

Qualitative ● First thing they do in the morning, last thing they do for the day
assessment ○ How long after waking up do you feel like smoking
(Triggers and ● How long can you sit before wanting to smoke
psycho-social ● What happens when you aren’t able to smoke after certain period of
factors) time
○ E.g. during work, movie, plane flight
● Situations they feel triggered to smoke
○ Anxious
○ Stressed
○ Social
● Symptoms during withdrawal
○ Agitation

Associated ● Respiratory symptoms

features ○ Coughing
○ SOB
○ Mucus
○ Haemoptysis
● Effects on:
○ Social
○ Financial
○ Physical
○ Psychological
○ Legal

Attempts to ● Attempts to quit

quit/motivation ○ What strategies they used
to quit ○ How many times (note: usually takes 6-7 tries)
○ How successful
● Motivation to quit

Alcohol Hx

History

Current/past ● Ask about how much and what they drink (wine, spirits, beer, etc)
drinking

Time course ● How long they’ve been drinking

● How often
● Past drinking
● Weekend vs weekdays
● Alone vs in social setting
Quantitative ● Number of standard drinks
assessment ● Ask in different ways
○ Glasses of wine /day and then bottles /weeks

Qualitative ● If they need one as soon as they wake up

assessment ● If they drink in the morning to cure hangover
(Triggers and ● How many drinks it takes to get desired effect
psycho-social ● Difficulty stopping once they start?
factors) ● Experienced TLOC/blackouts from drinking
○ Injuries
● Behaviour
○ Hurt themselves
○ Hurt others
○ Risky behaviour
■ Drink driving
■ Drinking during/before work
● Do they guilty about their drinking
● Anyone spoken to the/shown concern about their intake
● Impact on ability to care for self or others
○ E.g. care for kids

Associated ● Effects on:

features ○ Social
○ Financial
○ Physical
○ Psychological
○ Legal
● Obesity
● Liver problems
● Nutrition deficiencies
● Memory/cognition
● Injuries
● Neurological problems/deficits
○ Balance

Attempts to ● Attempts to reduce intake

quit/motivation
to quit

Cough

History Differentials

Site N/A Acute

● Foreign substance - choking, flushed face,
Quality ● Barking/hacking difficult breathing
● Choking ● Acute Bronchitis - runny nose, headache, sore
● Haemoptysis throat
○ Colour and amount ● Pneumonia - Fever, SOB, loss of appetite
● Productive? ○ COVID
○ Characterise sputum: colour, ● Asthma - trigger, wheeze, chest tightness
amount ● Pneumothorax
Chronic
Severity ● Frequency ● Bronchiectasis - SOB, blood with sputum, chest
● Effect on daily life pain
● Uncontrollable coughing fits?
 ● Coughing at night? ● Whooping cough - nasal congestion, fatigue,
fever, slightly productive, uncontrolled coughing
Time course ● Onset fits, immunisation history, sick contact
● Acute(< 3 weeks), chronic (> 8 weeks) ● COPD - SOB, respiratory infection, chest tightness,
● Progression fatigue, barrel chest , smoker, productive cough in
● Duration of coughing fits the morning
● Infection (TB, pneumonia) - fever, night sweats,
Context ● Recent infection: sick contacts, overseas productive cough, haemoptysis, recent travel,
travel LoW
● Medication: ACE inhibitors ● Asthma - wheeze, dry cough, chest tightness
● Hx of asthma, smoking, resp disease ● Lung cancer - fever, haemoptysis, LoW, LoA,
family Hx, change in normal cough
Relieving ● Antibiotics ● CHF (pulmonary oedema): orthopnea, fatigue
● Throat lozenges ● Gastro-oesophageal disease
● Propping up pillows

Aggravating ● Medication: ACEi

● Worse at night
● Cold air

Associated ● Infection: fever,

● Cancer/TB: night sweats, LoW,
● Haemoptysis
● Chest pain
● Resp symptoms: SOB, wheeze
● Fatigue

Past history ● Hx of lung disease

● Smoking
● Occupational → asbestos
● Asthma, allergies
● Immunisations
● Fam Hx
○ Cancer
○ Asthma

Red flags Cancer signs

TB signs

Haemoptysis
Note: very similar to cough
History Differentials

Site Important to distinguish from haematemesis ● Bronchitis - cough, a lot of mucus, wheeze
and epistaxis ● Lung cancer - Chest pain, weight loss, night
● Haematemesis: preceded by nausea, sweats
ado pain ● Pneumonia - Fever, SOB, loss of appetite
● Haemoptysis: chest pain, cough ● PE - SOB, chest pain, Leg pain (pale, cold, pain at
rest)
Quality ● Colour of blood ● TB - Blood in sputum, weight loss, from overseas
● Sputum? ● Portal hypertension
● Make sure it isn’t coming from upper ● Esophageal varices
respiratory tract vs nasopharynx ● Trauma
● Nose bleeds
Severity ● How much blood
● How often
Time course ● Onset - sudden or gradual
● Progression

Context ● Infection
● Previous medical Hx

Relieving ●

Aggravating ●

Associated ● Infection signs

● Cancer signs
● Other respiratory symptoms
● Chest pain

Past history ● Smoking

Red flags

Abdominal Pain

History Differentials

Site ● Visceral: poorly localized Generalised

● Somatic: can be localised well ● Food intolerance
● Locate which quadrant ● IBD
● Radiation ● IBS
● Gastroenteritis
Quality ● Dull, sharp, burning RUQ
● Constant, colicky (comes and goes) ● Liver disease/cirrhosis – weight loss, jaundice,
nausea
Severity ● Pain scale ● Gallstones – occurs after meal, nausea, sharp
● Effect on daily activities pain, very severe pain, walking around to relieve
● Change in posture pain, may have jaundice
● Waking up at night? ○ RISK FACTORS: “Female, Fertile, Fat,
Fair, and Forty”
Time course ● Onset, offset, duration ● Viral Hepatitis – jaundice, fever, diarrhoea
● Frequence and pattern over time ● Autoimmune Hepatitis
● Progression ● Alcoholic hepatitis
● Past episodes ● Cholangitis - fever, jaundice
● Relationship to meals ● Lobar Pneumonia - cough, coloured sputum, SOB
Epigastric
Context ● Women: pregnancy ● GORD - regurgitation, acid brash, heartburn
● Alcohol ● Esophagitis - heartburn, acid brash, dysphagia
● Meals: fatty meals, spicy food, food ● Gastritis - nausea, vomiting, melena
intolerances ● Peptic Ulcer Disease - haematemesis, melena,
● Caffeine perforation
● Sick contacts, dodgy food ● Barrett's Esophagus - Dysphagia, heartburn, acid
● Smoking Hx (risk Fx for bowel cancer) brash
● Cardio stuff
Relieving ● Pain medication
RIF
● Antacids
● Appendicitis - visceral to somatic, very bad pain
● Changing diet
● Ovarian cyst - lump, abnormal periods, hormonal
● Changing posture
abnormalities?
● Ureteric colic
Aggravating ● Movement, posture
● Diverticulitis - constipation
● Coughing
 ● Food ● Ectopic pregnancy - last menstrual cycle, OCPs,
● Medication - COX inhibitors severe sudden pain (if burst)
● Inguinal Hernia - straining, lump,
Associated ● Abdo: nausea, vomiting, diarrhoea or LIF
constipation ● Ovarian cyst
● Infection symptoms: fever, ● Ureteric colic
● haematemesis, melaena, bleeding per ● Diverticulitis
rectum ● Inguinal Hernia
● Hepatic: jaundice, dark coloured urine, Retroperitoneal
itch, pale stools ● Polycystic kidney disease
● Change in urine or bowel habits ● Pancreatitis
● Weight loss, anorexia ● Pancreatic cancer
● Cancer signs: night sweats, LoA, fatigue ● Pyelonephritis
● Difficulty swallowing (dysphagia)
● Referred pain: arm pain
○ Diaphragm irritation → Other
phrenic nerve ● Aortic dissection: often refers lower back pain,
can be in different areas (upper: chest pain)
Past history ● Food intolerances ● AAA: more diffuse
● Metabolic syndrome ● UTIs: bladder irritation
● Fam Hx ● Endometriosis
○ Inflammatory bowel disease ● Menstrual cramps
(IBD) ● Normal Pregnancy
○ Bowel cancer
● Women: contraception Superficial
● Appendectomy? ● Hernias
● Cholecystectomy? ● MSK
● Risk factors for gallstones
○ “Female, Fertile, Fat, Fair, ● Peritonitis - Stomach guarding
and Forty”

Red flags Bowel cancer

Ectopic pregnancy
Appendicitis
Pancreatitis
Family risk of cancer
Dysphagia
 History Differentials

Site ● Oropharyngeal: difficulty with initiation Oropharyngeal

● Oesophageal: food sticks after swallowing ● Psychogenic - existing psychological condition,
● Point to where food is being stuck family hx, stress
● Decreased salivation - medications hx, age,
Quality ● Oropharyngeal: choking, coughing, nasal blocked salivary gland
regurgitation ● Stroke - sudden numbness/weakness, trouble
● Difficulty swallowing speaking, confusion
○ Solid food ● Neurodegenerative disease (Alzhiemers, motor
○ Soft food neuron, stroke, Parkinson’s) - specific associated
○ Liquids features (memory loss, tremor, speech changes,
numbness), family hx, previous diagnosis
Severity ● How difficult it is to eat ● Tumour - pain, fatigue, weight loss
● Amount of weight loss ● Quinsy - pain, fever, difficulty speaking
○ Quantify ● Pharyngeal pouch - lump in neck, regurgitation
○ Clothes fitting loosely ● Damage to glossopharyngeal nerve
○ Belt buckle
● Loss of appetite Oesophageal
● Have they choked? ● Achalasia (loss of peristalsis in distal oesophagus)
- chest pain, heartburn, night time cough
Time Course ● Onset - sudden, gradual ● Oesophageal cancer - weight loss, fatigue,
● Progression heartburn
○ Solids only to both solid and ● Stricture - heartburn, pain, hiccups/burping
liquids ● Infection - fever, pain, heartburn
● Eosinophilic oesophagitis - nausea, vomiting,
Context ● Stroke chest pain
● Neurological disease: MS, Parkinson’s, ● Connective tissue disorder - muscle and joint
MND pain, rash, general malaise
● Medication ● Oesophageal hernia
Relieving ● Softer food
● Liquids
● Cutting up food

Aggravating ● Hard food

Associated ● Neurological: cognition, motor problems,

weakness, paralysis, numbness, speech
problems, tremor
● Weight loss
● LoA
● Heartburn
● Chest pain, abdo pain
● Cancer signs
● Cough, haemoptysis, haematemesis

Past history ● Hx and fam Hx of neurological disorders

● Past of stroke
● Risk factors for stroke
○ CVD
○ Smoking
○ Atrial fibrillation

Red flags Cancer signs

Neuro signs
Progression
Vomiting

History Differentials

Site N/A Vomiting

● Infection - fever, diarrhoea, recent sick contact,
Quality ● Contents of vomit - what does it look like? recent travel
○ Bile, food ● Pregnancy - missed period, unprotected sex,
● Haematemesis? repeated bouts of morning sickness, nausea
○ Colour (bright red), amount ● Medications - recent antibiotic use, drug use
(opioids), OCP
Severity ● Amount of vomit ● Appendicitis
● Frequency - how many times have they ● Meningitis
vomited Haematemesis
● GORD - regurgitation, acid brash, heart burn
Time course ● Onset, offset ● Peptic Ulcer Disease - haematemesis, melena,
● Duration perforation
● Pattern/fluctuations ● Liver pathologies - leading to reduced clotting
● Relationship with meals factor formation → bleeds
● Esophageal varices
Context ● Sick contacts? ● Cancer - gastric, oesophageal (weight loss,
● Medication fatigue, haematemesis)
● Change in diet - fatty foods, gluten ● Trauma
● Pregnancy ● Mallory Weiss tear
○ Possibility
○ Last period
○ Contraception
● Food intolerance

Relieving ● Anti-nausea medication

Aggravating ● FoDysphagia Ddx
● od
● Alcohol
● Smells, odours

Associated ● Haematemesis
● Malena, rectal bleeding
● Abdominal pain, cramps
● Diarrhoea, constipation, nausea
● Dehydration - thirst, dizziness
● Fever
● Weight loss
● Able to keep food/water down?
● Jaundice
● Dysphagia
● Malignancy - night sweats
● Meningitis

Past history ● Hx/fam Hx - food intolerances, IBD, IBS,

autoimmune disorders
● Alcohol
● Medication
● Hx - cancer

Diarrhoea/Constipation/Change in bowel habit

History Differentials

Site N/A Diarrhoea

● Infective (gastro, pancreatitis, parasites)
Quality ● What do the stools look like? ● Neoplastic (Pancreatic, bowel → PR bleeding,
○ Pale? Mucus? fever, weight loss)
○ Watery? Hard? ● Drugs (statins, metformin, anticholinesterase
○ Hard to flush? (fatty) inhibitors, antibiotics)
○ Size of stools ● Autoimmune (IBD - crohns and ulcerative colitis,
○ Smell (abdo pain, PR bleeding, mucus) coeliac disease
● Rectal bleeding (steatorrhoea, abdo pain),
○ Colour: bright red, malena malabsorption/intolerance (lactose, diet changes)
(slimy, sticky, smells), coffee ● Endocrine/metabolic - hyperthyroidism (heat
grounds intolerance, mood changes/anxiety, fatigue,
○ Mixed in with stool or weight loss), diabetes
separate? (on tissue, on toilet ● psychogenic/functional - IBS (chronic diarrhea,
bowl) constipation, recurrent abdo pain, pain
● Constipation improvement with defecation, change in
○ Straining? frequency, change in form of stool)
○ Slowing down of bowels, less
frequent Constipation
● Cancer - weight loss, blood in stool, fatigue
Severity ● Frequency ● Hypothyroidism - weight gain, fatigue, goiter
● Diarrhoea - amount ● Medication - Hx (iron tablets, codeine, opiates,
● Compare to normal diuretics, antidepressants, NSAIDs), no
unexplained WL, no blood in stool
Time course ● Onset ● Low Fibre Diet - change in diet coinciding with
● Duration symptom onset, lack of fibre, bloating
● Frequency ● IBS - no obvious pathogenesis, recent stress,
● Patterns
 ● Previous episodes mental illness, relieved with passing stool,
● Relationship to meals bloating, >3 months
● Diverticulitis
Context ● Infection - sick contacts
● Change in diet, medication, lifestyle Rectal bleeding
● Other symptoms ● Haemorrhoids - perianal itching, pain with
● Travel history defecation, bright red blood not mixed with stool
● Food (superficial).
● Anal fissure - tear in anus, bright red blood,
Relieving ● Medication, OTC associated with history of IBD (Crohn’s), older
● Constipation → water age, and constipation.
● Colorectal cancer - weight loss, blood mixed with
Aggravating ● Food/meals stool, mild fever, changes in bowel eg diarrhoea
and or constipation, abdominal pain possible,
Associated ● Nausea, vomiting history of bowel cancer, and/or aged.
● Abdominal pain ● Dysentery - blood with diarrhoea (darker red,
● Fever mixed with stool), fever, close contacts,
● Weight loss abdominal pain.
● Dehydration - thirst, dizziness, fatigue ● PUD haemorrhagic
● Stomach cancer
Past history ● Travel history
● IBDs
● Diabetes
● Oesophageal bleed
● Food intolerances
● Alcohol
● Surgeries
● Family Hx - bowel cancer (remember to
ask age)
● If sus and of age - previous testing for
bowel cancer
● Fam Hx of autoimmune
● Thyroid pathology

Jaundice

History Differentials

Site ● Where is the yellowing (eyes, skin) Pre-hepatic

● Haemolytic anaemia - rapid breakdown of RBC →
Quality N/A high levels of unconjugated bilirubin
● Sickle cell anaemia
Severity N/A ● Thalassemia
intrahepatic
Time Course ● Onset ● Liver cirrhosis - alcohol, drugs
● Progression ● Hepatitis - acute (flu like symptoms, jaundice,
● Previous episodes dark urine) and chronic (malaise, cirrhosis, liver
● Obtain timeline of other symptoms cancer)
● Liver cancer - jaundice, weight loss, cirrhosis
Context ● Hx of liver disease ● Intrahepatic obstruction - e.g. liver cirrhosis.
Patient risk factors post-hepatic
● Travel - immunisations for travel? ● Obstructive - narrowing/blocking of bile duct →
● Food and drink - ice cubes impedes bilirubin clearance → bilirubin
● IV drug use accumulation
● Sexual activity - unprotected ● Gallstone - acute, pain
● Medication: antibiotics, paracetamol ○ 5Fs
● Change in diet
 ● Recent tattoos and piercings ○ Female, Fat, Fertile, Fair, Forty
● Cancer in the head of pancreas - “painless
Relieving ● jaundice”, possible retroperitoneal pain, history
of (chronic/recurrent) pancreatitis
Aggravating ●

Associated ● 4 Ps
○ Pruritus (itch)
○ Pain
○ Pale stools
○ Pee - Dark urine
● Fever
● “Pounds” - Weight loss, LoA
● Nausea, diarrhoea, vomiting,
haematemesis, rectal bleeding
“Prodrome”
● Viral hepatitis - fever, malaise, flu-like
symptoms

Past history ● Alcohol

● Metabolic disease
● Immunisations
● Blood transfusions, blood donations

Shoulder Pain

History Differentials

Site ● Location Intrinsic - Traumatic

● Radiation ● Dislocation
● Fracture
Quality ● Dull ache, sharp ● MSK injury
● With movement ● Compression syndrome
Intrinsic - non-traumatic
Severity ● Quantify ● OA, RA
● Qualify - effect on life ● Infection
● Limit on range of motion ● Sepsis
● Cancer
Time course ● On/Off/duration ● Neuropathy
● Progression ● Tendonitis
● Pattern, previous experience ● Bursitis
Context ● Trauma Intrinsic: exacerbated by movement
● Infection
● Medication Extrinsic
● Referred pain - MI, cervical fracture,
Relieving ● Rest/no movement
diaphragm irritation/injury
● Pain relief
●

Aggravating ● exacerbated by movement

● Weight bearing

Associated ● Redness, swelling, hot

● Weakness
● Numbness/tingling
● Chest pain/other pain
 ● Cancer symptoms
● Infection symptoms

Past history ● Previous traumatic injuries

● Surgeries
● Fam Hx

Knee Pain

History Differentials

Site ● Location Acute

○ Anterior: OA, patella ● Injury - ACL, PCL, MSK, patellar dislocation
○ Posterior: bursitis, hamstring, ● Haemorrhage
Baker’s cyst, DVT ● Septic knee
● Both knees? ● Bursitis
● Other affected joints ● DVT
● Radiation ● Baker’s cyst

Quality ● Dull ache, sharp, burning Chronic

● Arthritis - OA, RA
Severity ● Quantify ● Bursitis
● Qualify - effect on life ● Tendonitis
● Limit on range of motion ● Cancer
● Patellofemoral pain syndrome
Time course ● On/Off/duration
● Progression
● Pattern, previous experience

Context ● Injury - specify position of knee at time of

injury and direction of force
○ E.g. changing direction
● Infection
● Surgery/procedures/hospitalisations

Relieving ● Rest
● Pain relief
● Better in morning/later in day

Aggravating ● Movement

Associated ● Infection
● Redness, swelling, hot
● Other affected joints
● Osteoporosis risk factors - gluco, inactivity,
diet, sun exposure, post menopausal,
obesity
● Recent weight gain

Past history ● Previous traumatic injuries

● Hospitalisation

Back Pain

History Differentials
Site ● Location Non-urgent/life-threatening
● Radiation ● Injury, lifting heavy objects
○ Buttocks and back of legs - ○ Impingement
central stenosis ○ Slip disk
● ● Bad posture
● Degenerative back pain
Quality ● Dull ache ○ Sciatica
● Sharp ● Referred pain - kidney (posterior), pancreas
(LUQ/epigastric)
Severity ● Quantify ● Central stenosis of spine
● Affect on daily life ● Ankylosing spondylitis (AS)
● Cauda Equina Syndrome
Time course ● Progressively worsening? degenerative Urgent
● Cancer
Context ● Injury ○ O-sarcoma - kids
● Infection ○ Myeloma - adults
● Surgery ○ Metastasis
■ Prostate
Relieving ● Change in position
● Sepsis
● Referred pain - abdominal aorta (AAA)
Aggravating ● Walking - Central stenosis of spine
● Fracture
Associated ● Osteoporosis risk factors ○ Traumatic
● Chest pain, epigastric pain, abdo pain ○ Osteoporosis fractures
● UTI?
● GI symptoms
● Incontinence
●
Red flags (TUNAFISH)

Past history ● Hx prostate cancer

Weight Loss

History Differentials

Site ● N/A ● Infection - Gastro

Quality ● Intentional/unintentional
○ Intentional - mood, stress
● Increased or decreased appetite
Severity ● Amount of weight loss
● Other indicators: belt buckles, loose fitting
clothing, other people noticing weight loss

Time course ● Onset, duration

● Sudden or gradual

Context ● Change in diet or physical activity

● Medication

Relieving ● Have they tried to put on more weight?

Aggravating ● Is there anything that seems to accelerate

the weight loss

Associated ● Gi symptoms - diarrhoea, vomiting,

nausea, bloating, steatorrhea, change in
bowels
● Renal/changes in urination
● Endocrine symptoms:
○ hyperthyroidism: feeling hot,
diarrhoea, anxiety,
palpitations, fatigue
● Infection symptoms
● Cancer symptoms
● Diabetes symptoms: thirsty, thin, toilet,
tired
● Fatigue

Past history ● Autoimmunity -

● Cancer
● Medication
● Diet/exercise

Headache

History Differentials

Site ● ●

Quality ●

Severity ●

Time course ●

Context ●

Relieving ●

Aggravating ●

Associated ●

Past history ●
Weakness

History Differentials

Site ● ●

Quality ●

Severity ●

Context ●

Relieving ●

Aggravating ●

Associated ●

Past history ●

Memory/Cognitive issues

History Differentials

Site ● ●

Quality ●

Severity ●

Context ●

Relieving ●

Aggravating ●

Associated ●

Past history ●

Sensory Disturbance

History Differentials

Site ● ●

Quality ●

Severity ●

Context ●

Relieving ●
Aggravating ●

Associated ●

Past history ●

Dizziness

History Differentials

Site ● ●

Quality ●

Severity ●

Context ●

Relieving ●

Aggravating ●

Associated ●

Past history ●

Menstrual Hx

History Differentials

Sensitivity ● Questions seem personal

● Can be quite embarrassing
● Routine questions - any information
is very important

Timing of ● Age of first period ●

Cycle ● Time of cycles
○ How many days apart are
your periods
● Duration of period
○ How many days does your
period last
● Regularity
○ Time between the start of
each periods

Quantity ● Amount of menstruation

○ Ask about what menstrual
items they use
○ Level of absorption (light,
medium, heavy)
● Are periods heavy?
● Ask how often sanitary products are
replaced
● Compare to normal
 ○ Amount
○ Frequency of changing
products

Contraception ● Contraception or hormonal therapy?

○ Pill
○ Implant Rod
○ IUD
● OCP contraindicated with Migraine
with aura

Context ● Sexual history

Relieving ●

Aggravating ●

Associated ● Change in appearance of period

● Blood clots
○ Infection
○ Increase amount of blood
● Spotting/bleeding between periods
● Spotting.bleeding after intercourse
● Missed periods
● Irregular period

Past history ●
Urine changes

History Differentials

Site N/A Storage (irritative) symptoms - Dysuria

● UTI (infection of the lower urinary tract)
Quality ● Storage ● Bladder irritation
○ Frequency ● STI
○ Urgency Voiding (obstructive) symptoms
○ Incontinence ● benign prostatic hyperplasia (BPH)
● Polyuria ● Urethral stricture
● Nocturia ○ Often after surgery
● Dysuria (pain) ● Prostate cancer
○ Pain at end of urination Polyuria
○ Burning
 ○ Stinging
● Voiding problems
○ Hesitancy (hard to start)
○ Straining
○ Dribbling/not continuous
○ Weaker and intermittent flow
○ Stream not straight
○ Incomplete emptying
● Diabetes
○ Mellitus - other associated features
○ Insipidus - dizziness
● Increased intake
○ Salt, alcohol, caffeine, thirst
● Chronic renal failure

Severity ● Frequency of symptoms

● Waking up at night

Time course ● Onset, offset

● Progression
● How often

Context ●

Relieving ●

Aggravating ●

Associated ● Other urinary symptoms

● UTI: fever, haematuria, back pain,
abdominal pain, smelly urine
● Diabetes: vision problems, salt cravings
● Polydipsia (thirst)
● Polyphagia (hunger)
● Weight loss

Past history ● Diabetes

● Female: sexual activity, instrumentation
● Family Hx:
○ Prostate
○ Diabetes
● Past surgeries
○ Catheters
○ Procedures
Vaginal Discharge

History Differentials

Site N/A ● Physiological:

○
Quality ● Colour ● Candidiasis
● Consistency ○ white discharge that is clumped,
● Quality - frothy similar to curd or cottage cheese
● Blood ● Bacterial vaginosis
○ whitish-grey discharge that has an
Severity ● unpleasant fishy smell
● Trichomonas
Context ● Partners ○ frothy discharge which is usually
(Sexual ○ Partners, regular or casual green or yellow in colour
history) sexual partners ●
○ Are your partners male,
female or both (what is
biological gender)
○ How many: within 3-6
months.
● Practices
○ What sexual practices do you
engage in?
○ Vaginal penetration
○ Anal, insertive, receptive,
both
○ Oral
○ Use and sharing of sex toys
● Prevention STIs
○ Condoms
● Prevent pregnancy
○ Condoms
○ Contraception
● Past Hx
○ History of patient
 ○ History of their partners

Other
● Antibiotics
● Change to contraceptive pill

Relieving ●

Aggravating ●

Associated ● Itch
● Lumbs/bumps
● Rash
● Discharge
● Intermenstrual bleeding
● Post coital bleeding
● Dyspareunia (pain during intercourse)

Past history ●