Focused History

Dr. Ahmed Laymouna

 Hemoptysis
• 50-year-old man presented to the ER because
of coughing of blood.
What would you like to ask this patient
regarding his symptom ?
 Hemoptysis
• Differential diagnosis of hemoptysis:
- Pulmonary embolism, pulmonary hemorrhage
- Bleeding disorders and blood thinning drugs
(anticoagulants, antiplatelets, thrombolytic
drugs)
- Infections
- Lung malignancies
- Trauma
- Autoimmune diseases
 Hemoptysis
• Introduce yourself, take permission
• Ask about age, occupation, smoking
 Hemoptysis
• Analysis of complaint:
- DD between hemoptysis and hematemesis
Hemoptysis Hematemesis

Colour Bright red and Dark red or

frothy brown
Consistency May be mixed May contain
with sputum food particles
Symptoms Accompanied by May be
coughing preceded with
nausea
 Hemoptysis
• Analysis of complaint:
- OCD, smoking
- Amount of blood (need blood transfusion or
hypotension)
- Previous attacks
- Associated symptoms
 Hemoptysis
• Other chest/cardiac symptoms:
- Shortness of breath
- Palpitations
- Syncope, dizziness
- Lower limb swelling
- Fever

- Family history of bleeding disorders, malignancy

 Hematemesis
• 52-year-old man presented to the ER because
of vomiting of blood.
What would you like to ask this patient
regarding his symptom ?
 Hematemesis
• Differential diagnosis of hematemesis:
- Peptic ulcer disease
- Malignancy
- Arterial malformation
- Trauma
- Liver cirrhosis
- Splenic vein thrombosis
- Bleeding disorders
- Blood thinning drugs
 Hematemesis
• Introduce yourself, take permission
• Ask about age, occupation
 Hematemesis
• Analysis of complaint:
- DD between hematemesis and hemoptysis
Hemoptysis Hematemesis

Colour Bright red and Dark red or

frothy brown
Consistency May be mixed May contain food
with sputum particles
Symptoms Accompanied by May be preceded
coughing with nausea
 Hematemesis
• Analysis of complaint:
- OCD
- Amount (Need blood transfusion, fainting)
- Colour
- Previous attacks
 Hematemesis
• Other symptoms:
- Melena
- Bleeding tendency elsewhere
- Nausea - LL edema - Weight loss
- Jaundice - Fever - Abdominal pain
- Disturbed concious level
 Hematemesis
• Risk factors:
- History of HBV, HCV
- Drugs
- Bleeding tendency

- Past history of liver cirrhosis, bleeding tendency,

peptic ulcer disease
- FH of bleeding disorders, hereditary GIT problems
 Melena
• 65-year-old man presented to the ER because
of vomiting of blood.
What would you like to ask this patient
regarding his symptom ?
 Melena
• Differential diagnosis of melena:

- Peptic ulcer disease

- Malignancy
- Arterial malformation
- Trauma
- Liver cirrhosis
- Splenic vein thrombosis
- Bleeding disorders
- Blood thinning drugs
 Melena
• Introduce yourself, take permission
• Ask about age, occupation
 Melena
• Analysis of complaint:
- OCD
- Amount (Need blood transfusion, fainting)
- Colour
- Previous attacks
 Melena
• Risk factors:
- History of HBV, HCV
- Drugs
- Bleeding tendency

- Past history of liver cirrhosis, bleeding tendency,

peptic ulcer disease
- FH of bleeding disorders, hereditary GIT problems
 Melena
• Other symptoms:
- Hematemesis
- Bleeding tendency elsewhere
- Nausea - LL edema - Weight loss
- Jaundice - Fever - Abdominal pain
- Disturbed conscious level
 Chronic Cough
• 52-year-old man presented to the ER because
of vomiting of blood.
What would you like to ask this patient
regarding his symptom ?
 Chronic Cough
• Differential diagnosis of chronic cough:
- Chronic bronchitis
- GERD (gastro-esophageal reflux)
- Bronchial asthma
- Bronchiectasis
- Interstitial pulmonary fibrosis
- Drugs (ACEIs)
 Chronic Cough
• Introduce yourself, take permission
• Ask about age, occupation, smoking
 Chronic Cough
• Analysis of complaint:
- OCD
- Expectoration - Fever - Positional
- Diurnal
- Exposure to fumes or dust
- Relieving factors (bronchodilators)
 Chronic Cough
• Associated symptoms:
- Dyspnea, orthopnea, PNDs - Palpitations
- Wheezes
- Chest pain
- Cyanosis - Syncope
- LL edema
 Chronic Cough
• Risk factors:
- Smoking, exposure to fumes or dust
- GERD
- Chronic sinusitis
- Malignancy
- Bronchial asthma

- Past history of infections (TB), autoimmune

disease (sarcoidosis), malignancy
- FH of AI disease, malignancy, bronchial asthma
 Jaundice
• 50-year-old man presented to the ER because
he noticed recent discoloration of his eyes and
skin.
What would you like to ask this patient
regarding his symptom ?
 Jaundice
• Differential diagnosis:
- Pre-hepatic: Hemolytic jaundice
(autoimmune, drug-induced, infections,
malignancy)
- Hepatic: Liver cirrhosis, drugs, infections,
malignancy
- Post-hepatic: stones, pancreatic malignancy,
cholangitis
 Jaundice
• Introduce yourself, take permission
• Ask about age, occupation
 Jaundice
• Analysis of complaint:
- OCD
- Previous attacks

Associated symptoms:
- Fever - Abdominal pain - LL edema
- Abdominal distension - Hematemesis, melena -
Disturbed concious level
- Anemic manifestations (palpitations, dyspnea,
dizziness, syncope)
- Weight loss
 Jaundice
• Risk factors:
- Risk factors of liver cirrhosis (HBV, HCV,
alcohol, AI hepatitis, cholangitis, drugs like
methotrexate)
- Travel history (malaria)
- AI disease diseases (auto-immune hemolytic
anemia)
- Malignancy
• Past history: gall bladder or pancreatic
diseases
• FH: AI diseases, malignancies