Weight loss or weight gain, Weight loss, + loss of appetite, Malignancy?, Depression? Anorexia nervosa?, Adrenal insufficiency?, + jaundice, Liver disease can cause disturbances of taste, + increased appetite, Malabsorption of nutrients?, Hypermetabolic state?, + early satiation, Gastric cancer?, Peptic ulcer?, "Functional" gastrointestinal disease?
Dysphagia, Is it true dysphagia, or just painful swallowing?, Painful swallowing, Any severe inflammatory process involving the oesophagus, Oesophagitis?, Peptic ulceration of the oesophagus?, Caustic damage to oesophagus?, Oesophageal perforation?, Dysphagia, Difficulty initiating swallowing..., Pharyngeal cause, eg neurological disease, such as motor neurone disease, "Do both solids and liquids stick?", Yes (neuromuscular cause more likely), "Is it intermittent or progressive?", Intermittent, Diffuse esophageal spasm?, Progressive, Scleroderma?, Achalasia?, No (mechanical obstruction more likely), "Is it intermittent or progressive?", Intermittent, Lower esophageal ring?, Progressive, Cancer?, Peptic stricture?, + possibly accompanied with heartburn (this is most commonly caused by acid reflux)
Heartburn?, Burning sensation?, Aggravated by bending, stooping, or lying supine?, Antacids relieve pain?, Sour or bitter taste in mouth?, Aggravated by alcohol, chocolate, caffeine, a fatty meal, theophylline, calcium channel blockers, anticholinergic drugs?
Nausea or vomiting, Acute, GIT infection?, Small bowel obstruction?, Chronic, Pregnancy?, Drugs? (digoxin, opiates, dopamine agonists, chemotherapy), Psychogenic, eating disorders, (Rarely) increased intracranial pressure, Peptic ulcer disease with gastric outlet obstruction, Does the patient have diabetes?, Gastroparesis?, Has the patient had gastric surgery?, Gastroparesis?, Is the patient jaundiced?, Acute hepatobiliary disease?, Alcoholism?
Abdominal pain, "Is it acute or chronic?", "Where does it hurt?", Localised, Parietal peritoneal inflammation?, Epigastric, Radiating to the back, Pancreatic?, + may be relieved by sitting up and leaning forwards, Peptic ulcer disease?, + episodic, + may occur at night, may wake patient from sleep, + may or may not be related to meals, Renal angle, possibly radiating to groin, Colicky, Renal colic?, Periumbilical region, Colicky, Small intestine obstruction?, Retrosternal, travelling upwards towards the throat, Gastroesophageal reflux?, "What is the nature of the pain?", Colicky, In renal angle, possibly radiating to groin, Obstruction of ureters?, Bowel obstruction?, Cycle: 2-3 minutes, Small intestine obstruction?, + may be in periumbilical region, + possible vomiting, + possible abdominal distension, + possible constipation, Cycle: 10-15 minutes, Large intestine obstruction?, + possible vomiting, + possible abdominal distension, + possible constipation, Dull, Relieved by food or antacids, Peptic ulcer disease?, Burning, Relieved by food or antacids, Peptic ulcer disease?, Gastroesophageal reflux?, "Does anything make it worse?", Eating, Ischaemic pain?, Alcohol, chocolate, caffeine, fatty meals, theophylline, calclium channel blockers, anticholinergic drugs, Gastroesophageal reflux, "Does anything make it better?", Rolling around, Colicky pain?, Food / antacids, Peptic ulcer disease?, Gastro-oesophageal reflux?, Vomiting, Peptic ulcer disease?, Gastro-oesophageal reflux?, Defecation,, Colonic disease?, Lying perfectly still, Peritonitis?, Red flags, Sudden onset, Increasing severity, Syncope/pre-syncope, Vomiting (esp. protracted), Haematemesis, Abdominal distension (esp. progressive), Pallor and sweating, Tachycardia/atrial fibrillation, Hypotension, Fever, Rebound tenderness, guarding, rigidity, Decreased urine output
Jaundice, "Is the urine dark?", Dark urine, Pale stools..., Post-hepatic cholestasis, Gallstones?, Malignancy?, + check for Courvoisier's sign:, palpable, non-tender gallbladder, Not dark, Haemolytic cause?, Liver disease..., Hepatitis?, Cirrhosis?, Transport protein defects?
Change in bowel motions, Diarrhoea, "How much has there been?", Bulky/high volume, "What have the stools been like?", Steatorrhoea, Maybe malabsorption due to ..., Giardia lamblia?, Pancreatic enzyme deficiency?, Pancreatitis?, Cystic fibrosis?, Bile salt deficiency?, Biliary obstruction?, Chronic liver disease?, Terminal ileal disease, such as Crohn's disease?, Small volume, but frequent, Possible pus or mucus in stools, Maybe exudative diarrhoea due to ..., Shigella? Salmonella? Campylobacter? Entamoeba histolytica?, Inflammatory bowel disease?, Colon cancer?, Constipation, Chronic, Chronic constipation, Distension due to neglect of impulse to defecate?, Drugs?, Metabolic/endocrine disease?, Neurological disorder?, Straining, feeling of blockage, Disorders of muscles/nerves of pelvic floor?, Anorectal disease (eg fissure, stricture)?, Erratic constipation, Irritable bowel syndrome?, + pain relieved by defecation?, + looser/more frequent stools w/ onset of pain?, + passage of mucus per rectum?, + a feeling of incomplete emptying?, + visible distension of the abdomen?, Mucus in bowel movements, Rectal ulcer?, Fistula?, Villous adenoma?, Irritable bowel syndrome?, Blood in feces, Malaena, Upper GI source of bleeding, Small amounts of bright red blood, Haemorrhoids?, Anal fissure?, Large amounts of blood, Distal colon/rectum source?, Major bleeding in proximal tract?, Angiodysplasia?, Diverticular disease?
Moist or dry?, Dry, Viral infection?, Asthma?, + possibly intermittent, clear-yellow, sticky sputum, Gastroesophageal reflux?, Interstitial lung disease?, ACE inhibitors?, Moist, Acute or chronic?, Chronic, COPD?, Bronchiectasis?, Acute, Viral infection?, Acute bronchitis?, Pneumonia?, What is the sputum like?, Copious, green-yellow, COPD?, Bronchiectasis?, Bronchitis?, Intermittent, clear-yellow, sticky, Asthma?, Haemoptysis (establish that it is true haemoptysis), Sudden onset, with weight loss, Lung malignancy?, Chronic, intermittent, with purulent sputum, Bronchiectasis?, Pink, frothy, Pulmonary oedema?, With acute dyspnoea and pleuritic chest pain, Pulmonary embolism with infarction
What time of day?, Nocturnal cough, Asthma?, LVF?, Post-nasal drip?, Morning cough, Smoking?
What's it sound like?, Paroxysmal, w/ terminal whoop, Whooping cough?, Bovine, Recurrent laryngeal nerve palsy?, Harsh, seal-barking, Croup?
"When does/did it occur?", On waking, COPD?, Nocturnal, Asthma?, LVF?
Sudden onset in young male, Pneumothorax?
Sudden onset, Anaphylaxis?, Inhaled foreign body?, Epiglottitis?, + look for classic forward-leaning posture, Croup?
Gradual onset, Malignancy?
Localised, not cleared with coughing, Carcinoma?