Written by Olivia Nwosu
Left-sided heart failure (due to orthopnoea, PND (paroxysmal nocturnal dyspnoea), cough on exertion, cardiovascular risk factors)
Other differentials:
COPD (due to cough and smoking history)
Idiopathic pulmonary fibrosis (due to cough)
Mark scheme for history taking can be found below
Musculoskeletal history 3 Written by Leya Bedar Diagnosis: Gout (attacks of pain, inflammatory features, alcohol use, dietary risk factors) Differential diagnosis: Pseudogout (similar features but unlikely to affect the big toe) Septic arthritis (inflammatory features, but not episodic or associated with these risk factors) Corns/callus on plantar surface of foot (possible to explain pain but…
Neurological history 1 Written by Leya Bedar Diagnosis: Tension headache (band-like distribution of pain, tight and constricting, link to stress, responds to painkillers, stress) Differential diagnosis: Migraine (generalised pain, stress, responds to painkillers but less likely due to nature of pain and lack of aura, photophobia, or clear triggers) Dehydration (dull headache but unlikely due…
Gastrointestinal history 4 Written by Leya Bedar Diagnosis: Gastroenteritis: food poisoning (diarrhoea following eating unusual food, features of infection) Other differentials: IBS: Irritable bowel syndrome (possible due to busy life, change in bowel habit and abdominal discomfort, but unlikely due to lack of anxiety, sudden onset and infectious features) Bowel cancer (possible due to family…
Cardiovascular history 4 Written by Leya Bedar Diagnosis: Pericarditis (features of infection, pleuritic chest pain, improves when leaning forward, recent viral illness) Other differentials: Pulmonary embolism (shortness of breath, sudden onset, pleuritic chest pain, but less likely due to features of infection) Oesophagitis (features of infection but unlikely as no link to swallowing/eating and no…
Neurological history 3 Written by Leya Bedar Diagnosis: Cluster headache (pain around eye, autonomic symptoms, periods of remission) Differential diagnosis: Temporal arteritis (pain around eye, but no visual disturbances, jaw claudication, or other suggestive features) Migraine with aura (intense headaches, but less likely due to autonomic features, triggers associated with cluster headache as well as…
Cardiovascular history 3 Written by Olivia Nwosu Diagnosis: Myocardial infarction (due to cardiac nature of pain, intense, autonomic features, family history of cardiovascular disease, T2DM, cardiovascular risk factors) Other differentials: Unstable angina (due to cardiac features, but pain usually goes away) Oesophageal spasm (due to chest pain and previous heartburn, unlikely as factors point to…
