Written by Moriom Begum
Haemorrhoids (fresh blood, pruritus, recent constipation, lumps)
Other differentials:
Anal fissure (fresh blood, recent constipation but lumps indicate haemorrhoids)
Anal cancer (unlikely due to acute history and age but may be considered if not responding to treatment)
Mark scheme for history taking can be found below
Cardiovascular history 1 Written by Olivia Nwosu Diagnosis: 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…
Gastrointestinal history 7 Written by Moriom Begum Diagnosis: Anal fissure (fresh blood, pain during bowel movement, previous constipation) Other differentials: Haemorrhoids (fresh blood, previous constipation but less likely due to sharp pain during bowel movement and no lumps or pruritus) Inflammatory bowel disease (possible due to family history, may present with perianal disease, blood in…
Gastrointestinal history 1 Written by Leya Bedar Diagnosis: Appendicitis (due to generalised pain to right iliac fossa and progression from dull to sharp suggesting peritonitis, along with exacerbating and relieving factors, anorexia, fever, and nausea) Other differentials: Ruptured ectopic pregnancy (possible cause of peritonitis but very unlikely as patient has never had sex) Ovarian torsion…
Gastrointestinal history 3 Written by Leya Bedar Diagnosis: Irritable bowel syndrome (flatulence, generalised abdominal pain, fluctuating between diarrhoea and constipation, link to anxiety) Other differentials: Inflammatory bowel disease – Crohn’s disease/ Ulcerative colitis (possible due to change in bowel habit but less likely due to lack of extra-gastrointestinal manifestations and no blood or mucus in…
