Fast Paces History PDF

Fast PACES
Academy for Doctors
Histories
DR IMRAN BABAR MRCP (UK)

FAST PACES Academy
www.facebook.com/fastpaces
+923004507980 mrcpfast@gmail.com
Contents
Topic Page
1 History Taking Pattern 2
2 Abdominal Swelling 4
3 Ankle Swelling (PHTN) Young, Non- Smoker 6
4 Asymptomatic HTN 8
5 Breathlessness 10
6 Burning of Feet 12
7 Chest Pain 14
8 Cold and Painful Fingers 16
9 Acute confusion 18
10 Collapse 19
11 Chronic Confusion (Forgetfullness) 22
12 Chronic Cough 24
13 Diabetic Foot 26
14 Difficulty in walking 28
15 Dizziness OR Feeling Faint 31
17 Double Vision 32
18 Dysphagia 34
19 Epigastric Pain & Nausea 36
20 Facial Swelling 38
21 Funny Turns 40
22 Backache 42
23 Hemoptysis 44
24 Headache 46
25 Hoarse Voice 50
26 Hypercalcemia 52
27 Hyperlipidemia 54
28 Jaundice 55
29 JOINTS 58
30 Loin Pain 59
31 Loss of weight 60
32 Weight loss and Diarrhea 62
33 Lower GI Bleeding 64
34 Megaloblastic Anemia 66
35 Lump in the neck (Lymph Nodes) 67
36 Painful Shins (Erythema Nodosum) 68
37 Painful Shoulders 69
38 Palpitations 71
39 Pins and Needles (Peripheral Neuropathy) 73
40 Carpal Tunnel Syndrome 75
41 Polyuria 76
42 Pruritis 78
43 Purpuric Rash 79
44 Pyrexia 81
45 Renal Colic & Hematuria 82
46 Tiredness 83
47 Tremors 84
48 Visual Disturbance 85
49 Vomiting 86
50 Weakness of one Arm 88
51 Weight Gain 90
52 Wheez 91
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1.History Taking Pattern
Introduction
Information sharing with the patient
Presenting Complaint
ODPARA (History of Present illness)
Associated System
Differential Diagnosis Related Questions:
Other information
(PAMM- Hugs -FOSS)
P → Have you ever had similar complaints it the Past?
A → Do you have Allergy to any thing?
M → Do you have any other Medical problems like Diabetes, high Blood pressure, problem related to
Liver,kidney etc
M → Are you taking any Medicines?
Which medicines? Can You please show me the List of medicines that you are taking?
(In which doses? For how long? Any particular side effects)
Any other medicines not given by the doctor?
Hugs → Have you ever been Hospitalized for any Medical or Surgical reason?
F → Any similar complaints in your other Family members? (Especially for communicable diseases)
Any other significant illness that runs in your Family? (Like DM, Heart problem, Kidney problem)
OB/Gynae: Any problem related to monthly periods?
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Sexual Hx: (If required, optional, not required always)
Is that alright if I ask you some personal questions?
Let me assure you what ever you tell me will be kept confidential.
Are you in relationship with someone?
Social History: (in detail)
 Job
 Living
 Daily activities
 Social and Financial support?
 How is affected?
 Smoking
 Alcohol and other drugs if required
 Diet and exercise (Sometimes required)
Driving: Do you Drive? is that private vehicle or else?
Travelling: Any recent Travel?
R.O.S: (Review of System)
Now I am going to ask you few more Questions which are not directly related to your problem but
sometimes useful. Is that fine with You?
Recap: After recap …would you like to add any thing else which I might have missed?
Idea:
Concern: Do you have any particular concern at the moment?
(Other possible questions ….Why you think like this? Did any one mention this possibility)
Explain:
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2.Abdominal Swelling
4 Fs
 Fluid (Ascites)
 Fat
 Flatus
 Fetus
Where exactly the swelling is?

Do you have swelling anywhere else?
For how long you have this?
Is it getting worse?
What makes it better?
What makes it worse?
GIT Also screening Questions for Hepatitis B and C and

Autoimmune, Metabolic causes of CLD
General (Malignancy, TB, other autoimmune conditions)

Thyroid
Heart
Chest
Kidney
Joint
P
A
M
M (Methotrexate, Amiodarone, Phenytoin, INH etc)
Hugs
F
O
Sx (HIV, HBV, HCV)
Social
 Exposure to asbestos
 Alcohol
 I/V Drugs
 Smoking
Recap
Idea
Concern
Explain
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DD For Ascites
1.GIT
a.CLD
 Alcohol
 Viral
 Autoimmune
 Metabolic
 Vascular
 Drugs
b.Malignancy
c.Malabsorption Syndrome
d.Budd Chiari Syndrome
e.Pancreatitis
2.Hypothyroid
3.Heart
 CCF
 Cor -Pulmonale
4.Chest
 TB
 Malignancy
5.Kidney
 Nephrotic Syndrome
6.Joints
 SLE
 RA
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3.Ankle Swelling (PHTN) Young, Non- Smoker
Young non- smoker with following complaints:

SOB, Chest Pain and Ankle swelling
SOB (Detail)
Chest pain (Detail)
Ankle swelling (Detail)
 General
 OSA (Obstructive Sleep Apnoea)
 Joints
P
A
M
M
Hugs
F
O
Social
R.O.S
Recap
Idea
Concern
Explain
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Secondary Causes of Pulmonary HTN
1.Chest
 Recurrent PE
 Chronic Conditions e.g Bronchiectasis
2.Heart
 Congenital
 Valvular Problem
3.Joints
 SLE
 Scleroderma
4.Medicine
 Fenfluramine
5.Sexual
 HIV
6.Social
 Job
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4.Asymptomatic HTN
Do you have any Symptoms like:
 Headache
 Vision Problem
 Chest Pain
 Difficulty in breathing
 Pain in Legs especially on walking
DD:
Do you feel anxious especially while visiting the

doctors? (White coat HTN)
General
Glands
Kidney
P
A
M
M
Hugs
F
O
Social
R.O.S
Recap
Idea
Concern
Explain
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DD Of HTN
A. Primary
B. Secondary
White Coat HTN

Glands
 Conns Syndrome
 Cushing Syndrome
 Acromegaly
 Phaeochromocytoma
Kidneys
 Diabetic Nephropathy
 APDK
 GN
Medicine
 Poor Compliance
 Steroids,OCPs,NSAIDs
Family History
 APKD
Pregnancy
Social
Alcohol, Cocaine
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5.Breathlessness
SOB (Detail)
DD
 Heart
 Chest
 General
 CNS
 Anemia
 Glands
 Kidney
 Psychological
Hugs
Social
Idea
Concern
Explain
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DD For SOB
Heart
 IHD
 Cardiomyopathy
 Valvular
 Pericardial Disease
Chest
 Pneumothorax
 Pleural effusion
 COPD
 Asthma
 Bronchiectasis
 Foreign body
 PE
 Pulmonary HTN
 Pneumonia
 ILD
 Sarcoidosis
 Malignancy
CNS
 Myasthenia Gravis
 MND
 GBS
Glands
 DM (DKA), Acromegaly, Hypothyroidism
Renal Failure
Psychological
Social
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6.Burning of Feet
Where exactly the burning is in your feet?

Up to which level?
Do you have burning anywhere else like in your
hands?
Sensory
- ve Any numbness?
+ ve Tingling
Motor
- ve Weakness or
+ ve Cramps
Balance or Gait
Any problem with your balance especially when you
close your eyes?
Autonomic
Do you feel dizzy when you stand up quickly from
sitting position?
For how long you have this problem?

(Numbness,tingling,burning,pain etc)
Associated cause like detail of DM if in history
 General
 Multiple Myeloma
 Thyroid
 GIT
 Kidneys
 Joints
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P
A
M
M
Hugs
F
O
Social
DD of Peripheral Neuropathy:
DM
General
 Malignancy
Multiple Myeloma
Hypothyroidism
GIT
 Vit. B12 Deficiency
 Autoimmune gastritis
 Malabsorption syndrome
Kidneys
 CRF
Joints
 RA
 SLE
Medicines
 IINH
 Chemotherapy
 Nintrofurantoin
Family History
 HMSN
Sexual history
 HIV
Social History
Alcohol
Nutrition
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7.Chest Pain
Where exactly it is?

For how long you have this?
How did it develop it,suddenly or gradually?
What were you doing at that time (If sudden)

More on pressing (Musculoskeletal)
Lying flat (Pericardial)
On Exertion (IHD)
Eating (GERD)
Taking deep Breath in (PE)
Coughing or sneezing
(Spinal due to Mass or Disc herniation)
DD
 Injury (Musculoskeltal)
 Heart
 Aortic Dissection
 GERD
 Lungs
 Spinal
 General
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A
M
M
Hugs
F
O
Social
DD of Chest Pain
Heart
 Pericarditis
 IHD
 AS
Aortic Dissection
GERD
Lungs
 Pleursy
 Pneumothorax
 Pneumonia
 Malignancy
 PE
 PHTN
Chest
 Trauma
 Post Herpetic Neuralgia
 Intervertebral Disc Disease
 Spinal mass
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8.Cold and Painful Fingers
In which Fingers you have this problem?

Where started first?
Any other part of body affected?
Any color changes? Which color changes?
White, Blue or Red?in which finger?
For how long you have this problem?

Associated system like JOINTS
DD
General
Any yellowness of your eyes? (Liver)
Any Problem adjusting to temperatures?
Any injury to neck area before developing these symptoms?
Any Problem with movement of Neck like stiffness?
Any numbness or tingling in your hands?
Any Pain in Legs on walking?
P
A
M
M
Hugs
F
O
Social
 Jobs (Vibrating tools)
 Smoking
 Cocaine
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DD
Joints
 RA
 SLE
 Scleroderma
 Polymyositis
 MCTD
General
 Myeloproliferative disorders
Liver
 Cryoglobulinemia (Hepatitis B and C)
Hypothyroidism
Trauma
Cervical Myelopathy
Cervical Rib
Neurological
 e.g Carpal Tunnel Syndrome
Medicines:
 B - Blockers
 Chemotherapy
Drugs
Cocaine etc
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9.Acute confusion
Head injury
Infections
 Meningitis / Encephalitis
 Abscess
 Pneumonia
 UTI
 Others
Stroke / TIA
Metabolic
 CRF
 CLD
 COPD (CO2 retention)
 Electrolyte Imbalances
Endocrine problems
 DKA
IHD
Stool Impaction
Urinary Retention
Drugs
Alcohol
 Intoxication
 Withdrawl
 Wernicke syndrome
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10.Collapse
Events Before Collapse
Please tell me what exactly happend?
What were you doing at that time?
Did you remember while falling?
Any unusual symptoms before this? (Aura)
Like:
Pre-syncope features like Light headedness, Darkening of vision/tunnel

of vision or any generalized body weakness
Blurring of vision,nausea and sweating (Autonomic)
Chest pain or racing of heart? Difficulty in breathing? (Caridiac)
Severe headache? (Subarachnoid hemorrhage)
Seeing of unusual object,abnormal smell Or ringing in the ears?

(Epilepsy, seizures)
During the Event
Was there anyone around you?

What did they tell?
Did you lose consciousness? (If yes)

Was it Complete or incomplete? For about how long you might have
been remain unconscious?
Did any one tell you about:
Any color changes of your skin?

(Whie,Blue or Grey )
Any shaking of your body limbs (Seizures)
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Post Recovery events
When you woke up?
Were you fully back to normal Or any confusion and sleepiness?

Did you wet yourself?
Any wound on your tongue?
Body Aches? Or Headache? Seizures
Did any one Checked your blood sugar level at that time? Hypoglycemia
Any problem with speech Or Weakness in body limbs? TIA or Stroke
Any Fever and Neck Stiffness? Meningitis
Fatigue or racing of heart on exertion? Anemia
P
A
M
M
Hugs
F
O
Social
 Alcohol
 Cocaine
 Other recreational drug like amphetamines
 Night club
 Lack of sleep
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Features of syncope
Sudden collapse due to sudden transient loss of blood supply to the brain followed by complete recovery within
short time without any problems after the event like weakness or speech problem
It may be preceded by Pre-syncope features or not like
 Light headedness, Darkening of vision/tunnel vision or generalized body weakness
It may also be preceded by Aura related to underlying type of syncope or not like
 Vasovagal (Autonomic e.g blurriness,nausea,sweating etc)
Or
It can be preceded by Triggers like
 Situational (coughing,sneezing etc)

 Neck movement (carotid sinus hypersensitivity)
 Sudden standing (Postural)
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11.Chronic Confusion (Forgetfullness)
What do you mean by that?
ODPARA
Does he know about the problem?

What does he forget about?
Does he know what day or time it is?
Does he forget where he is?
Does he lose the way to his home?
Does he forget the name of his family members?
Any problem recalling present or past event?
What about his personal hygiene?
Any changes in his mood or behavior?
Does he see the objects which others don’t see?
Any injury to head before this?
CNS
General
Depression
Thyroid
P
A
M
M
Hugs
F
O
Social
 Alcohol
 Recreational drugs
 Legal issues
 Lasting poser attorney
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DD:
Injury
 Hematoma
CNS
 Alzeihemr’s Disease
 Lewy body Dementia
 Crutzfeld Jacob Disease
 Picks Disease
 Normal Pressure Hydrocephalus
Hypothyroidism
Liver Disease
Kidney Disease
Drugs
 Alcohol
Others
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12.Chronic Cough
ODPARAA
Chest
Heart
GERD
ENT
General
P
A
M
M
Hugs
F
O
Social
 Job, Previous job
 Living, any recent renovation at home
 Smoking
 Alcohol
 Others
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DD of cough
Chest
 COPD, Asthma, Bronchiectasis, Foreign body
 Pneumonia, TB, Cancer, ILD, sarcoidosis
 Chronic Pulmonary Embolism
Heart
 CCF
 Valvular
 Cardiomyopathy
Medicines
 ACE inhibitors, Amiodarone, Tamoxifen
Dauxorubicin, Nitrofurantoin etc
GERD
ENT
 Chronic sinusitis
 Allergic Rhinitis
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13.Diabetic Foot
Ulcer
Gangrene
Charcot joint
What actually the problem is?Then
 Sensory
 Motor
 Balance
 Autonomic
 Pain in Legs on walking (PVD)
ODPARA
DM (Detail)
R.O.S
M (HTN,Cholesterol)
Hugs
F (Important)
Social
 Smoking
 Alcohol and other recreational drugs
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Management Plan
General measures
 Patient’s Education and explanation of the condition
 Avoidance of smoking
 Reduction in alcohol intake
MDC including
 Diabetic clinic
 Dietitian
 Physical trainer
 Physician
 Joint specialist
 Foot specialist
 Vascular surgeon
 Foot specialist etc
Specific measures
Control of DM, BP and Fat levels with therapy
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14.Difficulty in walking
What actually the problem is?
If weakness in which part?
Weakness in any other part?
Stiff or Floppy
ODPARA (Stiff or Spastic)
Any Backache
Any injury
Any swelling
Any other problem with legs

(Sensory symptoms,Balance problem, others)
CNS (Other questions)
General
Cervical spine
Chest
GIT
P
A
M
M
Hugs
F (Hereditary spastic paraparesis)
 HIV
 Syphilis
Social
 Smoking
 Alcohol etc
Recap
Idea
Concern
Explain
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Difficulty in walking
(DD of Flaccid Or Floppy Paraparesis)
Motor Neuropathy
 GBS
 CIDP
 Lead Poisoning
 Diphtheria
 Acute Intermittent porphyria
MND
Acute events
 Cord Compression
 Transverse Myelitis
 Infarction of the cord
Hypokalemia / Hyperkalemia
HMSN
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Weakness of Proximal Group Weakness of Distal parts Generalized body weakness

of Muscles
Muscular Dystrophy Myotonia Dystrophica Depression
Inflammatory conditions HMSN Malignancy

 Polymyositis
 Dermatomyositis Inclusion body Myositis CNS
 MG
Endocrine Peripheral Motor Neuropathy  MND
 Hyperthyroidism  Botulism
 Hypothyroidism
 Cushing Syndrome Endocrine
 Acromegaly  DM
 Addison’s Disease
Channelopathy
 MG Others
 LEMS  Hypokalemia
 Organo-phosphorus
Bones (Osteomalacia) poisoning
 Snake bite
Drugs
 Steroid
 Statins
 Alcohol
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15.Dizziness OR Feeling Faint
What exactly the problem is?

Any problem with your Balance or spinning?
Do you feel yourself spinning in the space or
The things spinning around you?
Any unusual symptoms before you collapse or having dizziness?

Aura (Autonomic, cardiac, epilepsy, subarachnoid haemorrhage etc)
Pre Event
During Event
Post Event
Do you get such symptoms during specific situations like while passing water works,coughing or sneezing etc?
(Situational)
Any such symptoms when you suddenly turn your Neck? (Carotid sinus Hypersensitivity)
Any problem when you suddenly stand up from sitting position? (Postural)
Hypoglycemia
Seizures
Stroke or TIA
Anemia
P
A
M
M
Hugs
F
O
Social
 Alcohol
 Drugs etc
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16.Double Vision
In which eye? In which direction?
Any other problem with your eye like pain,decreased
vision,problem recognizing the different colors etc
ODPARA
Does it improve by closing of one eye (MS, Nerve)
General
Flu like illness before this? (Miller Fischer)
Did you use any Cane foods before it develops? (Botulisum)
CNS (BIH,SOL,MS,MG)
Any Jaw Pain? (GCA)
Thyroid (Thyrotoxicosis)
Joints (SLE)
P
A
M—DM,HTN, IHD
M—Aminoglycosides, D-Penicillamine
Hugs
F
O
Social
 Smoking
 Alcohol
 Drugs
 Diet deficient in dairy products
 Exercise
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DD of Double vision
Extra Ocular Muscles
 Thyrotoxicosis
 Myositis
 Chronic Progressive External Opthalmoplegia
Channelopathy
 MG
 LEMS
Nerves
 Ischemic e.g DM, HTN
 Vasculitis e.g GCA, SLE
Infective
BIH
SOL
Miller Fischer
Botulism
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17.Dysphagia
Where exactly the food stucks?
Which type of food you feel problem with? Solid,Liquids Or
Both?
Any difficulty in starting your swallowing?
Any cough with swallowing?
Any Pain during swallowing?
ODPARA
GIT
Joints
General
CNS
Anemia Racing of heart or SOB on walking
Candidiasis Any white patch on your tongue?
Swelling in front of neck? Goiter
P
A
M—DM
M—NSAIDs, Steroids
Hugs
F
O
Sx—HIV
Social
 Smoking
 Alcohol
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DD of Dysphagia
1.Oropharyngeal (CNS Causes )
 Stroke
 MND
 MG
 Parkinson’s Disease
Others
 Globus Hystericus
 Pharyngeal Pouch
2.Esophageal
Inflammatory
 GERD
 Drugs
 Eosinophilic Esophagitis
Infective
 Viral
 Fungal
Strictures
 Peptic
 Caustic
 Ischemic
Motility Problem
 Scleroderma
 Achalasia
 DES
 Dermatomyositis
Others
 Rings
 Tumors
 Foreign body
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18.Epigastric Pain & Nausea
LOQIRAA
GIT
General
Heart
Chest
Psychological
P
A
M
M
Hugs
F
O
Social
 Alcohol
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DD Of Epigastric Pain and Nausea:
Inflammatory
 APD
Dyspepsia
 Pancreatitis
 Cholecystitis
 IBD
Infective
 Ascending cholangitis
 Acute viral Hepatitis
 Hepatic abscess
Malignancy
Stomach, Liver, Gall bladder, Pancreas, Small bowel
Ischemic
 IHD
 Bowel Ischemia
Drugs
 NSAIDs
 Antibiotics
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19.Facial Swelling
Where exactly the swelling is?

Anywhere else?
ODPARA
Rash
Abdominal pain
SOB / Whistling
Did you ever collapse or not?
General
Glands
Thyroid (Hyper? Or Hypo? )
Cushing?
Heart
GIT
Kidneys
Joints
R.O.S
P
A
M
M
Hugs
F
O
Sx
Social
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DD Of Facial Swelling:
 Angioedema (Hereditary or acquired)
 Urticaria
 SVC obstruction
 Hyperthyroid

 Cushing syndrome
 CCF
 CLD
 Nephrotic Syndrome
 Connective tissue disorders (Like SLE etc)

 Medicines (e.g ACE Inhibitors, Morphine etc)
Important:
Epi Pen
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20.Funny Turns
Syncope → detail
ODPARA
DM → Detail
Tight control of Diabetes may be the problem so

explore in detail
General
Glands
Post- Prandial
GIT
Liver Disease
Kidneys
P
A
M
M
Hugs
F
O
Social
Recap
Idea
Concern
Explain
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DD Of Funny Turns
Hypoglycemia
 Tight DM control
 Malignancy
 Insulinoma
 Glands (Adrenal Insufficiency,
Panhypopituarism)
 CLD
 CRF
 Post Prandial
 Alcohol
 Factitious
Syncope
Stroke or TIA
Seizures
Anemia
Drugs
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21.Backache
Features of multiple Myeloma

LOQIRAA
 Blurriness of vision
Local Causes
 Recurrent infections
 Injury
 Fractures after minor injury
 Weight lifting
 kidney Problems
 Swelling
 Hyper-uricemia
 Problem with legs
Cord compression
Features of Paget’s Disease:
Disc Herniation
 Changes in hat size
Spinal stenosis
 Hearing problem
Seronegative (Stifness)  Bowing of legs
General
Multiple Myeloma
Paget’s Disease
Thyroid
Breast
Chest
GIT
Prostate if Male (metastasis)
P
A
M
M
Hugs
F
Obs /Gynae
Social
 Driving
 Travelling
Recap
Idea
Concern
Explain
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DD Of Backache
Local Causes
Cord Compression due to:

 Tumor
 Trauma
 TB
 Abscess
 Hematoma
Other Local causes:
 Spinal stenosis
 Intervertebral Disc Herniation
 Cauda equina Syndrome
 Spinal Strain
Seronegative Arthropathies (ARPE)
 Ankylosing Spondylitis
 Reactive Arthritis
 Psoriatic Arthritis
 Enteropathic Arthropathy
General
 Malignancy, TB
Multiple Myeloma
Paget’s Disease
Thyrotoxicosis
Chest e.g TB, Cancer
Prostate
Osteoprosis
 Medicines e.g Steroids, Thiazide diuretics
 Early menopause
 Oophorectomy
 Smoking
 Diet deficient in Dairy products
 Lack of Exercise
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22.Hemoptysis
Hemoptysis or Hematemesis?
How much?
Color?
Bleeding from any other site?
Any injury before this?
Chest
Heart
ENT
General
Foreign body
P
A
M
M
Hugs
F
O
Social
 Smoking
 Alcohol
 Driving
 Travelling
Recap
Idea
Concern
Explain
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FAST PACES Academy
DD of Hemoptysis:
Lungs
Airways
 Exacerbation of COPD
 Bronchiectasis
 Foreign body
 Procedure (Bronchoscopy)
Parenchyma
 TB
 Pneumonia
 Cancer
Blood channels
 PE
 HHT
 Wegener’s Granulomatosis
 Good Pasture Syndrome
 Other vasculitides
Heart
 Mitral Stenosis
ENT
Bleeding disorders
Drugs
 Warfarin
 Heparin
Trauma
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FAST PACES Academy
23.Headache
LOQIRAA How to ask Questions:

Trigeminal neuralgia:
Aggravating factors
Sudden / Sharp triggered by chewing, talking
SOL Brain aggravated by: or shave?
 Coughing
 Sneezing Trauma:
 Straining or Bending  Any Injury before this?
Migraine: Macroadenoma If frontal Headache

 Any specific Food or drinks like alcohol , cheese etc
 Problem looking to extremes
 Lack of sleep
 Fasting
Meningitis:
 Exercise / Stress
 Fever and Stiffness in the neck?
 Does Noise bother you?
 Does Light bother you? Occipital headache due to Cervical
Spondylosis
Trigeminal neuralgia
 Problem with movements of neck?
Aura:
Any unusual symptoms before this like visual, speech, sensory Carotid artery dissection
or motor symptoms
 Any sever Neck pain?
Trauma
Macroadenoma
Giant Cell arteritis (If pain on side of Head or
CNS and General Temple)

 Any jaw pain?
Depression (SIEG CAPS)
Meningitis: Eye problems:

 Pain, Redness,watering ,Discharge ,
Blurriness or decreased vision?
Occipital headache due to Cervical Spondylosis
(Cluster headache, Glaucoma, Infection,
Cavernous sinus thrombosis, GCA,BIH,SOL
Carotid artery dissection Brain etc )
Giant Cell arteritis (If pain on side of Head or Temple)

Post Herpetic Neuralgia
Eye problems  Any Rash on face
Post Herpetic Neuralgia

Kidneys
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FAST PACES Academy
ENT
APKD (Kidneys)
M—Blood disorders (Clotting disorders)
Medicine:
 OCPs
 Calcium channel blockers
 Nitrates
 Analgesic overuse because of some other problem like
RA or OA
Hugs
F—Kidney problems in the family like APKD
O— Any recent Pregnancy because it ay cause Cerebral Venous

Sinus thrombosis (CVT)
Recurrent abortions may be related to Antiphospholipid
Syndrome with features of migraine or CVT due to
hypercoagulation
Sexual activity may cause Post-coital or exercise induced

headache
Social
 Cocaine etc
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FAST PACES Academy
DD of headache
Trauma
Infection
 Meningitis
 Encephalitis
SOL Brain
 Tumor
 Abscess
 Tuberculoma
 Lymphoma
Bleeding
 Intracranial
 Subarachnoid hemorrhage
 Epidural hematoma
 Subdural hematoma
Blood vessels
 CVT
 Posterior cerebral circulation ischemia
 Cavernous sinus thrombosis
Frontal Headache (Pituitary Macroadenoma) e.g

Acromegaly,Cushing disease, MEN 1 and Non Functioning
adenoma
Depression
Cervical Spondylosis
Others
GCT
BIH
Eyes Uveitis, Glaucoma etc
Cluster headache
Post Coital headache or Exercise induced headache
Cough headache
Caffeine with drawl
Analgesic over use Headache
Medicines e.g CCB , Nitrates , OCPs etc
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FAST PACES Academy
Headache with visual aura

 Migraine
 CVT
 Posterior cerebral circulation ischemia
Frontal Headache with vision problem on looking to sides

 Acromegaly
 Cushing disease
 Non Functioning pituitary adenoma
 MEN 1
Headache with Photophobia

 Migraine
 Cluster headache
 Meningitis
Sudden onset Headache

 Acute on chronic
 Subarachnoid hemorrhage
 Meningitis / Encephalitis
 Carotid / Vertebral artery dissection
Facial headache
 GCA
 Temporomandibular joint
 Post herpetic neuralgia
 Trigeminal neuralgia
 Toothache
 Otitis Media
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FAST PACES Academy
24.Hoarse Voice
ODPARA
Sore Throat
Smoke inhalation
GERD
General
Thyroid
Chest
Heart
P
A
M
M
Hugs
F
O
Social
Recap
Idea
Concern
Explanation
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FAST PACES Academy
DD of Hoarseness
Sore throat
 Viral
 Bacterial
Smoke Inhalation
GERD
Cancer
Hypothyroidism
Pancoast Tumor in Lungs
Mitral Stenosis
Asthma Use of steroid inhaler
Social— job Using voice e.g Announcement
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FAST PACES Academy
25.Hypercalcemia
Bones, Psychic Moans, Abdominal Groans & Renal Stones
Symptoms
 Bones
 Brain
 GIT
 Kidneys
General
 Malignancy
Macroadenoma
 Any Frontal Headache
 Any Vision problem on looking to the
extremes
Glands
Any Swelling in front of your neck

(Medullary carcinoma of the thyroid)
Any sudden onset headache with sweating, flushing of

face and racing of heart? (Phaeochromocytoma)
Any problem adjusting to Temperatures

(Thyrotoxicosis)
Changes in hand size and feet size? (Acromegaly)
Chest
Heart
P
A
M
M
Hugs
F
O
Social
 Diet, Exercise (Sedentary or immobile)
Recap
Idea
Concern
Explain
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FAST PACES Academy
DD Of Hypercalcemia:
Malignancy
 Breast
 Lung
 Prostate
 Hematological
MEN 1 (4 P’s)
 Pituitary Macroadenoma (Acromegaly)
 Parathyroid
 Pancreatic cancer
 Peptic Ulcers
Thyrotoxicosis
Chest
 Sarcoidosis
 TB
 Cancer
 Heart (Arrythmias due to Hypercalcemia)
Medical problems
Medicines
Vitamin D analogues,Calcium supplements, Thiazide
Diuretics
Social
Increase intake of Milk and Dairy products
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FAST PACES Academy
26.Hyperlipidemia
Details of Lipids
Symptoms related to Vasculopathy
Stroke,Eyes , IHD , CCF, Kidneys , PVD etc
OTHER RISK FACTORS
DM
HTN
Smoking
Hugs
Social
Recap
Idea
Concern
Explain
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FAST PACES Academy
27.Jaundice
Yellow Discoloration of any other part?
ODPARA
1.Post Hepatic Jaundice related Questions

 Any Itching
 Any Pale colored bowel works
 Any Dark colored water works
 Any fever or chills
2.Hepatic Causes Related Questions

General Questions
Prodrome of acute viral hepatitis

 Any flue like illness before this?
GIT Questions (CLD etc) and Hepatitis B and C Screening Questions:

 Piercing,Tatooing ,Blood transfusions etc
Autoimmune
 Any white patches on your skin
 Any joint pains
Metabolic
 Any darkening of skin
 Any stiffness in limbs or shaking of your hands
 Any difficulty in breathing and whistling sound
Heart (CCF)
 Any racing of your heart?
 Do you need to use extra pillows to sleep?
Kidneys
 Any decrease volume of water works Leptospirosis
Budd Chiari Syndrome

 Ever had clot in the blood channels of your legs or lungs
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FAST PACES Academy
3.Pre Hepatic related Questions
Anemia
 Any Racing of your heart,Fatigue and difficulty in
breathing on exertion?
M
 Any clotting problem or Liver related problem in the past
M
 Methotrexate, Amiodarone, Phenytoin, INH, Paracetamol
etc
Hugs
 Medical or Surgical procedures
F
 Gilbert syndrome and other familial causes
OBS /Gynae Pregnancy related e.g

 IHC of Pregnancy
 AFL of Pregnancy
 HELLP Syndrome etc
Sx
 Hepatitis B and C
Social
 Alcohol,Mushroom poisoning, Swimming in pool etc
Travelling
 Viral hepatitis
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FAST PACES Academy
DD of Jaundice
Painful Jaundice
 Acute Hepatitis
Alcohol
Viral
Drugs
 Biliary Colic
 Budd Chiari Syndrome
 CCF
 Metastatic
 Pancreatitis
Painless Jaundice
 Gilbert syndrome
 Hemolysis
 Cirrhosis
 Malignancy
Clues
PBC
 Middle aged female, Fatigue , pruritis , Malabsorption
Alcohol
 History and examination
 Pain,Raised MCV and Neutrophilia
Acute Viral
 Prodromal flue like illness
Autoimmune
 Other autoimmune conditions
 Fever, Arthralgia
Metabolic
Hemochromatosis
 Dark Skin, Joint replacement,DM , infertility
Wilson’s disease
 Extrapyramidal features
 Psychiatric problem
Alfa 1 anti trypsin deficiency

 Young,Non- smoker with COPD
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FAST PACES Academy
28.JOINTS
Symmetrical
1. Viral <6 weeks
2. SLE
3. RA
4. Vasculitis
5. Drug Induced Lupus
6. Psoriatic arthritis
Asymmetrical
1. Seronegative Arthropathies
2. Gout
3. Rheumatic Fever
4. Malignancy
Monoarticular
1. OA
2. Gout
3. Pseudogout
4. Septic
5. Malignancy
6. Trauma
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FAST PACES Academy
29.Loin Pain
LOQIRAA
Genitourinary Questions
BPH
Trauma
General
R.O.S
PAMM
Hugs
FOS
DD:
1. Renal Stones
2. Renal Cancer
3. Pyelonephritis
4. Hydronephrosis
5. BPH
6. Trauma
7. Cyst Rupture
8. Blood clots
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FAST PACES Academy
30.Loss of weight
A.With Good Appetite B
1.GI Causes:
 Dieting
 Malabsorption syndromes
 Medicines e.g Laxatives
2.Non GI Causes:
 Exercise
 Gland problem
DM
Thyrotoxicosis
Pheochromocytoma
 Medicines
Fenfluramine
Orlistat
Diuretics
Anti thyroid medicines e.g Thyroxine
Weight loss schemes
GIT
General
Glands
Heart
Chest
Kidney
Connective Tissue Disorders
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FAST PACES Academy
B.With Bad Appetite:
1.GI Causes:
 APD
 Chronic infections
 IBD
 Malignancy of GIT
 Medicines
2.Non GI Causes:
 Depression
 Adrenal Insufficiency
 Malignanacy
 Chronic Infections
 Medicines e.g Antibiotics
 Smoking
 Alcohol
P
A
M
M
Hugs
F
O
Social
Recap
Idea
Concern
Explain
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FAST PACES Academy
31.Weight loss and Diarrhea
Weight loss detail
Details of diarrhea according to scheme
GIT
Malabsorption
 Celiac Disease
 Whipple’s Disease etc
Chronic Pancreatitis
Crohn’s Disease
Chronic infections
 TB
 HIV etc
Malignancy
SIBO
 Scleroderma etc
Microscopic colitis (Usually middle aged lady with watery diarrhea but normal colonscopy and diagnosis is
established on biopsy)
General
Glands
 Thyrotoxicosis
 DM
Joints
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FAST PACES Academy
 Food allergy
 Allergy to medicines
 Eosinophilic gastroenteritis
 Lactose intolerance etc
 Diabetes mellitus with diarrhea due to autonomic neuropathy
 Medicines like Laxatives and antibiotics
Hugs
 Bowel surgery leading to SIBO
 Radiation Enteritis
 Family history of celiac disease or IBD etc
Ob/Gynae
Social
 Travelling diarrhea
 Sexual History for HIV and others
Recap
Idea
Concern
Explain
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FAST PACES Academy
32.Lower GI Bleeding
What is the color?
How much at a time? Questions:
Fissusre in ano
When you get this?  Any pain on passing bowel works?
Before, during or after bowel works?
Haemorrhoids
ODPARA  Any lump coming out of back passages?
Fissusre in ano Associated Questions of IBD and Celiac

 Redness or yellowness of eyes
Haemorrhoids  Ulcers in mouth
 Joint pain
 Rash
GIT and Associated Questions of IBD and Celiac
Other Malabsorption Questions:
General (ADEK,Anemia , Albumin)
Heart (AF → ischemic colitis)
P
A
M—Radiations
M
Hugs
F
O
Sexual History
Social History
Recap
Idea
Concern
Explain
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FAST PACES Academy
DD of Lower GI Bleeding
 Anal Fissure
 Hemorrhoids
 Collitis
Diverticulitis
Infective
Inflammatory
Ischemic
Radiations
Medicines e.g NSAIDs
Pseudomembranous
 Malignancy
 Polyps
 Blood vessels
Angiodysplasia
HHT
Drugs e.g Warfarin etc
 CLD
 Procedures e.g Colonoscopy
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FAST PACES Academy
33.Megaloblastic Anemia
Anemia and Pancytopenia related Questions?

Difficulty in breathing, racing of heart or fatigue on walking? (Anemia)
Bleeding from nose, gums or any other site? Any rash? (Thrombocytopenia)
Any fever? (Neutropenia)
ODPARA
B-12 Deficiency Questions

 Any Yellowness of your eyes
 Soreness of Tongue
 Any Numbness or Tingling in fee?
GIT
 Automimmune gastritis (B 12 Deficiency)
 Malabsorption (Celiac)
 Ever had Worms in bowel works?
Kidneys (CRF and dialysis leading to loss of Folate)
Skin problem (Psoriasis leading to increased demand of Folate)
P
A
M
M— Sulfonamides, Phenytoin etc
Hugs—Stomach or Bowel surgery
F
O Pregnancy, Breast feeding
Sx
Social Alcohol, Do you take balanced diet including Meat, dairy products, any use of over cooked vegetables
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FAST PACES Academy
34.Lump in the neck (Lymph Nodes)
Where exactly the swelling is in your neck?

Do you have swelling anywhere else?
Any pain in it?
Any other problem related to swelling?
Does it move when you swallow?
ODPARA
General
 Malignancy
 Metastatic
 Lymphoproliferative disorders
Sore Throat
 Viral (Non Specific),HIV,Infectious
mononucleosis
Thyroid
Chest
 TB,Sarcoidosis , Cancer
GIT
 Cancer
P
A
M
M
Hugs
F
O
Social
Recap
Idea
Concern
Explain
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FAST PACES Academy
35.Painful Shins (Erythema Nodosum)
Where exactly the rash is?

Anywhere else?
How does it look like?
Any problem with your rash like pain,itching, bleeding or discharge form it?
ODPARA
General
 Malignacy
 infections and inflammation
Sore Throat
 Streptococcus
Chest
 Sarcoidosis
 TB
 Mycoplasma / Psittacosis
 Fungal
GIT
 IBD
Skin
 Leprosy
P
A
M
M OCPs,Sunlfonamides
Hugs
F
O
Social Pets at home (cat scratch disease) and Travelling
Recap
Idea
Concern
Explain
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FAST PACES Academy
36.Painful Shoulders
LOQIRAA
Any Stiffness?
Are they sore to touch?

Any Rash? Where?
Do you feel weakness while going upstairs?
Any Injury to neck before this?
Problem with movement of neck?
Thyroid
Depression
Joints
R.O.S
P
A
M
M
Hugs
F
O
Social
Recap
Idea
Concern
Explain
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FAST PACES Academy
DD of Painful Shoulders
1. Polymyalgia Rheumatica
2. Polymyositis / Dermatomyositis
3. Osteomalacia
4. Trauma
5. Cervical Spondylosis
6. Hypothyroid
7. Fibromyalgia
8. Joints
RA and Ankylosing Spondylitis
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FAST PACES Academy
37.Palpitations
When did it happen?
Sudden or gradual?
What were you doing at that time?
How frequent do you get that?
For how long it remains there?
How does it feel like? Can you please tap for me?
Do you feel any Thumping in your chest? Regular or

irregular?
Did you ever check your pulse at that time? How fast it
was? Regular or irregular?
Heart
 IHD ,Valvular , AS , HOCM , CCF etc
Lungs
 PE ,COPD ,Asthma ,Chest infections
Chest wall
 Injury, Operations
Food Pipe
 GERD
Anxiety
Anemia
Glands
 Thyrotoxicosis
 DM
GIT
 Electrolyte imbalances due to Gastroenteritis
Kidneys
 Hyperkalemia
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FAST PACES Academy
P
A
M
M e.g Beta agonist,Thyroxine etc
Hugs
F
O
Social History: Alcohol, Cocaine,Caffeine etc
Recap
Idea
Concern
Explain
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FAST PACES Academy
38.Pins and Needles (Peripheral Neuropathy)
In which feet the problem is?

In which part of your feet?
Up to which level?
Do you have such symptoms anywhere else?
Sensory
+ ve
- ve
Motor
+ ve
- ve
Balance problem especially with closed eyes or in darkness?
Autonomic
Any dizziness on standing up suddenly?
ODPARA
DD:
Diabetes (In detail)
General (Multiple Myeloma,other Malignancy)
Thyroid
GIT Autoimmune Gastritis,Malabsorption syndrome (Celiac)
Kidney Uremia
Joints SLE,RA
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FAST PACES Academy
P
A
M (Vitamin B 12 deficiency)
M (INH,Nitrofurantoin, Chemotherapy)
Hugs
F (HMSN)
O
Sexual (HIV,Syphilis)
Social
Alcohol,Diet deficient in dairy products
Recap
Idea
Concern
Explain
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FAST PACES Academy
39.Carpal Tunnel Syndrome
Where exactly the numbness is?

In which hand?
Which part of your hand?
Up to which level?
Do you have such symptoms in your feet or not?
Any other problem with your hands? Like Pain and weakness or wasting?
ODPARA
Trauma Any injury before this?
General Malignancy
Glands weight gain

 Acromegaly
 Cushing
 DM
 Hypothyroid
Kidneys Dialysis
Joints RA ,Gout
P
A
M
M
Hugs
F
Ob/ Gynae
 Pregnancy
Social
 Stone Cutter, Vibrating tools,Tractor use ( Farmer )
Recap
Idea
Concern
Explain
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FAST PACES Academy
40.Polyuria

Approximately How much is the quantity?
What is the color?
How much fluids you take daily?
Which type of fluids you take?
ODPARA
Hypercalcemia
Bones,Psychic Moans, Abdominal groans and Renal stones?
Any Injury to head before this?
CNS
Panhypopituarism Questions
 GH
 Hypothyroid
 Adrenal insufficiency
 Sexual Problem
General
Chest TB, Sarcoidosis
P
A
M
M Lithium,Glibenclamide
Hugs Surgery, Radiations
F
O
Social
Recap
Idea
Concern
Explain
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FAST PACES Academy
DD
1.Diabetes Inspidus (PTI VTI)
 Postoperative
 Trauma
 Infection
 Vascular events (Stroke)

 Tumor
 Infiltrations e,g
TB,Sarcoidosis,Haemochromatosis,Malignancy
2.DM
3.Hypercalcemia
4.Psychogenic Polydypsia
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FAST PACES Academy
41.Pruritis
Where exactly the itching is on your skin?
Anywhere else?
ODPARA
Scabies Any one else at home have similar complaints?
General Lymphoma
Polycythemia Headache,Blurriness,Ringing in ears/vertigo
Glands
 DM
 Thyroid (Hyper OR Hypo)
Liver
 Obstructive
 PBC
 Hemochromatosis
 Cholestatic phase of acute viral hepatitis
 Pregnancy (IHC)
Kidney Uremia
Joints
Psychological
P
A
M
M
Hugs
F
O
Sx HIV
Social Occupation (Fiber glass) use of Soaps, Detergent, Washing liquids etc
Recap
idea
Concern
Explain
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FAST PACES Academy
42.Purpuric Rash
Where exactly the rash is?

Anywhere else?
How does it look like?
Can you feel it?
Does it disappear when you press it?
ODPARA
Any Bluish spots on your skin?

Bleeding from any part?
Any difficulty in Breathing,Fatigue or Racing of heart
on walking (Anemia)
DD
ITP---Any Flue like illness before this?
General --- Malignancy,Leukemias ,metastatic
CNS --- TTP
GIT --- Henosch Schonlein Purpura
Liver --- CLD
Kidney --- HUS
Joints -- SLE
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FAST PACES Academy
P
A
M -- Liver disease, Kidney disease
M --- Heparin, Aspirin , Warfarin ,Steroids
Hugs-- Radiation exposure
F -- HHT, Bleeding disorders
OB/Gynae -- Recurrent abortions, Periods

Pregnacny induced Theombocytopenia ,TP, Pre-
eclampsia
Sx --- HIV, EBV
Social -- Diet deficient in vitamin C
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FAST PACES Academy
43.Pyrexia
For how long you have fever?
Do you check it?
How high does it go?
Is it present all the time or comes and goes?
Any sweating or Chills?
Do you have any other symptoms with fever?
Have you had fever before travelling?
Did you visit your GP before travelling?
Did you take any Vaccination before travelling?
Did you take any Malaria preventive medicine before that?
For how long you took these medicines?
Infections
 CNS --- Meningitis, Encephalitis , Abscess
 ENT --- Ottitis Media, Acute viral illness like
HIV,EBV
 Chest --- Pnumonia
 Heart--- Infective Endocarditis
 Liver --- Acute Hepatitis , Liver abscess
 GIT--- Enteric fever, Gastroenteritis
 Kidney--- Pyelonephritis
 Genitourinary ---UTI ,PID
Joints-- RA ,SLE , others

General --- Malignacy
Thyrotoxicosis
P
A
M
M
Hugs
F
O
Sx--- HIV, EBV, HCV , HBV
Social
Vaccines DPT, Polio, MMR ,Hepatitis
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FAST PACES Academy
44.Renal Colic & Hematuria
Pain— LOQIRAA
When you get bleeding?
Before, During or After water works?
Any Injury before this? (e.g Catheter)
Any Burning or pain while passing water works?
Ever passed stone?
BPH
CRF
General
Sore Throat
Chest --- Wegener’s Granulomatosis ,Good Pasture Syndrome
Joints – SLE
P
A
M— TB, Bleeding disorders
M— Warfarin,Cyclophosphamide , Others
Hugs
F APKD, Alport Syndrome
O
Sx
Social
Smoking, Heroin
Occupation Plastic , Dye, Rubber etc
Travelling Travelling to Egypt (Schistosomiasis)
Recap
Idea
Concern
Explain
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FAST PACES Academy
45.Tiredness
ODPARA
Associated
DD
Obstructive Sleep Apnoea (OSA)
General Malignancy, Infection
CNS Myasthenia Gravis
Depression (SIEG CAPS)
Anemia
Sore Throat Post Viral
Glands
 DM
 Acromegaly
 Hypothyroid
Heart IHD, CCF, Infective Endocarditis
Chest COPD , TB , Cancer , Pulmonary HTN etc
Kidneys CRF
GIT
Joints
P
A
M
M
Hugs
F
O
Sx HIV
Social
Travelling
Recap
Idea
Concern
Explain
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FAST PACES Academy
46.Tremors
In which hand?
Any other part is affected or not? like Head, Jaw, Feet etc
Where started first?
When you get tremors?
ODPARA
(Scheme to rule out Cerebellar Causes)
CNS (Tumor, Stroke, MS, FA ,Parkinson’s Plus

syndrome)
 Cerebellum and other causes of CNS which
can cause Tremors
General
 Malignancy
Glands
 Thyrotoxicosis
 Hypothyroid
GIT
 Malabsorption causing vitamin E deficiency
P
A
M
M
 Resting Tremors---Neuroleptics , Anti
Psychotics
 Intentional intentional---Tremors Lithium,
Antiepileptics
 Others---Beta agonists ,Theophylline,
Cyclosporin
Hugs
F
O
Social
Occupation Mercury exposure
Alcohol
Cocaine, Amphetamines
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FAST PACES Academy
47.Vision Problem
In which eye?
Any other problem with your eyes?
like
Double vision, problem with color vision?
Redness,watering discharge or Pain?
ODPARA
CNS
Giant Cell Arteritis
DM—Symptoms
Thyroid
R.O.S DD
P Local
A  Trauma
M  Infection
M  Cataract
 Glaucoma
Hugs
Retinal
F  Retinopathy
O  Optic Atrophy Ethambutol
Sx  Detachment
Social
 Retinal Pigmentation
Driving
CNS
Travelling
 MG
 BIH
Recap
 Tumors
Concern
Explain  TIA
 Migraine
 Hyperviscosity
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FAST PACES Academy
48.Vomiting
ODPARA
GIT
General Malignancy
CNS
Eyes
ENT
Glands
 DKA
CKD
Psychiatric
P
A
M
M---Antibiotic,Chemotherapy
Hugs---Radiation
F
O
Social---Alcohol
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FAST PACES Academy
DD
GIT
 Esophagitis
 APD
 Tumor
 Small bowel Crohn’s
 Hepatitis
 Pancreatitis
 Gall stones
 Acute gastroenteritis
 Acute Enteric Fever
General---Cancer
CNS---Raised ICP,Tumor , infection, SOL ,TB
Eyes----Glaucoma
ENT--- Otitis Media,Labyrinthitis
Glands
CRF
Psychological
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FAST PACES Academy
49.Weakness of one Arm
Where exactly the weakness is?
Do you have weakness anywhere else?
ODPARA
CNS
 MS
 Stoke / TIA
 SOL Brain
 Migraine
 Epilepsy
Neck Pain (Carotid artery dissection)
Heart
AF, Infective Endocarditis , LVF
Blood clots in the blood channels of Legs or Lungs
R.O.S
P
A
M---DM, HTN, Fat Levels
M
Hugs
F---Stroke , MI , APKD
O
Social
Smoking ,Cocaine
Recap
Idea
Concern
Explain
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FAST PACES Academy
DD
 TIA/ Stroke
 Migraine
 Epilepsy Todd’s Paresis
 SOL Brain
 Psychological Hysterical
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FAST PACES Academy
50.Weight Gain
Where exactly you are putting weigh in your body?
How much weight you have gained?
Over how much time period?
Glands
 Cushing syndrome
 Acromegaly
 Hypothyroid
 Polycystic Ovarian Syndrome
Heart
 CCF, Cor Pulmonale
GIT
 Malabsorption leading to Hypoalbumenimia
Kidney
 Nephrotic syndrome
M---Insulin,Sulfonylureas , OCPS, Steroids , TCA , Antipsychotics
Hugs
Social
Alcohol, Excessive Diet,Lack of Exercise
Recap
Idea
Concern
Explain
90
FAST PACES Academy
51.Wheez
ODPARA
Chest
Heart
GERD
R.O.S
DD
 Occupational Asthma
 Churgh Strauss syndrome
 Foreign body
 Anaphylaxis
 CCF
 GERD
M NSAIDs ,Aspirin ,B -Blockers
Hugs
Social
Occupation, Smoking
Recap
Idea
Concern
Explain
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FAST PACES Academy
Possible List of common cases
1. Acute confusion due to UTI

2. Weakness Stroke/TIA
3. Memory problem with Transient Global amnesia
4. Fatigue and weigh loss with Infective endocarditis,SIADH with hyponatremia,malignancy
5. SOB with Joint pains usually Sarcoidosis
6. SOB and Cough with history of breast cancer and Chemotherapy induced cardiomyopathy
7. Occupational asthma due to work in paint factory or new bird at home etc
8. NSAIDs induced Renal Failure
9. Autoimmune disease like Type 1 DM and other autoimmune conditions like Adrenal insufficiency
10. Backache with history of Malignancy
11. Subacute intestinal obstruction with previous history of Operation
12. Bilateral knee pains with stiffness possibility of RA
13. Side effects of many medicines
92

Fast Paces History PDF

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Fast PACES

Academy for Doctors

DR IMRAN BABAR MRCP (UK)

Information sharing with the patient

ODPARA (History of Present illness)

Differential Diagnosis Related Questions:

(PAMM- Hugs -FOSS)

P → Have you ever had similar complaints it the Past?

A → Do you have Allergy to any thing?

M → Are you taking any Medicines?

Any other medicines not given by the doctor?

OB/Gynae: Any problem related to monthly periods?

Sexual Hx: (If required, optional, not required always)

Is that alright if I ask you some personal questions?

Are you in relationship with someone?

Social History: (in detail)

 Social and Financial support?

 Alcohol and other drugs if required

 Diet and exercise (Sometimes required)

Driving: Do you Drive? is that private vehicle or else?

Travelling: Any recent Travel?

R.O.S: (Review of System)

sometimes useful. Is that fine with You?

Concern: Do you have any particular concern at the moment?

Where exactly the swelling is?

GIT Also screening Questions for Hepatitis B and C and

General (Malignancy, TB, other autoimmune conditions)

d.Budd Chiari Syndrome

3.Ankle Swelling (PHTN) Young, Non- Smoker

Young non- smoker with following complaints:

Chest pain (Detail)

Ankle swelling (Detail)

Secondary Causes of Pulmonary HTN

Do you have any Symptoms like:

Do you feel anxious especially while visiting the

White Coat HTN

Where exactly the burning is in your feet?

For how long you have this problem?

Associated cause like detail of DM if in history

Where exactly it is?

What makes it worse?

Lying flat (Pericardial)

Taking deep Breath in (PE)

(Spinal due to Mass or Disc herniation)

In which Fingers you have this problem?

For how long you have this problem?

Associated system like JOINTS

Any yellowness of your eyes? (Liver)

Any Problem adjusting to temperatures?

Any injury to neck area before developing these symptoms?

Any Problem with movement of Neck like stiffness?

Any numbness or tingling in your hands?

Any Pain in Legs on walking?

Events Before Collapse

Please tell me what exactly happend?

What were you doing at that time?

Did you remember while falling?

Any unusual symptoms before this? (Aura)

Pre-syncope features like Light headedness, Darkening of vision/tunnel

Blurring of vision,nausea and sweating (Autonomic)

Chest pain or racing of heart? Difficulty in breathing? (Caridiac)

Severe headache? (Subarachnoid hemorrhage)