Core Presentations DDx Flashcards
Abdominal distension
Fat
Fluid: ascites (consider renal, hepatic, cardiac causes, as well as malignancy and infection)
Flatus: may be normal or in setting of SBO/LBO
Faeces
Foetus
Fibroids, large ovarian cyst
Acute upper abdominal pain
Gallstone colic (cholelithiasis/choledocolithiasis) Acute cholecystitis Acute cholangitis Acute pancreatitis Oesophagitis Gastritis ACS Other cardiorespiratory causes: pericarditis, pneumonia, empyema
Acute central abdominal pain
SBO
Abdominal aortic dissection/AAA rupture
Crohn’s disease
Mesenteric artery occlusion (ischaemic bowel)
Acute lateral abdominal pain
Appendicitis Pyelonephritis Renal/ureteric colic Salpingitis Ruptured ovarian cyst or torsion, endometriosis, etc
Acute lower central (hypogastric) abdominal pain
Cystitis due to bacterial infection PID Pelvic endometriosis Ectopic pregnancy Mittelschmerz LBO Infective colitis IBD
Anorectal pain
Anal fissure Haemorrhoids (thrombosed pile) Perianal abscess/pilonidal sinus and abscess Proctalgia fugax, coccydynia Proctitis Prostatitis (referred)
Localised tenderness in hypogastrium
Acute bladder distension
Cystitis
Localised tenderness in RUQ
Acute cholecystitis
Acute alcoholic hepatitis
Acute viral hepatitis
Acute liver congestion
Localised tenderness in LUQ
Pyelonephritis
Splenic rupture (?delayed)
Splenic infarct
Localised tenderness in epigastrium or central abdomen
Gastritis Duodenal ulcer (relieved by food) Gastric ulcer (exacerbated by food) Pancreatitis Small bowel infarction Ruptured or dissecting AAA
Localised tenderness in L or R loin
Pyelonephritis
Renal calculus
Ruptured or dissecting AAA
Localised tenderness in L or R lower quadrant
Appendicitis
Diverticulitis
Mesenteric adenitis/non-specific abdominal pain
Ectopic pregnancy
Purpura (clotting defects, blood vessel fragility) and petechiae (platelet defects, vasculitis)
Trauma
Thrombocytopaenia: ITP, SLE, drug-induced, bone marrow replacement
Pancytopaenia: aplastic anaemia, hypersplenism, myelodysplasia, DIC
Platelet dysfunction: aspirin, NSAIDs, renal failure
Acquired vasculopathy: senile changes, AI vasculitis (Henoch-Schonlein), steroids, vit C deficiency
Acquired coagulopathy: liver disease, vit K deficiency, DIC
Congenital coagulopathy: haemophilia, von Willebrand’s
Gait abnormality
Contralateral pyramidal tract lesion: cerebral hemisphere, internal capsule, brainstem or SC
Parkinsonism
Cerebellar lesion: tumours, ischaemia
Dorsal column loss or peripheral neuropathy: vit B12 deficiency, etc
Bilateral upper motor neuron lesion: usually SC
Pelvic girdle and proximal muscle weakness: hereditary muscular dystrophy, etc
Joint, bone, or muscle lesion
Lateral popliteal nerve palsy
Drug effect
Abnormal speech/communication
Deafness due to ear disease or 8th cranial nerve lesions
Inattention due to dementia, depression, etc
Dysphasia (sensory or motor, i.e. Wernicke’s or Broca’s)
Dysarthria: cerebellar dysfunction, upper or lower motor neuron lesion
Dysphonia (or aphonia): vocal cord dysfunction
Acute confusion
Septicaemia: UTI, URTI, etc Hypoxia Alcohol withdrawal, thiamine deficiency Post-ictal state Hypothyroidism/thyrotoxicosis Hypoglycaemia Adrenal failure: Addison's disease, ACTH deficiency Frontal lobe lesion: ischaemia, tumour, abscess Drug effect
Alcohol abuse
3 Qs and 3 Ds
Q: quantity, quality,
D: duration, dependence, damage
Altered bowel habit (increase in constipation or diarrhoea or both alternating)
Change in diet
Colonic carcinoma
Drug-induced: opioids, anti-HTN, aluminimum alkalis, laxatives
Depression
Immobility
Cerebral or spinal cord lesion
Metabolic: hypothyroidism, hyperthyroidism, hypercalcaemia, hypokalaemia
Altered conscious state
H A D H I M
Amenorrhoea
Pregnancy Normal menopause Premature ovarian failure PCOS Hyperprolactinaemia: macro-/micro-adenoma, idiopathic Thyrotoxicosis
Anorexia
?
Anuria/oliguria
?
Sudden (secs-hours) onset back pain
Mechanical: strains, tear, crushing of ligaments/disc/vertebrae
Posterior lumbar disc prolapse
Anterior lumbar disc prolapse
Spondylolisthesis: spondylolysis, congenital malformation of articular process, OA of posterior facet joints
Central disc protrusion
Bone pain
?
Breast lump
Benign fibrous mammary dysplasia Fibroadenoma Cyst Acute or chronic abscess Fat necrosis or sclerosing adenosis Carcinoma infiltrating ductal cancer or invasive lobar cancers
Breast pain (mastalgia)
?
Calf pain
?
Chest pain
Musculoskeletal injury or inflammation ACS: angina, STEMI, NSTEMI Pericarditis Dissecting aortic aneurysm Oesophagitis and oesophageal spasm PE/infarction Pneumothorax Pneumonia with pleurisy Referred cervical root pain
Chronic confusion or cognitive impairment
Alzheimer's disease Vascular (multi-infarct) dementia Lewy body dementia Huntington's disease CJD
Cough
APO due to LHF (pink frothy sputum) Mitral stenosis (pink frothy sputum) COPD Chronic asthma Chronic bronchitis Acute bronchitis: viral, bacterial Pneumonia Pulmonary TB Lung abscess Lung carcinoma ILD Post-nasal drip GORD Drugs (ACEIs)
Dizziness
Postural hypotension: anti-HTNs, hypovolaemia, dehydration, diabetic autonomic neuropathy, DA agonists, Addison’s disease
Anaemia
Hypoxia (including hyperventilation as a cause)
Carotid sinus hypersensitivity
Epilepsy
Drug effect: sedative, anti-HTNs, alcohol
Double vision
Oculomotor (3rd nerve) paresis: intra-cavernous or posterior communicating artery aneurysm, meningioma, tentorial pressure cone, diabetes mellitus, syphilis, and brainstem ischaemia Trochlear paresis Abducens paresis Myasthenia gravis Graves' disease Orbital cellulitis Tumour INO (usually due to MS, sometimes vascular)
Dysphagia
?
Dysuria
?
Ear pain
?
Epistaxis
?
Erectile dysfunction
?
Eye pain
?
Facial pain
?
Facial swelling
?
Faecal incontinence
?
Falls
?
Fatigue
?
Fever
?
Haematemesis
?
Haematuria
?
Haemoptysis
Acute bronchitis: viral, bacterial Pneumonia PE/infarction Lung carcinoma Pulmonary TB Lung abscess Bronchiectasis Wegener's granulomatosis Pulmonary AVM Goodpasture's syndrome
Acute headache
Meningitis Low CSF pressure SAH Intracranial haemorrhage Head injury with cerebral contusion Acute closed angle glaucoma Sinusitis Tension headache Bilateral migraine
Hoarseness
Inhaled steroids Chronic laryngitis Vocal nodules Laryngeal carcinoma Vocal cord paresis Functional hoarseness Myxoedema Acromegaly Granulomas (e.g. in TB, sarcoid, syphilis, GPA)
HTN
?
Hypotension
?
Inguinoscrotal lumps
?
Inguinoscrotal pain
?
Itch
?
Jaundice
?
Jaw pain
?
Joint pain
?
Joint swelling
?
Laceration
?
Leg pain
?
Lethargy
?
Loin pain
?
Loss of hearing
?
Malaise
?
Malaena
?
Muscle cramps
?
Generalised muscle weakness
?
Regional muscle weakness
?
Nausea
?
Neck lump
?
Neck pain
?
Neck stiffness
?
Night sweats
?
Nocturia
?
Pallor
?
Palpitations
?
Perianal pain
?
Perianal lump
?
Peripheral oedema
?
Polydipsia
?
Polyuria
?
Rash
?
Rectal bleeding
?
Red eye
?
Seizure
?
Sensory disturbance
?
Skin lumps and ulcers
?
Shoulder pain
?
Sore throat
?
Sweating
?
Generalised swelling
?
Regional swelling
?
Syncope
?
Tinnitus
?
TLOC
?
Tremor
?
Urinary frequency
?
Urinary incontinence
?
Vertigo
Vertebrobasilar insufficiency (brainstem ischaemia)
BPVV
Meniere’s disease
Vestibular neuronitis
Middle ear disease
Reversible drug toxicity: alcohol, barbiturates, phenytoin
Wernicke’s encephalopathy: thiamine deficiency (usually in alcoholism)
Ototoxic drugs: streptomycin, gentamicin, kanamycin, phenytoin, quinine, orsalicylate
Brainstem ischaemia or infarction
Posterior fossa tumour
MS
Migraine
Temporal lobe epilepsy
Ramsay Hunt syndrome due to herpes zoster
Vision loss?
?
Vomiting
?
Weight gain
?
Weight loss
?
Wheeze/stridor
?
Constipation
Change in diet: low-fibre, poor fluid intake Change in lifestyle or environment Immobility Drug-induced: opioids, anti-HTNs, aluminium alkalis Anal fissure Haemorrhoids Hypothyroidism Rectal tumour Colonic carcinoma Hypercalcaemia External pelvic mass compression
Recurrent diarrhoea with no blood in stools, no fever
IBS Faecal impaction with overflow Malabsorption: coeliac disease, lactose intolerance, pancreatic disease, Whipple's procedure Drug-induced: laxative abuse, magnesium alkalis, Abx, hypotensive agents, alcohol HIV Diabetic autonomic neuropathy Thyrotoxicosis Carcinoid syndrome
Watery diarrhoea
Traveller's diarrhoea ETEC (commonest) Vibrio cholera Rotavirus Norwalk virus
Dysentry (acute bloody diarrhoea +/- mucus)
Campylobacter enteritis Shigella (bacillary) dysentery EIEC EHEC Entamoeba histolytica
Bloody flux (recurrent diarrhoea with blood +/- mucus)
Crohn's disease UC Colonic carcinoma Colorectal carcinoma Diverticular disease/diverticulitis
Sudden diarrhoea, fever and vomiting
Viral gastroenteritis (usually Norwalk virus)
Rotavirus
Abx-induced bacterial opportunists (e.g. C. diff)
Food poisoning/toxins (Salmonella typhimurium; from meat)
Clostridium perfringens (from meat; incubation 8-16 hrs)
Staphylococcus aureus (from meat; incubation
Back pain (onset over days to months)
Lumbar spinal stenosis: due to facet joint OA
Spinal tumours: primary in SC/meninges/nerve roots, secondary from lung/breast/prostate/thyroid/kidney/lymphoma/myeloma
Pyogenic spinal infection: usually of disc space due to staphylococcus, Salmonella typhi
Spinal TB: abscesses, cord compression, psoas abscess
Chronic back pain (onset over years)
Kyphotic pain
Scoliotic pain
Idiopathic scoliosis of thoracic or lumbar spine
Subacute headache
Raised ICP due to tumour, hydrocephalus, cerebral, abscess
Encephalitis
GCA
Chronic and recurrent headache
Tension headache Migraine Cluster headache Cervical root headache Eye strain Drug side effect (e.g. nitrates)
