DDx

Question 1

Abdominal pain

Answer 1

Pancreatitis
Cholecystitis
Appendicitis
GERD
Gastritis
PID

Question 2

Back pain

Answer 2

Lumbar strain
Degenerative disc dz
Spinal stenosis
Osteomyelitis
Multiple myeloma
Metastatic Ca

Question 3

Amenorrhea

Answer 3

Pregnancy
Anorexia
PCOS
Prolactinoma
Anovulatory cycle
Thyroid dz

Question 4

Vaginal bleeding

Answer 4

Ectopic pregnancy, abortion
Endometriosis
Atrophic vaginitis
Endometrial hyperplasia/cancer
Cervical polyp
Ruptured ovarian cyst
Cervicitis, UTI, PID

Question 5

Lower GI bleed

Answer 5

Anal fissures, hemorrhoids
aortoenteric fistula
diverticulosis
meckel's diverticulum
angiodysplasia
Neoplastic - colorectal ca, polyps

Question 6

Chest pain

Answer 6

Chostochondritis, muscle strain
MI, pericarditis, aortic dissection, angina
PE, pneumothorax, pleural effusion
GERD, esophagitis, esophageal dysmotility
PNA, empyema, parapneumonic effusion

Question 7

Behavioral problems

Answer 7

ADHD, adjustement disorder, conduct disorder
oppositional defiant disorder
substance induced disorder

Question 8

Confusion

Answer 8

Dementia - AD, depression, stroke, CJD, LBD
hypothyroidism, hypo or hyperglycemia, hyponatremia
Delirium - medication, substance, encephalitis, sepsis
neurosyphilis, wernicke’s

Question 9

Cough/SOB

Answer 9

PNA, ARDS, bronchitis, COPD, asthma
CHF, PE, pericarditis
GERD, aspiration, postnasal drip
IPF, ILD, sarcodosis, silicosis

Question 10

Numbness

Answer 10

Postictal paresis, deg disc dz, polyradiculopathy
Diabetic neuropathy, B12 vit deficiency
MS, vasculitis, myasthenia gravis, osteomyelitis
neurosyphilis, intracranial abscess or tumor, MM

Question 11

Difficulty walking

Answer 11

Vascular insufficiency/claudication, aneurysm
Joint pain/osteoarthritis, RA, psoriatic arthritis
Ataxia/stroke, intracranial abscess or tumor

Question 12

Dental pain

Answer 12

Vasculitis
Trigeminal neuralgia
TMJ dysfunction
Caries, periodontitis 
dentin hypersensitivity
bruxism

Question 13

Dyspareunia

Answer 13

Endometriosis
Atrophic vaginitis
PID, cervicitis, UTI
Vaginismus, sexual abuse
cervical or endometrial cancer

Question 14

Dysphagia

Answer 14

Systemic sclerosis/sjogren's
esophagitis, gastritis
esophageal stricture, webs (plummer vinson syndrome)
Zenker diverticulum
esophageal cancer
achalasia, ALS
mitral valve stenosis

Question 15

Tinnitus/hearing loss

Answer 15

Otitis media
Labyrinthitis, meniere's 
TIA, stroke
ototoxicity (aspirin, loop diuretics, abx)
otosclerosis, presbycusis
acoustic neuroma

Question 16

bruising/bleeding

Answer 16

HSP, ITP, TTP
vWF deficiency
malnutrition (vit C or K deficiency)
cirrhosis
actinic purpura
antcoagulant or antiplatelet use

Question 17

Joint pain

Answer 17

RA, PA, SLE
gout, pseudogout
myositis, rhabdomyolysis
fibromyalgia, PMR, DVT
sprain ligament or meniscal tear
rheumatic fever, parvovirus B19
disseminated gonococcus, septic joint

Question 18

Eye pain/redness

Answer 18

Conjunctivitis (bacterial vs viral)
Uveitis (IBD)
allergies
keratitis

Question 19

Fatigue

Answer 19

Hypothyroid, hypocortisol, hypoglycemia
HF, valve dz, PND
anemia, cancer
OSA, insomnia, PLMD
depression, PTSD

Question 20

Fever/night sweats

Answer 20

TB, endocarditis, HIV, osteomyelitis
blood cancer, SLE, RA, Still’s dz
IBD, vasculitis
drug induced fever

Question 21

Flank pain

Answer 21

nephrolithiasis, glomerulonephritis
pyelonephritis, UTI, ascending cystitis
Polycystic kidney dz
Nephroblastoma, RCC

Question 22

Genital discharge or ulcers

Answer 22

Bacterial vaginosis, trichomonas, gonorrhea
syphilis, candidiasis, chlamydia
HSV, HPV
UTI, urethritis, pyelonephritis
pregnancy

Question 23

Hallucinations

Answer 23

Schizophrenia
Schizoaffective
Schizophreniform
Schizoid personality disorder
Schizotypal personality disorder
Psychosis 2/2 other medical condition or drug

Question 24

Headache

Answer 24

Stroke, ICH, SAH, vascular malformation
migraine vs tension vs cluster headache
trigeminal neuralgia
Pseudotumor cerebri
Partial seizure
cavernous sinus thrombosis
temporal arteritis, TMJ dysfunction
dehydration, hypoglycemia. caffeine withdrawal

Question 25

Hematemesis

Answer 25

``` Aortic aneurysm-duodenal fistula PUD, dieulafoy lesion mallory weiss tear, boerhaave syndrome variceal bleeding 2/2 cirrhosis gastric vs esophageal cancer EtOH abuse, caustic ingestion NSAID vs warfarin use ```

Question 26

Hemoptysis

Answer 26

``` Goodpasture, GPA IPF, pneumoconiosis, ARDS TB, blastomyces, coccidioides invasive pulmonary aspergillosis Lung cancer, med induced pneumonitis bronchiectasis PE ```

Question 27

Constipation/indigestion

Answer 27

``` gastrinoma/ZES, vipoma pernicious anemia, atrophic gastritis IBD, scleroderma giardia, gastroenteritis pancreatitis, diverticulosis, gallstones antacid abuse ovarian, gastric, colorectal ca ```

Question 28

Hot flashes

Answer 28

menopause, pregnancy insulinoma, glucagonoma, pheochromocytoma estrogen producing sex cord/stromal tumor (granulosa cell or thecoma) carcinoid tumor hormone abuse EtOH use

Question 29

Irritable infant

Answer 29

``` Pyloric stenosis Duodenal atresia Hirschsprung dz, volvulus Lactose intolerance Meckel's diverticulum Otitis, URI, UTI, meningitis, sepsis colic, formula allergy, insufficient fiber ```

Question 30

jaundice

Answer 30

biliary stricture, cholelithiasis, choledocholithiasis Rotor or Dubin Johnson syndrome (conjugated) Criggler Najjar or Gilbert syndrome (unconjugated) Acute vs chronic hepatitis PBC vs PSC, hemolysis Pancreatic ca, cholangiocarcinoma sarcoidosis, A1AT, Wilsons, hemochromatosis

Question 31

Weight loss

Answer 31

``` Hyperthyroidism, hyperparathyroidism malignancy, multiple myeloma celiac, IBD, pancreatic insufficiency lactose intolerance, SBO, constipation RA, SLE, PMR subacute endocarditis, TB, HIV anosmia, depression, EtOH abuse, laxative use ```

Question 32

Depressed mood

Answer 32

MDD, PTSD, normal bereavement adjustement disorder, schizoaffective GAD, panic disorder, specific phobia substance abuse, hypothyroidism

Question 33

Mouth lesions

Answer 33

varicella, herpes simplex stomatitis herpangina, HFMD pemphigus vulgaris, sjogren's, xerostomia aphthous ulcers, BCC, oral leukplakia

Question 34

Nausea/vomiting

Answer 34

``` gallstones, appendicitis achalasia, obstruction gastritis, gastroenteritis food borne toxins, norovirus, rotavirus meniere's stroke, vestibular neuritis, BPPV opiate ileus, digoxin, antibiotics atypical angina ```

Question 35

neck pain

Answer 35

``` head and neck cancer, spinal mets retropharyngeal abscess infected branchial cleft cyst Lyme dz, lymphadenitis torticollis, TMJ dysfunction, DJD carotid dissection, vertebrobasilar insufficiency ```

Question 36

Palpitations

Answer 36

arrhythmia, angina, mitral valve prolapse hyperthyroidism, hypoglycemia, stimulant abuse FAD, panic attack, specific phobia carcinoid syndrome, pheochromocytoma

Question 37

Pruritus/rash

Answer 37

conjugated hyperbilirubinemia 2/2 cholestasis atopic vs seborrheic dermatitis contact dermatitis psoriasis, xerosis pediculosis, scabies, dermatophyte infection cutaneous T cell lymphoma (mycosys fungoides) polycythmeia vera, uremia

Question 38

Syncope

Answer 38

seizure, stroke, encephalitis arrhythmia, embolic stroke, valvular dysfunction, PE adrenal insufficiency, hypovolemia, hypernatremia hypoglycemia, overdose, drug induced hypotension

Question 39

Erectile dysfunction

Answer 39

Peyronie's dz, arterial insufficiency, atherosclerosis hypogonadism, DM neuropathy psychogenic (depression, anxiety) drug induced (antidepressant, anticholinergic)

Question 40

Urinary problem

Answer 40

``` Prostate cancer, RCC urethritis, cystitis, prostatitis, STD atrophic vaginitis, lichen sclerosus BPH, kidney stones cognitive impairment diabetes mellitus stress vs urge vs overflow incontinence ```

Question 41

hematuria

Answer 41

``` kidney stones, pyelonephritis, acute GN bladder Ca, RCC, prostate ca polycystic kidney dz rhabdomyolysis hemolysis ```

Question 42

vertigo/dizziness

Answer 42

``` BPPV, vestibular neuritis Meniere's, labyrinthitis cerebellar or brainstem infarct vertebrobasilar insufficiency acoustic neuroma panic attack, agoraphobia orthostasis 2/2 diuretics, diarrhea ```

Question 43

Weight gain

Answer 43

``` PCOS Cushings steroid use substance abuse cessation fluid overload (liver or kidney failure, CHF) insulinoma ```

Question 44

Short stature

Answer 44

``` Hypogonadism, hypothyroidism Turner syndrome GH deficiency familial short stature malnutrition, vit deficiency ```

Question 45

Wheezing/stridor

Answer 45

``` Asthma, COPD Bronchitis, foreign body tracheomalacia epiglottitis allergic rhinitis angieodema, anaphylaxis pulmonary edema (CHF) CF, bronchiectasis ```

Question 46

infant with rash

Answer 46

``` 5th dz, rubella, roseola varicella scarlet fever meningococcus meningitis measles ```

Question 47

Infant with diarrhea

Answer 47

Viral gastroenteritis (norovirus, rotavirus) Bacterial enteritis (salmonella, Campylobacter, shigella) Malabsorption (milk, juice) UTI, bacteremia, meningitis intussusception

Question 48

infant with seizure

Answer 48

``` epilepsy simple febrile seizure brain tumor meningitis hyponatremia ```

Question 49

infant with jaundice

Answer 49

congenital infection physiologic jaundice unconjugated (criggler najjar, gilbert) conjugated (dubin johnson, rotor syndrome) hemolytic dz of newborn breast milk jaundice (late onset, persistent) breastfeeding jaundice (early onset, insufficient intake)

Question 50

Tremor

Answer 50

``` Heavy metal poisoning Parkinsons Essential tremor physiologic tremor drug induced tremor Wilson's disease ```

Question 51

trauma after MVA

Answer 51

Pneumothorax/hemothorax Splenic rupture Pleuritis/pleural effusion RIb fracture