DDx Flashcards by Maggie Musso

Behavioral problems in childhood

ADHD
ODD
Conduct disorder
Manic episode
Adjustment disorder
Hyperthyroidism
Substance use
Age-appropriate behavior

How well did you know this?

Not at all

Perfectly

Work-up - behavioral problems in childhood

Physical exam
Mental status exam
Urine toxicology
TSH, free T4

How well did you know this?

Not at all

Perfectly

Child with short stature

Constitutional short stature
Genetic disorders
Medical problems - chronic renal insufficiency, hypothyroidism, GH deficiency

How well did you know this?

Not at all

Perfectly

Work-up - child with short stature

CBC w/diff, BMP (lytes, BUN/Cr)
TSH, free T4
GH stimulation test, IGF-1 levels
XR - hand
U/S - renal, cardiac

How well did you know this?

Not at all

Perfectly

Child with red eye

Viral conjunctivitis
Bacterial conjunctivitis
Allergic conjunctivitis
Keratitis
Uveitis
Orbital cellulitis
Preseptal cellulitis

How well did you know this?

Not at all

Perfectly

Work-up - child with red eye

Ophthalmoscopic eye exam
Discharge cultures
Slit lamp exam
CT - orbit
CBC, BMP (electrolytes)

How well did you know this?

Not at all

Perfectly

Child with GI symptoms - 1 month infant, vomiting (non-bloody, non-bilious)

Pyloric stenosis
Partial/complete duodenal atresia
GERD
Gastroenteritis
Hepatitis
UTI

How well did you know this?

Not at all

Perfectly

Child with GI symptoms - 3 y/o with constipation

Hirschsprung disease
Low-fiber diet
Anal stenosis
Hypothyroidism
Lead poisoning
Celiac disease

How well did you know this?

Not at all

Perfectly

Child with GI symptoms - 8 mo with sudden-onset colicky abdominal pain, vomiting, bloody diarrhea

Intussusception
Appendicitis
Meckel diverticulum
Volvulus
Gastroenteritis
Enterocolitis
Blunt abdominal trauma

How well did you know this?

Not at all

Perfectly

Child with GI symptoms - 7 y/o with generalized abdominal pain, missing many school days

Somatoform disorder
Malingering
IBS
Lactose intolerance
Child abuse

How well did you know this?

Not at all

Perfectly

Child with GI symptoms - 2 mo with episodes of crying, subside after passing flatus

Colic
Formula allergy
GERD
Lactose intolerance
Strangulated hernia
Testicular torsion
Gastroenteritis

How well did you know this?

Not at all

Perfectly

Work-up - child with GI symptoms

Rectal exam, stool for occult blood

Labs: CBC, BMP, LFTs, alkaline phosphatase, UA, UCx, TSH, free T4, serum lead level, anti-tissue transglutaminase, anti-endomysial and total IgA antibodies, amylase, lipase, stool ova/parasites, CDiff toxin

Imaging: U/S (abdomen, testicular), barium swallow, esophageal pH probe, endoscopy, barium enema, contrast enema, rectal biopsy, anorectal manometry, CT - abdomen

How well did you know this?

Not at all

Perfectly

Child with fever - 20-day-old infant

Neonatal sepsis
Meningitis
Pneumonia
Pyelonephritis

How well did you know this?

Not at all

Perfectly

Child with fever - 3 y/o pulling on ear

Acute otitis media
URI
Meningitis
Pyelonephritis

How well did you know this?

Not at all

Perfectly

Child with fever - 12 mo with rash

Measles (or other viral exanthem)
Rubella
Roseola
Fifth disease
Varicella
Scarlet fever
Meningitis

How well did you know this?

Not at all

Perfectly

Child with fever - 4 y/o with diarrhea, vomiting

Gastroenteritis (viral, bacterial, parasitic)
Food poisoning
UTI
URI
Intusussception
Volvulus

How well did you know this?

Not at all

Perfectly

Work-up - child with fever

Labs: CBC, BMP, blood culture, LP (CSF analysis), UA, UCx, viral antibodies/titers, throat swab for culture, stool exam and culture

Imaging: CXR, abdominal XR

Low back pain

Lumbar muscle strain
Disk herniation
Lumbar spinal stenosis
Tumor in the vertebral canal
Vertebral compression fracture
PVD
Malingering
Knee or leg fracture
Osteoarthritis
Osteomyelitis
Epidural abscess
Ankylosing spondylitis

Work-up - Low back pain

Imaging: XR, CT, MRI (lumbar spine)

ABI, Doppler U/S - lower extremity, angiography

ESR, CRP, CBC

Joint/limb pain - wrist pain, numbness/burning in hand

Carpal tunnel syndrome
Median nerve compression in the forearm or arm
Radiculopathy of nerve roots C6 and C7 in the cervical spine
De Quervain tenosynovitis

Work-up - joint/limb pain (wrist pain, numbness/burning in hand)

Nerve conduction studies
EMG
U/S - wrist
MRI - spine

Joint/limb pain +/- systemic symptoms

SLE
RA
Psoriatic arthritis
OA

Gout
Pseudogout

Septic arthritis
Reactive arthritis
Lyme arthritis
Disseminated gonorrhea
Parvovirus B19 infection

Work-up - joint/limb pain +/- systemic symptoms

Labs: CBC, ESR, CRP, cervical/blood culture, uric acid

Antibodies: ANA, anti-dsDNA (SLE), anti-Sm (SLE), C3, C4, antiphospholipid antibodies, RF, anti-CCP (RA), parvovirus B19, Lyme titers (IgG, IgM)

Arthrocentesis and synovial fluid analysis (cell count, Gram stain, culture, crystals)

Imaging: XR - hands, knees, pelvis/SI joints

Joint/limb pain - hip pain, fall/trauma

Hip fracture
Hip dislocation (+/- traumatic)
Pelvic fracture

Work-up - hip pain

``` XR - hip/pelvis CT or MRI - hip CBC, serum Ca or vitamin D DEXA PT/PTT UDS, BAL U/S - abdomen (FAST exam) ```

Joint/limb pain - knee pain

``` OA Gout Pseudogout Meniscal or ligament damage Septic arthritis Lyme arthritis Trauma Reactive arthritis ```

Joint/limb pain - foot pain

``` Stress fracture Plantar fasciitis Sprain or strain Heel fracture Splinter/foreign body ```

Work-up - joint/limb pain - foot pain

XR - foot Bone scan - foot MRI - foot

Joint/limb pain - calf (red, tender, swollen)

``` DVT Baker cyst rupture Myositis Cellulitis Superficial venous thrombosis ```

Work-up - joint/limb pain - calf (red, tender, swollen)

Doppler U/S - leg | CBC, CPK, D-Dimer

Joint/limb pain - shoulder pain

Shoulder dislocation Humerus fracture Rotator cuff injury

Work-up - joint/limb pain - shoulder pain

XR - shoulder, arm | MRI - shoulder

Dyspareunia

``` Atrophic vaginitis Endometriosis Cervicitis Vaginismus Vulvodynia PID Depression ```

Work-up - dyspareunia

Pelvic exam LH/FSH Wet mount, KOH prep, cervical cultures Laparoscopy

Vaginal discharge

Bacterial vaginosis Vaginitis - candida, trichomonal Cervicitis (chlamydia, gonorrhea)

Work-up - vaginal discharge

Pelvic exam Wet mount, KOH prep, "whiff test" pH of vaginal fluid Cervical cultures/NAAT

Vaginal bleeding

``` Dysfunctional uterine bleeding Coagulation disorder (eg, von Willibrand disease, hemophilia) Hypothyroidism ``` Spontaneous abortion Ectopic pregnancy Molar pregnancy ``` Cervicitis PID Ruptured ovarian cyst Ovarian torsion Trauma ``` ``` Atrophic endometrium Endometrial hyperplasia Endometrial polyps Atrophic vaginitis Endometrial cancer Cervical cancer ```

Work-up - Vaginal bleeding

``` Pelvic exam Pap smear U/S - pelvis, abdomen Endometrial biopsy, curettage Colposcopy/biopsy HPV testing Hydro-ultrasonography? ``` CBC, PT/PTT, ESR, LH/FSH, TSH, Prl urine hCG, cervical culture, quantitative serum hCG

Amenorrhea

``` Pregnancy Anovulatory cycle Hyperprolactinemia/prolactinoma Hypothyroidism PCOS Ovarian or adrenal malignancy Premature ovarian failure Pituitary tumor Menopause Pituitary infarction (Sheehan syndrome) Asherman syndrome Anorexia nervosa Hyperthyroidism Anxiety-induced PTSD Depression ```

Work-up - amenorrhea

Urine hCG, CBC, Prl, TSH, free T4, LH/FSH, estradiol, testosterone, DHEAS, ACTH, urine cortisol, progesterone challenge test Pelvic exam, U/S transvaginal and transabdominal, hysteroscopy Pap smear MRI - brain