DDx based on chief complaints

Question 1

Headache

Answer 1

MM IT ACHES
*Migraine*, meningitis
↑ ITP - pseudotumor cerebri, brain tumor
Tension headache, temporal arthritis, trigeminal neuralgia, TMJ disorder
AVM malformation
Cluster headache, CAD
HTN
Eye: glaucoma
Sinusitis, SAH, seizure, systemic illness

Question 2

Insomnia

Answer 2

Caffeine-induced insomnia
OSA
Hyperthyroidism
Insomnia related to anxiety, MDD, or adjustment disorder (stress-induced insomnia)
Insomnia with circadian rhythm sleep disorder
Daytime fatigue in primary hypersomnia (depressed teenager, bipolar, or seasonal depression
Illicit drug use

Question 3

Cough/shortness of breath

Answer 3

PLEURAL CAP
PNA, pericarditis
Lung cancer
Exacerbation of COPD - chronic bronchitis
URI
Reactive airway disease (asthma)
Abscess
Lymphoma
CHF
ACE inhibitors
PND
**GERD, bronchiectasis, foreign body, vasculitis (wegener's granulomatosis)
** if weight loss + B symptoms: TB, PNA, lymphoma, HIV/AIDS, sarcoidosis

Question 4

Weight loss

Answer 4

Hyperthyroidism
Cancer
HIV
TB
Dieting/diet drugs
anorexia nervosa
malabsorption

Question 5

Vaginal bleeding

Answer 5

A PV BLEEDS
Abortion (spontaneous)
PID, PCOS
Von Willebrands (or other coag d/o: hemophilia)
Bad: cancer (cervical, endometrial), ruptured ovarian cyst
Leiomyoma
Ectopic pregnancy
Endometriosis, endocrine (hypothyroidism)
Dsyfunctional uterine bleeding (anovulatory cycle)

Question 6

Abuse - multiple bodily injuries

Answer 6

Domestic violence
Substance abuse
Rape
Consensual violent sexual behavior
Osteogenesis imperfecta

Question 7

Abuse - sexual assault

Answer 7

Fracture
STD: trich, chlamydia, gonorrhea, HIV, hep B
Pregnancy

Question 8

colicky, unilateral flank pain - radiates to groin
nausea, vomit
hematuria

Answer 8

nephrolithiasis
renal cell carcinoma
pyelonephritis
appendicitis

Question 9

dull, epigastric pain - radiates to back
weight loss
dark urine, clay-colored stool, jaundice
drinker + smoker

Answer 9

pancreatic cancer
cholangiocarcinoma
acute viral hepatitis
acute alcoholic hepatitis
chronic pancreatitis
cholecystitis/choledocolithiasis

Question 10

epigastric pain - radiates to back, improves leaning forward
anorexia, nausea, vomiting
drinker

Answer 10

acute pancreatitis
PUD
cholecysitis/choledocholithiasis
gastritis
AAA
alcoholic hepatitis

Question 11

RUQ pain - radiates to scapula, occurs after fatty foods
N/V
fever
+ murphy’s sign

Answer 11

acute cholecystitis
choledocholithiasis
hepatitis
ascending cholangitis

Question 12

RUQ pain
fever, hypotensive
jaundice
hx cholelithiasis (asymptomatic)

Answer 12

ascending cholangitis
acute gallstone cholangitis
acute cholecystitis
hepatitis
sclerosing cholangitis

Question 13

RUQ pain
fever
anorexia, N/V
dark urine, clay-colored stools

Answer 13

acute hepatitis
acute cholecystitis
ascending cholangitis
pancreatitis

Question 14

burning epigastric pain - relieved by food + antacids, occurs 2-3 hours after meals

Answer 14

PUD
gastritis
GERD

Question 15

epigastric pain
fever
N/V
hx int. epigastric pain - relieved by food + antacids
smoker
aspirin daily

Answer 15

perforated peptic ulcer
acute pancreatitis
hepatitis

Question 16

severe LUQ abdominal pain - radiates to L. scapulaa

hx infectious mononucleosis 3 wks ago

Answer 16

splenic rupture
kidney stone
rib fracture

Question 17

crampy abdominal pain
vomit
abdominal distention
no flatus/BM
hx abdominal surgeries

Answer 17

intestinal obstruction

Question 18

elderly - acute onset sever, crampy abdominal pain
massive dark BM
hx CHF/atrial fibrilation - on digitalis
pain OOP to exam

Answer 18

mesenteric ischemia
diverticultiis
PUD
gastroenteritis

Question 19

RLQ ab pain
N/V
hx ovarian cyst

Answer 19

ovarian torsion
appendicitis
nephrolithiasis
ectopic pregnancy
ruptured ovarian cyst

Question 20

LLQ ab pain
fever
diarrhea and constipation - alternating
low-fiber, high-fat diet

Answer 20

diverticultiis
chron’s disease
ulcerative colitis
gastroenteritis

Question 21

RLQ ab pain - started around umbilicus (vague pain), no sharp and RLQ
N/V
+McBurney’s, psoas sign

Answer 21

acute appendicitis
gastroenteritis
chron’s disease

Question 22

periumbilical pain for last 6 mo
relieved by defecation, worsens when upset
alternating constipation and diarrhea

Answer 22

IBS
chron’s disease
celiac diaseae
endometriosis

Question 23

BL lower ab pain - started first day of period
fever
thick greenish-yellow vaginal discharge
unprotected sex, multiple partners

Answer 23

PID
endometriosis
dysmenorrhea

Question 24

erectile dysfunction

Answer 24

drug-related ED
HTN-related ED
DM-related ED
Psychogenic ED
Peyronie's disease

Question 25

chest pain

Answer 25

substernal, better with rest, worse with activity (MI, stable/unstable angina)

CHEST P - other diagnoses
Cough (PE, GERD)
Hemoptysis (PE), heartburn (GERD)
Emesis, diarrhea, edema
SOB
Temperature, tenderness over chest wall (costrochondirits), tenderness over legs, trauma
Palpitations, pleuritic (PNA, pericarditis)
*improves leaning forward (pericarditis)
*radiates to back (aortic dissection)