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BPT Clinical Exam > DDx Lists > Flashcards

DDx Lists Flashcards

1
Q

Peripheral Neuropathy

A

Metabolic
-Diabetes, Hypothyroid, uraemia

Drugs/toxins
-Chemo, nitrofurantoin, TB drugs, amiodarone, antiepileptics, ETOH

Nutritional
-B12, thiamine, vitamin E, manganese

FHx
-Charcot marie tooth, Fredrich’s ataxia

Immunological
-RA, SLE, vasculitis, Sjogrens, amyloid, sarcoid

Paraneoplasic

Infective
-Syphilis, HIV

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2
Q

Proximal myopathy

A

Broad range of underlying causes most commonly of which is:

- Drugs - Steroids, statins, colchicine, zidovudine
- Alcohol 
Others to consider:
	- Endocrine: Thyroid, osteomalacia, diabetic amyotrophy, Addisons
	- Connective tissue disease: SLE, RA, systemic sclerosis 
	- Idiopathic inflammatory myopathies 
	- Hereditary myopathies
	- Malignancy
	- Infections - HIV, Hepatitis
Sarcoidosis
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3
Q

PR Bleeding

A
  1. Malignancy/pre-cancerous polyps
    1. Other anatomical: Haemorrhoids, Fissure, fistulae, varices, AVM
    2. Inflammatory bowel disease: UC, sometimes Crohns
    3. Infective - c diff, CMV, diverticulitis or parasitic (**immunodeficient population)
      Bleeding tendency: Coagulopathy, thrombocytopaenia, medications
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4
Q

Male infertility

A

• Previous undescended testes (uncorrected)
• Erectile/Ejaculatory dysfunction
• Azo/oligoospermia: CF, pituitary
Ix: Semen anaylsis, post ejaculatory urinalysis

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5
Q

Female infertility

A

• Infrequent/No ovulation
○ Ovarian pathology: PCOS, chemotherapy/radiotherapy
○ HPA axis pathology: pituitary dysfunction, Cushings, CAH, prolactinoma/hyperprolactinaemia, premature ovarian failure
○ Other endocrine: hypothryoid/hyperthyroid
• Anatomical: PID with adhesions, Karyotype abnormalities, Ashermans
• Recurrent miscarriages (genetics, anatomical eg fibroid, thrombophilias, cigarettes/EtOH/cocaine, obesity, infection)
• Lifestyle/psychological factors: eating disorders, stress, over-exercise
Medications

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6
Q

Female infertility Ix

A

• bHCG, TSH, Prolactin
• Pelvic US (+/- Karyotype)
• FSH, E2
○ If High FSH/Low E2 –> primary ovarian insufficiency (*think ovarian injury)
○ If Low FHS/Low E2 –> central causes e.g. GnRH deficiency, hypopituitary
○ If Normal FSH/Normal-low E2 –> PCOS, CAH, Cushings
§ Androgen profile, DHEAS, 17-OHP, cortisol, adrenal imaging
Hysterosalpingography or laparoscopy for tubal patency

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7
Q

Secondary HTN

A

Consider it when a person is <40 years old or on 4 agents or have HTN with hypokalemia.

Always consider end organ damage (eyes, kidney, heart).

Work up:
	- Endocrine
		○ Thyroid dysfunction- TFTs
		○ Primary hyperaldosteronism -Aldo/Renin ratio
		○ Cushings - overnight dexamethasone suppression test
		○ Pheao: plasma catecholamines
	- Other
		○ Renal artery stenosis: Renal doppler
                Cardiac causes: TTE
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8
Q

Diarrhea

A
  1. Infective - c diff, CMV, diverticulitis or parasitic (**immunodeficient population)
    1. Inflammatory bowel disease, microscopic colitis
    2. Malabsorptive: Coeliac, Pancreatic insufficiency/obstruction
    3. Hypermotility: Hyperthyroid, carcinoid, VIPoma, neuro drugs
    4. IBS
    5. Drugs (metformin, colchicine, Mg, MMF, CNIs esp tac)
Special circumstances probably evident on history:
		a. Antibiotic related or Post-antibiotic
		b. Short gut SND
		c. Dumping SND
		d. NSAID enteropathy
		e. Radiation
		f. Overflow
		g. SIBO
		h. Chemotherapy
		i. Radiotherapy
		j. Laxative overuse
Rectal cancer with tenesmus
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9
Q

Chronic Nausea DDx

A

Approach is to consider the many potential causes, categorise as drug-induced, alcohol, gastrointestinal, occult malignancy and neurological and Endo

  1. Drug-induced: chemotherapy, antibiotics, NSAIDs, metformin, MMF, opiates
  2. Alcohol and other illicit drugs (THC)
  3. GORD, functional dyspepsia, gastroparesis, GI obstruction, coeliac, gastric or small bowel Chrones
  4. Occult malignancy: associated features or B symptoms
  5. Increased ICP, migraine, vestibular such as vertigo
  6. Uraemia, hypothyroid, hyperthyroid, Addison’s
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10
Q

Vomiting

A
  1. GI
    a. Gastritis/PUD
    b. Gastric outlet obstruction
    c. Gastroparesis
    d. Cholecystitis
    e. Pancreatitis
    f. Gastroenteritis
    g. Constipation
    1. Neurological
      a. Meningitis
      b. Raised ICP: Mass, mets
    2. Drugs
      a. Chemo
      b. Marijuana
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11
Q

GAstric outlet obstruction

A

i. Neoplastic: Gastric cancer, lymphoma, pancreatic cancer with extension
ii. Inflammatory - duodenal stricture from pancreatitis, PUD
iii. Infiltrative: Crohn’s, gastric TB, eosinophilic gastritis
Iatrogenic: Complications of surgery

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12
Q

Dysphagia

A

• Intrinsic: reflux oesophagitis, stricture, oesophageal cancer, pharyngeal pouch, Schatzki ring, foreign body
• Xerostomia: drugs, Sjogrens, elderly, thrush
• Extrinsic: goitre with retrosternal extension, mediastinal tumor, bronchocarcinoma
• Motility: achalasia, diffuse oesophageal spasm, Scleroderma
• Neuro: bulbar and pseudobulbar palsy, myasthenia gravis, polymyositis, myotonic dystrophy
Psychiatric (globus pharyngus)

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13
Q

Constipation

A 
- Dietary and lifestyle
		○ Change in diet
		○ Poor fluid/fibre intake
		○ Immobility
	- Local
		○ Anal pathology: Anal fissure, hemorrhoids
		○ Slow transit
		○ Malignancy
	- Endocrine
		○ Hypothyroid
		○ Hypercalcemia
	- Drug induced
                Constipating drugs: Ondansetron, opioids
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14
Q

Monoarthritis

A

DDx

- Septic arthritis
- Crystal arthropathy
- OA
- Inflammatory causes: SLE, RA, PsA, Reactive arthritis
- Haemarthrosis
- Non joint related pathology: Bursitis, tendonitis, enthesitis, referred pain
Work Up:
	- Bloods
		○ WCC, CRP, ESR
		○ FBE
		○ INR
		○ Serum uric acid level
		○ If they have an autoimmune disorder: markers of disease activity
	- Imaging/Interventional
		○ XR
		○ USS
		○ Aspiration: Fluid appearance, MCS, crystals, cell counts

Mx
- Dependent on cause
- Simple analgesia with NSAIDs
Steroids PO/intraarticular if indicated

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15
Q

Polyarthritis

A

Septic arthritis, important to consider if bacteremia or immunosuppressed

Other infections: viral (EBV, rubella, mumps), rheumatic fever, Q fever

Inflammatory or autoimmune:
	• Reactive RA
	• OA
	• Lupus
	• UC/CD
	• Seroneg SpA
	• Polyarticular gout (uncommon)
	• Polyarticular pseudogout (uncommon)

Autoinflammatory
• Stills disease
• FMF

Drug reaction

Investigation:
• inflammatory markers
• Antibodies (RF, anti-CCP, dsDNA)
• Urate level
• Viral serologies + (Q fever serology, ASOT titre)
• Esophinilipa (may suggest drug reaction)
• Joint IMAGING +/- aspiration (if concerned for gout or septic arthritis)

Mgmt:
	• Aetiology based
	• Control pain
	• Maintain or maximise joint function
MTX is generally useful for autoimmune conditions involving joints
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16
Q

Syncope

A 
DDx
	- Cardiac/Cardiopulmonary
		○ Arrhythmia
		○ Valvular heart disease: AS
		○ HOCM
		○ PE
	- Autonomic
		○ Vasovagal
		○ Autonomic neuropathy: Diabetes, MS, MSA, Parkinson's 
	- Drugs
		○ Antihypertensives
		○ Antipsychotics
	- Hypovolemia
		○ Hemorrhage
		○ Dehydration
		○ Sepsis
	- Neurological
		○ Vascular event
		○ Seizure
	- Lifestyle
		○ ETOH

Ix

- Bystander collateral Hx
- Postural BP
- ECG
- Consider 24 hour holter
- TTE
- V/Q or CTPA
- MRI B, CTA
- EEG

Mx
- Dependent on cause
Consider risk with driving

17
Q

Secondary Amenorrhea

A

Secondary Amenorrhea defined as no menstruation for 3 months

DDx
	- Endocrine
		○ Pregnancy
		○ Normal menopause
		○ Premature ovarian failure
		○ PCOS
		○ Hyperprolactinemia
		○ Thyrotoxicosis
	- External Factors
		○ Anorexia
		○ Low weight
		○ Extreme exercise
		○ Poor nutrition

Ix
- Beta HCG
- Sexual Hormone profile: FSH, LH, Testosterone, sex binding hormone level, prolactin level
- TFTs
- Pelvic USS: for PCOS
Consider MRI B for pituitary adenoma in hyperprolactinemia

18
Q

Menorrhagia

A 
DDx
	- Structural
		○ Fibroids
		○ Endometrial cancer
		○ Pelvic endometriosis
		○ Chronic PID
	- Bleeding predisposition
		○ Haemophilia
		○ Thrombocytopenia
	- Endocrine
		○ Hypothyroid
	- Drugs
		○ Copper IUD
		○ Anticoagulation
Ix
	- Bloods:
		○ FBE, Coags
		○ TFTs
	- Imaging
		○ Pelvic USS/MRI
	- Surgical
		○ Hysteroscopy +/- Biopsy
Mx
	- Treat underlying cause
	- Tranexamic acid
	- Consider GnRH antagonist for fibroids
          OCP for endometriosis
          Surgical intervention: myomectomy, removal endometrial deposits, hysterectomy
19
Q

WEight Loss

A 
DDX
	- Malignancy
	- GI disease
		○ Dysphagia
		○ IBD
		○ Malabsorption
		○ Food intolerance
		○ Diarrhea
	- Endocrine
		○ Hyperthyroid
		○ Uncontrolled T1DM
		○ Addisons
	- Infection
		○ TB
		○ HIV
		○ Subacute IE
	- Mechanical (Physical barrier to getting food in)
		○ Stroke
		○ Dementia
		○ Scleroderma
	- ETOH excess
	- Psychiatric illness
		○ Depression
		○ Anorexia
20
Q

Weight Gain

A 
DDx
	- Lifestyle
		○ Excessive caloric intake
		○ Reduced activity
	- Drugs
		○ Steroids 
		○ Insulin
		○ Some OHGs
		○ Estrogens
	- Endocrine
		○ Hypothyroid
		○ Cushings
		○ PCOS
	- Fluid retention
		○ CCF
		○ Nephrotic Syndrome
		○ Cirrhosis
		○ CKD
Pregnancy
21
Q

Headaches

A 
DDx
	- Acute
		○ Meningitis
		○ SAH/ICH
		○ Venous sinus thrombosis
		○ Post LP headache
		○ Acute closed angle glaucoma
		○ Sinusitis
		○ Tension
		○ Migraine
	- Subacute
		○ Raised ICP: Tumor, hydrocephalous, IIH
		○ Encephalitis
		○ GCA
	- Chronic/Recurrent
		○ Migraine
		○ Tension
		○ Cluster
		○ Trigeminal neuralgia
		○ Cervical root headache
		○ Eye strain
Drug side effect or withdrawal
22
Q

Fatigue

A 
DDx
	- Sleep
		○ Poor sleep/sleep hygiene
		○ Narcolepsy
		○ OSA
		○ Restless legs Syndrome
	- Psychiatric
		○ Depression
	- Haeme
		○ Anaemia
		○ Iron deficiency
	- Infection
		○ Chronic infection: HIV
		○ TB
		○ Post viral fatigue
	- Chronic Disease
		○ CKD
		○ CCF
		○ Hypothyroid
		○ Diabetes
		○ Autoimmune disorders: SLE, RA, Scleroderma
		○ HIV
	- Drugs
		○ Opioids
		○ Antiepileptics
		○ Sedating meds
Diuretics: Overdiuresis
23
Q

Tremor

A 
DDX
	- Essential 
	- Thyrotoxicosis
	- Anxiety
	- Neurological
		○ Cerebellar disease: MS, stroke
		○ Parkinsonism
	- Flapping tremor
		○ Hepatic failure
		○ Renal failure: Uremia
		○ Hypercapnia
	- Drugs
		○ Thyroxine
		○ Salbutamol
		○ ETOH withdrawal
		○ Tacrolimus, ciclosporin
		○ Antiepileptics
		○ Antipsychotics
Lithium toxicity
24
Q

Vertigo

A 
DDx
Peripheral CAuse
-BPPV
-Vestibular neuritis
-Herpes zoster oticus
-Meniere disease
-Acoustic neuroma
-Otitis media

Central

  • Vestibular migraine
  • Brainstem ischemia
  • Cerebellar infarction and hemorrhage
  • MS
  • Chiari malformation
    • IF CVS risk factors, definitely think central cause
    • Hearing loss associated with vertigo suggests peripheral cause
    • Vertical nystagmus suggests central cause
    • Nystagmus disappearing with a fixed gaze in peripheral
Mx
	- Symptomatic management
		○ Short course of betahistine
			§ SE: drowsy, dry mouth
	- Lifestyle:
		○ Avoid ETOH and coffee 
PT referral for vestibular rehab and balance stabilization exercises
25
Q

B12/folate deficiency

A

Causes of B12/Folate deficiency

- Poor oral intake (ETOH, strict vegan or low protein diet)
- Malabsorption (Coeliac, tropical sprue, crohns)
- Previous gastric surgery
- SIBO
- Pernicious anaemia
26
Q

Drug causes of a megaloblastic anaemia

A
  • MTX
    • Trimethoprim
    • Metformin
      Colchicine

BPT Clinical Exam (11 decks)

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