ddx2 overall Flashcards
Acute onset Urgency, frequency, burning urination suprapubic pain LBP Female Hematuria non-sexually transmitted -cranberry juice may be preventative
Interstitial cystitis
bladder infection
MC solid tumor of infants & young children
Mild retardation
2-4 YO
Abdominal pain
Wilm’s tumor
nephroblastoma
Male Over 60 YO Decreased force/stream hesitancy dribbling incomplete voiding in urination obstructive incontinence Saw palmetto Tx works
Benign prostatic hypertrophy (BPH)
Males LBP/pelvic pain decreased force of urine stream hesitancy dribbling sense of incomplete bladder emptying >50 YO
Prostate cancer
(similar Sx in BPH)
2nd MCC of cancer (lung cancer)
Urinary frequency Sense of urgency Painful urination (dysuria) recurrent Meds: Amoxicillin/clavulanate; trimethoprim/sulfamethoxazole
UTI
Infection/neurologic dysfunction
dysuria
nycturia
polyuria
Irritative bladder
rule out DM
Prostatic involvement congenital drug-induced Sx: -dribbling -decreased stream/volume -hesitancy
obstructive bladder
Non-blood stools nausea/vomiting HA low-grade fever abdominal tenderness hyperactive bowel sounds
adenovirus
rotavirus
(resolves in 48 hrs)
after hiking/rafting (1-3 weeks prior) cysts in stools abdominal pain acute diarrhea Non-bloody diarrhea nausea/vomiting increase peristalsis
Giardia lamblia
Moderate to high fever with bloody stools
tenesmus
abdominal pain
recent, acute onset explosive diarrhea
dysentary: C. jejuni
if not explosive: Salmonella, shigella
chronic, recurrent onset diarrhea
bloody stools
Over 50 YO
sigmoid polyps
carcinoma
Non-bloody diarrhea acute nausea/vomiting increased peristalsis travel outside US
E. coli
chronic, recurrent onset diarrhea
bloody stools/ fluid loss
large volumes
increased in our overly stressed American population
Ulcerative colitis
chronic, recurrent onset diarrhea bloody stools weight loss associated joint pain inflammatory
Crohn’s disease
alternating chronic, recurrent onset diarrhea and constipation (early AM) non-bloody stools mucus in stools no cachexia lower left/suprapubic abdominal pain relieved by defecation Late teens/20s "high strung"
IBS
chronic, recurrent onset diarrhea
non-bloody stools
calcium supplements
enzymes needed
lactose intolerance
CN palsies Paralysis Respiratory failure lasting 12 hrs to days gastroenteritis
C. botulinum infection
abdominal cramping gastroenteritis diarrhea no fever past 2 days
Bacillus cereus infection
infant constipation-impaired peristalsis where normal enteric nerves not present swollen belly flatulence failure to gain weight
Hirschsprung’s disease
abdominal pain adult distention of stomach weight-loss blood in stool
colorectal cancer
Avoid gluten (wheat, barley, rye, oats) abdominal pain bloating flatulence constipation diarrhea (not often) itchy skin with rash (dermatitis herpetiformis)
celiac disease
Begins as central pain Localizes to RLQ (may develop anorexia) low-grade fever (<102 deg) psoas muscle irritation (+ Rovsing, rebound tenderness) nausea/vomiting increase WBCs
Appendicitis
fever chills unilateral inferior abdominal pain (sometimes bilateral) worse at menstruation (end) sexually active elevated WBCs
Pelvic inflammatory disease
Pain in lower quadrant HCG present spotting early morning nausea tenderness of breasts
ectopic pregnancy
Male 30s-40s sudden onset severe pain nausea/vomiting no position of relief costovertebral pain lower ribs radiating anteriorly (often to groin/labia)
renal caliculi
kidney/ureter stones
40s female overweight flatulent diabetic contraceptives severe RUQ abdominal pain referring to inferior scapula nausea/vomiting pain occur after fatty meals Increase ALT, AST, alkaline phosphatase
Cholelithiasis (Gb)
- medications
- alcohol
- possible fever before jaundice (IgM present)
- contaminated food/water
- anorexia
- malaise
- dark urine
- RUQ tenderness
- ESR normal
- high ALT, AST
Hep A viral infection
medications
alcohol
sexually active (blood, saliva, genital fluids)
chronic malaise/fatigue
signs of serum sickness: (urticaria, rash, arthralgias)
high ALT & AST
normal blood count & ESR
Hep B viral infection
epigastric pain on full stomach
worse with lying down
reflux esophagitis
epigastric pain 20s wake upon sleep due to pain relieved with antacids unaffected by position felt on empty stomach
peptic/duodenal ulcers
epigastric pain Over 50s wake upon sleep due to pain relieved with antacids unaffected by position
gastric ulcer
severe back pain alcohol abuse nausea/vomiting fetal position relieves pain recurrent abdominal pain (upper) mild fever tender, distended upper abdomen p-amylase present hypotension
pancreatitis
chronic recurrent abdominal pain
sharp increase in pain during menstruation
endometriosis/ (pelvic tumor)
over 60 YO lower abdominal pain low-grade fever blood in stools mild leukocytosis nausesa/vomiting
diverticulitis
- Chronic, recurrent lower abdominal pain & pelvis associated with menstrual cycle-sometimes radiating to the back & inner thighs
- 1-2 yrs postmenarchal
primary dysmenorrhea
Chronic, recurrent lower abdominal pain & pelvis associated with menstrual cycle-sometimes radiating to the back & inner thighs
hx of endometriosis, PID, ectopic prego, PCOD
- female (late 20s/30s)
- increased with infertility
secondary dysmenorrhea
- bilateral leg weakness
- distal paresthesia
- following viral infection/immunization
- absent DTRs
- fluctuation in BP
- diaphoresis
- Protein in CSF
Guillan-barre
MCC of blindness in geriatric population
macular degeneration
- Absent DTRs
- Loss of proprioception
- Neuropathy mainly sensory (as opposed to motor)
- Complaints vary from numbness/tingling to burning pain
- Pain resolves over months if controlled (but numbness remains in the feet)–painless
Symmetric distal neuropathy
o Affects CN 3,4, and 6 and peripheral nerves
o Abrupt onset (suggesting vascular pathology)
o Painful dysesthesias and hyperesthesias
o Resolves in weeks to months with control
-unilateral double vision
Asymmetric neuropathy
- diabetes first detected during pregnancy 24-28 weeks
- possible macrosomia–>preclampsia
- labs (glucosuria, proteinuria, ketonuria, hyperlipidemia)
- HbA1c
gestational diabetes
- elev bp*
- deposition of lipids
- moon face
- buffalo hump*
- trunk obesity
- thin extremities
- purple striations*
- bp slightly elevated possible
- easily bruised
- edematous
- weak
- acne (back)*
- decr LE muscle tone*
- dexamethasone suppression test
Cushing’s syndrome
- adrenal tumor*
- hypertensive
- irritated
- normal glucose levels
- mimic diabetes
- HA
- sweating
- palpitations
- weight loss
- tachycardia/elev bp*
- elev catecholamine upon urinanalysis*
Pheochromocytoma
- Unilateral weakness and atrophy of large muscle groups in the upper leg & pelvic girdle
- MC in elderly males
- Resolves in 6-12 months (when under control
Diabetic amyotrophy
- build up of pressure in anterior chamber before canal of schlemm
- loss of peripheral vision
- halos around light
glaucoma
“20/20” tunnel vision”/ loss of peripheral vision
- younger people
- poor night vision
- often present as “clumsy” or “accident-prone”
- peripheral ring scotoma
retinitis pigmentosa
- MC related cause of blindness in elderly population over 60 YO
- chronic loss of vision
- loss of central vision
- distorted vision
- painless
- slow developing
(dry) macular degeneration
- gradual loss of vision
- chronic loss of vision
Presbyopia
- thrombus in retinal artery
- “curtain goes up/down” when thrombus dissolves
- transient loss of vision/few min
- both eyes/ unilateral eye
- > 50 YO
- concurrent hx of (diabetes, hypertension, or smoking)
- ipsilateral carotid bruit
amaurosis fugax
- Autoimmune demyelination
- periodic blind spot in vision
- transient loss of vision
- both eyes
- vertigo-unilateral
- recurrent neurological signs
- hx of dizziness, numbness, tingling or weakness
- 30-40s
multiple sclerosis
- majority unilateral
- diplopia
- loss of central vision
cataracts
- autoimmune attack of Ach receptors resulting in progressive muscle weakness
- double vision from lack of contraction of eyes
- both eyes
- dysphagia
- weakness of jaw when chewing
- drooping eyelids
- slurred/nasal speech
myasthenia gravis
- aura
- female
- lasts from hrs to day
- incapacitating
- seeks dark, quite environment
- distorted vision
- flashes of light
- nausea/vomiting
- unilateral HA
classic migraine
- described as 12/10 pain
- Usually mandibular & maxillary divisions
- may be suicidal (psychologically painful)
- short, sharp recurrent pain
trigeminal neuralgia (tic douloureux)
(rare)
- related to swallowing & movement of pharynx
- pain on one side of the mouth
- short, sharp recurrent pain
Glossopharyngeal neuralgia
- “brain freeze”
- “ice cream HA”
- facial pain
- short, sharp recurrent pain
sphenopalatine ganglioneuralgia
- hyperthyroidism
- sjogren’s syndrome
DDx for dry eye, gritty eye
- exophthalmos
- High systolic bp (diastolic may be on the low end)
- dry eye
- gritty eye
- fatigue, but energetic
- weight loss
- intolerance to heat
- increased pulse rate
- menstrual irregularities
- tremors
hyperthyroidism
- autoimmune attack of exocrine glands that produce tears & saliva
- dry eye
- gritty eye
sjogren’s syndrome
- UTI
- eye pain (without vision loss)
Reiter’s syndrome
- deep dull pain
- worse with bending forward OR atmospheric changes
- asymmetry
sinusitis
- pain radiating from front of ear with opening of mouth
- associated with chewing/jaw motion
- worse with biting down
- associated with opening and with popping/clicking
TMJ dysfx
• Severe pain • Halos around light • Blurred unilateral vision (peripheral) • Nausea • Vomiting (Patient may have just had his/her eyes dilated) • Senior will present with: -Eye redness -Cloudy-looking cornea -Possibly hyperopic Medical EMERGENCY
acute-angle closure glaucoma
- peripheral field vision has been “cut” (usually nasal half)
- usually bilaterally (systemic in nature)
- may have previous eye surgery/ trauma
Open-angle glaucoma
- sudden, painless loss of vision
- caused by neovascularization
- geriatric population
“wet” macular degeneration
- abrupt, unilateral loss of central vision
- gets worse over 2 days
- secondary to infection (mumps, measles, influenza, varicella virus, meningitis)
optic neuritis
- older than 50 YO
- unilateral temporal HA
- generalized trunk muscle ache
- sudden loss of vision
- elevated c-reactive protein & ESR
- new HA
temporal arteritis
giant cell arteritis
- sudden onset of central vision with hx of trauma
- floaters?
- flashing lights in vision?
retinal detachment
- deterioration of vision
- red/irritated eyes
- strabismus
- 80% before 3 YO
retinoblastoma
- middle-aged male
- facial pain over orbit “clustering” over days/weeks
- 30 min on average (worst pain ever felt)
- Hx (smoking/alcohol abuse-triggers)
- nasal lacrimation on inspection during attacks
- beats against wall for relief
- thunderclap HA
- facial/orbital pain
cluster HA
- burning in face to ophthalmic division of CN5
- Associated with skin lesions
shingles
If 0-2 YO:
- fever
- red, bulging tympanic membrane
- ear pain
- ear “fullness” or blockage (with redness)
otitis media
present/past upper respiratory infection
acute otitis
may have had present/past upper resp infection
-dizziness
-and/or hearing loss
(rare)
labyrinthitis
sudden hearing loss
viral infection
- recurrent hearing loss
- dizziness
- vertigo
- unilateral
- localized tinnitus
Meniere’s disease
- older patient
- chronic hearing loss
- difficulty hearing in crowded rooms OR loud areas
- longstanding, bilateral tinnitus localized
presbycusis
- younger (20s-30s)
- chronic hearing loss primarily when speaking on the telephone
- no problem with loud areas
- secondary to Paget’s
- usually bilateral
- longstanding subjective tinnitus localized
otosclerosis
- chronic hearing loss
- unilateral
- localized tinnitus subjective
- vertical nystagmus
congenital acoustic neuroma
- more dizziness/pain
- -red, bulging tympanic membrane
- ear pain
- ear “fullness” or blockage (with redness)
cholesteatoma
- severe ear pain on airplane descent/underwater diving
- sharp, stabbing ear pain
barotrauma
- fullness for several weeks
- possible hearing loss
- pain associated with past hx of upper resp infection
- children
serous otitis media
- ear pain
- itching
- discharge
- present during warm, humid weather
- pain produced by pulling of ear
- swimmer?
otitis externa
- direct trauma related (consequence of rib fx)
- pain with full inspiration
- (spontaneous: tall, thin male, 20-40 YO, acute onset of sharp, unilateral chest pain, dyspnea, often occurs at rest/sleeping)
pneumothorax
pain with full inspiration
muscle strain
- chronic, non-productive cough
- dry cough
- longer than 3 weeks duration
- worse at night
post-nasal drip
- usually in recumbancy
- evening hours
- associated with fatty meals
- may stimulate cough receptors
- older
- overweight
- epigastric pain
- after eating large meals (choc, caffeine, fat, alcohol)
- obese
gastroesophageal reflux
smokers?
-chronic productive cough
chronic bronchitis
-exhalation most affected
-wheezes
-rhonchi
(asthma, chronic bronchitis, emphysema, bronchiectasis)
-cyanosis upon inspection
-prolonged respiration
COPD
Chronic Obstructive Pulmonary disease
- affects all aspects of respiration
- rales
Chronic restrictive pulmonary disease
-progressive LMN dysfx in absence of trauma
post infectious polyradiculitis
- sudden severe chest pain after pain in calf
- coughing
- diaphoresis
- tachycardia
- tachyapnea
- middle-aged male
pulmonary embolism
- dyspnea upon exertion AND/OR lying supine at night
- acites
- bilateral leg pitting edema
- rales
- Adventitious lung sounds upon auscultation
CHF
-inflammation due to mineral dust, fumes, and/or other organic/non-organic particulate matter
pneumoconiosis
