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
- autoimmune disorder
- (tender) pre-tibial erythema nodosum
- lymphadenopathy present in neck, liver, salivary, lacrimal glands
- low-grade fever
- fatigue
- anorexia
- elevated ACE
- hypercalcemia
sarcoidosis
- hx of smoking
- gradual difficulty breathing
- barrel chested
- breathing thru pursed lips
- thin, frail
emphysema
- productive cough
- fever
pneumonia
- older than 40 YO
- hx of smoking
- persistent cough
- hemoptysis
- weight loss
- solitary wheeze
bronchogenic carcinoma
dizziness drop attack dysphasia diplopia dysarthria ataxia nystagmus numbness nausea
stroke
- mild trauma
- dry environments
Anterior epistaxis
-uncontrolled bleeding disorder
blood dyscrasia
- persistent epistaxis
- excess WBC
leukemia
- tender anterior lymph nodes
- fever above 101 F
- loose, yellow in pharynx
- scarlatiniform rash
- recent cough
- sore throat
Strep pyogens
- recurrent, milder attacks of sore throat
- posterior lymph node involvement
- responds to NSAIDs
Viral pharyngitis
- axillary lymph node involved
- inguinal area involved
- risk of splenomegaly
- small, red lesions with white bases in oropharynx
- fever
- rash?
- lymphocytosis high
Mononucleosis
- genetic defect (dystrophin)
- affects resp muscles
- 1 to 5 YO
- difficulty rising from bent-over position
- falls often
Duchenne’s muscular dystrophy
- normal dystrophin
- pelvic area affected first then limbs
- slow progression
Becker’s muscle dystrophy
- adolescence
- Precipated by: CHO’s ingestion, EtOH, exposure to cold, stress, rest after exercise
hypokalemic paralysis
- attacks after exercise (lasting one hr)
- Relieved by: glucose, insulin, calcium gluconate
hyperkalmic paralysis
-brief, jerking motion in sleep
myoclonus dyskinesia
-resp/vocal manifestations
tics (tourette syndrome)
- chorea
- middle age
- motor decline
Huntington’s
- associated with rheumatic fever
- choreas (distal extrem & face)
Sydenham
- choreas
- joint pain
- rash
- kidney failure
SLE
- muscle weakness
- cramping in hands
- 30-60 YO
- progressive
- UMNL & LMNL sigs
ALS
- pediatric
- cafe-au-lait lesions on trunk, pelvis, flexor creases of arms
neurofibromatosis
- facial weakness
- unable to close one eye
- ear pain
- “woke up with it”
- expressionless on one side
- deficit in taste
- hyperacusis
bell’s palsy
- 45-65 YO
- difficulty moving
- rigidity
- bradykinesia
- resting tremor
- festinating gait
- sustained blink response
Parkinson’s disease
- young
- lose pain & temp sense in shawl-like distribution upper trunk & arms
- atrophy & areflexia (probable)
syringomyelia
-band squeezing head HA frontal
tension HA
- high fever
- neck stiffness
meningitis
- no aura
- female
- lasts 1-3 days
- no incapacitating
- distorted vision
- flashes of light
- nausea/vomiting may have relief
- unilateral HA
common migraine
- calf pain/tightness
- worse with walking
- hx of minor trauma, excessive immobilization
- predispositions: (prolonged rest, surgery, oral contraceptives, smoking, cancer)
- elevation of legs helps
- acute unilateral swelling
deep vein thrombosis
- diffuse, hot, swollen unilateral leg
- prob hx of skin lesions
- infection: gram +, e coli
cellulitis
- subacute/chronic
- itching
- dull ache
- worse with prolonged stanidng
- secondary to trauma?
- edema relieved by elevation of legs
venous insufficiency
-persistent pain
-swelling after trauma
-hyperactivity of SNS
Stages:
a. sharp, burning pain in area
b. mottled, atrophic, cold skin
c. aching, throbbing pain with dystrophic changes
reflex sympathetic dystrophy
- dull, aching heaviness LE
- worse with prolonged standing
- most affected: overweight, pregnancy
primary varicosities
- pelvic pain
- inguinal lymph nodes involved
- veneral disease
lymphogranuloma venerum
- night sweats
- fever
- weight loss
- HIV patients prone
- rubbery lymph nodes
Non-Hodgkin’s lymphoma
- night sweats
- fever
- weight loss
- generalized pruritis
- painless mass in neck
- Reed-Sternberg cells
- 20s/ 50s
- high WBC count
Hodgkin’s lymphoma
- persistent, generalized lymph node swelling
- CD4 count low
- thrush
- leukoplakia
- enzyme linked
- muscle wasting/cachexia
prior:
- fever
- sore throat
- HA
AIDS
AIDS: CD4 (300)
TB
AIDS: less than 200 CD4
Pneumocystis carinii
AIDS: less than 50 CD4
Cytomegalovirus
swelling around the face
hypothyroid myxedema
swelling at tibial crest
hyperthyroid myxedema
- chest pain
- thrombosis of superficial vein
Mondor’s syndrome
- chest pain
- pain/soreness upon contraction and stretching
intercostal strain
- pain along nerve distribution/rib-extending band
- unilateral
- diabetic patient with poor glycemic control likely
intercostal neuritis
- compression pain after trauma
- guarded respiration
- difficulty with lying supine
- posterolateral pain in back
rib fracture
- Unilateral sharp, severe pain at upper chest
- swelling and inflammation at upper rib (2nd/3rd costochondral)
- older women (over 50 YO)
- prolonged coughing
Tietze’s syndrome
- retraction of shoulders, head back causes bilateral pain (crowing rooster)
- young
- complaint of anterior chest pain
- location: middle ribs close to sternum
- tenderness without swelling at costal jx ribs 2-5
costochondritis
- came on suddenly after exercise/moving around
- pain relieved by rest/nitroglycerine
- no enzymes present
- squeezing/pressure in chest
- goes away after 10 or less
- aching pain felt down side of arm to fingers
stable angina
- -squeezing/pressure in chest
- lasts 10 min or more
- aching pain felt down side of arm to fingers
- pain relieved by rest/nitroglycerine
- C-reactive protein present
unstable/prinzmetal angina
- Nitro does not help
- severe pain
- may/may not be unconscious
- pain lasts longer than 30 min
- low grade fever may be present
- Elevation of CK-MB
- Cardiac specific troponin-T & troponin 1 elevated
MI
- loss of consciousness
- less than 1 min
- sweating
- lightheadedness
- queasiness
vasovagal/ emotional stress shock
- loss of consciousness 5-10 min
- post-faint convulsions/warning signs
epilepsy
- from 140/90 mmHg difference standing vs seated
- Hx of adrenal disease, diabetes, meds
orthostatic hypotension
- tight collars
- head turned to one side
- syncope
carotid sinus syndrome
- numbness
- paresthesia
- cold hands prior to fainting spell
hyperventilation
- exertion-related chest pain
- syncope post-exercise
- young athletes
- difficulty breathing
- worse with valsalva’s
- improved with squatting
hypertrophic cardiomyopathy
- sharp pain in chest
- coughing, sneezing?
- bending to same side/lying involved side pain?
- pleural friction rub heard
- decreased fremitus
- dullness to percussion
- increase/decrease breath sounds
pleurisy
-chest pain often radiating to neck/shoulder
-difficulty breathing
-worse lying down
-better seated
-pericardial friction rub
hx of: (resp infection, renal failure, or cancer)
pericarditis
- mild/severe abdominal pain
- blood in stool
Meckel’s diverticulum
- copper deposition Fleisher ring in eyes
- autosomal recessive disorder
Wilson’s
- bilateral abdominal pain
- kidney palpable fluid filled cysts
polycystic kidney disease
- MALES>females
- bronze skin
- liver cirrhosis
- DM
- pain, stiffness, swelling in joints bilaterally
- elevated ESR, serum iron
- increased saturation of plasma iron binding
hemochromatosis
Less than 20/Older than 50 Abdominal flank bruit* signs of end-stage organ damage Captopril stimulation test elev Plasma renin activity* grade 1 elev bp* elev serum creatinine*
Renal disease (Renal vascular hypertension)
- severe muscle weakness
- transient paralysis
- muscle cramps
- Labs (hypokalemia/hypernatremia)
primary aldosteronism
- associated murmur/thrills upon heart palp
- systolic BP greater in arms compared to legs
- femoral pulse decreased compared to subclavian
aortic coarctation
- weight gain (30% of patients)
- intolerance to cold
- perceived “slowness” of muscles
- diminished reflexes
- goiter
- Tendinitis
- dry skin
hypothyroidism
- FT4 low
- TSH elevated
- elevated anti-microsomal/anti-thyroglobulin antibodies
- slight thyroid enlargement
- thinning hair
- increased sensitivity to cold
Hashimoto’s hypothyroidism
- TSH elevated
- FT4 is normal
subclinical hypothyroidism
- TSH is low
- Either FT3 or FT4 elevated
- elevated anti-thyroid antibodies
- autoimmune condition
- increased bilateral pulse pressure
- dryness in eyes due to increased exophthalmos
Graves’ disease
- TSH is low
- FT3 & FT4 normal
subclinical hyperthyroidism
- anterior neck pain
- myalgia
- low-grade fever
- tiredness and/or tachycardia/palpitations
- acute onset
- usually females (vs males)
- may/may not have nodular goiter
- reduced radioactive iodine uptake
- normal thyroglobulin
DeQuervain’s (subacute) thyroiditis
- Female; 4-8 weeks post-partum
- nervousness
- palpitations
- (50%) non-tender goiter
- low radioactive uptake of iodine
- manage transient sx by beta-blockers
Silent thyroiditis
- abrupt onset of intense anterior neck pain
- fever (staph aureus/strep pyogens)
- chills
- Women (vs men)
- Lab (normal thyroid fx, elevated WBCs, normal radioactive uptake of iodine)
Acute (suppurative) thyroiditis
- middle-aged/elderly
- Women (vs men)
- slowly, enlarging, hard non-tender anterior neck mass/fibrosis
- Lab (normally fx thyroid gland)
Riedel’s thyroiditis
- small painless swelling in thyroid region
- hard, enlarged, non-motile nodule in gland (with/without lymph node involvement)
- thyroid fx test normal
- calcitonin levels may be elevated)
- radioactive iodine uptake: “cold” lesions
thyroid cancer
- middle aged
- fatigue*
- night sweats
- low grade fever
- splenomegaly*
- elevated WBC (by a lot)*
- sleeplessness*
- unexpl weight loss*
chronic myelogenous leukemia (CML)
- skin rash (red papulae)
- flu-like sx (after camping/hiking trip)
- multiple joint pains
- fatigue (later on)
- ELISA (+)
Lyme disease
- fatigue
- generalized musculoskeletal pain
- 11 of 18 sites of tenderness, 9 bilateral
- sleep disturbance
- paresthesia
- headache
- women (5:1)
- aching
- fatigued
- stiff sensation in multiple muscle groups
fibromyalgia
- disabling, debilitating fatigue
- ADL interfered for at least 6 months
- Rest does not help
Chronic fatigue syndrome
- tachycardia
- pallor in sclera/conjunctiva
- glossitis (geographic tongue)
anemia
- elevated bp
- cardiomegaly
- pericardial friction rub
chronic renal failure
- TSH is low; hyperthryoid
- FT4 or FT3 elevated
- nodule
thyrotoxicosis
- malaise
- HA
- cough
- sore throat
- abdominal pain
- constipation
- visible rashes (rose spots)
- abdominal distention
- splenomegaly
- bradycardia
- fever over 10-14 days
Typhoid fever
- high fever with leukopenia
- altered mental status
- hemorrhaging diathesis
hemorrhagic fevers
- fever
- shaking
- chills with flu-like Sx
- huddled in blanket and can’t get warm
- splenomegaly, hepatomegaly, cerebral ischemia, hypoglycemia, renal failure
malaria
- “flu”-like Sx
- fever
- bradycardia
- GI bleeding
- jaundice
- hypotension
- delirum
- ELISA
- IgM
yellow fever
- high fever (biphasic)*
- HA
- myalgia/athralgia
- petechia/erythematous rash on torso* due to thinned blood
- may maintain use of acetominophen
Dengue fever
- 104-106 deg F*
- disorientation*
- HA
- Vertigo
- fatigue
- LOC
- convulsions
- tachycardia (without incr in BP)
- flashed, hot, dry skin*
Heatstroke
- perspiration
- fatigue
- weakness
- anxiety
- COLD,CLAMMY skin, slow pulse rate
- 101-105 deg F
heat exhaustion
- excessive sweating (may begin in extremities or start in abdomen)
- athlete/working outdoors in dry environment
heat cramps
-child (fatty liver, severe encephalopathy) -related to aspirin administration -high fever, HA, vomiting, confusion -hyperactive reflexes, encephalitic stupor -coma, edema, respiratory arrest -dilated pupils, deepening coma -seizures, organ failure, death
Reye’s syndrome
- beta-hemolytic infection of pharynx
- skin lesions (erythema marginatum)
- Sydenham’s chorea
- increase in ESR
- Tx: penicillin, salicylates (fever, joint pain)
Rheumatic fever
- Group A streptococcal infection (similar to strept pharyngitis)
- abdominal rash/lateral to chest*
- high-grade fever*
- sore throat*
- “strawberry tongue”* (deafness if unTx)
- Tx: penicillin/erythromycin/ salicylates (fever)
scarlet fever
- severe dysesthesia (abnormal sensation)
- irresistible leg movements provide temporary relief
- sleep deprivation
- chronic muscle cramp (that does not respond to musculosk therapies)
- Tx: carbidopa, levodopa (Parkisonon’s meds)
restless leg syndrome
- sudden sleeping episodes during day (sleep/naps for 3 months)
- drop-attacks
- excessive daytime sleepiness
- sudden muscle weakness
- Tx: methylphenidate, anticholinergic drugs
narcoplepsy
- progressively deeper and faster breathing followed by gradual decrease resulting in temporary apnea/eponymic resp abnormality
- seen in patients with heart failure, strokes, hypernatremia, brain tumors, metabolic encephalopathy
- may occur at high altitudes in sleep
- reduction of weight & sleeping on one side may help
Cheyne-Stokes respiration
Quick, shallow breaths (equal) followed by regular periods of apnea caused by damage to pons due to strokes/trauma
(associated with strokes, trauma, opioid use)
Biot’s breathing
Deep, labored, gasping breathing (form of hyperventilation)
Kussmaul breathing
Anemia that has: -decreased MCV -serum [Fe] normal -decreased TIBC (total iron binding capacity) MC genetic disorder-->gen couseling 2nd MC anemia in humans young -Increased RBC -decreased MCV -normal serum ferritin -elevated reticulocytes Tx: hemoglobin electrophoresis
Thallassemia minor
- death within 2 yrs of life
- asymptomatic
- genetic counsel needed
- microcytic, hypochromic anemia
Thallassemia major
Anemia that has:
- decreased MCV
- decreased serum [Fe] and TIBC
- increased ferritin
- normal RDW
75%: normocytic, normochromic
25%: microcytic, decreased hematocrit, decreased TIBC, normal RDW & ferritin
Anemia of chronic disease
Anemia that has: -decreased MCV -decreased serum [Fe] & ferritin -increased TIBC MC hematological disorder o Fatigue o Orthopnea o HA o Dizziness o Pre-Syncope o Decreased ferritin o Increased TIBC o Decreased % of transferrin saturation Tx: ferrous sulfate
Iron-deficiency anemia
Lab values of:
-increased MCV (>130 fL)
B12 and/or folate deficiency
Increased MCV
(+) anti-IF antibodies
(+) Schilling’s test
Pernicious anemia
Increased MCV
Increased LDH, bilirubin
Normal RDW
Hemolytic anemia
Complaints of general weakness SOB Numbness/tingling (myelin synthesis) Difficulty walking Swollen tongue -elevated MCV -High methylmalonate & homocysteine
Vit B12 def
- Generalized fatigue
- (Alcoholic/pregnant)
- elevated MCV
- decreased hemoglobin
- low serum/RBC
- megaloblastic anemia
folic acid def
-Autosomal dominant
-spherical cells (lacking in Spetrin)
-decreased MCV
-Increased MCHC
-Normal hematocrit
-increased direct bilirubin
(-) Coomb’s test
Management: folate
Hereditary spherocytosis
- Autosomal recessive
- (Valine substituted for Glu in beta chain of hemoglobin A)
- 1st yr of life
- jaundice
- splenomegaly
- poor-healing lower tibial ulcers
- nucleated RBCs
- Howell-Jolly bodies
- elevated WBCs
- elevated indirect bilirubin
- Hemoglobin S
sickle cell anemia
-acute onset of fatigue
-jaundice
-splenomegaly
-immune thrombocytopenia present (Evan’s syndrome)
(+) direct Coomb’s test
-nucleated RBCs
-increased indirect bilirubin
Tx: prednisone/high dose IV immunoglobulin
Autoimmune hemolytic anemia
o Fatigue & weakness
o Predisposition to infection (neutropenia)
o Bleeding tendencies (decrease in platelets)
o Splenomegaly
o Hepatomegaly
o Pallor
o Lymphadenopathy
o Pancytopenia (Decreased RBCs, WBCs, and platelets)
o normal MCV
Tx: high dose immunosupp/bone marrow transplant
aplastic anemia
Paleness
Fatigue
Dizziness
Hepatomegaly/splenomegaly (iron buildup could lead to heart disease, liver damage, and/or kidney failure)
• Labs: (congenital) o Hypochromic, microcytic RBCs (pica?) o Elevated serum Fe o Increased ferritin o High transferrin saturation o Normal-to-decreased TIBC o 20-30% hematocrit o Prussian Blue staining marks ringed sideroblasts -decreased MCV -normal/decreased serum [Fe] & ferritin -increased RDW
siderblastic anemia
- malaise
- fever
- HA
- Lesion first appear on trunk (then spread to face & extremities)
- macropapules–>vesicles–>pustules–>crusting
varicella (chickepox)
- high fever (104-105 deg F)
- Koplik spots on mouth
- rash appears on face first, spreads to trunk & extrem
Rubeola (measles)
- begins as fine pink rash on face
- may be on trunk and extrem
- rash disappears after one day
Rubella (german measles)
- 6-18 months
- high-grade fever (103-105 deg F) for 5 days
- faint, macular (non-itchy) rash on trunk
Roseola (Exanthema subitum)
- extreme itching on face, neck, upper trunk, hands & wrists, knees, and elbows
- lichenification
- if untreated can lead to increased patches of diffuse hair loss
eczema
- silver scales/red plaques on scalp
- extensor surfaces of extrem (pitting of fingernails, arthritis of fingers & SI joint)
psoriasis
- dry or oily yellowing scaling of scalp, body folds, presternal areas
- (chronically in hospitals & immunocompromised)
seborrheic dermatitis
-oval shaped eruptions
-women
-spring & fall months
(goes away in 1-2 mo)
Pityriasis rosea
- Kerotogenous lesions on feet
- oral ulcers
- uveitis
- conjunctivitis
Reiter’s syndrome
- uveitis
- conjunctivitis
- bamboo spine, trolley-track sign
- conjunctivitis/iritis
- T/L ROM
- seroneg arthropathy
AS
- scales (silvery-white) on extensor surfaces
- pitting of nails
Psoriatic arthritis
-Subcutaneous nodules on extensor surfaces
RA
- malar erythema
- rash
- hair loss
- oral ulcers
- lymphadenopathy
- non-specific joint pain
- low grade depression
- elev anti-nuclear antibodies
SLE
atropic, edematous thickening of skin
scleroderma
- discoloration of upper eyelids
- weak anterior thigh/quads due to incr fibrosis/rigidity of skin
- elev CPK
- abnormal calcif via X-ray
dermatomyositis
- asymmetry
- border irregularity
- color variation
- diameter >6mm
- inflammation
- bleeding
- crusting
- ulceration
- sensory change
- elderly/diabetic
malignant melanoma
- fair-skinned young adults
- chronic sun exposure
- lesions appear “pearly”/translucent papules/nodules
basal cell carcinoma
-small, red, hard, ulcerating nodules
squamous cell carcinoma
-“slapped cheek”
erythema infectiosum
- “seven-year itch”
- water-related infection
- intense itching
- immunocompromised
scabies
- “flesh-eating bacteria”
- intense pain
- redness/necrosis
necrotizing fascitis
- itchy water-filled blisters
- gluten sensitivity
dermatitis herpetiformis
- cutaneous fungi infection affecting people in warm environ
- hypopigmentation
tinea versicolor
- flesh-colored, dome shaped lesions (1-5 mm in diameter)
- leads to eczema
- Sexually transmitted poxvirus
Molluscum contagiosum
- pruritic inflammation form of eczema
- hay fever asthma
atopic dermatitis
- common wart
- raised with roughened surface
Verruca vulgaris
- localized rash
- exposure to allergen/irritant (poison ivy, sumac, kerosene, acetone)
contact dermatitis
- skin color change (brownish-tan appearance without sun exposure) without lesions or itching
- signs of fatigue
Addison’s disease
major mechanism that involvesexcessive consumption of a poorly digested material such as sorbitol/mannitol
diarrhea
osmotic
- chronic, voluminous epistaxis
- form of herditary hemorrhagic telangiectasia
Rendu-Osler-Weber syndrome
