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Differential diagnoses Flashcards

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1
Q

DDx

Abdominal pain

  1. Constant
  2. Colicky
  3. Pain on eating
A
  1. Inflammation, ischaemia
  2. Obstruction of a viscus
  3. Peptic ulcer, pancreatitis, cholecystitis, mesenteric ischaemia
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2
Q

DDx

Epigastric pain

A
  1. Peptic ulcer
  2. Pancreatitis
  3. Reflux oesophagitis
  4. Acute gastritis
  5. Malignancy: gastric, pancreatic
  6. Pain from adjacent areas: RUQ, central abdo pain, cardio/pulm/pleural pathology
  7. Functional disorders: nono-ulcer dyspepsia, IBS
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3
Q

DDx

RUQ pain

A
  1. Gall bladder path: cholecystitis, biliary colic, cholangitis
  2. Liver path: hepatitis, hepatomegaly (CCF, Budd-chiari syndrome); hepatic tumours, hepatic/subphrenic abscess
  3. Pain from epigastrum (pancreatitis, peptic ulcer), RIF, loin pain, pulm/pleural path (pneumonia, empyema, pulm infarction)
  4. Appendicitis in pregnant women
  5. Colonic cancer in hepatic flexure
  6. Herpes Zoster
  7. Fitx-hugh curtis syndromerare - complication of pelvic inflammatory disease
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4
Q

DDx

RIF pain

A
  1. GI: appedicitis, IBD, colonic cancer, constipation IBD
  2. Repro: Females: ovarian cyst tortion/rupture/haemorrhage, ectopic pregnancy, salpingitis/pelvic inflammatory disease, endometriosis
    1. Males: seminal vesiculitis, cancer in undescended testis
  3. Renal: UTI, ureteric colic (renal stones)
  4. Pain from adjacent areas: RUQ, suprapubic, central abdo pain, groin pain, hip pathology, psoas abscess, rectus sheath haematoma, right-sided lobar pneumonia
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5
Q

DDx

Suprapubic pain

A
  1. Urinary retention
  2. Cystitis
  3. Pain from adjacent areas - RIF/LIF
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6
Q

DDx

LIF pain

A
  1. GI: diverticulitis, IBD, colonic cancer, constipation, IBS
  2. Repro:
    1. Females: ovarian cyst tortion/rupture/haemorrhage, ectopic pregnancy, salpingitis/pelvic inflammatory disease, endometriosis
    2. Males: seminal vesiculitis, cancer in undescended testis
  3. Renal: UTI, ureteric colic (renal stones)
  4. Adjacent areas: LUQ, suprapubic, central abdo, hip path, psoas abscess, rectus sheath haematoma, left sided lobar pneumonia
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7
Q

DDx

LUQ pain

A
  1. Splenic rupture, splenic infarction, splenomegaly
  2. Subphrenic abscess
  3. Pain from adjacent areas: epigastric, LIF, loin pain, cardio/pulm/pleural path (MI, pericarditis, pneumonia, empyema, pulm infarction)
  4. Colonic cancer in splenic flexure
  5. Herpes zoster
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8
Q

DDx

Central abdo

A
  1. GI: intestinal obstruction, early appendicitis, gastroenteritis
  2. Vascular: AAA (ruptured), mesenteric ischaemia
  3. Medical: DKA, uraemia
  4. Adj areas: epigastric, iliac
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9
Q

DDx

Loin pain

A
  1. Infection: UTI, perinephric abscess/pyonephrosis
  2. Obstruction: renal stones
  3. Renal disease: tubulointerstitial nephritis, IgA nephropathy, renal vein thrombosis, renal carcinoma, polycystic kidney disease
  4. Haemorrhagic adrenal infarction
  5. Aortic dissection (type B)
  6. Pain from vertebral column
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10
Q

DDx

Groin pain

A
  1. Renal stones (pain radiating from loin to groin)
  2. Testicular pain - tortion, epididymo-orchitis
  3. Hernia - inguinal
  4. Hip path
  5. Pelvic fractures
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11
Q

DDx

Diffuse abdo pain

A
  1. Gastroenteritis
  2. Peritonitis
  3. Intestinal obstruction
  4. IBD
  5. Mesenteric ischaemia
  6. Medical causes - DKA
    1. CVS/resp: MI, pneumonia
    2. Metabolic: DKA, addisonian crisis, HerCa, uraemia, porphyria,paheo, lead poisoning, hereditary angioedema
    3. Neuro: herpes zoster, tabes dorsalis
    4. Haem: sickle cell crisis, retroperitoneal haemorrhage, lymphadenopathy
    5. Inflammatory: vasculitis
    6. Infections: intestinal parasites, TB, malaria, typhoid fever
    7. IBS
  7. IBS
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12
Q

DDx

Abdo distention

A
  1. Fat
  2. Fluid
  3. Flatus (intestinal obstruction - small bowel: adhesions, herniae, intussusception, CD, tumour, TB; large bowel: cancer, volvulus, diverticulitis, faeces), perf viscus
  4. Faeces
  5. Fetus
  6. Giant organomegaly
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13
Q

DDx

Metabolic Acidosis

A
  1. Normal anion gap:
    1. ^GI bicarb loss: diarrhoea, fistula (biliary, intestinal, pancreatic), ileostomy
    2. t1 renal tubular acidosis: dec H+ secretion
    3. T2 RTA: dec HCO3 reabsorption
    4. T4 RTA: suppression of ammonia excretion hyperK
  2. High anion gap:
    1. Ketoacidosis: DM, excess alcohol, starvation
    2. Lactic acidosis -> tissue hypoxia, drugs (metformin, ethanol, methanol, zidovudine), short gut syndrome, leukaemia, lymphoma, liver failure, G6PD
    3. Renal failure
    4. Salicylate poisoning
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14
Q

DDx

Respiratory Acidosis

A
  1. CNS:
    1. Organic disease involving resp centre (vasc, infection, inflammatory, trauma, tumour)
    2. Drugs: opiates, BZD, barbiturates
  2. Lungs: severe asthma (uncommon), COPD, large airway obstruction, Obs sleep apnoea
  3. Neuromuscular:
    1. Motorneurone: Guillain-Barre syndrome, motor neurone disease, polomyelitis, acute porphyria
    2. NMJ/muscle: myasthenia gravis, muscular dystrophy, muscle relaxant, diaphragmatic paralysis
  4. Chest wall: severe kyphoscoliosis, severe obesity, traumatic flail chest
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15
Q

DDx

Metabolic alkalosis

A
  1. GI loss of H+: vomiting, laxative abuse, villous adenoma, VIPoma
  2. Renal loss of H+: hyperaldosteronism
    1. Excess glucocorticoids: cushing’s sydnrome, liquorice
    2. ^ Na delivery to distal nephron: diuretics thiazides and loop diuretics
  3. Intercellular shift of H+: hypokalaemia
  4. Others: compensation for resp acidosis
    1. Excessive alkali ingestion, fulminant hepatic failure
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16
Q

DDx

Respiratory Alkalosis

A
  1. Hyperventilation:
    1. Physiological (anxiety, pain, fever, pregnancy, high altitude)
    2. Mechanical overventilation
    3. Resp failure: type 1 - asthma, COPD, pneumonia, pulm oedema, pulm embolism, ARDS, fibrosing alveolitis
    4. CO poisoning
    5. CNS disease: stroke, infection, tumour, trauma
    6. Others: liver failure, GN septicaemia
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17
Q

DDx

Macrocytic Anaemia

A
  1. Alcohol
  2. Folate/B12 deficiency
  3. Haemolytic anaemia
  4. Hypothyroidism
  5. Liver disease
  6. Myelodysplasia
  7. Drugs: methotrexate, hydroxyurea, azathioprine, zidovudine
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18
Q

DDx

Microcytic anaemia

A
  1. IDA: blood loss (GI, urogenital, hookworm, malabsorption, ^ demands, decreased intake
  2. Thalassaemia
  3. Sideroblastic anaemia - x-linked, alcohol, drugs, lead, myelodysplasia
  4. Lead poisoning
  5. Anaemia of chronic disease
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19
Q

DDx

Normocytic anaemia

A
  1. Anaemia of chronic disease (chornic infection, inflamm/connective tissue diseases, malignancy)
  2. Haemolytic anaemia
  3. Hypothyroidism
  4. Pregnancy
  5. Renal failure
  6. Bone marrow failure
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20
Q

DDx

Haemolytic anaemia

A
  1. Hereditary:
    1. Haemoglobinopathies: sickle cell and thalassaemia
    2. Membrane defects: spherocytosis, elliptocytosis
    3. Metabolic defects: pyruvate kinase deficiency, G6PD
  2. Acquired:
    1. AI: warm Ab (SLE, lymphoma), cold Ab (EBV, lymphoma)
    2. Alloimmune: transfusion
    3. Drugs: penicillin, quinidine
    4. Microangiopathic haemolytic anaemia: TTP, HUS, DIC, malignant HTN
    5. Artificial heart valves
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21
Q

DDx

Aplastic anaemia

A
  1. Idiopathic:
    1. Inherited: fanconi anaemia, dyskeratosis congenita
    2. Acquired: drugs, chemicals, radiation, viral infection (B19 parvovirus, HIV, hepatitis, measles)
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22
Q

Causes of Aortic regurg:

A
  1. Valve leaflet abnormalities: infective endocarditis, RhF, trauma, bicuspid aortic valve
  2. aortic and valve ring dilatation: aortic dissection, aortitis, arthritides (RhA, ankspond) ^ BP
  3. Others: Marfan’s syndrome, pseudoxanthoma elasticum, Ehlers-Danlos syndrome, osteogenesis imperfecta, IBD
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23
Q

Causes of Aortic stenosis

A
  1. Stenosis secondary to RhHD
  2. Calcification of a congenital bicuspid AV
  3. Calcification/degeneration of a tricuspid AV in elderly
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24
Q

DDx

Increased APTT

A
  1. Haemophilia
  2. vWD
  3. Liver disease
  4. Warfarin therapy, vitamin K def
  5. Heparin
  6. DIC
  7. Antiphospholipid syndrome
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25
Q

DDx

Hypoxia and

  1. Normal/low PaCO2
  2. High PaCO2
A
  1. Resp Failure T1:
    1. Asthma
    2. COPD
    3. Pulm embolism
    4. Pulm oedema
    5. Pneumonia
    6. Pulm fibrosis
    7. R -> L shunt
    8. ARDS
  2. Resp Failure T2:
    1. CNS:
      1. Organic disease involving resp centre
      2. Drug: opiates, BZD, Barb
    2. Lungs:
      1. Severe asthma
      2. COPD
      3. Large airway obstruction
      4. Obstructive sleep apnoea
    3. Neuromuscular:
      1. Motor neurones: GBS, MND, poliomyelitis, acute porphyria
      2. NMJ/muscle: myasthenia gravis, muscular dystrophies, uscle relaxants, diaphragmatic paralysis
    4. Chest wall: severe kyphoscoliosis, severe obesity, traumatic flail chest
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26
Q

DDx

Ascites

A
  1. Transudate:
    1. Cirrhosis
    2. Cardiac failure/constrictive pericarditis
    3. Nephrotic syndrome, renal failure
    4. Rare: Meigs’ syndrome, ovarian hyperstimulation
  2. Exudate:
    1. Malignancy (abdo, pelvic, peritoneal mesothelioma)
    2. Infection: TB, pyogenic
    3. Pancreatic
    4. Myxoedema (hypothyroidism)
    5. Budd-Chiari syndrome (hepatic vein obstruction), portal vein thrombosis
    6. Chylous ascites - obstruction of lymphatics
  3. Haemorrhagic ascites:
    1. Tumour
    2. Trauma
    3. Acute pancreatitis
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27
Q

DDx

Left axis deviation

A
  1. L ant hemiblock
  2. MI in inferior wall
  3. Wolff-parkinson-white syndrome
  4. Ventricular tachycardia
  5. Obesity, pregnancy, congenital heart defects
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28
Q

DDx

Right axis deviation

A
  1. R ventricular hypertrophy, pulm embolism
  2. MI to antero-lateral
  3. Wolff-parkinson-white syndrome - left sided accessory pathway
  4. Dextrocardia
  5. Left post hemiblock - rare
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29
Q

Causes of B12 deficiency

A
  1. Decreased absorption:
    1. Decreased IF (pernicious anaemia, gastroscopy)
    2. Terminal ileal surgery/disease (coeliac disease, crohn’s disease, TB, bacterial overgrowth, lymphoma, pancreatic insufficiency)
    3. Drug induced malabsorption - metformin
  2. Decreased intake: vegans
  3. Other: transcobalamin deficiency, nitrous oxide
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30
Q

DDx

Back pain

A
  1. Trauma/fractures, strenuous activity
  2. Younger pts <40
    1. Prolapsed disc
    2. Ankspond
    3. Spondylolisthesis
    4. (alkaptonuria)
  3. Older pts >40
    1. Osteoarthritis, osteoporosis
    2. Spinal stenosis, spinal claudication
    3. Paget’s
    4. Herpes Zoster
  4. Serious causes:
    1. Infection (TB, bacterial osteomyelitis)
    2. Malignancy (metastasis, multiple myeloma)
    3. Cord compression
    4. Fracture
  5. Vascular/GI/Pelvic
    1. Aortic aneurysm
    2. Peptic ulcer, pancreatic cancer
    3. Renal disease, rectal cancer, uterine tumours
    4. Pelvic inflammatory disease, endometriosis, ovarian cyst
    5. Retroperitoneal fibrosis
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31
Q

DDx

Blackouts

A
  1. Cardiovascular:
    1. Arrhythmia: bradycardia, tachycardia
    2. Outflow obstruction: aortic stenosis, hypertrophic obstructive cardiomyopathy, pulm embolism, pulm stenosis
    3. Postural hypotension: hypovolaemia, autonomic neuropathy, antihypertensive meds
    4. MI, aortic dissection
  2. Neurological:
    1. Epilepsy
    2. Stroke/TIA
  3. Vasovagal (reflex bradycardia):
    1. Prolonged standing esp. in warm surroundings
    2. Other causes of vagal overactivity: micturition, cough, carotid sinus hypersensitivity
    3. Metabolic: hypoglycaemia
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32
Q

DDx

Breathlessness

A
  1. Acute (mins):
    1. Pulm embolism
    2. Pneumothorax
    3. Foreign body
    4. Anaphylaxis
    5. Anxiety
  2. Subacute (hrs)
    1. Left ventricular failure - pulm oedema)
    2. Asthma
    3. COPD
    4. Chest infection
    5. Metabolic acidosis
  3. Chronic (days-wks):
    1. Anaemia
    2. Recurrent pulm emboli
    3. Cardiac disease (HF, arrhythmia, valvular heart disease)
    4. Asthma
    5. COPD
    6. Chest infection/bronchiectasis
    7. Lung cancer
    8. Pulm fibrosis
    9. Pulm HTN
    10. Hepatorenal syndrome
    11. Cirrhotic hydrothorax
    12. NM disorders, chest wall deformities
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33
Q

DDx

Bundle Branch block

A
  1. LBBB:
    1. IHD
    2. Cardiomyopathy
    3. Left ventricular hypertrophy - aortic stenosis, HTN
    4. Conduction system fibrosis
  2. RBBB:
    1. IHD
    2. Cardiomyopathy
    3. Massive pulm embolism
    4. Atrial septal defect, Ebsteins anomaly
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34
Q

DDx

Chest pain

A
  1. Cardiac large vessels: angina pectoris, MI, pericarditis, aortic dissection, rupture of thoracic aortic aneurysm, bleeding into atheroma
  2. Resp: PE, pneumothorax, pneumonia, connective tissue disease
  3. GI: reflux oesophagitis, oesophageal spasm, hiatus hernia, peptic ulcer, pancreatitis
  4. MSK: Teitze’s syndrome, fractured rib
  5. Neuro: herpes zoster, nerve root compression

Pleuritic:

  1. PE
  2. pneumothorax
  3. pneumonia
  4. pericarditis
  5. connective tissue disease
  6. Malignancy involving pleura
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35
Q

DDx

CXR - bilat hilar lymphadenopathy

A
  1. TB
  2. Sarcoidosis
  3. Lymphoma
  4. Others: bronchial carcinoma, metastatic tumours, recurrent chest infections, AIDS, berylliosis, silicosis
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36
Q

DDx

CXR - Cavitating lung lesions

A
  1. Abscess - staph aureus, klebsiella, p aeruginosa, TB, histoplasmosis
  2. Tumour - squamous cell carcinoma, lymphoma
  3. Infarct
  4. Inflammatory: rheumatoid nodule, wegner’s granulomatosis
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37
Q

DDx

CXR: coin lesions

A
  1. Tumours: bronchial crcinoma, met deposit
  2. Infection: TB, pneumonia, abscess, hydatid cyst
  3. Infarction
  4. Encysted pleural effusion
  5. Rheumatoid nodule
  6. Vasculitides
  7. AV malformation
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38
Q

DDx

CXR: Airspace/alveolar shadows

A
  1. Pus - consolidation
  2. Fluid - pulm oedema
  3. Blood - pulm haemorrhage
  4. Cells - lymphangitis carcinomatosis, alveolar cell carcinoma
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39
Q

DDx

Reticulonodular shadowing

A
  1. Pulm fibrosis:
    1. Cryptogenic fibrosing alveolitis
    2. Connective tissue disease: scleroderma, SLE, sarcoidosis, RhA, ankspond
    3. Drugs (amiodarone, NFT), radiation
    4. Extrinsic allergic alveolitis
    5. Pneumoconioses
  2. Upper zone: TB, allergic bronchopulm aspergillosis, radiation, ext allergic alveolitis, ankspond, sarcoidosis
  3. Middle zone: sarcoidosis
  4. Lower zone: cryptogenic fibrosing alveolitis, drugs, asbestosis, RhA, scleroderma
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40
Q

DDx

CXR: White hemithorax

A
  1. Large pleural effusion
  2. Pneumonectomy
  3. Congenital absence of lung/extensive hypoplasia
  4. Collapse
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41
Q

DDx

Increased Creatine Kinase

A
  1. MI, myocarditis
  2. Meds: statins, azathioprine, alcohol
  3. Surgery, trauma, burns, haematoma, IM injections, defib
  4. Rhabdomyolysis, rigorous exercise, seizures
  5. Dermatomyositis, polymyositis, muscular dystrophy
  6. Bowel ischaemia
  7. Myxoedema
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42
Q

DDx

Clubbing

A
  1. Congenital
  2. Acquired:
    1. CVS:
      1. Congential cyanotic heart disease
      2. Infectiv endocarditis
      3. Atrial myxoma
    2. Resp:
      1. Cancer: bronchial, mesothelioma
      2. Fibrosis
      3. Suppurative lung disease
      4. Cryptogenic organising pneumonia
    3. GI:
      1. Cirrhosis
      2. IBD
      3. GI lymphoma, malabsorption
      4. Others: thyroid acropachy, unilat clubbing: axillary artery aneurysm, brachial AV malformations
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43
Q

DDx

Decreased Consciousness

A
  1. Hypoglycaemia
  2. Hypoxia: cardiac arrest, shock (hypovolaemic, septic), resp failure
  3. Vascular: intracranial haemorrhage/iinfarction
  4. Infection: meningitis, encephalitis
  5. Inflammation
  6. Trauma
  7. Toxic:drugs - opiates, alcohol
  8. Metabolic: liver/renal failure, electrolyte (Na/K/Ca/Mg) disturbances, andocrinopathies
  9. Epilepsy
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44
Q

DDx

Constipation

A
  1. Diet: low fibre, inadequate fluid intake
  2. Drugs: opiates, anticholinergic, iron
  3. Immobility
  4. Old age
  5. Surgical/GI:
    1. Anorectal disease
    2. Intestinal obstruction
    3. IBS
    4. Post op
  6. Endo: hypothyroidism, hyperCa, hypokalaemia, porphyria, lead poisoning
  7. Neuro/muscular: autonomic neuropathy, spinal/pelvic nerve injury, scleroderma
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45
Q

DDx

Cough

A
  1. URTI
  2. Pulm causes: all lung diseases: asthma, COPD, PE, infection, bronchiectasis, malignancy, interstitial lung disease, sarcoidosis, pneumoconiosis
  3. Other causes:
    1. Post-nasal drip
    2. GORD
    3. ACEi
    4. HF
    5. Psychogenic
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46
Q

DDx

Auscultation: Crackles

A
  1. Fine crackles: pulm fibrosis, pulm oedema
  2. Coarse crackles: Brochiectasis, consolidation, COPD
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47
Q

DDx

Cranial Nerve lesions: III

A
  1. Brainstem: demyelination, infarction, tumour, basilar aneurysm
  2. Posterior communicating artery aneurysm
  3. Inflammation/infiltration of basal meninges: TB, sarcoidosis, lymphoma, carcinoma, syphilis
  4. Cavernous sinus: aneurysm, thrombosis, tumour
  5. Sup orbital fissure/orbit: tumour, granuloma
  6. Medical 3rd nerve palsy - pupil spared: infarction in nerve trunk 2ry to DM, HTN, SLE, polyarteritis nodosa, GCA
  7. Migraine
  8. Tentorial herniation
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48
Q

DDx

Cranial nerve lesion: IV

A
  1. Brainstem: demyelination, infarction, tumoour
  2. Head trauma
  3. Inflammation/infiltration of basal meninges: TB, sarcoidosis, lymphoma, carcinoma, syphilis
  4. Cavernous sinus: aneurysm, thrombosis, tumour
  5. Superior orbital fissue/orbit: tumour, granuloma
  6. Infarction to nerve trunk 2ry to DM, HTN, SLE, polyarteritis nodosa, GCA
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49
Q

DDx

Cranial Nerve lesions: V

A
  1. Sensory involvement: trigeminal neuralgia, herpes zoster, nasopharyngeal carcinoma
  2. Brainstem: demyelination, iinfarction, tumour
  3. Cerebellopontine angle: acoustic neuroma, meningioma
  4. Inflammation/infiltration of basal meninges: TB, sarcoidosis, lymphoma, carcinoma, syphilis
  5. Petrositis
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50
Q

DDx

Cranial nerve lesions VI

A
  1. Damage to nerves blood supply: DM, HTN, Wernicke-Korsakoff syndrome
  2. Brainstem: demyelination, infarction tumour
  3. False localising sign of raised ICP
  4. Cerebellopontine angle tumour
  5. Inflammation/infiltration of basal meninges: TB, sarcoidosis, lymphoma, carcinoma, syphilis
  6. Petrositis
  7. Orbital tumour
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51
Q

DDx

Cranial nerve lesions causing multiple palsies

A
  1. Brainstem lesions (stroke, tumour)
  2. Basal meningeal infiltration: carcinoma, TB, sarcoid, lymphoma, leukaemia
  3. Trauma
  4. Guillain-Barre syndrome
  5. Botulism
  6. Mononeuritis multiplex
  7. Arnold-Chiari malformation
  8. Paget’s disease
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52
Q

DDx

Increased Creatinine

A
  1. Decreased GRFR, high muscle mass, rhabdomyolisis
  2. Tranient/minimal increase: after exercise, high meat meal
  3. Decreased tubular secretion; trimethoprim, cimetidine
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53
Q

DDx

Decreased creatinine

A
  1. Increased GFR - pregnancy
  2. Low muscle mass
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54
Q

When in CRP elevated?

A
  1. Infection
  2. Inflammation
  3. Malignancy
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55
Q

DDx

Increased WCC in CSF

A
  1. Predominantly lymphocytes:
    1. Infective meningitis: viral meningitis/meningoencephalitis, TB, fungal, listerial, syphilis
    2. Inflammatory diseases: Behcet’s disease, sarcoidosis, SLE, MS
    3. Malignancy: lymphoma, leukamia, other tumours
    4. Drugs: NSAIDs, trimethoprim
  2. Predominantly neutrophils
    1. Bacterial meningitis
    2. Brain abscess eroding into ventricles
    3. Initial phase of viral meningitis
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56
Q

DDx

Decreased glucose in CSF

A
  1. Bacterial meningitis
  2. TB meningitis
  3. Fungal meningitis
  4. Occasionally mumps meningitis and herpes encephalitis
  5. Sarcoidosis, CNS vasculitides, carcinomatous meningitis
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57
Q

DDx

Central and peripheral cyanosis

A
  1. Central:
    1. Decreased O2 transfer due to lung disease: fibrosing alveolitis, severe pneumonia, COPD, massive PE
    2. R->L shunt (cyanotic congenital HD)
    3. methaemaglobinaemia, sulfhaemoglobinaemia
    4. Acute: asthma, pneumothorax, inhaled foreign body LVF
  2. Peripheral
    1. same as central cyanosis
    2. Cold exposure
    3. Raynauds phenomenon
    4. Arterial occlusion
    5. Decreased cardiac output
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58
Q

DDx

Deafness: sensorineural or conductive

A
  1. Conductive:
    1. Wax in canal
    2. Eardrum: perforation, cholesteatoma
    3. Ostosclerosis, ossicular abnormality
    4. Middle ear effusion
  2. Sensorineural:
    1. Infection: measles, mumps, meningitis, syphilis
    2. Trauma: noise, head injury, surgery
    3. Tumour: acoustic neuroma
    4. Toxic: aminoglycosides, cytotoxic drugs, frusemide
    5. Congenital: maternal rubella, eclampsia, perinatal hypoxia
    6. Genetic: Alport syndrome/Waardenburg syndrome
    7. Degenerative: presbyacusis
    8. Others: Meniere’s disease, Paget’s disease
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59
Q

DDx

Dehydration

A
  1. Decreased fluid intake: severe illness, anorexia, malnutrition
  2. Pyrexia/excess sweating
  3. GI loss: D/V
  4. Polyuria - DM, DI, hyperCa
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60
Q

DDx

Delirium

A
  1. Hypoxia - resp/cardiac failure
  2. Hypoglycaemia
  3. Toxic: alcohol withdrawal, Wernicke’s encephalopathy
  4. Drugs: opiates, Anticholinergics, anxiolytics, anticonvulsants, corticosteroids, digoxin, dopaminergic agonists, recreatioonal drugs
  5. Metabolic: Liver/renal failure, electrolyte imabalances (hypoNa, HyperCa), endocrinopathies, nutritional def (B12, nicotinic acid, thiamine)
  6. Vascular: intracranial bleeding, infarction, venous sinus thrombosis
  7. Infection: intracranial (meningitis/encephalitis), extracranial: chest infection, urinary infection, surgical wounds, IV lines
  8. Inflammation: vasculitis
  9. Trauma: head injury, subdural haematoma
  10. Tumour: space occupying lesions
  11. Hypertensive encephalopathy
  12. Epilepsy: status epilepticus, post-ictal states
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61
Q

DDx

Dementia

A
  1. Alzheimers
  2. Vascular: multiple infarctions
  3. Infection: HIV, syphilis, Whipple’s disease
  4. Inflammation: vasculitis, SLE, sarcoid, MS
  5. Trauma: head injury, subdural haemorrhage
  6. Tumour: frontal, post fossa, brain mets and paraneoplastic
  7. Toxic: alcohol, lead, barbiturates
  8. Metabolic: myxoedema, vit B12 def, hypoglycaemia
  9. Inherited: Wilson’s disease, huntington’s chorea
  10. Degenerative: Parkinson’s, Pick’s disease, prion disease, Lewy body dementia
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62
Q

DDx

Diarrhoea

A
  1. Infection:
    1. Viral: rotavrius, adenovirus
    2. Campylobacter, Salmonella
    3. Shigella, E coli
    4. Yersinia enterocolitica
    5. Staph aureus
    6. Clostridium botulinum/perfringens/difficile
    7. Virbrio cholerae/parahaemolyticus
    8. Parasites: Giardia, cryptosporidium, entamoeba histiolytica
    9. AIDS: enteropathy, cryptosporidia, microsporidia, CMV
  2. IBD
  3. Malabsorption: small intestine disease/resection, pancreatic insufficiency
  4. Medication: laxatives, Abx
  5. Overflow diarrhoea: 2ry to constipation
  6. Endocrine: thyrotoxicosis, carcinoid syndrome, DM, VIPomas
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63
Q

DDx

Bloody diarrhoea

A
  1. Infective colitis: campylobacter, haemorrhagic E coli, entamoeba histiolytica, salmonella, shigella- CMV in immunocompromised
  2. IBD
  3. Ischaemic colitis
  4. Diverticulitis
  5. Malignancy
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64
Q

DDx

Dullness at base of lung

A
  1. Pleural effusion
  2. Pleural thickening - old TB, empyema, mesothelioma
  3. Basal collapse
  4. Raised hemidiaphragm - hepatomegaly, phrenic nerve palsy
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65
Q

DDx

Dysarthria - difficulty with speech

A
  1. Cerebellar disease: slurred, scanning speech
  2. Bulbar palsy: nasal speech
  3. Pseudobulbular palsy: slow, indistinct, effortful - spastic speech
  4. Extrapyramidal disease: soft, monotonous
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66
Q

DDx

Dyspepsia

A
  1. GORD, oesophagitis
  2. Peptic ulcer, hiatus hernia, gastritis, duodenitis, gastric cancer
  3. Chronic cholecystitis
  4. Non-ulcer dyspepsia
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67
Q

DDx

Dysphagia

A
  1. Intraluminal: foreign body
  2. Intramural:
    1. Achalasia
    2. Benign stricture: oesophageal webs/rings
    3. Cancer - oesophageal, gastric, pharyngeal
    4. Diffuse oesophageal spasm
    5. Oesophagitis: infection - candidiasis, HSV, CMV, HIV, inflammation (GORD, corrosives, radiotherapy)
    6. Others: scleroderma, chagas’ disease
  3. Extramural:
    1. Lung cancer
    2. Lymphadenopathy
    3. Retrosternal goitre
    4. Pharyngeal pouch
    5. Paraoesophageal hiatus hernia
    6. Aortic aneurysm
    7. Aberrant SCA
    8. Left atrial enlargement
  4. Neuromuscular:
    1. Stroke
    2. Guillain Barre
    3. Bulbar/pseudobulbar palsy
    4. Myaesthenia gravis
    5. Inflammatory myositis
    6. Motor neurone disease
    7. Syringobulbia
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68
Q

DDx

Dysphasia

A
  1. Broca’s expressive: lesions affecting inferolateral frontal lobe
  2. Wernicke’s reeptive: lesions afecting posterior superior temporal lobe
  3. Conduction dysphasia
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69
Q

DDx

Dysuria

A
  1. UTI: cystitis, urethritis, acute pyelonephitis
  2. Urethritis: chlamydial, gonococcal; trichonomas vaginalis, candida albicans, herpes simplex
  3. Vaginitis: candida albicans, trichonomas vaginalis, bacterial vaginosis
  4. Prostatitis
  5. Interstitial cystitis
  6. Female urethral syndrome
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70
Q

DDx

ESR

A
  1. Increased:
    1. Infection
    2. Inflammatory/connective tissue diseases
    3. Malignancy
    4. metabolic - phaeo
  2. ^ESR with normal CRP
    1. SLE
    2. UC
    3. Myeloma
    4. Recovery from infection
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71
Q

DDx

Unilateral facial palsy

A
  1. Bell’s palsy/pathologies along course of nerve
    1. brainstem: infarction, demyelination, tumour
    2. cerebellopontine angle: acoustic neuroma
    3. Basal meningeal inflammation/infiltration: TB, sarcoidosis, lymphoma
    4. Middle ear: infection or herpes zoster
    5. Face/parotid: surgery/trauma
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72
Q

DDx

Bilateral facial nerve palsy

A
  1. Congenital facial diplegia
  2. Guillain-Barre
  3. Sarcoidosis
  4. Motor neurone disease
  5. Myasthenia gravis
  6. Muscular dstrophy
  7. Infections: lyme disease and HIV
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73
Q

DDx

Facial pain

A
  1. Neuro:
    1. GCA
    2. Trigeminal neuralgia
    3. Glossopharyngeal neuralgia
    4. Migrainous neuralgia and migraine
    5. postherpetic neuralgia
  2. Local causes:
    1. Post traumatic
    2. Sinusitis
    3. Orbital and ocular disease, optic neuritis, retroorbital disease
    4. Dental/oral disease
    5. TMJ dysfunction
    6. Ear and parotid disease
    7. Nasopharyngeal tumours
    8. Referred cardiac pain
    9. Atypical facial pain
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74
Q

DDx

Facial swelling

A
  1. Periorbital oedema
    1. Infection - peri/orbital cellulitis, trichinosis
    2. Allergy - anaphylaxis
    3. Hypo/erthyroidism
    4. Nephrotic syndrome, hypoalbuminaemia
    5. Cavernous sinus thrombosis
    6. Dermatomyositis
  2. Other causes:
    1. Dental/sinus infection
    2. Trauma, burns
    3. Subcut emphysema
    4. SVC thrombosis
    5. Cushing’s syndrome, obesity
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75
Q

DDx

Faecal incontinence

A
  1. Diarrhoea
  2. Overflow - faecal impaction, neoplasm
  3. Pelvic floor abnormality: accidental injury, traumatic childbirth, rectal prolapse
  4. Neurological: epilepsy, spinal cord compression, stroke, MS, trauma and tumours, peripheral neuropathy, dementia, parkinson’s
  5. Congenital: meningomyelocele, anorectal abnormalities
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76
Q

DDx

Fatigue

A
  1. anaemia
  2. endocrine/metabolic: DM, hypo/erthyroidism, addison’s disease, uraemia
  3. HF
  4. infection
  5. inflammatory/connective tissue diseases
  6. malignancy
  7. drugs - b-blockers
  8. depression
  9. chronic fatigue syndrome
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77
Q

DDx

Ferritin- high or low

A
  1. High:
    1. Acute phase response: infection, inflammation, malignancy
    2. Haemochromatosis
    3. Repeated transfusions in thalassaemia, iron therapy
    4. Still’s disease
    5. Sideroblastic anaemia
    6. anaemia of chronic disease, chronic haemolysis
  2. Low: IDA
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78
Q

DDx

Fever in travellers

A
  1. Hep A
  2. Malaria
  3. Typhoid
  4. Leptospirosis
  5. Dengue
  6. haemorrhagic fevers
  7. Longer incubation:
    1. malaria
    2. typhoid
    3. TB
    4. brucellosis
    5. leishmaniasis
    6. amoebic abscess
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79
Q

DDx

Finger pain

A
  1. Vascular: vasospasm, vasculitis, PVD, emboli
  2. Nerve/root compression: carpal tunnel syndrome, radiculopathy
  3. Infeciton: paronychia, tendon sheath inection, pulp space infection
  4. Inflammation/connective tissue disease: RhA, gout, scleroderma
  5. Trauma: fx, subungual haematoma
  6. Tumour: bone tumour, glomus tumour
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80
Q

DDx

Flaccid paralysis

A
  1. Anterior spinal artery syndrome
  2. Anterior horn cells: poliomyelitis, enterovirus, echovirus, adenovirus, west nile virus
  3. Nerve root: polyradiculopathy, tabes dorsalis, cauda equina
  4. Peripheral nerves: GBS
  5. Myoneural junction: myasthenia gravis, lambert-eaton syndrome
  6. Myopathy
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81
Q

DDx

Folate deficiency

A
  1. Increased demand: pregnancy/lactation, malignancy, chronic inflammation, chronic haemolytic anaemia, haemodialysis
  2. Decreased absorption: jejunal disease (coeliac, tropical sprue, whipple’s disease, small intestinal resection
  3. Decreased intake: alcoholics, elderly, anorexia
  4. Drugs: phenytoin, trimethoprim, sulphasalazine
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82
Q

DDx

Foot drop

A
  1. Neuro:
    1. Common peroneal nerve lesion: mononeuritis multiplex (DM)
    2. L5 root lesion
    3. Rare: motor neuron disease, MS, stroke
  2. Musc:
    1. injury to dorsiflexors
    2. Compartment syndrome
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83
Q

DDx

Foot pain

A
  1. Deformities, strain
  2. Skin: cellulitis, warts, corns, callosities
  3. Bone: fracture, osteomyelitis, osteochondritis (metatarsal head and navicular), tumours
  4. Joints: septic arthritis, gout, RhA, osteoarthritis
  5. Periarticular: plantar fasciitis, tendonitis, bursitis
  6. Vascular: ischaemia, ulcers
  7. Neuro: L4/5/S1 root pain, morton’s metatarsalgia, tarsal tunnel syndrome
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84
Q

DDx

Nocturia, Urinary frequency

A
  1. Polyuria
  2. Frequent passage of small amounts of urine:
    1. UTI
    2. Bladder (stone, tumour, compression by pelvic mass)
    3. Prostate enlargement (BPH, cancer)
    4. Genuine stress incontinence
    5. Detrusor instability
    6. Sensory urgency
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85
Q

DDx

GI bleeding

A
  1. Upper:
    1. Peptic ulcer
    2. Gastritis/gastric erosions, duodenitis, oesophagitis
    3. G-O varices
    4. Mallory-Weiss tear
    5. Medications: NSAIDs, anticoag, steroids, thrombolytics
    6. Oesophageal/gastric cancer
    7. Rare:
      1. Bleeding disorders, hereditary haemmorrhagic telangiectasia, Dieulafoy gastric vascular abnormality
  2. Lower GI:
    1. Anal: haemorrhoids, fissure
    2. Angiodysplasia
    3. Bowel cancer, polyps
    4. Colitis: inflammative (UC), infective, ischaemia, radiation
    5. Diverticulae (colonic)
    6. Excessive GI (upper) bleeding
    7. Other: bleeding disorders, aortoenteric, fistula, meckel’s diverticulum, solitary renal ulcer
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86
Q

DDx

Gaze palsy - horizontal and vertical

A
  1. Horizontal:
    1. Ipsilat pontine or contralat frontal lobe lesions
      1. Vascular, tumour, demyelination, infection
  2. Vertical:
    1. Superior midbrain lesions:
      1. Vascular, tumours (mets), demyelination, infection, metabolic, neurodegen
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87
Q

DDx

Glossitis

A
  • Iron def
  • Def of folate, B12, niacin (B3, thiamine (B1), riboflavin, Zinc
  • Candidiasis
  • Syphilis - rare
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88
Q

DDx

increased GGT

A

Liver disease:

  • Cholestasis
  • alcohol-induced damage
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89
Q

DDx

Glycosuria

A
  1. DM - 1 and 2
  2. Pregnancy
  3. Chronic renal failure
  4. Renal tubular dysfunction/damage
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90
Q

DDx

Goitre

A
  1. Simple goitre - euthyroid: puberty, pregnancy
  2. Thyrotoxicosis: Graves, toxic adenoma, toxic multinodular goitre with palpable nodule, thyroiditis
  3. Hypothyroidism: hashimoto’s
  4. Lithium, anti-thyroid drugs, iodine def/excess, dyshormogenesis
  5. thyroid cyst
  6. thyroid carcinoma: papillary, follicular, anaplastic, medullary, lymphoma
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91
Q

DDx

Gynaecomastia

A
  1. Physiological: puberty, elderly
  2. Pseudogynaecomastia - obese men
  3. Drugs: spironolactone, chlorpromazine, oestrogens, digoxin, drugs of abuse - marijuana/heroin
  4. Chronic liver disease
  5. Chronic renal failure
  6. Hypogonadism
  7. Hyperthyroidism
  8. Tumours: ectopic hCG, oestrogen producing
  9. Unilat:
    1. Breast carcinoma
    2. Lipoma, lymphangioma, neurofibroma, haematoma, dermoid cyst
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92
Q

DDx

Haematuria

A
  1. Kidney, bladder, ureter or urethra:
    1. Trauma
    2. Infection: UTI, (TB), schistosomiasis
    3. Stones
    4. Tumours
    5. Others: glomerulonephritis, IgA nephropathy, interstitial nephritis, cystic renal disease, emboli, renal vein thrombosis, vascular malformation, drugs, excessive exercise
    6. Prostate: BPH, prostate cancer, prostatitis
    7. General: haematological disorders, anticoags
  2. Other causes of urine discolouration:
    1. Food: beetroot
    2. Drugs: senna, rifampicin
    3. Haemoglobinuria/myoglobinuria
    4. Porphyria
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93
Q

DDx

Haemoptysis

A
  1. Lung:
    1. Infection - TB, pneumonia, absces, bronchitis, bronchiectasis
    2. PE
    3. Malignancy
    4. Vasculitis - Wegner’s granulomatosis, Goodpasture’s
    5. Trauma
    6. Foreign body
  2. Heart: Mitral stenosis
  3. Rarer: arteriovenous malformation, amyloidosis, sarcoidosis
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94
Q

DDx

Hallucination

A
  1. Psych:
    1. Schizophrenia/schizoaffective disorder
    2. Mania with psychosis
    3. Severe depression with psychosis
    4. Dementia
    5. Delirium
    6. Puerperal psychosis
    7. Alcoholic hallucinosis
  2. Organic:
    1. Cerebrovascular
    2. Infection
    3. toxic/metabolic - alcohol, hallucinogens
    4. Drug-induced psychosis - amphetamine, cocaine
    5. Sensory organ disease
    6. Seizures
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95
Q

DDx

Headache - acute/subacute

A
  1. Head injury
  2. Meningitis/encephalitis
  3. Subarachnoid haemorrhage, cerebral venous thrombosis
  4. Carotid/vertebral artery dissection
  5. Acute angle closure glaucoma
  6. GCA
  7. Pit apoplexy
  8. Other: Increased BP, drugs (GTN, CCB), infections, hypoNa, hyperviscosity syndromes
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96
Q

DDx

Chronic/recurrent headaches

A
  1. Raised ICP: space occupying lesion - tumour/abscess, hydrocephalus, benign intracranial HTN
  2. Reduced ICP: post LP
  3. Migraine
  4. Migrainous neuralgia
  5. Tension headache, rebound headache
  6. Sinusitis
  7. Others: carvicogenic, hypnic headache, meningeal infiltration - malignancy/sarcoidosis; refractive errors, Paget’s, acromegaly, antiPL syndrome
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97
Q

DDx

Loud heart sounds - S1, S2

A

S1:

  1. Mitral stenosis
  2. Atrial myxoma
  3. Tachycardia
  4. Hyperdynamic circulation
  5. Decreased PR interval - preexcitation syndromes

Variable S1 intensity:

  1. AF
  2. AV block
  3. nodal/ventricular tachycardia

S2:

  1. Systemic HTN
  2. Tachycardia
  3. Pulm HTN
98
Q

DDx

Soft heart sounds - S1, S2

A

S1

  1. Mitral Regurgitation
  2. Aortic regurgitation
  3. Long PR interval
  4. LBBB
  5. Severe HF

S2

  1. Aortic stenosis
  2. Pulmonary stenosis
99
Q

DDx

Extra heart sounds - S3, S4

A

S3

  1. Normal in under 35s
  2. Ventricular failure
  3. Mitral regurg
  4. Tricuspid Regurg
  5. VSD
  6. Constrictive pericarditis
  7. Restrictive cardiomyopathy

S4

  1. Aortic stenosis
  2. HTN HD
  3. Hypertrophic cardiomyopathy
  4. MI
  5. Pulm stenosis
100
Q

DDx

S2 abnormalities: splitting - wide, reversed splitting and single S2

A
  1. Wide:
    1. Delayed activation of RV:
      1. RBBB
      2. LV pacing/pre-excitation - WPWS
    2. Prolonged RV ejection time:
      1. Pulm stenosis
      2. Pulm HTN
    3. Decreased LV ejection time:
      1. Mitral regurg
      2. VSD
    4. Wide fixed splitting: ASD
  2. Reversed splitting:
    1. Delayed action of LV:
      1. LBBB
      2. RV pacing/preexcitation
    2. Prolonged LV ejection time:
      1. Aortic stenosis
      2. HOCM
      3. HTN
      4. PDA
  3. Single S2:
    1. Apparent: obesity, COPD, pericardial effusion
    2. Absent a2: severe aortic stenosis, severe aortic regurg
    3. Absent p2: absent pulm valve, pulm atresia, pulm stenosis, Fallot tetralogy
    4. Fusion of a2 and p2: Eisenmenger’s syndrome
101
Q

DDx

Hemiparesis/hemiplegia

A
  1. Vascular: stroke
  2. Infection: brain abscess from local or distant infections
  3. Inflammation: MS, cerebral vasculitis
  4. Trauma: extradural/subdural haemorrhage
  5. Tumour
  6. Metabolic: hypoglycaemia causes tranisent
  7. Others: epileptic seizures, migraine
102
Q

DDx

Hepatomegaly

A
  1. Cancer: 2ry mets, hepatoma, liver cell adenoma
  2. Cirrhosis: alcoholic, 1ry biliary cirrhosis
  3. CCF
  4. Budd-Chiari (hepatic vein thrombosis)
  5. Polycystic liver disease
  6. Infection: Hep A/B/C, EBV, CMV, toxoplasmosis, leptospirosis, abscess, hydatid cyst
  7. Infiltration: fatty (alcohol), haemochromatosis, amyloidosis, sarcoidosis, lymphoproliferative diseases
103
Q

DDx

Hepatosplenomegaly

A
  1. Myeloprolif disorders: CML, myelofibrosis, polycythaemia rubra vera, essential thrombocythaemia
  2. Lymphoprolif disorders: lymphoma, CLL, myeloma, ALL, hairy cell leukaemia
  3. Portal HTN
  4. Megaloblastic anaemia - pernicious
  5. Infection: Hep B/C, EBV, CMV, leptospirosis, toxoplasmosis, TB, brucellosis, malaria, schistosomiasis, leishmaniasis
  6. Other: amyloidosis, storage disorders, infantile polycystic disease
104
Q

DDx

Horner’s syndrome

A
  1. Brainstem/cervical spinal cord: tumour, infarction, syringomyelia/bulbia
  2. T1 root: brachial plexus lesion, neurofibromatosis
  3. Cervical sympathetic chain: pancoast tumour
  4. Internal carotid artery: dissection, occlusion
  5. Migraine, cluster headaches
105
Q

DDx

Hyperaldosteronism

A
  1. 1ry:
    1. Adenoma (conn’s),
    2. bilat adrenal hyperplasia,
    3. glucocorticoid-remediable aldosteronism
  2. Hyperaldosteronism:
    1. Increased Renin: tumour
    2. Renal artery stensosi
    3. Cirrhosis
    4. HF
    5. diuretics
    6. Bartter’s syndrome
106
Q

DDx

hyperbilirubinaemia

A
  1. Unconjugated:
    1. Haemolysis
    2. ineffective eryhtropoesis
    3. Decreased glucuronidation - Gilbert’s
  2. Conjugated: Jaundice - hepatocellular and obstructive
107
Q

DDx

Hypercalcaemia

A
  1. HyperPTH - 1ry and 3ry
  2. Malignancy: multiple myeloma, bone mets (prostate, kidney, thyroid, breast, lung), bronchial squamous cell carcinoma, lymphoma
  3. Excess vit D: self-admin, sarcoid, TB
  4. Immobility
  5. Others:
    1. Increased Ca intake
    2. Drugs: lithium, thiazides
    3. Endocrine disease: hyperthyroidism, phaeo, acromegaly, Addison’s
    4. Familial hypocalciuric hypercalcaemia
108
Q

DDx

Hypercalciuria

A
  1. Hypercalcaemia
  2. Idiopathic hypercalciuria
  3. Increased Ca intake
  4. Renal tubular acidosis
  5. X linked hypercalciuria
109
Q

DDx

Hyperglycaemia

A
  1. Stress - acute/severe illness
  2. DM:
    1. Type 1 and 2
    2. 2ry to
      1. steroids
      2. Endocrine: Cushing’s syndrome, acromegaly, phaeo, glucagonomas, somatostatinomas
      3. Pancreatectomy, chronic pancreatitis, haemochromatosis
110
Q

DDx

Hyperhidrosis

A
  1. Endocrine: thyrotoxicosis, acromegaly, phaeo
  2. Chronic infection: TB, brucellosis
  3. Malignancy: lymphoma
  4. Medications: opiates, drugs with cholinergic properties, sympathomimetics
  5. Acute: acute febrile illness, MI, hypoglycaemia, hypotension
111
Q

DDx

Hyperkalaemia

A
  1. Released from cells: acidosis, rhabdomyolysis, suxamethonium
  2. Renal failure
  3. Renal tubular acidosis type 4
  4. ACEi
  5. Addison’s
  6. Amiloride and other K sparing diuretics
  7. Increased intake
  8. PsuedohyperK - haemolysis, leucocytosis, thrombocytosis
112
Q

DDx

Hyperlipidaemia

A
  1. diabetes
  2. Drugs: alcohol, OCP, steroids, thiazides
  3. Myxoedema
  4. Nephrotic syndrome, renal impairment
  5. Obesity
  6. Obstructive jaundice
113
Q

DDx

Hypernatraemia

A
  1. Dehydration
  2. Decreased fluid intake: elderly, confused, unconscious
  3. Increased fluid loss:
    1. GI: diarrhoea, vomiting
    2. Renal: diabetes insipidus, osmotic diuresis
    3. Skin: excessive sweating
    4. Hyperosmolar non-ketotic coma
    5. Excess Na admin
    6. Excess mineralocorticoids: hyperaldosteronism
114
Q

DDx

Hyperphosphataemia

A
  1. Renal failure
  2. Psuedo/HypoPTHism
  3. Rhabdomyolysis
  4. Tumour lysis syndrome
  5. Acromegaly
  6. Excessive phosphate intake/admin
  7. Vit D intox
115
Q

DDx

Hyperprolactinaemia

A
  1. Physiological: pregnancy, lactation, stress
  2. Prolactinoma, rarely ectopic prolactin
  3. Decreased DA transport to ant pit: pit tumour compressing pit stalk
  4. Drugs:
    1. Depletion of central DA stores: reserpine, methyldopa
    2. DA receptor blockers: haloperidol, metoclopramide, domperidone
  5. Increased TRH secretion stimulates PL release
  6. Oestrogens: HRT/OCP, PCOS
  7. Chest wall injury
  8. Other: Liver failure, decreased DA synthesis/release from hypothalamus (tumour, inflammation, arteriovenous malformation)
116
Q

DDx

HTN

A
  1. Essential
  2. Renal disease: chronic glomerulonephritis, chronic pyelonephritis, cystic kidney disease, renal carcinoma
  3. Drugs: oestrogen containing OCPs, steroids
  4. Endocrine disease: cushing’s, conn’s, phaeo, acromegaly, 1ry hyperPTH
  5. Vascular: coarctation of aorta, renal artery stenosis
  6. Pre-eclampsia
117
Q

DDx

Hyperuricaemia

A
  1. Decreased renal excretion:
    1. Idiopathic
    2. Drugs: ciclosporin, aspirin, nicotinic acid, thiazides, loop diuretics, ethambutol, alcohol, pyrizinamide
    3. Chronic renal disease
  2. Increased intake/production:
    1. Increased dietary intake
    2. Increased synthesis: Lesch-Nyhan syndrome
    3. Increased nucleic acid turnover: lymphoma, leukaemia, polycythaemia vera, psoriasis
118
Q

DDx

Hypoalbuminaemia

A
  1. Decreased synthesis:
    1. Acute phase reaction
    2. Liver disease
    3. Malnutrition
  2. Increased loss:
    1. Nephrotic syndrome
    2. Protein-losing enteropathy - coeliac disease, IBD, sprue, whipple’s disease, intestinal lymphoma, intestinal lymphangiectasia
    3. Burns
    4. Bullous skin lesions
  3. Haemodilution: sample from IV infusion arm, pregnancy
  4. Rare: familial idiopathic dysproteinaemia
119
Q

DDx

Hypocalcaemia

A
  1. Hypoparathyroidism
    1. Congenital - digeorge’s
    2. autoimmune
    3. surgical
    4. PseudohypoPTHism
    5. Decreased Mg, Fe overload, increased copper
  2. Vit D def:
    1. decreased dietary intake/malabsorption
    2. Lack of sunlight
    3. liver disease
    4. anticonvulsants
    5. Renal failure
    6. vit D resistance
  3. Increased PO4: chronic renal failure, phosphate therapy
  4. Pancreatitis
  5. Resp alkalosis
  6. Hypoalbuminaemia
  7. Others: artifact, iatrogenic: bisphosphonates, calcitonin, citrated blood
120
Q

DDx

Hypoglycaemia

A
  1. Excess insulin, sulphonylureas, salicylate, pentamidine, quinine
  2. Insulinomas, hepatomas, sarcomas
  3. alcohol
  4. Addison’s
  5. Renal failure
  6. Liver failure
  7. Malaria
  8. Post-gastrectomy
121
Q

DDx

Hypokalaemia

A
  1. GI loss:
    1. Vomiting
    2. Diarrhoea
    3. Villous adenoma
    4. VIPoma
    5. Fistulae
    6. Ileostomies
  2. Renal loss:
    1. Excess mineralocorticoids (increased excretion):
      1. Hyperaldosteronism
      2. Increased glucocorticoids: cushing’s, liquorice
      3. Congenital adrenal hyperplasia
    2. Increased Na delivery to distal nephron (increased Na absorption and K secretion)
      1. Osmotic diuresis
      2. Diuretics: thiazides and loop diuretics
      3. Bartter’s syndrome, Gitelman’s syndrome
    3. Others:
      1. Hypomagnesaemia
      2. Renal tubular acidosis
      3. Renal tubular damage
      4. Liddle’s syndrome
  3. Redistribution into the cells: insulin, beta agonists, alkalosis
122
Q

DDx

Hypomagnesaemia

A
  1. decreased intake or GI losses:
    1. Malnutrition, alcoholism, diarrhoea, malabsorption, intestinal resection, intestinal fistulae
  2. Renal losses:
    1. Diuretics
    2. Alcohol abuse
    3. Drugs: nephrotoxins
    4. DM, hyperCa, hyperthyroidism, hyperaldosteronism, tubular dysfunction
  3. Other: post-op, post parathyroidectomy, pancreatitis, foscarnet
123
Q

DDx

Hyponatraemia

A
  1. Pseudohyponatraemia:
    1. Hyperproteniaemia, hypertriglyceridaemia
    2. hyperglycaemia
  2. Artifactual: taking blood frm the arm into which low Na solution is infused
  3. Hypervolaemic pts: cirrhosis, CCF, nephrotic syndrome, renal failure
  4. Hypovolaemic pts: renal loss - diuretics, renal tubular acidosis, salt losing nephropathy, adrenal insufficiency
    1. Extra-renal loss: diarrhoea, vomiting, burns, pancreatitis
  5. Euvolaemic pts: hypothyroidism, adrenal insufficiency, SIADH
124
Q

DDx

Hypophosphataemia

A
  1. Redistribution into cells:
    1. Increased insulin: recovery from DKA, refeeding
    2. Resp alkalosis
    3. Hungry bone syndrome: due to marked deposition of Ca and PO4 in bone
  2. GI:
    1. PO4 binders
    2. Diarrhoea - chronic
    3. Decreased dietary intake
  3. Renal:
    1. HyperPTH 1ry, 2ry: increased urinary excretion
    2. Vit D deficiency/resistance: by decreased GI absorption and causing hypoCa and 2ry hyperPTH
    3. Hereditary hypoPO4 rickets, tumour induced Osteomalacia
    4. Osmotic diuresis
    5. Fanconi syndrome
125
Q

DDx

Hypotension

A
  1. Septicaemia
  2. Hypovolaemia:
    1. Haemorrhage
    2. GI loss
    3. Renal loss (diuretic, DM, DI, post-obstructive diuresis, acute renal failure)
    4. Cutaneous loss (exudative lesions, burns)
    5. Adrenal insufficiency
    6. Cardiovascular: any condition that decreased CO (arrhythmias), decreased diastolic filling (pericardial disease), myocardial disease, outflow obstruction
126
Q

DDx

Postural hypotension

A
  1. Volume depletion
  2. Autonomic neuropathy:
    1. Metabolic: DM, amyloidosis, drugs (TCA, L DOPA)
    2. Inflammation: GBS
    3. Infection: HIV, syphillis
    4. Tumours: paraneoplastic, hypothalamic
    5. Degenerative: Parkinson’s, multpile system atrophy, shy-drager syndrome
    6. Familial dysautonomia
  3. Drugs: antihypertensives, diuretics, nitrates, antidepressants, sedatives
  4. Leg vein insuffiency
127
Q

DDx

Impotence

A
  1. Psych
  2. Drugs: alcohol, antidepressants, b-blockers, cannabis, diuretics, major tranq
  3. Endocrine disorders: hypogonadism/androgen deficiency, hyperthyroidism, prolactinoma, acromegaly
  4. Neurological: autonomic neuropathy, nerve damage after bladder neck/prostate surgery, MS
  5. Vascular disease
128
Q

DDx

Infertility

A
  1. Female:
    1. anovulation - 1ry/2ry hypogonadism
    2. obstructed fallopian tubes - adhesions
    3. uterine cavity abnormalities - fibroids, endometriosis
    4. chromosome abnormalities
    5. antiphospholipid syndrome
  2. Male
    1. Hypogonadism 1ry/2ry
    2. Varicocoele
    3. Immotile sperm
    4. obstruction of epididymis, vas deferens
    5. coital disorders
129
Q

DDx

Increased ICP

A
  1. vascular: haemorrhage (extradural, subdural, subarachnoid, intracerebral)
  2. Infection: meningitis/encephalitis, abscess
  3. Trauma: head injury
  4. Tumours
  5. Benign intracranial HTN, hydrocephalus, cerebral oedema
130
Q

DDx

Jaundice

A
  1. Pre-hepatic:
    1. Haemolysis
    2. ineffective erythropoiesis
    3. decreased glucuronidation (gilbert’s)
  2. Hepatocellular:
    1. Viral: Hep ABC - other infections: CMV, EBV, toxoplasmosis, leptospirosis, Q fever
    2. Drugs: paracetamol, anti-TB drugs, statins, Na valproate, toxins, herbal meds
    3. Alcoholic hep
    4. Autoimmune hep
    5. Cirrhosis, hep mets, hep abscess
    6. Wilson’s, haemochromatosis, alpha1-antitrypsin def, Budd-chiari syndrome
    7. Septicaemia
    8. Dubin-johnson syndrome, rotor syndrome
  3. Obstructive:
    1. Gallstones
    2. Carcinoma of head of pancreas/ampulla of vater/bile duct
    3. Lymphadenopathy at porta hepatic
    4. Benign stricture
    5. Drugs: ABx, OCP, chlorpromazine, sulphonylureas
    6. Primary schlerosing cholangitis, primary biliary cirrhosis
    7. Parasites: schistosomiasis, pancreatitis, AIDS cholangiopathy
131
Q

DDx

Increased JVP

A
  1. RHF
  2. Tricuspid regurg
  3. Pericardial effusion, constrictive pericarditis
  4. Fluid overload
  5. Obstruction of SVC
  6. a waves - cannon waves
    1. Regular: nodal rhythm, paroxysmal nodal tachycardia, partial heart block with very long PR interval
    2. Irregular: complete heart block, multiple ectopic beats
132
Q

DDx

Ketonuria

A
  1. diabetes
  2. Starvation
  3. Increased metabolic requirements: fever, pregnancy, thyrotoxicosis
  4. Glycogen storage diseases
133
Q

DDx

Enlarged Kidneys

A
  1. Cystic kidney
  2. Carcinoma
  3. Hydronephrosis, pyonephrosis
  4. Hypertrophy
  5. Perirenal haematoma
  6. Congenital anomaly
134
Q

DDx

Swelling of knee

A
  1. Septic arthritis
  2. trauma, haemarthosis
  3. pseudo/gout
  4. RhA, OA
  5. Seronegative athritides - reactive arthritis, enteropathic arthrits, ankspond, psoriatic arthritis
  6. Systemic: SLE, sjogren’s, sarcoidosis, Behcet’s, vasculitidies
  7. Malignancy
  8. Localised swellings:
    1. Ant:
      1. Prepat bursa
      2. Infrapat bursa
      3. Osgood-schlatter disease
    2. Lat/medial:
      1. lat/med meniscus cyst
      2. Exostosis
    3. Post:
      1. Semimembranous bursa
      2. Baker’s cyst
      3. Popliteal aneurysm
135
Q

DDx

Kussmaul’s sign

(paradoxical rise in JVP on inspiration, or a failure in the appropriate fall of the JVP with inspiration)

A
  1. Pericardial effusion
  2. Constrictive pericarditis
  3. Restrictive cardiomyopathy
136
Q

DDx

Increased LDH

A
  1. MI
  2. Haemolysis
  3. Hepatocyte damage
  4. Pulm Embolism
  5. Lymphoma, tumour necrosis
137
Q

DDx

Leg pain

A
  1. Vascular: aterial occlusion - acute/chronic, DVT
  2. Neurological: lumbar canal stenosis radiculopathy, plexopathy, peripheral neuropathy
  3. MSK: soft-tissue injury, muscle spasm
  4. Arthritis
138
Q

DDx

Leg swelling

A
  1. Bilat:
    1. HF
    2. Liver failure - other causes of hypoalbuminaemia (malnutrition, malabsorption, nephrotic syndrome)
    3. Renal failure
    4. Hypothyroidism
    5. Iatrogenic: oestrogens, CCB, fluid overload
    6. Venous insufficiency: acute/chronic
    7. Venous obstruction
  2. unilat:
    1. Acute:
      1. DVT
      2. Cellulitis
      3. Compartment syndrome, trauma
      4. Baker’s cyst rupture
    2. Chronic:
      1. Varicose veins
      2. Lymphoedema: primary, LN involvement (RT, infection)
      3. Immobility
139
Q

DDx

Deranged LFTs

(raised AST, ALT, ALP)

A
  1. AST:
    1. hepatocyte damage
    2. haemoysis
    3. MI
    4. Skeletal muscle damage
  2. ALT:
    1. Hepatocyte damage
    2. Shock
  3. ALP:
    1. Liver disease: cholestasis
    2. Bone disease: growth in adolescence, healing fx, paget’s, osteomalacia, bone mets, hyperPTH, renal failure
    3. Placenta: pregnancy
    4. Other: RHF, Polymyalgia rheumatica, thyrotoxicosis
140
Q

DDx

FEV1/FVC ratio

A
  1. Obstructive <75%:
    1. Asthma, COPD
  2. Restrictive >75%
    1. Pulm fibrosis:
      1. Idiopathic fibrosing alveolitis
      2. Connective tissue diseases: scleroderma, SLE, sarcoidosis, RhA, ankspond
      3. Drugs: amiodarone, nitrofurantoin, radiation
      4. Extrinsic allergic alveolitis
      5. Pneumoconioses
141
Q

DDx

Lymphadenopathy

A
  1. Infection:
    1. Bacterial, TB, less commonly: brucellosis, syphilis
    2. Viral: HIV, EBV, CMV, rubella, measles
    3. Toxoplasmosis, filariasis, fungal
  2. Inflammatory/connective tissue disease: RhA, sarcoidosis, SLE
  3. Malignancy: mets, lymphoma, leukaemia
  4. Rare: thyrotoxicosis, psoriasis, eczema, phenytoin
142
Q

DDx

Macroglossia

A
  1. Hypothyroidism
  2. Amyloidosis
  3. Acromegaly
  4. Mucopolysaccharidosis
  5. Down’s syndrome
  6. Chronic infections TB
  7. Space-occupying lesions - rhabdomyosarcomas
143
Q

DDx

Megacolon

A
  1. IBD
  2. Ischaemic colitis
  3. Pseudomembranous colitis
  4. Amoebic colitis
  5. CMV colitis
  6. Trypanosomiasis
144
Q

DDx

Miosis

A
  1. Reactive to light:
    1. Old age
    2. Horner’s
  2. Non-reactive:
    1. Drugs: pilocarpine eye drops, opiates, organophosphate
    2. Argyll robertson pupil
    3. Anterior uveitis
    4. Pontine lesion
145
Q

DDx

Monoarthralgia

A
  1. Articular:
    1. Infection: septic arthritis
    2. trauma, haemarthrosis
    3. Gout/pseudogout
    4. RhA, OA
    5. Seronegative arthitides
    6. Systemic: SLe, sjogren’s syndrome, sarcoidosis behcets, vasculitides
    7. Malignancy
  2. Extra-articular:
    1. Bursitis
    2. Tenosynovitis
    3. Cellulitis
146
Q

DDx

Murmurs (systolic and diastolic)

A
  1. Systolic:
    1. Ejection:
      1. Aortic area: aortic stenosis, aortic sclerosis
      2. Pulm area: innocent, atrial septal defect, pulm stenosis
    2. Pansystolic:
      1. Mitral Regurg, VSD
      2. Tricuspid regurg
  2. Diastolic:
    1. Early: aortic regurg, pulm regurg
    2. Mid diastolic: mitral stenosis, tricuspid stenosis
    3. Continous: patent ductus arteriosus
147
Q

DDx

Mydriasis

A
  1. Drugs: mydriatic eye drops, OD (cocaine, amphetamine), poisoning
  2. Trauma: post traumatic iridoplegia, iridectomy, lens implant
  3. Third nerve palsy
  4. Holmes-Adie pupil
  5. Acute angle closure glaucoma
  6. Deep coma, cerebral death
148
Q

DDx

Nasal discharge

A
  1. Allergic rhinitis
  2. vasomotor rhinits
  3. Infection - viral, sinusitis
  4. Inflammation polyps, wegner’s granulomatosis, sarcoidosis, midline granuloma
  5. Trauma: foreign body, fx of anterior fossa
  6. tumours
149
Q

DDx

Neck swelling

A
  1. Midline:
    1. thyroid gland swelling
    2. thyroglossal cyst
    3. LN
    4. Manubrium swelling:
      1. Soft: lipoma
      2. Hard: bony tumour
      3. Pulsatile: eroding aortic aneurysm
  2. Ant triangle:
    1. LN
    2. Cold abscess
    3. salivary gland swelling
    4. branchial cyst
    5. carotid body tumour/aneurysm
    6. sternomastoid tumour
  3. Post triangle:
    1. LN, cold abscess
    2. cystic hygroma
    3. subcalvian artery aneurysm
    4. tumour of clavicle
150
Q

DDx

Night sweats

A
  1. Infections: chronic - TB, subacute bacterial infections, HIv histoplasmosis
  2. Malignancy: lymphoma, solid tumours
  3. Menopause
  4. Meds - GnRH agonists, antidepressants
151
Q

DDx

Nystagmus

A
  1. Physiological = extreme lat gaze
  2. Pendular: congenital
  3. Jerky:
    1. Acute labyrinthitis, other inner ear diseases - meniere’s, BPPV, vestibular neuronitis, acoustic neuroma = NB: hearing loss, tinnitus and vertigo may be present
    2. Brainstem/vestibular nuclei: vascular (stroke), inflammation (MS/tumours). toxic (alcoholism)
    3. Cerebellar disease
    4. Drugs -phenytoin
  4. Rotary nystagmus: lesion in labyrinth or brainstem
  5. Vertical nystagmus: drugs or brainstem lesion
152
Q

DDx

Oedema in ankles

A
  1. Pitting/bilat:
    1. HF
    2. LF, or hypoalbuminaemia: malnutrition, malabsorption, nephrotic syndrome, protein losing enteropathy
    3. Renal failure
    4. hypothyroidism
    5. iatrogenic: oestrogens, CCB, fluid overload
    6. Venous insufficiency: acute, chronic
    7. Venous obstruction: pelvic mass, pregnancy
  2. Non-pitting:
    1. Lymphoedema: 1ry, LN involvement: RT,infection, malignant infiltration, excision
153
Q

DDx

Optic disc atrophy

A
  1. Optic neuritis
  2. ^ ICP: 2ry to papilloedema
  3. Toxic/met/drugs: tobacco, alcohol, vit B12 def, diabetes, ethambutol
  4. Infection/infiltration: spread from sinuses, syphilis, sarcoid
  5. Compression: intraorbital, tumour of pit/sphenoid sinus, carotid aneurysm
  6. Ant ischaemic optic neuropathy
  7. Trauma: orbital fracture, indirect trauma
  8. Retinal disease: retinitis pigmentosa, macular degeneration
  9. Occlusion of retinal artery
  10. ^ pressure inside eye
  11. Hereditary - leber’s optic atrophy, hereditary ataxis
154
Q

DDx

Osler’s nodes

A
  1. subacute bacterial endocarditis
  2. SLE
  3. Haemolytic anaemia
  4. gonococcal infection
155
Q

sources of O2 sat errors

A
  1. hypoperfusion
  2. improper probe placement
  3. intensive ambient light
  4. motion artifact
  5. MRI
  6. Nail polish
  7. Skin pigmentation
  8. Abnormal Hb
  9. Venous congestion/pulsations
156
Q

DDx

P wave

A
  1. Absent:
    1. AF
    2. Hyperkalaemia
    3. Sinoatrial block, junctional rhythm
  2. Tall:
    1. Pulm HTN
    2. Pulm stenosis
    3. tricuspid stenosis
157
Q

DDx

Painful red eye

A
  1. Scleritis
  2. Anterior uveitis
  3. Acute angle closure glaucoma
  4. corneal ulcer/bacterial keratitis
158
Q

DDx

High arched palate

A
  1. Marfan’s
  2. Homocytinuria
  3. MEN2b
  4. turner’s syndrome
  5. Noonan’s syndrome
  6. friedrich’s ataxia
  7. Fragile x syndrome
159
Q

DDx

Palmar erythema

A
  1. Liver disease
  2. Alcoholism
  3. RhA
  4. Thyrotoxicosis
  5. Pregnancy
  6. Chornic leukaemia
160
Q

DDx

Palpitations

A
  1. fever, exercise, anaemia, pregnancy
  2. Drugs - caffeine, nicotine salbutamol, anticholinergics, vasodilators, cocaine
  3. Cardiac: arrhythmias - AF/SVT/VT, pacemaker, valvular disease, cardiac shunts, cardiomyopathy, atrial myxoma
  4. Endocrine: thyrotoxicosis, phaeo, hypoglycaemia, mastocytosis
  5. Psych: panic attacks, generalised anxiety disorder, depression
161
Q

DDx

Pancytopaenia

A
  1. Aplastic anaemia
    1. Congenital: fanconi’s
    2. Radiation
    3. Chemicals: benzene, insecticides
    4. Drugs: chloramphenicol, gold
    5. Infection: HIV, viral hep, measles
    6. Idiopathic
  2. Megaloblastic anaemia
  3. Marrow infiltration
    1. Lymphoma, leukaemia, metastasis, myeloma, myelofibrosis
  4. SLE, sepsis, hypersplenism, paroxysmal nocturnal Hburia
162
Q

DDx

Paraesthesia

A
  1. Peripheral neuropathy: DM, alcoholism
  2. Peripheral nerve entrapment/compression - carpal tunnel, disc herniation
  3. Spinal cord disease - MS
  4. Hypocalcaemia
163
Q

DDx

Parotid enlargement

A
  1. Bilat:
    1. Sjorgens
    2. sarcoidosis
    3. lymphoma
    4. anorexia
    5. acromegaly
    6. alcoholics
    7. diabetics, hypertriglyceridaemia
    8. Infection: mumps, HIV
  2. Unilat:
    1. Tumours
    2. Calculi
    3. Cysts
    4. Bacterial infection
164
Q

DDx

Percussion notes - dull, hyperresonant

A
  1. Dull:
    1. Pleural effusion
    2. Collapse
    3. Consolidation
    4. Fibrosis
    5. Pleural thickening
  2. Hyperresonant:
    1. Pneumothorax
    2. COPD (hyperinflation)
165
Q

DDx

Pericarditis

A
  1. Idiopathic
  2. Infection: viral - EBV, varicella, mumps, HIV; bacterial - strep, TB; fungal
  3. Inflammatory: RhA, SLE
  4. MI
  5. Malignancy
  6. Myxoedema
  7. Uraemia
  8. Radiotherapy
  9. Surgery/trauma
  10. Drugs: hydralazine, isoniazid
166
Q

DDx

Decreased platelets

A
  1. Decreased production:
    1. Bone marrow failure:
      1. Myeloma, myelofibrosis, marrow infiltration, anaemia, leukaemia
      2. Drugs: cytotoxics, chloramphenicol, alcohol
      3. Decreased megaaryocytes: chemicals, drugs, viral infection
  2. Increased destruction/consumption:
    1. Autoimmune - ITP
    2. SLE, CLL, lymphoma
    3. Infections (malaria, viral: HIV)
    4. Drugs: Analgesics, abx, anticonvulsant, anti-diabetics, heparin, quinine
    5. DIC, TTP, HUS
    6. Sequestration: splenic pooling due to splenomegaly
    7. Dilutional loss
    8. Artifactial
167
Q

DDx

Increased platelets - thrombocytosis

A
  1. 2ry:
    1. blood loss
    2. infection
    3. inflammation
    4. malignancy
    5. splenectomy
    6. trauma/surgery
  2. 1ry
    1. essential thrombocythaemia
    2. polycythaemia vera
    3. myelofibrosis
    4. myelodysplasia
    5. CML
168
Q

DDx

Pleural effusion

A
  1. Exudate:
    1. infection: TB, bacterial, pneumonia
    2. inflammation/connective tissue: SLE, sarcoidosis
    3. Malignancy: bronchial carcinoma, mesothelioma
    4. Pulmonary infarction
    5. post-MI
    6. pancreatitis
  2. Transudate:
    1. Cardiac failure
    2. Hypoproteinaemia
    3. hypothyroidism
    4. constrictive pericarditis
    5. Meigs’ syndrome
169
Q

DDx

Polyarthralgia

A
  1. Infection: disseminated septic arthritis, viral, rheumatic fever, lyme disease, TB
  2. Pseudo/gout
  3. RhA, OA
  4. Seroneg arthritis - reactive (reiters), enteropathic, ankspond, psoriatic
  5. Systemic diseases: SLE, sarcoid, sjogrens, behcets, primary vasculitides, polymyalgia rheumatica
  6. Other: haemochromatosis, sickle cell, malignancy
  7. Migratory polyarthralgia:
    1. Gonococcal arthritis
    2. Rheumatic fever
170
Q

DDx

Polycythaemia

A
  1. Reactive: dehydration, Gaisbock’s syndrome
  2. True:
    1. Polycythaemia rubra vera
    2. Appropriate increase in EPO:
      1. Chronic hypoxia - high altitude, chronic lung disease, cyanotic heart disease
        1. Inappropriate increase EPO: renal cell carcinoma/cysts, hepatoma, cerebellar haemangioblastoma, fibroids
171
Q

DDx

Polyuria

A
  1. DM
  2. DI:
    1. Central: tumour, trauma/surgery, infiltration (TB, sarcoid, histiocytosis X)
    2. Nephrogenic: hyperCa, hypoK, lithium
  3. Diuretics
  4. Diuretic phase of acute RF/chronic RF
  5. Post-obstructive diuresis
  6. Psychogenic polydypsia
172
Q

DDx

Portal HTN

A
  1. Prehepatic: portal/splenc vein thrombosis
  2. Hepatic: cirrhosis, granulomata, schistomiasis
  3. Post-hepatic: budd-chiari syndrome, CCF, constrictive pericarditis
173
Q

DDx

PR interval

A
  1. Long: 1st degree AV block
  2. Short: Wolff-parkinson-white syndrome; HOCM, Duchenne’s muscular dystrophy
174
Q

DDx

Proteinuria

A
  1. Pregnancy
  2. DM
  3. HTN
  4. UTI
  5. Inflammation - SLE, glomerulonephitis
  6. Multiple myeloma
  7. Amyloidosis
  8. Other: fever, exercise, CCF
175
Q

DDx

Increased Prothrombin time

A
  1. Warfarin/vit K deficiency
  2. Liver disease
  3. DIC
  4. Hepparin
    5.
176
Q

DDx

Proximal muscle weakness

A
  1. Toxic/metabolic: steroids, cushing’s syndrome, thyrotoxicosis, hypothyroidism, OM, alcohol, heroin
  2. Inflammatory: dermatomyositis, polymyositis
  3. Infectio: staph myositis, parasites, viral
  4. Inherited: muscular dystrophies, metabolic/mitochondrial myopathies, familial periodic paralysis, acid maltase deficiency
177
Q

DDx

Pruritis

A
  1. Cutaneous:
    1. Eczema, allergic reactions
    2. Lichen planus
    3. Scabies, herpes simplex/zoster, parasites
    4. Dermatitis herpetiformis
    5. Psoriasis
    6. Nodularr prurigo
    7. prurigo preganancy
  2. Systemic disease
    1. Metabolic: LF, chronic renal failure
    2. Endocrine: hyperthyroidism, hypothyroidism, DM
    3. Haematological: polycythaemia, IDA, hodgkin’s lymphoma
    4. Psych: parasitophobia, anxiety
    5. Tropical infection: filariasis, hookworm
    6. Drugs: alkaloids
178
Q

DDx

Puritus ani

A
  1. Incontinence, diarrhoea, poor hygeine
  2. Infection: threadworm, fungal (candidiasis, tinea cruris), scabies
  3. Anal disease: haemorrhoids, fissure, fistula, wart
  4. Skin disease: contact dermatitis, eczema, psoriasis, lichen sclerosis
  5. Other: anxiety, tight pants
179
Q

DDx

Ptosis

A
  1. 3rd nerve palsy
  2. Horner’s syndrome
  3. Myasthenia gravis
  4. Myotonic dystrophy
  5. Ocular myopathy
  6. Congenital
  7. syphilis
180
Q

DDx

Puberty - delayed or precocious

A
  1. Delayed:
    1. constitutional growth and puberty delay
    2. hypogonadism of prepubertal onset
  2. Precocious:
    1. Complete:
      1. Congenital: hydrocephalus, brain malformation
      2. Acquired: tumours, trauma, radiation, infiltrations
    2. Incomplete:
      1. Premature pubic/axillary hair development: excess androgens
      2. Leydig cells simulated by hCG - hepatoma, pineal/hypothalamic teratomas
      3. Leydig cells premature activation due to mutation in LH receptor
      4. Leydig cell tumour
      5. McCune-albright syndrome
      6. Excess androgens from adrenal tumours, CAH
      7. Exogenous sex steroids
    3. Premature breast development - excess oestrogens:
      1. Ovarian cyst
      2. hypothyroidism
      3. Ovarian neoplasm
      4. McCune-Albright
181
Q

DDx

Pulmonary HTN

A
  1. 1ry
  2. 2ry:
    1. L heart disease - mitral valve disease, LVF, left atrial myxoma
    2. COPD
    3. Recurrent PE
    4. Increased pulm blood flow - VSD, ASD, patent ductus arteriosus
    5. Connective tissue disease - SLE, scleroderma
    6. Drugs: fenfluramine
    7. HIV
182
Q

DDx

Irregular/Bounding/Unequal or delayed pulse

A
  1. Irregular:
    1. Sinus arrhythmia
    2. Irreg irreg: AF, mutliple ectopic beats, atrial flutter with variable block
    3. reg irreg: 2nd degree heart block, ventricular bigemini
  2. Bounding
    1. Peripheral vasodilation: CO2 retention, sepsis, liver failure, thyrotoxicosis
    2. Increase SV: aortic regurg, patent ductus arteriosus, large AV fistulas thyrotoxicosis, severe anaemia, exercise
  3. Unequal/delayed:
    1. Atherosclerosis, thromboembolic disease
    2. Aortic dissection
    3. Aortic aneurysm
    4. Arteritis: large vessel vasculitis
    5. Subcalvian steal syndrome
    6. Supravalvular aortic stenosis
183
Q

DDx

Increased/decreased Pulse pressure

A
  1. Increased:
    1. Aortic regurg
    2. Thyrotxicosis
    3. Pregnancy
    4. Patent ductus arteriosus
    5. High-output HF
  2. Decreased:
    1. Aortic stenosis
    2. Shock
    3. Pericardial effusion, constrictive pericarditis
184
Q

DDx

Pyoderma gangrenosum

A
  1. IBD, autoimmune hepatitis
  2. RhA, seroneg arthritides
  3. Haematological: leukaemia, myeloma, polycythaemia rubra vera
  4. Wegner’s granulomatosis
  5. Idiopathic
185
Q

DDx

Pyrexia of unknown origin

A
  1. Infection: abscesses
    1. Bacterial: infective endocarditis, osteomyelitis, UTI, biliary infection
    2. TB, brucellosis, viral infections: HIV, CMV EBV, malaria
  2. Inflammation/CTD: RhA, SLE, sarcoidosis, vasculitides, polymyalgia rheumatica
  3. Malignancy: lymphomas, leukaemia, renal cell carcinoma, hepatocellular carcinoma, pancreatic carcinoma
  4. DrugS: sulphonamides, isoniazid, aspirin
  5. Familial mediterranean fever, familial periodic fever
186
Q

DDx

Q waves

A
  1. Normal: <25% of height of following R wave, or <2mm deep
    1. Septal q waves in lat leads
    2. Common in III, V5-V6
    3. MI
    4. Left ventricular hypertrophy
    5. BBB
187
Q

DDx

QRS complexes

A
  1. Axis deviation
  2. BBB
  3. Low QRS
    1. incorrect standardisation
    2. Obesity
    3. COPD
    4. Pericardial effusion
    5. Myxoedema
  4. Wide QRS
    1. Ventricular extrasystoles, ventricular tachycardia, complete AV block, BBB - L/R
    2. Dominant R waves in V1
188
Q

DDx

QT interval

A
  1. Long:
    1. Hypothermia
    2. HypoCa/Mg/K
    3. Congenital: Romano-Ward syndrome, jervell-lange-nielsen syndome
    4. Drugs: TCA, chloroquine, class Ia anti-arrhythmics
    5. Acute MI, acute myocarditis
    6. Cerebral injury
  2. Short:
    1. Hyperthermia
    2. Hypercalcaemia
    3. Digoxin
189
Q

DDx

R wave dominant in V1

A
  1. RV hypertrophy, RBBB, pulm embolism
  2. Post MI
  3. Myocarditis
  4. WPW syndrome
  5. Misplaced pacemaker
190
Q

DDx

Raynaud’s phenomenon

A
  1. Idiopathic
  2. Occupational
  3. Connective tissue disease: slceroderma, SLe, sjogren syndrome, RhA, dermatomyositis
  4. Cold agglutinins
  5. Cryoglobulinaemia, macroglobuniaemia
  6. cervical rib
  7. drugs - b blockers
  8. vascular disease
191
Q

DDx

Rectal discharge

A
  1. Common:
    1. Haemorrhoids
    2. Anal fissure
    3. Rectal prolapse
    4. Proctitis
    5. Perianal warts
  2. Occasional:
    1. Rectal carcinoma
    2. anal fistula
    3. Perianal IBD
    4. Solitary rectal ulcer syndrome
    5. villous adenoma
192
Q

DDx

Red eye

A
  1. Conjunctivitis - allergic, viral, bacterial, chlamydial
  2. Episcleritis
  3. Scleritis
  4. Iritis
  5. Acute angle closure glaucoma
  6. Other: inflamed pinguecula, subconjunctival haemorrhage
193
Q

DDx

Absent red reflex

A
  1. Cataract
  2. corneal oedema
  3. vitreous haemorrhage
  4. retinal detachment
194
Q

DDx

RAPD

A
  1. Optic neuritis
  2. Optic nerve compression
  3. Central retinal artery occlusion
  4. Retinal detachmment
  5. Unilat glaucoma
195
Q

DDx

Resp Rate -> increased/decreased

A
  1. Increased:
    1. Physiological: exercise, anxiety
    2. Lung disease: pneumothorax, PE, obstructive disease, restrictive disease, infection, inflammation, malignancy
    3. Elevation of diaphragm: ascites, diaphragmatic paralysis
    4. met acidosis
  2. Decreased:
    1. Physiological: well-conditioned athletes
    2. CNS disease: infection (meningitis, encephalitis), trauma, tumour, drugs, coma
196
Q

DDx

+ve rheumatoid factor

A
  1. Sjogren’s
  2. RhA
  3. SLE
  4. Scleroderma
  5. Mixed connective tissue disease
  6. mixed cryoglobulinaemia
  7. Poly/dermatomyositis
  8. Infection/inflammatory disease - TB, infectious mono, subacute bacterial endocarditis, chronic hepatitis
197
Q

DDx

Roth’s spots

A
  1. Infective endocarditis
  2. leukaemia
  3. anaemia
  4. vasculitis: SLE, PAN
198
Q

DDx

Seizures

A
  1. Adults:
    1. Vascular: infarction, haemorrhage, cortical venous thrombosis, vascular malformation
    2. Trauma: head injury
    3. Tumours
    4. Toxic: alcohol, drugs, lead, CO
    5. Metabolic: hypoxia, hypoglycaemia, electrolyte disturbances, renal/hepatic failure, endocrine disorders (hypopit, hypo/erPTH, addison’s disease, insulinoma), vit deficiency
    6. Infection: meningitis, encephalitis, abscess, TB, cysticercosis, HIV
    7. Inflammation: MS, vasculitis, SLE, sarcoidosis
    8. Degen disorders: alzheimer’s, prion disease
    9. HTN
  2. Children;
    1. Congenital anomaly
    2. Tuberous sclerosis
    3. Metabolic storage diseases
199
Q

DDx

Sore throat

A
  1. Pharyngitis
  2. Strep tonsilits
  3. Infectious mono
  4. Gonococcal pharyngitis
  5. Diptheria
  6. With pharyngeal ulcers:
    1. Herpes simplex
    2. Herpangina
    3. Vincent’s angina
    4. cadidiasis
200
Q

DDx

Splenomegaly

A
  1. Massive:
    1. CML, myelofibrosis
    2. tropical infections: malaria, leishmaniasis, schistosomiasis, tropical splenomegaly
    3. Gaucher’s disease
  2. Moderate:
    1. Haematological - haemolytic anaemia, lymphoma, leukaemia, myeloprolif disorders
    2. Portal HTN
    3. Infection: infective endocarditis, infectious mono, TB, brucellosis
    4. Inflammatory/connective tissue diseases: RhA, SLE, sarcoidosis, amyloidosis
201
Q

DDx

Splinter haemorrhages

A
  1. Trauma
  2. Infective endocarditis
  3. Vasculitis
  4. Psoriasis
  5. Mitral stenosis
202
Q

DDx

Purulent sputum

A
  1. Upper resp source - acute sinusitis, rhinitis, bronchitis
  2. Infection: pneumonia, TB, lung abscess
  3. Bronchiectasis
  4. Bronchopleural fistula
203
Q

DDx

ST segment - depression, elevation

A
  1. Depression:
    1. MI - posterior
    2. Myocardial ischaemia
    3. Drugs - Digoxin, quinidine
    4. Ventricular hypertrophy
  2. Elevation:
    1. MI - acute
    2. Pericarditis
    3. Prinzmetal angina
    4. Left ventricular aneurysm
    5. Brugada syndrome
    6. High take off
204
Q

DDx

Short stature

A
  1. CGPD, familial
  2. Syndromic: turner’s syndrome, achondroplasia, prader-willi
  3. Psychosocial factors: child abuse, anorexia nervosa, emotional deprivation
  4. Endocrine factors:
    1. Decreased growth hormone - hypopit
    2. Mutations: pit1, PROP1, GHRH receptor
    3. Cushing’s syndrome and excess endogenous corticosteroids
    4. Biologically inactive GH
    5. GH resistance
    6. Low levels of IGF1 (laron dwarfism)
    7. decreased thyroid hormones
  5. nutritional factors
  6. Systemic illness:
    1. GI: malabsorption - coeliac disease, milk protein intolerance, IBD
    2. CV: Congenital cyanotic heart disease
    3. Resp: CF
    4. Renal: chronic renal failure
205
Q

DDx

Tall stature

A
  1. Familial
  2. Syndromic:
    1. Klinefelter’s syndrome
    2. Marfan’s syndrome
    3. Homocystinuria
  3. Endocrine:
    1. Excess GH
    2. Excess thyroid hormones
    3. Excess sex steroids/precocious puberty
206
Q

DDx

Steatorrhoea

A
  1. Small bowel disease/resection:
    1. Bacterial overgrowth
    2. coeliac disease
    3. crohn’s disease
    4. ileocaecal TB
    5. parasite infection
    6. intestinal lymphoma
    7. radiation enteritis
  2. Pancreatic insufficiency
    1. Chronic pancreatitis
    2. Pancreatic cancer
    3. CF
  3. Biliary insufficiency:
    1. Biliary obstruction
    2. 1ry biliary cirrhosis
207
Q

DDx

Striae

A
  1. Cushing’s syndrome
  2. Systemic steroids
  3. Physiological:
    1. Pregnancy
    2. Adolescence
    3. weightlifters
208
Q

DDx

Stridor

A
  1. Partial obstruction of upper airways
  2. Intraluminal:
    1. foreign body, tumour
  3. Intramural:
    1. Infection: epiglottitis, croup in children, resp papillomata
    2. Laryngeal oedema/carcinoma
    3. cricoarytenoid RhA
    4. Tracheal stenosis
  4. Extramural:
    1. Goitre
    2. Lymphadenopathy
209
Q

DDx

T waves - tall, small, inverted

A
  1. Tall:
    1. HyperK
    2. Acute MI
    3. Normal variant
  2. Small
    1. HypoK
    2. Pericardial effusion
    3. hypothyroidism
  3. Inverted:
    1. V1-V3/4:
      1. Normal variant in children and black people
      2. RBBB
      3. PE
    2. V2-V5
      1. Non-Q wave MI
      2. Hypertrophic cardiomyopathy
      3. Subarachnoid haemorrhage, lithium
    3. V4-V6 and lateral
      1. Left ventricular hypertrophy
      2. Myocardial ischaemia
      3. associated with LBBB
210
Q

DDx

Tachycardia: Sinus, SVT, AF, VT

A
  1. Sinus tachy:
    1. Fever, exercise, anxiety, anaemia, drugs (caffeine, salbutamol, catecholamines, nicotine), pregnancy
    2. Hypotension
    3. Cardiac: MI, CCF, constrictive pericarditis
    4. Pulm: PE, asthma, chronic lung disease
    5. Endocrine: hyperthyroidism, phaeo, hypoglycaemia
  2. SVT:
    1. Idiopathic
    2. WPW
  3. AF/flutter:
    1. Idiopathic
    2. Thyrotoxicosis
    3. alcohol abuse
    4. pulm: embolism, infection, cancer
    5. pericarditis, cardiomyopathy, IHD, Rheumatic heart disease, mitral stenosis
  4. Ventricular tachycardia:
    1. Idiopathic
    2. IHD/MI
    3. Hypertensive heart disease, cardiomyopathy, myocarditis
    4. long QT syndrome, drugs
211
Q

DDx

Testicular pain and swelling

A
  1. Testicular torsion
  2. epidydimo-orchitis
  3. TB, sarcoid
  4. leukaemia
  5. polyarteritis nodosa
  6. renal vein thrombosis
212
Q

TFTs

DDx

A
  1. Normal T3/4/TSH = euthyroid
  2. Normal T3/4 and low TSH = subclinical hyperthyroidism
  3. Normal T4/3 and high TSH = subclinical hypothyroidism
  4. Low T3/4, high TSH = 1ry hypothyroidism
  5. Low T3/4, low/normal TSH = 2ry hypothyroidism, sick euthyroid syndrome
  6. High T3/4, low TSH = primary thyrotoxicosis
  7. high t3/4/tsh = 2ry hyperthyroidism
  8. High T4/3, normal TSH - increased serum Thyroxine binding globulin
  9. Familial dysalbuminaemic hyperthyroxinaemia
  10. anti-T4 Ab
213
Q

DDx

Thyrotoxicosis

A
  1. Graves disease
  2. toxic mutlinodular goitre
  3. toxic adenoma
  4. thyroiditis
  5. gestational thyrotoxicosis
  6. Rare causes:
    1. 2ry hyperthyroidism
    2. follicular carcinoma of thyroid
    3. choreocarcinoma
    4. struma ovarii
    5. drugs: amiodarone, surreptitious thyroxine consumption
    6. TSH-receptor mutations, McCune albright syndrome
214
Q

DDx

Tracheal deviation

A
  1. Collapse
  2. Tension pneumothorax
  3. large pleural effusion
215
Q

Increased Tumour markers (8)

A
  1. alpha-fetoprotein: hepatoma, germ cell tumour, pregnancy, hepatitis, cirrhosis, open neural tube defects
  2. CA 125: ovarian cancer, other malignancy (breast, endometrial, lung, pancreas), benign conditions (endometriosis, fibroids, pelvic inflammatory disease, peritonitis, cirrhosis)
  3. CA 15-3: breast cancer, benign breast disease
  4. CA 19-9: pancreatic cancer, colorectal cancer, cholestasis
  5. CEA: colorectal cancer, medullary thyroid carcinoma, cirrhosis, panceatitis, smoking
  6. HCG: pregnancy, germ cell tumours, hydatidiform mole, choriocarcinoma
  7. PLAP: seminoma, smoking, pregnancy, ovarian carcinoma
  8. PSA: prostate cancer, BPH, prostatitis, DRE
216
Q

DDx

U wave

A
  1. Normal
  2. HypoK
  3. HyperCa
  4. Hyperthyroidism
217
Q

DDx

Mouth Ulcers

A
  1. Trauma, aphthous ulcers
  2. GI diseases: crohn’s, coeliac
  3. Infection: herpes simlex, acute ulcerative stomatitis, candidiasis TB, syphilis
  4. Exclude: leukaemia, agranulocytosis
  5. Inflammatory: behcets, reactive arthritis, SLE
  6. Skin diseases: pemphigus, pemphigoid, erythema multiforme, lichen planus
  7. Malignancy: squamous cell carcinoma
  8. Other: strachan’s syndrome
218
Q

DDx

Genital ulcers

A
  1. Infection:
    1. Painful: herpes simplex, haemophilus ducreyi
    2. Painless: Syphilis (treponema pallidum), chlamydia trachomatis, granuloma inguinale
  2. Behcet’s disease
  3. Crohn’s
  4. Reiter’s syndrome
  5. Erythroplasia of Queyrat, squamous cell carcinoma
  6. trauma
  7. Other genital rashes: fixed drug eruption, eczema, psoriasis, scabies
219
Q

DDx

Orogenital ulcers

A
  1. Infectious:
    1. Herpes simplex, syphilis
  2. Inflammatory diseases:
    1. Behcet’s disease, reiter’s syndrome
  3. Skin diseases
    1. Pemphigus, erythema multiforme
  4. GI: Crohn’s
  5. Other: Strachan’s diseases
220
Q

DDx

Leg ulcer

A
  1. Venous: superficial venous insufficiency, DVT
  2. Arterial: atherosclerosis
  3. Diabetic: ischaemia, neuropathic
  4. Vasculitis: RhA, 1ry vasculities
  5. Sickle cell anaemia
  6. Pressure
  7. Pyoderma gangrenosum
  8. Malignancy
221
Q

DDx

Decreased urea

A
  1. Increased GFR (pregnancy)
  2. Low-protein diet, starvation, liver failure
  3. SIADH
  4. Drugs: Na valproate
222
Q

DDx

Increased urea

A
  1. Impaired glomerular filtration rate
  2. High protein diet, GI haemorrhage, catabolic states
  3. Dehydration
  4. Drugs: steroids, tetracycline
223
Q

DDx

Urgency

A
  1. UTI
  2. Bladder: stone, tumour, compression by pelic mass
  3. Prostate enlargement (BPH, cancer)
  4. Genuine stress incontinence
  5. Detrusor instability
  6. sensory urgency
224
Q

DDx

Urinary stress incontinence

A
  1. females:
    1. Pelvic floor weakness/bladder neck descent (pregnancy, vaginal delivery, obesity, menopause)
  2. Males:
    1. Prostate surgery
225
Q

DDx

Urge incontinence

A
  1. Detrusor instability
    1. Idiopathic,
    2. 2ry to bladder outflow obstruction
    3. Stroke, MS, cord compression
  2. Bladder stone, tumour, infection (cystitis)
226
Q

DDx

Continous incontinence - urinary

A
  1. Chronic retention/overdistention/overflow
    1. Outflow obstruction
    2. Bladder atonia due to damage to S2-4, parasympathetic fibres in lower spinal cord, cauda equina or pelvis, diabetic autonomic neuropathy
    3. Fistula 2ry to obstructed labour, surgery, malignancy, radiotherapy
227
Q

DDx

Acute urinary retention

A
  1. Males:
    1. Prostatic hyperplasia/carcinoma
    2. Obstruction of urethral lumen/bladder neck
    3. Post-op
    4. Medications: anticholinergic, antidepressants, alcohol
    5. Neurological: MS, spinal cord disease, diabetic autonomic neuropathy, herpes zoster
  2. Females:
    1. Pelvic mass: fibroids, ovarian mass, pregnancy
    2. Obstruction of urethral lumen/bladder neck
    3. Post-op
    4. Medication: anticholinergics, antidepressants, alcohol
    5. Neurological: MS, spinal cord disease, diabetic autonomic neuropathy, herpes zoster
228
Q

DDx

Urinary tract obstruction

A
  1. Lumen:
    1. stones, tumours, blood clots
  2. Wall: stricture, defective peristalsis, neuropathic bladder
  3. Pressure from the outside: postatic/pelvic mass, retroperitoneal fibrosis, phimosis
229
Q

DDx

Uveitis

A
  1. Inflammatory/connective tissue diseases:
    1. Seroneg spondyloarthropathies (reactive arthritis, IBD, ankspond, psoriatic arthritis)
    2. Sarcoidosis
    3. Behcet’s disease
    4. juvenile chronic arthritis
  2. Infection:
    1. CMV
    2. Toxoplasmosis
    3. Post-op infection
    4. Fungal, herpetic, TB, syphilis
  3. Ocular disease
230
Q

DDx

Vertigo

A
  1. Labyrinth:
    1. Acute labrynthitis
    2. BPV
    3. Meniere’s disease
    4. 2ry to middle ear disease
  2. Vestibular nerve
    1. Herpes zoster
    2. Acoustic neuroma
    3. Ototoxic drugs
  3. Brainstem:
    1. Ischaemia/bleeding
    2. MS, tumours
  4. Other: migraine, vertiginous epilepsy
231
Q

DDx

Sudden visual loss

A
  1. Unilat:
    1. Amaurosis fugax
    2. Central retinal vein/artery occlusion
    3. Vitreous haemorrhage
    4. Retinal detachment
    5. GCA
    6. Optic neuritis
    7. Ischaemic optic neuropathy
  2. Bilat:
    1. Severe bilat papilloedema
    2. Rapid progression of lesion compressing the optic chiasm
    3. Bilat infarcts of occipital lobes
    4. Bilat optic neuritis
232
Q

DDx

Gradual visual loss

A
  1. Cataracts
  2. Glaucoma
  3. Diabetic retinopathy
  4. Macular degeneration
  5. optic nerve compression
233
Q

DDx

Vomiting

A
  1. Drugs, poisoning, alcohol
  2. Abdo pathology - GI, hep, gynae
  3. Metabolic/endocrine: DKA, addisonian crisis, hyperCa, uraemia, pregnancy
  4. Neurological: increased ICP, acute labyrinthitis
  5. Acute angle closure glaucoma
234
Q

DDx

Weight loss

With appetite loss and increase

A
  1. Voluntary: diet, exercise
  2. Increased appetite:
    1. Increase in physical activity
    2. Malabsorption syndrome
    3. Endocrine: hyperthyroidism, uncontrolled DM, phaeo
  3. Decreased appetite:
    1. Chronic systemic illness:
      1. Infections
      2. Malignancy
      3. cardiopulm disease
      4. GI disease
      5. Endocrine disease
    2. Psychiatric: depression, eating disorder
    3. Drugs: antidepressants, L-dopa, digoxin, metformin NSAIDs, alcohol, opiates, amphetamine, cocaine
235
Q

DDx

Weight gain

A
  1. Pregnancy
  2. Excessive calorific intake
  3. Endocrine: PCOS, cushing’s syndrome, hypothyroidism, hypothalamic disease, acromegaly
  4. Drugs: steroids, OCPs, androgenic steroids, antidepressants, anticonvulsants
  5. Depression
  6. Increased fluid: CCF, RF, cirrhosis, excess IV fluids, lymphatic obstruction
  7. Cessation of smoking
236
Q

DDx

Wheeze

A
  1. Anaphylaxis
  2. Asthma, allergic bronchopulm aspergillosis
  3. COPD
  4. Pulm oedema
  5. Aspiration
  6. PE
  7. Bronchiolitis:
    1. Infection
    2. Connective tissue diseases
    3. Transplant
    4. Toxic fume inhalation
    5. UC
    6. Idiopathic
  8. Carcinoid syndrome
  9. Lung cancer
  10. Lymphangitic carcinomatosis
  11. Bronchiectasis, CF
  12. Parasitic infections
237
Q

DDx

Neutrophilia

A
  1. Infection - bacterial
  2. Inflammation/connective tissue diseases/vasculitis
  3. Tissue damage: trauma/surgery, burns, MI
  4. HAemorrhage/haemolysis
  5. Myeloprolif disease - polycythaemia, CML
  6. Meds: steroids
  7. Malignancy - solid/necrotic tumours
238
Q

DDx

Neutropaenia

A
  1. Pancytopaenia
  2. Infection: viral, typhoid, TB, brucellosis
  3. Drugs: sulphasalazine, sulphonamides, carbimazole
  4. Immune: AI neutropaenia, SLE, felty’s
  5. Benign racial: black africans
  6. Congenital: kostmann’s syndrome
239
Q

DDx

Eosinophilia

A
  1. Allergic diseases: asthma, urticaria, eczema, hay fever, food allergy
  2. Drugs
  3. Parasitic infections
  4. Addison’s disease
  5. Blistering skin disease: pemphigus, pemphigoid, erythema multiforme
  6. Hodgkin’s lymphoma
  7. mstocytosis
240
Q

DDx

Increased lymphocytes

A
  1. Infections: viral, TB
  2. CLL, prolymphocytic leukaemia, ALL, hairy cell leuk
  3. NHL
  4. Thyrotoxicosis
241
Q

DDx

Decreased lymphocytes

A
  1. Pancytopaenia
  2. Infections: AIDS, legionnaires’
  3. Steroids
  4. SLE
  5. Uraemia

Year 3 (13 decks)

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