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Differential Diagnoses Flashcards

1
Q

Chest pain

10

A
  1. Angina
  2. ACS/unstable angina
  3. GORD
  4. Pulmonary embolism
  5. Pneumothorax
  6. Pneumonia
  7. Pericarditis
  8. Aortic dissection
  9. Pancreatitis
  10. Musculoskeletal
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2
Q

Palpitations

7 categories

A
  1. CARDIAC - Atrial (AF, WPW, sick sinus syndrome, ectopic beats), Ventricular (VT, VF), Sinus tachycardia
  2. METABOLIC - hyperthyroidism, hypoglycaemia, hypo/hyperCa, hypo/hyperK
  3. DRUGS - alcohol, amphetamines, anticholinergic, caffeine, nicotine, cocaine, nitrates
  4. STRUCTURAL ABN. - left heart failure, aortic aneurysm, cardiomegaly, congenital heart disease (ASD, PDA, VSD), mitral prolapse, pericarditis, PE
  5. HIGH CARDIAC OUTPUT - anaemia, fever, pregnancy, thyrotoxicosis
  6. PSYCHOGENIC - panic attacks, anxiety disorders, depression, phobia
  7. Other - emotional distress, hyperventilation, migraine, PMS
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3
Q

Intermittent Claudication

5 + features

A
  1. INTERMITTENT CLAUDICATION
    Calf/buttock/thigh pain worse on exertion and relieved by rest.
    Claudication distance.
    Associated with ED.
  2. OA HIP
    Hip pain radiating to thigh or buttock.
    Worse on weight bearing and can occur at rest (less intensity) or certain positions.
    O/E: antalgic gait, reduced ROM] at hip joint
  3. LUMBAR RADICULOPATHY
    Hx of back pain, burning sensation back of leg.
    Worse on bending/carrying.
    O/E: reduced SLR, altered sensation in lower leg, reduced ankle reflexes
  4. CHRONIC COMPARTMENT SYNDROME
    Tight bursting pain in the calf muscle (common in athletes)
    Starts after exercise and relief on elevation of leg.
    O/E: ABPI normal
  5. SPINAL STENOSIS
    May present with slowly worsening back pain. Worse on exercise but patient has to sit down for few minutes to relieve the pain.
    May also have assoc numbness/tingling.
    O/E: pain reduced on spinal flex ion forwards. No weakness
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4
Q

Varicose Veins

3 + features

A
  1. VARICOSE VEINS
    Tortuous, unpleasant, along saphenous distribution
    Aching, heaviness
    Worse at end of the day, worse on standing; improved with rest & elevation
    O/E: dilated veins in long/short saphenous vein distribution, pedal oedema, skin changes
  2. SAPHENA VARIX
    Enlarged saphenous vein at saphenous-femoral junction
    O/E: cough impulse, lump in groin, bluish tinge, disappears on lying down. May appear with varicose veins
  3. THROMBOPHLEBITIS
    Superficial inflammation of a vein
    May cause pain, redness, swelling
    O/E: tender and hard vein
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5
Q

Cough

6 + questions

A
  1. PNEUMONIA
    Any phlegm/sputum? Colour (white, grey, yellow)?
    Any fever/sweats?
2. PE
Did it come on suddenly?
SOB or coughing up any blood?
Any leg pain?
Recent flight?
  1. GORD
    Get any heartburn?
    Worse if you lie flat?
    Ever get excessive saliva (water brash) or acidic taste in your mouth (acid brash)?
  2. ASTHMA
    Worse in morning or late at night?
    Assoc with wheeze?
    Do you suffer from hay fever or eczema?
  3. TB
    Had any night sweats?
    Lived abroad for prolonged period?
    Cough up any blood?
  4. LUNG CANCER
    Noticed any hoarseness to voice?
    Coughed up any blood? How much?
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6
Q

SOB

6 + questions

A
  1. HEART FAILURE
    Worse when you lie down (orthopnoea)?
    It ever wake you up in the middle of the night (PND)?
    Any swelling of your legs?
    How many pillows do you sleep on? Has this changed recently?
  2. PNEUMONIA
    Bring up phlegm/sputum? Colour (white, grey, yellow, green)?
    Any fever/sweats?
  3. PE
    Come on suddenly?
    Coughing up any blood?
    Leg pain?
  4. ASTHMA
    Worse in morning or late at night?
    Assoc with wheeze?
    Suffer from hay fever/eczema?
  5. PANIC ATTACK
    Experience any palpitations, sweaty palms or pins and needles around lips?
    Describe yourself as an anxious person?
  6. CARDIAC
    Did you experience your heart beating heavier of faster when the breathlessness started?
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7
Q

Asthma

4

A
  1. Asthma
  2. Pneumonia
  3. PE
  4. GORD
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8
Q

COPD

4

A
  1. COPD
  2. Asthma
  3. Pneumonia
  4. Heart failure
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9
Q

Abdo pain

9 + questions

A 
1. PEPTIC ULCER
Pain related to meals?
Drinking milk make it better?
Find spicy foods make it worse?
Any black/tarry stools?
Vomited up any blood?
  1. PANCREATITIS
    Pain move to back?
    Made worse by drinking alcohol or better if you lean forwards?
3. GASTROENTERITIS
Eaten out recently?
Any diarrhoea/vomiting?
Cramping abdominal pains?
Been abroad?
  1. GALLSTONES
    Pain in right upper part of tummy?
    Go to your shoulder?
    Made worse after fatty foods?
  2. APPENDICITIS
    Pain shifted from middle tummy to lower right side?
    Worse on walking or moving?
    Fever/diarrhoea?
6. DIVERTICULITIS
Cramping pain lower left side?
Feel bloated?
Any fever or blood in your stools?
Constipation/diarrhoea?
  1. INTESTINAL OBSTRUCTION
    Opened bowel recently or passed any wind?
  2. RENAL COLIC
    Experienced dull ache?
    Does it go from back to groin?
    How bad is the pain?
  3. ECTOPIC
    Missed your period recently?
    Any PV bleeding?
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10
Q

Dyspepsia

5 + questions

A 
1. GORD
Pain - burning feeling?
Go to your throat?
Acidic taste or excessive saliva?
Worse at night?
  1. PEPTIC ULCER
    Pain go to back?
    Related to meals?
    Milk make it better? Find spicy food make it worse?
  2. STOMACH CANCER
    Loss of appetite/weight recently?
    Vomiting blood or black stools recently?
    Difficulty swallowing?
  3. BILIARY
    Pain in right upper tummy? Go to shoulder?
    Made worse after fatty foods?
    Fever?
  4. CARDIAC
    Pressure on your chest?
    Symptoms go to left arm?
    Come on at rest or exercise?
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11
Q

Obesity

3

A
  1. Obesity
  2. Hypothyroidism
  3. PCOS
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12
Q

Diarrhoea

11 + questions

A 
1. FOOD POISON
Eaten out recently?
Eat any uncooked foods?
Anyone else unwell?
Vomited?
  1. TRAVEL
    Abroad recently?
    Visit a farm?
3. IBD
Mucus or blood in stool?
Ulcers in the mouth?
Hay fever or weight loss?
Any eye symptoms?
  1. IBS
    Any stress?
    Feel bloated?
    Pain better with bowel motions?
  2. COELIAC
    Stool difficult to flush away (steatorrhoea)?
    Related to certain foods (gluten)?
    Weight loss?
6. CANCER
Recent change in bowel habits (>50yo)?
Weight loss?
Loss of appetite?
Blood in stool?
  1. PANCREATITIS
    Problems flushing away stool?
    Upper tummy pain?
    Drink alcohol?
  2. HYPERTHYROID
    Feel tired all the time?
    Always feel hot and sweaty?
  3. APPENDICITIS
    Pain shifted from middle of your tummy to lower right side?
    Worse on walking or moving?
  4. DIVERTICULITIS
    Any cramping pain on lower left side of tummy?
    Feel bloated?
    Fevers or noted blood in stool?
  5. OVERFLOW
    Becoming more constipated before diarrhoea started?
    Sometimes have no control over it?
    Soil your underwear?
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13
Q

Travel

7

A
  1. Malaria
  2. Travellers diarrhoea
  3. Giardiasis
  4. Cholera
  5. Typhoid
  6. Dengue fever
    7 Hepatitis A
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14
Q

Dysphagia

8 + questions

A
  1. GORD
    Burning feeling in chest? Does it go to your throat?
    Acidic taste or too much saliva in your mouth?
    Worse at night?
  2. ACHALASIA
    Difficult swallowing both solids and liquids?
    Bring up food?
    Coughing fits at night when trying to sleep?
3. PHARYNGEAL POUCH
Noticed bulge in side of neck?
First mouth full easy to eat then it gets progressively more difficult to swallow?
Bring up food?
Noticed any bad breath?
  1. GLOBUS PHARYNGEUS
    Feel as if there is a lump in the throat? Otherwise have no problems swallowing?
    Suffer from stress/anxiety?
  2. OESOPHAGEAL CANCER
    Had to swallow solids (meals) initially, then now affecting liquids (drinks) as well?
    Lost any weight?
    Discomfort when you swallow?
  3. BULBAR PALSY
    Harder to swallow at the beginning rather than at the end?
  4. CVA
    Have slurred speech?
    Weakness of arms or legs?
    Problems with vision?
  5. CREST
    Tightening or thickening of skin of hands or feet?
    Notice your hands change colour from white to blue or red?
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15
Q

PR bleeding

7 + questions

A
  1. PEPTIC ULCER
    Burning pain? Drinking milk make it better? Black tarry stools? Vomited up any blood?
  2. DYSENTERY
    Eaten out recently? D/V? Cramping abdo pains? Recently travelled abroad?
  3. COLON CANCER
    Change in bowel habits? Weight loss? Blood mixed with stool? Tenesmus?
  4. ANAL FISSURE
    Soreness in back passage particularly when wiping?
  5. PILES
    Strain when you open your bowels? Blood bright red on tissue paper? Itchy back passage? Been constipated?
  6. IBD
    Pass mucus with stool? Abdo pain or fevers with it? Ulcers in mouth or anus?
  7. DIVERTICULITIS
    Cramping pain on lower left side of tummy? Feel bloated? Any fevers?
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16
Q

Pruritis ani

6 + questions

A
  1. ANAL FISSURE
    Sting when you wipe? Any blood on tissue?
  2. PILES
    Felt or seen any lumps that come out when you open your bowels? Strain when passing stool? Any constipation?
  3. THREADWORMS
    Itching worse at night? Felt anything move in back passage? Seen any worms or white eggs in stool? Lost any weight?
  4. CROHN’S
    Mucus from back passage? Fevers or abdo pain?
  5. SKIN
    Rash? Other family members affected (scabies)?
  6. STI
    In relationship at the moment? Practice anal sex?
17
Q

Constipation

7 + questions

A
  1. DIET/FUNCTIONAL
    Eaten out recently? Anyone else unwell? Vomited?
  2. INTESTINAL OBSTRUCTION
    Opened bowels, passed wind or vomited recently?
  3. IBS
    Any stress? Feel bloated? Pain made worse by eating and better by opening bowels?
  4. HYPOTHYROID
    Felt tired or cold all the time? Noticed any hair loss or dry skin? Put on any weight recently?
  5. CANCER
    Stools looser than normal? Recent change in bowel habits to looser stools (in 50 yo)? Weight loss? Blood mixed with stools?
  6. DEPRESSION
    How is your mood? Feel tired all the time or anhedonia?
  7. FISSURE
    Blood on toilet paper when finished? Painful when you go?
18
Q

Liver disease

7

A
  1. Abnormal LFTs (post-infection or on statin)
  2. Fatty liver
  3. Alcoholic hepatitis
  4. Cirrhosis
  5. Viral hepatitis (A, B, C)
  6. Gilbert’s
  7. Haemochromatosis
19
Q

Other than liver disease

4 + questions

A
  1. GALLSTONES
    Pain on right side of tummy? Move to shoulder tip? Urine darker or stools lighter in colour? Have an itch?
  2. PANCREATITIS
    Problems flushing away stools? Upper tummy pain?
  3. HAEMOLYSIS
    Weakness, dizziness or SOB with jaundice? Problems worse after taking a medicine or after an infection?
  4. PRIMARY BILIARY CIRRHOSIS
    Itchy skin? Dry mouth and eyes and feel tired all the time?
20
Q

Probability of diagnosis of Asthma:

HIGH (3)

Low (3)

A

HIGH:

  1. Symp - wheeze, SOB, chest tightness, cough (night, early morning, after exercise, cold, allergens)
  2. PMH - atopy, FH of atopy, asthma
  3. Exam - widespread wheeze (expiratory, bilateral), prolonged expiration, increase RR

Low:

  1. S - assoc with cold only, history of moist cough
  2. E - Repeated normal chest when symptomatic
  3. Ix - normal PEFR or spiro when symptomatic
21
Q

Questions to assess Asthma (3)

A

In the last month…

  1. Difficulty sleeping because of your asthma symptoms (including cough)?
  2. Had your usual asthma symptoms during the day (cough, wheeze, chest tightness or SOB)?
  3. Has your asthma interfered with your usual activities (e.g. housework, work/school, etc)?
22
Q

Wheeze differentials

A
  1. Asthma

2. FB - did wheeze, noisy breathing or SOB come on suddenly? Have they been eating peanuts?

23
Q

ADHD (2)

A
  1. AUTISM
    Social interaction (enjoy playing with others or alone, avoid eye contact with you/others?)
    Playing (play with different toys or concentrate on one?)
    Communication (start speaking on time? Repeat themselves or a phrase a lot? Able to understand if you are joking with them?)
  2. ANXIETY/DEPRESSION
    How is mood recently?
    Any stress at school?
    Bullying?
24
Q

URTI

10

A
  1. MENINGITIS
    (Non-blanching rash? Neck stiffness, drowsiness or problems with light?)
  2. OTITIS EXTERNA
    (Swim? Ears itch a lot?)
  3. SCARLET FEVER
    (Bright red spots/rash over body - neck, upper chest? When did it start - 2nd day? Colour change to tongue - strawberry?)
    Characteristic red blush blanching rash starts on day 2 and slowly fades over 3 weeks, can start from upper chest or neck spreading to abdomen and extremities, skin creases that can peel off (toes, fingers); sandpaper texture. Assoc with exudative tonsillitis (red spots on palate, flushing face, strawberry tongue)
  4. OTITIS MEDIA
    (Common - peak 6-15mo; Viral - RSV, rhinovirus or Bacterial - strep pneu, H influenza; pulling/rubbing ears, poor feeding, high fever >40ºC; Red, cloudy, bulging TM +/- fluid level, occasional perforation with discharge seen)
  5. OTITIS MEDIA WITH EFFUSION
    (‘Glue ear’ - collection of fluid in middle ear without signs of inflammation; 1-6yo; Can cause hearing loss - resolves in weeks to months - can sometimes cause language delays; RF similar to OM; o/e often no signs of inflammation of TM, effusion - blood, mucous, purulent - w loss of light reflex, yellow or blue retracted drum and fluid level with air bubbles)
  6. TONSILLITIS
    Common in children; many present with sore throat, painful swallowing, headache, loss of voice; pain may radiate to ears; o/e red tonsils with exudate, tender anterior cervical lymph nodes
  7. SINUSITIS
    Bacterial or viral infection of sinuses (frontal, maxillary or ethmoid); presents with cold or flu-like illness and symp including fever, tenderness over sinus, halitosis, nasal congestion with rhinitis, pressure/throbbing over the head which is worsened when bending forwards
  8. CROUP
    Viral (e.g. parainfluenza); 6-36mo particularly in autumn/spring; starts with coryzal symp, sore throat, mild fever progressing to barking cough, hoarseness or inspiratory stridor with high fever >40ºC; cough often at night or when child agitated
  9. BRONCHIOLITIS
    Caused by RSV, often seen in winter months; Typically <1yo and presents with fever with runny nose; worsening symp include irritable cough, worsening SOB and feeding difficulties; o/e widespread fine crepes with high pitched wheeze
  10. GLANDULAR FEVER
    Infectious, spread by saliva, EBV; presents with fever and acute fatigue with worsening sore throat, lymphadenopathy, macular rash. Can last for 2-3 weeks. Check for splenomegaly (complications include splenic rupture)
25
Q

Limping child

6

A
  1. IRRITABLE HIP
    Common in boys 2-12yo (mean 6yo)
    Assoc with viral infection (mild fever) or mild trauma
    Acute hip pain with gradually improving limp over 10d
    Both hips often affected
    Child systemically well
    O/E: hip held in flexion, abduction and moderate external rotation; limited ROM particularly addiction & extension (increases intracapsular pressure)
    Often diagnosis of exclusion
  2. PERTHES DISEASE
    Avascular necrosis to femoral head resulting in abnormal growth
    3-11yo (peak 4-7yo)
    10% bilateral
    Insidious onset (over 1m) - hip pain or knee pain (synovitis) causing limp
    O/E: short stature, reduced abduction and internal rotation with leg length inequality, +ve Thomas test
  3. MALIGNANCY
    E.g. neuro blastema s, leukaemias (ALL), osteosarcomas
    Present with pain at night and/or bone pain distant from the joint
  4. JUVENILE IDIOPATHIC ARTHRITIS
    Arthritis in <16yo for more than 3m
    Presentation varies, often affects large joints
    May present with painless limp
    Assoc features - swinging fever, maculopapular rash, arthralgia (similar features to RA)
  5. SEPTIC ARTHRITIS/OSTEOMYELITIS
    Bacterial infection of joint space (spread from blood, penetrating wound or local infection - chronic osteomyelitis)
    Often seen in immunosuppressed, DM, RA, steroid use, recent joint surgery
    Presents with high fever and unwell child with redness, swollen, tender hip joint
    Often absent movements due to pain with joint tenderness
    Signs of tachycardia and swinging pyrexia
  6. SLIPPED UPPER FEMORAL EPIPHYSIS
    Upper femoral epiphysis slips across the femur displaced posters-inferiorly
    Rare cause of limp
    More common in boys than girls - peak age early adolescent 10-15yo
    Left hip > right, but can be bilateral
    Child often overweight with hypothyroidism
    Presents with pain in hip, groin medial thigh or referred to knee. Worse with walking or running
    O/E: reduced ROM hip (resists internal rotation), leg is externally rotated and shortened
26
Q

Nocturnal enuresis

3

A
  1. NOCTURNAL ENURESIS
    Common (15% of 5yo, 5% of 10yo, 2% of 15yo)
    Assoc with FH or ADHD
    Often caused by sleep arousal difficulties (sensation of full bladder), polyuria or bladder dysfunction (overactive)
    Exclude other causes - UTI, constipation, psychological
  2. UTI
    Common (8% of girls at 5yo)
    Nocturia, frequency, urgency
    May have smelly and dark urine
    O/E: suprapubic pain, dipstick - pro, nit
    If 2x +ve MSU & <5yo —> need referral
  3. DM TYPE 1
    Rare
    Causes weight loss, severe thirst, hunger, tiredness, frequency and nocturia
    If v high may lead to ketoacidosis
    O/E: thin, unwell child; Raised BMs; Dipstick - ket, glu
    Needs urgent referral to hospital
27
Q

Functional constipation

3

A
  1. INTESTINAL OBSTRUCTION
    Passing wind/flats? Vomiting?
    (Colicky abdo pain, distension, absolute constipation including wind, bowels not opened, ‘tinkling’ bowel sounds)
  2. HYPOTHYROID
    Tired all the time? Not putting on weight? Feel cold?
  3. ANAL FISSURE
    Blood on toilet paper? Painful when they go?

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