DIFFERENTIAL DIAGNOSIS Flashcards
What is the differential diagnosis for acute pelvic pain?
Gynaecological: Pelvic inflammatory disease Tubo-ovarian abscess Ectopic pregnancy Miscarriage Malignancy Ovarian cyst Fibroid necrosis Ovulation pain
Non-gynaecological:
UTI
Renal calculi
Appendicitis
What is the differential diagnosis for chronic pelvic pain?
Gynaecological: Adenomyosis Endometriosis Adhesions Malignancy
Non-gynaecological:
Diverticulitis
Irritable bowel syndrome
What is the differential diagnosis for superficial dyspareunia?
Congenital vaginal atresia Infection: vulvovaginitis Post-surgery: pelvic floor repair, FGM Vulval disease: Bartholin's cyst, carcinoma Psychosexual: vaginismus Atrophic changes
What is the differential diagnosis for deep dyspareunia?
Congenital vaginal atresia Infection: PID Post-surgery: pelvic floor repair Endometriosis Fibroids Ovarian cyst/tumours Psychosexual: vaginismus
What is the differential diagnosis for abdominal swelling?
Gynaecological: Ovarian cyst Pregnancy Fibroid uterus Malignancy
Non-gynaecological: Full bladder Ascites Malignancy Constipation or ileus
What is the differential diagnosis for vaginal discharge?
Physiological - eg vestibular gland secretions
Infection - STDs (Chlamydia, Trichomonas, Gonorrhea); Candida, Bacterial vaginosis
Inflammatory - Allergy, atrophic changes, postop granulation tissue
Malignancy
Foreign body - retained tampon/condom
Fistula - Bowel, bladder, ureter
What are the obstetric causes of abdominal pain in the 2nd or 3rd trimesters?
Labour Placental abruption Symphysis pubic dysfunction Ligament pain Pre-eclampsia/HELLP syndrome Acute fatty liver of pregnancy
What are the gynaecological causes of abdominal pain in the 2nd or 3rd trimesters?
Ovarian cyst rupture/torsion/haemorrhage
Uterine fibroid degeneration
What are the gastrointestinal causes of abdominal pain in the 2nd or 3rd trimesters?
Constipation Appendicitis Mesenteric adenitis Gallstones/cholecystitis Pancreatitis Peptic ulcer disease
What are the genitourinary causes of abdominal pain in the 2nd or 3rd trimesters?
Cystitis
Pyelonephritis
Renal stones/renal colic
What is the most likely diagnosis in a pregnant woman in the 2nd or 3rd trimester based on clinical features?
Intermittent pain, usually regular in frequency, associated with uterine tightenings. Vaginal examination shows cervical change
Labour
What is the most likely diagnosis in a pregnant woman in the 2nd or 3rd trimester based on clinical features?
Mild to severe pain, more commonly associated with vaginal bleeding. Tender uterus to palpation and can be irritable or tense. Might be symptoms of pre-eclampsia.
Placental abruption
What is the most likely diagnosis in a pregnant woman in the 2nd or 3rd trimester based on clinical features?
Pain is usually low and central in abdomen just above the symphysis pubis, which is tender on palpation.
Symphysis pubis dysfunction
What is the most likely diagnosis in a pregnant woman in the 2nd or 3rd trimester based on clinical features?
Epigastric or right upper quadrant pain, associated with nausea and vomiting, headache and visual disturbances.
Pre-eclampsia or HELLP
What is the most likely diagnosis in a pregnant woman in the 2nd or 3rd trimester based on clinical features?
Epigastric or right upper quadrant pain, associated with nausea, vomiting, anorexia and malaise.
Acute fatty liver of pregnancy
What is the most likely diagnosis in a pregnant woman in the 2nd or 3rd trimester based on clinical features?
Unilateral pain, which is intermittent and might be associated with vomiting
Ovarian cyst
What is the most likely diagnosis in a pregnant woman in the 2nd or 3rd trimester based on clinical features?
Pain is localised centrally and constant. On palpation, mass is noted which is tender.
Fibroid
What is the difference between small for gestational age and intrauterine growth restriction?
SGA: fetus is small for expected size at certain gestation, but continues to grow at a normal rate
IUGR: fetus is small or normal sized for expected size at a certain gestation, but the growth rate slows down as the pregnancy advances
What are the causes of increased liquor volume?
Diabetes
Fetal abnormality
Multiple pregnancy
Fetal infection
What are the causes of decreased liquor volume?
Ruptured membranes
Fetal abnormality
Aneuploidy
IUGR
Fetal infection
Maternal drugs eg atenolol
What are some causes for fetus being small for gestational age (as opposed to IUGR)?
Alcohol
Drugs
Smoking
What are the causes of symmetrical (growth of the head is not spared) IUGR?
Chromosomal abnormalities such as trisomy 21, 18 and 13
Fetal alcohol syndrome
Intrauterine infections (i.e CMV, rubella, toxoplasmosis)
What are the causes of asymmetrical (growth of the head is spared) IUGR?
Multiple gestations
Maternal malnutrition
Hypertension and pre-eclampsia
Clotting problems: Anti-phospholipid syndrome and hereditary thrombophilia
Diabetes mellitus
Renal or cardiac disease)
