Differential Diagnosis

Question 1

Weight Loss

Answer 1

M G3 E2 P3 I

Malignancy

Gastrointestinal
- Colon Cancer
- IBD
- Coeliac

Endocrinological
- Thyrotoxicosis
- T1DM

Psychological
- Anorexia/ Bulimia (menstrual cycle disturbance)
- Depression
- Stress

Infection

Question 2

Fatigue

Answer 2

H E2 P2 R1 O3

Haematological
- Anaemia

Endocrine
- Hypothyroidism
- Diabetes

Psychological
- Depression
- Stress

Respiratory
- Sleep Apnoea

Others
- Infection
- Drugs
- Malignancy

Question 3

Headache

Answer 3

P4 I4 E2 O3

Primary-
- Tension
- Cluster
- Migraine
- Trigeminal Neuralgia

Secondary (Intracranial)
- Meningitis
- Temporal Arteritis
- Subarachnoid Haemorrhage (any falls/ blood thinners)
- Raised ICP

Secondary (Extracranial)
- Glaucoma
- Sinusitis

Other
- Infections
- Pre- Eclampsia
- Drugs (PPI, Caffeine, Analgesia)

Question 4

Vertigo

Answer 4

P4 C1 O3

Peripheral
- Benign Positional Vertigo
- Vestibular Neuritis
- Viral Labyrinthitis
- Menieres (Vertigo/ Tinnitus/ Hearing Loss)

Central
- Vertebrobasilar Insufficiency (caused by NEXK Extension, especially if Cervical Osteoarthritis)

Other
- NEUROMA (RULE THIS OUT)
- Cerebellar Stroke (ask about raised ICP signs and VISION/ BALANCE changes and say you would want to rule this out at the end)
- Neurological Causes- MS

Question 5

Fits/ Falls/ Syncope

Answer 5

C3 N5 O3+2

Cardiovascular
- Postural Hypotension (Recent medication change)
- Arrhythmia (if during exercise/ with palpitation)
- Aortic Stenosis (if SOB on exertion)

Neurological
- Seizure
- Parkinsons
- TIA/ STROKE (Ask about Neurological Symptoms)
- Vasovagal (if Stimuli)/ Situational if Cough/ Micturition
- Haemorrhage

Other
- Structural Heart Disease
- Drugs/ Alcohol (POLYPHARMACY)
- Hypoglycaemia (if Diabetes and medication change)

Also Ruptured Ectopic/ AAA

Question 6

Chest Pain

Answer 6

C4 R2 N3

Cardiac
- MI
- Angina
- Aortic Dissection
- Pericarditis

Respiratory
- Pulmonary Embolism
- Pneumothorax

Non Cardiorespiratory
- GORD
- Anxiety/ Panic Attacks
- MSK

Question 7

Breathlessness

Answer 7

C2 R6 O4

Cardiac
- Myocardial Infarction
- Heart Failure

Respiratory
- LRTI/ Pneumonia
- Asthma
- COPD
- Pneumothorax
- Pulmonary Embolism
- Pulmonary Fibrosis

Other
- Anaemia
- DKA
- Pleural Effusion
- Bronchiectasis

Question 8

Cough

Answer 8

R5 O4

Ask about Haemoptysis

Respiratory
- URTI/ LRTI/ Pneumonia
- Asthma
- COPD
- Lung Cancer
- Post nasal drip (if cough to clear throat)

Other
- GORD
- Smoking
- Cystic Fibrosis
- ACE Inhibitor

Question 9

Abdominal Pain

Answer 9

Always ask about gynaecological symptoms if relevant

G7 U1 G2 O3

Gastrointestinal
- Appendicitis
- Gallstones
- Pancreatitis
- Peptic Ulcer
- Diverticulitis
- Bowel Obstruction
- IBD

Urological
- Renal COLIC (loin to groin and N+V)

Gynaecological
- Ectopic Pregnancy
- PID/ Endometriosis

Other
- Ruptured AAA
- DKA
- MI

Question 10

Change in Bowel Habit

Answer 10

G5 E2 O2

Gastrointestinal
- Colon Cancer
- Gastroenteritis
- IBD
- IBS
- Coeliac

Endocrinological
- Thyrotoxicosis
- Hypothyroidism

Other
- Drugs
- Diet and Lifestyle Changes

Question 11

Rectal Bleeding

Answer 11

On tissue or mixed with stool and what colour and any mucus

The 10 causes
AH DDI HAP HO

Anal Fissure
Haemorrhoids

Diverticular Haemorrhage
Distal Polyp or Malignancy (Weight Loss/ change in bowel habit)
IBD (Mucus)

Haemorhagic Gastroenteritis (if recent infecitve food intake)
Angiodysplasia if painless and subtle in elderly (abnormal blood vessel dilatation in the bowel)
Proximal Polyp (Weight loss and Anaemia)

Haemorrhagic Peptic Ulcer (Haematemesis/ NSAID/ ALcohol)
Oesophageal Varices (Liver Disease/ Alcohol)

Question 12

Haematemesis

Answer 12

The 5 causes

OMP +2
Oesophageal Varices
Mallory weiss
Peptic Ulcer Disease
Oesophageal carcinoma
Gastric Cancer

Question 13

Dysphagia

Answer 13

S O3 N2 M2 C2

Swallowing Difficulty- Globus/ Odynophagia

Not an Oropharyngeal Cause- if they report food sticking to the lower throat-
- Stricture
- Oesophagitis (UGIE)
- Motility Issue/ Pharyngeal Pouch

Neurological
- Bulbar Palsy
- Parkinson’s

Muscle Weakness
- Myasthenia Gravis
- Myositis

Cancer- Oropharyngeal Cancer or Pharyngeal Pouch if No neurological/ neuromuscular cause

Question 14

Scrotal Swelling

Answer 14

I OP UTO

Inflammation VISIBLE
- Cellulitis/ Fournier’s Gangrene

Oedema
- Consider causes of Oedema such as HF/ Hypoalbuminaemia/ Nephrotic Syndrome- ask about swelling elsewhere

Painful
- Torsion
- Epidydimo Orchitis
- HERNIA

Unable to Feel above Swelling-
- Varicocele
- Inguinal Hernia

Transillumination
- Hydrocele

Other
- Tumour (Weight Loss)
- Spermatocoele

Question 15

Frequency/ Dysuria/ Nocturia

Answer 15

U4 O2

Urological
- UTI
- Urethritis (if pus in urine)
- Pyelonephritis (Loin Pain/ Fever)
- BPH

Other
- Drugs
- Pregnancy

Question 16

Haematuria

Answer 16

U6 O4

Urological
- Bladder Transitional cell Cancer- Painless Haematuria and AMINE Exposure (Involved with PAINT)
- Renal Cell Cancer (Mass and Flank Pain)
- Urethral Trauma (Catheter)
- UTI
- Urethritis (if Purulent)
- Calculi (Loin to Groin pain)

Other-
- Prostate Cancer/ BPH
- Haematological (Bleeding Disorder/ Anticoagulants)

Question 17

Polyuria

Answer 17

E2 U1 O3

Endocrine
- Diabetes MELLITUS
- Diabetes INSIPIDUS (if NO fatigue and weight loss etc.)

Urological
- CKD (ask about Pruritus, Dyspnoea, Fatigue, Weakness)

Other
- UTI
- Drugs (Diuretics, Lithium)
- Psychogenic

Question 18

Incontinence

Answer 18

S1 U2 O3 M T O

Stress
- Incompetent Sphincter (if multiple pregnancies, post-menopause, pelvic floor trauma)

Urge
- Detrusor Instability
- SPINAL PATHOLOGY (MS/ SCC)

Overflow
- Prostatic Hypertrophy
- Stone or TUMOR
- SPINAL PATHOLOGY

Mixed

True Incontinence (CONTINOUS LEAKAGE OF URINE)
- Theres a FISTULA

Other
- Pscyhogenic

Question 19

Retention

Answer 19

U5 N2 D

Urological
- Prostate Hypertrophy
- Stricture (if trauma/ Catheterisation)
- Bladder obstruction (Stone or tumour)
- UTI
- Constipation

Neurological
- MS
- SCC

Drugs (anticholinergics/ TCA)

Question 20

Pelvic Pain (Gynaecology)

Answer 20

G5 U1 G3

Gynaecology
- PID/ Salpingitis (dyspareunia and dysmenorrhoea)
- Ectopic Pregnancy
- Ovarian Cyst Rupture/ Torsion (Fever and Vomiting)
- Endometriosis (deep dyspareunia and menstrual disturbance)
- Mittelschmirz

Urological
- Pyelonephritis

Gastrointestinal
- Appendicitis
- Diverticulitis
- IBS/ IBD

Question 21

PV Bleeding (Gynaecology)

Answer 21

M6 I7 P4 P4

Menorrhagia
- Dysfunctional Uterine Bleeding
- Endometriosis
- Fibroids
- PID
- Endometrial Cancer
- IUD

Intermenstrual Bleeding
- Pregnancy
- PID
- Endometrial Cancer
- IUD
- Ectropion
- Polyps
- IUD

Post-Coital Bleeding
- Cervical Trauma
- Cervical Polyps
- Cervical Cancer
- PID

Post-Menopausal Bleeding
- Endometrial Cancer
- Atrophic Vaginitis is the MOST COMMON
- Oestrogen WITHDRAWAL
- Cervical Cancer

Question 22

Secondary Amenorrhoea

Answer 22

G3 E5 D2

Gynaecology
- Pregnancy
- PCOS
- Menopause/ Premature Ovarian Failure

Endocrinology
- Hypothalamic Amenorrhoea (Anxiety, Stress, Athletes)
- Cushing’s
- Hyperprolactinaemia
- Hyper/hypothyroidism
- Pituitary Failure

Drugs
- Drug causes (Hormonal therapy, Antipsychotics)

Question 23

Subfertility

Answer 23

G6 O2/ 2

Gynaecology
- PCOS
- Fallopian Tube Damage (PID/ Surgery)
- Endometriosis (Menstrual Disturbance)
- Cervical Barrier (Mucus/ Polyp/ Inflammation)- STI/ Surgery
- Hyperprolactinaemia (antipsychotics, prolactinoma)
- Hypothalamic Disturbance (Anxiety, Anorexia, Stress, Exercise)

Other
- Hypogonadotrophic hypogonadism (Pituitary disease)
- Hypergonadotrophic Hypogonadism (Premature Ovarian Failure (female), Klinefelters (male) or gonadal damage (both)
- Erectile Dysfunction
- Timing

Question 24

Abdominal Pain (Obstetrics)

Answer 24

O7 G3

Obstetrics
- Ectopic
- Miscarriage
- Placental Abruption
- Pre Eclampsia
- Acute Fatty Liver Disease
- Braxton Hicks (Infrequent Irregular Contractions)
- Labour (painful regular)

Gynaecology
- Fibroids
- PID
- Ovarian Torsion

Question 25

PV Bleeding (Obstetrics)

Answer 25

E3 L4 O2

Early
- Implantation (if 6-12 days after conception)
- Ectopic (usually 4-12 weeks gestation)
- Miscarriage

Late
- Labour
- Placental Abruption
- Placenta Praevia (sudden bleeding >28 weeks)
- Vasa Praevia

Other
- Cervical Pathology (Polyps/ Cancer/ Ectropion)
- PID

Question 26

Lower Back Pain

Answer 26

O6 R1

Orthopaedics
- Muscular (Acute and ONLY paraspinal muscles are affected
- Lumbar Spondylosis (progressive stiffening/ related to sitting/ standing in one space)
- Lumbar Disc Prolapse (Sciatica and pain when coughing/ lifting)
- Discitis (Fever and IVDU)
- Spinal Fracture
- Cauda Equina
- Osteoporosis

Rheumatology
- Ankylosing Spondylitis
-

Question 27

Joint pain/ stiffness/ swelling

Answer 27

R7 O3

Rheumatological
- Rheumatoid Arthritis
- Psoriatic Arthritis
- Gout
- Pseudogout
- SLE
- Enteropathic Arthritis
- Transient Synovitis

Orthopaedics
- Fracture
- Osteoarthritis
- Septic Arthritis

Question 28

Anxiety

Answer 28

P6 O4

Psychiatry
- Generalised Anxiety Disorder
- Depression
- Panic Disorder
- Phobia
- OCD
- PTSD

Other
- ACS
- Hyperthyroidism
- Arrhythmia
- Phaeochromocytoma

Question 29

Psychosis

Answer 29

P8 O5

Psychiatry
- Schizophrenia
- Delusional Disorder (only disorder)
- Dementia with Lewy Bodies
- Schizoaffective Disorder (Both Schizophrenia and Bipolar Disorder)
- Psychotic Depression
- Puerperal Psychosis
- Delirium
- Bipolar Disorder

Other
- Drugs (Recreational Drugs, Steroids, Levodopa, Antimalarials)
- Space Occupying Lesion
- Temporal Lobe Epilepsy
- Alcohol
- SLE

Question 30

Low Mood

Answer 30

P5 O2

Psychiatry
- Depression
- Bipolar Disorder
- Adjustment Disorder
- Psychotic Depression
- Postnatal Depression

Other
- Hypothyroidism
- Drug Reactions

Question 31

Memory Loss

Answer 31

D5 P2

Dementia
- Alzheimer’s
- Vascular Dementia
- Lewy Body Dementia
- Fronto-Temporal Dementia
- Creutzfeldt Jakob Disease

Psychiatric
- Positive Depression Screen
- Delirium (fluctuating, reduced consciousness, infection)

Question 32

Eating Disorder

Answer 32

2

Anorexia (BMI<17.5, Amenorrhoea, Developmental delay, Poor Sleep)

Bulimia (BMI>17.5, Binge Eating)

Question 33

Paediatric Failure to Thrive

Answer 33

G7 N4 O3

Gastrointestinal
- Coeliac Disease
- Protein Intolerance (Cows Milk)
- Carbohydrate (Lactose) Intolerance
- Pyloric Stenosis
- GORD/ Oesophagitis
- Cystic Fibrosis
- IBD

Non-Gastrointestinal
- Not enough FOOD (most obvious)
- Nutritional neglect
- Emotional Neglect (poor interaction)
- Eating Disorder

Other
- Malignancy
- Chronic Infection/ Illnesses
- Toxins

Question 34

Paediatric Weight Increase

Answer 34

E3 N2 O2

Endocrine
- Hypothyroidism
- Cushing’s
- PCOS

Non Endocrine
- Obesity
- Familial

Other
- Steroid
- Genetic Syndromes (Turner’s Syndrome, Prader Willi)