Differential Diagnosis Flashcards
Causes of Afib (at least 10)
- PE
- Ischemia
3,Resp Dz - COPD
- Atrial enlargement
- TSH
- ETOH
- Sepsis
- HTN Cardiomyopathy
- Valvular dz
- CHF
- SSS
- Myocardial contusion
- Cardiac surgery
- Catecholamine excess
- Accessory pathyway - WPW
Sick Neonate ddx (at least 9)
Sepsis, Sepsis, Sepsis
T-Trauma (nonaccidental and accidental)
H-Heart disease/hypovolemia/hypoxia E-Endocrine (congenital adrenal hyperplasia, thyrotoxicosis)
M-Metabolic (electrolyte imbalance)
I-Inborn errors of metabolism: Metabolic emergencies
S-Sepsis (meningitis, pneumonia, urinary tract infection)
F-Formula mishaps (under- or overdilution) I-Intestinal catastrophes (volvulus, malrotation, intussusception, necrotizing enterocolitis) T-Toxins/poisons
S-Seizures
ddx microcytic anemia
- Fe Def anemia
- Thalasemia
- Anemia of Chronic dz
- Lead poisoning
- Sideroblastic anemia
Syncope ddx (at least 10)
R/O seizure
Neurologic:
- Seizure
- Stroke
- Vasovagal
- Situational syncope
- Orthostatic HypoTN
- Carotid sinus sensitivity
- Autonomic neuropathy
Cardiac:
- Tachy or brady arrhythmia
- AoStenosis
- MI
- HOCM
- Cardiac Tamponade
- Atrial myoma
- Aortic dissection
Pulmonary
- PE
- Hypoxia
- Hypercapnia
Non-cardiac:
- hypovolemia
- Drugs (ccb, bb, vasodilators, diuretics)
- Autoimmune insuff (DM, AI, spinal cord lesion),
- Hypoglycemia - Narcolepsy - Vertigo
DDX Abdominal pain in peds (at least 10)
- Pyloric Stenosis 2. Malrotation 3. Mid gut volvulous (commonly rotates around SMA causing ischemia) 4. Appendicitis 5. Intusseception 6. Duodenal Atresia 7. Mesenteria adenitis 8. Constipation 9. Referred pain from pneumonia, UTI, Renal colic (RLL can mimic appy) 10. Gastroenteritis 11. PUD 12. DKA 13. Henoch-Schnlein purpura 14, Testicular Torsion (Check cremaster reflex) 15. Renal colic
DDX Normocytic anemia (at least 3)
- Anemia chronic disease 2. Hemolytic anemia 3. Acute hemorrage 4. Myelodysplasia 5. Infiltration (leukemia, myeloma, mets, infection) 6. Aplasia 7. Liver Dz 8. Uremia 9. Hyper/Hypothyroid 10. Treated nutritional def
DDX Macrocytic anemia (at least 3)
- Folate or B12 def 2. Reticulocytosis 3. ETOH 4. Liver Dz 5. Myelodysplasia 6. Drugs
DDX isolated elevated PT/INR
- Factor 7 def (inherited) 2. Warfarin 3. Vit K def 4. Liver disease 5. Factor 7 inhibitor
DDX isolated elevated PTT (3)
- Heparin 2. Hemophilias 3. vWF
DDX elevation PT/INR and PTT (4)
- Deficencies of prothrombin, fibrinogen, Factors V and X 2. Heparin + warfarin 3. DIC * 4. Liver Dx
DDX agitated Delirium (at least 10)
DIMS DRUGS 1. Sympathemimometics/Stimulants: - Cocaine, amphetamines, methamphetamines - PCP, ketamine 2. Anticholinergics - Serotonin Syndrome - Sedative withdrawl syndrome INFECTION 3. Viral or bacterial meningitis, encephalitis METABOLIC/Endocrine 4. Hyponatremia, Hypercalemia 5. Hypoglycemia 6. Hypoxia 7. Uremia 8. Hyperammonia 9. Thyrotoxicosis STRUCTURAL 10. Trauma 11. Stroke 12. Hemorrhage 13. Mass
DDX Fever in returning traveller
- Malaria 2. Typhoid 3. Dengue Fever 4. Meningitis 5. Rickettsial disease 6. Mononuecleosis (CMV, EBV) – 7. Yellow Fever 8. Lassa Fever 9. Japanese encephalitis 10. Cysteriosis 11. Viral hemorragic fevers 12. Common infections (pnuemonia, UTI, gastroenteritis) 13. Hepatitis A,B,C 14. HIV 15. STIs- do GU exam
Ddx of Vertigo (8)
Cerebellar stroke Vertebrobasilar a. Insufficiency Vertebral artery dissection Multiple sclerosis BPPV Vestibular neuritis Labyrinthitis Ménière’s disease
Ddx acute painful vision loss (5)
Acute angle closure glaucoma Optic neuritis Trauma Uveitis Temporal arteritis Keratitis
Ddx painful red eye (6)
Acute angle closure glaucoma Keratitis ( UV or ulceration) Epi scleritis Uveitis Scleritis Enopthalmitis Conjunctivitis Orbital cellulitis
Ddx acute painless vision loss (8)
Central retinal artery occlusion Central retinal vein occlusion Retinal detachment Temporal arteritis Amaurosis fugax (TIA) Vitreous hemorrage Macular degeneration Optic neuritis (MS) Papilledema Opthalmic migraine
DDX of hypertensive emergencies with ‘toxicologic’ characteritics
- MAOI toxicity - Drug/Sympathomimetic OD - Anti-cholinergic - Methylxanthine toxicity Non-toxicologic causes - Environmental hyperthermia - Febrile illness - Pheochromocytoma - Carcinoid syndrome - Thyroid Storm - Meningitis - Hypertensive Emergency
DDX pin point pupils (5)
- Cholinergic syndrome (organophosphates) 2. Opiate OD 3. Central pontine stroke (hemorrage) 4. Neurosyphilis apparently.. 5. Pilocarpine drops..
DDX of Hyperkalemia (10)
- Pseudohyperkalemia (due to hemolysis) Decreased excretion - Renal failure - Renal secretory defects (interstitial nephritis, sickle cell) - Hypoaldosteronism: hyporeninism (type IV RTA) - Adrenal insuff - Drugs (spironolactone, Acei, NSAIDS) K shift out of cells - Burns - Rhabdomyalysis - Hemolysis - Severe infection - Metabolic acidosis - Insulin deficiency - Hyperkalemic periodic paralysis - Drugs (digitalis toxicity, beta-adrenergic antagonists, suxx) Iatrogenic
DDX Bitemporal hemianopsia (3)
Pituitary tumor Craniopharyngioma Meningioma Aneurysm of circle of willis Metastatic carcinoma
DDX Dyspnea (10)
CV - MI - CHF - Tamponade Pulmonary - PTX - Asthma - COPD - Pneumonia - PE - Aspiration - Anaphylaxis Anemia Acidosis
DDX Hemoptysis (8)
Malignancy Bronchiectasis Lung abcess Pulmonary AVM CHF Alveolar hemorrhage syndrome Infection - Bacterial - Viral - TB - Fungal Inflammation - SLE - Goodpastures syndrome - Wegeners Granulomatosis
DDX intraocular HTN (>20mmHg) (3)
Glucoma Suprachoroidal hemorrage Retrobulbar space occupying tumor
DDX Drug induced Hyperthermia? (5)
- Malignant hyperthermia 2. NMS 3. Psychostimulants (cocaine, amphetamines,MDMA) 4. Anticholinergic toxicity 5. Serotonin syndrome 6. Salicyclate poisoning 7. Withdrawal syndromes (last 2 are more fever than hyperthermia)
DDX Severe Headache (10)
SAH/ICH Sub-dural hemorrage Temporal arteritis Meningitis Migraine Acute angle glucoma Cerebral venous thrombosis CO poisoning Preeclampsia Brain Tumor/ Increased ICP Idiopathic intracranial HTN Pseudotumor cerebri
DDX rash on palms/soles (6)
- Syphilis (secondary) 2. Erythema multiforme/SJS (Drug rxn) 3. Hand, foot, mouth dz (Coksakie virus) 4. Rocky Mountain spotted fever 5. Kawasaki’s 6. Atypical Measles 7. Toxic Shock syndrome 8. Meningococcemia may cause petichiae on the palms and soles. 9. Bacterial endocarditis with it’s Janeway lesions and Osler’s nodes. 10. Scabies 11. Tinea mannum 12. Atopic dermatitis
DDX penile ulcer (at least 4)
Syphilis Herpes Simplex Chancroid Lymphogranuloma venereum Bechet’s syndrome Neoplasm Lichen Planus
DDx of ‘Fever and Altered LOC’ - state 6 categories and at least 3 in each
Infection - Sepsis - Meningitis - Encephalitis - Abcess - Tetanus - Typhoid - Malaria Drug/Toxin - Psychostimulants(cocaine, amphetamines, MDMA) - Malignant hyperthermia - NMS - Anti-cholinergic syndrome - Serotonin syndrome - Salicyclate toxicity - Withdrawal syndromes Neurologic - Hypothalamic stroke - Status Epilepticus - Cerebral hemorrage Environmental - High temperature or humidity Endocrine - Thyroid storm - Pheochromocytoma - DKA Oncologic - Lymphoma - Leukemia
DDX Altered LOC
A — Alcohol/Acidosis E — Endocrine Epilepsy Electrolytes (Na, K, Ca) I — Infection (Meningitis, Sepsis)/Insulin O — Oxygen, Opiates, Overdose U — Uremia T — Trauma/Toxins/Temperature I — Insulin/Infection P — Poisoning/Psychosis S —Stroke/Seizure/Space occupying lesions Or DIMS Or Diffuse/Metabolic processes vs. Focal/ structural
What are 7 causes of mesenteric ischemia? (there are 4 main categories)
- Arterial mesenteric embolus (usu cardiac in origin) 2. Arterial mesenteric thrombus - 2ndary to atherosclerotic dz. 3. Venous mesenteric thrombus (least common) usu SMV - Thrombotic d/o (Factor V leiden, protein c/s, AT III) - Hypercoagulable state - Sickle cell crisis - Polycythemia 4. Non-occlusive - Hypovolemia/Shock - Pancreatitis - Sepsis - Drugs causing vasoconstriction
Ddx Vesiculobullous Rash (name 5, there are 10)
- Herpes 2. Varicella 3. Dyshidrotic eczema 4. EM Major 5. SJS/TEN 6. SSSS 7. TSS 8. P. vulgaris 9. Meningococcemia/gonococcemia 10. Nec Fasc
DDX Rash and joint pain (name 5, there are 9)
- HSP 2. R. Fever 3. Lyme Disease 4. Reactive arthritis/Reiter’s 5. Transient synovitis 6. Drug Reactions – including SJS/TEN 7. Rheumatic illnesses (SLE, IBD, Psoriatic, JIA, Ank spond…) 8. Dermatomyositis 9. Septic joint + sepsis
DDX for strawberry tongue (3)
- Kawasaki 2. Scarlet fever 3. TSS/STSS
DDX of Delirium (iwatchdeath approach)
- Infectious: Sepsis, encephalitis, meningitis, syphilis, central nervous system abscess 2. Withdrawal: Alcohol, barbiturates, sedative-hypnotics 3. Acute metabolic: Acidosis, electrolyte disturbance, hepatic or renal failure, other metabolic disturbances (↑ or ↓ glucose,magnesium, calcium) 4. Trauma Head trauma, burns 5. CNS disease: Hemorrhage, stroke, vasculitis, seizures, tumor 6. Hypoxia: Acute hypoxia, chronic lung disease, hypotension 7. Deficiencies: Vitamin B12, hypovitaminosis, niacin, thiamine 8. Environmental: Hypothermia, hyperthermia, Endocrinopathies (diabetes, adrenal, thyroid) 9. Acute vascular: Hypertensive emergency, subarachnoid hemorrhage, sagittal vein thrombosis 10. Toxins or drugs Medications, street drugs, alcohol, pesticides,industrial poisons (e.g., carbon monoxide, cyanide,solvents) 11. Heavy metals Lead, mercury
DDX cerebral ring enhancing lesion (8)
D - demyelinating disease (incomplete ring) R - radiation necrosis or resolving haematoma M - metastasis A - abscess G - glioblastoma multiforme I - infarct (subacute phase) C - contusion L - lymphoma
DDX of asterixis (3)
- Hepatic encephalopathy 2. Hypercarbia 3. Uremic encephalopathy
Ddx for Petechiae and Purpura (5)
