Differential Diagnosis Flashcards
0A 70-year-old male presents with a persistent productive cough with yellowish sputum, shortness of breath on exertion, and a history of smoking. He has no fever, and his lung examination reveals wheezing and decreased breath sounds. Which of the following is the most likely diagnosis?
A) Pneumonia
B) COPD
C) Heart Failure
D) Tuberculosis
Answer: B) COPD
Rationale: COPD is highly associated with a smoking history, productive cough, and wheezing or decreased breath sounds on auscultation.
Incorrect choices:
A) Pneumonia – Pneumonia generally presents with fever, acute onset of symptoms, and may have crackles rather than wheezes on lung exam. Patients with pneumonia also often experience chest pain and acute shortness of breath.
C) Heart Failure – Heart failure commonly presents with symptoms like shortness of breath, especially when lying flat (orthopnea), leg swelling (edema), and fatigue. Auscultation often reveals crackles or rales rather than wheezes due to fluid accumulation in the lungs.
D) Tuberculosis – Tuberculosis may present with night sweats, unexplained weight loss, and chronic cough, which often becomes productive and may include hemoptysis. It also typically involves constitutional symptoms that are absent here.
A patient reports chronic fatigue, significant shortness of breath on mild exertion, and a persistent cough. On physical exam, there are fine crackles at the lung bases. Which diagnostic test is most appropriate to confirm the suspected diagnosis?
A) Spirometry
B) High-Resolution CT (HRCT)
C) Chest X-ray
D) Tuberculin Skin Test (TST)
Answer: B) High-Resolution CT (HRCT)
Rationale: HRCT is the most sensitive test for diagnosing Interstitial Lung Disease (ILD), which can cause chronic fatigue, progressive dyspnea, and fine crackles. HRCT can reveal characteristic patterns of lung fibrosis, which help confirm ILD.
Incorrect choices:
A) Spirometry – Although helpful for detecting obstructive lung disease (e.g., COPD), spirometry does not reveal detailed structural lung changes characteristic of ILD.
C) Chest X-ray – While a chest X-ray can sometimes show fibrotic changes, it is less sensitive for diagnosing ILD than HRCT and often misses early disease stages.
D) Tuberculin Skin Test (TST) – TST is specific for tuberculosis but would not detect ILD, and the patient lacks other symptoms, like night sweats, to suggest tuberculosis.
A 65-year-old woman presents with fever, chills, productive cough, and sharp chest pain. Her oxygen saturation is 88%, and she has crackles and bronchial breath sounds on auscultation. Which condition should be ruled out immediately?
A) COPD
B) Emphysema
C) Pneumonia
D) Interstitial Lung Disease
Answer: C) Pneumonia
Rationale: Pneumonia is often indicated by fever, cough with sputum, low oxygen saturation, and sharp pleuritic chest pain. Crackles and bronchial breath sounds are typical on auscultation, suggesting lung infection and inflammation.
Incorrect choices:
A) COPD – COPD usually presents without fever or acute pleuritic chest pain and more frequently includes chronic symptoms like productive cough and dyspnea. Auscultation findings would more likely include wheezing and decreased breath sounds.
B) Emphysema – Emphysema, a type of COPD, typically presents with chronic dyspnea and barrel chest but is not usually associated with fever or acute symptoms unless there is a superimposed infection.
D) Interstitial Lung Disease (ILD) – ILD usually presents with progressive shortness of breath and crackles but lacks acute fever, pleuritic chest pain, and productive cough.
A 55-year-old patient presents with chronic shortness of breath and cough. Imaging reveals hyperinflation of the lungs. Which of the following conditions is most likely?
A) Emphysema
B) Heart Failure
C) Tuberculosis
D) Pneumonia
Answer: A) Emphysema
Rationale: Emphysema often shows lung hyperinflation on imaging due to alveolar damage. Symptoms include chronic cough, dyspnea, and a history of smoking, with decreased lung elasticity leading to hyperinflation.
Incorrect choices:
B) Heart Failure – Heart failure often involves symptoms of shortness of breath and swelling but does not typically cause hyperinflation on imaging. Heart failure imaging would more commonly show pulmonary edema or pleural effusion.
C) Tuberculosis – Tuberculosis can cause chronic cough but is more likely to show localized lung consolidation or cavitation rather than hyperinflation.
D) Pneumonia – Pneumonia would likely show focal consolidation, not hyperinflation, and often has an acute presentation with fever and productive cough.
A 50-year-old man reports a worsening cough, wheezing, and frequent infections. He has also experienced occasional hemoptysis. Which condition should be prioritized for evaluation?
A) COPD
B) Chronic Bronchitis
C) Bronchiectasis
D) Interstitial Lung Disease
Answer: C) Bronchiectasis
Rationale: Bronchiectasis is characterized by recurrent infections, chronic productive cough, hemoptysis, and wheezing due to dilated airways, commonly worsened by infections.
Incorrect choices:
A) COPD – COPD commonly involves wheezing and chronic cough but lacks the frequent infections and hemoptysis seen in bronchiectasis.
B) Chronic Bronchitis – Chronic bronchitis involves chronic cough and mucus production but typically does not present with hemoptysis or recurrent infections unless complications arise.
D) Interstitial Lung Disease (ILD) – ILD usually presents with progressive dyspnea, fatigue, and fine crackles rather than frequent infections or hemoptysis.
more info
In bronchiectasis, the airways are persistently inflamed due to repeated or chronic infections. This inflammation damages the bronchial walls and their associated blood vessels.
Chronic infection promotes the formation of fragile blood vessels (neovascularization) within the damaged bronchial walls, making them more prone to rupture.
. A 45-year-old woman reports a flu-like illness following a recent hiking trip. She noticed a circular red rash on her thigh with a clear center that has grown over the past week. She also has joint pain and fatigue. Which diagnosis is most likely?
A) Rocky Mountain Spotted Fever
B) Lyme Disease
C) Systemic Lupus Erythematosus
D) Chronic Fatigue Syndrome
Answer: B) Lyme Disease
Rationale: The characteristic “bullseye” or erythema migrans rash is specific to Lyme disease. The patient’s recent outdoor activity in an endemic area, along with flu-like symptoms, joint pain, and fatigue, is highly indicative of Lyme disease.
Incorrect choices:
A) Rocky Mountain Spotted Fever (RMSF) – Although RMSF can present with fever, fatigue, and rash, it usually lacks the classic bullseye appearance and is commonly found on the wrists and ankles.
C) Systemic Lupus Erythematosus (SLE) – SLE may cause fatigue and joint pain, but the rash in SLE is typically a butterfly-shaped rash on the face, not a circular lesion.
D) Chronic Fatigue Syndrome (CFS) – CFS presents with chronic fatigue but lacks characteristic skin changes such as an erythema migrans rash.
A 50-year-old male presents with high fever, severe headache, nausea, and a non-itchy rash on his wrists and ankles after a camping trip. Which diagnosis should be considered first?
A) Lyme Disease
B) Systemic Lupus Erythematosus
C) Rocky Mountain Spotted Fever
D) Fibromyalgia
Answer: C) Rocky Mountain Spotted Fever
Rationale: RMSF often presents with a high fever, headache, nausea, and a characteristic rash that begins on the wrists and ankles and then migrates toward the trunk. The history of recent tick exposure and flu-like symptoms makes RMSF the most likely diagnosis.Answer: C) Rocky Mountain Spotted Fever
Incorrect choices:
A) Lyme Disease – Lyme disease can cause fever and rash, but the rash usually appears as a bullseye and does not start on the wrists and ankles.
B) Systemic Lupus Erythematosus – SLE can present with fever and fatigue but typically has a butterfly rash on the face and lacks a tick exposure history.
D) Fibromyalgia – Fibromyalgia primarily causes widespread musculoskeletal pain and fatigue rather than acute fever, rash, or headache.
More information:
Rocky Mountain Spotted Fever (RMSF), the rash often becomes petechial as the disease progresses, although it may initially appear as small, pink macules. The petechial rash is a key feature of more advanced RMSF and suggests increased severity, as it reflects damage to small blood vessels caused by Rickettsia rickettsii.
A 60-year-old woman presents with a painful, red, swollen area on her lower leg following a minor cut. The area is warm and tender, with red streaking towards her groin. What is the most likely diagnosis?
A) Rocky Mountain Spotted Fever
B) Lyme Disease
C) Cellulitis
D) Systemic Lupus Erythematosus
Answer: C) Cellulitis
Rationale: Cellulitis commonly presents as a painful, red, warm area of skin with irregular borders following skin trauma. The presence of red streaking (lymphangitis) is also a common finding in cellulitis.
Incorrect choices:
A) Rocky Mountain Spotted Fever – RMSF causes a generalized rash on the wrists and ankles, not localized redness and swelling.
B) Lyme Disease – Lyme disease may present with erythema migrans but not with the warmth, pain, or lymphangitic spread typical of cellulitis.
D) Systemic Lupus Erythematosus – SLE can involve rashes but typically presents as a butterfly rash on the face or photosensitive rash, not localized swelling, redness, and tenderness.
A 45-year-old woman presents with widespread pain affecting her shoulders, lower back, and thighs. She reports fatigue, trouble sleeping, and frequent “brain fog” or difficulty concentrating. She also has heightened sensitivity to bright lights and loud noises. Her symptoms have persisted for over 6 months. What is the most likely diagnosis?
A) Systemic Lupus Erythematosus (SLE)
B) Rheumatoid Arthritis
C) Fibromyalgia
D) Chronic Fatigue Syndrome (SEID)
Answer: C) Fibromyalgia
Rationale: Fibromyalgia often presents with multisite pain (defined as pain in at least 6 out of 9 possible pain sites), along with fatigue or sleep problems persisting for at least 3 months. Additional supportive features include dyscognition (brain fog) and environmental sensitivity (e.g., sensitivity to lights and sounds). The patient’s long-standing, multisite pain and other symptoms fit the AAPT criteria for fibromyalgia.
Multisite pain defined as 6 or more pain sites from a total of 9 possible sites (head, left arm, right arm, chest, abdomen, upper back and spine, lower back and spine including buttocks, left leg, and right leg)
Incorrect choices:
A) Systemic Lupus Erythematosus (SLE) – SLE can involve joint pain and fatigue but typically has additional systemic signs, such as a butterfly-shaped facial rash or organ involvement.
B) Rheumatoid Arthritis – RA generally presents with joint swelling and morning stiffness rather than widespread pain and cognitive issues.
D) Chronic Fatigue Syndrome (SEID) – SEID causes fatigue and cognitive impairment, but widespread musculoskeletal pain and environmental sensitivity are more characteristic of fibromyalgia.
A 40-year-old male presents with extreme fatigue, muscle pain, headaches, and sore throat persisting over the past eight months without an apparent cause. Physical exam reveals normal vital signs. Which diagnosis should be considered?
A) Systemic Lupus Erythematosus
B) Chronic Fatigue Syndrome
C) Rocky Mountain Spotted Fever
D) Fibromyalgia
Answer: B) Chronic Fatigue Syndrome
Rationale: Chronic Fatigue Syndrome is defined by persistent, severe fatigue lasting more than six months without an identifiable cause, along with symptoms like muscle pain, cognitive impairment, and sore throat.
Incorrect choices:
A) Systemic Lupus Erythematosus – SLE can cause fatigue and muscle pain, but it usually presents with other systemic features such as a butterfly rash, photosensitivity, or organ involvement.
C) Rocky Mountain Spotted Fever – RMSF is an acute, rather than chronic, condition and would present with high fever, rash, and muscle pain shortly after tick exposure.
D) Fibromyalgia – Fibromyalgia also involves chronic fatigue and muscle pain but typically includes tender points, which are absent in this patient.
A 32-year-old female presents with fatigue, joint pain, a low-grade fever, and a butterfly-shaped rash across her cheeks and nose. She reports that her symptoms worsen after being in the sun. She has no history of recent tick bites or infections and denies recent travel. What is the most likely diagnosis?
A) Lyme Disease
B) Rocky Mountain Spotted Fever
C) Systemic Lupus Erythematosus
D) Dermatomyositis
Answer: C) Systemic Lupus Erythematosus
Answer: C) Systemic Lupus Erythematosus
Rationale: Systemic Lupus Erythematosus (SLE) is characterized by systemic symptoms such as fatigue, fever, and joint pain, often accompanied by a butterfly-shaped (malar) rash that worsens with sun exposure (photosensitivity). The absence of recent tick exposure or travel reduces the likelihood of tick-borne illnesses, making SLE the most likely diagnosis in this case.
Incorrect choices:
A) Lyme Disease – Lyme disease can cause fatigue and joint pain but is usually associated with a history of tick exposure and typically presents with an erythema migrans (“bullseye”) rash, not a malar rash.
B) Rocky Mountain Spotted Fever – RMSF may present with fever and a rash, but it typically starts on the wrists and ankles and spreads inward, eventually becoming petechial. Additionally, a history of tick exposure is usually present.
D) Dermatomyositis – Dermatomyositis can cause a similar facial rash and photosensitivity, but it is more commonly associated with proximal muscle weakness (e.g., difficulty climbing stairs or raising arms) and may show Gottron’s papules on the knuckles, which are absent here.
A 65-year-old woman presents with severe morning stiffness, fatigue, and leg swelling. Her physical exam reveals decreased oxygen saturation and jugular vein distention. Which diagnosis should be considered first?
A) Chronic Myofascial Pain Syndrome
B) Systemic Lupus Erythematosus
C) Polymyalgia Rheumatica
D) Heart Failure
D Heart Failure
Rationale: Heart failure is suggested by symptoms such as fatigue, leg swelling, jugular vein distention, and decreased oxygen saturation, which are classic signs of worsening cardiac function.
Incorrect choices:
A) Chronic Myofascial Pain Syndrome – This primarily involves localized pain and stiffness at trigger points rather than systemic findings like oxygen saturation and jugular distention.
B) Systemic Lupus Erythematosus – While SLE can cause fatigue, it typically doesn’t present with leg swelling or jugular vein distention, which are signs of heart failure.
C) Polymyalgia Rheumatica – This is characterized by morning stiffness and pain in the shoulders and hips but usually does not include severe leg swelling or signs of cardiac decompensation.
A 45-year-old female reports worsening fatigue, joint pain, and episodes of unexplained low-grade fever. She has recently noticed a butterfly-shaped rash on her face that worsens with sun exposure. What diagnosis should be prioritized?
A) Hypothyroidism
B) Rheumatoid Arthritis
C) Systemic Lupus Erythematosus (SLE)
D) Chronic Myofascial Pain Syndrome
Answer: C) Systemic Lupus Erythematosus (SLE)
Rationale: SLE is associated with fatigue, joint pain, fever, and a characteristic butterfly rash that is photosensitive, making it the most likely diagnosis.
Incorrect choices:
A) Hypothyroidism – Although fatigue and joint pain can occur in hypothyroidism, it doesn’t usually cause a photosensitive rash or fever.
B) Rheumatoid Arthritis – RA may present with joint pain and fatigue, but it typically does not include fever or a butterfly rash.
D) Chronic Myofascial Pain Syndrome – This condition is characterized by localized muscle pain rather than systemic symptoms like fever and rash.
A 52-year-old male presents with rapidly worsening shortness of breath, night sweats, and hemoptysis. He recently moved to an area where tick-borne diseases are prevalent. What diagnosis should be considered first?
A) Lyme Disease
B) Tuberculosis
C) Polymyalgia Rheumatica
D) Chronic Viral Infection
Answer: B) Tuberculosis
Rationale: Tuberculosis commonly presents with symptoms like night sweats, hemoptysis, and worsening dyspnea. The red flags for TB are evident in his presentation.
Incorrect choices:
A) Lyme Disease – While Lyme disease can cause fatigue and flu-like symptoms, it doesn’t typically cause hemoptysis or night sweats.
C) Polymyalgia Rheumatica – This often presents with stiffness and pain but does not usually involve respiratory symptoms.
D) Chronic Viral Infection – Viral infections can cause fatigue and muscle aches but do not typically cause hemoptysis or night sweats.
A 39-year-old woman presents with progressive muscle weakness, fatigue, and numbness in her feet and hands. She also reports difficulty concentrating. What is the most likely diagnosis?
A) Small Fiber Neuropathy
B) Polymyalgia Rheumatica
C) Fibromyalgia
D) Hypothyroidism
Answer: A) Small Fiber Neuropathy
Rationale: Small Fiber Neuropathy is associated with neuropathic pain, numbness, and burning sensations in the extremities, as well as sensory symptoms that fit this presentation.
Incorrect choices:
B) Polymyalgia Rheumatica – This condition typically presents with pain and stiffness in the shoulders and hips rather than neuropathy.
C) Fibromyalgia – Fibromyalgia often includes widespread musculoskeletal pain but does not usually involve numbness or tingling in the hands and feet.
D) Hypothyroidism – Although hypothyroidism can cause fatigue and cognitive impairment, it doesn’t commonly lead to numbness in the hands and feet.
A 44-year-old male presents with severe fatigue, muscle pain, cognitive impairment, and a history of tick exposure. He has also developed a circular “bullseye” rash on his arm. Which diagnosis is most likely?
A) Chronic Myofascial Pain Syndrome
B) Lyme Disease
C) Systemic Lupus Erythematosus
D) Small Fiber Neuropathy
Answer: B) Lyme Disease
Rationale: Lyme disease is suggested by a “bullseye” rash (erythema migrans), history of tick exposure, and symptoms like fatigue and cognitive impairment.
Incorrect choices:
A) Chronic Myofascial Pain Syndrome – This condition involves muscle pain localized to trigger points rather than systemic symptoms or rashes.
C) Systemic Lupus Erythematosus – While SLE can cause fatigue and joint pain, it typically doesn’t present with a bullseye rash or a history of tick exposure.
D) Small Fiber Neuropathy – Small Fiber Neuropathy causes neuropathic symptoms but doesn’t involve a bullseye rash or systemic symptoms.
A 50-year-old female presents with severe morning fatigue, weight gain, and difficulty concentrating. On physical examination, she has dry skin and coarse hair. Which diagnosis should be considered?
A) Fibromyalgia
B) Systemic Lupus Erythematosus
C) Hypothyroidism
D) Multiple Sclerosis
Answer: C) Hypothyroidism
Rationale: Hypothyroidism commonly presents with fatigue, weight gain, dry skin, coarse hair, and cognitive issues. These symptoms, along with physical exam findings, align with thyroid dysfunction.
Incorrect choices:
A) Fibromyalgia – Fibromyalgia may include fatigue, but it lacks the classic signs of dry skin and weight gain associated with hypothyroidism.
B) Systemic Lupus Erythematosus – SLE may present with fatigue but often includes a butterfly rash and other systemic signs, which are absent here.
D) Multiple Sclerosis – MS could cause fatigue and cognitive impairment, but it usually also involves neurological symptoms like numbness or tingling.
A 30-year-old male reports chronic fatigue, muscle pain, and recent unintentional weight loss. His lab work reveals a Vitamin D deficiency. What should be considered first?
A) Chronic Viral Infection
B) Vitamin Deficiency
C) Systemic Lupus Erythematosus
D) Small Fiber Neuropathy
Answer: B) Vitamin Deficiency
Rationale: A Vitamin D deficiency can result in fatigue, muscle pain, and sometimes weight changes. Addressing the deficiency can often improve these symptoms.
Incorrect choices:
A) Chronic Viral Infection – While chronic infections can cause fatigue and weight loss, this patient’s Vitamin D deficiency better explains his symptoms.
C) Systemic Lupus Erythematosus – SLE could present with fatigue and weight loss but often includes additional signs, such as a rash or joint involvement.
D) Small Fiber Neuropathy – This usually presents with pain or burning in the extremities rather than systemic symptoms like fatigue and weight loss.
A 55-year-old woman complains of persistent pain in her neck, shoulders, and hips, especially in the morning, along with new difficulties sleeping. She denies joint swelling. What is the likely diagnosis?
A) Rheumatoid Arthritis
B) Polymyalgia Rheumatica
C) Hypothyroidism
D) Fibromyalgia
Answer: B) Polymyalgia Rheumatica
Rationale: Polymyalgia Rheumatica commonly presents with pain and stiffness in the neck, shoulders, and hips, particularly in the morning, and is more common in individuals over 50.
Incorrect choices:
A) Rheumatoid Arthritis – RA often involves joint swelling and younger age groups.
C) Hypothyroidism – Hypothyroidism may cause fatigue but does not typically present with localized pain in the shoulders and hips.
D) Fibromyalgia – While fibromyalgia may present with diffuse pain, it typically affects more areas and does not localize to the shoulders and hips in the same way.
A 28-year-old male presents with fatigue, sore throat, and diffuse muscle aches for the past three months. He recalls an infection with a flu-like illness two years ago. What diagnosis should be considered?
A) Systemic Lupus Erythematosus
B) Chronic Viral Infection
C) Hypothyroidism
D) Small Fiber Neuropathy
Answer: B) Chronic Viral Infection
Rationale: Chronic viral infections, such as Epstein-Barr Virus (EBV), can cause prolonged symptoms of fatigue, sore throat, and muscle aches, especially if there was a prior flu-like illness.
Incorrect choices:
A) Systemic Lupus Erythematosus – SLE could cause fatigue, but typically involves other symptoms such as rash or joint pain.
C) Hypothyroidism – Hypothyroidism may cause fatigue, but sore throat and muscle aches are not typical.
D) Small Fiber Neuropathy – This condition presents with neuropathic pain rather than generalized fatigue or sore throat.
A 46-year-old woman presents with fatigue, muscle spasms at night, and frequent waking. Her spouse reports she snores loudly. Which diagnosis should be prioritized?
A) Systemic Lupus Erythematosus
B) Sleep Apnea
C) Multiple Sclerosis
D) Fibromyalgia
B) Sleep Apnea
Rationale: Sleep apnea often involves symptoms such as frequent waking, snoring, and fatigue, which align with her presentation.
Incorrect choices:
A) Systemic Lupus Erythematosus – SLE may present with fatigue, but it does not typically cause sleep disruptions or snoring.
C) Multiple Sclerosis – MS could cause fatigue but would more likely present with neurological deficits.
D) Fibromyalgia – Fibromyalgia could cause fatigue and muscle pain but does not cause snoring or frequent waking related to breathing issues.
A 35-year-old female reports persistent fatigue, widespread muscle pain, and cognitive issues for the past year. Physical exam reveals tenderness at specific points on her body. What is the most likely diagnosis?
A) Chronic Fatigue Syndrome
B) Systemic Lupus Erythematosus
C) Fibromyalgia
D) Lyme Disease
Answer: C) Fibromyalgia
Rationale: Fibromyalgia is characterized by widespread musculoskeletal pain, chronic fatigue, and cognitive issues (“fibro fog”). The presence of tender points on physical exam is a classic finding.
Incorrect choices:
A) Chronic Fatigue Syndrome (CFS) – CFS also causes fatigue, but it does not typically include tender points or widespread musculoskeletal pain.
B) Systemic Lupus Erythematosus (SLE) – SLE can cause fatigue and muscle pain but usually presents with a rash, photosensitivity, or other systemic symptoms.
D) Lyme Disease – Lyme disease can cause fatigue and joint pain but often involves a history of tick exposure and erythema migrans rash in the early stages.
