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Medicine Placement > Differential Diagnosis > Flashcards

Differential Diagnosis Flashcards

1
Q

Haematemsis

A 
Gastritis/oesophagitis/duodenitis
Peptic ulcer (gastric/duodenal)
Oesophageal varices
Mallory-Weiss tears
Oesophageal carcinoma
Gastric carcinoma
Oesophageal or gastric trauma
Aorto-venous malformations
Bleeding diathesis (congenital or acquired)
Vascular angiodysplasia in stomach or oesophagus e.g. hereditary haemorrhage telangiectasia
Boerhaarve's perforation
Haemobilia
Aorto-enteric fistula
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2
Q

High Dysphagia

A 
Functional:
Stroke
Parkinson's Disease
Myasthenia gravis
Multiple sclerosis
Myotonic distrophy
Motor Neuron Disease
Inadequate salivation eg 2o to Sjogrens, anticholinergics

Structural:
Cancer
Pharyngeal pouch
Cricopharyngeal bar - radiological sign due to prominent cricopharyngeal muscle contour on barium swallow

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3
Q

Low Dysphagia

A 
Functional:
Achalasia
Chagas disease
Nutcracker oesophagus aka hypertensive peristalsis
Diffuse oesophageal spasm
Limited cutaneous scleroderma (CREST)
Infective oesophagitis
Eosinophilic oesophagitis

Structural:
Luminal
Foreign body

Mural
Cancer
Stricture
Plummer-Vinson syndrome aka sideropenic dysphagia
(acquired oesophageal webs- mucosal & submucosal)
Schatzki ring (mucosal ring at squamocolumnar jnc)
Congenital atresia
Post fundoplication

Extrinsic
    Mediastinal mass
    Retrosternal goitre
    Bronchial carcinoma
    Thoracic aortic aneurysm
    Pericardial effusion
    Ortner's syndrome
    Dysphagia lusoria
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4
Q

Cough - acute

A 
Dry (8):
Asthma
Rhinitis/Sinusitis w/ post nasal drip
Upper resp tract infection
Drug induced e.g. ACE inhibitors
Smoke/toxin inhalation
Inhaled foreign object
Lung cancer - obstruction of a major bronchus
Pulmonary oedema - secondary to heart failure

Productive (3):
Lower resp tract infection
COPD
TB

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5
Q

Cough - chronic

A 
Dry (11):
Asthma
GORD
Post nasal drip
Smoking
Lung cancer
Drug induced
COPD
Pulmonary oedema - secondary to heart failure
Non-asthmatic eosinophilic bronchitis
Recurrent aspiration due to defective swallow mechanism
Psychogenic

Productive (5):
COPD
TB
Lung cancer
Recurrent aspiration due to defective swallow mechanism
Congenital - cystic fibrosis, primary ciliary dyskinesia

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6
Q

Haemoptysis

A

Infective: TB, bronchitis, pneumonia, lung abscess

Neoplastic: primary lung cancer, metastatic lung cancer

Vascular: PE, left ventricular failure, bleeding diathesis, arteriovenous malformations, vascular-bronchial fistula

Inflammatory: granulomatosis w/ polyangitis (Wegener’s), Goodpasture’s Syndrome, SLE, hereditary haemorrhagic telangiectasia, polyarteritis nodosa, microscopic polyangitis

Trauma: iatrogenic (post lung biopsy, intubation), wounds (stabbing, rib fracture)

Endocrine: none

Degenerative: bronchiectasis

Metabolic: none

Drugs: warfarin, crack cocaine

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7
Q

Clubbing - other (2)

A

Congenital

Thyroid acropachy

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8
Q

Clubbing - cardiovascular (5)

A

Infective endocarditis
Congential cyanotic heart disease e.g. Tetralogy of Fallot
Atrial myxoma (benign, pedunculated, gelatinous neoplasm)
Axillary artery aneurysm
Brachial arteriovenous malformation

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9
Q

Clubbing - respiratory (4+4)

A 
Pulmonary fibrosis
Supprative lung disease
    Bronchiectasis
    Lung abscess
    Cystic fibrosis
    Empyema
Bronchial carcinoma
Mesothelioma
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10
Q

Clubbing - gastrointestinal (6)

A 
Inflammatory bowel disease
Cirrhosis
Malabsorption e.g. coeliac disease
Gastric lymphoma
Liver abscess
Liver or bowel carcinoma
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11
Q

Chest Pain (patient over 60)

A 
Musculoskeletal inflammation
Acute coronary syndrome (unstable angina, MI)
Pulmonary embolism
Stable angina
Pleurisy
Oesophagitis
Pneumothorax
Anxiety
Peptic ulcer disease 
Gastritis
Myopericarditis
Thoracic aortic dissection
Thoracic aortic aneurysm
Cholecystitis
Pancreatitis
Coronary vasospasm e.g. secondary to cocaine
Oesophageal spasm
Boerhaave's perforation
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12
Q

Epigastric Pain

A 
Acute pancreatitis
Perforated peptic ulcer
Gastritis/duodenitis
Peptic ulcer disease
Biliary colic
Acute cholecystitis
Ascending cholangitis
MI
Ruptured AAA
Mesenteric ischaemia
Basal pneumonia
Oesophagitis (due to GORD)
Non-ulcer dyspepsia
Chronic pancreatitis
Incomplete bowel obstruction
Boerhaave's perforation
Gastric cancer
Pancreatic cancer
Acute hepatitis (usually painless unless hepatomegaly is causing stretching of the capsule)
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13
Q

Nausea and vomiting

A 
Vestibular system - vertigo
    Benign paroxysmal positional vertigo
    Labyrinthitis
    Motion sickness
    Meniere's disease (tinnitus, vertigo, hearing loss)
Chemoreceptor trigger zone (CTZ) - chemicals in blood
    Medications
    Alcohol
    Hormones
    Electrolytes
    Toxins
CNS - brain problems
    Pain
    Anxiety
    Raised ICP
    Meningitis
    Encephalitis

Cranial nerves IX, X - Abdo and heart problems
GI obstruction
GI infection
Inflammation of diaphragm (inferior MI)
Inflammation of liver, gallbladder, pancreas, peritoneum

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14
Q

Acute flank pain

A 
Muscular
Nephrolithiasis / ureteric colic
Spinal pathology - fractures, metastases, disc prolapse
Leaking/ruptured AAA
Testicular Torsion
Gynaecological pathology - ectopic pregnancy, ovarian torsion, ruptured cyst or haemorrhage into a  cyst
Pyelonephritis (more common in women)
Perforated peptic ulcer
Renal cancer
Abscess - perinephric, renal
Basal pneumonia
Also consider appendicitis, pancreatitis, diverticulitis etc
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15
Q

Constipation

A 
Abnormal Bowel Peristalsis
    Irritable bowel syndrome
    Medications e.g. opiates, iron, Ca2+ channel blockers
    Hypothyroidism
    Hypercalcaemia
    Hypokalaemia
    Multiple sclerosis
    Diabetic neuropathy
    Parkinson's
    Idiopathic toxic megacolon
    Idiopathic slow transit

Hard Faeces
Low fibre diet
Dehydration

Bowel Obstruction
Colorectal adenocarcinoma
Sigmoid volvulus
Other pelvic masses - uterine fibroids, ovarian tumour
Colonic strictures - radiotherapy, diverticulitis, Crohn’s

Patient not pushing
Haemorrhoids
Anal fissure
Pelvic floor dysfunction post e.g. post hysterectomy

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16
Q

Diarrhoea in a young person

Diarrhoea in an older person

A 
Infective
IBS
Coeliac disease
Crohn's
Ulcerative colitis
Medications e.g. antibiotics, laxatives
Hyperthyroidism

Neoplastic disease - villous polyps, colonic adenocarcinoma, pancreatic cancer
Diverticular disease
Overflow diarrhoea secondary to constipation
Ischaemic colitis
Microscopic colitis
Bacterial overgrowth e.g. in diabetes mellitus
Medicaions
IBD
Hyperthyroidism

17
Q

Rectal bleeding - anorectal (9)

overt bleeding

A 
Haemorrhoids
Rectal tumour
Anal tumour
Anal fissure
Anal fistula
Solitary rectal ulcer
Radiation proctitis
Rectal varices 
Trauma
18
Q

Rectal bleeding - colonic (6)

overt bleeding

A

Diverticular disease
Angiodysplasia
Colitis - infective, inflammatory, ischaemic
Colonic tumour - benign or malignant
Iatrogenic - endoscopic biopsy, anastomotic leakage
Vasculitis

19
Q

Rectal bleeding - ileo-jejunal (7)

overt bleeding

A 
Peptic ulceration (including Meckel's diverticulum)
Angiodysplasia
Arterio-venous malformation
Crohn's disease
Coeliac disease
Aorto-enteric fistula
Small bowel tumours
20
Q

Rectal bleeding - upper-GI (8)

overt bleeding

A 
Peptic ulcer
Gastritis/duodenitis
Varices
Tumour
Mallory-Weiss tears
Herediatry haemorrhagic telangectasia (Osler-Weber-Rendu syndrome)
Aorto-enteric fistula
Dieulafoy lesion
21
Q

Poor Urinary Output

A

Pre-renal (inadequate blood supply)
Hypovolaemia
Hypotension
↓ vascular resistence e.g. sepsis, pancreatitis
Heart failure
Reduced local perfusion
e.g. dissecting aneurysm, renal emboli

Renal (damage causing impaired kidney function)
Tubular - acute tubular necrosis
Glomerular - glomerulonephritis
Interstitial - interstitial nephritis (usually NSAIDs, Abx)
Vascular
vasculitides (destroy blood vessels by inflammation)
haemolytic uraemic syndrome (HUS)
thrombotic thrombocytopenic purpura (TTP)
disseminated intravascular coagulopathy (DIC)
malignant hypertension
scleroderma
Infectious - malaria, legionnaire’s disease, leptospirosis
Complex mechanism - multiple myeloma

Post-renal (obstruction to urinary flow)
    Ureter
      abdominal/pelvic mass compressing ureters
      complications of pelvic surgery
      bilateral calculi
      retroperitoneal fibrosis
    Bladder
      neuropathic bladder
      anticholinergic or symmpathomimetic drugs
      bladder stones or tumour
      uterovaginal prolapse in women
    Urethra
      benign prostatic hyperplasia (BPH)
      blocked catheter
      prostate cancer
      urethral stricture
      posterior urethral valve
      trauma
      infection - e.g. herpes simplex causes dysuria
22
Q

Polyuria - increased frequency + increased volume

A 
Diabetes mellitus (type 1 & 2)
Diuretics e.g. diuretic meds, caffeine, alcohol, lithium
Heart failure
Hypercalcaemia
Hyperthryoidism
Primary polydipsia
Hypokalaemia
Hyperuricaemia
Diabetes insipidus (cranial or nephrogenic)
23
Q

Groin lump

A 
Inguinal hernia - direct or indirect
Femoral hernia
Inguinal lymphadenopathy
Saphena varix - dilated great saphenous vein 
Psoas bursa/abscess
Lipoma
Sebaceous cyst
Neuroma
Femoral aneurysm/pseudoaneurysm
Ectopic testes
Undescended tests
Hydrocele of cord
24
Q 
Scrotal Mass
   Can you get above it?
   Is it separate from the testes?
   Is it transillumable?
   Is it tender?
A 
Inguinoscrotal hernia (2)
Epididymal cyst (2)
Acute iodiopathic scrotal oedema
Acute epididymitis (1)
Torsion of hydatid of Morgagni
TB epididymitis
Post vasectomy sperm granuloma
Hydrocele (1)
Torsion
Orchitis (1)
Epididymo-orchitis (1)
Acute haematoma
Cancer (1)
Chronic haematoma
Gumma

1 - more common
2 - less common
no number - rarer

25
Q

Limb Weakness - sudden onset (secs to mins)

A 
Brain
    Ischaemic stroke
    Transient ischaemic attacks
    Haemorrhagic stroke
    Hemiplegic migraine
    Todd's palsy (post seizure paralysis)
    Hypoglycaemia
Spinal cord
    Spinal disc prolapse
    Spinal cord transection
    Spinal cord infarction
Nerve root
    Spinal disc prolapse
    Vertebral fracture
Peripheral nerve or nerve plexus
    Acute limb ischaemia e.g. peripheral artery embolus
    Traumatic nerve injury
26
Q

Limb Weakness - subacute onset (hours to days)

A 
Brain
    Multiple sclerosis
    Haematoma - subdural, extradural
    Tumour
    Abscess
Spinal cord
    Multiple sclerosis
    Tumour
    Transverse myelitis (inflammation of spinal cord)
Nerve root
    Guillain-Barre syndrome
    Poliomyelitis
Neuromuscular junction
    Botulism
    Tetanus
27
Q

Limb weakness - gradual onset (weeks to months)

A 
Spinal cord
    Spinal canal stenosis
    Vit B12 def
Peripheral nerve or nerve plexus
    Diabetes mellitus
    Vasculitides
Neuromuscular junction
    Myasthenia gravis
    Lambert-Eaton syndrome
Muscle
    Myositis
28
Q

Acutely swollen calf (7)

A 
Deep vein thrombosis 
Cellulitis
Ruptured Baker's cyst
Muscular strain e.g. torn gastrocnemius
Septic arthritis
Allergic response e.g. insect bite
Compartment syndrome
29
Q

Bilateral swollen legs (8)

A

Right heart failure +/- left heart failure
Lymphoedema
Venous insufficiency
Pregnancy
Vasodilaters e.g. calcium channel blockers
Hypoalbuminaemia: from renal failure (nephrotic syndrome), liver failure, malabsorption/malnutrition, sepsis
Pelvic tumour compressing on IVC e.g. ovarian cancer
Fluid overload (iatrogenic)

30
Q

Leg Ulcer (11)

A

Venous ulcer (70%)
Mixed arterial/venous ulcer (10%)
Arterial (atherosclerotic) ulcer (10%)
Pressure ulcer
Neuropathic ulcer
Lymphoedema ulcer
Traumatic ulcer
Malignant ulcer e.g. Marjolin’s: SCC in longstanding ulcer
Vasculitic ulcer e.g. RA, pyoderma gangrenosum
Infective ulcer e.g. TB, syphilis, leprosy
Haemolytic anaemia:sickle cell, hereditary spherocystosis

31
Q

Carpal tunnel syndrome (RAPID TTT)

A 
Rheumatoid arthritis
Acromegaly
Pregnancy
Idiopathic
Diabetes
Trauma
Tendons - tenosynovitis of long flexors
Thyroid - hypothyroidism

Medicine Placement (15 decks)

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