Differential Diagnosis Flashcards
Haematemsis
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
High Dysphagia
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
Low Dysphagia
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
Cough - acute
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
Cough - chronic
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
Haemoptysis
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
Clubbing - other (2)
Congenital
Thyroid acropachy
Clubbing - cardiovascular (5)
Infective endocarditis
Congential cyanotic heart disease e.g. Tetralogy of Fallot
Atrial myxoma (benign, pedunculated, gelatinous neoplasm)
Axillary artery aneurysm
Brachial arteriovenous malformation
Clubbing - respiratory (4+4)
Pulmonary fibrosis
Supprative lung disease
Bronchiectasis
Lung abscess
Cystic fibrosis
Empyema
Bronchial carcinoma
MesotheliomaClubbing - gastrointestinal (6)
Inflammatory bowel disease Cirrhosis Malabsorption e.g. coeliac disease Gastric lymphoma Liver abscess Liver or bowel carcinoma
Chest Pain (patient over 60)
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
Epigastric Pain
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)
Nausea and vomiting
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
Acute flank pain
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
Constipation
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
