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Oral Boards > Differential Diagnosis > Flashcards

Differential Diagnosis Flashcards

1
Q

DDx post-op disorientation/agitation

A
  1. Unstable vitals - hypoxia, hypotension, malignant arrhythmia
  2. Anesthesia causes - residual anesthetic/paralysis, narcotic overdose, medication reaction
  3. Delirium tremens from withdrawal
  4. Metabolic or endocrine causes - hypoNa, K, Ca, glycemia, thyroidism, hypothermia, hyperglycemia, hyperthermia,
  5. Neurological - post-ictal, cerebral edema, stroke
  6. Pain, anxiety
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2
Q

DDx for post op weakness

A 
Residual NMB
Narcotic overdose
Residual inhalational anesthetic
Hypothermia
Hypocarbia
Acidosis
Hypoxia
Myasthenic crisis
Cholinergic crisis
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3
Q

DDx for desaturation and hypotension

A

PTX
Airway obstruction
Bronchospasm
Tracheal rupture/tear

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4
Q

DDx for hypotension in anhepatic phase of OLT

A

Assuming normal CVP and other stable vitals, blood loss usually not culprit in this phase

Rule out mechanical cause for surgical manipulation
Prolonged QT/poor contractility for hypoCa
ST segment changes from ischemia
TEE for WMA

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5
Q

Ddx for post-op stridor

A
  1. Laryngeal nerve injury
  2. Laryngospasm
  3. Hematoma
  4. Inadequate reversal
  5. Residual anesthetic
  6. Tracheomalacia
  7. HypoCa (post thyroid, circumoral tingling)
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6
Q

Ddx for hypotension

A 
Hypoxia
Dysrhythmia 
Dec after load
- vasodilation
- sepsis
- anaphylaxis
- high spinal or spinal shock

Dec Preload

  • Hypovolemia secondary to blood loss
  • PTX
  • PE
  • aortic cross clamp
  • Tamponade
  • IVC occlusion
Dec Contractility
- Ischemia
- RV failure/LV failure
- acidosis
- hypocalcemia
Anesthetic overdose
Carcinoid crisis
Erroneous value
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7
Q

DDx for hypotension and inc airway pressures

A
  1. Tension PTX
  2. Hemothorax with trauma
  3. Anaphylaxis
  4. Mainstem ETT
  5. Bronchospasm
  6. Kinked ETT
  7. ETT obstruction due to mucous plug or pulmonary edema
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8
Q

Ddx for low etCO2

A

With crani = venous air embolism
Hypotension = PE, fat embolism, MI, arrhythmia
Disconnected ETT

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9
Q

DDX for delayed awakening

A 
hypoxia
hypercapnia
hypotension
Metabolic
 - acidosis
- hypoglycemia
- hyperMag
- hepatic encephalopathy

residual anesthetic - scopolamine, benzos
pain medicine overdose - review chart and MAR
inadequate NMB reversal
neurologic insult

Asses oxygenation, adequate CO2 to stimulate breathing but not excessive, pulse oximeter, patient’s color, capnograph. Check twitches, pupils. Obtain ABG, glucose electrolytes, head CT

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10
Q

Causes of oliguria

A

Pre-renal

  • asses volume status, HR, BP, hemodynamic cause
  • hypovolemia, hypotension
  • Urine Na <20
  • FeNa <1%

Renal

  • ischemia, toxins (contrast, abx), mechanical injury
  • Urine Na >40
  • FeNa >1%

Post-renal

  • check foley for kinks/clots
  • urethral or ureteral obstruction

Review anesthetic record, look for drug exposures, BUN, Cr, UA, FeNa

FeNa (Na clearance/CrCl)

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11
Q

Ddx for hypoxia

A 
Low insp [O2]
Hypoventilation/hypercarbia
Shunt-V/Q mismatch
- atalectasis
- mucous plug
- PTX
- pleural effusion
- pulmonary edema
- PNA
- endobronchial intubation
- aspiration
- bronchospasm
- PE
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12
Q

Ddx for hypercarbia

A

Inc CO2 production

  • fever
  • MH
  • high carbohydrate intake
  • thyroid storm
  • bicarbonate administration
  • release of tourniquet or clamp

Hypoventilation

  • large PE
  • significant hypotension
  • pneumonperitoneum

Rebreathing

  • incompetent insp/expiratory valve
  • exhausted soda lime

Check ETT, adequate ventilation, breath sounds, rhythm, BP, etCO2

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13
Q

DDX for wheezing

A

Lower airway

  • kinked ETT
  • mucous plug
  • foreign body
  • endobronchial intubation
  • PTX
  • bronchospasm
  • PE
  • anaphylaxis
  • Aspiration

Upper airway

  • laryngeal edema
  • laryngospasm
  • laryngomalacia
  • foreign body
  • vocal cord paralysis
  • tumor
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14
Q

Ddx for hypertension

A 
Hypoxia
Hypercarbia
Light anesthesia
Pain
Anxiety
Inc ICP
Hypovolemia
Bladder distention
Pheo
Thyroid Storm
MH
Carcinoid
Drug effect - cocaine, MAOI
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15
Q

Ddx for tachycardia

A 
Hypoxia
Hypercarbia
Light anesthesia
Pain 
Anxiety
Drug withdraws - clonidine, etOH
Dysrhythmia 
Hypovolemia/hypotension
Fever
MH
Pheo
Thyroid storm
Carcinoid
MI
Bladder distention
Drug effect - pancuronium, cocaine, epi
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16
Q

Ddx for bradycardia

A 
Hypoxia
Hypercarbia
Anesthetic overdose
Dysrhythmia - AVB, pacer malfunction
MI
High spinal/ spinal shock
Vagal reflex
- HTN (autonomic hyperreflexia)
- visceral traction
- insufflation
- inc ICP
- RA distention
hypothermia
Suctioning of airways
Drug effects
- opiates
- BB, CCB
- Antichoinesterase
- Sux
Baseline condition (athletes)
17
Q

DDx for post-op tachycardia

A 
Pain
Hypoxia
Hypercarbia
Delirium - inadequate reversal
Signs of MH - rigidity, temp, peripheral mottling, rhabdo
18
Q

DDx for prolonged NMB

A 
Pseudocholinesterase deficiency
Drug error
Defective nerve stim
NM disease (myasthenia, LEMS, ALS, MS, DMD)
Hypothermia
Acidosis
Hypercarbia

Vec - active metabolite in renal failure

19
Q

DDX delayed emergence s/p crani

A 
hematoma
tension pneumoephalus
cerebral edema
cerebral ischemia
hypoxia
hypercarbia
seizure
obstructive hydrocephalus
20
Q

DDX for neonatal seizure

A 
ICH
hypoxic-ischemic encephalopathy
cerebral edema
hypoglycemia
hypoCa, Mag
Benign seizures
TORCH (toxoplasmosis, rubella, CMV, herpes)
Sepsis
21
Q

DDX unresponsive/cardiac arrest in pregnant patient

A

Eclamptic seizure until proven otherwise

A - Anesthetic complication, Abruption
B - Bleeding
C - Cerebral (bleed, stroke, tumor), Cardiovascular
D - Drugs (medication, IVDU)
E - Embolism (PE, AFE) + Epilepsy
F - Fever
G - General non-obstetric causes (H&Ts)
H - Hypoglycemia, HTN

Trauma

22
Q

DDX for post-op rhonchi

A

Pulmonary edema

  • aspiration
  • volume overload/cardiomopathy
  • PE
23
Q

Causes of Anion-gap acidosis

A

MUDPILES

  • Methanol
  • Uremia
  • DKA
  • Paraldehyde
  • Iron
  • Lactic Acid
  • Ethylene Glycol
  • Salicylate
24
Q

Causes of Non-anion gap metabolic acidosis

A

GI losses
Urinary losses
Saline

25
Q

Causes of inspiratory stridor

A

above vocal cords

  • croup
  • laryngomalacia
  • VC paralysis
  • epiglottitis
26
Q

Causes of expiratory stridor

A

Tracheal or bronchial tree obstruction

  • tracheal stenosis, tracheomalacia
  • anaphylaxis
27
Q

Causes of biphasic stridor

A

Glottic/Subglottic

  • foreign body
  • mass
  • edema
28
Q

Ddx for inverted T-waves

A 
MI
BBB
Strain pattern (LVH)
HOCM
PE
Normal in kids

Normal in lead III otherwise always abnormal!

29
Q

Ddx for jaundice

A

Pre-hepatic (inc production)

  • hemolysis
  • sickle cell, thalassemia, G-6PD etc
  • absorption of hematoma

Hepatic

  • ischemia
  • antibiotics (tetracycline, isoniazid, sulfa)
  • acetaminophen
  • steroids
  • OCPs
  • etOH
  • infection, hepatitis

Post-hepatic
- obstruction from stone, stricture or atresia

H&P –> recent medications, LFTs, CBC, ultrasound

Unconjugated

  • hemolysis
  • hemglobinopathies
  • hematoma
  • Dubin-Johnson, Crigler najaar

Conjugated
- most everything else intra-hepatic or post-hepatic d/t blockage

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