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Respiratory Medicine > Differential Diagnosis > Flashcards

Differential Diagnosis Flashcards

1
Q 
Clinical clue: Predominant cough without lung
function abnormalities

Possible diagnosis?

A

Chronic cough syndromes; pertussis

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2
Q

Clinical clue: Prominent dizziness, light-headedness, peripheral tingling

Possible diagnosis?

A

Dysfunctional breathing

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3
Q

Clinical clue: Recurrent severe asthma attacks without objective confirmatory evidence

Possible diagnosis?

A

Vocal cord dysfunction

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4
Q

Clinical Clue: Predominant nasal symptoms without lung function abnormalities

Possible diagnosis?

A

Rhinitis

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5
Q

Clinical clue: Postural and food-related symptoms, predominant cough

Possible diagnosis?

A

Gastro-oesophageal reflux

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6
Q

Clinical clue: Orthopnoea, paroxysmal nocturnal dyspnoea, peripheral oedema, pre-existing cardiac disease

Possible diagnosis?

A

Cardiac failure

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7
Q

Clinical clue:
Crackles on auscultation

Possible diagnosis?

A

Pulmonary fibrosis

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8
Q

Clinical clue:
Significant smoking history (ie, >30 pack-years), age of onset >35 years

Possible diagnosis?

A

COPD

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9
Q

Clinical clue:
Chronic productive cough in the absence of wheeze or breathlessness

Possible diagnosis?

A

Bronchiectasis; inhaled foreign body; obliterative bronchioitis; large airway stenosis

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10
Q

Clinical clue:
New onset in smoker, systemic symptoms, weight loss, haemoptysis

Possible diagnosis?

A

Lung cancer; sarcoidosis

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11
Q

What questions should you ask when a patient presents with a cough?

A 
Duration? 
Character (e.g. barking/hollow/dry)? 
Nocturnal (asthma, ask about other atopic symptoms, i.e. eczema, hay fever)? 
Exacerbating factors? 
Sputum (colour? how much? 
any blood/ haemoptysis
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12
Q

What questions should you ask when a patient presents with haemoptysis?

A

always think about TB (recent foreign travel?) and malignancy (weight loss?).

Mixed with sputum? (Blood not mixed with sputum suggests pulmonary embolism, trauma, or bleeding into a lung cavity). Melaena? (Occurs if enough coughed-up blood is swallowed).

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13
Q

What questions should you ask when a patient presents with Dyspnoea?

A

Duration? Steps climbed/distance walked before onset?
NYHA classification? Diurnal variation (asthma)

Ask specifically about circumstances in which dyspnoea occurs (e.g. allergen exposure)

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14
Q

What questions should you ask when a patient presents with hoarseness?

A

E.g. due to laryngitis, recurrent laryngeal nerve palsy, singer’s nodules, or laryngeal tumour

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15
Q

What questions should you ask when a patient presents with chest pain?

A

SOCRATES, usually “pleuritic” if respiratory (ie. worse in inspiration?)

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16
Q

What are the main differentials for acute breathlessness?

A

Acute (onset over mins/hours): Acute asthma, exacerbation COPD, pneumothorax, pulmonary embolism, pneumonia, hypersensitivity pneumonitis, upper airway obstruction (inhaled foreign body, anaphylaxis), left heart failure, cardiac tamponade, panic with hyperventilation

17
Q

What are the main differentials for chronic breathlessness?

A

chronic (onset over days/months): Asthma, COPD, diffuse parenchymal lung disease, pleural effusion, cancer of the bronchus/trachea, heart failure, severe anaemia.

18
Q

What are the main differentials of a persistent cough?

A

Postnasal drip, asthma, GORD, post-viral cough, lung airway disease (COPD, bronchiectasis, tumour, foreign body), lung parenchymal disease (interstitial lung disease, lung abscess), Drugs (ACE inhibitors).

19
Q

What are the different characteristics of a cough?

A
  1. Loud, brassy cough - suggests pressure on the trachea e.g. a tumour.
  2. Hollow, “bovine” coughing - associated with recurrent laryngeal nerve palsy
  3. Barking cough - Croup
  4. Chronic cough - pertussis, TB, foreign body, asthma (e.g. nocturnal)
  5. Dry, chronic coughing may occur following acid irritation of the lungs in oesophageal reflux, and as a side-effect of ACE inhibitors
20
Q

What are the main differentials of a wheeze?

A

Anaphylaxis, asthma, bronchiectasis, bronchiolitis, childhood asthma, emphysema, epiglottis, foreign object inhaled, smoking, GORD, heart failure, lung cancer, medications, obstructive sleep apnoea, pneumonia, respiratory tract infection, vocal cord dysfunction.

21
Q

What are the main infective differentials of haemoptysis?

A

TB, bronchiectasis, bronchitis, pneumonia, lung abscess, COPD, fungi (e.g. aspergillosis), viruses (from pneumonitis, cryoglobinaemia e.g. with hepatitis viruses, HIV associated pneumonitis or MAI).. Helmiths: paragonimiasis, hydatid, schistomosomiasis.

22
Q

What are the main groups of differentials for haemoptysis?

A

Infective, neoplastic, vascular, parenchymal, pulmonary hypertension, coagulopathies, trauma/foreign body, pseudo-haemoptysis

23
Q

What are the main vascular differentials of haemoptysis?

A

Lung infarction (PE), vasculitis (ANCA-associated, RA, SLE), hereditary haemorrhagic telangeictasia, AV malformation, capillaritis

24
Q

What are the main parenchymal differentials of haemoptysis?

A

Diffusse interstitial fibrosis, sarcoidosis, haemosiderosis, goodpasture’s syndrome, cystic fibrosis.

25
Q

What are the main coagulopathies differentials for haemoptysis?

A

Any - e.g. thrombocytopenia, DIC, warfarin excess.

26
Q

What are the main cardiac and non cardiac differentials for pleuritic chest pain?

A

Cardiac:

  • IHD
  • coronary artery spasm
  • pericarditis
  • mitral valve prolapse
  • aortic aneurysm/dissection
  • dissecting aortic aneurysm

Non-cardiac:

  • pulmonary embolism
  • oesophageal disease
  • mediastinitis
  • costochondritis
  • trauma
27
Q

What are the main pulmonary and non pulmonary differentials for pleuritic chest pain?

A

Pulmonary:

  • infarction
  • pnuemonia
  • pneumothorax
  • lung cancer
  • mesothelioma

Non-pulmonary

  • Bornholm disease
  • Herpes zoster
  • Trauma (ribs/muscular)
28
Q

What are the main differentials for cough productive of sputum”

A
  • Black carbon specks: smoking
  • yellow/green: suggests infection, e.g. bronchiectasis, pneumonia
  • pink frothy sputum: may be due to malignancy, TB, infection, or trauma, pulmonary infarct or pulmonary oedema.
29
Q

What are the main thoracic differentials for finger clubbing?

A

Thoracic:

  • bronchial lung cancer
  • chronic lung suppuration (discharge of pus) - emphysema, bronchiectasis, cystic fibrosis.
  • fibrosing alveolitis
  • mesothelioma
  • TB
30
Q

What are the main GI differentials for finger clubbing?

A

IBD
Cirrhosis
GI lymphoma
Malabsorption e.g. coeliac

31
Q

What are the main CVS differentials for finger clubbing?

A
  • cyanotic congenital heart disease
  • Endocarditis
  • Atrial myxoma
  • Aneurysms
  • Infected grafts
32
Q

What are the main differentials for unilateral finger clubbing?

A
  • Upper-limb artery aneurysm

* Brachial arteriovenous malformations

Respiratory Medicine (20 decks)

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