- Migraine - Tension - Cluster - SAH (non-contrast head CT, +/- LP, coags) - Intracranial neoplasm, abscess (MRI) - Inc ICP / pseudotumor cerebri (LP - opening pressure) - Meningitis / encephalitis (CBC, LP) - CNS vasculitis (ESR, CRP) - Temporal arteritis (ESR, CRP, biopsy) - TMJ - Trigeminal neuralgia - Carotid or Vertebral dissection (doppler, CT-angio) - Sinusitis (CBC, sinus CT) - HTN - Intracranial hemorrhage (non-contrast head CT) - Intracranial venous thrombosis - Caffeine withdrawal

- Retinal artery occlusion - Acute angle-closure Glaucoma - Retinal vein occlusion - Retinal detachment - Temporal arteritis Work - Up: fluorescein angiogram, tonometry, ECHO, carotid doppler, ESR, CRP, temporal artery biopsy

- MDD - Bipolar disorder I and II - Normal bereavement - Adjustment disorder - PTSD - MDD w/ psychotic features - Schizoaffective - Dysthymic - Cyclothymic - Substance induced depressive disorder Work-Up: Beck's Depression Inventory, CBC, TSH, urine tox screen

- Brief psychotic disorder - Schizophreniform - Schizophrenia - Schizoaffective - MDD w/ psychotic features - Substance induced - 2/2 medical condition - Schizotypal personality disorder Work-Up: CBC, BMP, LFTs, BUN/Cr, alcohol level, urine drug screen, TSH, Dep Inventory

- Meniere's (VDLR/RPR) - Vestibular neuronitis (CBC, audiogram) - Labyrinthitis (CBC, audiogram) - BPV (dix hallpike) - Acoustic neuroma - Orthostatic hypotension (orthostatic vitals, rectal, CBC, electrolytes) - Vertebrobasilar stroke (MRI/MRA) - Brainstem or cerebellar tumor

- Syncope / orthostatics - Seizure - Stroke - Hypoglycemia - Sub Use - MI - PE - Arrhythmia or aortic stenosis Work-Up: EKG, maybe ECHO or Holter monitor, CBC, electrolytes, GLUCOSE, AED levels, drug screen, MI/PE work-up if high suspicion, +/- head imaging

- Stroke /TIA (CBC, elec, CT head, lipids, EKG, ECHO, carotid dopplers, MRI) - GBS (LP, nerve conduction studies) - Polymyositis (CPK) - Myasthenia gravis (acetylcholine receptor antibodies) - MS (VDLR/RPR, ESR, MRI) - ALS - Todd's Paralysis (MRI) - Peripheral neuropathy (Ca, Vit B12, HgbA1c) - Mult Myeloma (SPEP, UPEP) - CNS vasculitis (CRP, ESR) - Syringomyelia (MRI) - Conversion disorder

- Sleep apnea - Insomnia - Depression - Hypothyroid - Anemia - Shift Work Sleep Disorder Work Up: CBC, TSH, polysomnography, Beck's Dep Inventory

- Tuberculosis (PPD, quantiferon gold, CXR, CBC, sputum gram stain and acid fast stain) - Leukemia/ lymphoma - Acute HIV (HIV antibody) - Hyperthyroid (TSH, free T4) - Pheochromocytoma (urine catecholamines ) - Carcinoid (5-HIAA)

- Strep pharyngitis - Viral pharyngitis - Epiglossitis - Retropharyngeal abscess or peritonsillar abscess - EBV - Acute HIV - Postnasal drip 2/2 allergies - Secondary syphilis Work Up: pharyngeal cx, CBC w/ peripheral smear, Monospot, HIV antibodies, VLDR/RPR

- COPD exacerbation (sputum cx, CXR) - Asthma exacerbation (peak expiratory flow measure, pulse ox, CBC, CXR) - PNA (CBC, CXR) - Atypical pneumonia (legionella, mycoplasma IgM) - CHF / pulmonary edema (CXR, ECHO, BNP) - PE (ct angio?) - Pneumothorax (CXR) - MI (ECG, troponin, CXR) - Viral URI - Lung cx - GERD - Pulmonary vasculitis (ANCA) - Pneumonitis - Foreign body in airway (lateral decubitus films or insp/exp films) - Bronchitis - Tb / lymphoma / mets/ HIV / sarcoidosis (PPD, CXR, sputum x with acid fast stain, HIV antibody) - Mitral stenosis, valve disease - Arrhythmia, A fib (ECG)

- PE - PTX - PNA - Cardiac tamponade - MI - Aortic dissection - GERD - CHF exacerbation - Pericarditis, myocarditis - Pancreatitis/ esophagitis/ PUD - Esophageal spasm - MSK / ribs - Herpes zoster - Sickle cell acute chest Work Up: ECG, CXR, trop, d-dimer or CT-angio, CBC (reticulocyte count and smear), electrolytes, possible ECHO, stress test if angina, barium swallow, manometry, EGD w/ H pylori

- A fib, dysrhythmia - Hypoglycemia - Panic attack - Hyperthyroidism - Pheochromocytoma - Carcinoid syndrome - MV prolapse - Sub use Work-Up: EKG, CBC, elec, glucose, TSH, +/- urine catecholamines and 5-HIAA, ECHO and holter if poss MV prolapse, urine tox

- anorexia - depression - chron's / UC / malabsorption - cx - HIV, Tb - Hyperthyroid Work-Up: CBC, TSH, elec, HIV antibodies, quant gold, dep screen, urine tox,

Differential / Work-Up by CC Flashcards by Sarah Hogan

Headache

Migraine
Tension
Cluster
SAH (non-contrast head CT, +/- LP, coags)
Intracranial neoplasm, abscess (MRI)
Inc ICP / pseudotumor cerebri (LP - opening pressure)
Meningitis / encephalitis (CBC, LP)
CNS vasculitis (ESR, CRP)
Temporal arteritis (ESR, CRP, biopsy)
TMJ
Trigeminal neuralgia
Carotid or Vertebral dissection (doppler, CT-angio)
Sinusitis (CBC, sinus CT)
HTN
Intracranial hemorrhage (non-contrast head CT)
Intracranial venous thrombosis
Caffeine withdrawal

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Confusion / Memory Loss

Az
Lewy body dementia
Vascular dementia
Depression
Normal pressure hydrocephalus
Frontotemporal dementia
Intracranial hemorrhage
CJD (brain biopsy)
Neuro-syphilis or HIV dementia
Hypothyroid, B12 def
TIA (ECHO, ECG, head imaging)
Hypoglycemia

Work-Up: CBC, BMP, VLDR/RPR, B12, TSH, CT head +/- MRI, depression screen, LP with opening pressure if normal pressure hydrocephalus

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Vision Loss

Retinal artery occlusion
Acute angle-closure Glaucoma
Retinal vein occlusion
Retinal detachment
Temporal arteritis

Work - Up: fluorescein angiogram, tonometry, ECHO, carotid doppler, ESR, CRP, temporal artery biopsy

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Depression

MDD
Bipolar disorder I and II
Normal bereavement
Adjustment disorder
PTSD
MDD w/ psychotic features
Schizoaffective
Dysthymic
Cyclothymic
Substance induced depressive disorder

Work-Up: Beck’s Depression Inventory, CBC, TSH, urine tox screen

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Psychosis

Brief psychotic disorder
Schizophreniform
Schizophrenia
Schizoaffective
MDD w/ psychotic features
Substance induced
2/2 medical condition
Schizotypal personality disorder

Work-Up: CBC, BMP, LFTs, BUN/Cr, alcohol level, urine drug screen, TSH, Dep Inventory

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Dizziness

Meniere’s (VDLR/RPR)
Vestibular neuronitis (CBC, audiogram)
Labyrinthitis (CBC, audiogram)
BPV (dix hallpike)
Acoustic neuroma
Orthostatic hypotension (orthostatic vitals, rectal, CBC, electrolytes)
Vertebrobasilar stroke (MRI/MRA)
Brainstem or cerebellar tumor

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LOC

Syncope / orthostatics
Seizure
Stroke
Hypoglycemia
Sub Use
MI
PE
Arrhythmia or aortic stenosis

Work-Up: EKG, maybe ECHO or Holter monitor, CBC, electrolytes, GLUCOSE, AED levels, drug screen, MI/PE work-up if high suspicion, +/- head imaging

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Numbness/Weakness

Stroke /TIA (CBC, elec, CT head, lipids, EKG, ECHO, carotid dopplers, MRI)
GBS (LP, nerve conduction studies)
Polymyositis (CPK)
Myasthenia gravis (acetylcholine receptor antibodies)
MS (VDLR/RPR, ESR, MRI)
ALS
Todd’s Paralysis (MRI)
Peripheral neuropathy (Ca, Vit B12, HgbA1c)
Mult Myeloma (SPEP, UPEP)
CNS vasculitis (CRP, ESR)
Syringomyelia (MRI)
Conversion disorder

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Fatigue / Sleepiness

Sleep apnea
Insomnia
Depression
Hypothyroid
Anemia
Shift Work Sleep Disorder

Work Up: CBC, TSH, polysomnography, Beck’s Dep Inventory

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Night Sweats

Tuberculosis (PPD, quantiferon gold, CXR, CBC, sputum gram stain and acid fast stain)
Leukemia/ lymphoma
Acute HIV (HIV antibody)
Hyperthyroid (TSH, free T4)
Pheochromocytoma (urine catecholamines )
Carcinoid (5-HIAA)

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Sore Throat

Strep pharyngitis
Viral pharyngitis
Epiglossitis
Retropharyngeal abscess or peritonsillar abscess
EBV
Acute HIV
Postnasal drip 2/2 allergies
Secondary syphilis

Work Up: pharyngeal cx, CBC w/ peripheral smear, Monospot, HIV antibodies, VLDR/RPR

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Cough/ SOB

COPD exacerbation (sputum cx, CXR)
Asthma exacerbation (peak expiratory flow measure, pulse ox, CBC, CXR)
PNA (CBC, CXR)
Atypical pneumonia (legionella, mycoplasma IgM)
CHF / pulmonary edema (CXR, ECHO, BNP)
PE (ct angio?)
Pneumothorax (CXR)
MI (ECG, troponin, CXR)
Viral URI
Lung cx
GERD
Pulmonary vasculitis (ANCA)
Pneumonitis
Foreign body in airway (lateral decubitus films or insp/exp films)
Bronchitis
Tb / lymphoma / mets/ HIV / sarcoidosis (PPD, CXR, sputum x with acid fast stain, HIV antibody)
Mitral stenosis, valve disease
Arrhythmia, A fib (ECG)

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PE
PTX
PNA
Cardiac tamponade
MI
Aortic dissection
GERD
CHF exacerbation
Pericarditis, myocarditis
Pancreatitis/ esophagitis/ PUD
Esophageal spasm
MSK / ribs
Herpes zoster
Sickle cell acute chest

Work Up: ECG, CXR, trop, d-dimer or CT-angio, CBC (reticulocyte count and smear), electrolytes, possible ECHO, stress test if angina, barium swallow, manometry, EGD w/ H pylori

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Palpitations

A fib, dysrhythmia
Hypoglycemia
Panic attack
Hyperthyroidism
Pheochromocytoma
Carcinoid syndrome
MV prolapse
Sub use

Work-Up: EKG, CBC, elec, glucose, TSH, +/- urine catecholamines and 5-HIAA, ECHO and holter if poss MV prolapse, urine tox

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Wt Loss

anorexia
depression
chron’s / UC / malabsorption
cx
HIV, Tb
Hyperthyroid

Work-Up: CBC, TSH, elec, HIV antibodies, quant gold, dep screen, urine tox,

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Wt Gain

Depression
Hypothyroid
Cushing’s
DM
Smoking cessation
PCOS
Insulinoma

Work-Up: CBC, electrolytes, glucose, 24 hr urine free cortisol, TSH, HgBA1c, insulin level, if suspect PCOS … vaginal US and testosterone level

Dysphagia

achalasia (barium swallow)
esophagitis (candida, CMV, herpes, pills) - HIV antibody
esophageal dysmotility (manometry)
GERD
gastric carcinoma or esophageal carcinoma (CXR, upper endoscopy with biopsy)
MSK (ALS, MG)
CREST
Stricture
Plummer Vinson Syndrome (iron, ferritin, TIBC)
Mitral valve stenosis
Zenker’s diverticulum

Neck Mass

Thyroid cx or nodule
Lymphoma
Tb
Gastric cx

Work -Up: CBC w/ diff, elect, CXR, US thyroid, upper endoscopy, LN biopsy, PPD

N&V

Gastroenteritis
Food poisoning
Pregnancy
Inc ICP
Renal colic
Ovarian or testicular torsion
Volvulus, pyloric stenosis
Appendicits
Hepatitis
UTI/ pyelonephritis
SBO

Work-Up: CBC, elect, urine preg test, pelvic US, UA

Ab Pain

Hepatitis
Gastritis
PNA
GB stones, cholecystitis, cholangitis
Pancreatitis
SBO
Appendicitis
Diverticulitis
Pyelonephritis / UTI
Renal stones
PID
Mesenteric ischemia (ECG)
IBS
Chron’ s / UC
Torsion
Endometriosis, vag infection, ectopic

Work-Up: CBC, electrolytes, UA, hepatitis serologies, amylase, lipase, CT abdomen for stones or diverticulitis, pelvic US (doppler), RUQ US for gallstones, MRCP/ERCP, LFTs, upper endoscopy w/ H pylori testing, colonoscopy, stool studies, urine preg test, cervical cx

Constipation / Diarrhea

SBO (CT abdomen and pelvis)
IBS (CBC, electrolytes)
Low fiber diet
Traveler’s Diarrhea
Hepatitis (viral serologies)
Diverticulitis (CT abdomen)
Colon cx (rectal exam, colonoscopy)
Parasitic infection (stool O&P, stool leuks and cx)
Hypothyroid (TSH)
Depression
C diff (stool toxin)
Lactose intolerance

Upper GI Bleed

Esophageal varices
Boorheaves
PUD / bleeding ulcer
Mallory Weiss Tear
Epistaxis
Gastritis
Esophageal or gastric cx

Work-Up: CBC, type and screen, FOBT, LFTs, coag, upper endoscopy, H pylori

Lower GI Bleed

Colon cx
Diverticulosis
Hemorrhoids
Fissure
Infectious diarrhea
Angiodysplasia
Chron’s / UC
Ischemic bowel

Work-Up: CBC, elec, rectal exam/FOBT, colonscopy, C diff toxin, stool leuks and cx, CT ab and pelvis, coags

Hematuria

Bleeding disorder
UTI
Renal stones
Bladder cx
Menses
Dietary
Polycystic kidney disease
Renal cell carcinoma
Prostate cx
IgA Nephropathy

Work-Up: UA, CBC, coags, renal US, CT abdomen, cystoscopy, rectal & pelevic exam

Other Urinary Sx

- BPH / prostate cx (rectal exam, Cr, trans-rectal US) - Urge incontinence - Stress incontinence - Overflow incontinence - Stricture - Urethritis / cystitis / prostatitis (UA, urethral cx, chlamydia and gonorrhea) For incontinence ... bladder stress test, poss post-void residual, UA + cx

Erectile Dysfunction

- Psych related - 2/2 HTN or DM - Drug induced - Peyronies (plaques & curvature) Work-Up: CBC, elec, glucose, HgBA1c, lipids, genital and rectal exams, testosterone

Amenorrhea

- Preg - Menopause - Anorexia / diet / exercise - Anxiety / PTSD / dep - Hypopituitary / pituitary tumor - Thyroid disease - Anovulatory cycles - Prolactinoma / hyper-prolactin - PCOS - Premature ovarian failure - Asherman's - Sheehan Work-Up: CBC, elec, urine preg, TSH, pelvic exam, pelvic US, prolactin, LH/FSH, testosterone (PCOS), MRI brain if suspect mass / Sheehan's, hysteroscopy for Asherman

Vaginal Bleeding

- Cervicitis - Endometriosis / polyps / hyperplasia - Coagulopathy / VWF - PID / Fitz Hugh Curtis - Cervical cx - Endometrial cx - Spont abortion - Dysfunctional Uterine Bleeding - Ectopic - Molar pregnancy - Atrophic vaginitis - Ruptured ovarian cyst - Trauma Work-Up: pelvic exam, urine preg, CBC, coags, cervical cx, pap smear, colposcopy, HPV testing, LH/FSH/prolactin / TSH, pelvic US, endometrial biopsy

Vaginal Discharge

- Candida - Bac vaginosis - Trich - Cervicitis Work-Up: KOH prep, wet mount, cervical cx, pelvic exam

Dyspareunia

- atrophic vaginitis - menopause - cervicitis - endometrial cx / endometriosis - IPV - vaginismus - PID Work-Up: pelvic exam, cervical cx, LH/FSH, endometrial biopsy, wet mount, KOH prep

Abuse

- IPV - Consensual - Osteogenesis imperfecta - Sub abuse - Rape Work-Up: skeletal survey, forensic exam, urine hcg, wet mount, KOH prep, cervical cx, CBC, HIV, hepatitis

Joint / Limb Pain

- OA - Rheumatoid arthritis - Ankylosing spondylitis - Lyme disease - Polymyalgia rheumatica - SLE - Psoriatic arthritis - Gout - Disseminated gonorrhea - Septic arthritis - Reactive arthritis - Rhabdo - Polymyositits - Inclusion Body Myositis Work-Up: CBC, ESR, CRP, ANA, anti-ds DNA, CCP, RF, X-ray of involved joints, synovial fluid analysis, uric acid, cervical cx (if suspect gonorrhea), lyme titers, CPK, elec, urine myoglobin - Hip frax - Hip dislocation - Plantar fasciitis - Stress frax - Shoulder dislocation v. rotator cuff v. humerus frax Work-Up: CBC, VitD, Ca, X-ray (joint above and below), DEXA, - DVT - Claudication Work-Up: d dimer, lower extremity doppler, ABI's angiography

Lower Back Pain

- Epidural abscess - Sciatica - Ankylosing spondylitis - DJD / disc disease / herniation - Vert compression frax (DEXA) - Lumbar/sacral strain - Spinal stenosis Work-Up: spinal X-ray, MRI imaging only if neuro deficits, pt tenderness or history of cx

Peds Fever

- PNA - Viral URI, bronchiolitis - Meningitis - Bacteremia - UTI - Neonatal sepsis - AOM (otoscope) - Measles, mumps, rubella, Fifth's disease, varicella, scarlet fever, roseola (throat swab?) - Gastroenteritis - Volvulus / intussusception (US) Sepsis Work-Up: CBC, elec, blood cx, UA + cx, CXR, LP

Peds GI

- Pyloric stenosis - Volvulus - Intussusception - Gastroenteritis - Appendicitis - Hirschsprung's / anal stenosis - Functional / somatoform - GERD - Lead poisoning (constipation) - Hypothyroidism - Lactose intolerance - Child abuse - IBS - Torsion / strangulated hernia - Colic Work-Up: CBC, elec, UA, ab US, TSH, lead, amylase, lipase, contrast enema + rectal full thickness biopsy for Hirschsprung's

Peds Short Stature

- GH def - Constitutional - CF - Hypothyroid - Genetic disorder - Malabsorption Work-Up: CBC, elec, IGF-1 levels, TSH, chloride sweat test, karyotype, hand X-ray for bone age determination

Peds Behavioral Issues

- ADHD - Autism spectrum - Oppositional defiant disorder - Conduct disorder - Hyperthyroid - Adjustment disorder - Sub use - Mania Work - Up: TSH, tox screen