Differentials Flashcards
Fever
(From rheum notes)
Rheum:
Systemic JIA, SLE, vasculitis, acute rheumatic fever, sarcoidosis, MCTD
Non Rheum:
Malignancies, infections and post-infectious syndromes, inflammatory bowel disease, periodic fever (autoinflammatory) syndromes, Kawasaki disease, HSP
Arthralgia
(From rheum notes)
Rheum:
JIA, SLE, rheumatic fever, JDM, vasculitis, scleroderma, sarcoidosis
Non Rheum:
Hypothyroidism, trauma, endocarditis, other infections, pain syndromes, growing pains, malignancies, overuse syndromes
Weakness
(From rheum notes)
Rheum:
JDM, myositis secondary to SLE, MCTD, and deep localized scleroderma
Non Rheum:
Muscular dystrophies, metabolic and other myopathies, hypothyroidism
Chest pain
(From rheum notes)
Rheum:
Juvenile rheumatoid arthritis, SLE (with associated pericarditis or costochondritis)
Non Rheum:
Costochondritis (isolated), rib fracture, viral pericarditis, panic attack, hyperventilation
RCH:
Musculoskeletal strains
Respiratory infections with or without cough
Asthma exacerbations
Upper GI or biliary disease
Precordial “catch” - sudden short sharp pains experienced, often on left side of chest, usually in healthy teenagers and young adults. The origin of this pain is unknown.
Anxiety, idiopathic - many children have no organic diagnosis made.
Risk factors predispose to more severe pathologies, e.g. trauma, myocardial ischaemia, PE, pericarditis, dissection
Back pain
(From rheum notes)
Rheum:
Enthesitis related arthritis, juvenile ankylosing spondylitis
Non Rheum:
Vertebral compression fracture, diskitis, intraspinal tumor, spondylolysis, spondylolisthesis, bone marrow–occupying malignancy, pain syndromes, osteomyelitis, muscle spasm, injury
Fatigue
(From rheum notes)
Rheum:
SLE, JDM, MCTD, vasculitis, JIA
Non Rheum:
Pain syndromes, chronic infections, chronic fatigue syndrome, depression
Anaemia
Malar Rash
(From rheum notes)
Rheum:
SLE (classically spares nasolabial folds), JDM
Non Rheum:
Sunburn, parvovirus B19 (fifth disease), Kawasaki disease
Oral ulcers
(From rheum notes)
Rheum:
SLE, Behçet disease (also a/w genital ulcers)
Non Rheum:
HSV infection, PFAPA syndrome
Purpuric rash
(From rheum notes)
Rheum:
Vasculitis, e.g., ANCA-associated vasculitis, HSP
Non rheum:
Meningococcemia, thrombocytopenia, clotting disorders
Gottron papules (flat-topped, erythematous to violaceous papules and plaques found over bony prominences, particularly the metacarpophalangeal joints, the proximal interphalangeal joints, and/or the distal interphalangeal joints)
(From rheum notes)
Rheum:
JDM (juvenile dermatomyositis)
Non Rheum:
Psoriasis, eczema
Arthritis
From Rheum notes
Rheum:
Juvenile idiopathic arthritis, SLE, vasculitis, HSP, MCTD, scleroderma, acute rheumatic fever, reactive arthritis
Non Rheum:
Postviral arthritis, reactive arthritis, trauma, infection, Lyme disease, Kawasaki disease, malignancy, overuse syndromes
Sjogren Syndrome
a. Juvenile recurrent parotitis
i. Intermittent unilateral parotid swelling typically lasting only a few days.
ii. Frequently associated with fever and may undergo remission with puberty
iii. Male predominance, it is seen in the younger children (3-6 yr of age)
iv. Lack of focal lymphocytic infiltrates on biopsy.
b. Eating disorders
c. Infectious parotitis (mumps, strep and staph, EBV, CMV, HIV, parainfluenza, influenza enterovirus)
d. Local trauma to buccal mucosa
Knee pain
(From rheum notes)
Poorly Localised
Patellofemoral pain syndrome Patellar subluxation Osteochondritis dissecans Chronic ACL injury Referred hip pain Referred back pain (L2/L3/L4 radiculopathy) Patellar stress fracture Malignant tumors (eg, osteosarcoma, Ewing sarcoma, and leukemia) Benign tumors
Localised
Osgood-Schlatter disease (tibial tuberosity apophyseal avulsion) Sinding-Larsen-Johansson disease (patellar apophyseal avulsion) Patellar and quadriceps tendinitis Fat pad impingement (Hoffa disease) Bipartite and tripartite patella Prepatellar bursitis
Hip pain
(From rheum notes)
Infectious
Septic arthritis Septic arthritis of the sacroiliac joint Osteomyelitis of femoral head or pelvis Psoas abscess (referred pain) Appendicitis or abdominal/pelvic abscess Discitis (referred pain)
Inflammatory
Transient synovitis JIA Infectious arthritis Postinfectious or reactive Idiopathic chondrolysis of the hip Chronic recurrent multifocal osteomyelitis
Mechanical/Orthopedic
SUFE AVN = Legg-Calvé-Perthes disease AVN = secondary avascular necrosis Femoral stress fracture Muscular strain Iliac apophysitis Snapping iliopsoas tendon Trochanteric bursitis Acetabular labral tear Femoroacetabular impingement
Neoplastic
Osteoid osteoma
Malignant neoplasms, primary or metastatic (eg, leukemia, lymphoma, Ewing sarcoma, etc)
Pigmented villonodular synovitis
Polyuria
Primary polydipsia (increased water intake) Osmotic diuresis e.g. diabetes mellitus Urinary tract - UTI, RTA Post obstructive diuresis Diabetes insipidus
Stroke
Migraine
- evolving/marching symptoms, short, complete resolution, personal/fam hx
- normal imaging
Seizure
- positive symptoms, Todds paralysis
- normal imaging or underlying cause e.g. malformation
Infection
- fever, encephalopathy, gradual onset, meningism
Demyelination
- gradual onset, multifocal, encephalopathy, optic neuritis or TM
Hypoglycaemia
- risk factors, meals, systemic symptoms
HIE (watershed infarction)
- risk factors, bilateral
- bilateral, symmetric restriction diffusion in border zones between major arteries (watershed zones)
Hypertensive encephalopathy (PRES = posterior reversible encephalopathy syndrome) - HTN, bilateral visual symptoms, encephalopathy
Vestibulopathy
- vertigo, imbalance, no weakness, gradual onset
- normal imaging
Inborn error metabolism (IEM)
- pre-existing delays/regressions, multisystem disease, abnormal biochemical profile
Acute cerebellar ataxia
- sudden onset bilateral symmetric ataxia, post viral
- normal imaging
Channelopathy
- syndromic, not localised, gradual
- normal imaging
Alternating hemiplegia
- history of contralateral events, choreoathetosis, dystonia
- normal imaging
Cafe au Lait Macules (CALM)
Definite:
- NF1
- NF2 (less common than NF1)
- McCune Albright
- Ring chromosome syndromes
- Watson syndrome
Questionable:
- Bloom syndrome
- Ataxia telangiectasia
- Tuberous sclerosis
- LEOPARD syndrome
- Russel-Silver syndrome
Seizure
a. Normal phenomenon
i. Jitteriness
ii. Sleep jerks
iii. Daydreaming
iv. Startle reflex
b. Parasomnias/sleep disorders
i. Night terrors
ii. Sleep walking
iii. Narcolepsy/cataplexy
c. Syncope
i. Neurocardiogenic (vasovagal)
ii. Reflex anoxic
iii. Orthostatic
iv. Congenital Heart Disease (AS, tetralogy)
v. Arrythmia
d. Breath-holding (forms of syncope)
i. Cyanotic = hyperventilation + vasovagal syncope
ii. Pallid = reflex anoxic syncope (also vasovagal)
e. Cerebrovascular disorders
i. Ischaemic stroke
ii. ICH
f. Migraine with aura
g. Migraine variants
i. Benign paroxysmal torticollis of infancy
ii. Benign paroxysmal vertigo/vertebrobasilar migraine
iii. Confusional migraine
h. Metabolic
i. Movement disorders
i. Tic
ii. Tremor
iii. Stereotypy
iv. Paroxysmal dyskinesis (dystonia, choreoathetosis)
v. Myoclonus
vi. Benign myoclonus of infancy
vii. Hyperkeplexia
j. Iatrogenic and PICU non-epileptic events
i. Anaesthetic emergence phenomenon
ii. PICU HR and pupillary changes
iii. PICU sedation and emergence movements
iv. Post cardiac bypass myoclonus
v. NICU Brainz and other CFM artefacts
vi. Coning (decorticate, decerebrate, hiccoughs)
Splenomegaly
Anatomical • Cysts • Hamartomas • Polysplenia • Haemangioma
Haematological – hyperplasia
• Acute and chronic haemolysis
• Chronic iron deficiency
• Extramedullary haematopoeisis
Storage disease
• Lipidosis, mucopolysaccharidoses, mucolipidoses, defects in CHO metabolism etc.
Immunological/ inflammatory
• All autoimmune conditions
Infections
• Almost all infections can cause splenomegaly
Malignancies
• Primary – leukaemia, lymphoma, angiosarcoma, Hodgkin
• Metastasis
Other
• Heart failure
• Portal hypertension
Eosinophilia
- Allergic disease – atopic conditions
- Respiratory – eosinophilic pneumonia, ABPA
- GIT – eosinophilic gastroenteritis, allergic colitis, IBD
- Infections – helminthic infection
- Neoplastic – eosinophilic leukemia, Hodgkin disease
- Drug induced
Elevated serum IgE
- Allergic disease – atopic conditions (eczema most common)
- Helminthic infection
- Hyper IgE syndrome
- ABPA
- Wiskott/Aldrich syndrome
- Bone marrow transplant
- Hodgkin disease
- Bullous pemphigoid
- Idiopathic nephritic syndrome
