Differentials

Question 1

Differentials

Melanoma types

Answer 1

Superficial Spreading Melanoma
Lentigo Maligna
Acral Lentiginous Melanoma
Nodular Melanoma

Question 2

Differentials

Headache DDx

Answer 2

Meningitis
SAH / Intracranial Haemorrhage
Tumour
GCA
Migraine
Cluster
Tension
Medication-overuse
Head injury
Sinusitis
Raised ICP
Trigeminal Neuralgia

Question 3

Differentials

Syncope DDx

Answer 3

Vasomotor (postural, vasovagal, drug)
Arrhythmias (VT, SVT, brady/heart block)
Neurological (Seizure, CVD)
Metabolic (low BGL)
Psychological (anxiety)

Question 4

Differentials

Hepatomegaly DDx

Answer 4

Nodular
- NASH / CLD -> Cirrhosis
- Malignancy (secondary > primary)
Tender
- RHF (pulsatile)
- Infection
CTD - Connective Tissue Disorder

Question 5

Differentials

Hepatosplenomegaly or Splenomegaly DDx

Answer 5

CLD + Portal HTN
Haem Malignancies & Disorders
- RC
- WC - LL (A,C, Lymph) & ML (A,C, MDS)
Infection
- HAV, HBV, HVC, EBV, CMV
CTD

Question 6

Differentials

Enlarged Kidney DDx

Answer 6

PCKD
Hydronephrosis
Diabetes
Bilateral RCC
Pyelonephritis

Question 7

Differentials

ID History

Answer 7

Country of Origin
Housing
Immunisations
Contacts
Travels
Occupation
Animals
Drugs
Sexual Hx

Question 8

Differentials

Peripheral Neuropathy DDx

Answer 8

Diabetes
Alcohol
Nutritional (eg B12 deficiency)
Guillain-Barre
Toxic (eg amiodarone)
Heriditary
Endocrine
Recurring (10% of G-B)
Amyloid
Pb (lead)
Idiopathic
Sarcoid
Thyroid

Question 9

Differentials

Diarrhoea DDx

Answer 9

Exudative
Secretory
Osmotic
Malabsorptive
Increased motility

Question 10

Differentials

Haemoptysis DDx

Answer 10

Resp
- Lung Carcinoma
- Pneumonia
- TB
- Bronchiectasis
- Abscess
- PE
- Trauma
CV
- CCF
Haem
- Coagulopathy

Question 11

Differentials

Haemoptysis Ix

Answer 11

Bedside
- Vitals x5, ECG
Bloods
- FBE, CRP, UEC, LFT, COAGs
Sputum sample
- MCS
Radiology
- CXR, CT, Biopsy or bronchoscopy
Others
- VATS - video assisted thoracoscopy + biopsy

Question 12

Differentials

CXR Interpretation

Answer 12

Name, date, orientation, rotation, penetration/quatlity
A – Airways
B – Bones
C – Cardiac silhouette
D – Diaphragm
E – Equal volume
F – Fine detail
G – Gastric bubble
H – Hilum
I – Iatrogenic

Question 13

Differentials

CXR upper lobe opacification DDx

Answer 13

-Right upper lobe bronchopneumonia
(klebsiella , mycoplasma, viral )
- Pulmonary tuberculosis
- Pancoast tumor
- Lung abscess

Question 14

Differentials

Chest Pain DDx

Answer 14

Cardio
- Angina & ACS
- Pericarditis
- Myocarditis
- Arrhythmia
Resp
- Pneumothorax
- PE
GI
- GORD
- Gastritis
- PUD
MSk
- Tietze's syndrome

Question 15

Differentials

Chest Pain Ix

Answer 15

Bedside
- Vitals x5, ECG
Bloods
- FBE, UEC, LFT, Trops, CK-MB
Radiology
- CXR, CT, Angiogram

Question 16

Differentials

Murmur characteristics

Answer 16

Location
Character
Radiation
Manoeuvres

Question 17

Differentials

ECG Interpretation

Answer 17

Introduction
- Confirm patient name & age
- ECG date
Rate
Rhythm - Sinus?
Axis - Deviated?
P wave
- Shape & size
P-R interval
- Prolonged or short (WPW)?
QRS complex
- Width
- Height
- Pathological Q wave (> 1 sm sq wide, > 2mm deep; MI)
ST segment
- Elevation (acute MI, pericarditis)
- Depression (ischaemia, digoxin)
T wave
- Inverted in I,II & V4-V6 (ischaemia, infarction, BBB, ventricular hypertrophy)
- Peaked (hyperkalaemia)
- Flattened (hypokalaemia)
U waves - In hypokalaemia

Question 18

Differentials

STEMI Mx

Answer 18

Short term
- MONAS
- PCI or thrombolysis
- Cardiac monitoring
Long term
- Lifestyle mods
- BB, ACEi, Statin, aspirin / antiplatelet

Question 19

Differentials

CCF CXR Signs

Answer 19

Alveolar oedema
Kerley B lines (interlobular septal lines) Cardiomegaly
Distended upper lobe vessels
Bilateral pleural effusions

Question 20

Differentials

Exacerbation CCF Mx

Answer 20

• Acute – Transfer to ED,

LMNOPP