Differentials

Question 1

Colitis

Answer 1

Infective
- Bacterial (C diff, salmonella, E. Coli)
- Viral (Norovirus, CMV)
- Parasitic (Entomoeba histolytica, Giardia)
Non-infective
- Ischaemic (embolism, thrombosis, low flow state)
- Inflammatory (Crohn’s, UC)
Diversion colitis

Question 2

Large bowel obstruction

Answer 2

Malignancy, diverticulitis

Mechanical
Intramural
- malignancy
- inflammation (Chrons, UC, diverticulitis)
Intraluminal
- Stricture
- faecal impaction
Extraluminal
- Volvulus, pelvic mass
Non mechanical: Functional BO/ pseudo-obstruction

Question 3

SBO

Answer 3

Adhesions, hernias

Extraluminal
- Adhesions
- Hernias
- Volvulus
- Mass lesion
- Meckels
- Intussusception

Intraluminal
- Foreign body
- Gall stone
- Bezoar

Intramural
- Benign: Lipoma, leiomyoma, hamartoma, benign polyp
- Malignant: adenocarcinoma, NET, GIST, lymphoma

Question 4

Neck lump

Answer 4

Most common: reactive LN, benign growth

Infective
- Viral (EBV, CMV, HIV)
- Bacterial (strep, TB)
- Protozoal
- Toxoplasmosis
Non-infective
- Inflammatory (sialadenitis, sarcoidosis)
- Congenital (thyroglossal duct cyst, branchial cleft cyst)
- Neoplastic (lipoma, sebaceous cyst, lymphoma, SCC, BCC, salivary gland tumour, thyroid tumour, melanoma)
- Vascular (carotid body tumour, carotid artery aneurysm)

Question 5

Nipple discharge

Answer 5

*Papilloma
*Duct ectasia
DCIS or breast cancer
Physiological
Galactorrhoea
Pituitary prolactinoma

Question 6

Portal hypertension

Answer 6

Most common: cirrhosis secondary to ETOH, Hepatitis B and C

Pre-hepatic
- PV thrombosis, SV, SMV/IMV thrombosis
Intrahepatic
Presinusoidal
- Schistomiasis
- Sarcoidosis
Sinusoidal
- Cirrhosis (ETOH, hep, PBC, PSC, Wilsons, hemochromotosis)
- Cytotoxic drugs (chemo)
Post sinusoidal
- Veno occlusive disease
Post-hepatic
- Budd Chiari
- Right heart failure
- Constrictive pericarditis

Question 7

Acute liver failure

Answer 7

Drugs (paracetamol, anticonvulsants, cocaine, tricyclics, statins)
Hepatitis (viral or autoimmune)
Wilson disease
Hypoperfusion (cardiac failure, sepsis, vasoconstrictors)
HELLP
Malignancy
Post surgical/ iatrogenic

Question 8

Splenomegaly DD

Answer 8

Infective (EBV, CMV, malaria, TB, hepatitis, hydatid)
Congestive (Portal HTN, PV, SV thrombosis, heart failure)
Malignant (lymphoma, leukaemia, mets, myeloma)
Haematological (sickle cell, hemolytic anaemia)
Inflammatory (Feltys, sarcoid)
Infiltrative (amyloid)