Differentials Flashcards
Differentials for LOC
SYNCOPAL: CROC
1. CARDIAC (arrhythmias, structural cardiac pathology causing outflow obstruction - e.g. aortic stenosis, hypertrophic obstructive cardiomyopathy)
- REFLEX (vasovagal, carotid sinus hypersensitivity, situation syncope - e.g. micturition)
- ORTHOSTATIC (dehydration, drugs - e.g. antihypertensives/sympathomimetics, autonomic instability, baroreceptor dysfunction in hypertensive patients
- CEREBROVASCULAR (vertebrobasilar insufficiency, subclavian steal, aortic dissection)
NON-SYNCOPAL
- Intoxication (alcohol/sedatives)
- Head trauma
- Metabolic
- Non-epileptic seizure (psychologically driven)
- Epileptic seizure
- Narcolepsy
Differentials for Headache
SINISTER CAUSES: VIVID
- VASCULAR: Subarachnoid haemorrhage; sub-dural/extra-dural haematoma, cerebral venous sinus thrombosis, cerebellar infarct
- INFECTION: Meningitis, encephalitis
- VISION THREATENING: Acute glaucoma, temporal arteritis, pituitary apoplexy, posterior leucoencephalopathy, cavernous sinus thrombosis
- INTRACRANIAL PRESSURE (raised): SOL (e.g. tumour, abscess, cyst); cerebral edema (trauma, altitude); hydrocephalus; malignant hypertension
- DISSECTION: carotid dissection
NON-SINISTER: tension headache, migraine, sinusitis, medication overuse headache, TMJ syndrome, trigeminal neuralgia, cluster headache
Differentials for Chest pain
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Differentials for Dyspnoea
ACUTE: Acute asthma, pulmonary oedema, pneumothorax, PE, anaphylaxis, foreign body causing obstruction
INTERMEDIATE: exacerbation of COPD, cardiac failure, asthma, respiratory infection, pleural effusion, metabolic acidosis
CHRONIC: COPD, interstitial lung disease, pleural effusion, anaemia, carcinoma
Differentials for Oedema
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Differentials for GI bleeding
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Differentials for weakness
SUDDEN ONSET (seconds-minutes): trauma, vascular insult (stroke, TIA, SAH) SUBACUTE ONSET (hours-days): GBS (progressive autoimmune demyelination), venous thrombosis (progressive blockage of a vein), subdural haematoma (progressive enlargement of the haematoma) CHRONIC ONSET (weeks-months): slow growing tumour, motor neuron disease (progressive degeneration of motor neurons)
Differentials for Falls
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Differentials for Delirium
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Differentials for Dementia
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Differentials for Vertigo
PERIPHERAL: Labyrinthitis, Meniere’s disease, BPPV, acoustic neuroma, vestibular neuronitis
CENTRAL: lesion to brainstem/cerebellum (therefore TIA may cause vertigo)
Differentials for RUQ pain
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Differentials for RIF pain
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Differentials for LIF pain
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Differentials for Flank pain
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Differentials for confusion
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Differentials for stroke
She Hikes Mountains Every Autumn Til December
Seizure Hypoglycaemia Migraine with aura Encephalopathy (Wernicke's/hypertensive) CNS Abscess CNS Tumour Drug toxicity Psychogenic
Differentials for haemoptysis
Bronchitis
Bronchial carcinoma
Bronchiectasis
Pneumonia
Signs of Horner’s syndrome and cause
Ptosis, miosis, anhydrosis, exopthalmos - due to interruption of sympathetic chain in neck/brainstem - commonly due to apical lung tumour interrupting sympathetic chain
Respiratory causes of raised JVP
Cor pulmonale, elevated intrathroacic pressures (acute asthma, tension pneumothorax), SVC obstruction
Causes of clubbing
RESP: carcinoma of bronchus, chronic suppurative lung disease (e.g. CF, empyema, bronchiectasis, lung abscess, fibrosing alveolitis)
CARDIAC: cyanotic heart disease, infective endocarditis
GI: liver cirrhoses, irritable bowel disease
IDIOPATHIC, FAMILIAL
dDx anosmia
URTI (commonest), smoking and increasing age, ethmoid tumours, basal skull fracture, Kallman’s syndrome (hypogonadotrophic hypogonadism).
UML vs. LMN signs
UMN: increased tone, increased reflexes, clonus (sometimes), upgoing plantar (babinki reflex). Extensors disproportionately weaker than flexors in the upper limb, and vice versa in the lower limb.
LMN: decreased tone, decreased reflexes, wasting, fasiculations (sometimes)
