Differentials Flashcards by Nathalyn Quan

Chronic constipation

C - hirschprung

T - post traumatic stricture; retroperitonela bleed secondary to SX

N -

Infl - ?

Infe - ?

E - hypothyroidism; hyperPTH; DM; hypoK

N - low fiber; high fat

Dr - codeine; Fe; aluminum; nitrates; Ca channel; anti-histamines; laxative abuse

De - fissue; PILES

PSYCH

old age; decreased exercise

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H5 hearing loss in 10 month old

C - Maternal infections (congenital rubella syndrome: Sensorineural HL)

T -

N -

Infl -

Infe - middle ear effusions (transient, conductive HL), neonatal hyperbilirubinemia (cerebral damage)

E -

N -

D - Ototoxic drugs (aminoglycosides- gentamycin; chemo - cisplatin & carboplatin); temporary HL ( ASA, Quinine, loop diuretics- furosemide)

D -

P-

Perinatal jaundice

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H6 hair loss

C - Down’s syndrome

T - post traumatic alopecia

Infl - atopic dermatitis, vitiligo

Infe - tinea capitis, syphilis

E - thyroid disease, androgenetic alopecia

N -

D - telogen effluvium

D - collagen vascular disease

P - stress, trichotillomania

Alopecia areata

Telofen effluvium - metabolic, hormonal, and medications

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H7 feeling a lump in the throat

C -

T -

N - esophageal cancer,

Infe -

Infl -

E - goitre

N - GORD, visceral hypersensitivity, UES problems or esophageal dismotility, cricooharyngeal dysfunction,

D -

Deg-

P - globus pharyngeus

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H22 headache

C - AVM

T - epidural hemorrhage/hematoma

N - brain tumor (pituitary adenoma, etc)

Infe - meningitis, encephalitis

Infl - SLE, temporal arteritis

E - pheochromocytoma

N -

Dr - alcohol withdrawal, recreational drugs

De - Fibromuscular dysplasia,

P -

Migraine, cluster, tension

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H23 neck lump (anterior triangle)

C -

T -

N - lymphoma (hodgkin’s and non- hodgkin’s?), NPCA (post triangle),

Infe - lymph node enlargement,

Infl -

E - giotre,

N -

Dr -

De -

P -

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H25 dysphagia

C -

T -

N - thyroid hyperplasia, esophageal neoplasm, gastric neoplasm

Infe -

Infl - myasthenia gravis

E - thyroid enlargement

N - GORD, benign peptic stricture

Dr -

De - achalasia, zenker’s,stroke

P -

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H26 low back pain

C - gastroschisis?

T - fracture of the lumbar area

N - spinal metastasis, spinal cord neoplasm

Infe - osteomyelitis, septic arthritis, UTI

Inf - cellulitis

E -

N -

Dr -

De - spondylosis (osteoarthritis), intervertebral disc prolapse, arterial occlusive disease

P - fibromyalgia

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Chronic cough

C - cystic fibrosis, a1 antitrypsin deficiency–>centrilobular emphysema

T - foreign body

N- carcinoma (lungs, larynx), vocal nodule

Infl- COPD, asthma, sarcoidosis

Infe- viral, bacterial, fungal, atypical, parasite (ascariasis, filiriasis), chronic bronchitis

E - thyroid enlargement

N- GORD

Dr - ACEI, smoking

De - voice abuse, chronic laryngitis

Psych

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H27 knee pain

C - chondromalacia patellae

T - meniscal tears, fx,

N - bone neoplasia, mets,

Infe - septic arthritis,

Infl - SCFE, Osgood Schlatter disorder

E -

N - gout

Dr -

De - Perthe’s disease, osteoarthritis, patellofemoral syndrome, prepatellar bursitis, dvt, RA, juvenila arthritis,

P -

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H28 increasing abdominal pain

65 yo

C -

T - adhesions,

N - gastric cancer,

Inf - Appendicitis

Inf - crohns, ulcerative colitis

E -

N - GORD, peptic ulcer disease

Dr -

De - mesenteric ischemia,

P -

Cholesystitis

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H29 hematemesis and melena

C -

T - ruptured AAA?,

N - gastric neoplasm with erosion, colin cancer (left),

Infe -

Infl -

E -

N - esophageal tear (Boerhave’s), PUD,

Dr -

De - diverticulitis

P -

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H30 Neonatal jaundice

1st 24H of life:
ABO incompatibility
Rh isoimmunization
G6PD

> 24HOL

CONJUGATED:
biliary atresia

UNCONJUGATED:
breastmilk jaundice

Congenital hypothyroidism

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H32 loud and disruptive behavior of 6 yo boy

C -

T -

N -

Infe - meningitis

Infl -

E -

N -

Dr -

De -

P - oppositional defiant disorder, ADHD, conduct disorder (after ruling out organic causes)

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H33 shakes

C -

T -

N - cerebellar disease

Infe -

Infl -

E - hyperthyroidism

N -

Dr - alcohol withdrawal, drug abuse

De - parkinson’s disease

P - anxiety state

Benign essential tremor

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H35 lethargy

50 female

H emochromatosis/ Hepatitis

Endo: hypothyroidism, DM, Addison’s

M alignancy: pituitary disorder

Infection: infective endocarditis

F atigue sx

A naemia / Atypical pneumonia

D epression/ drugs

S leep apnea

C oeliac disease

N - decreased intake, lack of iodine in diet

lithium and amiodarone –> hypothyroidism

De - RA, early dementia

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H36 Syncope

C -

T - stroke

N - cerebral tumor

Infe - meningitis

Infl -

E -

N - hypoglycemia

Dr - anti- hypertensive drugs

De - postural hypotension, aortic stenosis, TIA, aFib, CHF

P -

Epilepsy

H38 primary amenorrhea

18 yo

C - turner’s (hypergonadotropic hypogonadism), Mayer- Rokitansky-Hauser syndrome ( vaginal agenesis ), Imperforate hymen, Vaginal septum

T -

N - Anterior pituitary prolactinoma

Infe -

Infl -

E - ovarian failure (hypergonadotrpic hypogonadism- inc FSH and LH, low Es), Kallman syndrome (anosmia and pubertal delay), PCOS, thyroid disorder

N - malabsorption and poor nutrition, obesity

Neck lumps

Lymphatic spread from (chest and lungs, abdomen, genitals.

Papillary carcinoma (thyroid)

Systemic lymphoid pathology (hodgkin)

H44 Coma

C - CNS
      C - Ruptured berry aneurysm
      T - head injury (don't move neck)
      N - brain tumor
      Inf - meninggoenceph

O -verdose
Opiates
Barbiturates
Iv

M - etabolic
DM coma
Hypothy (myxedema coma)
Addisonian crisis

A - lcohol
Overdose
Withdrawal
Hep failure

H45 poor distance vision

Myopia

Astigmatism

If on pinhole, no improvement- macular degeneration, glaucoma, cataract

Red eye

Conjunctivitis

Foreign body

Inflammation

Ulceration

Glaucoma

Subconjunctival hemorrhage

H48 fever, maculopapular rash, lymphadenopathy

HIV infection

EBV

CMV

secondary syphillis

Toxoplasmosis

Rubella

HSV

Disseminated gonococcal infxn

Hep A, B, C, D, E

Inf mononucleosis

H67 weakness and urinary symptoms

BPH

Drug induced (thiazides can cause hupoK)

Cancer

H68 aches and pains

Polymyalgia rheumatica Chronic fatigue syndrome Fibromyalgia Polymyositis Carcinoma

H72 dizziness (mid aged man)

C T- subdural hematoma? N- tumor (CPA) infe- Infl- BPPV, neuronitis, acute labyrinthitus, meniere, chronic petrositis E- N- Dr- Deg- stroke, TIA, MS P- Migraine

H73 urinary frequency in a 60 yo man

C T N- Prostate CA, BPH Infe- UTI inlf- Endo- maturity onset DM2 N- Dr- Deg- P-

H111 IDA in 55yo

C - T N - benign or malignant tumor of stomach or large bowel Infe Infl E N- Vit B12 def, peptic ulcer, reflux oesophagitis Dr - NSAID, ASA De P

H117 post partum hge

C T - laceration if genital tract ( vagina, cervix, uterine rupture) N - Infe Infl E N Dr Deg - uterine atony P Others: retained placental fragments, cotyledon, membranes Coagulation disorder

H133 intrauterine growth restriction

kidney disease -->oligohydramnios Congenital anomaly Pre eclampsia Congenital infections (CMV and Toxoplasmosis) Placental dysfunction Lupus APAS

H134 delirium

C T - brain injury, hypoxia N Infe - infection and sepsis Infl Endo - hypoglycemia or hyperglycemia, hyper/hypothyroidism N D - intoxicatio or withdrawal (sedatives, opiates, anesthetics, neuroleptanalgesics, alcohol) Deg P Liver dse, anaemia, uremia, hypo/hypernatremia

H135 chronic diarrhea mid age

C - CF, T N - ca Infe - gastroenteritis Infla- IBS, IBD E - hyperthryroidism N - lactose intolerance, gluten sensitivity (celiac dse) Dr- laxative abuse, antibiotic induced (pseudomembranous colitis) Deg- dumping syndrome, mesenteric ischaeimia P Travel- tropical sprue

H144 nausea and vomiting in first trimester

Hyperemesis gravidarum Multiple gestation UTI Molar pregnancy Other less likely dd's: SBO CEREBRAL tumor Addison's dse

H149 delirium

C T - stroke, peritonitis due to ruptured viscus (diverticulum) N- Infection/sepsis Infl E- hypothyroidism, hypogly N- hypoxia (possible pulmo embo),hypotension, electrolyte abn Dr- opioids, hypnotics?, bzd withdrawal, alcohol, narcotics Deg- cardiac abn, pain, peritonitis (ruptured viscus-- diverticulosis) P

Hypertension

T hyrotoxicosis R enal artery stenosis (bruit) A ortic coarctation (radiofemoral d) C ushing's K idney (PCKD, Glomerulonephritis) P heochromocytoma A ldosteronism (Conn's) D rugs (OCP, NSAIDs, steroids, alcohol) M arfan's

Intermittent fever (karen's) Pyrexia of unknown origin

Travel Sexual hx Lymphoma Inf mono Ebv Tb Malria

Petechiae

ITP HSP MALIGNANCY MENINGGOCOCCEMIA

Postural hypotension

H ypovolaemia (DHN, bleed, hypopit) A ddison's (adrenal gland failure) N europathy (DM) D rugs (vasodilators, antiHTN, TCA, diuretics, antipaychotics) I diopathic orthostatic (geria)

Skin change

Hemochromatosis Addison's disease

Pain to one side of face

C T rauma, mandibular fracture/dislocation N Infe- Acute sinusitis Infl- trigeminal neuralgia, migraine, dental problem, temporal arteritis E N Deg- TMJ dysfxn Dr P