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Life Stages > Differentials > Flashcards

Differentials Flashcards

1
Q

Secondary amenorrhea: DDx

A 
Pregnancy
Hyperprolactinemia
Hyperandrogenism/PCOS
Hyperinsulinemia/obesity
Primary ovarian failure
Functional hypothalamic amenorrhea
Endometrial scarring (Asherman's)
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2
Q

Hyperprolactinemia: DDx

A

Hypothyroidism
Dopamine antagonists
Prolactinoma (micro and macro)
Reflex stimulation (chest wall injuries, suckling)

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3
Q

Female infertility: DDx

A

Big categories:

  • Male factor (40-50%)
  • Pelvic disease, e.g. endometriosis (25%)
  • Anovulation, e.g. PCOS (15-25%)
  • Social issues: caffeine, drug use, smoking
**
Pelvic disease (25%)
- PID
- Endometriosis
- Hx of previous surgeries

Anovulation (15-25%): hypothalamic, pituitary, ovarian

  • H: functional hypothalamic amenorrhea
  • P: hyperprolactinemia
  • O: primary ovarian failure
  • PCOS: most common
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4
Q

Male infertility: DDx

A

Big categories:
- Pre-testicular (endocrine), testicular (spermatogenesis defects), post-testicular (sperm transport), idiopathic

40%: varicocele (dilation of spermatic veins in scrotum)

**
Pre-testicular:
- Pituitary tumor
- Kallman's (hypogonadotropic hypogonadism)
- Medications

Testicular:

  • Cancer, chemo, radiation
  • Heat and exposures
  • Genetic causes: Klinefelter’s, Y-chromosome microdeletion

Post-testicular:
- Hypospadias, obstruction, ejaculatory dysfunction

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5
Q

First trimester bleeding in pregnancy: DDx

A 
Spontaneous abortion (threatened, inevitable, incomplete, complete, missed)
Ectopic pregnancy
Molar pregnancy
Normal implantation bleeding
Bleeding from cervix, vagina, rectum

[Affects 25% of pregnancies!]

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6
Q

Short stature in children: DDx

A

Normal variation:

  • Familial short stature
  • Constitutional growth delay

Pathologic variations:

  • Endocrine (GH deficiency, Cushing’s, hypothyroidism)
  • Non-endocrine (congenital heart disease, cystic fibrosis, etc)
  • Genetic syndromes (Turner, Down’s, Prader-Willi, Angelman)
  • Achondroplasia
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7
Q

Tall stature in children: DDx

A

Exogenous:
Obesity
GH excess

Endogenous:
Marfan Syndrome
Klinefelter
Homocystinuria

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8
Q

Obesity in children: DDx

A

If tall stature:

  • exogenous obesity
  • insulin cross reacts with IGF “insulin-like growth factor” –> GH effects

If short stature:

  • endogenous obesity
  • hypothyroidism, Cushing’s, GH deficiency
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9
Q

Failure to thrive in children: DDx

A
  1. Inadequate intake (malnutrition, food insecurity)
  2. Caloric wasting (malabsorption in GI system, vomiting, renal losses)
  3. Increased caloric needs (congenital heart disease, cancer, inborn errors of metabolism)
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10
Q

Delayed puberty: DDx

A

Constitutional growth delay

Hypogonadotropic hypogonadism

  • Kallman
  • idiopathic HH

Hypergonadotropic hypogonadism
- primary testicular/ovarian failure: Klinefelter, Turner

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11
Q

Sexual precocity: DDx

A

“True” precocious puberty

McCune-Albright Syndrome

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12
Q

Elevated PSA: DDx

A

Prostate adenocarcinoma
Benign prostatic hyperplasia
Prostatitis

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13
Q

Mobile, palpable breast masses

A

Fibroadenoma (most common benign tumor)

NOT tumors:
- Nonproliferative breast changes (cyclical “lumpy-bumpy” feeling) - physiologic with hormone level changes

  • Proliferative fibrocystic changes (usual ductal hyperplasia) - no cellular atypia but increased risk of breast cancer
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14
Q

Dysmenorrhea: DDx

A

Endometriosis
Adenomyosis
Primary dysmenorrhea - diagnosis of exclusion

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15
Q

Post-menopausal bleeding: DDx

A

MUST EXCLUDE: endometrial cancer
Endometrial polyps
Chronic endometritis due to endometrial atrophy

Less likely:

  • endometrial hyperplasia
  • leiomyoma (more common in premenopausal women)
  • adenomyosis
  • hormone therapy
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16
Q

Heavy menstrual bleeding: DDx

A

Submucosal leiomyoma (less likely: intramural)
Adenomyosis
Coagulopathy - von Willebrand’s (esp. if younger age)

Others - endometrial conditions:

  • endometrial hyperplasia
  • endometrial cancer
  • endometrial polyps
  • endometritis, pelvic inflammatory disease
17
Q

Intermenstrual bleeding: DDx

A

Polyps
Endometrial cancer
Submucosal leiomyomas (size can cause unstable lining)
Cervical cancer
Endometritis, pelvic inflammatory disease

18
Q

Irregular bleeding: DDx

A

Ovulatory dysfunction

Life Stages (10 decks)

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