Differentials Flashcards
confusion/memory loss
vascular dementia
Alzheimer’s disease
Normal pressure hydrocephalus
loss of vision
retinal artery occlusion retinal vein occlusion acute angle-closure glaucoma Retinal detachment temporal arteritis
depressed mood
Normal bereavement
Adjustment disorder with depressed mood
Major depressive disorder
Substance-induced mood disorder
psychosis
schizophrenia schizoid or schizotypal personality disorder Schizophreniform disorder Substance-induced psychosis Depression with psychotic features
dizziness
Menier’s disease
Vestibular neuritis
Benign positional vertigo
Orthostatic hypotension due to dehydration
Loss of consciousness
Generalized tonic-clonic seizure Convulsive syncope Substance abuse/overdose Hypoglycemia Vasovagal syncope Stroke PE Cardiac arrhythmia Severe aortic stenosis
numbness/weakness
TIA Hypoglycemia Seizure Stroke Facial nerve palsy
bilateral loss of strength
Guillain-Barre MS Polymyositis Myasthenia gravis Peripheral neuropathy
double vision
Myasthenia gravis
Horner’s syndome
MS
tingling/numbness of thumb
Carpal tunnel syndrome secondary to hypothyroidism Median nerve compression in forearm/arm
Radiculopathy of nerve roots
De Quervain’s tenosynovitis
fatigue
Depression
Adjustment disorder
Hypothyroidism
Anemia
fatigue/insomnia after bad event
PTSD
Depression
Generalized anxiety disorder
Psychotic or delusional disorder
constipation
…
fatigue + weight gain + depression
hypothyroidism
depression
diabetes
fatigue + daytime sleepiness
OSA
hypothyroidism
narcolepsy
Diabetes-like presentation
Diabetes mellitus
Diabetes insipidus
Atypical depression
Primary polydipsia
fatigue after starting night job
shift work sleep disorder
sleep apnea
anemia
Night sweats
TB acute HIV infection Lymphoma Leukemia Hyperthyroidism
hyperthyroidism presentation
Hyperthyroidism
Pheochromocytoma
Carcinoid syndrome
insomnia
Stress-induced insomnia
Caffeine-induced insomnia
Insomnia related to major depressive disorder
sore throat
Infectious mononucleosis Hepatitis Viral or bacterial pharyngitis Acute HIV infection Secondary syphilis
sore throat in injection drug user
HIV Infectious mononucleosis Hepatitis Viral pharyngitis Streptococcal tonsilitis Secondary syphilis
fever + sore throat
Bacterial or viral pharyngitis
Mycoplasma pneumonia
Acute HIV infection
Infectious mononucleosis
SOB + cough + wheezing
Asthma GERD Bronchitis Pneumonitis Foreign body
SOB + productive cough for 3 months over last two years
Chronic bronchitis
Bronchiectasis
Lung cancer
TB
Nonproductive cough following sore throat and runny nose a couple weeks ago
atypical pneumonia reactive airway disease URI-associated cough postnasal drip GERD
cough for 6 months with hemoptysis, dyspnea, weakness, weight loss
lung cancer TB lung abscess COPD vasculitis (GPA) ILD
dyspnea + sputum production for three days in COPDer
COPD exacerbation (bronchitis) Lung cancer Pneumonia URI CHF
SOB + cough + unprotected sex
TB Pneumonia Bronchitis Asthma Acute HIV infection
Cough worse when laying down + improved when propping up on pillows
CHF Cardiac valvular disease GERD Pulmonary Fibrosis COPD Postnasal drip
dyspnea of 6 hrs duration + cough with sputum production
pulmonary edema
CHF
mitral valve stenosis
pneumonia
pneumonia clinical features
Cough Increased sputum production SOB Pleuritic chest pain Fever Chills Weakness
CHF clinical features
paroxysmal nocturnal dyspnea orthopnea dyspnea on exertion fatigue and weight gain cough exercise intolerance increasing abdominal girth lower extremity edema shortness of breath when bending forward.
MI features
dyspnea
diaphoresis
nausea
history of HTN, HLD, smokin
MI differential
MI GERD angina costochondritis aortic dissection pericarditis PE Pneumothorax
chest pain in SCD patient
acute chest syndrome PE pneumonitis MI pneumothorax aortic dissection
GERD differential
GERD
esophagitis
peptic ulcer disease
esophageal spasm
stable angina differential
stable angina
esophageal spasm
esophagitis
pericarditis differential
pericarditis aortic dissection MI costochondritis GERD esophageal spasm
PE differential
PE Pneumonia Costochondritis MI CHF Aortic dissection
PE features
acute onset SOB pleuritic hcest pain tachycardia hypotension tachypnea mild fever
aortic dissection differential
Aortic dissection MI Pericarditis Esophageal rupture Esophageal spasm GERD Pancreatitis
palpitations and diaphoresis in diabetic patient
Hypoglycemia Cardiac arrhythmia Angina Hyperthyroidism Panic atack Pheochromocytoma
panic attack differential
Panic attack GAD Acute stress disorder Specific phobia Hyerthyroidism
palpitations during speeches
Social phobia
Avoidant personality disorder
Generalized anxiety disorder
Panic attack
young woman with episodic palpitations accompanied by lightheadedness and sharp chest pain
MVP
cardiac arrhythmia
panic attack
pheochromocytoma
weight loss + tremor + tachy
Hyperthyroidism Cancer HIV infection Dieting drugs Anorexia nervosa
weight gain after quitting smoking (and otherwise)
Smoking cessation Drug side effect Hypothyroidism Cushing's syndrome PCOS DM Atypical depression
Insulinoma presentation
Tremor Palpitations Anxiety Hunger Proximal muscle eeakness Easy bruising
Dysphagia differential
Esophageal cancer Achalasia Esophagitis Systemic sclerosis Esophageal stricture ALS
Plummer-Vinson syndrome presentation
Dysphagia
Odynophagia
Fatigue
Pika
dysphagia + odynophagia
Esophagitis Systemic sclerosis GERD Esophageal stricture Zenker's diverticulum
Hodgkin’s presentation
night sweats fever weight loss loss of appetite early satiety
sudden onset of colicky right-sided flank pain radiating to testicles
Nephrolithiasis
Renal cell carcinoma
Pyelonephritis
Appendicitis
nephrolithiasis presentation
colicky pain flank pain pain radiating to testicles nausea vomiting hematuria CVA tenderness
pancreatitis presentation differential
pancreatic cancer cholangiocarcinoma acute viral hepatitis acute alcoholic hepatitis Chronic pancreatitis Abdominal aortic aneurysm Peptic ulcer disease
acute pancreatitis differential
Acute pancreatitis Peptic ulcer disease Cholecystitis Gastritis Abdominal aortic aneurysm Mesenteric ischemia Alcoholic hepatitis
cholecystitis differential
Acute cholecystitis Choledocholithiasis Hepatitis Ascending cholangitis Peptic ulcer disease
burning epigastric pain after meal differential
Peptic ulcer disease Gastritis Cholecystitis Chronic pancreatitis Mesenteric ischemia
Severe LUQ abdominal pain
Splenic rupture Kidney stone Rib fracture Pneumonia Perforated peptic ulcer Splenic infarct
intestinal obstruction differential
Small bowel obstruction Small bowel or colon cancer Volvulus Gastroenteritis Food poisoning Ileus Hernia
Dark bowel movement/bloody bowel movement
mesenteric ischemia/infarction Diverticulitis PUD Gastroenteritis acute pancreatitis cholecystitis
severe RLQ pain in young woman
ovarian torsion appendicitis nephrolithiasis ectopic pregnancy ruptured ovarian cyst pelvic inflammatory disease Bowel infection or perforation
diverticulitis differential
Diverticulitis Crohn's disease Ulcerative colitis Gastroenteritis Abscess
young male with severe RLQ abdominal pain
Acute appendicitis Gastroenteritis Crohn's disease Nephrolithiasis Perforation
IBS differential
Irritable bowel syndrome Inflammatory bowel disease Crohn's disease Celiac disease Chronic pancreatitis
pelvic inflammatory disease differential
Pelvic inflammatory disease Endometriosis Dysmenorrhea Vaginitis Cystitis Spontaneous abortion
constipation differential
Low-fiber diet Depression Substance abuse (heroin) Irritable bowel syndrome Hypothyroidism
infectious diarrhea differential
Infectious diarrhea
Food poisoning
Traveler’s diarrhea differential
Traveler's diarrhea Giardiasis Amebiasis Food poisoning Hepatitis A
coffee-ground emesis + epigastric pain
Bleeding peptic ulcer
Gastritis
Gastric cancer
Esophageal varices
blood in stool differential
colorectal cancer anal fissure hemorrhoids diverticulosis ischemic bowel disease angiodysplasia IBD
painless hematuria differential
Bladder cancer Renal cell carcinoma Nephrolithiasis Acute glomerulonephritis Prostate cancer Coagulation disorder Polycystic kidney disease
BPH differential
BPH
Prostate cancer
UTI
Bladder stones
dysuria + discharge + unprotected sex
Urethritis
Cystitis
Prostatitis
pyelo differential
Acute pyelonephritis
Nephrolithiasis
Lower UTI (cystitis, urethritis)
Renal cell carcinoma
urinary leakage differential
Stress incontinence
Mixed incontinence
Urge incontinence
Overflow incontinence
pregnancy differential
pregnancy
anovulatory cycle
Hyperprolactinemia
PCOS/amenorrhea differential
PCOS
Thyroid disease
Hyperprolactinemia
Pregnancy
menopause differential
Menopause
Pregnancy
Pituitary tumor
Thyroid disease
Sheehan’s syndrome presentation
amenorrhea cold intolerance coarse hair weight loss fatigue
amenorrhea in young woman differential
Anorexia nervosa
Pregnancy
Hyperthyroidism
Anxiety-induced amenorrhea
vaginal bleeding history
- pre vs. post menopausal
- status
- duration
- amount
- menstrual history and relation to last menstrual period
- associated discharge
- pelvic or abdominal pain
- urinary symptoms
- trauma
- medications (especially blood thinners, contraceptives)
- history of easy bleeding or bruising
- history of abnormal pap smears
differential for prolonged, excessive, irregular bleeding
- dysfunctional uterine bleeding
- coagulation disorder
- cervical cancer
- molar pregnancy
vaginal bleeding in post-menopause differential
endometrial cancer cervical cancer atrophic endometrium endometrial hyperplasia endometrial polyp
postcoital bleeding differential
cervical cancer
endometrial cancer
cervical polyp
cervicitis
vaginal bleeding in pregnant patient differential
spontaneous abortion
ectopic pregnancy
molar pregnancy
left lower abdominal pain in female differential
ectopic pregnancy
ruptured ovarian cyst
ovarian torsion
PID
grayish-white, foul-smelling vaginal discharge differential
Bacterial vaginosis
Candidal vaginitis
Trichomonal vaginitis
Cervicitis (chlamydia, gonorrhea)
painful intercourse differential
Atrophic vaginitis
Endometriosis
Cervicitis
Domestic violence
dyspareunia + dysmenorrhea differential
Endometriosis Cervicitis Vaginismus Vulvodynia PID domestic violence
Domestic violence differential
Domestic violence
Osteogenesis Imperfecta
Substance abuse
Rape differential
Rape
Domestic violence
Lupus differential
SLE
RA
Psoriatic arthritis
Parvovirus B19 infection
young person with joint pain
RA
SLE
Disseminated gonorrhea
Arthritis associated with IBD
changes associated with pregnancy
polyuria
breast tenderness
nausea/morning sickness
constipation
murphy’s sign
ask pt to breathe out – place the hand below the costal margin on the right side at the mid-clavicular line (the approximate location of the gallbladder) – tell patient to breathe in – positive if pt stops breathing in and whinces (gallbladder comes in contact with examiner’s fingers)
Mcburney’s point
have patient lay supine – place hand one-third of the distance from the anterior superior iliac spine to the umbilicus (navel) –
ROS frame
Head to Toe Constitutional HEENT CV PULM GI GU MSK DERM Neuro Psych Endocrine
constitutional ROS
weight loss
night sweats
fatigue/malaise
sleeping appetite fever
HEENT ROS
Vision changes HA Double vision Runny nose Nose bleeds sinus pain Ear pain sore throat odynophagia
CV ROS
chest pain PND orthopnea edema palpitations faintness LOS
Pulm ROS
cough sputum wheeze hemoptysis SOB Exercise intolerance
GI ROS
abdominal pain weight loss dysphagia indigestion bloating/cramping anorexia N - V diarrhea/constipation obstipation hematemesis BRBPR melena
GU ROS
incontinence dysuria hematuria nocturia polyuria Genital -- discharge pain with urination, menstruation use of pads/tampons duration LMP contraception
MSK ROS
pain, stiffness, joint swelling, ROM, crepitus, arthritis
Neuro ROS
sight, smell, hearing, taste seizures faints HA numbness/paresthesias weakness speech problems
psych ROS
depression sleep anxiety concentrating energy personality
inability to use leg
Hip fracture
Hip dislocation
Pelvic fracture
fever + joint pain
Septic arthritis
Gout
Pseudogout
Lyme arthritis
right foot pain related to overuse
stress fracture
plantar fasciitis
foot sprain or strain
plantar fasciitis differential
plantar fasciitis
heel fracture
pain in both legs induced by walking and relieved by rest differential
peripheral vascular disease
Lumbar spinal stenosis
Osteoarthritis
DVT differential
DVT
baker’s cyst rupture
cellulitis
Superficial venous thrombosis
shoulder dislocation differential
shoulder dislocation
fracture of the humerus
rotator cuff injury
crampy muscle pain + fatigue + dark urine
rhabdomyolysis due to statins
polymyositis
Inclusion body myositis
low back pain differential
Disc herniation Lumbar muscle strain vertebral compression fracture Lumbar spinal stenosis Peripheral vascular disease
fever + lethargy in infant differential
neonatal sepsis
meningitis
pneumonia
gastroenteritis in kid differential
gastroenteritis
food poisoning
volvulus
intussusception
infant spitting up milk
pyloric stenosis
GERD
gastroenteritis
hirschprung’s differential
Hirschprung’s
Low-fiber diet
anal stenosis
hypothyroidism
bloody stools + abdominal pain in infant
intussusception appendicitis Meckel's diverticulum volvulus gastroenteritis
kid with abdominal pain worse at school
somatoform disorder
malingering
IBS
persistent crying differential
colic
formula allergy
GERD
pink eye differential
Bacterial conjunctivitis
Viral conjunctivitis
Keratitis
short kid + lack of sexual development differential
Constitutional short stature
Growth hormone deficiency
Hypothyroidism
ADHD differential
ADHD Oppositional defiant disorder Conduct disorder Adjustment disorder Substance abuse Age-appropriate behavior
orders for headache workup
ESR
CT-head
MRI-brain
temporal arteritis orders
ESR
CRP
Temporal artery biopsy
sinusitis differential
Sinusitis
Migraine
Tension headache
Meningitis
subarachnoid hemorrhage differential
SAH
Migraine
Meningitis
Intracranial hemorrhage
meningitis differential
meningitis
migraine
SAH
Encephalitis
SAH orders
Noncontrast CT-head
LP-CSF analysis
CBC
meningitis orders
CT-head
MRI-brain
LP-CSF
pseudotumor orders
urine hCG
CT-head
LP–opening pressure + CSF
dementia orders
CBC VDRL - RPR B12 TSH MRI-brain CT-head LP-CSF
hypoglycemic episode orders
Glucose
CBC
Troponin
ECG
subdural hematoma orders
CT-head
CBC
LP-CSF
pysch disorders orders
TSH
Urine toxicology
BPV order
Dix-hallpike maneuver
orthostatic hypotension order
orthostatic vital signs
BMP
Menier’s disease order
audiogram
electronystagmography
other disorder that can cause positional dizziness
vertebrobasilar insufficiency
seizure workup
BMP Blood glucose Utox EEG CT-head ECG
syncope orders
ECG Holter monitoring CT-head BMP-glucose Echocardiography
TIA-stroke orders
CT-head Fasting lipid panel ECG MRI_brain Doppler US-carotid Echocardiography EEG
GBS-MS orders
LP-CSF MRI-brain,spine nerve conduction studies Edrophonium test (MG) serum B12
carpal tunnel syndrome orders
TSH
Nerve conduction studies
colon cancer orders
Colonoscopy
rectal exam
CBC
(CT abdomen-pelvis)
OSA orders
Nocturnal pulse oximetry
Polysomnography
TSH
DM2 orders
Glucose tolerance test HbA1c UA CBC BMP
TB orders
Quantiferon gold CBC CXR Sputum grain stain, acid-fast stain HIV antibody
pheochromoctyoma orders
24-hour urinary catecholamines
TSH
carcinoid syndrome order
5-HIAA
mono-sore throat orders
Monospot test
Throat culture
HIV antibody test
Anti-EBV antibodies
orders for fever + sore throat
Rapid streptococcal antigen
Throat swab for culture
Monospot test
Cold agglutinin titer for mycoplasma
MI orders
troponin x3
CXR
Echo
d-dimer
acute chest syndrome orders
CBC with reticulocyte count and peripheral smear
GERD-esopaghitis-PUD workup
ECG
Upper endoscopy
stable angina workups
Exercise stress test Cardiac catheterization ECG Troponins CXR
PE order
CTA-chest with IV contrast
Doppler U/S legs
pancreatitis orders
amylase, lipase
what to order for weight loss + fine tremor + tachycardia
TSH + Utox + BMP
what to order for Cushing’s
24-hour urine free cortisol
Hodgkin’s orders
CBC with differential
Lymph node biopsy
Thyroid US
pregnancy orders
Urine hCG
Pelvic exam
Pelvic US
nephrolithiasis orders
KUB
Renal US
CT–abdomen
hepatitis orders
viral hepatitis serologies
PID-endometriosis orders
Pelvic exam US-pelvis Urine hCG CBC UA-Urine culture
constipation orders
rectal exam
TSH
Electrolytes
U toxicology
pseudomembranous colitis order
stool for c diff toxin
lactose interolerance order
hydrogen breath test
bladder cancer order
cystoscopy
CT–abdomen-pelvis
painless hematuria other oder
Genitourinary exam
BPH-prostate cancer orders
PSA US-prostate Rectal exam CBC prostate biopsy
STD-dysuria orders
UA-urine culture
Chlamydia and gonorrhea PCR
Gram stain and culture of discharge
pyelo orders
UA, urine culture and sensitivity
Blood cultures
US-renal
CT-abdomen
incontinence orders
UA-culture
Urodynamic testing
IVP
Cystourethroscopy
impotence differential
Drug-related ED
ED caused by HTN
ED caused by DM
Psychogenic ED
impotence orders
GU exam
Glucose
CBC
Testosterone level
PCOS orders
LH-FSH, TSH, prolactin
molar pregnancy order
pelvic US
endometrial cancer orders
endometrial biopsy-curretage
US pelvics
cervical cancer order
Colposcopy
spontaneous abortion-ectopic pregnancy-molar pregnancy
Urine hCG quantitative serum hCG US-abdomen-pelvis Pelvic exam CBC
vaginal discharge orders
Pelvic exam
Wet mount, KOH prep
vaginal fluid pH
Cervical cultures
order for rape
forensic exam
pelvic exam
SLE orders
ANA, anti-dsDNA, ESR, C4, C4
parvovirus B19 infection
antibody titers for parvovirus B19
gout-psuedogout orders
knee arthroentesis and synovial fluid analysis
uric acid
PVD order
ankle-brachial index
angiography
back pain orders
XR-L-spine
MRI-L-spine
infant with constipation orders
Anorectal manometry Rectal exam Stool exam and culture TSH electrolytes
conjunctivitis orders
Discharge cultures
Slit lamp exam
delayed growth orders
GH stimulation test IGF-1, IGFBP-3 TSH XR-hand Sweat chloride testing
cholecystitis clinical features
after eating fatty food colicky nausea vomiting fever on exam
choledocholothiaisis presentation
jaundice
endometrial cancer
abdominal-pelvic pain abdominal distention bloating early satiety change in bowel-bladder function
retinal artery occlusion presentation
sudden painless, monocular vision loss or degradation
lung cancer presentation
dyspnea
persistent cough
wheezing
hemoptysis
schizophrenia features
hearing voices which are often critical or abusive (auditory hallucinations)
articulating strange beliefs (delusions)
disorganized speech and thought (thought disorder)
disorganized social behavior
social withdrawal and loss of will (negative symptoms)
flattened affect
GERD features
- burning behind sternum
- burning worse after meals or in recling position
- eased by antacids
- hoarseness
- throat clearing
- chronic cough
asthma features
cough
chest tightness
wheezing
dyspnea
OSA features
insomnia snoring awakenings excessive daytime sleepiness decreased concentration and memory morning HA
Infectious mononucleosis
features
fever pharyngitis fatigue HA abdominal pain nausea vomiting
PCOS
infertility hirsutism acne amenorrhea obesity hair loss
AAA features
smoking
back pain
hematuria
colon cancer presentation
rectal bleeding change in bowel habit fatigue weight loss generalized or localized abdominal pain
meniere’s disease presentation
hearing loss tinnitus fullness vertigo hearing loss
meningitis presentation in infant
neck pain HA fevers poor cry poor feeding altered behavior altered muscle tone signs of respiratory distress seizure oliguria
sepsis in child
fever hypothermia tachypnea abdominal pain with vomiting or diarrhea lethargy, which may be profound altered mental status
Neonatal Jaundice differential
crigjler-najjar
breast milk jaundice
hemolytic disease of newborn
diarrhea in a child
intussusception
gastroenteritits
functional diarrhea
lactase deficiency