Differentials

Question 1

Chest pain

Answer 1

Cardiac - MI, Angina, aortic dissection
Resp - Pneumonia, PE, pneumothorax
GI - GORD, oesophageal spasm, PUD, ( epigastric pain -> pancreatitis)
MSK - muscular pain

Question 2

Dyspnoea

Answer 2

Cardiac - HF, MI, angina ( stable - on exertion ), anaemia, Aortic stenosis

Resp - Asthma, acute exacerbation COPD, LRTI, Pulmonary Embolism, pneumothorax, ILD, ( chronic - bronchiectasis, TB)

Other - metabolic acidosis, anxiety /panick attack

Question 3

PND and Orthopnoea

Answer 3

Pulmonary oedema due to heart failure
COPD
Asthma

Question 4

Syncope

what would decide the likely differentials

Answer 4

Neurology ( balance, vision, evidence of tongue biting
Cardiac ( chest pain, SOB, palpitations, postural)
Medication related - anxiety, palpitations, is it happening repeatedly since a med was changed? Too much anti-HTN agent?
Metabolic - hypoglycaemia

Question 5

PR bleeding

Answer 5

Age!
older CRC
younger + diarrhoea / abode pain -> IBD ( most likely UC)
Diverticular disease
Haemorrhoids
anal fissures ( UC or crohns)

Bloody diarrhoea - fever? abdo pain? could it be gastroenteritis - shigella, salmonella, campylobacter, VTEC

ask about tenesmus

Question 6

Diarrhoea

Answer 6

IBD
CRC - change in bowel habit
gastroenteritis
flu 
medications

Question 7

Nausea and Vomiting

Answer 7

Pregnancy

GI infection,

Gastric outlet obstruction ( ulcer / inflammation) , SBO, Ileus ( post op)

Cholecystitis, pancreatitis, appendicitis
PUD, erosive gastritis

Cardiac - MI

metabolic - Renal failure, DKA

Question 8

Weight loss

Answer 8

ask about GI - bleeding, colour of stools
crc
ibd - crohns 
tb
malignancy

Question 9

Oedema

Answer 9

HF
Nephrotic syndrome
Liver failure
malnutrition - Crohn’s protein malabsorption

Question 10

Fevers, rigors

Answer 10

• TB
• Myelodysplastic syndrome
• look for splenomegaly
• Hyperthyroidism
• look for other signs
• Pyelonephritis
• dysuria, urinary frequency

Question 11

Haemoptysis

Answer 11

Vascular diseases - e.g. Wegner’s granulomatosis ( look at kidneys for glomerulonephritis)

• bronchitis
• TB
• Lung cancer
• pneumonia

after severe infection and accompanied by a lot of mucosal bleeding - consider DIC - disseminated intravascular coagulation - would have depleted platelets and clothing factors ( check platelet count and PT time, also Ddimer)

• could be a GI bleed haematemesis that has aspirated into the Resp tract

Question 12

haematemesis

Answer 12

Confirm its not haemoptysis

Question 13

Fever

Answer 13

Most common infections in hospital are respiratory tract and UTI