Differentials and Ix Flashcards
SOB differentials acute
- PE
- Pneumothorax
- Asthma/COPD
- Pneumonia
- Acute HF
- ACS
Ix for SOB
BOXES
Bloods: • FBC, U&E, CRP • D-Dimer to rule out PE • Blood culture if pyrexic • ABG
Orifice tests:
• Sputum
X-rays:
• CXR
ECG
Special:
• CTPA for PE
chest pain acute differentials
3Ps, 2As
1. ACS 2. PE 3. Aortic dissection 4. Pnuemothorax 5. Pneumonia
Chest pain ix
BOXES - Bloods - trop, FBC, WBC, CRP
CXR
ECG
CTPA (PE), CT angio (aortic dissection)
Abdo pain differential generalised
Generalised:
1. Peritonitis 2. AAA 3. Ischemic bowel 4. Medical causes (DKA, pneumonia, MI, Addisonian crisis)
RUQ abdo pain differentials
Hepatitis, cholecystitis
LUQ abdo pain differentials
LUQ:
1. Peptic ulcer 2. Pancreatitis
Abdo pain ix
BOXES
Bloods: • FBC, CRP, U&E • LFTs, amylase • INR • Glucose • VBG (lactate)
Orifice tests:
• Urine dip
• Urine beta HCG
Xrays:
• Erect CXR
• AXR if SBO
ECG
Special test:
• FAST scan for AAA
• USS/CT abdo
Red eye differentials
Differentials: • Conjunctivitis • Corneal ulcer • Iritis • Episcleritis • Scleritis • Acute angle closure glaucoma • Age related macular degeneration • Diabetic Retinopathy
Sudden loss of vision painless differentials
Central retinal artery occlusion:
• Sudden painless loss of vision
• Cherry red spot on a pale retina
Central retinal vein occlusion:
• Causes - glaucoma, polycythemia, HTN
• Severe retinal hemorrhages on fundoscopy
Retinal detachment:
• Flashes of light
• Floaters
• Curtain being drawn, tunnel vision to central vision.
Goitre differentials
Non neoplasm:
Single nodule - colloid, cyst
Multinodular goitre
Neoplasm:
• Benign:
○ Adenoma
• Malignant:
○ Papillary adenocarcinoma - hx of irradiation
○ Follicular carcinoma - mets to bone and lungs
Medullary carcinoma - seen in MEN syndrome
Neck lump differentials
Reactive lymphadenopathy - hx of local infection
Lymphoma - rubbery + painless, night sweats
Thyroid swelling - moves up on swallowing
Thyroglossal cyst - midline. Moves upwards with protrusion of tongue
Branchial cyst - mobile cyst between SCM and pharynx
Cervical rib - adult females
Carotid aneurysm - pulsatile mass, doesnt move on swallow
Paeds wheeze differentials
Wheeze: • Pneumonia • Asthma • Bronchiolitis • Bronchitis • Cystic Fibrosis • Inhalation of foreign body • Aspiration
Paeds acute cough differentials
Acute Cough: • Upper airways: ○ Rhinovirus ○ Croup ○ Allergy • Lower airways: ○ Asthma ○ Bronchitis, bronchiolitis
Paeds chronic cough differentials
Chronic cough: • Upper airways: ○ Infection - chronic sinusitis, tonsillitis ○ GORD • Lower airways: ○ Asthma ○ Foreign body ○ Bronchiectasis ○ CF • Psychogenic cough
Paeds stridor differentials
Stridor: • Nose and nasopharynx: ○ Inflammation eg rhinitis and sinusitis • Mouth: ○ Tonsillar hypertrophy ○ Foreign body • Larynx: ○ GORD ○ Epiglottitis ○ Abscess ○ Foreign body • Trachea: ○ Tracheomalacia ○ Tracheitis
Syncope differentials
Syncope differentials: • Epilepsy • Narcolepsy • Dizziness without LOC • TIA/Stroke Hypoglycaemia
Neural causes of syncope
• Neural causes:
○ Vasovagal (most common):
§ Severe pain, fear, blood phobia
§ Orthostatic stress eg prolonged standing or in hot places
○ Situational eg micturition, Cough, sneeze
Carotid sinus hypersensitivity - while shaving, tight collar
Postural hypotension causes of syncope
Postural hypotension:
○ Autonomic failure - postprandial, medication, MSA, parkinsons, diabetic neuropathy
Hypovolemia - haemorrhage, addisons, dehydration
Cardiac arrhythmia causes of syncope
○ Long QT
○ Drug induced arrhythmia
AV conduction disease
Structural cardiopulmonary causes of syncope
○ Aortic stenosis
○ ACS
○ Pericardial tamponade
HOCM
Tremor differentials and classification
Classifying tremors:
• Rest - PD (pill rolling, bradykinesia)
• Intention - Cerebellar disease
• Tremor on movement - Essential tremor, thyrotoxicosis, anxiety, drugs (beta agonists)
Acute cough <3wks differentials normal and abnormal cxr
• Normal CXR : ○ bacterial / viral RTI ○ Inhaled foreign body ○ Irritation from fumes • Abnormal CXR: ○ Pneumonia ○ Inhaled foreign body Extrinsic allergic Alveolitis
Chronic cough >8 wks differentials normal and abnormal cxr
• Normal CXR: ○ GORD ○ Asthma ○ ACEi - bradykinin • Abnormal CXR: ○ TB ○ Lung cancer ○ ILD Bronchiectasis
Miosis differentials
pinpoint pupils - Differentials:
• Opioids
• Horners
Pilocarpine
Mydriasis differentials
Mydriasis (blown out pupils) differentials:
• 3rd nerve palsy
• Phaeochromocytoma
• Holmes-Adie pupil - damage to PS innervation of eye by infection
• Topical mydriatics - atropine
• Cocaine and amphetamines
Massive splenomegaly causes
CML,CLL
Malaria
Myelofibrosis
Young - EBV, Haemolytic anaemia
Acute recurrent headaches differentials
migraine, cluster, sinusitis, trigeminal neuralgia
Chronic headache differentials
Increased ICP eg SOL
Tension headache
Analgesia rebound
Single episode headaches differentials
Meningitis
encephalitis
Subarach hemorrhage
Sinusitis
Sensory neuropathies causes
• Diabetes • Alcohol • RA • Drugs • Malignancy B12 deficiency
Motor neuropathy causes
• Guillan Barre
• Motor neurone disease
• Charcot-marie-tooth disease
Lead toxicity
Muscle myopathy causes
Inherited:
• Duchenne’s
• Becker’s
Acquired:
• Cushings
• Hyperthyroidism
• Drugs - statin, steroids
