Differentials and workups Flashcards
Basic presentation, differential, and workup for appendicitis?
Vague pain around the umbilicus that becomes sharp and migrates to McBurney’s point. Usually with nausea, vomiting (after pain onset), and fever. Psoas, obturator, and McBurney sign are positive.
Gastroenteritis
Nephrolithiasis
Ovarian cyst or tortion
Crohn disease
CBC, with differential Electolytes Blood culture U/S abdomen CT abdomen
Basic presentation, differential, and workup for acute pancreatitis?
Severe midepigastric pain that radiates to the back and improves when leaning forward. Accompanied by anorexia, nausea, and vomiting. Worse after eating.
Peptic ulcer disease
Cholecystitis
Gastritis
CBC Electrolytes, calcium BUN/Cr Amylase, Lipase ALT, AST, Alkaline phospatase, bilirubin U/S abdomen CT abdomen ECG Upper endoscopy
Basic presentation, differential, and workup for nephrolithiasis?
Colicky, flank pain that radiates to the inguinal region. With nausea, vomiting, hematuria, and CVA tenderness.
Pyelonephritis RCC Appendicitis Diverticulitis Ovarian cyst or torsion
CBC Electolytes, calcium BUN/Cr Blood culture UA urine culture with sensitivities CT abdomen U/S renal KUB x-ray intravenous pyelogram
Basic presentation, differential, and workup for acute cholecystitis?
RUQ abdominal pain that radiates to the right scapula after eating fatty food. Lasts for more than 3 hours. Associated with nausea, vomiting, and fever. Positive Murphy’s sign.
Choledocholithiasis
Peptic ulcer disease
Ascending cholangitis
Hepatitis
CBC, differential Electrolytes AST, ALT, alkaline phosphatase, bilirubin Blood culture U/S abdomen CT abdomen Hepatitis serologies
Basic presentation, differential, and workup for Peptic ulcer disease?
Epigastric pain that is exacerbated or relieved by eating.
Gastritis
GERD
Cholecystitis
Chronic pancreatitis
CBC Electrolytes Amylase, Lipase AST, ALT, alkaline phosphatase, bilirubin Rectal exam with stool for occult blood Upper endoscopy Upper GI series CXR Urea breath test
What is the differential for severe, acute, diffuse abdominal pain?
Peritonitis Bowel obstruction (vomiting) Mesenteric ischemia (pain disproportionate to tenderness)
Basic presentation, differential, and workup for dysphagia?
Difficulty swallowing liquids, solids, or both. ±odynophagia, ±nausea/vomiting
Esophageal stricture
Zenker Diverticulum
Achalasia
Esophagitis
CBC Electrolytes Serum iron, ferritin, TIBC CXR Barium swallow Upper endoscopy Esophageal manometry
Basic presentation, differential, and workup for GERD?
Burning retrosternal chest pain
±sour taste, odynophagia, nocturnal asthma
Esophagitis
Esophageal spasm
Angina
MI
CBC Electorlytes ECG Barium swallow Upper endoscopy Esophageal pH monitoring
Basic presentation, differential, and workup for bloody diarrhea?
Acute: Shigella Salmonella Campylobacter EHEC
Chronic: UC Crohn's Diverticulitis Malignancy
CBC Electrolytes Stool: leukocytes, culture, ova, and parasites, C. diff toxin rectal exam + stool for occult blood CT abdomen p-ANCA, ASCA
Basic presentation, differential, and workup for watery diarrhea?
Lactose intolerance Cryptosporidium C. diff IBS giardiasis amebiasis food poisoning hyperthyroidism
CBC Electolytes Hydrogen breath test Stool leukocytes, culture, ova and parasits, C. diff toxin Rectal exam + stool for occult blood giardia antigen entamoeba histolytica antigen TSH, FT4
What conditions cause mucus in diarrhea?
IBS
colonic adenocarcinoma
polyps
What condtions cause pus in diarrhea?
UC
Crohn’s
Diverticulitis
Basic presentation, differential, and workup for constipation?
Low fiber diet
Colon cancer
Hypothyroidism
Substance abuse
CBC Electrolytes Rectal exam + occult blood TSH Urine toxocology
Basic presentation, differential, and workup for watery dysphagia?
Trouble swallowing
Neurological:
Achalasia
Diffuse esophageal spasm
Mechanical:
Esophageal stricture, possibly malignant
Zenker diverticulum
Left atrial hypertrophy
Other:
Esophagitis
CBC Electorlytes Barium swallow Upper endoscopy Esophageal manometry CXR Serum iron, ferritin, TIBC
Basic presentation, differential, and workup for nausea and vomiting?
Hyperemesis gravidarum gastritis food poisoning idiopathic intracranial hypertension hypercalcemia diabetes mellitus
CBC Electrolytes, calcium, glucose urine hCG UA with culture pelvic exam abdominal U/S
Basic presentation, differential, and workup for blood in the stool?
Melena vs bright red
Colon Ca Hemorrhoids Anal fissure Diverticulosis UC Crohn's Large upper GI bleed
CBC Electrolytes Rectal exam Colonoscopy CT abdomen/pelvis PT, PTT, INR ALT, AST, alkaline phosphatase, bilirubin CEA
Basic presentation, differential, and workup for Upper GI bleed?
Coffee ground emesis, melena, possibly hematochezia
Gastritis Peptic ulcer Esophageal varices Gastric Cancer Mallory-Weiss tear
Electrolytes Rectal exam + occult blood CBC, type and cross AST, ALT, alkaline phosphatase, bilirubin PT, PTT, INR Upper endoscopy
Basic presentation, differential, and workup for headaches?
Tension Migraine Cluster Sinusitis Temporal arteritis Meningitis Subarachnoid hemorrhage Trigeminal neuralgia
CBC Electrolytes CRP ESR CT head LP - opening pressure MRI brain
Basic presentation, differential, and workup for low back pain?
Lumbar muscle strain Disc herniation Lumbar spinal stenosis Vertebral compression fracture Ankylosing spondylitis Osteomyelitis Epidural abscess
Straight leg raise
Xray lumbar spine MRI lumbar spine HLA-B27 CRP ESR
Basic presentation, differential, and workup for jaundice?
Obstructive:
pancreatic cancer
Choledocholithiasis
Liver mets
Hepatocellular:
Hepatitis (viral, alcoholic, hemochromatosis, wilsons)
Right heart failure
Prehepatic:
Hemolysis
Ineffective erythropoesis
glucuronyl transferase deficiency
CBC Reticulocyte count Electrolytes AST, ALT, alkaline phosphatase, bilirubin albumin haptoglobin LDH EBV, CMV, hepatitis serologies Serum iron, ferritin, TIBC Serum ceruplamin Abdominal CT
What is the tetrad of narcolepsy?
Daytime sleepiness
Hypnagogic hallucinations
Cataplexy
Sleep paralysis
Basic presentation, differential, and workup for insomnia?
Stress induced insomnia Caffeine induced insomnia Insomnia with circadian rhythm sleep disorder Insomnia related to major depression OSA Primary hypersomnia Narolepsy
Polysomnoram
Nocturnal pulse ox
EEG
Basic presentation, differential, and workup for night sweats?
Hyperthyroidism Tuberculosis Acute HIV infection Lymphoma Leukemia Pheochromocytoma Carcinoid syndrome
CBC with differential Electrolytes CXR PPD/QuantiFERON Gold Sputum gram stain acid fast HIV antibody 24 hour urine catecholamines 5-HIAA
Basic presentation, differential, and workup for Lightheadedness?
Orthostatic hypotension
- dehydration
- drug induced
Orthostatic vital signs
CBC
Electrolytes
Rectal exam for occult blood
Basic presentation, differential, and workup for vertigo?
BPPV (lasts minutes with movement)
Menieres Disease (20min to hours w/hearing loss tinnitus, +/- N/V or drop attacks
Acoustic neruoma (gradual onset +hearing loss)
Vestibular neuritis (sudden onset +N/V, -hearing loss -tinnitus)
Larynthitis (+N/V, +hearing loss, +tinnitus)
Vertebrobasilar insufficiency (-hearing loss +focal neuro)
Dix-Hallpike manouver Epley manouver CBC Electrolytes MRI/MRA - brain Audiogram VDRL/RPR Electronystagmography
Basic presentation, differential, and workup for deafness?
Conductive:
Cerumen impaction
Otosclerosis
Otitis media
Sensory:
Auditory nerve damage
Labrinthitis
Acoustic neruoma
Audiogram
MRI - brain
CT - head
Weber lateralizes to good side in sensorineural loss
Renne BC>AC in conductive loss on affected side
Basic presentation, differential, and workup for loss of consciousness?
Generalized tonic-clonic seizure Drug-induced orthostatic hypotension Cardiac arrythmia Hypoglycemia Severe aortic stenosis Substance abuse
CBC Electrolytes EEG ECG 24 hour Holter monitor Urine tox CT-head LP-CSF analysis MRI-brain Echocardiogram
Basic presentation, differential, and workup for Numbness/weakness?
Stroke TIA Seizure - Todd's paralysis Guillian-Barre Syndrome Myasthenia Gravis Lambert-Eaton CNS tumor Subdural or epidural hematoma MS
CT - head MRI - brain CBC Electrolytes PT/PTT Carotid doppler EEG ECG Echocardiogram LP - CSF analysis B12 Tensilon test EMG
Basic presentation, differential, and workup for loss of vision?
Retinal artery occlusion
Retinal vein occlusion
Acute angle-closure glaucoma
CBC Electrolytes PT/PTT Flourescein angiogram Carotid doppler Echocardiogram Intaocular tonometry
Basic presentation, differential, and workup for Depression?
Major depression Bipolar I or II Bereavement Dysthymic disorder Hypothyroidism Substance abuse
Beck depression inventory
Urine tox
TSH
What is PH9?
Depressed mood Anhedonia Changes in sleep Changes in appetite Trouble concentrating Decreased energy Psychomotor depression Feelings of guilt or worthlessness Thoughts of self harm
Basic presentation, differential, and workup for confusion and memory loss?
Alzheimer disease Vascular dementia Normal pressure hydrocephalus Lewy body dementia Anterofrontal dementia Depression (pseudodementia) Chronic subdural hematoma B12 deficiency Hypothyroidism Wernicke's Encephalopathy Delerium Intracranial neoplasm
CBC Electrolytes TSH B12 VDRL/RPR CT - head LP - opening pressure, CSF analysis MRI - brain
Basic presentation, differential, and workup for psychosis?
Schizophrenia Schizophreniform disorder Schizoaffective disorder Psychotic disorder due to general medical condition Substance induced psychosis
MSE Urine toxicology CBC Electrolytes TSH Beck depression inventory
Basic presentation, differential, and workup for fatigue and sleepiness?
Depression Hypothyroidism Cancer OSA DM II Anemia Narcolepsy Shift work sleep disorder
Beck depression inventory TSH, fT3, fT4 CBC Electrolytes Urine toxicology Glucose tolerance test HbA1c Nocturnal Pulse ox Polysomnography
Basic presentation, differential, and workup for sore throat?
Viral pharyngitis Bacterial pharyngitis Mononucleosis Acute HIV infection Streptococcal tonsilitis Secondary syphilis Mycoplasma pneumonia Post nasal drip
CBC w/ differential, and peripheral smear Electrolytes Throat culture HIV antibody Monospot test anit-EBV antibodies Rapid strep test ALT,AST,alkaline phosphatase, bilirubin VDRL/RPR Cold agglutinin for mycoplasma
Basic presentation, differential, and workup for cough?
Asthma Bronchitis GERD COPD (or exacerbation) Pneumonia Atypical pneumonia Lung cancer Tuberculosis Heart failure
CBC Electrolytes Sputum gram stain, culture, and acid fast stain PFTs CXR ECG Echocardiogram BNP
Basic presentation, differential, and workup for chest pain?
MI PE Angina Pneumonia Aortic dissection Pericarditis Pleurisy Costochondritis Pneumothorax
ECG CXR CBC Electrolytes CPK-MB + troponin x3 Echocardiogram d-dimer CT-chest CTA-chest US doppler LEs
Basic presentation, differential, and workup for palpitations?
Hyperthyroidism Hypoglycemia Cardiac arrhythmia Panic attack Pheochromocytoma Carcinoid syndrome Substance abuse
CBC Electrolytes TSH, fT4 ECG Blood glucose 24 hour urine catecholamines 5-HIAA Urine toxicology
Basic presentation, differential, and workup for weight loss?
Hyperthyroidism DM Cancer HIV Tuberculosis Anorexia nervosa Malabsorption Substance abuse - dieting drugs
CBC
Electrolytes, glucose
TSH, fT4
Basic presentation, differential, and workup for weight gain?
Hypothyroidism Smoking cessation Drug side effect Cushing syndrome Polycystic ovarian syndrome DM Atypical depression
CBC Electrolytes, glucos TSH 24 hour urine free cortisol Dexamethasone suppression test
Basic presentation, differential, and workup for Neck mass?
Hodgkin’s/Non-Hodgkin’s lymphoma
Tuberculosis
Thyroid nodule
Gastric carcinoma
CBC w/ differential Electrolytes ESR CRP PPD TSH CXR US thyroid Upper endoscopy
Basic presentation, differential, and workup for Hematuria?
UTI Nephrolithiasis Bladder Ca RCC Acute glomerulonephritis Prostate Ca Coagulation disorder Pyelonephritis PKD
Genitourinary exam UA, urine cytology BUN/Cr CBC Electrolytes PT/PTT US renal, bladder Cystoscopy CT - abdomen/pelvis PSA
Basic presentation, differential, and workup for urinary obstruction?
BPH Prostate Ca UTI Bladder Stones RCC
Genitourinary exam Rectal exam PSA CBC Electrolytes Alkaline phosphatase UA, urine culture and cytology US - prostate
Basic presentation, differential, and workup for dysuria?
UTI -urethritis -cystitis -prostatitis -pyelonephritis Nephrolithiasis Prostatitis Chlamydia Gonorrhea
CBC Electrolytes UA, urine culture and sensitivity BUN/Cr Gram stain and culture of discharge Chlamydia and gonorrhea PCR US - renal CT - abdomen/pelvis
Basic presentation, differential, and workup for incontinence?
Stress incontinence Urge incontinence Mixed incontinence Overflow incontinence Functional incontinence UTI DM
CBC Electrolytes, glucose BUN/Cr UA, urine culture urodynamic testing IVP Cystourethroscopy
Basic presentation, differential, and workup for amenorrhea?
Pregnancy Anovulatory cycle Polycystic ovarian syndrome Hyperprolactinemia Premature ovarian failure Thyroid disease Pituitary tumor Ovarian or adrenal malignancy Menopause Sheehan's syndrome Anorexia nervosa
CBC Electrolytes Urine hCG Pelvic exam US - abdomen/pelvis Prolactin TSH LH/FSH Testosterone MRI - brain
Basic presentation, differential, and workup for vaginal bleeding?
Dysfunctional uterine bleeding Coagulation disorder Cervical cancer Molar pregnancy Cervical cancer Molar pregnancy Cervical polyp Endometrial hyperplasia Atrophic endometrium Endometrial polyp Cervicitis Atrophic vaginitis Trauma Ectopic pregnancy Ruptured ovarian cyst Ovarian torsion PID Hypothyroidism Spontaneous abortion
CBC Electrolytes Urine hCG US abdomen/pelvis Pelvic exam Pap smear cervical culture PT/PTT Colposcopy Hysteroscopy Quantitative serum hCG US - abdomen/pelvis
Basic presentation, differential, and workup for vaginal discharge?
Bacterial vaginosis
Candidal vaginitis
Trichomonal vaginitis
Cervicitis - chlamydia, gonorrhea
CBC Electrolytes Pelvic exam Wet mount KOH prep, "whiff test" pH of vaginal fluid Cervical cultures
Basic presentation, differential, and workup for dyspareunia?
Atrophic vaginitis Endometriosis Cervicitis Vaginismus Vulvodynia PID Depression Domestic violence
CBC Electrolytes Pelvic exam LH/FSH Wet mount KOH prep Cervical cultures US - pelvis Endometrial biopsy
Basic presentation, differential, and workup for abuse?
Domestic violence Osteogenesis imperfecta Substance abuse Consensual violent sexual behavior Factitious disorder RAPE
XR - skeletal survey CT - maxillofacial urine toxicology CBC Electrolytes
RAPE Sexual Assault Forensic Evidence collection kit Pelvic exam Urine hCG Wet mount KOH prep Cervical cultures NAAT - chalmydia and gonorrhea Xray skeletal servey HIV antibody Viral hepatitis serologies
Basic presentation, differential, and workup for carpal tunnel?
Carpal tunnel syndrome
Median nerve compression in the forearm or arm
Radiculopathy of C6 - C7 nerve roots
De Quervain’s tenosynovitis
Phalen's manuever Tinel's sign Finklestein's test Nerve conduction studies EMG
Basic presentation, differential, and workup for hip fracture?
Hip fracture
Hip dislocation
Pelvic fracture
X-ray - pelvis/hip CT - hip CBC, type and cross Electrolytes, calcium DEXA scan
Basic presentation, differential, and workup for osteoarthritis of knee?
Osteoarthritis - knee
Pseudogout
Gout
X-ray - knee CBC Electrolytes ESR Uric acid MRI - knee Arthrocentesis and synovial fluid analysis -cell count, gram stain, culture, crystals
Basic presentation, differential, and workup for Septic arthritis knee?
Septic arthritis knee Gout Pseudogout Lyme arthritis Reiter's syndrome Disseminated gonorrhea
CBC Electrolytes PT/PTT Arthrocentesis, synovial fluid analysis -cell count, gram stain, culture, crystals Blood cultures x2 UA, urine culture X-ray knee Uric acid Lyme titers
Basic presentation, differential, and workup for stress fracture?
Foot pain after exercise
Stress fracture
Plantar fasciitis
Foot sprain
X-ray foot
MRI - foot
Bone scan foot
Basic presentation, differential, and workup for tennis elbow?
lateral epicondylitis
Stress fracture
Cozen’s test
X-ray - arm
Bone scan
MRI - elbow
Basic presentation, differential, and workup for golfers elbow?
medial epicondylitis
Little leaguer’s elbow
UCL injury
X-ray - arm
Bone scan
MRI - elbow
Basic presentation, differential, and workup for claudication?
Peripheral vascular disease
Leriche syndrome - aortoiliac occlusive disease
Lumbar spinal stenosis
Ankle-brachial index
Dobbler US of lower extremities
Angiography
MRI lumbar spine
Basic presentation, differential, and workup for DVT?
DVT
Baker’s cyst rupture
Cellulitis
CBC Electrolytes, calcium PT/PTT d-dimer Doppler US lower extremities
Basic presentation, differential, and workup for Left arm pain on exertion?
Angina MI Tendonitis Bursitis Osteoarthritis
ECG CBC X-ray shoulder CXR Echocardiography Stress test
Basic presentation, differential, and workup for Shoulder dislocation?
Shoulder dislocation
Proximal humerus fracture
Rotator cuff injury
Torn labrum
X-ray - shoulder
X-ray - arm
MRI shoulder
Basic presentation, differential, and workup for muscle pain?
Rhabdomyolysis from statins
Polymyositis
Inclusion body myositis
CBC Electrolytes Phosphate Potassium BUN/Cr Calcium Uric acid CPK Aldolase ALT/AST UA Urine myoglobin
Basic presentation, differential, and workup for child with short stature?
Constitutional short stature Growth hormone deficiency Hypothyroidism Chronic renal insufficiency Genetic causes Cystic fibrosis
Physical exam CBC Electrolytes IGF-1 IGFBP-3 GH stimulation test TSH, fT4 X-ray hand US renal/cardiac Sweat chloride test BUN/Cr Karyotype
Basic presentation, differential, and workup for child with behavioral problems?
ADHD Oppositional defiant disorder Conduct disorder Manic episode Hyperthyroidism Adjustment disorder Substance abuse Age appropriate behavior
Physical exam Mental status exam Urine toxicology TSH EEG
Basic presentation, differential, and workup for baby crying for weeks?
Crying or weeks relieved by flatus or eruction
- no vomiting, constipation, or fever
- no change in appetite, weight, or growth
Colic Formula allergy GERD Lactose intolerance Strangulated hernia Testicular torsion
Physical eam
Rectal exam + stool for occult blood
US - abdomen, testicular
Basic presentation, differential, and workup for pink eye?
started in one eye now in both \+mucoid discharge \+itching \+difficulty opening eyes in AM \+photophobia
Bacterial conjunctivitis Viral conjunctivitis Keratitis Uveitis Seasonal allergies
Physical exam Opthalmoscopic exam CBC Electrolytes Discharge cultures Slit lamp exam
Basic presentation, differential, and workup for an infant with colicky abdominal pain and vomiting?
Abdominal pain, with vomiting, bloody stools
Well between episodes
Intussusception Appendicitis Meckel's diverticulum Volvus Gastroenteritis Entercolitis Trauma
Physical exam Rectal exam + occult blood CBC Electrolytes Contrast enema US abdomen CT abdomen
Basic presentation, differential, and workup for child with abdominal pain at convenient times?
Worse in morning better on weekends and holidays Missed school a lot Normal growth and development \+/- Emotional trauma Malingering Somatoform disorder IBS Lactose intolerance Child abuse
Physical exam CBC Electrolytes US - abdomen CT - abdomen Amylase, lipase Stool exam
Basic presentation, differential, and workup for an infant with vomiting?
Pyloric stenosis Partial duodenal atresia GERD Gastroenteritis Hepatitis UTI
Physical exam CBC Electrolytes US - abdomen Barium swallow pH probe Endoscopy
Basic presentation, differential, and workup for a child with constipation?
Hirschprung’s disease
Low fiber diet
Anal stenosis
Hypothyroidism
Physical exam Rectal exam Stool exam culture Barium enema Anorectal manometry Suction rectal biopsy
Basic presentation, differential, and workup for a child with measles?
Fever + rash, not immunized
Rubella Roseola Fifth disease Varicella Scarlet fever Meningitis
Physical exam CBC Viral antibodies/titers Throat swab for cultures CT - head LP - CSF analysis
Basic presentation, differential, and workup for a child with gastroenteritis?
Fever, diarrhea, lethargy, and weakness
Viral gastroenteritis Bacterial gastroenteritis Parasitic gastroenteritis Food poisoning UTI URI Volvus Intussception
Physical exam Stool exam, culture, parasites and ova CBC Electrolytes UA, urine culture AXR
Basic presentation, differential, and workup for neonatal sepsis?
Fever, decreased breast feeding, and lethargy
Neonatal sepsis
Meningitis
Pneumonia
Pyelonephritis
Physical exam CBC Electrolytes Blood culture x2 LP - CSF analysis CXR UA, urine culture
Basic presentation, differential, and workup for a child with acute otitis media?
Fever, ear pulling
URI
Meningitis
Pyelonephritis
Physical exam with otoscopy CBC Blood culture Tympanocentesis + culture LP + CSF analysis UA, urine culture
