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
