Differentials For Symptom Histories Flashcards
What are the differentials for loss of consciousness?
ACS
Ventricular arrhythmias
AV block (HB)
Acute AF
CHF
Hypovolaemia
Aortic stenosis
Neurally mediated syncope (precipitated by stimuli)
Orthostatic hypotension
Migraine
Seizure
Uncommon: Aortic dissection Cardiac tamponade PE Long QT syndrome Hypertrophic cardiomyopathy Mitral stenosis Cardiac sarcoidosis
Hypoglycaemia
Acute vertebrobasilar stroke
Pseudosyncope (GAD, Depression etc)
Addison’s disease
Ectopic pregnancy
What are the differentials for sudden onset severe abdominal pain with hypotension and poor peripheral perfusion?
Ruptured or leaking abdominal aortic aneurysm
Acute pancreatitis
Biliary colic
Acute cholangitis
Perforated viscus (bowel or gastro/duodenal ulcer)
Acute mesenteric occlusion
Above the diaphragm:
Basal pneumonia
Inferior MI
What are common differentials for chest pain?
ACS Stable Angina Aortic dissection HF Aortic stenosis Pericarditis
Pneumonia
PE
Oesophageal reflux - GORD
Acute pancreatitis
Acute cholecystitis
Gastritis
Costochondritis
Trauma
What are the differentials for a lump in the neck?
Malignant or inflammatory lymphadenopathy
(Inflammatory are painful normally, malignant are more often painless)
Goitre or thyroid cancer (cancer is rare)
Salivary gland lumps (most often parotid lump)
Lipoma
What are common differentials for blood in stools?
Anal fissure Haemorrhoids IBD Anal cancer Colorectal cancer Acute proctitis Gastroenteritis (dysentery)
What are the differentials for constipation?
Primary constipation:
Slow transit constipation
Dyssynergic defecation
IBS
(Due to disordered regulation of colonic and anorectal neuromuscular functions as well as brain-gut neuroenteric disorders)
Secondary constipation:
Metabolic disturbances (hypercalcaemia, hypothyroidism)
Medicines (e.g., opiates, CCBs, antipsychotics)
Neurological disorders (Parkinsonism, spinal cord lesions, diabetes mellitus)
Primary diseases of the colon (stricture, cancer, anal fissure, proctitis).
From outside, then head to toe, what are the differentials for tiredness?
Outside: poor sleep, stressful job, caring for someone/children
Head: Depression
Neck: hypothyroidism, viral illness
Chest: cardiac failure, breast/lung cancer
Abdomen: anaemia (NSAIDS), diabetes, renal failure, liver failure, colorectal cancer
Pelvis: menorrhagia, prostate cancer
Check for anaemia of chronic disease: PMH
What are the differentials for falls with no LOC?
Postural hypotension
Mechanical fall
What are the differentials for fever?
<3 weeks duration : Self-limiting viral infection Uncomplicated bacterial infection (e.g. flu) Meningitis Hepatitis Pancreatitis
>3 weeks duration: TB Abscess Infectious endocarditis Malignancy Autoimmune e.g. vasculitis Drug induced fever (changes in dose/starting new meds)
What are the differentials for rash?
Note: use SOCRATES for rashes
Meningitis Atopic Eczema Psoriasis Contact dermatitis Seborrhoeic dermatitis HUS or TTP Cellulitis Others
What are the differentials for bruising?
Henoch–Schönlein purpura
Thrombocytopenia due to: malignancy, marrow failure, haematological malignancy, uremia, autoimmune disorders.
Haemophilia A or B
Von willebrands disease
Simple trauma
Liver failure: alcoholic liver disease, hepatitis, drug-induced damage.
Drugs: warfarin, aspirin, steroids
Differentials for chest pain?
Stable angina GORD MSK - costochondritis Pneumonia ACS Aortic dissection PE Tension pneumothorax Pericarditis
Angina: Rad to arm/jaw, only assoc SOB (not sweating, nausea or vomiting), pain lasts for 20 mins max at rest and relieved by GTN
GORD: Burning sensation, worse; lying flat/large meals/bending/straining, relief; swallowing water/saliva/antacids, assoc regurgitation and sour taste
Musculoskeletal: localised pleuritic pain, no assoc symptoms, possible hx of trauma
Pneumonia: hx of cough/purulent sputum/malaise/fever, pleuritic pain with assoc haemoptysis/wheeze/SOB, possible hx of respiratory disease
ACS: severe crushing pain WITH SOB/nausea/vomiting/sweating, rad to arm/jaw, hx of angina
Aortic dissection: tearing/ripping pain felt between shoulder blades, hx of traffic accident/HTN, assoc ischemic limbs/stroke/MI
PE: pleuritic pain, assoc SOB/fever/haemoptysis, possible unilateral swollen hot tender leg prev, RFs; malignancy/pregnancy/clotting disorders/long haul flights/surgery
Tension pneumothorax: pleuritic pain and SOB, hx of lung disease or recent chest trauma (including central line insertion)
Pericarditis: pleuritic pain, worse on coughing
Differentials for acute Dyspnoea?
Asthma exacerbation - triggers, diurnal variation
Pneumonia - pleurisy, haemoptysis
Acute pulmonary oedema - orthop
