Murtagh Diagnoses and Buzzwords Flashcards
pale child + severe colic + vomitting
acute intussusception
prostration and anxiety + intense central pain + profuse vomiting +/- bloody diarrhea
mesenteric arterial occlusion
localised RIF pain + anorexia + nausea + vomitting + gaurding
acute appendicitis
colicky central pain + vomiting + distension + no flatus + spasms for 1 minute
small bowel obstruction
colicky pain hypogastric + distension +/- vomiting
large bowel obstruction
sudden severe continuous epigastric pain + anxious, still, grey, sweaty + deceptive improvement
perforated peptic ulcer
intense loin pain to groin + microscopic haematuria
ureteric clic
severe pain + vomiting + pain radiation (shoulder/scapula)
biliary colic
severe epigastric pain + N/V + relative lack of abdominal signs
acute pancreatitis
acute left iliac fossa pain + left sided radiation + fever
acute diverticulitis
non specific urethritis + conjunctivitis +/- iritis + arthritis
reactive arthritis
arthralgia + purpuric rash +- abdominal pain
Henloch Schoenlein purpura
bruising + oral bleeding + epistaxis
ITP
menorrhagia + bruising + increased bleeding (incisions, dental, mucosal)
von Willebrand disease
spontaneous haemarthrosis + musce bleeds + delayed bleeding
haemophilia A
(unilateral) tinnitus + hearing loss + unsteady gait
acoustic neuroma
acute vertigo + nausea + vomiting
vestibular neuritis
hearing loss + acute vertigo + nausea + vomiting +- tinnitus
acute labyrinthitis
vertigo + vomitting + tinnitus + sensoneural deafness
Meniere syndrome
malaise + anorexia + dyspepsia + weight loss
stomach cancer
loss of appetite + weight + colour
stomach cancer
fatigue + dysphagia + weight loss
oesophageal cancer
headache + vomiting + visual aura
migraine with aura classic
retroorbital headache + rhinorrhea + lacrimation
cluster headache
drowsiness + vomiting + seizure
raised intracranial pressure
occiputal headache + vomiting + neck stiffness
sub arachnoid headache
headache + visual obscurations + nausea
benign intracranial hypertension
fever + upper abdominal pain + jaundice
acute cholangitis
jaundice + constitutional symptoms (malaise anorexia weight loss) + epigastric pain (radiating to back)
pancreatic cancer
myalgia, fever, headaches for 2-3 days, then vesicular rash
adult chicken pox
fever, malaise, anorexia, cough, cory conjunctivitis, then rash first behind ears, then on face, then truck then limbs
measles
pale pink maculopapular rash, starts on face and neck, then trunk and extremities, no prodrome, low fever
Rubella
bright macular rash on face/cheeks circumoral pallor, then maculopapuar rash on limbs, worse with sun,wind, bath
erythema infectiosum/parvovirus/slapped cheek
child 6-18 months
roseola infantum
high fever and runny nose then 3 days later red maclopapular rash mainly on trunk
herpes virus 6
children under 10
hand foot mouth
fever headache malaise, 1-2 days then, vesicles on mouth, gums, hands palms soles
cocksackie
2 days of malaise, fever, sore throat and vomiting
scarlet fever
rash on day 2 blanching starts on neck then cubital fossae, skinfolds, axillae, groin, circumoral pallor, feels like sandpaper, strawberry tongue
strep pyogenes
miserable child, high fever >39 for 5 days not responding to paracetamol
kawasaki disease
high fever headache malaise, orchitis unilateral, parotid swelling
mumps
1 week of coryza, anorexia, conjunctivitis, dry cough, then evere paroxysms at night with post tussive vomit and inspiratory sound
pertussis, whooping cough
proteinuria, generalised oedema, waxy pallor
nephrotic syndrome
discoloured urine, periorbital oedema, oliguria
post strep glomerulonephritis
painful swallow, referred ear pain, hoarseness
pharyngeal cancer
dry eyes, dry mouth, arthritis
sjogrens syndrome
recurrent oral and genital ulcers, uveitis, arthritis
Behcet syndrome
40 yo and over with restricted shoulder movement unilaterally
Rotator cuff syndrome
teenager - sore shoulder
laxity
50 yo with sore shoulder increasingly worse mobility, shoulder pain no good reason
adhesive capsulitis - frozen shoulder
65 over with sore shoulder
arthritis
Choice of imaging for ac joint -
bone scan
choice of imaging for osteoarthritis
xray
imaging for instability in shoulder
mri
choice of imaging for rotator cuff syndrome
uss
non healing otitis externa in diabetic or immunocompromised
malignant otitis externa
Dizziness in bed - multiple attacks - only for minutes
BPPV
Dizziness while standing (not in bed) multiple episodes with no hearing loss -
Migraine with vertigo
Dizziness while standing not postural, multiple episodes with hearing loss, no headache and tinnitus
Meniere’s
Dizziness not postural, single episode for hours to 24 hours – no hearing loss
Vestibular neuronitis
Dizziness not postural, single episode for hours to 24 hours – with hearing loss + DDx
Labyrinthitis DDx cerebellar stroke
returned traveller, abdo pain, fever,chills
malaria
traveller, fever, jaundice, bradycardia
yellow fever
traveller, fever, vomiting, stupor
japanese encephalitis
traveller, painful bite, parasthesia, painful drinking
rabies
traveller, stepladder fever, abdo pain then pea soup diarrhea, bradycardia
typhoid
fever, vomiting, abrupt watery diarrhea
cholera
fever, severe aching, rash, traveller
dengue
fever, pneumonia, myalgia
melioidosis
abdo pain mild, recurrent diarrhea, eosinophilia
strongyloides
angina, blackouts, dyspnoea
aortic stenosis
menstrua dysfunction, obesity, hirsutism
pcos
malaise, night sweats, pruritus
Hodgkin lymphoma
abdo pain, diarrhea, fever
Crohn’s disease
vertigo, vomiting, tinnitus
Meniere’s
fatigue, muscle weakness, cramps
hypokalaemia
fever, rigors, hypotension
septicemia
fever, vomiting, headache
meningitis
fever, drooling, stridor
epiglottitis
headache, vomiting, altered consciousness
suarachnoid haemorrhage
abdo pain, amenorrhea, pv bleeding
ectopic pregnancy
fatigue, dyspnoea on exertion, dizziness
cardiomyopathy
fatigue, weight loss, diarrhea
coeliac disease
anorexia, nausea, faecal leaking, abdo bloating
faecal impaction
abdo cramps, flatulence, profuse diarrhea
giardiasis
lethargy, tiredness, arthralgia
haemochromatosis
lethargy, abdo pains, irritable child
lead poisoning
aching bones, waddling gait, deafness in child
Paget disease
malaise, cough, fever +/- erythema nodosum
sarcoidosis or TB
male child, snorting, blinking, grunts, expletives
Tourettes
fever, sore throat, cervical lymphadenopathy
epstein barr mononucleiosis
fatigue, anorexia, nausea, vomiting, sallow skin
chronic kidney disease
polyuria, polydipsia, skin/orifice infections
diabetes
FUO, cardiac murmur, embolic signs
infective endocarditis
fatigue, polyarthritis, fever or skin lesions
SLE
loin pain, haematuria, palpable loin mass
kidney carcinoma
malaise, weight loss, cough
lung carcinoma
fever, myalgia, headache, non productive cough
atypical pneumonia
malaise, night sweats, painless lymphadenopathy
non Hodgkin lymphoma
arthralgia, Raynauds phenomenon, GORD, skin thickening
systemic sclerosis
fatigue, headache, jaw pain on chewing
temporal arteritis
weakness, back pain, weight loss
multiple myeloma
lethargy, physical mental slowing, constipation
hypothyroidism
resting tremor, rigidity, bradykinesia, postual instability
Parkinson disease
dysarthria, intention tremor, nystagmus
cerebellar disease eg MS
visual disturbance (blurred or transient loss), weakness in limbs +/- weakness in limbs
MS
rigidity, bradykinesia, resting tremor
Parkinsons Disease
tremor (postural/action), head tremor, absence of parkinsonian features
essential tremor
fatiguable weak eyes/lids, limbs and bulbar muscles (speech/swallowing)
myasthenia gravis
weakness of limbs, face and areflexia
Guillaume Barre
dementia, myoclonus, ataxia
Creuzfedt Jakob disease
drowsiness, vomiting, waking headache
raised intercranial pressure
enopthalmos, meiosis, ptosis +/- anhydrosis
horners syndrome
blank spell, lip smacking (or other automation), olefactory/gustatory hallucination
complex partial seizure
gradual spread of focal jerking (mouth,arm,leg) or sensory disturbance or rarely visual field disturbance
simple partial seizure
raised intracranial pressure +/- focal signs +/-seizures
cerebral tumour
dysphagia, dysphonia/dysarthria, spastic tongue
pseudobulbar palsy
recurrent unilateral headache, nausea (+/- vomiting), visual aura
classic migraine with aura
recurrent severe retro-orbital headache, rhinorrhea, lacrimation
cluster headache
instantaneous headache, vomiting, neck stiffness, relapsing consciousness
subarachnoid haemorrhage
young obese female with headache, visual obscurations, papilloedema
benign intracranial hypertension
acute and transient amaurosis fugax/dysphagia/hemiplegia
TIA
temporalis atropy, frontal balding, muscle weakness +/-myotonia and cataracts
myotonic dystrophy
ataxia, opthalmoplegia, areflexia
Miller Fischer variant of GBS
vertigo, postural or on rolling
BPPPV
upper and lower motor neurone signs with fasiculations
motor neurone disease
abdominal pain, palpable rash on legs in child or young adult
Henloch Schonlein Purpura
child with red itchy rash in flexure
atopic dermatitis
crazy paved red rash on legs in 70 yo
asteatotic dermatitis
bizzrre or linear shaped red rash
contact dermatitis
well demarcated plaque on wrist with intense scratching
lichen simplex
thirsty, polyuria, weight loss
DM1
fatigue, palpitations, SOB on exercise
anaemia
microcytic anaemia, Fe and ferritin down, transferrin up
iron deficiency
microcytic anaemia, normal or raised iron and ferritin
thalassemia or sideroblastic anaemia
macrocytic anaemia, with megaloblastic changes
Vit B12/folate deficiency, cytotoxic drugs
macrocytic anaemia, normal B12/folate
liver disease/alcoholism/myelodysplastic
normocytic anaemia
acute blood loss, anaemia of chronic disease, haemolysis
tiredness, husky voice, dry cool coarse skin, large tongue
hypothyroidism
anxiety, weight loss, weakness
thyrotoxicosis
sweating, nasal problems, tight rings/shoes
acromegaly
weakness, polyuria, polydypsia
diabetes insipidus
female with amenorrhea, loss of pubic/axillary hair, breast atrophy
hypopituitarism
male with low libido, impotence, loss of body hair
hypopituitarism
fatigue, anorexia, nasea, vomiting, abdo pain, skin discolouration
addisons disease
thin extremities, muscle weakness, fat face
cushing syndrome
weakness, constipation, polyuria
hypercalcemia
cramps, confusion, tetany
hypocalcemia
malaise weight loss cough
lung cancer
child haematuria, abdo mass, malaise
Wilms tumour
haematuria, loin pain, palpable kidney mass
renal cancer
abdo discomfort, anorexia, abdo bloating/distension over 50 nulliparous woman
ovarian cancer
blood in stool, abdo discomfort, change in bowel habit
colon cancer
jaundice, anorexia, abdo discomfort/pain radiating to back relieved by sitting forward
pancreatic cancer (body/tail)
jaundice, no pain
pancreatic cancer (head)
child with malaise, pallor, bone pain
Acute lymphocytic leukaemia
45 yo with malaise, pallor, oral problems
acute myeloid leukaemia
50 yo with fatigue, night sweats, abdo fullness (or palpable spleen)
Chronic myeloid leukemia
lymphadenopathy, fatigue, weight loss, fever/night sweats in late middle age/elderly
Chronic lymphocytic leukemia
painless cervical lymphadenopathy, malaise, fever/night sweats, pruritus
Hodgkins lymphoma
rubbery lymph nodes, malaise, fever/night sweats
non - Hodgkin lymphoma
older person with weakness, unexplained back pain, susceptible to infection
multiple myeloma
headache, nausea, anorexia, vomiting, ataxia in child
medulloblastoma
fever, extreme malaise, a/n/v, +/- anaemia
neuroblastoma
fever, severe malaise, lymphadenopathy
acute HIV
polyarthritis, fever, rash
Ross River fever
fever unknown origin, cardiac murmur, embolism
endocarditis
Cattle farmer with chronic fatigue, headache and wavering fever
brucellosis
abrupt fever, headache, conjunctivitis
leptspirosis
malaise, a/n/v, confusion +/- oliguria
acute renal failure
5 days of fever, conjunctivitis then swollen hands feet
kawasaki
child with respiratory symptoms, vomiting, mental changes +/- coma/seizure
Reye syndrome
child with pallor, drowsiness, fever
meningitis
child with malaise, fever, flitting plyarthritis, +/- rash, +/- chorea
rheumatic fever
child undr 12 months with drowsiness, cough, wheezing
bronchiolitis
boy under 3 months with weakness, weight loss, severe intermittent vomiting
pyloric stenosis
neonate with drooling, vomit after first feeds, abdo distension
oesophageal or duodenal atresia
child with pallor, malaise, bone pain
acute lymphatic leukemia
child with malaise, pallor, oral problems (gum hypertrophy, bleeding, ulceration)
acute myeliod leukemia
child abdo pain, malar flush, fever, +/- urti
mesenteric adenitis
child with drowsiness, tachypnoea, chest wall recession
pneumonia
child with fever, drowsiness, purpurice rash
meningococcal infection
child with lethargy, drooling, stridor
epiglottitis
child wih urti, diff cough, insp stridor
croup
child wih cough, wheeze, chest wall recession
asthma or foreign body
child with large ears, long narrow face, large genitals
fragile x
child with small extremities, narrow forehead, eating disorder
prader willi
elfin face, low set ears, cardiac murmur
williams syndrome
girl with short neck webbed neck, pigmented naevi +/- cardiac diorder
turners syndrome
child with fuo, abdo mas (haematuria sometimes)
wilms tumour
child ith malaise, vague abdo pain, abnormal behaviour
lead poisoning
child under 2 with lethargy, irratibility, pallor
iron def anaemia or thalassemia major
child with fever, extreme malaise, a/n/v, +/- anaemia
neuroblastoma
child with headache, a/n/v, ataxia
medulloblastoma
teenager with irritability, vague abdo pain, disordered appetite
substance abuse
teenager with mid low back pain, cant touh toes, kyphosis
Scheuermann disorder
adolescent with limp, hp and knee pain
sipped capital femoral epiphysis
fever, rigors, hypotension
septicemia
fever, vomiting, headache
meningitis
fatigue +/- dizziness +/- syncope
cardiac arrhythmia
headache, vomiting, altered consciousness
sub arachnoid haemorrhage
abdo pain, amenorrhea, abnormal vaginal bleeding
ectopic pregnancy
fatigue, dyspnoea on exertion, dizziness
cardiomyopathy
asthma, rhinitis, vasculitis, hypereosinophilia
churg strauss vasculitis
malaie, rhinitis, sinusitis, wheeze, cough
wegeners granulomatosis
male, oral/genital ulcers, knee pain, eye inflammation
Behcets
malaise, painsful shoulder girdle, morning stiffness, over 50 years
polymyalgia rheumatica
fatigue, jaw claudication, headache
temporal arteritis
young-middle aged male; arthralgia, weight loss, fever +/- skin lesions
polyarteritis nodosa
female 40-60, weakness, joint muscle pain, “sun burn” rash with periorbital oedema
dermatomyositis
severe abdo pain, abnormal illness behaviour, red urine
acute intermittent porphyria
microencephaly, retarded growth, facies
fetal alchol syndrome
lanky menm small testes, infertility
klinefelter syndrome
tall stature, dislocated lens, myopia, aortic root dilatation
marfans
facies, Intellectual disability, large testes
fragile X
urinary incontinence, ataxia, dementia
normal pressure hydrocephalus
arthritis of DIP>PIP, base of thumb, 1st mtp, cervical and lumber spine, hips and knees, over 50 yo
osteoarthritis
arthritis of PIP, MCP of hands, wrist, base of toes MTP, symmetrical, 30 - 50 yo female to male 3:1
rheumatoid arthritis
arthritis symmetrical and variable, small joints fingers often slight, female to male 9:1 15-35 yo
SLE
symmetrical arthritis, polyarthritis fingers, 20-50 yo, F:M 3:1
scleroderma
transient arthritis, usually PIPs fingers, children
viral arthropathies
arthritis of sacroiliac, vertebral column esp lumbar, costovertebral, plus knees, hips or ankles, M:F 3:1, 18-30
ankylosing spondylitis
arthritis of DIPs fingers and toes, sacroiliacs
psoriatic arthritis
arthritis of big toe, knee/ankle
gout
liquid uniform stool
small bowel, gastroenteritis
loose stool with bits of faeces
colonic disorder
watery, offensive bubbly stool
giardia
bulky, pale offensive stool
malabsorption
pellets or ribbons stool
ibs
stool: large volume, central pain, borborygmi, undigested food, fat?
small bowel
stool small volume, lower, lif pain, blood, mucous,urgency or tenesmus
colonic cause
sudden sharp chest pain worse on inspiration, sneezing
pleuritis
central crushing chest pain referred to back/shoulder relieved sitting up, worse lying flat
pericarditis
unilaterail knife like chest pain following urti, normal cxr
pleurodynia / Bornholm disease/cocksackie B
sudden, severe, midline pain, inequality in pulses
aortic dissection
retrosternal chest pain, dyspnoea, syncope
PE
skin flushing (face esp), diarrhea with abdo cramps, valvular heart disease
carcinoid syndrome
Bone mets, primary?
Breast, prostate then lung, Hodgkin lymphoma, kidney, thyroid, melanoma
Brain mets, primary?
Breast, lung then colon, lymphoma, kidney, melanoma, prostate
Liver mets, primary?
Colon, pancreas, then stomach, breast, lung, melanoma
Lung and mediastinal mets, primary?
Breast, lung, colon, kidney, testes, cervix/uterine, Hodkin lymphoma, melanoma
High cervical lymph node mets, primary?
Hodgkin lymphoma, lymphoma, SCC, oropharynx, nasopharynx
Low cervical lymph node mets, primary?
Lung, stomach, lymphoma, Hodgkin Lymphoma, oropharynx, larynx, skin, tongue
axillary lymph node mets, primary?
breast, lung, lymphoma
Inguinal node mets
lymphoma, ovary, uterus, vulva, prostate, skin
Retroperitoneal mets, primary?
Lymphoma, Hodgkin lymphoma, ovary, uterus, testes, prostate
Mets to skin, primary?
Lung, colon, melanoma, Kaposi sarcoma
1-3 weeks of headache, photophobia and malaise/fatigue
Acute HIV seroconversion
Child with non pruritic rash mainly on trunk, non desquammating and passes in 48 hours
viral exanthem
itchy rash behind knees, ankles, cub fossa, neck, behind ears and peri orbital in child
atopic dermatitis
white patches on face of children and adolescents around mouth and cheeks (maybe on limbs/trunk)
pityriasis alba
non itchy rash in scalp, eyebrows, nasolabial folds, chest
seborrhoeic dermatitis
baby with rash at 4-12 weeks on scalp, cheeks, folds of neck, axillae, folds of elbows
infant seborrhoeic dermatitis
baby with rash at 2 months, severely itchy, starts on face elbow and knee flexures
eczema
female 30-50 yo with fluctuating erythema, papules, pustules on forehad, cheeks, nose and chin
rosacea
acute red rash in child/adolescent post strep throat, scaly drop like lesions mainly on trunk
guttate psoriasis
acute eruption age 5-35 symetrical erythematous papules mainly backs of hands, palms, flexor surface of forearms with sometimes feet, toes, truck, genitals
erythema multiforme
acute hepatitis in young person with tremor, gait (neuro features)
Wilsons
unilateral burning/searing facial pain in 50 yo lasts for minutes
trigeminal neuralgia
bilateral recurring headache lasting hours usually female, non pulsating, mild moderate, no nausea/vomiting, no photphobia, worse throughout day
tension headache
sudden onset of floaters, flashes or black spots with blurred vision or curtain/cloud and patiral or total loss of visual field, normal pupil
retinal detachment
sudden onset of floaters, reduced light reflex, loss of vision possible
vitreous haemorrhage
sudden loss of vision, curtain coming down on vision, no light perception, normal fundoscpy at first then cherry red macula
central retinal artery occlusion
sudden loss of vision (possibly over days), on fundoscopy swollen disc, stormy sunset appearance
central retinal vein thrombois
sudden fading of central vision, distorted vision
wet macular degeneration
slow onset of painless distorted loss of centra vision
dry macula degeneration
20-40 yo woman loss of vision in 1 eye over few days with discomfort behind eye and central scotoma
optic neuritis
