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PACES Differentials & Causes Flashcards

1
Q

Differentials of Chest pain

A

Pleuritic:
 Infectious: Pneumonia
 Respiratory: Pneumothorax, Pleural effusion, Pulmonary Embolism
 Cardiac: Pericarditis, (Myocarditis)
Angina-like:
 Ischaemic: ACS
 Valvular: Aortic Stenosis, Aortic Regurgitation
 Structural: Aortic Dissection, Thoracic Aortic Aneurysm rupture
Non-cardiorespiratory:
 Muscular: Costochondritis
 GI: GORD
 Somatic: Anxiety

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2
Q

Differentials of Acute onset Dyspnoea

A

Cardiorespiratory:
 Cardiac: Pulmonary oedema,
 Resp: Asthma, Anaphylaxis, Pleural effusion, Pneumothorax, PE
 Infectious: Covid-19, Infective exacerbation of COPD, Pneumonia,

Systemic:
 Anaemic: Bleeding (inc. trauma)
 Neurological: MG, MS, GBS,

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3
Q

Differentials of Cough

A

 Infectious: typical or atypical pneumonia, tuberculosis, COVID-19, Influenza
 Inflammatory: Asthma, COPD, pulmonary fibrosis, bronchiectasis, interstitial lung disease, sarcoidosis
 Malignant: lung cancer, mesothelioma
 Iatrogenic: medication changes (ACEi)

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4
Q

Differentials of an acute Headache

A

Primary headaches…
 Tension
 Cluster
 Migraine

Secondary headaches…
 Neurological: Temporal arteritis, SAH, Meningitis,
Encephalitis
 ENT: Sinusitis, TMJ syndrome
 Iatrogenic: medication overuse
 Trauma: concussion

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5
Q

Differentials of delirium

A

 Endocrine & Biochemical causes: HypoNa, HyperNa, HyperCa, hypoglycaemia, hypothyroidism, DKA, HHS.
 Infectious: Sepsis, UTI, Pneumonia
 Neurological: intracranial bleeding, (hepatic) encephalopathy, concussion.
 Iatrogenic: medications, environmental change

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6
Q

Differentials of syncope

A

 Neurological: Vasovagal, Epilepsy, psychogenic seizures
 Cardiac: Arrhythmia (electrolyte), ACS, Aortic stenosis, HOCM
 Vascular: PE, Dissection, Aneurysm rupture, Subclavian steal syndrome
 Toxicological: overdose, alcohol, iatrogenic
 Trauma

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7
Q

Differentials of acute limb weakness

A

 Vascular: Ischaemic stroke, haemorrhagic stroke, TIA,
 Neurological: Hemiplegic migraine, Hypoglycaemia, Todd’s Paresis, GBS
 Trauma: spinal disc injury
Note: in isolated limb findings consider – Acute limb Ischaemia, Peripheral nerve injury

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8
Q

Differentials of chronic limb weakness

A

 Inflammatory: MS, Myasthenia Gravis
 Infectious: GBS, Tetanus, Botulism,
 Malignant: Space occupying lesion, Lambert Eaton
 Vascular: Stroke, SAH, subdural haematoma

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9
Q

Differentials of dysphagia

A

 Luminal: foreign body
 Intramural: Oesophageal Cancer, Barrett’s oesophagus, Pharyngeal Pouch, Plummer-Vinson, GORD, Achalasia, Stricture
 Extra-mural: Lung cancer, Goitre, Head & Neck cancer.
 Neurological: Parkinson’s, MND, Stroke, MS, MG, CREST, Globus

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10
Q

Differentials of a breast lump

A

Benign:
 Areola: Duct Ectasia, Galactocele
 Parenchyma: Fibroadenoma, Fibrocystic change, breast cyst, Mastitis, Abscess
 Adipose: Lipoma, Fat necrosis
Malignant:
 Areola: Paget’s disease of the breast
 Parenchyma: Breast Cancer (IDC), Lymphoma

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11
Q

Differentials of PR bleeding

A

 Colorectal: Cancer, IBD, Diverticular disease, angiodysplasia
 Anus: Haemorrhoids, rectal prolapse, Anal fissure, Anal fistula, peri-anal abscess
 Upper GI: Cancer, Peptic ulcers

+coagulaopathy

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12
Q

Causes of (true) Bowel Obstruction

A

 Luminal: Faecal impaction, Gallstone Ileus
 Intramural: Colorectal Cancer, Strictures, Diverticulitis, Meckel’s diverticulum
 Extrinsic: Adhesions, Incarcerated Hernia, Volvulus

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13
Q

Causes of Pseudo-obstruction

A

Pseudo Obstruction…
 Acute event: Post-operative, Recent cardiac ischaemia
 Endocrine: Hypothyroidism, Hypercalcaemia, hypomagnesaemia
 Neurological: Parkinson’s, MS
 Medications: Opioids

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14
Q

Causes of Ascites

A

Transudative “Failures”
 Cirrhosis, ALF
 Cardiac failure (inc. constrictive pericarditis)
 Nephrotic syndrome

Exudative
 Malignancy: Colorectal, pelvic,
 Infectious: tuberculosis
 Budd-Chiari syndrome

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15
Q

Causes of RUQ pain

A

Hepatic
 Hepatitis (viral, ischaemic, toxic)
 Perihepatitis (Fitz-Hugh Curtis syndrome)
 Abscess (including subphrenic)
Biliary
 Biliary colic
 Cholecystitis (acute, chronic)
 Cholangitis (ascending, primary sclerosing)
Referred:
 RLL pneumonia

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16
Q

Causes of RIF pain

A

Gastrointestinal…
 Acute appendicitis
 IBD or IBS
 Mesenteric adenitis
 Bowel obstruction…
 Constipation
Gynaecological…
 Ovarian: torision, cyst rupture, haemmorhage
 Ectopic pregnancy
 Acute PID
 Endometriosis
 Mittelschmerz
Urological:
 Testicular Torsion
 Renal colic
 UTI

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17
Q

Causes of LIF pain

A

Gastrointestinal…
 Diverticulitis
 IBD or IBS
 Bowel obstruction – including colorectal cancer..
 Constipation
Gynaecological…
 Ovarian: torision, cyst rupture, haemmorhage
 Ectopic pregnancy
 Acute PID
 Endometriosis
 Mittelschmerz
Urological:
 Testicular Torsion
 Renal colic
 UTI

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18
Q

Causes of epigastric pain

A

Cardiac:
 ACS
 Aortic Dissection
Pancreatic:
 Acute pancreatitis
 Chronic pancreatitis
Gastric:
 GORD
 Peptic Ulcer disease
 Mesenteric Ischaemia

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19
Q

Causes of LUTS

A

Urological
 Urethra: Stricture, UTI
 Prostatic: BPE, Prostatitis, Prostate Cancer
 Bladder: Cancer, Detrusor muscle weakness
Non-urological
 Extrinsic compression: Pelvic mass compression e.g. colorectal cancer.
 Endocrine: Diabetes Mellitus, Diabetes Insipidus, Psychogenic Polydipsia
 Neurological: spinal cord injury

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20
Q

Differentials of Scrotal swelling

A

Painful
 Infectious: Epididymo-orchitis
 Acute event: Testicular torsion, Torsion of the Hydatid of Morgagni
 Extra-testicular: Incarcerated inguinal hernia

Painless
 Benign: Hydrocele, varicocele, epididymal cyst, gumma
 Malignant: testicular seminomas and non-seminomas
 Extra-testicular: Inguinal hernia

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21
Q

Differentials of Acute limb pain

A

 Arterial: Acute limb ischaemia, acute on chronic PAD,
 Venous: DVT, Lymph: lymphoedema
 MSK: Compartment syndrome, Trauma
 Infectious: osteomyelitis

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22
Q

Differentials of Chronic limb pain

A

 Arterial: PAD
 Venous: Chronic DVT, Post-thrombotic syndrome, venous insufficiency
 Neurological: lumbar stenosis, radiculopathy/sciatica
 Lymph: lymphoedema

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23
Q

Differentials of a leg ulcer

A

 Venous: Venous insufficiency
 Arterial: PAD
 Neurological: Diabetes
 Environmental: Pressure ulcers
 GI: Pyoderma gangrenosum
 Malignant: Marjolin’s Ulcer

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24
Q

Causes of AR

A

 Acute: Aortic dissection, IE
 Chronic: Syphilis (Luetic disease), CTDs inc. Marfan’s, Rheumatic heart disease

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25
Q

Causes of MS (cardio)

A

 Infectious: Rheumatic fever/rheumatic heart disease

 Age related calcification
 Congenital valve defects

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26
Q

Causes of MR

A

Causes:
 Infectious: Infective endocarditis, rheumatic fever & heart disease
 Structural defect: papillary muscle rupture, mitral valve prolapse

27
Q

Causes of MVP (cardio)

A

• Primary/idiopathic
• Rheum: Marfan’s, Ehlers Danlos, osteogenesis imperfecta,
• Endocrine: turner’s, Fragile X
• Cardiac: WPW, PDA, ASD, Cardiomyopathies
• Renal: ADPKD

28
Q

Causes of TR

A

 Infectious: Infective Endocarditis (IVDU), Rheumatic fever & heart disease
 Congenital: Ebstein’s anomaly

29
Q

Causes of a third heart sound? By what mechanism?

A

 Physiological (<30)
 Heart failure
 Dilated cardiomyopathy

Caused by Rapid ventricular filling (RVF - 3 letters)

30
Q

Causes of a forth heart sound? By what mechanism?

A

 Hypertension
 HOCM (4 letters)
 End stage heart failure (gallop)

Caused by atrial contraction against a stiff ventricle (CASV - 4 letters)

31
Q

Cardiac causes of Clubbing

A

 Atrial Myxoma
 Bacterial endocarditis
 Congenital cyanotic heart disease

32
Q

Respiratory causes of Clubbing

A

 Infection: Empyema
 Inflammation: Bronchiectasis & Interstitial lung disease (classically IPF)
 Malignant: Lung cancers (non-SCC classically) & Mesothelioma

33
Q

Gastro causes of Clubbing

A

 Hepatocellular Carcinoma
 Cirrhosis
 Crohn’s & UC
 Coeliac

34
Q

Causes of Asterixis

A

 Hepatic: Acute liver failure
 Respiratory: Type 2 respiratory failure
 Medications: Phenytoin, Benzodiazepines & Barbiturates

35
Q

Causes of Coarse crepitations

A

 Pneumonia
 Severe pulmonary Oedema
 COPD
 Bronchiectasis

36
Q

Causes of Fine crepitations

A

 Interstitial Lung Disease
 Early Pulmonary oedema

37
Q

Causes of Wheeze

A

Polyphonic
 Asthma
 COPD
 Aspiration
 Congestive heart failure (“cardiac wheeze”)
Monophonic
 Foreign body
 Bronchial carcinoma
 Goitre

38
Q

Causes of Barrel chest

A

 COPD
 Alpha-1 antitrypsin deficiency
 Acromegaly
 Chest deformity: pectus carinatum

39
Q

Causes of Dupytren’s contracture

A

 Alcoholic Liver disease
 Peyronie’s disease
 Idiopathic/Familial

40
Q

Causes of Splenomegaly

A

“Hinfectious”:
 Viral: Glandular fever
 Bacterial: Salmonella, Brucellosis
 Parasitic: Malaria, schistosomiasis
Hepatic:
 Portal hypertension
 Primary Sclerosing Cholangitis
 Wilson’s disease
Haemolytic (any severe haemolysis will do):
 G6PD deficiency
 Sickle Cell splenic sequestration
 Thalassaemia
Haematological:
 Myelofibrosis
 Chronic Myeloid Leukaemia
 Felty’s Syndrome

41
Q

Causes of Hepatomegaly

A

Regular…
 Jaundiced: Hepatitis, Cholangitis, Biliary tract obstruction
 Not jaundiced: Heart failure, Budd-Chiari, Amyloidosis

Irregular…
 HCC, Mets, (macro) Cirrhosis, Liver Abscess,

42
Q

Causes of Nephromegaly

A

 Malignant: Kidney Cancer (in adults RCC, in children Nephroblastoma), Lymphoma
 Cystic: Polycystic kidney disease
 Obstruction: Hydronephrosis

43
Q

Causes of Gynaecomastia

A

 Hepatic: Chronic liver disease
 Endocrine: Klinefelter’s, puberty, testicular tumours,
 Drug related: Spironolactone, Digoxin, Marijuana

44
Q

Causes of Proximal Myopathy

A

NERD
 Neuromuscular: Myasthenia gravis, LEMS
 Endocrine: Hypothyroidism, hyperthyroidism, Cushing’s syndrome, Acromegaly
 Rheumatological: Dermatomyositis, polymyositis
 Dystrophic: Becker’s
 Drugs: Steroids, Statins, Alcohol

45
Q

Causes of peripheral sensory Neuropathy

A

 Metabolic: Diabetes, Hypothyroidism, Alcohol, Dietary B12 def., Pernicious Anaemia*
 Neuromuscular: GBS, Chronic inflammatory demyelinating polyneuropathy (CIDP)
 Drug related: Isoniazid, Nitrous Oxide gas abuse

46
Q

Causes of tremor

A

Resting tremor
 Essential tremor
 Neurodegenerative causes: Parkinson’s, Parkinson’s plus syndromes
 Metabolic: Hyperthyroidism, Alcohol withdrawal
 Iatrogenic: Salbutamol

Intention tremor:
 Cerebellar dysfunction e.g. acute alcohol abuse

Both: Dystonic tremor (tug of war)

47
Q

Causes of Trendelenburg gait

A

Neuromuscular
 Bilateral = Proximal myopathy at the hip
 Superior gluteal nerve injury
 L5 radiculopathy
 Lesion to G. medius & minimus

Skeletal
 DDH
 SUFE
 Perthes disease

48
Q

Causes of Foot drop

A

LMN
 Common peroneal nerve palsy….
o Trauma
o Plaster cast compression
o Posture (sitting cross-legged)
o Diabetic neuropathy
o Leprosy
 L5 Radiculopathy….
o Lumbar disc prolapse
o Spinal stenosis
o Impingement due to a mass

UMN
 Stroke
 Multiple sclerosis
 Cerebral palsy

49
Q

Causes of Carpal tunnel

A

 Idiopathic
 Occupational: repetitive movement/vibration
 Endocrine: Obesity, DM, Hypothyroidism, Acromegaly
 Rheumatological: RhA
 Pregnancy

50
Q

Causes of Tracheal deviation

A

 Towards: Lobar collapse, pneumonectomy, pulmonary fibrosis
 Away: Tension pneumothorax, Large pleural effusion, Mediastinal mass

51
Q

Causes of a displaced apex beat

A

 Cardiac: Dilated cardiomyopathy, MR, Dextrocardia
 Respiratory: Tension pneumothorax, Lung collapse

52
Q

Causes of Syncope

A

 Neurological: Vasovagal, Epilepsy, psychogenic seizures
 Cardiac: Arrhythmia (electrolyte), Postural hypotension, ACS, Aortic stenosis, HOCM, PE,
 Vascular: Dissection, Aneurysm rupture, Subclavian steal syndrome
 Toxicological: overdose, alcohol, iatrogenic
 Trauma

53
Q

Causes of stridor

A

Acute:
 Intraluminal: foreign body
 Intramural: Anaphylaxis, Epiglottitis, Croup
 Extramural: Ludwig’s Angina, Abscess
Chronic:
 Intramural: Laryngomalacia, Vocal cord paralysis
 Extrinsic compression: malignancy

54
Q

Causes of pulmonary fibrosis

A

Upper
 Infectious: TB
 Inflammatory: Ankylosing Spondylitis, Sarcoidosis,
 Environmental: Radiation, Silicosis, Coal Worker’s lung

Basal
 Idiopathic
 Inflammatory: Rheumatoid
 Environmental: Asbestosis
 Iatrogenic: Methotrexate, Amiodarone

55
Q

Causes of pleural effusion

A

Transudative
 Failures: cardiac, cirrhosis
 Hypoalbuminaemia: nephrotic syndrome
 Meig’s Syndrome (benign ovarian tumour, ascites, pleural effusion)

Exudative
 Infectious: Tuberculosis, pneumonia
 Inflammatory: pancreatitis, rheumatoid,
 Malignancy: Lung cancer, mesothelioma,

56
Q

How is a pleural effusion determined to be an exudate or transudate?

A
  1. protein level <25 is transudate, >35 is exudate
  2. if in middle apply Light’s criteria:

 Fluid/Serum Protein > 0.5
 Fluid/Serum LDH >0.6
 Fluid LDH >2/3 of normal upper limit
…if any apply - exudate.

57
Q

Chronic causes of Dyspnoea

A

Respiratory:
 Infectious: Tuberculosis
 Inflammatory: COPD, interstitial lung disease, bronchiectasis, sarcoidosis
 Malignant: lung cancer, mesothelioma

Non-respiratory
 Cardiac: Heart failure, AS, AR
 Anaemic: Any bleeding
 Neurological: MND

58
Q

Differentials of chronic headache

A

Idiopathic raised ICP
Malignancy
Malignant hypertension

59
Q

Causes of Bronchiectasis?

A

Congenital: Cystic fibrosis (ΔF508), Primary ciliary dyskinesias inc. Kartagener’s syndrome

Acquired: post- TB, pneumonia

60
Q

Differentials of a systollic murmur

A

Left sided:
Aortic Stenosis
Aortic Sclerosis
Mitral regurgitation

Right sided:
Tricuspid regurgitation

61
Q

Causes of Cirrhosis

A

Acquired:
 Alcohol & NAFLD
 Infectious: HBV, HCV, HIV
 Malignant: HCC, metastatic liver disease
 Auto-immune: PBC, PSC
 Drug related (e.g. paracetamol)

Inherited:
 Metabolic: Wilson’s, Haemochromatosis, Alpha-1-antitrypsin deficiency

62
Q

Causes of acute liver failure

A

Ischaemic: hypovolvaemic shock, distributive shock.
Toxicological: Paracetamol, Aspirin (Reye’s Syndrome)
Viral: HAV, acute HBV

63
Q

Features of an UMN lesion

A

Weakness
Hypertonia (rigidity)
Spasticity
Hyperreflexia
Babinski present

64
Q

Features of a LMN lesion

A

Weakness
Hypotonia
Flaccid paralysis
Hyporeflexia
Wasting
Fasciculations

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