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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

PACES Vivas (4 decks)

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