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Final Med > Presenting complaint and ddx > Flashcards

Presenting complaint and ddx Flashcards

1
Q

headache

A
  1. vascular: subarachnoid heamorrhage, heamatoma (subdural or extradural), cerebral venous thrombosis, cerebellar infarct.
  2. infection: meningitis, encephalitis
  3. vision threatening: temporal arthritis, acute glaucoma, cavernous sinus thrombosis, pituitary apoplexy, posterior leucoencephalopathy
  4. Intercranial pressure: SOL (tumour abcess or cyst), cerebral oedema (trauma or altitude), hydrocephalus, malignant hypertension, idiopathic intercranial hypertension
  5. Dissection: carotid artery
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2
Q

ddx non-sinister headache

A
  1. Tension type headache
  2. Migraine
  3. Sinusitis
  4. medication overdose
  5. TMJ syndrome
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3
Q

Confusion (delirium)

A
  1. infection: (chest, urinary, enchalitis, brain abcess, sepsis)
  2. Drugs: diuretics, thyroid medication, digoxin or withdrawal from medications)
  3. metabolic: electrolyte disturbances (hypercapnia, Na, thiamine)
  4. trauma: subdural or extradural heamatoma
  5. stroke or MI
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4
Q

blackout

A
  1. reflex (vasovagal response)
  2. cardiac (rhythm or outlet obstruction) Arrythmias
  3. orthostatic - drugs (antihypertensives and antisympathetics)
  4. cerebralvascular (vertebral basilar insufficiency)
  5. non-syncopal: intoxication and head trauma, metabolic, epilepsy
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5
Q

lateral neck lump

A

think anatomically:
Artery: carotid artery aneurysm, subclavian artery aneurysm, carotid body tumour
nerves: neurofibromas or schwannoma
Lymphatic: malformation
lymphoma, infection
salivatory glands: infection, autoimmune, neoplasm
larynx: laryngocele
pharynx: pharngeal pouch
branchial arch remanant: brachial cyst/ sinus/ fistula
skin or superficial subcutaneous: lipoma, epidermal cyst, abcess, dermiod cyst.
muscle. cartilage. bone: sarcoma, cervical rib, torticollis.

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6
Q

midline neck lump

A
  1. Thyriod: physiological goitre, multinodular goitre, graves’ disease, hashimoto’s thyroiditis, thyroglossal cyst
  2. non-thyriod:lipoma, dermoid cyst, epidermal cyst, abcess, lymphoma
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7
Q

heamatemesis

A
  1. inflammation: stomach (gastritis)/ duodenitis
  2. esophagus (oesophagitis, trauma, boerhaave’s oesphagus performation) varices cancer
  3. mallory weiss tears
  4. stomach cancer
  5. arteriovenous malformations
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8
Q

high dysphagia

A

functional: stroke, parkinson’s disease, myasthenia gravis, multiple sclerosis, myotonic dystrophy
Structural: mural (cancer, pharyngeal pouch, cricopharyngeal bar)

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9
Q

low dysphagia

A

functional: achalsia, chagas’ disease, nutcracker oesophagus, diffuse esophageal spasm, CREST syndrome

structural:
lumen: foreign body
mural: cancer, stricture, plummer vinson syndrome, schatzki ring, congenital atresia, post-fundoplication
Extrinsic: mediastinal mass, retrosternal goitre, bronchial carcinoma, thoracic aortic aneurysm, pericardial effusion

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10
Q

acute cough

A

dry: asthma, rhinitis/sinusitis with post nasal drip, upper respiratory tract infection, drug induced (ACE inh), lung cancer
productive: lower respiratory tract infection (pneumonia, bronchitis)
COPD, TB

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11
Q

chronic cough

A

dry: asthma, GORD, post nasal drip, smoking, lung cancer, COPD,
productive: bronchiectasis, TB, lung cancer, recurrent aspiration, Cystic fibrosis

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12
Q

heamoptysis

A
  1. Infective: TB, pneumonia, lung abcess, mycetoma
  2. neoplasticism: primary lung cancer or met
  3. vascular: pulmonary embolism, bleeding tendency, vascular bronchial fistula
  4. inflammatory: goodpastures syndrome., granulomatosis with polyangiitis, hereditary heamorrhagic telangiectasia
  5. degenerative: bronchiectasis
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13
Q

chest pain

A
  1. musculoskeletal inflammation
  2. heart: ACS, pericarditis, stable angina, vasospasm (cocaine)
  3. PE
  4. pancreatitis and cholcystitis
  5. Aortic dissection/ aneurysm
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14
Q

shortness of breath

A
  1. insufficient air getting into the lungs:
    obstruction: asthma, COPD, tumour, airway oedema
    intra thoracic: pneumothorax., PEffusion
    extrathoracic: chest wall abnormality (pectus excavatum, kyphoscoliosis)
  2. not enough air getting into the blood:
    alveolar damage: emphysema, interstitial lung disease
    fluid between the alveolar wall and the capillary
    oedema (heart/liver/ kidney failure)
    inflammation (pneumonia)
  3. insufficient O2 getting around the body
    CO= heart failure, aortic stenosis, immobility
    Anaemia
    shock
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15
Q

ddx of SOB based on time frame seconds to minutes

A

seconds to minutes

  1. bronchospasm (asthma or COPD)
  2. anaphylaxis
  3. laryngeal oedema
  4. pulmonary embolism
  5. acute epiglottis
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16
Q

SOB time frame hours to days

A
  1. pneumonia
  2. heart failure
  3. pleural effusion
  4. ARDs
  5. post op atelectasis
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17
Q

SOB weeks to months

A
  1. COPD
  2. Chronic asthma
  3. Heart failure
  4. Pulmonary fibrosis
  5. anaemia
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18
Q

Breast Lump

A
  1. benign cystic change
  2. fibroadenoma
  3. cyst
  4. carcinoma
  5. other: phyllodes tumour
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19
Q

epigastric pain

A
  1. pancreas: acute pancreatitis
  2. stomach: PUD (perforation), gastritis/ doudenitis, borhaaves perforation
  3. heart: MI
  4. Aorta: AAA
  5. Bowel: mesentaric ischemia
  6. gallbladder: cholecystitis (acute/ ascending) biliary colic
  7. Lung: basal pneumonia
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20
Q

nausea and vomiting based on Brain centres

A
  1. vestibular system- BPPV, labrinthitis, motion sickness, Meniere’s disease
  2. CNS- pain, anxiety, raised ICP, meningitis, encephalitis
  3. chemoreceptors trigger zone= meds, alcohol, e-, toxins
  4. CN 9 and 10 - GI obstruction, GI infection, inflammation of the diaphragm, inflammation of the liver, pancreas, gallbladder and peritoneum
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21
Q

female of reproductive age vomiting

A

pregnancy

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22
Q

acute (less than one month) vomiting

A
  1. abdominal pain with fever- gastritis, food poisoning, appendicitis, mesenteric adenitis, pancreatitis
    without fever- SBO, DKA, drug SE or overdose, mesentaric ischemia, MI, testicular torsion
  2. headache- meningitis, raised ICP, SOL, migraine
  3. Vértigo- labyrinthitis, meniere, BPPV, acoustic neuroma
  4. shortly after food- gastric outlet obstruction,
  5. none- drug SE, anxiety, hyperthyroid, renal failure plus uremia, cyclic vomiting syndrome
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23
Q

chronic (greater than 1 month) vomiting

A 
weight loss- upper GI obstruction (esophageal cancer) 
or functional (motor neuron disease), coeliac disease 
no weight loss- oesophagitis, and pharyngeal pouch
24
Q

Jaundice ddx

A
  1. pre hepatic- intravascular haemolysis
    congenital: G6DPH def, PK def, sickle cell, thalassemia
    acquired: artificial heart valves, blood group mismatch, DIC, malaria, HELLP syndrome, meds
    extravascular: congenital: hereditary spherocytosis,
    acquired: autoimmune haemolysis
  2. hepatic: reduced hepatic uptake: cholycystographic contrast agents, portosystemic shunts to bypass the cirrhosis liver
    congenital: gilbert’s syndrome, Crigler- Najjar syndrome
    infection: viral hep, bacterial hep (leptospirosis, Weil’s disease), ascending cholangitis, liver abcess, tapeworm infection
    neoplasm: metastatic liver disease, hepatocellular carcinoma, pancreatic cancer,
    vascular Budd Chiari
    autoimmune hepatitis
    wilson’s disease and heamachromotosis
    rifampcin
  3. posthepatic
    gallstones, cholecystectomy, PBC, cholangiocarcinoma
    COCP, nitrofurtoin, co-amox
25
right upper quadrant pain
1. Liver= hep, biliary colic, cholecystitis, ascending cholangitis 2. duodenal ulcer = gastritis 3. Pancreas- pancreatitis 4. Appendix appendicitis 5. Kidney= pyloenephritis 6. bowel- small bowel obstruction 7. lung- pneumonia
26
right illiac fossa pain
1. Appendicitis 2. bowel- gastroenteritis, constipation, Meckels diverticulitis, DKA, cae cal volvulous 3. kidneys- ureteric colic , pyleonephritis, UTI 4. inguinal/ genital: testicular torsion, femoral hernia, ectopic pregnancy, posas abcess 5. pancreas and bile duct- acute pancreatitis, cholecystitis
27
left illiac fossa pain
1. large bowel= acute diverticulitis, constipation, IBD, ischaemic colitis, pseudomembranous colitis, sigmoid perforated carcinoma, IBS 2. aorta: AAA leaking 3. kidney: pyelonephritis and UTI. ureteric colic 4. DKA
28
Flank pain
1. muscular sprain or spinal pathology 2. kidney: nephrolithiasis, ureteric colic, pyelonephritis 3. AAA leaking 4. testicular torsion
29
Constipation
1. abnormal peristalsis- IBS, Meds, hypothyriodism, hypercalcaemia, hypokalaemia 2. hard faeces- lack of fibre or dehydration 3. bowel obstruction- colorectal adenocarcinoma, sigmoid volvulus, other pelvic masses, chron’sm diverticulitis 4. not pushing- haemorrhoids, anal fissure, pelvic floor dysfunction
30
diarrhoea
1. infection 2. inflammation= IBS, chron’s, UC 3. increased bowel motility hyperthyroid 4. malabsorption= coeliac, CF (pancreatic insufficiency) 5. obstruction and overflow- chronic constipation 6. meds antibiotic and laxatives
31
rectal bleeding
1. anorectal = haemorrhoids, tumour (rectal/anal), anal fissure, rectal varices, and fistula 2. colonic: diverticular disease, angiodysplasia, colitis, colonic tumour, latrogenic (endoscopic biopsy, anatomical leak) and vasculitis 3. illeo- jejunal- PUD (plus meckels), coeliac, aorto-enteric fistula, crohn’s disease 4. upper GI - Peptic ulcer disease, gastritis, varices, mallory weiss, osler weber rendu syndrome
32
poor urinary output
1. prerenal - hypovolemia, hypotension, heart failure 2. renal- tubular causes- acute tubular necrosis glomerular- glomerulonephritis interstitial- interstitial nephritis (NSAIDS or ABX) vascular- vasculatides, haemolytic uraemic syndrome, TTP- thrombocytes thrombocytopenic purpura, DIC, malignant hypertension infection- malaria, legionnaires disease, leptospirosis complex- Multiple myeloma 3. post renal= ureter- obstruction, bilateral calculi, retroperitoneal fibrosis bladder- neuropathic bladder urethra- BPH, blocked catheter, stricture, posterior urethral valve, infection, trauma
33
polyuria ddx
1. diabetes mellitus or diabetes insipidus 2. diuretics 3. heart failure 4. hyperthyriodism 5. electrolyte: hypokalaemia hypercalcaemia
34
groin lump ddx
1. testicle- ectopic testis, undescended testis, hydrocele of cord 2. lymph node- lympadenopathy 3. hernial orifices- inguinal hernia, femoral hernia 4. femoral artery (aneurysm) and nerve (neuroma) and vein (sapiens varix) 5. skin/subcutis = lipoma, infected abscess, sebaceous cyst.
35
scrotal mass algorithm can not get above the scrotal mass
algorithm: can I get above it? no = inguinoscrotal hernia
36
scrotal mass algorithm Can get above it and it is not separate from the testis and the mass is transilluminable
hydrocele
37
scrotal mass you can get above it, it is not separate from the testes and the mass is not transilluminable and it is tender
torsion, orchitis, epididymorchitis, acute heamatocele
38
scrotal mass that you can get above it, it is not separate from the testes, it is not transilluminable, and it is not tender
cancer, chronic haematocele, and gumma
39
scrotal mass that you can get above it, it is separate from the testes it is transilluminable
epididymal cyst, acute idiopathic scrotal oedema
40
scrotal mass that you can get above it and it is separate from the testes, it is not transilluminable and it is tender
acute epididymitiis | torsion of the hydatid of Morgagni
41
scrotal mass you are able to get above it, it is separate from the testes, it is not transilluminable, it is not tender
TB epididymitis | post vasectomy sperm granuloma
42
limb weakness sudden onset
1. brain ischeamic stroke, TIA, haemorrhagic stroke, hemiplegic migraine, Todd’s palsy, hypoglycaemia 2. spinal cord- spinal disc prolapse, spinal cod transaction, spinal cord infarction 3. Nerve root- spinal disc prolapse, cerebral fracture 4. P. Nerve- acute limb ischaemia, tramatic nerve injury
43
limb weakness subacute onset (hours to days)
1. brain multiple sclerosis, heamatoma, tumour, abcess 2. spinal cord- M.S, tumour, transverse myelitis, Guillian Barre, poliomyelitis 3. Neuromuscular junction botulism and tetanus
44
gradual onset (weeks to months) limb weakness
1. Spine= spinal canal stenosis, B12 deficiency 2. P.Nerve= D.M, vasculitis 3. Neuromuscular junction= Myasthemia gravis and Lambert Eaton syndrome, Myositis
45
acute joint pain
articular- trauma, gout, pseudogout, septic arthritis, seronegative spondyloartropathy, transient synovitis, SLE, sarcoidosis peri articular- ligament injury, tendinitis, bursitis, fasciitis, epicondylitis non-articular- nerve entrapment, radiculopathy, bone malignancy, osteomyelitis, vasculopathy
46
leg ulcer
1. venous ulcer 2. Mixed 3. arterial 4. pressure 5. neuropathic ulcer 6. malignancy (marjolin, squamous cell carcinoma
47
bilateral leg swelling
1. right heart failure 2. lymphoedema 3. venous insufficiency 4. pregnancy 5. vasodilators (ca channel blockers) ] hypoalbuminaemia from renal failure (nephrotic syndrome)
48
Causes of dysphagia (long list)
``` intra luminal: FB, polyploid tumours, oesophageal inflammation, infection extraluminal intramural: strictures, malignant, achalasia, webbing, nutcracker esophagus, diffuse spasm, scleroderma, presbyoesphagus extramural pharyngeal pouch rolling hiatus hernia malignancy retrosternal goitre vascular structures systemic causes: MG, MS, PD, Pseudobulbar palsy, psych, MND ```
49
What is your ddx for epigastric pain:
``` Peptic ulcer disease pancreatitis acute cholecystitis pain of cardiac origin perforation of PU gastritis ```
50
LUQ pain
peptic ulcer splenic infarction or injury pancreatitis
51
CENTRAL abdominal pain
``` early appendicitis mesentaric adenitis SBO pancreatitis ischemic bowel ```
52
LIF pain
``` diverticulitis ureteric colic ectopic pregnancy PID ovarian cyst testicular torsion ```
53
Supra pubic pain
ÚTI and retention | gyn causes
54
RIF pain
``` appendicitis mesentaric adenitis Chrons inflammatory mass Meckels ectopic pregnancy ovarian cyst PID ureteric colic ```
55
RUQ pain
``` acute cholecystokinin PUD cholangitis right lower lobe pneumonia biliary colic ```
56
upper Gi bleeding
``` duodenal ulcer disease gastric ulcer disease acute erosions or gastritis Mallory weiss oesophageal varices oesophagitis cancer of the stomach or esophagus ```

Final Med (35 decks)

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