Presenting complaint and ddx Flashcards
headache
- vascular: subarachnoid heamorrhage, heamatoma (subdural or extradural), cerebral venous thrombosis, cerebellar infarct.
- infection: meningitis, encephalitis
- vision threatening: temporal arthritis, acute glaucoma, cavernous sinus thrombosis, pituitary apoplexy, posterior leucoencephalopathy
- Intercranial pressure: SOL (tumour abcess or cyst), cerebral oedema (trauma or altitude), hydrocephalus, malignant hypertension, idiopathic intercranial hypertension
- Dissection: carotid artery
ddx non-sinister headache
- Tension type headache
- Migraine
- Sinusitis
- medication overdose
- TMJ syndrome
Confusion (delirium)
- infection: (chest, urinary, enchalitis, brain abcess, sepsis)
- Drugs: diuretics, thyroid medication, digoxin or withdrawal from medications)
- metabolic: electrolyte disturbances (hypercapnia, Na, thiamine)
- trauma: subdural or extradural heamatoma
- stroke or MI
blackout
- reflex (vasovagal response)
- cardiac (rhythm or outlet obstruction) Arrythmias
- orthostatic - drugs (antihypertensives and antisympathetics)
- cerebralvascular (vertebral basilar insufficiency)
- non-syncopal: intoxication and head trauma, metabolic, epilepsy
lateral neck lump
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.
midline neck lump
- Thyriod: physiological goitre, multinodular goitre, graves’ disease, hashimoto’s thyroiditis, thyroglossal cyst
- non-thyriod:lipoma, dermoid cyst, epidermal cyst, abcess, lymphoma
heamatemesis
- inflammation: stomach (gastritis)/ duodenitis
- esophagus (oesophagitis, trauma, boerhaave’s oesphagus performation) varices cancer
- mallory weiss tears
- stomach cancer
- arteriovenous malformations
high dysphagia
functional: stroke, parkinson’s disease, myasthenia gravis, multiple sclerosis, myotonic dystrophy
Structural: mural (cancer, pharyngeal pouch, cricopharyngeal bar)
low dysphagia
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
acute cough
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
chronic cough
dry: asthma, GORD, post nasal drip, smoking, lung cancer, COPD,
productive: bronchiectasis, TB, lung cancer, recurrent aspiration, Cystic fibrosis
heamoptysis
- Infective: TB, pneumonia, lung abcess, mycetoma
- neoplasticism: primary lung cancer or met
- vascular: pulmonary embolism, bleeding tendency, vascular bronchial fistula
- inflammatory: goodpastures syndrome., granulomatosis with polyangiitis, hereditary heamorrhagic telangiectasia
- degenerative: bronchiectasis
chest pain
- musculoskeletal inflammation
- heart: ACS, pericarditis, stable angina, vasospasm (cocaine)
- PE
- pancreatitis and cholcystitis
- Aortic dissection/ aneurysm
shortness of breath
- insufficient air getting into the lungs:
obstruction: asthma, COPD, tumour, airway oedema
intra thoracic: pneumothorax., PEffusion
extrathoracic: chest wall abnormality (pectus excavatum, kyphoscoliosis) - 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) - insufficient O2 getting around the body
CO= heart failure, aortic stenosis, immobility
Anaemia
shock
ddx of SOB based on time frame seconds to minutes
seconds to minutes
- bronchospasm (asthma or COPD)
- anaphylaxis
- laryngeal oedema
- pulmonary embolism
- acute epiglottis
SOB time frame hours to days
- pneumonia
- heart failure
- pleural effusion
- ARDs
- post op atelectasis
SOB weeks to months
- COPD
- Chronic asthma
- Heart failure
- Pulmonary fibrosis
- anaemia
Breast Lump
- benign cystic change
- fibroadenoma
- cyst
- carcinoma
- other: phyllodes tumour
epigastric pain
- pancreas: acute pancreatitis
- stomach: PUD (perforation), gastritis/ doudenitis, borhaaves perforation
- heart: MI
- Aorta: AAA
- Bowel: mesentaric ischemia
- gallbladder: cholecystitis (acute/ ascending) biliary colic
- Lung: basal pneumonia
nausea and vomiting based on Brain centres
- vestibular system- BPPV, labrinthitis, motion sickness, Meniere’s disease
- CNS- pain, anxiety, raised ICP, meningitis, encephalitis
- chemoreceptors trigger zone= meds, alcohol, e-, toxins
- CN 9 and 10 - GI obstruction, GI infection, inflammation of the diaphragm, inflammation of the liver, pancreas, gallbladder and peritoneum
female of reproductive age vomiting
pregnancy
acute (less than one month) vomiting
- abdominal pain with fever- gastritis, food poisoning, appendicitis, mesenteric adenitis, pancreatitis
without fever- SBO, DKA, drug SE or overdose, mesentaric ischemia, MI, testicular torsion - headache- meningitis, raised ICP, SOL, migraine
- Vértigo- labyrinthitis, meniere, BPPV, acoustic neuroma
- shortly after food- gastric outlet obstruction,
- none- drug SE, anxiety, hyperthyroid, renal failure plus uremia, cyclic vomiting syndrome
chronic (greater than 1 month) vomiting
weight loss- upper GI obstruction (esophageal cancer) or functional (motor neuron disease), coeliac disease no weight loss- oesophagitis, and pharyngeal pouch
Jaundice ddx
- 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 - 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 - posthepatic
gallstones, cholecystectomy, PBC, cholangiocarcinoma
COCP, nitrofurtoin, co-amox
right upper quadrant pain
- Liver= hep, biliary colic, cholecystitis, ascending cholangitis
- duodenal ulcer = gastritis
- Pancreas- pancreatitis
- Appendix appendicitis
- Kidney= pyloenephritis
- bowel- small bowel obstruction
- lung- pneumonia
right illiac fossa pain
- Appendicitis
- bowel- gastroenteritis, constipation, Meckels diverticulitis, DKA, cae cal volvulous
- kidneys- ureteric colic , pyleonephritis, UTI
- inguinal/ genital: testicular torsion, femoral hernia, ectopic pregnancy, posas abcess
- pancreas and bile duct- acute pancreatitis, cholecystitis
left illiac fossa pain
- large bowel= acute diverticulitis, constipation, IBD, ischaemic colitis, pseudomembranous colitis, sigmoid perforated carcinoma, IBS
- aorta: AAA leaking
- kidney: pyelonephritis and UTI. ureteric colic
- DKA
Flank pain
- muscular sprain or spinal pathology
- kidney: nephrolithiasis, ureteric colic, pyelonephritis
- AAA leaking
- testicular torsion
Constipation
- abnormal peristalsis- IBS, Meds, hypothyriodism, hypercalcaemia, hypokalaemia
- hard faeces- lack of fibre or dehydration
- bowel obstruction- colorectal adenocarcinoma, sigmoid volvulus, other pelvic masses, chron’sm diverticulitis
- not pushing- haemorrhoids, anal fissure, pelvic floor dysfunction
diarrhoea
- infection
- inflammation= IBS, chron’s, UC
- increased bowel motility hyperthyroid
- malabsorption= coeliac, CF (pancreatic insufficiency)
- obstruction and overflow- chronic constipation
- meds antibiotic and laxatives
rectal bleeding
- anorectal = haemorrhoids, tumour (rectal/anal), anal fissure, rectal varices, and fistula
- colonic: diverticular disease, angiodysplasia, colitis, colonic tumour, latrogenic (endoscopic biopsy, anatomical leak) and vasculitis
- illeo- jejunal- PUD (plus meckels), coeliac, aorto-enteric fistula, crohn’s disease
- upper GI - Peptic ulcer disease, gastritis, varices, mallory weiss, osler weber rendu syndrome
poor urinary output
- prerenal - hypovolemia, hypotension, heart failure
- 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 - post renal=
ureter- obstruction, bilateral calculi, retroperitoneal fibrosis
bladder- neuropathic bladder
urethra- BPH, blocked catheter, stricture, posterior urethral valve, infection, trauma
polyuria ddx
- diabetes mellitus or diabetes insipidus
- diuretics
- heart failure
- hyperthyriodism
- electrolyte: hypokalaemia hypercalcaemia
groin lump ddx
- testicle- ectopic testis, undescended testis, hydrocele of cord
- lymph node- lympadenopathy
- hernial orifices- inguinal hernia, femoral hernia
- femoral artery (aneurysm) and nerve (neuroma) and vein (sapiens varix)
- skin/subcutis = lipoma, infected abscess, sebaceous cyst.
scrotal mass algorithm can not get above the scrotal mass
algorithm: can I get above it? no = inguinoscrotal hernia
scrotal mass algorithm Can get above it and it is not separate from the testis and the mass is transilluminable
hydrocele
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
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
scrotal mass that you can get above it, it is separate from the testes it is transilluminable
epididymal cyst, acute idiopathic scrotal oedema
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
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
limb weakness sudden onset
- brain ischeamic stroke, TIA, haemorrhagic stroke, hemiplegic migraine, Todd’s palsy, hypoglycaemia
- spinal cord- spinal disc prolapse, spinal cod transaction, spinal cord infarction
- Nerve root- spinal disc prolapse, cerebral fracture
- P. Nerve- acute limb ischaemia, tramatic nerve injury
limb weakness subacute onset (hours to days)
- brain multiple sclerosis, heamatoma, tumour, abcess
- spinal cord- M.S, tumour, transverse myelitis, Guillian Barre, poliomyelitis
- Neuromuscular junction botulism and tetanus
gradual onset (weeks to months) limb weakness
- Spine= spinal canal stenosis, B12 deficiency
- P.Nerve= D.M, vasculitis
- Neuromuscular junction= Myasthemia gravis and Lambert Eaton syndrome, Myositis
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
leg ulcer
- venous ulcer
- Mixed
- arterial
- pressure
- neuropathic ulcer
- malignancy (marjolin, squamous cell carcinoma
bilateral leg swelling
- right heart failure
- lymphoedema
- venous insufficiency
- pregnancy
- vasodilators (ca channel blockers) ]
hypoalbuminaemia from renal failure (nephrotic syndrome)
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
What is your ddx for epigastric pain:
Peptic ulcer disease pancreatitis acute cholecystitis pain of cardiac origin perforation of PU gastritis
LUQ pain
peptic ulcer
splenic infarction or injury
pancreatitis
CENTRAL abdominal pain
early appendicitis mesentaric adenitis SBO pancreatitis ischemic bowel
LIF pain
diverticulitis ureteric colic ectopic pregnancy PID ovarian cyst testicular torsion
Supra pubic pain
ÚTI and retention
gyn causes
RIF pain
appendicitis mesentaric adenitis Chrons inflammatory mass Meckels ectopic pregnancy ovarian cyst PID ureteric colic
RUQ pain
acute cholecystokinin PUD cholangitis right lower lobe pneumonia biliary colic
upper Gi bleeding
duodenal ulcer disease gastric ulcer disease acute erosions or gastritis Mallory weiss oesophageal varices oesophagitis cancer of the stomach or esophagus
