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Differentials PE Flashcards

1
Q

DIFFERENTIAL DIAGNOSIS OF ITP

A

DIFFERENTIAL DIAGNOSIS OF ITP - Haematological exam

  • ITP
  • HSP
  • EBV
  • CLL - Leukemia
  • Lymphoma
  • Meningococcemia
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2
Q

DIFFERENTIAL DIAGNOSIS OF RASH

A 
DIFFERENTIAL DIAGNOSIS OF RASH - Focused exam 
	- Allergy 
		○ Contact Dermatitis 
		○ Atopic Dermatitis - Eczema 
	- Infection
		○ Lymphangitis
		○ Cellulitis 
		○ Meningococcemia 
	- CVS 
		○ DVT 
	- Trauma 
		○ Insect bite 
Malignancy : Leukemia, Lymphoma
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3
Q

DIFFERENTIAL DIAGNOSIS OF MURMUR

A

DIFFERENTIAL DIAGNOSIS OF MURMUR
- Physiologic
- Infective Endocarditis
- Anaemia
- Hyperthyroidism
- Valvular disease
○ Aortic stenosis, Aortic regurgitation
○ Pulmonary stenosis, Pulmonary regurgitation
○ Mitral stenosis, Mitral regurgitation
Tricuspid regurgitation

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4
Q

DIFFERENTIAL DIAGNOSIS OF HYPERTENSION IN PREGNANCY

A 
DIFFERENTIAL DIAGNOSIS OF HYPERTENSION IN PREGNANCY 
	- Pregnancy induced Hypertension 
	- Pre eclampsia 
	- Chronic Hypertension 
	- Secondary Hypertension 
		○ Thyroid
		○ Renovascular 
		○ Aortic Coarctation 
		○ Cushings 
		○ Kidney disease - CKD 
		○ PCKD /Pheochromocytoma 
		○ Aldosteronism 
		○ Drugs 
		○ Sleep apnea 
		○ Smoking 
Stress
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5
Q

DIFFERENTIAL DIAGNOSIS OF BREAST LUMP

A

DIFFERENTIAL DIAGNOSIS OF BREAST LUMP
1-breast cancer (nasty growth).
2-fibroadenoma (benign or non-cancerous overgrowth of connective tissue of the breast)
3-fibroadenosis (lumpy-bumpy breast)
4-breast cyst (fluid-filled bubbles, similar to blisters, in the breast tissue)
5-fat necrosis or traumatic injury to the breast.
6-breast abscess (localized collection of pus in the breast tissue)

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6
Q

DIFFERENTIAL DIAGNOSIS OF SOB

A 
DIFFERENTIAL DIAGNOSIS OF SOB 
	- Asthma 
	- COPD 
	- Pleural Effusion 
	- Pneumonia
	- Pneumothorax
	- Pulmonary embolism 
	- Pulmonary Atelectasis
	- Pulmonary Fibrosis 
	- Occupational Lung disease 
	- Heart failure 
	- Liver failure 
	- Kidney failure 
	- Anemia 
	- GERD 
Panic Disorder
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7
Q

DIFFERENTIAL DIAGNOSIS OF FACIAL SWELLING

A 
DIFFERENTIAL DIAGNOSIS OF FACIAL SWELLING 
	- Periorbital swelling 
	- Facial Cellulitis 
	- Tooth abscess 
	- Anaphylaxis - Delayed 
Cavernus sinus thrombosis
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8
Q

DIFFERENTIAL DIAGNOSIS OF NECK LUMP

A 
DIFFERENTIAL DIAGNOSIS OF NECK LUMP 
- Hyperthyroidism / hypothyroidism 
- Lymphadenopathy 
- Sebaceous cyst 
- Lipoma 
- Globus hystericus 
- Colloid cyst 
- Dominant nodule in a multinodular goiter – most common 
- True solitary nodule (adenoma)
- Thyroid Cancer 
- Hashimoto thyroiditis
- Lymph Node *
Thyroglossal cyst *
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9
Q

DIFFERENTIAL DIAGNOSIS OF HYPERTHYROIDISM

A

DIFFERENTIAL DIAGNOSIS OF HYPERTHYROIDISM
1-hyperthyroidism (most likely): thyroid gland is over active with increase hormone secretion causing your symptoms.
2-graves disease (autoimmune disease) (young woman with eye signs and thyroid bruit)
3-thyroiditis (infection or inflammation) less likely no tenderness, warmth or fever.
4-anxiety
5-medications less likely as she does not take any such medications.
6-nasty growth or cancer less likely from examination.

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10
Q

DIFFERENTIAL DIAGNOSIS OF HYPOTHYROIDISM

PRIMARY

A

DIFFERENTIAL DIAGNOSIS OF HYPOTHYROIDISM
PRIMARY
Without a goitre (decreased or absent thyroid tissue):
• Idiopathic atrophy
• Treatment of thyrotoxicosis (e.g. 131I, surgery)
• Agenesis or a lingual thyroid
• Unresponsiveness to TSH
With a goitre (decreased thyroid hormone synthesis):
• Chronic autoimmune diseases (e.g. Hashimoto’s thyroiditis)
• Drugs (e.g. lithium, amiodarone)
• Inborn errors (enzyme deficiency)
• Endemic iodine deficiency or iodine-induced hypothyroidism
SECONDARY
Pituitary lesions
Tertiary Hypothalamic lesions
Transient
Thyroid hormone treatment withdrawn
Subacute thyroiditis
Postpartum thyroiditis

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11
Q

Differential diagnosis of foot/heel pain

A

Differential diagnosis of foot/heel pain

  • Plantar fasciitis
  • Achilles tendonitis
  • ankle joint arthritis
  • heel spur
  • Plantar Bursitis
  • flexor tendon inflammation
  • nerve entrapment
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12
Q

DIFFERENTIAL DIAGNOSIS OF EYE REDNESS

A 
DIFFERENTIAL DIAGNOSIS OF EYE REDNESS 
	- Conjuntivitis - viral or bacterial 
	- Allergies 
	- Keratitis 
	- Eye Trauma 
	- Foreign object 
	- Uveitis 
Iritis
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13
Q

1-Right upper quadrant pain

A

1-Right upper quadrant pain

  • cholecystitis
  • cholangitis
  • pancreatitis
  • hepatitis
  • Duodenal ulcer
  • MI
  • pneumonia
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14
Q

2-Right iliac fossa pain

A

2-Right iliac fossa pain

  • ovarian cyst torsion
  • appendicitis
  • ectopic
  • Pelvic inflammatory disease
  • pyelonephritis
  • kidney, ureteric stone
  • crohn IBD
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15
Q

3-Epigastric

A

3-Epigastric

  • pancreatitis
  • Duodenal ulcer
  • Gall bladder, liver
  • MI
  • pneumonia
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16
Q

4-Left iliac fossa pain

A

4-Left iliac fossa pain

  • diverticulitis
  • ovarian cyst torsion
  • ectopic
  • Pelvic inflammatory disease
  • pyelonephritis
  • kidney, ureteric stone
  • crohn IBD
17
Q

5-Peritonitis (inflammation of membrane surrounding organs and the abdominal wall)

A

5-Peritonitis (inflammation of membrane surrounding organs and the abdominal wall)

  • ruptured viscus (ruptured diverticula, perforated ulcer)
  • pancreatitis
  • mesenteric ischaemia
18
Q

compartment syndrome 5P

A

compartment syndrome

5P

  • Pallor
  • Pain
  • Pulselessness
  • Paresthesia
  • Paralysis
19
Q

Differential diagnosis of Unsteady gait

A 
1-alcoholic peripheral neuropathy (most likely)
2-hypertensive peripheral neuropathy
3-diabetes neuropathy but HBAIC normal
4-B12 deficiency but B12 normal
5-nerve compression in the back
20
Q

Differential diagnosis of comatose patient

A 
Differential diagnosis of comatose patient
1-meningitis
2-encephalitis
3-subarachnoid hemorrhage
4-hypoglycemia
5-electrolye disturbance
6-drug/ alcohol
7-trauma
8-CVA
9-Epilepsy
21
Q

Differential diagnosis of facial trauma

A
  • compression of muscle
  • bone problem/ fracture
  • compression of nerve
  • fracture of orbital floor
22
Q

Hematology examination

A 
176-Hematology examination
Examination steps (in general)
1-General appearance
-pallor (anemia)
-jaundice (hemolysis)
-Rash on other parts 
-Bruising 
2-Vital signs (pulse, blood pressure)
3-Hands
-nails: spoon shaped, brittle nail, koilonychias (IDA)
            pale nail beds (anemia)
-palmar crease (anemia)
-joints (PIP, DIP, MCP, Wrist): swelling (RA, CTD)
-purpura, petechial, ecchymosis
4-Arms
-Epitrochlear LN
-Axillary LN.
5-Face
-eyes: pallor, jaundice, subconjunctival hemorrhage.
-Mouth: glossitis, angular stomatitis, gum hypertrophy
                use tongue depressor for tonsils
6-Neck
-Cervical LN+ supraclavicular LN
-Bone tenderness: tap spine-àpress ribsàgently press sternum and clavicle
7-Chest and heart
8-Abdomen
-palpate liver, spleen, kidney
-DRE, genitalia
-Inguinal LN
-Para aortic LN
9-Legs
-bruising, scratch marks.
-Ulcers
-neuro (B12 deficiency).
10-Others 
-fundoscopy
-urine dipstick
-temperature chart
23
Q

CVS exam

A

WIPE
*position: patient lying in bed with enough pillow at 45 degree
2-General appearance
-dyspnea
-cyanosis
-oedema
-cachexia
3-Hands
I would like to have a look at your hands if you could bring them up in front of you please?
-clubbing.
-signs of infective endocarditis: (you do not have to mention them just say no signs of IE)
splinter hemorrhage
Osler’s node (red tender nodules on pulp of fingers)
janeway lesion (non tender erythema on palm)
-Exanthomata (optional)
-cyanosis
-pallor
4-Arms
pulse:
-rate
-rhythm
-radio radial delay (examiner will say no)
-radio femoral delay (examiner will say no)
*in the exam just check for 15 seconds and multiply by 4 . I think that either the examiner will give you the result straight away or there will be a stop watch inside to count 15 seconds.
Blood pressure: (examiner will give you the results in this case so you will not have to measure)
Estimate radial pulse
-feel: put the cuff on the right arm and feel the radial pulse. inflate it till the radial pulse disappear and increase 20 mm hg above then start deflating and when the radial pulse returns this is the SBP.
-Measure: with the stethoscope on the brachial artery of the right arm start inflating the cuff 20 mm hg above the previous SBP then start deflating every 3-4 mmhg and when the pulse appear this is the SBP, then continue deflating and when pulse disappear this is the DBP.
-Measure the BP of the left arm only with stethoscope
-Measure BP now with patient standing (only for postural hypotension):
>15 mm hg decrease in SBP
>10 mmhg decrease in DBP
5-Face
-eyes (pallor, jaundice, exanthelasma) I am gonna pull down your lower eyelids
-malar flush
-mouth (central cyanosis). Can you open your mouth for me? And For central cyanosis ask Can you lift your tongue to the roof of the mouth?
6-Neck
-feel the carotid pulse (one artery per time; not two carotid together)
-measure JVP: >3 cm increase JVP. Ask patient to turn his head to left.
-hepatojugular reflux: press on tummy for 10 sec. ask if any tummy pain before you press.
7-Heart examination
inspection
-scars (median sternotomy, lateral thoracotomy) ask patient to lift arm to look for lat. Scars.
-deformity
-visible pulsation
-pacemakers
Palpation
-apex beat (5th intercostal space mid clavicular line 1 cm medial and below the nipple) heel off
-heave: left sternal edge fingers off
-thrills (palpable murmurs): 3 positions: apex beat, left sternal edge, upper chest
Auscultation
-bell on apex
-diaphragm on apex
-diaphragm on tricuspid area (5h intercostal space left sternal edge)
-diaphragm on pulmonary area (2nd intercostal space left sternal edge)
-diaphragm on aortic area (2nd intercostal space right sternal edge)
-axilla (radiation of systolic murmur of MR)
-right neck (radiation of systolic murmur of AS) + carotid bruit.
-left neck (carotid bruit) as patient to hold breath during listening of carotid bruit.
-lean forward for AR
-Left side turn for MS

Notes
bell=low pitch sounds= S3 or diastolic murmur
diaphragm=high pitch sounds=S1, S2, S4, systolic murmur
S1 à loud=MS/ soft=MR
S2à loud=AS/ soft = AR
P2à loud= pulmonary hypertension
S3àphysiological(young, pregnancy, thyrotoxicosis)/ heart failure/ MR, AR, VSD, PDA
S4à AS, HTN, IHD
opening snapà MS
Ejection systolic clickà AS, PS
8-Back
inspection: kyphoscoliosis
palpation: sacral oedema
percussion: base of lungs
auscultation: basal crackles (imp)
9-Abdomen (lie flat) (no need in this case)
inspection: distension
palpation: (liver) (kidney only in HPT) (aorta only in Hpt)
percussion: ascites
auscultation (aortic and renal bruit only in HPT)
10-legs (no need in this case)
inspection: color and swelling
palpation,: tenderness, oedema, hot, pulses
11-office tests (if you have time)
-urine dipstick
-fundoscopy
-ECG
Explanation.
-I have examined you very carefully but I could not find any murmur. I reassure you that it was completely normal cvs exam. Maybe at that time, you might have some fever or illness; sometime we can find some temporary murmurs during illnesses because of increased blood flow and work of the heart. We call it physiological murmur, which I think it was the most likely in your case.
-For more reassurance, I can do ECG to read your heart.
-Are u with me so far? Any questions?

24
Q

Hypertension exam

A 
1-WIPE
2-General appearance
-cyanosis , dyspnea, Oedema
-weight
3-Hands
-cyanosis, clubbing, pallor
-nail changes
4-Arm
Pulse
-rate and rhythm
-radio radial delay
-radio femoral delay with permission (coarctation of aorta) 
Blood pressure 
-make sure cuff size is correct
-position patient correctly (elbow at heart level, lying)
-take the SBP on one arm by palpation method
-take the BP same arm by auscultation method both SBP & DBP
-then take by auscultation the BP on the other arm (difference between the arms of >10 mmhg suggest vascular disease).
-take the BP in standing (ask permission first) to look for any postural changes).
Note/ the examiner will not let you do all the steps usually after measuring one arm the will give you the other arm and the postural one)
5-Face
-eye (pallor and jaundice)
-malar flush
-mouth (central cyanosis)
-cushinoid facies (moonface, plethora, acne)
-eye puffiness, sallow skin (kidney px)
-verilisation (pcos).
6-Neck
-JVP
-carotid artery palpation be careful one at a time not both together
-Thyroids
7-Heart
inspection
-scar, deformity, visible pulsation)
palpation
-apex beat
-heave and thrill
auscultation
-heart sounds and murmurs
Mitralà tricuspidàpulmonaryà aorta
-radiation
axillaà neck
-carotid bruit (breath in and out then hold)   
8-Back
inspection (oedema)
palpation (sacral oedema)
percussion (upper and lower lobe)
auscultation (basal crackles).
9-Abdomen
Inspection (distension, visible bruit)
palpation 
-liver
-kidney 
-abdominal aorta 
auscultation (diaphragm)
-aorta and renal bruit 
-AORTIC BRUIT - 2.5cm above the umbilicus 
-RIGHT AND LEFT RENAL BRUIT 2.5 cm beside Aorta 
10-leg
-pulses
-oedema
tenderness
11-others
-fundoscopy (showed AV nipping and silver wiring – said its grade 2 Hypertensive eye changes) (other case with papilledema and grade 4 hypertension)
-UDT 
-ECG
Explain
even though your BP normal now , u have hypertensive eye changes which means ur having poorly controlled long standing high blood pressure
Differential diagnosis EAR M
-Endocrine (Cushing, conn, acromegaly, thyroid, pheochromcytoma)
-arteries (Coarctation of aorta, Aortic Stenosis)
-Renal (renal artery stenosis, polycystic kidney, DM)
-Medications (NSAIDS, OCP)

o Fundoscopy findings
▪ I – Arteriolar narrowing and silver wiring
▪ II – AV nipping
▪ III – Cotton wool spots and flame-shaped hemorrhages
▪ IV – Papilledema

25
Q

Pre eclampsia exam

A
  1. Hand
    • Temperature
    • Pulse
    • CRT
    • Palm paleness
  2. Arm
    • Bruises
    • BP
  3. Eye
    • Icterus
    • Pallor
    • Fundoscopy
  4. Heart
    • Murmur
  5. Abdomen
    • RUQ tenderness
    • Uterine tenderness
    • FH
    • FHR
    • Lie and presentation
  6. Lower extremities
    • Edema - Pitting / non pitting
    • Reflexes - ankle
    • Clonus
26
Q

Breast examination

A

WIPE
3-Inspection (4 positions all sitting)
sitting with her hands on her thighs relaxed
-asymmetry (if you noticed any gross asymmetry ask if it is latest or not).
-Scars (lumpectomy, mastectomy).
-skin changes:
erythema ex. Infection/malignancy
puckering or dimpling of the skin ex breast cancer
peau d’orange ex aggressive breast cancer
-visible lump or not (if you can see it then you need to talk about the site, size and others in the exam unlikely you will see it)
-nipples (retraction, distortion, ulceration, discharge)
Hands on hip pressing inwards
-if lump visible (look if it is moving or fixed)
Both hands behind her head
-puckering or dimpling become more evident
-lower side of breast clearly
-if any lymph nodes in the armpits
Hands still behind head and ask the patient to lean forward
-if lump falling forward with lump tissue (again if not then it is attached to chest wall indicating malignancy)
4-palpation
-wear gloves
-if you could lie down on the bed for me and ask her to raise the hand of the side that will be examined and put it behind the head (for example if you start with left breast ask her to raise her left hand and put it behind her head).
-ask about pain then start with the normal breast first.
-palpate in a spiral way starting from the nipple then proceeding outwards and always make sure to palpate the axillary tail.
-then go to the abnormal breast the same maneuver and if you found a lump leave it complete the whole breast the go back to it.
-Lump examination
Site and size
-site is in what quadrant and the distance away from the nipples.
-size is to take a tape measure and find the length and width
Surface and border
-surface if even or not (smooth or nodular)
-border if regular or irregular
Consistency and tenderness
-consistency if soft, firm or hard
-tenderness
Mobility and fluctuation

  • ask the patient to squeeze her nipples
  • palpate the lymph nodes of the axilla and the neck
  • recover the dummy with the sheet
27
Q

Neonatal exam

A

Examination
1-G/A
- Active, alert
- No signs of respiratory distress
- No bruises, pink, jaundice, rash
2- Auscultate the chest and heart sounds while sitting in mum’s lap. Then put on the couch
3- Hands
-Dorsum: nails, cyanosis, syndactyly, polydactyly
-Palm: no single palmar crease, Grasp reflex
-Pulse: regular, RR delay, RF delay
4- Arms
-Tone, movement
-palpate clavicles
5-Head and Face
-Fontanelle (bulging or depression) and sutures
-Eyes (epicanthic fold, squint, pallor, jaundice, red conjunctivae, Fundoscopy red reflex, )
-Nose (shape and discharge)
-mouth (cleft lip, cleft palate, tongue, cyanosis, Rooting reflex, suckling reflex with gloves)
-Ears (ear tag, low set ears, otoscopy)
-Mandible (prognathia, retrognathia). (You will just say normal jaw position.)
Note/ with fundoscopy use just its torch and point to the eyes as red reflex in babies very obvious with just light so no need to look through the fundoscope.
6-Neck
-swelling, web neck, trachea position
7-Chest
-Deformity, wide spaced nipples
8-Abdomen
-LOOK (distension, umbilicus)
-FEEL (organomegaly)
-Hernia orifices
9-Pelvis and Lower limbs
-Asymmetrical creases
-Barlow and Ortolani (DDH) = hip stability tests
-Tone and movements of the legs
10-Feet
-club foot, nails, space between 1st and 2nd toe
11-Back passage and Genitalia (Take consent from mum plus wear gloves)
-Imperforated anus, opening of urethral meatus, testicles
- Hypospadia, Epispadia, Undescended testis (male )
-Ambiguous genitalia, clitoromegaly (female)
12-Back
-tuft of hair, swelling
13-Moro reflex
14-Ask for Growth Chart ( weight, length, head circumference)
Comment for mum
*Your baby is well and nothing to be worried about
*Encourage immunisation
*Continue breast feeding
*

28
Q

Facial swelling exam

A 
GA 
	- Alert and active 
	- Dyspnea 
	- Cyanosis 
	- Nasal flaring 
	- Use of accessory muscle 
	- Audible breathing sound 
		○ Wheeze
		○ Stridor

Hand

- Temp 
- CRT 
- Pulse 
- BP 
Eyes 
	- Look 
		○ Alignment and symmetry of eye 
		○ Redness
		○ Swelling 
			§ Note the location of swelling 
			§ Any tenderness 
			§ Change of temperature 
		○ Discharge
	- Feel 
		○ Tenderness 
		○ Hardness of eye 
		○ Temperature 
	- Move 
		○ Extraocular eye movement 
		○ Any blurring of vision 
		○ Pain on movement 
		○ Double vision 
	- Visual Acuity 
	- Visual field 
	- Vision color 
	- Accomodation 
	- Pupillary reflex 
	- Ophthalmoscope 
Ears 
	- Discharge 
	- Redness 
	- Otoscope 
		○ Redness/ bulging at TM 
Nose 
	- Erythema 
	- Discharge 
	- Tenderness 
Mouth 
	- Dental hygiene 
	- Swelling 
	- Tenderness 
Neck 
	- Cervical LN 
Chest 
Auscultate
29
Q

Alcoholic Neuropathy

A 
1-WIPE
-wash hands
-Introduce yourself
-permission and consent
-exposure
2-Gait
-walking (symmetry, broad based gait, antalgic gait)
-turning (slow or quick)
-tandem gait
-walk on toes
-walk on heels
-Romberg test
3-Look (SSSDW)
-scars, missing toes or limbs
-skin (color, ulcers, caluses, atrophic changes like shiny skin and hair loss)
-swelling
-deformity (charcot joints)
-muscle wasting
note/ in the exam most likely to be all normal 
4-Feel (TCP+ MVPR)
-Temperature
-capillary refill time
-pulses (dorsalis and posterior tibial)
note/ in the exam most likely be normal
-again cotton wool/ pinprick or monofilament (I think in the exam there will be cotton wool/pinprick).
-vibration
-proprioception
-reflexes
note/ in the exam there will be loss of sensation and vibration up to….
5-Tone, power and coordination (I think we need to do them but again after inspection, sensation and reflexes)

6-I would like to complete my examination by doing
-upper limb neuro exam
-cranial nerve exam
-cerebellar signs
-chronic liver disease signs
7-rewash hands and thanks the patient and the examiner

30
Q

Comatose pe

A 
1-general inspection
-raccoon eyes, battle signs, Ottorrhea, rhinorrhea.
-trauma, injury, bruising, rash.
-insulin injections especially on tummy / IV drug injection sites on arms 
2-Vital signs
3-Neck 
-stiffness
4-Eyes
-pupil size and shape
-light reflex
-corneal reflex
-fundoscopy
5-Ears
-otoscopy
6-Chest
-breathing pattern
-heart sounds
7-abdomen
-insulin injection 
-other aspects
8-Neuro: tone and reflex
9-office tests
-BSL  -ECG

differentials (7 decks)

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