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MD2 Core Presentation DDx > Core Presentations DDx > Flashcards

Core Presentations DDx Flashcards

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1
Q

Abdominal distension

A

Fat
Fluid: ascites (consider renal, hepatic, cardiac causes, as well as malignancy and infection)
Flatus: may be normal or in setting of SBO/LBO
Faeces
Foetus
Fibroids, large ovarian cyst

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2
Q

Acute upper abdominal pain

A 
Gallstone colic (cholelithiasis/choledocolithiasis)
Acute cholecystitis
Acute cholangitis
Acute pancreatitis
Oesophagitis
Gastritis
ACS
Other cardiorespiratory causes: pericarditis, pneumonia, empyema
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3
Q

Acute central abdominal pain

A

SBO
Abdominal aortic dissection/AAA rupture
Crohn’s disease
Mesenteric artery occlusion (ischaemic bowel)

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4
Q

Acute lateral abdominal pain

A 
Appendicitis
Pyelonephritis
Renal/ureteric colic
Salpingitis
Ruptured ovarian cyst or torsion, endometriosis, etc
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5
Q

Acute lower central (hypogastric) abdominal pain

A 
Cystitis due to bacterial infection
PID
Pelvic endometriosis
Ectopic pregnancy
Mittelschmerz
LBO
Infective colitis
IBD
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6
Q

Anorectal pain

A 
Anal fissure
Haemorrhoids (thrombosed pile)
Perianal abscess/pilonidal sinus and abscess
Proctalgia fugax, coccydynia
Proctitis
Prostatitis (referred)
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7
Q

Localised tenderness in hypogastrium

A

Acute bladder distension

Cystitis

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8
Q

Localised tenderness in RUQ

A

Acute cholecystitis
Acute alcoholic hepatitis
Acute viral hepatitis
Acute liver congestion

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9
Q

Localised tenderness in LUQ

A

Pyelonephritis
Splenic rupture (?delayed)
Splenic infarct

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10
Q

Localised tenderness in epigastrium or central abdomen

A 
Gastritis
Duodenal ulcer (relieved by food)
Gastric ulcer (exacerbated by food)
Pancreatitis
Small bowel infarction
Ruptured or dissecting AAA
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11
Q

Localised tenderness in L or R loin

A

Pyelonephritis
Renal calculus
Ruptured or dissecting AAA

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12
Q

Localised tenderness in L or R lower quadrant

A

Appendicitis
Diverticulitis
Mesenteric adenitis/non-specific abdominal pain
Ectopic pregnancy

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13
Q

Purpura (clotting defects, blood vessel fragility) and petechiae (platelet defects, vasculitis)

A

Trauma
Thrombocytopaenia: ITP, SLE, drug-induced, bone marrow replacement
Pancytopaenia: aplastic anaemia, hypersplenism, myelodysplasia, DIC
Platelet dysfunction: aspirin, NSAIDs, renal failure
Acquired vasculopathy: senile changes, AI vasculitis (Henoch-Schonlein), steroids, vit C deficiency
Acquired coagulopathy: liver disease, vit K deficiency, DIC
Congenital coagulopathy: haemophilia, von Willebrand’s

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14
Q

Gait abnormality

A

Contralateral pyramidal tract lesion: cerebral hemisphere, internal capsule, brainstem or SC
Parkinsonism
Cerebellar lesion: tumours, ischaemia
Dorsal column loss or peripheral neuropathy: vit B12 deficiency, etc
Bilateral upper motor neuron lesion: usually SC
Pelvic girdle and proximal muscle weakness: hereditary muscular dystrophy, etc
Joint, bone, or muscle lesion
Lateral popliteal nerve palsy
Drug effect

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15
Q

Abnormal speech/communication

A

Deafness due to ear disease or 8th cranial nerve lesions
Inattention due to dementia, depression, etc
Dysphasia (sensory or motor, i.e. Wernicke’s or Broca’s)
Dysarthria: cerebellar dysfunction, upper or lower motor neuron lesion
Dysphonia (or aphonia): vocal cord dysfunction

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16
Q

Acute confusion

A 
Septicaemia: UTI, URTI, etc
Hypoxia
Alcohol withdrawal, thiamine deficiency
Post-ictal state
Hypothyroidism/thyrotoxicosis
Hypoglycaemia
Adrenal failure: Addison's disease, ACTH deficiency
Frontal lobe lesion: ischaemia, tumour, abscess
Drug effect
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17
Q

Alcohol abuse

A

3 Qs and 3 Ds
Q: quantity, quality,
D: duration, dependence, damage

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18
Q

Altered bowel habit (increase in constipation or diarrhoea or both alternating)

A

Change in diet
Colonic carcinoma
Drug-induced: opioids, anti-HTN, aluminimum alkalis, laxatives
Depression
Immobility
Cerebral or spinal cord lesion
Metabolic: hypothyroidism, hyperthyroidism, hypercalcaemia, hypokalaemia

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19
Q

Altered conscious state

A 
H
A
D
H
I
M
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20
Q

Amenorrhoea

A 
Pregnancy
Normal menopause
Premature ovarian failure
PCOS
Hyperprolactinaemia: macro-/micro-adenoma, idiopathic
Thyrotoxicosis
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21
Q

Anorexia

A

?

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22
Q

Anuria/oliguria

A

?

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23
Q

Sudden (secs-hours) onset back pain

A

Mechanical: strains, tear, crushing of ligaments/disc/vertebrae
Posterior lumbar disc prolapse
Anterior lumbar disc prolapse
Spondylolisthesis: spondylolysis, congenital malformation of articular process, OA of posterior facet joints
Central disc protrusion

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24
Q

Bone pain

A

?

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25
Breast lump
``` Benign fibrous mammary dysplasia Fibroadenoma Cyst Acute or chronic abscess Fat necrosis or sclerosing adenosis Carcinoma infiltrating ductal cancer or invasive lobar cancers ```
26
Breast pain (mastalgia)
?
27
Calf pain
?
28
Chest pain
``` Musculoskeletal injury or inflammation ACS: angina, STEMI, NSTEMI Pericarditis Dissecting aortic aneurysm Oesophagitis and oesophageal spasm PE/infarction Pneumothorax Pneumonia with pleurisy Referred cervical root pain ```
29
Chronic confusion or cognitive impairment
``` Alzheimer's disease Vascular (multi-infarct) dementia Lewy body dementia Huntington's disease CJD ```
30
Cough
``` APO due to LHF (pink frothy sputum) Mitral stenosis (pink frothy sputum) COPD Chronic asthma Chronic bronchitis Acute bronchitis: viral, bacterial Pneumonia Pulmonary TB Lung abscess Lung carcinoma ILD Post-nasal drip GORD Drugs (ACEIs) ```
31
Dizziness
Postural hypotension: anti-HTNs, hypovolaemia, dehydration, diabetic autonomic neuropathy, DA agonists, Addison's disease Anaemia Hypoxia (including hyperventilation as a cause) Carotid sinus hypersensitivity Epilepsy Drug effect: sedative, anti-HTNs, alcohol
32
Double vision
``` Oculomotor (3rd nerve) paresis: intra-cavernous or posterior communicating artery aneurysm, meningioma, tentorial pressure cone, diabetes mellitus, syphilis, and brainstem ischaemia Trochlear paresis Abducens paresis Myasthenia gravis Graves' disease Orbital cellulitis Tumour INO (usually due to MS, sometimes vascular) ```
33
Dysphagia
?
34
Dysuria
?
35
Ear pain
?
36
Epistaxis
?
37
Erectile dysfunction
?
38
Eye pain
?
39
Facial pain
?
40
Facial swelling
?
41
Faecal incontinence
?
42
Falls
?
43
Fatigue
?
44
Fever
?
45
Haematemesis
?
46
Haematuria
?
47
Haemoptysis
``` Acute bronchitis: viral, bacterial Pneumonia PE/infarction Lung carcinoma Pulmonary TB Lung abscess Bronchiectasis Wegener's granulomatosis Pulmonary AVM Goodpasture's syndrome ```
48
Acute headache
``` Meningitis Low CSF pressure SAH Intracranial haemorrhage Head injury with cerebral contusion Acute closed angle glaucoma Sinusitis Tension headache Bilateral migraine ```
49
Hoarseness
``` Inhaled steroids Chronic laryngitis Vocal nodules Laryngeal carcinoma Vocal cord paresis Functional hoarseness Myxoedema Acromegaly Granulomas (e.g. in TB, sarcoid, syphilis, GPA) ```
50
HTN
?
51
Hypotension
?
52
Inguinoscrotal lumps
?
53
Inguinoscrotal pain
?
54
Itch
?
55
Jaundice
?
56
Jaw pain
?
57
Joint pain
?
58
Joint swelling
?
59
Laceration
?
60
Leg pain
?
61
Lethargy
?
62
Loin pain
?
63
Loss of hearing
?
64
Malaise
?
65
Malaena
?
66
Muscle cramps
?
67
Generalised muscle weakness
?
68
Regional muscle weakness
?
69
Nausea
?
70
Neck lump
?
71
Neck pain
?
72
Neck stiffness
?
73
Night sweats
?
74
Nocturia
?
75
Pallor
?
76
Palpitations
?
77
Perianal pain
?
78
Perianal lump
?
79
Peripheral oedema
?
80
Polydipsia
?
81
Polyuria
?
82
Rash
?
83
Rectal bleeding
?
84
Red eye
?
85
Seizure
?
86
Sensory disturbance
?
87
Skin lumps and ulcers
?
88
Shoulder pain
?
89
Sore throat
?
90
Sweating
?
91
Generalised swelling
?
92
Regional swelling
?
93
Syncope
?
94
Tinnitus
?
95
TLOC
?
96
Tremor
?
97
Urinary frequency
?
98
Urinary incontinence
?
99
Vertigo
Vertebrobasilar insufficiency (brainstem ischaemia) BPVV Meniere's disease Vestibular neuronitis Middle ear disease Reversible drug toxicity: alcohol, barbiturates, phenytoin Wernicke's encephalopathy: thiamine deficiency (usually in alcoholism) Ototoxic drugs: streptomycin, gentamicin, kanamycin, phenytoin, quinine, orsalicylate Brainstem ischaemia or infarction Posterior fossa tumour MS Migraine Temporal lobe epilepsy Ramsay Hunt syndrome due to herpes zoster
100
Vision loss?
?
101
Vomiting
?
102
Weight gain
?
103
Weight loss
?
104
Wheeze/stridor
?
105
Constipation
``` Change in diet: low-fibre, poor fluid intake Change in lifestyle or environment Immobility Drug-induced: opioids, anti-HTNs, aluminium alkalis Anal fissure Haemorrhoids Hypothyroidism Rectal tumour Colonic carcinoma Hypercalcaemia External pelvic mass compression ```
106
Recurrent diarrhoea with no blood in stools, no fever
``` IBS Faecal impaction with overflow Malabsorption: coeliac disease, lactose intolerance, pancreatic disease, Whipple's procedure Drug-induced: laxative abuse, magnesium alkalis, Abx, hypotensive agents, alcohol HIV Diabetic autonomic neuropathy Thyrotoxicosis Carcinoid syndrome ```
107
Watery diarrhoea
``` Traveller's diarrhoea ETEC (commonest) Vibrio cholera Rotavirus Norwalk virus ```
108
Dysentry (acute bloody diarrhoea +/- mucus)
``` Campylobacter enteritis Shigella (bacillary) dysentery EIEC EHEC Entamoeba histolytica ```
109
Bloody flux (recurrent diarrhoea with blood +/- mucus)
``` Crohn's disease UC Colonic carcinoma Colorectal carcinoma Diverticular disease/diverticulitis ```
110
Sudden diarrhoea, fever and vomiting
Viral gastroenteritis (usually Norwalk virus) Rotavirus Abx-induced bacterial opportunists (e.g. C. diff) Food poisoning/toxins (Salmonella typhimurium; from meat) Clostridium perfringens (from meat; incubation 8-16 hrs) Staphylococcus aureus (from meat; incubation
111
Back pain (onset over days to months)
Lumbar spinal stenosis: due to facet joint OA Spinal tumours: primary in SC/meninges/nerve roots, secondary from lung/breast/prostate/thyroid/kidney/lymphoma/myeloma Pyogenic spinal infection: usually of disc space due to staphylococcus, Salmonella typhi Spinal TB: abscesses, cord compression, psoas abscess
112
Chronic back pain (onset over years)
Kyphotic pain Scoliotic pain Idiopathic scoliosis of thoracic or lumbar spine
113
Subacute headache
Raised ICP due to tumour, hydrocephalus, cerebral, abscess Encephalitis GCA
114
Chronic and recurrent headache
``` Tension headache Migraine Cluster headache Cervical root headache Eye strain Drug side effect (e.g. nitrates) ```

MD2 Core Presentation DDx (2 decks)

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