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DDX Flashcards

1
Q

What is the botanical differential diagnosis for hepatitis?

A

Ceanothus americanus

Ganoderma lucidum

Glycyrrhiza glabra

Curcuma longa

Arctium lappa

Leptandra virginica

Scutellaria baicalensis

Taraxacum officinale (root)

Silybum marianum

Schisandra chinensis

“Constantly Gulping Gin Causes ALT/AST to Suddenly Skyrocket”

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2
Q

What is the differential diagnosis for proteinuria?

A

Physiologic causes:
Fever
Congestive heart failure

Tubulointerstitial causes:
Franconi’s syndrome

Primary glomerular dysfunction:
Membranous glomerulonephritis
Interstitial nephritis
Post-streptococcal glomerulonephritis
IgA nephropathy

Secondary glomerular dysfunction:
Systemic disease (SLE, diabetes, sickle cell anemia, polycystic kidney disease)
Infectious disease (UTI, HIV, hepatitis B/C, bacterial endocarditis)
Medications (NSAIDs,, heavy metals)
Cryoglobulinemia

Vascular causes:
Hypertension
Hemolytic uremic syndrome
Thrombotic thrombocytopenic purpura
Medium or small vessels vasculitis*

Overflow:
Multiple myeloma
Amyloidosis
Waldenstrom’s macroglobulinemia

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3
Q

What is the botanical differential diagnosis for hemorrhage?

A

Capsella bursa-pastoris

Cinnamomum zelynicum

Geranium maculatum

Hamamelis virginiana

“Cuts Cause Great Hemorrhage

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4
Q

What is the botanical differential diagnosis for gastroenteritis?

A

Berberis aquifolium/vulgare

Commiphora myrrh

Hydrastis canadensis

Matricaria recutita

Thymus vulgaris

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5
Q

What is the differential diagnosis for tracheal deviation?

A

Pneumothorax and atelectasis

Pneumothorax is a space occupying lesion, which pushes the trachea away (contralateral deviation) and causes decreased breath sounds and hyperresonance.

Atelectasis is lung collapse, which allows the trachea to fall towards the empty space (ipsilateral deviation) and has absent breath sounds.

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6
Q

What is the differential diagnosis for sensorineural hearing loss?

A

With sensorineural hearing loss, there is a defect in the conversion of sound into neural signals, such the air conduction is > bone conduction (Rinnie), and sound lateralizes to the unaffected side (Weber).

Congenital:
Intrauterine infections (TORCH diseases)
Teratogens
Perinatal hypoxia
Hyperbilirubinemia

Acquired:
Presbycusis
Meniere’s disease
CNS disease
Cranial nerve VII damage
Labyrinthitis*
Autoimmune disease of the inner ear
Infection (post meningitis, syphilis, mumps, CMV, HSV)
Neoplasms (acoustic neuroma)
Ototoxic drugs

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7
Q

What is the differential diagnosis for female infertility?

A

Ovulatory dysfunction:
Hypothalamic dysfunction
Hypopituitarism
Prolactinoma
Premature ovarian failure
Polycystic ovarian syndrome
Systemic disease (thyroid disease, Cushing’s syndrome, renal or hepatic failure)
Congenital (Turner’s syndrome, gonadal dysgenesis, gonadotropin deficiency)
Lifestyle factors (stress, poor nutrition, excessive exercise)

Outflow tract abnormalities:
Pelvic inflammatory disease
Adhesions
Tubal ligation
Congenital abnormalities
Endometriosis
Leiomyoma (fibroids)
Hostile or acidic cervical mucus
Antisperm antibodies
Structural defects

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8
Q

What is the homeopathic differential diagnosis for suicidal ideation?

A

Aurum (< cold)

Nat-sulph (< music)

Psorinum (< cold)

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9
Q

What is the botanical differential diagnosis for cholelithiasis?

A

Cholelithiasis:
Chelidonium majus
Mentha piperita

Cholelithiasis prevention:
Curcuma longa
Silybum marianum

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10
Q

What is the botanical differential diagnosis for benign prostatic hyperplasia?

A

Prunus africanum

Urtica dioica (root)

Serenoa repens

Hydrangea arborescens

“Cock PUSH”

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11
Q

What is the differential diagnosis for seizures?

A

Epilepsy, status epilepticus

Migraine variant

Syncope

Panic attack

Transient ischemic attack

Movement disorder

Narcolepsy

Cataplexy

Viral encephalitis

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12
Q

What is the botanical differential diagnosis for hay fever (allergic conjunctivitis, rhinitis or sinusitis)?

A

Euphrasia officinalis

Larrea tridentata

Sambucus nigra

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13
Q

What is the homeopathic differential diagnosis for fever without thirst?

A

Belladonna (< motion)

Gelsemium (> continued motion)

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14
Q

What is the botanical differential diagnosis for inflammatory bowel disease?

A

Aloe vera

Boswellia serrata

Glycyrrhiza glabra/ DGL

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15
Q

What is the differential diagnosis for elevated liver enzymes?

A

Drastically elevated AST and ALT (> 1000):
Acute viral hepatitis (most common)
Autoimmune hepatitis
Hepatic ischemia
Drugs and toxins

ALT > AST:
Chronic hepatitis
Fatty liver

ALT < AST:
Alcoholic liver disease
Cirrhosis

Elevated ALP and GGT:
Cholestasis

Increased AST and ALT indicate hepatocellular damage. ALLT is more specific for the liver, whereas AST can be elevated by multiple sources (especially muscle).

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16
Q

What is the botanical differential diagnosis for general infections?

A

Astragalus membranaceus

Baptisia tinctoria

Bryonia alba

Commiphora myrrha

Echinacea spp.

Eleutherococcus senticosus

Eucalyptus globulus

Eupatorium perfoliatum

Glycyrrhiza glabra

Hydrastis canadensis

Juniperus communis

Larrea tridentata

Ligusticum porteri

Ligustrum lucidum

Panax spp.

Rosmarinus officinalis

Salvia officinalis

Sambucus nigra

Scutellaria baicalensis

Thymus vulgaris

Withania somnifera

Zingiber officinale

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17
Q

What is the differential diagnosis for secondary amenorrhea?

A

Functional causes:
Pregnancy
Prolonged, intense exercise
Excessive dieting

Endocrine causes:
Hypothyroidism or hyperthyroidism
Hypothalamic dysfunction
Prolactinoma

Ovarian causes:
Menopause
Premature ovarian failure
Polycystic ovarian syndrome
Gonadal dysgenesis

Structural causes:
Atrophy
Imperforate hymen
Mullerian agenesis

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18
Q

What are the red flags for emergent abdominal pain?

A

Extremes of age

Unstable vital signs

Fever

Signs and symptoms of shock

Rapid onset severe pain

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19
Q

What is the differential diagnosis for emergent dyspnea?

A

Respiratory causes:
Bronchospasm
Pulmonary embolism
Pneumothorax
Infection (bronchitis, pneumonia)
Upper airway obstruction (aspiration, anaphylaxis)

Cardiac causes:
Acute MI
Congestive heart failure
Cardiac tamponade

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20
Q

What is the differential diagnosis for casts on urinalysis?

A

Hyaline casts:
Physiologic (concentrated urine, dehydration, fever, exercise)

Red blood cell casts:
Glomerular bleeding (glomerulonephritis, vasculitis)

White blood cell casts:
Infection (pyelonephritis)
Inflammation (interstitial nephritis)

Pigmented granular casts:
Acute tubular necrosis
Glomerulonephritis
Interstitial nephritis

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21
Q

What is the differential diagnosis for non-articular joint pain?

A

Localized:
Bursitis
Tendonitis
Capsulitis
Muscle sprain

Generalized:
Polymyalgia rheumatica
Fibromyalgia
Myofascial pain syndrome

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22
Q

What is the botanical differential diagnosis for uterine prolapse?

A

Chamaelirium luteum

Caulophyllum thalictroides

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23
Q

What is the differential diagnosis for otalgia?

A

Local causes:
Infection (AOE, AOM, herpes simplex/zoster, auricular cellulitis, mastoiditis)
Trauma (burns, hematoma, lacerations, traumatic perforation, barotrauma)
Obstruction (neoplasms, foreign body, cerumen impaction, cholesteatoma)

Referred pain (from CN V, IX, X):
Eustachian tube
TMJ syndrome
Trismus
Dental conditions
Tonsils (tonsillitis, tonsillar cancer)
Thyroiditis
Bell’s palsy (CN VII palsy)

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24
Q

What is the botanical differential diagnosis for diabetes?

A

Allium cepa/sativum

Panax spp.

Theobroma cacao

Linum usitatissimum

Momordica charantia

Gymnema sylvestre

“Ate Protein To Lower My Glucose”

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25
What is the botanical differential diagnosis for headache?
Piscidia erythrina Tanacetum parthenium Vinca major/minor
26
What is the differential diagnosis for azotemia (elevated levels of urea and nitrogen)?
Prerenal causes: Hypovolemia Fluid losses (hemorrhage, gastrointestinal, urine) Sepsis Hepatorenal syndrome Renal causes: Renal failure Glomerulonephritis Renal tubular necrosis Acute interstitial nephritis Pyelonephritis Renal artery obstruction (thrombosis, embolism, aortic dissection) Postrenal causes: Obstruction (stones, tumor, BPH) Neurogenic
27
What is the differential diagnosis for diplopia (double vision)?
Monocular diplopia (persists when good eye covered): Cataracts Dislocated lens Binocular diplopia (resolves with either eye covered): Strabismus Cranial nerve palsy (CN III, IV, VI) Diabetes Myasthenia gravis Multiple sclerosis
28
What is the differential diagnosis for Kussmaul’s sign?
Kussmaul’s sign is a paradoxical rise in jugular venous pressure (JVP) on inspiration. It can be seen in some forms of heart disease and is usually indicative of limited right ventricular filling due to right heart failure. Constrictive pericarditis Right ventricular myocardial infarction Tricuspid stenosis Cardiac tamponade
29
What is the differential diagnosis for headaches?
Intracranial pressure causes: Hypertensive encephalopathy Brain tumor Preeclampsia, eclampsia Vascular causes: Migraine Temporal arteritis Cerebrovascular accident Pituitary apoplexy Hematoma Subarachnoid hemorrhage Musculoskeletal causes: Tension type Temporomandibular joint syndrome Infectious causes: Meningitis Brain abscess Other causes: Cluster headaches Trigeminal neuralgia Acute angle-closure glaucoma Medication overuse or withdrawal Red flags of serious headaches include sudden onset of severe pain, accompanying symptoms (impaired mental status, fever, seizures, focal neurological deficits) and new headaches beginning > 50 yo.
30
What is the differential diagnosis for acute diarrhea?
Diarrhea is the production of >200g of feces per day along with a change in stool consistency. Acute onset diarrhea is usually infectious and self-limiting. The causes of acute diarrhea can be inflammatory (which present with small volume, high frequency, often bloody diarrhea, with urgency, fecal WBC and RBC, and possible fever) or non-inflammatory (which present with high volume, watery diarrhea that is negative for fecal WBC). The most common cause of pediatric diarrhea is rotavirus infection. Inflammatory causes: Invasive bacteria (Salmonella, Campylobacter, C. difficile, E. coli, Shigella, Yersinia) Protozoal (E. histolytica, amoebiasis) Drugs (NSAIDs) Inflammatory bowel disease Non-inflammatory causes: Non-invasive bacteria (S. aureus, B. cereus, C. perfringens, V. cholera) Protozoal (Giardia) Viral (Rotavirus, Norwalk virus, CMV) Drugs (antacids, antibiotics, laxatives, Colchicine) Sugars (lactose, sorbitol, mannitol)
31
What is the botanical differential diagnosis for amenorrhea?
Angelica sinensis Chamaelirium luteum Caulophyllum thalictroides Verbena officinalis Vitex agnus-castus
32
What is the differential diagnosis for tremors?
Intention tumors: Benign essential tremor Hypoglycemia Brainstem lesion Cerebellar lesion (MS, stroke, trauma) Wilson’s disease Sedative or alcohol withdrawal Thyrotoxicosis Pheochromocytoma Anticonvulsant use Resting tremors: Parkinson’s disease Wilson’s disease Lewy body disease Mercury poisoning
33
What is the differential diagnosis for hematuria?
Pre-renal causes: Hematologic (coagulopathy, sickle cell disease, thromboembolism) Leukemia Neoplasms Drugs (anticoagulants) Renal causes: Trauma Infarct Obstruction (renal colic, urolithiasis) Neoplasms (renal cell carcinoma, bladder cancer, prostate cancer, Wilms tumor) Inflammation (pyelonephritis, glomerulonephritis, interstitial nephritis) Connective tissue disorders (Wegner’s, Goodpasture’s disease, SLE, Churg-Strauss, Henoch-Schonlein purpura, polyarteritis nodosa) Hereditary (polycystic kidneys, Alport’s syndrome, arteriovenous malformation) Post-renal causes: Obstruction (nephrolithiasis, polyps, tumor, urethral stricture) Inflammation (prostatitis, cystitis, urethritis) Pseudohematuria: Vaginal bleeding Dyes (beets, rhodamine B) Hemoglobin (hemolytic anemia) Myoglobin (rhabdomyolysis) Drugs (rifampin, phenazopyridine, pyridium, phenytoin) Porphyria Laxatives (phenolphthalein) Gross painless hematuria is bladder cancer until proven otherwise.
34
What is the homeopathic differential diagnosis for diarrhea?
Arsenicum (< cold) Gelsemium (from fright, > continued motion) Podophyllum (< heat, morning) Sulphur (< heat, morning) Veratrum (< cold, motion)
35
What is the differential diagnosis for hematemesis?
Hematemesis is passage of dark brown, partially digested blood by mouth. It usually presents with coffee-grounds consistency, and may be accompanied by melema, hematochezia and symptoms of blood loss including shock, dizziness and dyspnea. Upper gastrointestinal causes: Oral laceration Pharyngeal lesion Esophageal varices or laceration Gastric causes: Bleeding gastric ulcer Bleeding duodenal ulcer Stress ulcer Gastric laceration Non-gastrointestinal causes: Aspirin or NSAID use Caustic toxic ingestion
36
What is the differential diagnosis for chronic dyspnea?
Cardiac causes: Valvular disease Decreased cardiac output (CHF) Respiratory causes: Upper airway obstruction (tumor) Airway disease (asthma, COPD) Parenchymal lung disease (interstitial disease, fibrosis, bronchiectasis, sarcoidosis) Pulmonary vascular disease (pulmonary hypertension, vasculitis) Pleural disease (effusion, mesothelioma) Gastrointestinal causes: Gastroesophageal reflux disease Hematologic causes: Severe anemia Neuromuscular causes: Amyotrophic lateral sclerosis Myasthenia gravis
37
What is the differential diagnosis for sore throat?
Streptococcal or viral pharyngitis Infectious mononucleosis Tonsillitis Peritonsillar abscess Leukemia Hodgkin’s disease
38
What is the homeopathic differential diagnosis for hypertension?
Belladonna (< heat, motion, lying down) Glonoine (< heat, especially around the head)
39
What is the differential diagnosis for restrictive lung disease?
Pneumonia Acute respiratory distress syndrome Interstitial lung disease Pulmonary fibrosis Scleroderma Pulmonary edema Effusion Neuromuscular disease (myasthenia gravis, poliomyelitis) Chest wall disease (scoliosis)
40
What is the differential diagnosis for loss of vision?
Transient vision loss: Transient ischemic attack Migraine with aura Acute vision loss: Trauma/foreign body Cerebrovascular accident Occipital infarction Retinal artery or vein occlusion Retinal detachment Uveitis Optic neuritis Chronic vision loss: Cataracts Corneal dystrophy Corneal ulcer Macular degeneration Glaucoma Diabetic retinopathy Compressive optic neuropathy (intracranial mass, pituitary tumor, orbital mass) Pituitary adenoma Nutritional deficiency
41
What is the differential diagnosis for constipation?
Constipation is defined as infrequent bowel movements (typically less three times per week), often with difficulty or straining during defecation. The most common cause is inadequate fiber or fluid intake. Obstructive causes: Colorectal cancer Stricture Extrinsic compression Rectocele Metabolic causes: Diabetes Thyroid dysfunction Hypercalcemia, hypokalemia Neurological causes: Parkinson’s disease Multiple sclerosis Stroke Collagen vascular disease: Scleroderma Dermatomyositis Iatrogenic causes: Narcotics Antidepressants Calcium channel blockers
42
What is the differential diagnosis for syncope?
Syncope is a sudden, transient loss of consciousness and postural tone secondary to abrupt drops in cerebral perfusion. Cardiac causes: Acute coronary syndrome Ventricular arrhythmia Acute atrial fibrillation Tachycardia Heart block Myocardial infarction Aortic dissection Congestive heart failure Valvular disease (aortic or mitral stenosis) Outflow obstruction (pulmonary embolism, cardiac tamponade, tension pneumothorax, pulmonary hypertension) Neurologic causes: Vasovagal Orthostatic hypotension Epilepsy, seizure Dysfunctional brainstem Cerebrovascular disorders Metabolic causes: Hypoglycemia Addison’s disease Hypoxemia Alcohol intoxication Psychogenic causes: Anxiety
43
What is the differential diagnosis for lower GI bleeds?
Common causes: Diverticulosis Ischemia Angiodysplasia Infection Anorectal (hemorrhoids, fissures, ulcers) Uncommon causes: Post-polypectomy Radiation colitis Irritable bowel disease Upper GI bleed
44
What is the differential diagnosis for abnormal uterine bleeding?
Gynecological causes: Cervical cancer Endometrial hyperplasia or carcinoma Leiomyoma (fibroids) Adenomyosis Pelvic inflammatory disease Copper IUD Infection (endometritis*, cervicitis, vaginitis, STI) Obstetric causes: Miscarriage Ectopic pregnancy Placenta previa Endocrine causes: Polycystic ovarian syndrome Hyper or hypothyroidism Adrenal insufficiency Insulin resistance Prolactinoma Estrogen producing tumor Weight loss Hematological causes: Coagulopathy (von Willebrand’s disease) Platelet abnormalities (immune thrombocytopenic purpura) Hematologic malignancy (leukemia, lymphoma) Renal causes: Impaired estrogen excretion Hepatic causes: Decreased coagulation factors Impaired estrogen metabolism Drug causes: Anticoagulants Danazol OCP, HRT Spironolactone Steroids Neuroleptics
45
What is the differential diagnosis for dysphagia?
Dysphagia is difficult swallowing. Mechanical dysfunction (symptoms primarily with solids): Eosinophilic esophagitis Stricture Schatzki ring/esophageal web Zenker’s diverticulum Extrinsic compression (thyromegaly, tumor) Mobility dysfunction (symptoms with solids and liquids): Diffuse esophageal spasm Achalasia Scleroderma Neurological dysfunction* (cortical, bulbar, peripheral) Muscular dysfunction (muscular dystrophy, myasthenia gravis, polymyositis)
46
What is the differential diagnosis for dyspareunia?
Introital pain: Inadequate lubrication Rigid or intact hymen Bartolin’s or Skene’s gland infection, abscess* Lichen sclerosus Vulvovaginitis (atrophic, chemical, infectious) Herpes simplex Midvaginal pain: Urethritis Short vagina Trigonitis Vaginal atrophy Congenital abnormality of the vagina Deep pain: Endometriosis Endometritis Cervicitis Adenomyosis Leiomyoma (fibroids) Pelvic inflammatory disease Hydrosalpinx Tubo-ovarian abscess Uterine retroversion Ovarian cyst
47
What is the differential diagnosis for claudication?
Vascular causes: Atherosclerotic disease Vasculitis (Buerger’s disease, Takayasu’s arteritis) Diabetic neuropathy Venous disease (deep vein thrombosis, varicose veins) Neurologic causes: Neuro Spinal disease (spinal stenosis) Reflex sympathetic dystrophy Musculoskeletal causes: Osteoarthritis Rheumatoid arthritis Connective tissue disease
48
What is the differential diagnosis for jaundice with conjugated (direct) hyperbilirubinemia?
Serum bilirubin is a maker of RBC metabolism and hepatic excretion. Unconjugated bilirubin is a breakdown product of hemoglobin destruction, which travels to the liver where it becomes conjugated before being excreted.Thus, elevation of conjugated bilirubin in the serum is indicative of a pathology downstream of the liver. Impaired hepatic secretion: Hepatic disease (hepatitis,, cirrhosis) Metabolic disease (Wilson’s disease, hemochromatosis) Drug-induced cholestasis (OCP, chlorpromazine) Primary biliary cirrhosis Primary sclerosing cholangitis Sepsis Extrahepatic, intraductal biliary obstruction: Gallstone Biliary stricture Parasites Malignancy (cholangiocarcinoma) Sclerosing cholangitis Extrahepatic, extratraductal biliary obstruction: Malignancy (pan occlusion, pancreatic cancer) Inflammation (pancreatitis)
49
What is the botanical differential diagnosis for hypertension?
Adrenergics: Rauwolfia serpentina Circulatory stimulants: Allium cepa/sativum Theobroma cacao Camellia sinensis Inotropics: Crataegus oxycantha Vasodilators: Coleus forskohlii Ganoderma lucidum Tilia europaea Veratrum alba/viride Vinca minor/major Viscum flavescens
50
What is the botanical differential diagnosis for varicose veins and hemorrhoids?
Centella asiatica Hamamelis virginiana Aesculus hippocastanum Geranium maculatum Vaccinium myrtillus “Curse My Hemorrhoids And Giant Veins”
51
What is the botanical differential diagnosis for dermatitis?
Calendula officinalis Quercus alba Symphytum officinale
52
What is the differential diagnosis for emergent coma?
Primary CNS disease: Epilepsy Diffuse trauma or ischemia Compression (tumor, hematoma) Brainstem infarct or hemorrhage Metabolic causes: Acid or base disorders Hypo- or hyperglycemia Endocrine disorders Electrolyte disturbances Hypoxia Lactate Toxic causes: Alcohol Infection, sepsis Rapid or abrupt onset suggests CNS hemorrhage, ischemic or cardiac causes. Gradual progression suggests CNS lesion, toxic or metabolic causes.
53
What is the botanical differential diagnosis for threatened miscarriage and premature labor?
Uterine tonics Angelica sinensis Chamaelirium luteum Caulophyllum thalictroides Mitchella repens Spasmolytics: Cimicifuga racemosa Dioscorea villosa Viburnum opulus
54
What is the differential diagnosis for emergent headache?
Meningitis Increased intracranial pressure Temporal arteritis Subarachnoid hemorrhage Red flags of serious headaches include sudden onset of severe pain, accompanying symptoms (impaired mental status, fever, seizures, focal neurological deficits) and new headaches beginning > 50 yo.
55
What is the differential diagnosis for GI bleeds?
Common causes: Ulcers Esophageal varices Mallory-Weiss tears Erosive esophagitis Erosive gastritis Uncommon causes: Tumors Arteriovenous malformation Gastric antral vascular gastropathy Portal hypertensive gastropathy
56
What is the botanical differential diagnosis for wet cough?
Stimulating expectorants: Asclepias tuberosa Aspidosperma quebracho Lobelia inflata Sanguinaria canadensis Mixed expectorants Inula helenium Anticatarrals Solidago odora
57
What is the differential diagnosis for infective diarrhea?
Watery diarrhea with minimal abdominal pain and no fever: Staphylococcus aureus Clostridium perfringens Vibrio cholera Enterotoxigenic E. coli Watery diarrhea with moderate abdominal pain and variable fever: E. coli Giardia Bloody diarrhea with severe abdominal pain and mild fever: Hemorrhagic E. coli Clostridium difficile Bloody diarrhea with severe abdominal pain and high fever: Salmonella Campylobacter Shigella Enterovasive E. coli Entamoeba histolytica
58
What is the botanical differential diagnosis for symptoms of menopause?
Humulus lupulus Angelica sinensis Linum usitatissimum Trifolium pratense Salvia officinalis Medicago sativa “HALTS Menopause”
59
What is the botanical differential diagnosis for hypoadrenocorticism (adrenal fatigue)?
Eleutherococcus senticosus Glycyrrhiza glabra
60
What is the botanical differential diagnosis for urinary tract infections?
Antimicrobials Arctostaphylos uva ursi Barosma betulina Berberis aquifolium/vulgaris Juniperus communis Glycyrrhiza glabra Antiadhesions Vaccinium macrocarpon Alteratives: Equisetum arvense Galium aparine Diuretics: Hydrangea arborescens Urtica dioica (leaf) Solidago odora Taraxacum officinle (leaf) Anodynes: Salix alba Demulcent: Ulmus rubra

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