DDx Flashcards Preview

Step 2CK > DDx > Flashcards

Flashcards in DDx Deck (51):
1

Jaundice in pregnancy

-HELLP
Hemolysis, Elevated Liver enzymes, Low Platelet
Preeclampsia, RUQ pain, N/V

-Intrahepatic cholestasis of pregnancy
Very elevated AST/ALT, direct bilirubinemia
Pruritus and jaundice

-AFLP
Liver failure, DIC, mod elevated AST/ALT
RUQ pain, malaise, N/V

2

Erythema nodosum

Sarcodosis
Group A strep
TB
Histoplasmosis
IBD
(always do a CXR)

3

Hemorrhagic vs ischemic stroke

If hemorrhagic rapidly worsening sx
N/V, headache, AMS
Risk factors: smoking, HTN
Dx with CT scan w/o contrast

4

Anemia of chronic dz

Low MCV
Low iron (if high and microcytic think thalassemia)
Low TIBC
High ferritin

5

Lumbar spinal stenosis

Worse with extension
Pain when standing and walking downhill
Neurological deficits
Dx with MRI

6

Spondylolisthesis/spondylolysis

Fracture of pars interarticularis
Stiffness that radiates to buttocks and back of thighs
Worsen with standing/walking
Improves with rest

7

Solitary lung nodule

Concerning if on CXR:
>2cm size
spiculated, scalloped
then biopsy
causes: primary cancer, metastasis, granuloma, benign neoplasm (lipoma, granuloma, hamartoma), vascular malformation

8

Laryngomalacia

chronic stridor
Peaks at 4-8 months
dx with laryngoscopy
worse when supine, better when prone

9

CVID

Low Ig in all classes
Recurrent resp infxn, sinusitis, GI infxn
Tx with immunoglobulin replacement

10

Lung cancer

Adenocarcinoma
Squamous
Small cell
Large cell
Carcinoid

11

Spherocytosis

Extravascular hemolysis, jaundice, splenomegaly
Hgb concentration elevated, ankyrin mutation
Spherocytes on smear
negative Coombs
Glycerol lysis test positive for fragility
eosin 5 maleimide binding test
B19 parvovirus -> aplastic crisis

12

Hypoparathyroidism

Post surgical or autoimmune
High phos, low Ca
Tetany spasms (Chvostek sign)
Prolonged QT from hypocalcemia

13

Hyperparathyroidism

Low Phos, high Ca, due to adenoma, hyperplasia, carcinoma
Secondary from CKD -> high Phos, low Ca
Vit D def -> high Ca, low Phos
Bones, stones, groans, psych overtones

14

HUS

follows Shiga like E coli infection
MAHA (Coombs neg), thrombocytopenia, AKI
bruising, petechiae, edema
schistocytes on smear

15

Pernicious anemia

Abs against parietal cells producing intrinsic factor
Low B12 serum levels with glossitis, neuropathy, macrocytic anemia
Atrophic gastritis increases risk of gastric cancer, carcinoid

16

Primary sclerosing vs biliary cholangitis

Fatigue, pruritus, cholestasis
mutlifocal narrowing with onion skin fibrosis
PBC = middle aged women
anti mt abs +
PSC = young men with IBD
pANCA abs + (nonspecific)

17

Epidural vs subdural

Epidural:
Does not cross suture lines
biconvex shape, fast growing, mass effect
Subdural:
Crosses suture lines
lentiform shape, slow growing, no mass effect

18

NPH

onset in 60 to 70s, M=F
Early gait impairment with broad based shuffling
Incontinence
Late memory and cognitive impairment
normal CSF opening pressure

19

PE

Elevated JVP, loud P2
Tachycardia, hypoxia, chest pain, syncope
Reduced EF, hypotension
on echo, R free wall hypokinesis with apical sparing
Bowing of septum into LV due to PHTN
Tx with LMWH then switch to warfarin

20

Thyroiditis

Hashimoto's = chronic autoimmune, hypothyroid
nontender diffuse goitier, + TPO, variable iodine uptake
Painless = mild, transient, hyperthyroid
nontender small goitier, + TPO, low iodine uptake
De Quervain = subacute postviral, hyperthyroid
tender goitier, low iodine uptake

distinguish Graves from painless t. with uptake test

21

Muscular dystrophy

Becker = no dystrophin, early onset, XLR
Duchenne = reduced dystrophin, early onset, XLR
Myotonic = DMPK triplet expansion, late onset, dominant

22

Hepatorenal syndrome

precipitated by infxn, GI bleed, vomiting, diuresis, NSAID
Renal hypoperfusion with low FeNa, no tubular injury
no sediment, no improvement with IV fluids
Tx: splanchnic vasoconstriction with octeotride, midodrine, NE, address precipitating factors

23

Beckwith-Wiedemann syndrome

Hemihyperplasia
macroglossia
omphalocele
abd U/S for Wilms tumour
Monitor alpha fetoprotein

24

Wilms tumor

Hypertension, hematuria, abd mass
associated with:
Beckwith-Wiedemann
neurofibromatosis
WAGR syndrome

25

Pediatric hip disorders

SCFE - obese adolescent boys, cartilage, Sx
LCP dz - younger boys, avascular necrosis, orthoses
CHD - from birth, harness

26

Post op fever

water, wind, walk, wawa, weird drugs
Immediate - trauma, infxn, blood products, drugs
Acute - Infxn group a strep, C perfringens, MI, PE, DVT
Subacute - catheter, drug fever, PE, DVT, C diff
Delayed - viral or surgical site infxn
PE, DVT, atelectasis have similar timing

27

Dementias

FTD = cortical atrophy frontal and temporal lobes
early onset (50-60s), personality changes, Pick bodies
AD = cortical atropy of parietal and temporal lobes
late onset (60-70s), memory loss, senile plaques
LBD = generalized atrophy, parkinsonism, late dementia
insidious onset, hallucinations, Lewy bodies

28

Cervicits

Chlamydia (most common)
dysuria, + cx, doxy or azythro
Gonorrhea
mucopurulent d/c, + cx, ceftriaxone
Trichomonas (least common, strawberry cervix)
green, frothy d/c, motile orgs, metronidazole

29

Adnexal mass

Endometrioma - homogeneous mass, infertility
Epithelial carcinoma - septations, solid components, high serum CA-125
Mature teratoma - echogenic material, calcifications
Malignant signs: fixed, firm, b/l, multilocular, ascites
Benign signs: mobile, soft/cystic, unilocular, < 8cm

30

Ovarian tumor markers

Epithelial - CA 125
Endodermal or embryonal - AFP
Choriocarcinoma - hCG
Dysgerminoma - LDH
Granulosa cell - Inhibin

31

Precocious puberty

True if advanced bone age, <8 for girls, <9 for boys
Administer GnRH agonist (leuprolide)
Central - positive GnRH stimulation test (high LH)
Constitutional, CNS lesion, or dysgerminoma
Peripheral - negative GnRH stimulation test (low LH)
CAH, McCune Albright, gonadal tumor

32

Lyme disease

ELISA first, then confirmatory Western blot
early dz with doxycycline (amoxicillin or cefuroxime if peds)
late disseminated dz (arthritis, CNS) with IV ceftriaxone

33

Placenta previa vs vasa previa

Placenta previa - maternal painless bleed, FHT unaffected, associated with smoking, previous c section
Vasa previa - umbilical vessel damage, fetal distress
Avoid intercourse, digital exam w/o prior US if either is suspected

34

Pseudotumor cerebri

Young obese women with daily headaches, worse in AM
Impaired CSF resorption leads to high ICP
Papilledema, oculomotor abnormalities, N/V
May lead to blindness
Weight loss, acetazolamide, surgical fenestration of CNII

35

Herpangina vs herpetic gingivostomatitis

Herpangina - Coxsackie A virus
3-10 years old
Fever, pharyngitis, gray vesicles/ulcers in post mouth
Herpetic gingivostomatitis - HSV type I
1-5 years old
Fever, pharyngitis, clusters of small vesicles in ant mouth

36

Leukemoid vs lymphomas vs leukemias

Leukemoid reaction - infection, serum LAP high
ALL (3-5 yrs old) - Down syndrome, lymphoblasts in bone marrow
AML (13-40 yrs old) - Auer rods, myeloblasts in bone marrow, high LDH, tx for PML subtype with ATRA
CML (40-60 years old) - BCR-ABL fusion/Philadelphia chromosome, serum LAP low
CLL (males > 50) - smudge cells, splenomegaly

37

Felty syndrome

RA with neutropenia and splenomegaly
Rheumatoid nodules, mononeuritis multiplex, vasculitis
ESR, anti CCP and RF elevated,

38

Mallory Weiss tear vs Boerhaave syndrome

MW = mucosal tear, hematemesis
BS = transmural tear, esophageal air/fluid leakage

39

Anemia due to iron def vs thalassemias

Thalassemia (alpha, beta, Hgb H)
extramedullary hematopoiesis with bone changes
target cells, high or normal iron and ferritin
Iron deficiency
hypochromia, low iron and ferritin, elevated TIBC

40

Cyanide vs CO vs methemoglobinemia

Cyanide - burning polymers
tx with hydroxycobalamin, thiosulfate or nitrites
CO - burning of carbons
tx with pure O2
Methemoglobin - nitrites and oxidants, dapsone
tx with O2, methylene blue

41

Hemorrhagic stroke

Cerebrum - contralateral hemiparesis and sensory loss, eye deviation away from lesion, seizures, homonymous hemianopsia
Cerebellum - ataxia, nystagmus, n/v, neck stiffness
Thalamus - contralateral hemiparesis and sensory loss, eye deviation towards lesion, upgaze palsy
Pons - coma, paralysis, locked in syndrome with pinpoint reactive pupils
Basal ganglia - contralateral hemiparesis and sensory loss

42

Breast feeding vs breast milk jaundice

Breastfeeding - inadequate feeding in first week of life
Breast milk - adequate feeding, peaks at 2 weeks due to excess deconjugation from milk in intestine

43

Herniation

1 - ipsilateral hemiparesis (crus cerebri)
2 - Mydriasis (CNIII parasympathetics)
3 - ptosis, down and out gaze (CN III motor)
4 - homonymous hemianopsia (PCA compression)
5 - LOC, coma (reticular formation)

44

Rashes of childhood

Pytiriasis rosea - herald patch, xmas tree sign, self resolving
Erythema marginatum - faint borders, evanescent, ARF
Erythema multiforme - dusky center, red borders, due to infection or medication
Tinea corporis - contact sports, scaly rash, central clearing, raised borders
Eczema - scaly or papular patches in flexural areas
Urticaria - raised plaques resolve over 24 hrs

45

central vs peripheral Bell's palsy

Central - contralateral, spares forehead
Peripheral - ipsilateral, affects forehead
may cause decreased tearing, hyperacusis, decreased taste in anterior 2/3 tongue

46

Skin infection

Erysipelas - (S pyo), raised sharp edges, fever, superficial dermis and lymphatics, rapid onset
Non purulent cellulitis - (MSSA, S pyo), flat, blurred edges, deeper layers of dermis, indolent
Cellulitis - (MSSA, MRSA), folliculitis, abscess formation

47

Immunodeficiencies

Affect B cells:
Bruton's agammaglobulinemia, CVID, IgA deficiency
Affect T cells:
Di george syndrome, SCID, Wiskott Aldritch
Affects phagocytes:
Chronic granulomatous disorder, Leukocyte adhesion defects, Chediak Higashi
Affects complement:
C1 esterase def, terminal complement def

48

Vaginal bleeding in pregnancy

Vasa previa - fetal distress and painless bleeding
Placenta accreta - retained placenta
Uterine rupture - tender uterus, palpable parts
Abruptio placentae - fetal distress, distended uterus

49

Amniotic fluid embolus vs pulm edema in pregnancy

embolus - hypotension, shock, resp failure peri partum
edema - hypertension, low albumin, low renal function in pre-eclampsia

50

RTA

hyperchloremic metabolic acidosis with normal AG
Type 1 - meds, autoimmune dz, genetic dz
reduced H excretion (low K, high urine pH)
Type 2 - Fanconi syndrome
poor bicarb reabsorption (low K, low urine pH)
Type 4 - obstruction, adrenal hyperplasia
aldosterone resistance (high K, low urine pH)

51

Multiple myeloma

CRAB - calcium is elevated, renal failure, anemia, bone lesions
Protein-albumin gap
SPEP with M-spike, Rouleux formation
Dx with bone marrow biopsy showing clonal plasma cell