Ddx of conditions Flashcards
(193 cards)
1
Q
Abdominal pain, relieved by leaning forwards or drinking alcohol. Weight loss. Anorexia. avoidance of food. DM (30 - 70%). Diarrhoea. Steatorrhoea (when 90% of exocrine tissue destroyed). Exudate production from lungs. Symptoms of other alcohol and smoking related illnesses. Mostly affects middle aged alchoholic men. Toxic(T): Alcohol (80% of western cases), tobacco, hypercalcaemia, chronic renal failure. (I)diopathic. (G)enetic, cystic fibrosis. (A)utoimmune. (R)ecurrent acute pancreatitis. (O)bstructive: neoplasia, pancreas divisum. NOT GALLSTONES.
A
Chronic pancreatitis
2
Q
Acute abdominal or lumbopelvic pain - onset in minutes. General malaise and leg weakness. Possible vascular claudication.
A
Ruptured abdominal aortic aneurysm
3
Q
Acute abdominal pain and possible lumbopelvic pain, that increases after menstruation in sexually active female. Fever, chills, dyspareunia (pain during intercourse) and abnormal vaginal discharge.
A
Pelvic inflamatory disease possibly related to STD (Chlamydia, gonorrhoea)
4
Q
Acute abdominal pain between periods (while ovlating)
A
Mitelschmertz
5
Q
Acute abdominal pain in sexually active woman with missed or spotty last period 6-8 weeks before. Sudden onset.
A
Ectopic pregnancy
6
Q
Acute abdominal pain. Sudden onset. Young person. Poorly localised becoming more specific to RLQ within 2-12 hours. Nausea and vomiting. Annorexia, diahrroea.
A
Appendicitis
7
Q
Age 30 to 60 most common. Head and neck pain. Worse with extension, lat flex or rotation. Better with flexion. Hand numbness, hoarseness, vertigo, tinnitus, deafness. Spastic gait. Drop attacks. ataxia. Loss of hand function. Poss loss of bl & bwl function. Cogwheel hyperreflexia.
A
Cervical stenosis/Cervical myelopathy
8
Q
Age 30-50 yrs. Men > Women. Following twisting event. Severe LBP and then leg pain to below knee. Patient leans away from medial lesion or towards lateral lesion. May be LMN symptoms at site of lesion and possible UMN below lesion if posterior.
A
Prolapsed intervertabral disc with radiculopathy (lumbar)
9
Q
Age 50+ History of breast, prostate, lung or kidney cancer. Gradual onset of pain, worse at night. Weight loss. Fatigue.
A
Spinal tumour (Mets)
10
Q
Age 50+ Persistant LBP. Worse at night. Osteoporosis. Hypercalcaemia. Anaemia. Renal disease. Infection due to suppressed immune system.
A
Multiple myeloma
11
Q
Alteration in mental state and cognitive function.Confusion. Slurred speech, Change in personality. Violent behaviour. Sleepy. Difficult to arouse. Flapping termors. Leads to coma - initially responsive to noxious stimuli, later unresponsive. Patient with liver disease.
A
Hepatic encephalopathy
12
Q
Areas of skin that are itchy, dry, cracked, sore and red. Episodic. Most common on hands, backs of elbows, knees and face. Scratching makes it worse and can disrupt sleep. Area can turn temporarily darker or lighter after condition improves
A
Eczema
13
Q
Asymptomatic at first. Upper abdominal pain radiating to the lower back. Asymptomatic at first. Jaundice, loss of appetite, Cachexia, Depression, Vomiting from duodenal obstruction, Lymphadenopathy, scratch marks (Obstructive jaundice), venous thrombosis. Affects 1 in 1000 over 70s. Men> women 2:1. Risk factors: age, smoking, acute pancreatitis. DM. Obesity. Diet rich in red meat and lacking fruit and veg. 5 to 10 % patients have genetic predisposition.
A
Pancreatic cancer (carcinoma)
14
Q
Back or leg pain with varicous veins or history of DVT. Swelling in lower legs. Tiredness. Leathery, flaking or itching skin or ulcers on legs or feet. More likely in older obese inactive or pregnant women.
A
Venous hypertension
15
Q
Back pain with balance and sensory problems.
A
Dorsal column lesion.
16
Q
Bilateral calf pain - cramping aching. Does not depend on spinal position. Agrivated by physical exertion. Pain relieved promptly by rest. Sensory loss in stocking distribution. Cool, dry, scaly skin. Poor nail and hair growth. Decreased or absent pulses. 40-60+ yrs.
A
Vascular claudication
17
Q
Bilateral or unilateral pain in low back, buttocks, thigh, calves, feet. Sciatic distribution. Pain increases with extension or walking, decreases with flexion, rest and sitting. Burning pain and numbness. Segmental sensory loss. Normal pulses. Good skin nutriton. 40-60+ yrs.
A
Neurogenic claudication
18
Q
Bone pain in spine, pelvis, skull, shoulders, arms or legs. Most likely more than one bone. Can also cause joint pain, joint stiffness or compression or damage to nerves. Hearing loss, vertigo, headaches and tinnitus if in skull.
A
Paget’s disease
19
Q
Breathlessness, tight chest, fast breathing, frequent sighing, tingling fingers, arms, mouth, muscle stiffness, trembling hands, dizziness, blurred vision, faintness, headaches, palpitations, tachycardia, cold hands and feet, shivering. Warm feeling in head, sickness, abdominal pain, tension, anxiety, fatigue, insomnia. History of stress.
A
Hyperventilation syndrome
20
Q
Bronchiectasis. Spontaneous pneumothorax. Haemoptysis. Nasal polyps. Respiratory failure. Cor pulmonale. Lobar collapse. Malabsorbtion. Steatorrhoea. Intestinal obstruction. Billiary cirrhosis and portal hypertention. Gallstones. Diabetes. Delayed puberty. Infertility in men. Stress incontinence. Psychosocial problems. Osteoporosis. Arthropathy. Cutaneous vasculitis. The most common fatal genetic disease in caucasians. Autosomal recessive. 1:25 are carriers. Incidence 1:2500 live births. Diagnosed in childhood.
A
Cystic fibrosis
21
Q
Calf pain and tenderness. Low grade fever. Pitting oedema around ankle. Patient may have risk factors: immobility, injury to vein or increased clotting.
A
DVT
22
Q
Can be asymptomatic at first until it presents with signs and symptoms of renal failure. Uraemia. Hypertension. Oedema, fluid retention. Protienuria. Anaemia. Nocturia can be an early symptom. Tiredness, breathlessness. At end stage: Pruritis, anorexia, nausea, vomiting, hiccups, twitching, fits, drowsiness and coma. Hypertensive encephalopathy. 10% of adults in developed nations have mild CKD. Causes: Congenital genetic. Renal artery stenosis. Hypertention. Glomerular disease (IgA nephropathy). Interstitial disease. Systemic inflammatory disease (SLE, vasculitis). DM. Unkown causes. Immunological injury (immune reaction triggered by streptococcus), inherited abnormality.
A
Chronic kidney disease (CKD)/ Glomerolunephritis
23
Q
Can be asymptomatic. Dyspnoea and decreased lung function. Gland enlargement. Skin plaques and nodules. Bone cysts on fingers. Space occupying lesion in brain. Diabetes insipidus. Uveitis. Liver disease. Risk factors: Colder parts of northern europe. > west indian or asians, but eskimos, arabs and chinese rarely affected. Presents in spring and summer. Genetic link - family clustering. Less frequent in smokers.
A
Sarcoidosis
24
Q
Can be asymptomatic. Headache with progressive or constant neurological signs and symptoms. Vomiting. Fits. Changes to vision. History of cancer. Wakes with headache in morning.
A
Brain tumour
25
Can be asymptomatic. Highly variable. Weakness, fatigue, muscle cramps, weight loss, anorexia, nausea, vomiting, upper abdominal discomfort. Hepatic insufficiency (jaundice, circualory changes, endocrine changes (menstrual, impotence etc.) heamorragic tendancy. Hepatic encephalopathy. Digital clubbing. Dupuytrens contracture. Can also lead to shortness of breath, hepatopulmonary syndrome, hypoalbuminaemia. Any age. Important cause of premature death and morbidity. Most common causes: Chronic viral hepatitis. Prolonged excessive alcohol consumption. Other causes: Non alcoholic fatty liver disease. Autoimmune (PSC & PBC). Secondary biliary (obstruction) or cystic fibrosis. Genetic (haemochromatosis (iron), Wilsons disease (copper), antitrypsin deficiency). Unknown cause. Chronic venous outflow obstruction
Cirrhosis of the liver
26
Can be asymptomatic. Recurrent pain in right upper & central abdomen, right shoulder tip,neck scapula and thoracic spine (bilary colic), often at night or after a heavy or fatty meal. Possible nausea and vomiting. Pain not relieved by vomiting. Symptoms of acute cholecystitis but milder. Fat, fair, female, fertile, forty.
Cholelithiasis/chronic cholecystitis
27
Can be asymptomatic. Sudden onset frequency of micturition. Urgency. Dysuria (scalding pain in urethra during micturition). Suprapubic pain during and after voiding. Constant dull pain in pubic region. Back pain. Strangury (intense desire to pass more urine after micturition). Cloudy, unpleaseant smelling urine. Microscopic or visible haematuria. General sense of unwellness. Can lead to septicaemia. Very common. Women > men. Less common in children. Risk factors: Incomplete emptying from obstruction - kidney stones, neurological problems, uterine prolapse, vesico-ureteric reflux. Catheter or stent. Post menopausal vaginitis, or urethritis. DM. Chemotherapy, HIV. Extra risk for women: sexually active, use of diaphram or spermicide. Extra risk for men: enlarged prostrate.
Urinary tract infection (Lower UTI)
28
Cardiac pain (dull heavy, squeezing, crushing burning) in centre of chest, neck, jaw, arms, possibly back, without exertion. Dyspnoea. Orthopnoea. Discomfort rather than pain. Takes several minutes or longer to develop. Sweating, nausea, vomiting. Collapse/syncope. Pallor. Nitroglycerin does not help. Onset can be sudden or gradual. Women more likely to get non pain symptoms. Most likley caused by blod clot due to atherosclerosis, but can be other reasons.
Myocardial Infaction (MI) - Heart attack
29
Caused by head injury and can cause death if not treated promptly. Can be weeks or months after injury. Symptoms fluctuate. Headache, drowsiness, sensory loss, hemiparesis, epilepsy followed by stupor and coma, but can resolve spntaneously.
Haemorrage - Subdural and extradural
30
Chest pain in patient with history of arthritis (osteophytes) or diabetes. Sharp stabbing pain, numbness and tingling. Bilateral. Can radiate to back. May also have abdominal pain, fever and pain in arms and shoulders.
Osteophitic Intercostal neuritis
31
Chest pain or dyscomfort similar to MI. Sudden severe persistant dyspnoea. Patient looks anxious. Signs of DVT - ankle oedema, calf tenderness. Smaller embolysm can cause heamoptysis and pleural chest pain. Causes: DVT. Inactivity. Blood vessel damage due to chemotherapy and vasculitis. Blood that clots too easily - Cancer, chemotharapy, radiotherapy, heart failure, thrombophillia, Hughes syndrome. Risk factors: Age > 60. Familial. Obese. Pregnant. Smoker. Combined pill or HRT.
Pulmonary embolism
32
Chest pain with popping or clunking with certain activities.
Slipped rib
33
Chronic bronchitis: Cough and sputum on most days for > 3 months in 2 consec year. COPD: impaired nutrition, weight loss, muscle weakness. Smoker's cough (with black particles). Haemoptysis. Breathlessness. Morning headaches. Pink puffers: Thin and breathless. Blue bloaters: Oedema, hypercapnia, polycythaemia. Peripheral oedema. Pitting oedema. COPD is chronic bronchitis and emphysema. >40 yrs. Causes: Tobacco, biomass fuels (dev countries). Unsusual to develop COPD if smoked less than 10 pack years. Other risk factors: Occupation (coal, cadmium), Air pollution, Low birth weight, maternal smoking (lung growth), Infections, low socioeconomic status, nutrition, cannabis, genetic factors, airway hyperreactivity.
Chronic obstructive pulmonary disease (COPD)
34
Chronic productive cough, worse in mornings. Copious puulent sputum and halitosis. Fever, malaise, recurrent infection of lungs and pleura. Recurrent haemoptysis. May be the only symptom in "dry bronchiectasis". Weight loss, anorexia, lassitude, digital clubbing, failure to thrive in children. Can be congenital: cystic fibrosis, ciliary dysfunction syndromes, primary hypogammaglobulinaemia. Aquired in children: Pneumonia (from whooping cough or measles). Primary TB. Inhaled foreign body. Aquired in adults: Suppurative pneumonia. Pulmonary TB. Allergic bronchopulmonary aspergillosis (asthmatic allergy to mould). Bronchial tumour.
Bronchiectasis
35
Chronic recurrent abdominal and possible lumbopelvic pain related to menstrual cycle with recent increase in pain. May pass blood in stool or rarely cough it up. Heavy or painful periods. Fertility problems. Depression. Pain during and after sex. Bleeding between periods. Exhastion and tiredness. Risk faactors: IUD use or post abortion. Genetic. Afro caribean, Asian.
Endometriosis
36
Chronic recurrent abdominal pain in lower abdomen, pelvis and possibly inner thighs, related to menstrual cycle.
Primary dysmenorrhoea
37
Chronic recurrent abdonimal pain with jaundice. Episodic tiredness, anorexia, nausea, diziness, IBS, concentration problems, general malaise. Triggered by dehydration, fasting, stess, illness, exertion, lack of sleep, surgery, menstruation. Genetic condition
Gilberts syndrome
38
Chronic thoracic pain or neck pain and stiffness with imbalanced muscle tighness and history of bad posture.
Postural syndrome
39
Colicky abdominal pain associated with defacation. Abdominal distention.Alternating constipation and diarrhoea. Rectal mucus. Feeling of incomplete defacation. Young women > men. Most common cause of GIT referral. Cause of absence from work and impaired quality of life. Stress worsens symptoms.
Irritable bowel syndrome
40
Colicky lower adbominal pain. Rectal bleeding. Peritonitis. Localised abcess. Fistula formation. Aneamia. Weight loss. Palpable mass. Hepatomegaly from metastases. Left colon: Early bleeding and obtruction. Right colon: Amemia, altered bowel habit. Obstruction late. Rectum: Early bleeding, mucus discharge, feeling of incomplete emptying. Common in the west, > 50s, genetic predisposition and dietary factors - red meat and saturated fat, some(5%) have single gene mutation as the cause, IBD with PSC, uterosigmoidostomy, acromegaly, pelvic radiotherapy. Obesity. Smoking. Cholesistectomy. Type 2 diabetes. Reduced risk: Asprin, NSAIDS, statins.Fibre, fruit and veg, calcium, folic acid and omega 3.
Colorectal cancer
41
Colicky pain in right lower abdomen, releived by defacation. Diarrhoea. Variable symptoms anywhere in GIT. Oral ulcers. Growth retardation. Sacroiliitis. Fistulous communication with bowel, skin, urinary bladder. General symptoms for IBD: Nausea. Vomiting. Weight loss. Relapse and remittance over years. Conjunctivitis, Iritis, Episcleritis. Mesenteric or portal vein thrombosis. Venous thrombosis. Arthralgia of large joints. Erythema nodosum. Pyoderma gangrenosum. Autoimmune hepititis. gall stones. Metabolic bone disease. Amyloidosis and oxylate caculi. Risk factors: Smokers. Ashkenazi jews. SLE. IBD patients with HLA B27 gene comonly develop AS.
IBD - crohn's disease
42
Common cause of neck pain. More common over 45, even more over 60. Sharp burning arm pain in dermatome distribution. One side only. Gradual onset. Agf: looking behind. All: neck flexion or hands on head.
Cervical spondylosis with radiculopathy
43
Commonly caused by RTC. Can be caused by posture. - sitting for long periods , driving, desk job. Intermittent, dull achy pain in neck, upper back, shoulders and base of skull. Headache.
Cervical facet syndrome
44
Constant dizziness. Acute onset. Slowly improves. May have some associated hearing loss or tinnitus. Can be caused by stress, head injury, virus or bacteria. May have had a cold just before.
Labrithitis
45
Cough. Haemoptysis. Bronchial obstruction. Stridor. Chest pain. Nerve entrapment (Horner's syndrome due to sympathetic nerves - ptosis, enopthalmos, miosis, hypohidrosis of face or pancoasts syndrome die to brachial plexus - pain in shoulder and inner arm, atrophy in hand). Dyspnoea. Dysphagia from mediastinal spread. Arrythmia or pericardial effusion from pericardium invasion. Swelling of neck, face, conjuntival oedema, headache from Superior Vena cava obstruction. Vocal cord parallysis or bovine cough if laryngeal nerve is affected. Mets can cause anorexia, weight loss, finger clubbing, liver , bone and neurological symptoms. Hormones can also be secreted from the tumour - SIADH (small cell - anti diuretics), andrenocorticotropic hormones (small cell) or hyper calcaemia (squamous). Men> women. 18% of all cancer deaths. Increasing in women. Causes and risk factors: Smoking. Passive smoking. Pollution. Ocupation - industrial materials ( e.g. silica, asbestos).
Primary Lung Tumours
46
Diffuse aching pain in cervical, thoracic, lumber spine or limb. Sudden high temperature and malaise. Swelling, redness, warmth, tender to touch. Lymph glands swollen. May be history of trauma, DM,RA or sickle cell.
Osteomyelitis
47
Diffuse headache with dry mouth and feeling of thirst. Lightheadedness. Dark coloured strong smelling urine. Passing urine less often. Tiredness.
Dehydration headache
48
Diffuse joint and bone pain, especially spine, pelvis and legs. Muscle weakness. Easy fracturing. Risk for elderly, housebound or nursing home or other lack of sunlight.
Osteomalacia/Rickets
49
Diffuse pain in right upper & central abdomen, right shoulder tip,neck scapula and thoracic spine (bilary colic). Pain severe and prolonged up to several hours after a fatty meal or at night after a drink. Possible nausea and vomiting. Pain not relieved by vomiting. Fever. Jaundice in only 10% of case. Mostly caused by cholelithiasis, but can be due to sickle cell, parasites, tumour or endocopic stent insertion.
Acute cholecystitis/Cholelithiasis
50
Difuse acute abdominal pain in RLQ suddenly relieved, followed by increase in pain. Rigid abdomen. > Young person. Nausea and vomiting. Shortness of breath.
Ruptured appendix/ Peritonitis
51
Dizziness or vertigo, tinnitus or tremors with or without hyperventialation. History of stress or emotional trauma.
Anxiety
52
Dull aching limb pain, swelling and local tenderness with history of trauma or overuse.
Muscle strain (limb)
53
Dull, deep and boring, diffuse pain in pubic area, coccyx and inner thighs or central lower abdomen. Hypersensitive to touch.
Referred viceral pain - Urinary bladder
54
Dull, deep and boring, diffuse pain in central lower abdomen. Hypersensitive to touch.
Referred viceral pain - Colon
55
Dull, deep and boring, diffuse pain in central mid thoracics or sternum. Hypersensitive to touch.
Referred viceral pain - Stomach
56
Dull, deep and boring, diffuse pain in central upper thoracics or left arm. Hypersensitive to touch.
Referred viceral pain - Heart (Angina, MI)
57
Dull, deep and boring, diffuse pain in left front and back of neck. Hypersensitive to touch.
Referred viceral pain - Lung or diaphram
58
Dull, deep and boring, diffuse pain in right lower anterior ribs, Hypersensitive to touch.
Referred viceral pain - Gall bladder
59
Dull, deep and boring, diffuse pain in right neck, shoulder and scapula or right posterior ribs. Hypersensitive to touch.
Referred viceral pain - Liver or gall bladder
60
Dull, deep and boring, diffuse pain in waist, abdominal and pelvic area. Hypersensitive to touch.
Referred viceral pain - Kidneys
61
Dull, deep and boring, diffuse pain umbilical area. Hypersensitive to touch.
Referred viceral pain - Small intestine or ovaries
62
Dyspepsia - more discomfort than pain, Anorexia, Nausia, Vomiting, Haematemesis and Melaena. H Pylori is most common cause.
Gastritis
63
Dyspnea - orthopnoea, extremely tired, agitated, pale, clammy, pulse rapid, cool peripheries. Left - more respiratory symptoms - rapid shallow respiration. Wheeze. Unable to speak. Can cause renal failure, hypo or hyperkalaemia, hyponatraemia, thromboembolism, arrhythmia, impaired liver function. Most common cause of premature death.
Heart failure (dilated cardiomyopathy) - acute
64
Dyspnoea at first with moderate exertion, gradually provoked by less exertion. Orthopnaea - use of pillows, waking in night. Cheyne-stokes respiration. Relapsing and remitting. Fatigue, listlessness, cold peripheries. Swollen ankles. Weight loss. R - Hepatomegaly, ascties and peripheral oedema. L - Pitting oedema, pulmonary oedema & pleural effusion.
Heart failure (dilated cardiomyopathy) - chronic
65
Effort related cardiac pain (dull heavy, squeezing, crushing burning in centre of chest, neck, jaw, arms, possibly back) similar to MI, but relieved by rest or nitroglycerin. Predicable. Long term. Dyspnoea. Also brought on by emotion, large meal or cold wind. Most likley caused by atherosclerosis in coronary artieries, but can be other reasons.
Stable angina
66
Episodic pain, swelling and stiffness in joints, especially hands, feet and wrists. Throbbing aching pain, worse in morning for > 1 hour. Joints red and tender to touch. Bilateral. Multiple joints. May also have tiredness, fever, sweating, anorexia, weight loss. can affect eyes, heart and lungs. Can cause joint deformities. Commonly starts age 40 to 50. More women than men. Genetic tendancy.
RA
67
Episodic recurrent severe vertigo lasting hours or days. Ear feels full. Tinnitus and hearing loss. Possible hypersensitivity to sound. Anxiety or depression. May be history of diabetes or fluid retention. Age 20 to 60. Familial tendancy.
Meniere's disease
68
Extreme tiredness. Numbness and tingling. Blurring of vision. Problems with motility and balance. Muscle weakness and tightness. Unlikely to have all symptoms at once. Episodic. Unpredictable. Can lead to loss of vision in one eye, colour blindness, eye pain, light flashes when moving eye, double vision. Neuropathic pain - stabbing, burning with extreme sensitivity. Pain in muscles and joints. Ataxia. tremor. Dizziness. Vertigo. Cognitive dysfunction. Depression. Anxiety. Sexual problems. Frequency. Urgency. Nocturia. Constipation. Bowel and bladder Incontinence. Dysphagia. Dysphasia. Age 20 to 40 most common.
MS
69
First - Fatigue, lethargy, depression, iritability, anorexia, unintentional weight loss, frequency, thirst, salt craving, dehydration. Later - Nausea, vomiting, diarrhoea, joint or back pain. Muscle cramps. Reduced libido. Irregualr periods. Low blood sugar.
Adrenal disorders - Addison's disease (hypoadrenalism)
70
Flu like symptoms. Respiratory chest pain. Lung consolidation and collapse. Obstructive emphysema. Pleural effusion. Meningitis. Pericarditis. Erythema nodosum. Phlyctenular conjunctivitis. Dactylitis. Pulmonary: Chronic cough with haemoptysis. Pyrexia. Pneumonia. Weight loss. Pneumothorax. Can have extra pulmonary symptoms. More common in developing countries. Risk from Smoking. HIV. Malignancy. DM type 1. Chronic renal failure. Silicosis. Malnutricion from GI disease. Vit A, D deficient. Recent measles.
Tuberculosis - primary
71
Frequent urination. Thirsty. Hungry. Can lead to CV disease, Kidney failure, foot ulcers and eye damage. Blurry vision, headache, fatigue, slow healing, itchy skin, rashes. Diabetic neuropathy. Risk factors: obesity, smoking.
Diabetes mellitis
72
Frozen shoulder. Causes unknown but associated with trauma, immobilisation, diabetes (poor blood flow), thyroid issues and cardiac problems. More common in women. Usually non dominant side. Severe pain during freezing phase. Tender to touch. May disturb sleep. Agf: ext rotation. Lying on it. Alf: Arm in sling position. Pain lessens during frozen phase.
Frozen shoulder/Adhesive capsulitis
73
Genetic condition. Inabilty to clot. Bruising. Joint pain and stiffness. Hot swollen tender joints..
Haemophillia
74
Genetic suseptability. More common in northern europe. 1% prevalence in UK. Can present at any age, most common 30-50. Females > males. Linked to hyposplenism. 50% asymptomatic. Oral ulcers. Infants present with diarrhoea, malabsorbtion, failure to thrive. Older childen - delayed growth, puberty delay, mild abdominal distension, short stature in adulthood. Adults: Tiredness, weight loss, folate deficiency, iron deficiency anaemia, dyspepsia, bloating, undernutrition. Risk of osteoporosis.
Coeliac disease
75
Gradual onset diffuse aching pain. Fatigue, weight loss fever, anaemia and unexplained fractures. More likely in young people or osteochondroma in hips, shoulders or pelvis.
Primary bone tumour
76
Gradual onset, but constant symptoms. Hearing loss in one ear (may be sudden). Tinnitus. Vertigo. Facial numbness, tingling or pain. Possible headache, but rare. Ataxia. Can be realted to neurofibromatosis.
Acoustic neuroma
77
Haematemisis after violent retching or vomiting. Melaena (blood in stool). Oesophageal pain. Risk factors: Alcoholism, eating disorders, severe morning sickness in pregnancy. Possibly hiatus hernia and NSAID abuse. Mostly men over 60.
Mallory - Weiss syndrome
78
Headache at front and side of head possibly back or top of head with proximal muscle weakness or tenderness, jaw claudication and visual disturbances - diplopia. Possible history of polymyalgia rheumatica. New headache in older patient - onset may be sudden. Paracetamol does not help. Extreme tiredness, anorexia, weight loss, depression.
Temporal Arteritis
79
Headache , weakness, paralysis (one side) and confusion. Rapid onset. 10% of strokes. Risk factors: Hypertension. Aneurysm. Severe headache and dramatic loss of brain function leading to coma.
Haemorrage - Intracerebral
80
Headache that lasts for 30m to several hours. Not severe enough to prevent everyday activities. Ache on both sides of head. Tight neck muscles. Pressure behing the eyes. Women> men. Teenagers and adults. Chronic - > 15 times a month. Can be triggered by stress, squinting, posture, lack of exercise, noise, bright light,dehydration missing meals, tiredness, some smells.
Tension headache
81
Headache with rapid reduction of conciousness. Nystagmus. Devated gaze. Cerebellar symptoms (ataxia, lack of proprioception and balance)
Haemorrage - Cerebellar
82
Headache with sensory or balance problems.
Parietal lobe lesion
83
Headache. Myalgia. Arthralgia. Nausea. Anorexia. Jaundice. Vomitting. Diarrhoea. Abdominal discomfort. Dark urine. Pale stools. Symptoms rarely last more that 3 - 6 weeks. Can lead to acute liver failure, aplastic anaemia or relapsing hepatitis. Been abroad without vaccination (A), sexual contact with carrier (B), IV drug use (C), glandualr fever (Epstein Barr), immunocompromised (Cytomegalovirus)
Viral hepatits
84
History of MI, cancer, infection, rheumatic fever or blunt trauma to chest. Retrosternal, left of sternum or L or R shoulder sharp pain. Varies with movement and respiration - catches during inpiration, coughing or lying flat. Can point to where pain is. Low grade fever.
Pericarditis (or myocarditis)
85
History of overuse, especially running or jumping. Common in tibia, metatarsals, navicular.
Stress fracture
86
History of trauma or osteoporosis. Chest pain worse on deep inspiration, coughing, sneezing and while lying supine. Patient can point to where it hurts. Most commonly posteriolateral. Worse at night.
Rib fracture
87
Hot, red, swollen joint. History of open wound, chronic inflammation or immunosupression.
Infective/Septic arthritis
88
Hyperactivity, mood swings, anxiety, insomnia, frequency of bowel and bladder, steatorrhoea, sweating, sensitivity to heat, weight loss, light or no periods, infertility, loss of libido.
Graves' disease - (overactive thyroid)
89
In West - atheroscelosis is main cause. 20% have it but only 1 in 4 have symptoms. Associated with diabetes. Pain caused by intermittent vascular claudication in calves, buttock, hip or thigh, when walking or climbing stairs. Quickly releived with rest. Hair loss, numbness or weakness,muscle wasting, ulcers, blue shiny skin - all on legs. Brittle toenails. Erectile dysfunction.
Peripheral artierial disease
90
Intense pain and bleeding with other symptoms of ovarian cyst. Women 18 to 35.
Ruptured ovarian cyst
91
Irregular heart beat. Possible dyspnoea if there is a structural heart abnormality. Can cause collapse or stroke. Other symptoms: palpitations, dizziness, fainting. Possible oliguria and uraemia. Risk factors: Old age, excess alcohol, overweight. History of MI or heart failure. Congenital. Drug reaction.
Arrhythmia
92
Irregular or no periods. Difficulty getting pregnant. Hirsuitism. Weight gain. Hair loss or thinning on head. Oily skin or acne.
Polycystic ovary syndrome
93
Itching and hypersensitivity to touch in affected area. Can cause sleeping dificulties. Over 50. 20% of people who have had shingles.
Post herpetic nueralgia
94
Itchy skin or raised red rash. Swollen eyes, lips, hands and feet. Felling feint. Swollen mouth, throat, tongue. Breathing and swallowing difficulty. Wheezing. Abdominal pain. Collapse and unconsciousness.
Anaphalaxis
95
Joint pain, carpal tunnel syndrome. Sweating, fatigue. Headaches.Loss of libido. Abnormal periods. Erectile dysfunction.
Hypothalamic/Pituitary - Acromegaly
96
Limb pain with painful contractions post exercise. Family history. Later onset is less severe. Changes to diet and lifestyle can reduce symptoms. Can also affect heart, liver or kidneys.
Muscle enzyme deficiency syndrome
97
Liver disease (hepatitis, cirrhosis, failure) and neuropsychiatric symptoms (ataxia, prakinsonism, dystonia, dememtia) Copper rings in eyes (Kayser-Fleisher rings) Hypoparathyroidism. Heart and Kidney symptoms. Genetic (Autosomal recessive). 1% have single abnormal copy, but only 1-4 per 100000 have both copies. Symptoms appear between ages 6 and 20.
Wilson's disease
98
Local pain at ulcer site. Causes: Idiopathic. Premenstrual. Fungal. Viral. Barterial. Crohn's disease. Coeliac disease. Dermatological conditions. Drugs. SLE. Neoplasia.
Oral ulcers
99
Low back and leg pain following myelographic or spinal anaesthetic procedures. Possible cauda equina symptoms.
Arachnoiditis
100
Low back or thoracic pain with local tenderness. Radiation to groin, buttock, thigh. Knee to chest relieves lumber pain. Limb pain in non dermatomal pattern with no neuro signs.
Facet syndrome (Lumbar)
101
Lumbopelvic pain that came on while lifting or twisting
Muscle strain (lumbar)
102
Many be asymptomatic at first or repeated attacks of pain in the side, lower back and genitals. Fever. Shivering. Chills. Weak and tired. Loss of appetite. Nausea. Vomiting. Diarrhoea. May also show symptoms of lower UTI. Can be caused by obstruction repeated acute attacks or vesico-ureteral reflux.
Chronic pyelonephritis
103
May be assymptomatic. Hypertensive retinopathy. Can lead to aortic aneurysm and dissection, hypertensive encephalopathy and stroke, heart failure, cardiomegaly, atrial fibrillation, hypertensive nephropathy and kidney failure. More common in black americans and japanese. Can be genetic factors. High salt intake, heavy alcohol consumption, obesity, lack of exercise, drugs. Can indicate renal dysfunction, insulin resistance, phaeocromocytoma, cushings syndrome, adrenal tumour or thyrotoxicosis.
Hypertention
104
May be asymptomatic at first. Features of cirrhosis if present. If no cirrhosis - Abdominal pain and weight loss. Possible hepatic rupture with abdominla bleeding. Most common primary liver tumour. 6th most common cause of cancer worldwide. More in asia, southern europe than northern europe. Risk factors: > In men. > with age. Cirrhosis major factor. Hep B infection. 4x risk if HBeAg present.
Hepatic tumour - Hepatocellular carcinoma (HCC)
105
May be asymptomatic at first. Heamaturia. Loin pain, mass. Some have only one of these, some all three. Disorders of coagulation (too much) due to hormones from tumour. Rarely may present with neuropathy. Most common malignant tumour of the kidneys in adults. Males > females. 65 - 75 yrs. Unlikely < 40.
Renal adenocarcinoma
106
May be asymptomatic. Pelvic pain dull or severe and sharp. Nausea, vomiting. Pain during sex. Difficulty emptying bowels and frequent urinating. Heavy light or irrregular periods. Bloating. Feeling full. Difficulty getting pregnant. Linked to endomatriosis an polycycstic ovary syndrome.
Ovarian cyst
107
May be painless. Confusion followed by coma. Changes to intellect, personality, emotions, speech and consciousness with or without neurological signs. Convulsions may occur. Flapping tremor and hyper reflexia. Portal hypertension. Variceal bleeding, Ascites, hepatorenal syndrome - kidney failure. Caused by liver disease.
Chronic liver failure
108
May be painless. Jaundice. Malnutrition. Features of portal hypertension (ascites, encephalopathy). Features of cirrhosis. Can lead to liver failure. Alcohol is one fo the most common causes of chronic liver disease. Average age is falling. 10% of alcoholics have cirrhosis at death. Incidence in women increasing. Unexplained rib fractures can indicate alcohol misuse. Risk factors: Continuous drinking. Genetic factors. Possible nutritional factors associated with choline (part of vit B complex) deficiency.
Alchoholic liver disease (ALD)
109
May be painless. Mental changes from hepatic encephalopathy progress from stupor to coma. Jaundice, vomiting, hypoglycaemia. Uncommon. Caused by paracetamol overdose, viral infection or poison.
Acute liver failure
110
May resemble viral hepatitis at first or insidious asymptomatic onset. Fatigue, anorexia and jaundice. Can also cause vitiligo, epistaxis (nosebleed), amenorrhoea. More common in women 11 to 30. Strong association with other autoimmune diseases (pernicious anaemia, thyroiditis, rheumatoid arthritis, ulcerative colitis).
Autoimmune hepatitis
111
Memory loss. Difficulty with problem solving and language. > 65. Gradual onset. Patient may not be able to look after themselves. May also have balance problems and tremor.
Dementia
112
Migraine like headache or cluster headache. Depression, anxiety or other mood changes. Can cause acromegaly, cushings.
Pituitary tumour (Benign adenoma)
113
Mild lower abdominal cramps. Dehydration. Bloody diarrhoea. Tenesmus. Dehydration. Anorexia. Palor. Cholangitis and Cholangiocarcinoma. Toxic megacolon. General symptoms for IBD: Nausea. Vomiting. Weight loss. Relapse and remittance over years. Conjunctivitis, Iritis, Episcleritis. Mouth ulcers. Fatty liver. Liver abscess. Mesenteric or portal vein thrombosis. Venous thrombosis. Arthralgia of large joints. Erythema nodosum. Pyoderma gangrenosum. Autoimmune hepititis. gall stones. Metabolic bone disease. Amyloidosis and oxylate caculi. Risk factors: Genetic . Non smokers with appendix. IBD patients with HLA B27 gene comonly develop AS.
IBD - ulcerative colitis
114
Miosis (constricted pupil), ptosis (drooping eyelid), anhydrosis (reduced sweating), possible enopthalmus (inset eyeball). Possible bloodshot conjunctiva.
Horner's syndrome
115
Moderate to severe headache with or without aura. Throbbing pain at front or side of head. Possible nausea and vomiting. Women > men. Begins in early childhood. May be sensitive to light and sound.
Migraine
116
More common in women. Dyspnoea with little or no chest pain. History of chest tightness and close correlation with exercise.
Angina equivalent
117
More common in young men. Low back pain and stiffnesss that improves with exercise. Costovertebral and hip joints. Heel, pubic, ischial pain. Acchillies tendonitis. Heel pain. Loss of lordosis. Increased kyphosis. Uveitis. Aortitis. Fatigue. Starts from pelvis and moves up. May be family history. Increased risk of CV diesease.
AS
118
Most common in patients with congenital or valvular heart disease or history of heart surgery. May not be painful. Subacute: Persistent fever, unusually tired, night sweats, weight loss or new signs of heart dysfuction. headache and muscle ache like flu. Acute: Fever. Prominent & changing heart murmers. Petechiae (bleeding spots). Post operative: Fever after heart valve surgery. Any: Subconjunctive haemorrhage. Roths spots in eye. Petechial haemorrage on mucous membranes or rash. Poor dental health. Systemic emboli - eg nail fold infarct. digital clubbing, splinter haemorrhages. Blood in urine. Oslers nodes.
Infective endocarditis
119
Mostly asymptomatic. Pain like appendicitis if obstruction. Pain in liver (from metastases). Flushing. Wheezing. Diarrhoea. Facial telangiectasia. Jaundice and hepatomegaly (from liver metastases). Carcinoid syndrome symptoms can include cardiac involvementfrom peptide hormones. Most common in appendix (benign) or rectum (malignant).
Carcinoid bowel tumour/carcinoid syndrome
120
Mostly men over 65. Most are aysymptomatic until rupture, but can cause mild to severe persistant central abdominal pain or persistant low back pain. A pulsing feeling may be felt when touching near the umbilicus. There may also be associated vascular claudication in the lower limbs - leg pain and weakness on exercising, quickly releived by rest.
Abdominal aortic aneurism
121
Mostly young women aged 25 to 30 in temperate climates, genetic link. White fingers triggered by cold, anxiety and stress lasting minutes to hours. Cyanosis and rubor. Not usually painful. Can also affect toes.
Reynauds phenomenum/disease - primary
122
Muscle aches, stiffness and fatigue in multiple areas of the body, often including thoracic spine. Pain is continuous but severity may vary. Can be burning, sharp, stabbing or aching. Extra sensitivity to pain and pain on light touch. Aggrivated by cold, stress, damp, overexertion, sedentary positions, poor posture. May be sensitive to bright lights. Associated headaches like migraine, IBS and depression. May affect sleep and cause concentration difficulties. More likely in women. Familial tendancy. May be triggered by a stressful event.
Fibromyalgia
123
Normally starts with painless weakness in hand, shoulder or foot. Possible twitching of muscles, cramping and atrophy. Dysarthria. Dysphagia. Shortness of breath. Headache in the morning.Progresses at a constant rate. Swallowing difficulty. Excessive yawning. Emotional changes. Dementia.
Motor Neuron Disease
124
Odynophagia. Heatburn. Oesophageal chest pain. Can mimic pain of angina - Worse when exercising. Relieved by nitrates. Worse when supine, related to eating and drinking. Often radiates to back. Regurgitation when bending, straining , lying down. Waterbrash. Waking up at night choking. Dysphagia. Acid laryngitis. Recurrent chest infections, chronic cough. Asthma. 30% of population get reflux. Obesity. Dietary factors. Defective oesophageal clearance. Hiatus hernia. Abnormal sphincter. Delayed gastric emptying. Increased intra abdominal pressure. Smokers.
Gastrooesophageal reflux disease
125
Odynophagia. Oral ulcers. White patches on tongue and buccal mucosa. Dysphagia. More common in babies, debilitated patients. Corticosteroid or antibiotics. DM. Immunosuppressed. Cytotoxic therapy. AIDS.
Oral candidiasis
126
Oesophageal chest pain. Progressive painless dysphagia. Bolus obstruction. Extreme weight loss in late stages. Cachexia. Hoarseness. Fistulation to trachea causing coughing, pneumonia, pleural effusion. Lymphadenopathy. metatastic spread.Squamous call carcinoma common in asia & africa. Risk factors - smoking, alchohol excess, betel nuts, tobacco, coeliac disease, achalasia, post cricoid web, post caustic stricture, tylosis. Adenocarcinoma increasing in West due to prevalence of GORD and Barrets oesophagus.
Oesophageal tumour
127
Older people with family history and lifestyle risks (smoking, obesity, alcohol, diet, personality, social deprivation, diabetes). Male or post menopausal women. Asymptomatic at first. Can cause angina, MI, embolism or CVE. May have history of high BP and cholesteral.
Atherosclerosis
128
Older people with vibration injury or thoracic outlet obstruction (TOS), RA or lupus. White fingers triggered by cold, anxiety and stress lasting minutes to hours. Cyanosis and rubor. Can progress to ulceration, necrosis and pain. Can also affect toes.
Reynauds phenomenum/disease - secondary
129
Over 50s, risk increasing with age. Men > Women. May be aysymptomatic until rupture, but can cause chest pain, back pain, difficulty breathing, coughing, wheezing, hoursness and difficulty swallowing. Risk factors: Smoking, HBP, Family histoy, marfans, TB.
Thoracic aortic aneurism
130
Pain and fever with weight loss and depression. Associated with temporal artieritis. Stiffness in the morning for > 45 mins. Extreme tiredness. Loss of appetite. Mostly over 70 when diagnosed. Rare in under 50s. More common in women. Normally starts with shoulders.
Polymyalgia rheumatica
131
Pain around anus. Bright red rectal bleeding after defecation. Mucus discharge. Itching anus. Unkown cause, but associated with constipation and straining. May develop initially during pregnancy.
Haemorrhoids (Piles)
132
Pain in the neck and sometimes ears. Trouble swallowing. Trouble breathing. Hoarseness, Frequent cough not related to a cold.
Thyroid tumour
133
Pain in the side, lower back and genitals. Fever. Shivering. Chills. Weak and tired. Loss of appetite. Nausea. Vomiting. Diarrhoea. May also show symptoms of lower UTI. Slightly more common in women. Additional for children: irritability, poor feeding, not growing at expected rate, abdonimla pain, jaundice, blood in urine, bed wetting.
Acute pyelonephritis
134
Pain on passive movement of a muscle with sensory loss. Muscle may have a woody or solid feel. Mostly in calf or forearm. Can be acute (caused by injury) or chronic (caused by repetitive exercise such as running or cycling).
Compartment syndrome
135
Pain tingling and numbness in the buttocks. Pain can be severe. Can be triggered by sitting, running, climbing stairs or applying pressure to piriformis muscle. Can cause some sciatic symptoms.
Piriformis syndrome
136
Painfull neck and shoulders. Tender muscles. Migraine like headaches. Stiff neck. Mostly car accident related. Caused by acceleration-deceleration. Other causes: backwards fall, skiing, horse riding. Reduced ROM.
Whiplash
137
Painless testicular lump. Possible testicular ache. Possible gyneacomastia. Uncommon.Men. Age 20-40.
Testicular tumour
138
Painless, visible haematuria. Can also cause obstruction or dysuria. Males > Femles. Unlikely under 40. Mostly in urinary bladder and mostly benign
Urothelial tumour (Bladder, ureteral, urethral or Kidney tumour)
139
Pathological fractures. More common in post menopausal women or people with RA, COPD, Hyer or hypo thyroidism, family history, steroids, heavy drinking and smoking.
Osteoporosis
140
pericarditis, sore throat, fitting, erythema marginatum, subcutaneous nodules, dyspnoea, syncope, fever, oedema, polyarthritis. Explosive , halting speech. Emotional lability may present first. Chorea at late stage.Children between 5 and 15. Rare in western europe. Endemic in africa, asia and south america. History of recent strep infection or scarlet fever. Risk factors: malnutrition, poverty.
Reumatic heart disease - acute rheumatic fever.
141
Persistant headache after a cold or URTI. Dull throbbing pain in the upper face, cheeks, eyes and forhead. Fever, bad breath, reduced sense of smell. Purulent nasal discharge. Toothache. Fever. Worse in the morning.
URTI's - Sinusitis
142
Pleuritic chest pain. Dyspnoea. Cough with sputum. Chills. Clamminess. Blueness. Headaches. Loss of appetite. Mood swings. Nausea. Vomiting. Joint pain. Fatigue. Muscle aches. Spread by droplet infection. Can affect healthy individuals, some more predisposed through risk factors: Smoking. URTI. Alcohol. Corticosteroids. Old age. Recent flu injection. Lung disease. HIV. Indoor air pollution. More likely to be viral in children.
Pneumonia
143
Primary symptoms: Hesitancy. Poor prolonged flow. Sensation of incomplete emptying. Secondary symptoms: Frequency. Urgency. Urge incontinence. Emergency symptoms: Acute urinary retention. Anuria, painful distended bladder. Chronic symptoms: Chronc urinary reterntion. Pain free bladder dystention that can lead to hydroureter, hydronephrosis and renal failure or acute urinary retention. Men only. From age 40 prostate increases in size. Symptoms are common in > 60. 50% of > 80 have lower UT symptoms.
Benign prostatic hyperplasia (BPH)
144
Problems with senses, balance, face and throat. May be due to tumour, heamorrhage or contusion.
Cranial nerve lesion
145
Ptosis, dysphagia, dysarthria, diplopia. Dizziness or vertigo continuous with gradual onset. Possible convulsions or conciousness change. CN signs. Nystagmus changes in different fields of gaze, lasts for > 1m and does not fatigue.
Brain stem or cerebellar tumour
146
Ptosis. Diplopia. of eye muscles. Slurred speech. Swallowing problems. Neck or limb weakness (arms or legs). Mostly painless, but muscles may ache.
Myesthenia gravis
147
Rapid onset. Sneeezing, sore throught, watery nasal discharge, cough, possible hearing impairement due to blockage of eustachian tubes. May have severe sore throat, hoarse or lost voice, pain on speaking with unproductive painful cough. May have fever. May develop to respiratory chest pain, retrosternal discomfort in trachea,wheeze, tight chest, mucopurulent sputum, may be blood stained.
URTI - cold, pharyngitis, acute bronchitis
148
Rare. Mostly young adults. Focal pain in the neck or back that is worse in the morning, with weakness or numbness in limbs or changes in bowel and bladder habits. Pain is severe on direct manipulation, does not diminish with rest and is worse at night. Loss of appitite, unexpected weight loss, nausea, vomiting, fever, chills or shakes. Mostly benign.
Spinal tumour (Primary)
149
Recurrent abdominal pain - localised to epigastrium (pointing sign), related to food, episodic. Pain when stomach is empty. pain releived by vomiting or antacids or H2 agonists. Disturbed sleep. May be no pain in elderly patients being treated with NSAIDS. Vomiting, Anorexia, Nausia, Sense of undue repletion after meals. Silent ulcer - no symptoms. Anemia. Can cause obstruction. Higher prevalence in developing countries. M > F especially duodenal. Risk factors: Smoking, NSAIDS.
Peptic ulcer - gastric or duodenal
150
Recurrent diarrhoea after recent travel
Parasitic infection
151
Reduction in urine volume, unless patient has pre-existing renal impairment or is on diuretics. Metabolic acidosis. Hyperkalaemia. Anorexia, nausea, vomiting, confusion, apathy, muscle twitching, hiccups, fits and coma. Anaemia. Pre-renal reversible: Internal bleeding after trauma may be asymptomatic at first. Established: Can be asymptomatic at first. Possible anuria. Hyponatraemia. Hypocalcaemia. Causes: Pre-renal - Heart failure. Blood or fluid loss (trauma). Renal artery oclusion or stenosis. Arteriole disease. Intrinsic renal - Tubular necrosis/toxic/septic/drugs, glomerular disease, interstitial disease. Post-renal - obstruction. Commmon cause: combination of sepsis with NSAIDS.
Acute renal failure (ARF)
152
Renal colic - suden pain in the loin that radiates round the flank and often to the testes or labium. L1 sensory distribution. Pain steadily increases over a few minutes, causing patient to restlessly try to obtain relief by changing position or pacing the room. Pallor, sweating, and often vomiting. They may groan in agony. Dysuria, frequency and heatamuria may occur. Constant pain may last 2 hours to several days, with only slight variations in severity. Attack may be followed by intermittent dull pain in the loin or back. May also have frequency and haematuria. Risk factors: Diet (high protein, low fibre), not drinking enough fluid, hypercalcaemia, genetic predisposition, inactive, only one kidney works, already has disease of small intestine e.g. crohn's. Drugs: aspirin, antacids, calcuim and Vit D, some antibiotics, HIV meds, anti epileptic drugs.
Urinary calculi (renal colic) /Nephrolithiasis (Kidney stones)/Obstructive nephropathy.
153
Respiratory chest pain. Chest tightness, dyspnoea, wheeze and cough. Airflow obstruction. Possible chest pain. Likely to be brought on by exercise, cold weather, airborne allergens, pollutants, viral URTIs. Relieved by rest. May also have nasal polyps and eczema. Can be intermittent or persistant (constant symptoms). Worse in morning and maybe at night. Variant where cough is the main symptom. Atopy - tendancy towards alergies. Very common. Genetic. Environmental factors. Possible role for microbes, diet, vitamins, breastfeeding, air pollution, obesity. Allergy - eg to pets or dust mites. May be affected by chilhood exposures. Drug related - beta blockers, NSAIDS, pill, choliergic agents, prostaglandin F2alpha and betel nuts. Occupational asthma is caused by working with certain substances.
Asthma
154
Respiratory chest pain. Fever. Night sweats. Anorexia. Weight loss. Dry cough. Headache. Crackles. Bone marrow - Anaemia, leucopenia. Extra pulmonary: Seizures, confusion, SOL, cranial nerve palsy, chronic back pain, kyphosis, chord compression, abdominla mass, ascites, Psoas abcess, monoarthritis, haematuria,dysuria, infertility in women, epidydimitis, pericardial effusion. Risk factors: Cancer. HIV. Malnutrician. DM. Silicosis. End stage renal disease. Major surgery.
Tuberculosis - milary
155
Rigid abdomen. Sudden onset acute agonising diffuse abdominal pain. Pale and sweating. May have history of ulcer, but it may have been asymptomatic.
Perforated ulcer
156
Risk factors: Older people. High blood pressure. History of rheumatic heart disease, endocarditis, congential heart defect, marfans syndrome. May be asymptomatic. Sharp left sided muscualoskeletal like pain that patient can point to. Shortness of breath, tiredness, dizziness. Can lead to arrhythmia, palpitations, pulmonary hypertension and heart failure.
Mitral valve prolapse
157
Severe sharp burning or peircing headache with lacrimation and rhinorrhoea that occurs in bouts over several weeks. Usually on one side, often around the eye. More common in men. Sudden onset. Lasts 15 m to 3 hrs. May be seasonal or triggered by smoking or alcohol. Restlessness and agitation. Wakes patient at night.
Cluster headache
158
Severe stabbing chest pain worse when deep breathing, coughing or sudden movements. Pain is intermittent lasting 15 to 30 mins at a time. May also have headache, sore throat and muscle pain. Mainly under 30s and in epidemics during summer and autumn.
Bornholm disease /epidemic myalgia/coxsackie viral infection)
159
Severe, constant abdominal pain in upper L or middle abdomen.May radiate to back, L shoulder blade and iner-scapular region. Builds up/spreads over 15 to 60 mins.Triggered by eating high fat content food. Worse lying down. Nausea. Vomitting. Hypoxia, Hypovolaemic shock. Oliguria. Caused by gallstones, alcohol, post-ERCP or idiopathic. Men - more likely alcohol, women - gallstones. Rarely caused by surgery, trauma, birth defect, metabolic or drugs, petrochemicals, infection, renal failure, transplants or severe hypothermia.
Acute pancreatitis
160
Severely sore thoat. Swollen gland in neck. Fatigue. Teenagers and young adults.
Infectious mononucleosis
161
Sharp burning pain in almost all arm dermatomes. Pain in trapezius. Heavy arm. Tingling in arm. Blue arm if vein compressed .Causes: Extra rib, fibrous muscles. Overuse or sustained postures.
Thoracic outlet syndrome
162
Sharp chest and shoulder pain when breathing deeply, coughing, sneezing or moving. Shortness of breath and dry cough. Hisory of infection. Can point to pain.
Pleurisy
163
Sharp chest pain in lung or rib area with side bending or deep breathing after trauma.
Haemothorax
164
Sharp chest pain worse when lying down, deep breathing, physical activity, coughing or sneezing. Can be gradual onset or sudden. May be unilateral or bilateral and cover multiple ribs. May be caused by severe coughing, physical strain, infection or wear and tear. Females > 50
Costochondritis
165
Sharp chest pain worse when lying down, deep breathing, physical activity, coughing or sneezing. There may also be swelling. Can be gradual onset or sudden. Unilateral. May be caused by severe coughing, physical strain, infection or wear and tear. Young adults under 40.
Tietze's syndrome
166
Shuffling gait. Resting tremor. Difficulty starting movements. Slow movement. Stiff and inflexible muscles. Depression. Insomnia. Anosmia. Memory problems.
Parkinsons
167
SI joint pain. Radiation to hip, buttock, upper posterior thigh. Stabbing pain on lifting or straightening from stooped. Relieved by sitting or lying.
Sacroiliac syndrome
168
Side effect, rebound or withdrawal. Drug or alcohol dependance. Taking painkillers. Angina spray (Nitrates). Diet pills. Birth control pills. Menoupause hormones. Caffeine withdrawal.
Drug related headache
169
Sudden devastating headache. Vomiting and posible coma. Can be followed by less severe headaches. Neck stiffness. Papiloedema. Can present like severe migraine. 5% of strokes. Risk factors: anurysm or arteriovenous malformation. Menegitis, SLE, Marfans, Ehlers-Danlos.
Haemorrage - Subarachnoid
170
Sudden dizziness with a particular head position lasting 1-2 mins. Triggered on moving head. Normally > 60 or has suffered trauma. Horizontal nystagmus that fatigues and adapts. May also have nausea or feel feint. No hearing loss.
Benign Positional Vertigo.
171
Sudden fever, aching, headache, anorexia, nausea, vomiting, harsh unproductive cough. Most recover in 3-5 days, but post viral syndrome can last for weeks. Mostly occurs as epidemic.
URTI - Influenza
172
Sudden onset pleural chest pain. Dyspnoea. Can be spontanious, iatrogenic or due to trauma. Risk factors: Smoking. Tall stature. Existing lung disease.
Spontaneous pneumothorax
173
Swelling of neck armpit or groin. Night sweats. Unexplained weight loss. Persistent tiredness or fatigue. Recurrent infections and longer recovery. Persistant cough or feeling of breathlessness. Persitent itching all over body.
Hodgkin's lymphoma (HL) or Non-hodgkin lymphoma (NHL)
174
Symptoms same as BPH. (Hesitancy. Frequency. Urgency. Urinary retention. Anuria. Painful distended bladder. Mets cause lumbar and pelvic pain, weight loss, anaemia, obstruction of the ureters. Common in Northern Europe and USA, rare in China and Japan. > black population. 2nd most common malignancy in men. Rare < 50 yrs. Ave 70 yrs.
Prostate cancer
175
Thoracic pain and possibly neck or lumbar pain, but more stiffness and increasingly restricted ROM. Worse in morning. Possible dyphagia or hoarseness. Males > 60. Not genetic and no organs affected.
Diffuse idiopathic skeletal hyperostosis (DISH).
176
Thoracic pain that radiates around chest and is aggrivated by yawning or stretching. History of trauma.
Intercostal muscle injury/strain
177
Thoracic pain with midscapular fatigue and deformity. More common in males. Can also occur in female gymnasts or weight lifting adolecents.
Scheuermanns disease
178
Throbbing headache worse in the morning and vomiting possibly without nausea. Worse when lying. Papileodema. Cranial nerve III or VI palsy. Tinitus and dyplopia. Benign raised ICP more common in women 20 - 40.
Raised ICP
179
Tiredness, breathlessness, frequent infections, bleeding gums, nosebleeds in over 60 or children mostly 2 to 5 yrs. Tiredness, weight loss, night sweats, bloating, repeated infections, bruising and bone pain in 40 to 60 yrs.
Leukemia
180
Tiredness, sensitivity to cold, weight gain, constipation, depression, slow movements and thoughts, muscle aches and cramps, dry scaly skin, loss of libido, btittle hair and nails, carpal tunnel syndrome, irregular or heavy periods. Gradial onset.
Hashimoto's thyroiditis or other hypothyroidism
181
Tiredness, shortness of breath, heart palpitations. Could indicate a stomach ulcer, stomach or bowel cancer or lack of iron in diet
Anaemia
182
Trismus (Pain opening mouth). Solitary Ulcer. White or red patch. Fixed lump. Lip numbness without trauma or infection. Cervical lymphadenopathy.Common worlwide. Incidence in UK increased by 25% over last decade. Risk factors: Poor diet, smoking, tobacco chewing, acohol excess, HPV virus. Chewing betel nuts (asia). Older adults. Men> women.
Oral cancer
183
Ulcer like pain (50%). May be asymptomatic. Dyspepsia. Weight loss. Anorexia, Nausea. Early satiety. Haematemesis. Malaena. Disphagia if Gastro-oesophageal junction is obstructed. Anaemia. Palpable epigastric mass. Jaundice. Ascites. Dermatomyositis. Leading cause of cancer death worldwide. More common in China, Japan, South America. Environmental factors indicated. Men> women. > 50 yrs. Risk factors: salted, pickled, smoked food. Nitrites & Nitrates. Lack of Fresh fruit, veg, vit A, vit C. Genetic, blood group A, CDH1 gene auto somal dominant. History of gastritis (pernicious anaemia). Adenatemous gastric polyps in patient or family. Smoking. Alchohol. Previous partial gastrectomy.
Gastric carcinoma
184
Uncontrollable shivering. Nausea. Vomiting. Diarrhoea. Moderate to severe pain in side, back or groin that is worse when urinating. May also display symptoms of lower UTI. Can spread from lower to upper. Women> Men, Risk factors as lower UTI
Urinary tract infection (Upper UTI)
185
Unilateral headache with reduced ROM in neck, Neck shoulder and arm pain. Made worse by neck movement or posture.
Cervicogenic headache
186
Unilateral NOT bilateral , sharp, burning, recurrent chest pain with skin vesicles after a few days and hypersensitivity in dermosomal pattern. Radiates around chest and improves with antivirals. Reccurs with stress.
Herpes Zoster (Shingles)
187
Very rare. Risk if HBP, known thoracic aortic aneuysm, Marfan's syndrome or Ehlers-Danlos syndrome. Sudden onset severe, sharp, tearing excruciating chest pain may begin near shoulder blades. Possible sweating , nausea and vomiting. Pain follows the path of dissection. CT,MRI or echocardiogram to investigate/confirm.
Aortic disection (thoracic)
188
Very similar to MI. Cardiac pain (dull heavy, squeezing, crushing burning) in centre of chest, neck, jaw, arms, possibly back, at rest. Unpredictable (new onset or rapidly worsening). Lying flat. Nocturnal symptoms. Dyspnoea. Discomfort rather than pain, takes several minutes or longer to develop. Most likley caused by atherosclerosis in coronary artieries, but can be other reasons.
Unstable angina
189
Vomiting (possible coffee grounds), dehydration, deep gasping breath, confusion and possible coma.
Diabetic Ketoacidosis
190
Weight gain, thin skin, easy to bruise. Bone weakness. Loss of libido. Can be caused by corticosteroids.
Adrenal disorders - Cushing's syndrome (hypercortisolism)
191
Women > men. Familial tendancy. Over 50s, younger with trauma or obesity. Pain worse in evening, agrivated by use, relieved by rest. Stiffness for 30 m in morning and after rest. Swelling, crepitus, limited ROM, mild inflamation, muscle wasting, joint deformity. Monoarticular or aysymetrical. Knee, hip, feet, ankle, lumbar spine (with sciatic nerve involvement). Risk factors: injury, obesity.
Osteoarthritis
192
Women > men. Over 40. Chronic. Episodic. Headache and excrutiating face pain in short attacks < 2 mins. Like an electric shock. Sudden onset. Unilateral. Mostly lower face. May be triggered by light touch.
Trigeminal neuralgia
193
Young or Middle aged adults. Occurs most frequently in supraspinatus tendon. Acute intense stabbing pain in shoulder and upper arm. Tender to touch. Often worse at night. Risk factors: Hyperthyroidism, prone to kidney or gall stones. Familial trait. Diet may influence. Can be triggered by stress to body - injury, operation or illness.
Acute calific tendonitis
