ddx2 overall Flashcards by KaTe Wong

Acute onset
Urgency, frequency, burning urination 
suprapubic pain 
LBP
Female
Hematuria
non-sexually transmitted
-cranberry juice may be preventative

Interstitial cystitis

bladder infection

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MC solid tumor of infants & young children
Mild retardation
2-4 YO
Abdominal pain

Wilm’s tumor

nephroblastoma

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Male
Over 60 YO
Decreased force/stream
hesitancy
dribbling
incomplete voiding in urination
obstructive incontinence
Saw palmetto Tx works

Benign prostatic hypertrophy (BPH)

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Males
LBP/pelvic pain
decreased force of urine stream
hesitancy
dribbling 
sense of incomplete bladder emptying
>50 YO

Prostate cancer
(similar Sx in BPH)

2nd MCC of cancer (lung cancer)

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Urinary frequency
Sense of urgency
Painful urination (dysuria)
recurrent
Meds: Amoxicillin/clavulanate; trimethoprim/sulfamethoxazole

UTI

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Infection/neurologic dysfunction
dysuria
nycturia
polyuria

Irritative bladder

rule out DM

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Prostatic involvement
congenital
drug-induced
Sx: 
-dribbling
-decreased stream/volume
-hesitancy

obstructive bladder

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Non-blood stools
nausea/vomiting
HA
low-grade fever
abdominal tenderness
hyperactive bowel sounds

adenovirus
rotavirus
(resolves in 48 hrs)

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after hiking/rafting (1-3 weeks prior)
cysts in stools
abdominal pain 
acute diarrhea
Non-bloody diarrhea
nausea/vomiting
increase peristalsis

Giardia lamblia

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Moderate to high fever with bloody stools
tenesmus
abdominal pain
recent, acute onset explosive diarrhea

dysentary: C. jejuni

if not explosive: Salmonella, shigella

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chronic, recurrent onset diarrhea
bloody stools
Over 50 YO

sigmoid polyps

carcinoma

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Non-bloody diarrhea
acute
nausea/vomiting
increased peristalsis
travel outside US

E. coli

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chronic, recurrent onset diarrhea
bloody stools/ fluid loss
large volumes
increased in our overly stressed American population

Ulcerative colitis

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chronic, recurrent onset diarrhea
bloody stools
weight loss
associated joint pain 
inflammatory

Crohn’s disease

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alternating chronic, recurrent onset diarrhea and constipation (early AM)
non-bloody stools
mucus in stools
no cachexia
lower left/suprapubic abdominal pain 
relieved by defecation 
Late teens/20s
"high strung"

IBS

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chronic, recurrent onset diarrhea
non-bloody stools
calcium supplements
enzymes needed

lactose intolerance

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CN palsies
Paralysis
Respiratory failure
lasting 12 hrs to days
gastroenteritis

C. botulinum infection

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abdominal cramping
gastroenteritis
diarrhea
no fever
past 2 days

Bacillus cereus infection

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infant
constipation-impaired peristalsis where normal enteric nerves not present
swollen belly
flatulence
failure to gain weight

Hirschsprung’s disease

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abdominal pain 
adult
distention of stomach
weight-loss
blood in stool

colorectal cancer

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Avoid gluten (wheat, barley, rye, oats)
abdominal pain 
bloating
flatulence
constipation
diarrhea (not often)
itchy skin with rash (dermatitis herpetiformis)

celiac disease

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Begins as central pain 
Localizes to RLQ
(may develop anorexia)
low-grade fever (<102 deg)
psoas muscle irritation (+ Rovsing, rebound tenderness)
nausea/vomiting
increase WBCs

Appendicitis

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fever
chills
unilateral inferior abdominal pain (sometimes bilateral)
worse at menstruation (end)
sexually active
elevated WBCs

Pelvic inflammatory disease

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Pain in lower quadrant
HCG present
spotting
early morning nausea
tenderness of breasts

ectopic pregnancy

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``` Male 30s-40s sudden onset severe pain nausea/vomiting no position of relief costovertebral pain lower ribs radiating anteriorly (often to groin/labia) ```

renal caliculi | kidney/ureter stones

``` 40s female overweight flatulent diabetic contraceptives severe RUQ abdominal pain referring to inferior scapula nausea/vomiting pain occur after fatty meals Increase ALT, AST, alkaline phosphatase ```

Cholelithiasis (Gb)

- medications - alcohol - possible fever before jaundice (IgM present) - contaminated food/water - anorexia - malaise - dark urine - RUQ tenderness - ESR normal - high ALT, AST

Hep A viral infection

medications alcohol sexually active (blood, saliva, genital fluids) chronic malaise/fatigue signs of serum sickness: (urticaria, rash, arthralgias) high ALT & AST normal blood count & ESR

Hep B viral infection

epigastric pain on full stomach | worse with lying down

reflux esophagitis

``` epigastric pain 20s wake upon sleep due to pain relieved with antacids unaffected by position felt on empty stomach ```

peptic/duodenal ulcers

``` epigastric pain Over 50s wake upon sleep due to pain relieved with antacids unaffected by position ```

gastric ulcer

``` severe back pain alcohol abuse nausea/vomiting fetal position relieves pain recurrent abdominal pain (upper) mild fever tender, distended upper abdomen p-amylase present hypotension ```

pancreatitis

chronic recurrent abdominal pain | sharp increase in pain during menstruation

endometriosis/ (pelvic tumor)

``` over 60 YO lower abdominal pain low-grade fever blood in stools mild leukocytosis nausesa/vomiting ```

diverticulitis

* Chronic, recurrent lower abdominal pain & pelvis associated with menstrual cycle-sometimes radiating to the back & inner thighs * 1-2 yrs postmenarchal

primary dysmenorrhea

Chronic, recurrent lower abdominal pain & pelvis associated with menstrual cycle-sometimes radiating to the back & inner thighs hx of endometriosis, PID, ectopic prego, PCOD - female (late 20s/30s) - increased with infertility

secondary dysmenorrhea

- bilateral leg weakness - distal paresthesia - following viral infection/immunization - absent DTRs - fluctuation in BP - diaphoresis - Protein in CSF

Guillan-barre

MCC of blindness in geriatric population

macular degeneration

* Absent DTRs * Loss of proprioception * Neuropathy mainly sensory (as opposed to motor) * Complaints vary from numbness/tingling to burning pain * Pain resolves over months if controlled (but numbness remains in the feet)--painless

Symmetric distal neuropathy

o Affects CN 3,4, and 6 and peripheral nerves o Abrupt onset (suggesting vascular pathology) o Painful dysesthesias and hyperesthesias o Resolves in weeks to months with control -unilateral double vision

Asymmetric neuropathy

- diabetes first detected during pregnancy 24-28 weeks - possible macrosomia-->preclampsia - labs (glucosuria, proteinuria, ketonuria, hyperlipidemia) - HbA1c

gestational diabetes

- elev bp* - deposition of lipids - moon face - buffalo hump* - trunk obesity - thin extremities - purple striations* - bp slightly elevated possible - easily bruised - edematous - weak - acne (back)* - decr LE muscle tone* - dexamethasone suppression test

Cushing's syndrome

- adrenal tumor* - hypertensive - irritated - normal glucose levels - mimic diabetes - HA - sweating - palpitations - weight loss - tachycardia/elev bp* - elev catecholamine upon urinanalysis*

Pheochromocytoma

* Unilateral weakness and atrophy of large muscle groups in the upper leg & pelvic girdle * MC in elderly males * Resolves in 6-12 months (when under control

Diabetic amyotrophy

- build up of pressure in anterior chamber before canal of schlemm - loss of peripheral vision - halos around light

glaucoma

"20/20" tunnel vision"/ loss of peripheral vision - younger people - poor night vision - often present as "clumsy" or "accident-prone" - peripheral ring scotoma

retinitis pigmentosa

- MC related cause of blindness in elderly population over 60 YO - chronic loss of vision - loss of central vision - distorted vision - painless - slow developing

(dry) macular degeneration

- gradual loss of vision | - chronic loss of vision

Presbyopia

- thrombus in retinal artery - "curtain goes up/down" when thrombus dissolves - transient loss of vision/few min - both eyes/ unilateral eye - > 50 YO - concurrent hx of (diabetes, hypertension, or smoking) - ipsilateral carotid bruit

amaurosis fugax

- Autoimmune demyelination - periodic blind spot in vision - transient loss of vision - both eyes - vertigo-unilateral - recurrent neurological signs - hx of dizziness, numbness, tingling or weakness - 30-40s

multiple sclerosis

- majority unilateral - diplopia - loss of central vision

cataracts

- autoimmune attack of Ach receptors resulting in progressive muscle weakness - double vision from lack of contraction of eyes - both eyes - dysphagia - weakness of jaw when chewing - drooping eyelids - slurred/nasal speech

myasthenia gravis

- aura - female - lasts from hrs to day - incapacitating - seeks dark, quite environment - distorted vision - flashes of light - nausea/vomiting - unilateral HA

classic migraine

- described as 12/10 pain - Usually mandibular & maxillary divisions - may be suicidal (psychologically painful) - short, sharp recurrent pain

``` trigeminal neuralgia (tic douloureux) ```

(rare) - related to swallowing & movement of pharynx - pain on one side of the mouth - short, sharp recurrent pain

Glossopharyngeal neuralgia

- "brain freeze" - "ice cream HA" - facial pain - short, sharp recurrent pain

sphenopalatine ganglioneuralgia

- hyperthyroidism | - sjogren's syndrome

DDx for dry eye, gritty eye

- exophthalmos - High systolic bp (diastolic may be on the low end) - dry eye - gritty eye - fatigue, but energetic - weight loss - intolerance to heat - increased pulse rate - menstrual irregularities - tremors

hyperthyroidism

- autoimmune attack of exocrine glands that produce tears & saliva - dry eye - gritty eye

sjogren's syndrome

- UTI | - eye pain (without vision loss)

Reiter's syndrome

- deep dull pain - worse with bending forward OR atmospheric changes - asymmetry

sinusitis

- pain radiating from front of ear with opening of mouth - associated with chewing/jaw motion - worse with biting down - associated with opening and with popping/clicking

TMJ dysfx

``` • Severe pain • Halos around light • Blurred unilateral vision (peripheral) • Nausea • Vomiting (Patient may have just had his/her eyes dilated) • Senior will present with: -Eye redness -Cloudy-looking cornea -Possibly hyperopic Medical EMERGENCY ```

acute-angle closure glaucoma

- peripheral field vision has been "cut" (usually nasal half) - usually bilaterally (systemic in nature) - may have previous eye surgery/ trauma

Open-angle glaucoma

- sudden, painless loss of vision - caused by neovascularization - geriatric population

"wet" macular degeneration

- abrupt, unilateral loss of central vision - gets worse over 2 days - secondary to infection (mumps, measles, influenza, varicella virus, meningitis)

optic neuritis

- older than 50 YO - unilateral temporal HA - generalized trunk muscle ache - sudden loss of vision - elevated c-reactive protein & ESR - new HA

temporal arteritis | giant cell arteritis

- sudden onset of central vision with hx of trauma - floaters? - flashing lights in vision?

retinal detachment

- deterioration of vision - red/irritated eyes - strabismus - 80% before 3 YO

retinoblastoma

- middle-aged male - facial pain over orbit "clustering" over days/weeks - 30 min on average (worst pain ever felt) - Hx (smoking/alcohol abuse-triggers) - nasal lacrimation on inspection during attacks - beats against wall for relief - thunderclap HA - facial/orbital pain

cluster HA

- burning in face to ophthalmic division of CN5 | - Associated with skin lesions

shingles

If 0-2 YO: - fever - red, bulging tympanic membrane - ear pain - ear "fullness" or blockage (with redness)

otitis media

present/past upper respiratory infection

acute otitis

may have had present/past upper resp infection -dizziness -and/or hearing loss (rare)

labyrinthitis

sudden hearing loss

viral infection

- recurrent hearing loss - dizziness - vertigo - unilateral - localized tinnitus

Meniere's disease

- older patient - chronic hearing loss - difficulty hearing in crowded rooms OR loud areas - longstanding, bilateral tinnitus localized

presbycusis

- younger (20s-30s) - chronic hearing loss primarily when speaking on the telephone - no problem with loud areas - secondary to Paget's - usually bilateral - longstanding subjective tinnitus localized

otosclerosis

- chronic hearing loss - unilateral - localized tinnitus subjective - vertical nystagmus

congenital acoustic neuroma

- more dizziness/pain - -red, bulging tympanic membrane - ear pain - ear "fullness" or blockage (with redness)

cholesteatoma

- severe ear pain on airplane descent/underwater diving | - sharp, stabbing ear pain

barotrauma

- fullness for several weeks - possible hearing loss - pain associated with past hx of upper resp infection - children

serous otitis media

- ear pain - itching - discharge - present during warm, humid weather - pain produced by pulling of ear - swimmer?

otitis externa

- direct trauma related (consequence of rib fx) - pain with full inspiration - (spontaneous: tall, thin male, 20-40 YO, acute onset of sharp, unilateral chest pain, dyspnea, often occurs at rest/sleeping)

pneumothorax

pain with full inspiration

muscle strain

- chronic, non-productive cough - dry cough - longer than 3 weeks duration - worse at night

post-nasal drip

- usually in recumbancy - evening hours - associated with fatty meals - may stimulate cough receptors - older - overweight - epigastric pain - after eating large meals (choc, caffeine, fat, alcohol) - obese

gastroesophageal reflux

smokers? | -chronic productive cough

chronic bronchitis

-exhalation most affected -wheezes -rhonchi (asthma, chronic bronchitis, emphysema, bronchiectasis) -cyanosis upon inspection -prolonged respiration

COPD | Chronic Obstructive Pulmonary disease

- affects all aspects of respiration | - rales

Chronic restrictive pulmonary disease

-progressive LMN dysfx in absence of trauma

post infectious polyradiculitis

- sudden severe chest pain after pain in calf - coughing - diaphoresis - tachycardia - tachyapnea - middle-aged male

pulmonary embolism

- dyspnea upon exertion AND/OR lying supine at night - acites - bilateral leg pitting edema - rales - Adventitious lung sounds upon auscultation

CHF

-inflammation due to mineral dust, fumes, and/or other organic/non-organic particulate matter

pneumoconiosis

- autoimmune disorder - (tender) pre-tibial erythema nodosum - lymphadenopathy present in neck, liver, salivary, lacrimal glands - low-grade fever - fatigue - anorexia - elevated ACE - hypercalcemia

sarcoidosis

- hx of smoking - gradual difficulty breathing - barrel chested - breathing thru pursed lips - thin, frail

emphysema

- productive cough | - fever

pneumonia

- older than 40 YO - hx of smoking - persistent cough - hemoptysis - weight loss - solitary wheeze

bronchogenic carcinoma

``` dizziness drop attack dysphasia diplopia dysarthria ataxia nystagmus numbness nausea ```

stroke

- mild trauma | - dry environments

Anterior epistaxis

-uncontrolled bleeding disorder

blood dyscrasia

- persistent epistaxis | - excess WBC

leukemia

- tender anterior lymph nodes - fever above 101 F - loose, yellow in pharynx - scarlatiniform rash - recent cough - sore throat

Strep pyogens

- recurrent, milder attacks of sore throat - posterior lymph node involvement - responds to NSAIDs

Viral pharyngitis

- axillary lymph node involved - inguinal area involved - risk of splenomegaly - small, red lesions with white bases in oropharynx - fever - rash? - lymphocytosis high

Mononucleosis

- genetic defect (dystrophin) - affects resp muscles - 1 to 5 YO - difficulty rising from bent-over position - falls often

Duchenne's muscular dystrophy

- normal dystrophin - pelvic area affected first then limbs - slow progression

Becker's muscle dystrophy

- adolescence | - Precipated by: CHO's ingestion, EtOH, exposure to cold, stress, rest after exercise

hypokalemic paralysis

- attacks after exercise (lasting one hr) | - Relieved by: glucose, insulin, calcium gluconate

hyperkalmic paralysis

-brief, jerking motion in sleep

myoclonus dyskinesia

-resp/vocal manifestations

tics (tourette syndrome)

- chorea - middle age - motor decline

Huntington's

- associated with rheumatic fever | - choreas (distal extrem & face)

Sydenham

- choreas - joint pain - rash - kidney failure

SLE

- muscle weakness - cramping in hands - 30-60 YO - progressive - UMNL & LMNL sigs

ALS

- pediatric | - cafe-au-lait lesions on trunk, pelvis, flexor creases of arms

neurofibromatosis

- facial weakness - unable to close one eye - ear pain - "woke up with it" - expressionless on one side - deficit in taste - hyperacusis

bell's palsy

- 45-65 YO - difficulty moving - rigidity - bradykinesia - resting tremor - festinating gait - sustained blink response

Parkinson's disease

- young - lose pain & temp sense in shawl-like distribution upper trunk & arms - atrophy & areflexia (probable)

syringomyelia

-band squeezing head HA frontal

tension HA

- high fever | - neck stiffness

meningitis

- no aura - female - lasts 1-3 days - no incapacitating - distorted vision - flashes of light - nausea/vomiting may have relief - unilateral HA

common migraine

- calf pain/tightness - worse with walking - hx of minor trauma, excessive immobilization - predispositions: (prolonged rest, surgery, oral contraceptives, smoking, cancer) - elevation of legs helps - acute unilateral swelling

deep vein thrombosis

- diffuse, hot, swollen unilateral leg - prob hx of skin lesions - infection: gram +, e coli

cellulitis

- subacute/chronic - itching - dull ache - worse with prolonged stanidng - secondary to trauma? - edema relieved by elevation of legs

venous insufficiency

-persistent pain -swelling after trauma -hyperactivity of SNS Stages: a. sharp, burning pain in area b. mottled, atrophic, cold skin c. aching, throbbing pain with dystrophic changes

reflex sympathetic dystrophy

- dull, aching heaviness LE - worse with prolonged standing - most affected: overweight, pregnancy

primary varicosities

- pelvic pain - inguinal lymph nodes involved - veneral disease

lymphogranuloma venerum

- night sweats - fever - weight loss - HIV patients prone - rubbery lymph nodes

Non-Hodgkin's lymphoma

- night sweats - fever - weight loss - generalized pruritis - painless mass in neck - Reed-Sternberg cells - 20s/ 50s - high WBC count

Hodgkin's lymphoma

- persistent, generalized lymph node swelling - CD4 count low - thrush - leukoplakia - enzyme linked - muscle wasting/cachexia prior: - fever - sore throat - HA

AIDS

AIDS: CD4 (300)

AIDS: less than 200 CD4

Pneumocystis carinii

AIDS: less than 50 CD4

Cytomegalovirus

swelling around the face

hypothyroid myxedema

swelling at tibial crest

hyperthyroid myxedema

- chest pain | - thrombosis of superficial vein

Mondor's syndrome

- chest pain | - pain/soreness upon contraction and stretching

intercostal strain

- pain along nerve distribution/rib-extending band - unilateral - diabetic patient with poor glycemic control likely

intercostal neuritis

- compression pain after trauma - guarded respiration - difficulty with lying supine - posterolateral pain in back

rib fracture

- Unilateral sharp, severe pain at upper chest - swelling and inflammation at upper rib (2nd/3rd costochondral) - older women (over 50 YO) - prolonged coughing

Tietze's syndrome

- retraction of shoulders, head back causes bilateral pain (crowing rooster) - young - complaint of anterior chest pain - location: middle ribs close to sternum - tenderness without swelling at costal jx ribs 2-5

costochondritis

- came on suddenly after exercise/moving around - pain relieved by rest/nitroglycerine - no enzymes present - squeezing/pressure in chest - goes away after 10 or less - aching pain felt down side of arm to fingers

stable angina

- -squeezing/pressure in chest - lasts 10 min or more - aching pain felt down side of arm to fingers - pain relieved by rest/nitroglycerine - C-reactive protein present

unstable/prinzmetal angina

- Nitro does not help - severe pain - may/may not be unconscious - pain lasts longer than 30 min - low grade fever may be present - Elevation of CK-MB - Cardiac specific troponin-T & troponin 1 elevated

- loss of consciousness - less than 1 min - sweating - lightheadedness - queasiness

vasovagal/ emotional stress shock

- loss of consciousness 5-10 min | - post-faint convulsions/warning signs

epilepsy

- from 140/90 mmHg difference standing vs seated | - Hx of adrenal disease, diabetes, meds

orthostatic hypotension

- tight collars - head turned to one side - syncope

carotid sinus syndrome

- numbness - paresthesia - cold hands prior to fainting spell

hyperventilation

- exertion-related chest pain - syncope post-exercise - young athletes - difficulty breathing - worse with valsalva's - improved with squatting

hypertrophic cardiomyopathy

- sharp pain in chest - coughing, sneezing? - bending to same side/lying involved side pain? - pleural friction rub heard - decreased fremitus - dullness to percussion - increase/decrease breath sounds

pleurisy

-chest pain often radiating to neck/shoulder -difficulty breathing -worse lying down -better seated -pericardial friction rub hx of: (resp infection, renal failure, or cancer)

pericarditis

- mild/severe abdominal pain | - blood in stool

Meckel's diverticulum

- copper deposition Fleisher ring in eyes | - autosomal recessive disorder

Wilson's

- bilateral abdominal pain | - kidney palpable fluid filled cysts

polycystic kidney disease

- MALES>females - bronze skin - liver cirrhosis - DM - pain, stiffness, swelling in joints bilaterally - elevated ESR, serum iron - increased saturation of plasma iron binding

hemochromatosis

``` Less than 20/Older than 50 Abdominal flank bruit* signs of end-stage organ damage Captopril stimulation test elev Plasma renin activity* grade 1 elev bp* elev serum creatinine* ```

Renal disease (Renal vascular hypertension)

- severe muscle weakness - transient paralysis - muscle cramps - Labs (hypokalemia/hypernatremia)

primary aldosteronism

- associated murmur/thrills upon heart palp - systolic BP greater in arms compared to legs - femoral pulse decreased compared to subclavian

aortic coarctation

- weight gain (30% of patients) - intolerance to cold - perceived "slowness" of muscles - diminished reflexes - goiter - Tendinitis - dry skin

hypothyroidism

- FT4 low - TSH elevated - elevated anti-microsomal/anti-thyroglobulin antibodies - slight thyroid enlargement - thinning hair - increased sensitivity to cold

Hashimoto's hypothyroidism

- TSH elevated | - FT4 is normal

subclinical hypothyroidism

- TSH is low - Either FT3 or FT4 elevated - elevated anti-thyroid antibodies - autoimmune condition - increased bilateral pulse pressure - dryness in eyes due to increased exophthalmos

Graves' disease

- TSH is low | - FT3 & FT4 normal

subclinical hyperthyroidism

- anterior neck pain - myalgia - low-grade fever - tiredness and/or tachycardia/palpitations - acute onset - usually females (vs males) - may/may not have nodular goiter - reduced radioactive iodine uptake - normal thyroglobulin

DeQuervain's (subacute) thyroiditis

- Female; 4-8 weeks post-partum - nervousness - palpitations - (50%) non-tender goiter - low radioactive uptake of iodine - manage transient sx by beta-blockers

Silent thyroiditis

- abrupt onset of intense anterior neck pain - fever (staph aureus/strep pyogens) - chills - Women (vs men) - Lab (normal thyroid fx, elevated WBCs, normal radioactive uptake of iodine)

Acute (suppurative) thyroiditis

- middle-aged/elderly - Women (vs men) - slowly, enlarging, hard non-tender anterior neck mass/fibrosis - Lab (normally fx thyroid gland)

Riedel's thyroiditis

- small painless swelling in thyroid region - hard, enlarged, non-motile nodule in gland (with/without lymph node involvement) - thyroid fx test normal - calcitonin levels may be elevated) - radioactive iodine uptake: "cold" lesions

thyroid cancer

- middle aged - fatigue* - night sweats - low grade fever - splenomegaly* - elevated WBC (by a lot)* - sleeplessness* - unexpl weight loss*

chronic myelogenous leukemia (CML)

- skin rash (red papulae) - flu-like sx (after camping/hiking trip) - multiple joint pains - fatigue (later on) - ELISA (+)

Lyme disease

- fatigue - generalized musculoskeletal pain - 11 of 18 sites of tenderness, 9 bilateral - sleep disturbance - paresthesia - headache - women (5:1) - aching - fatigued - stiff sensation in multiple muscle groups

fibromyalgia

- disabling, debilitating fatigue - ADL interfered for at least 6 months - Rest does not help

Chronic fatigue syndrome

- tachycardia - pallor in sclera/conjunctiva - glossitis (geographic tongue)

anemia

- elevated bp - cardiomegaly - pericardial friction rub

chronic renal failure

- TSH is low; hyperthryoid - FT4 or FT3 elevated - nodule

thyrotoxicosis

- malaise - HA - cough - sore throat - abdominal pain - constipation - visible rashes (rose spots) - abdominal distention - splenomegaly - bradycardia - fever over 10-14 days

Typhoid fever

- high fever with leukopenia - altered mental status - hemorrhaging diathesis

hemorrhagic fevers

- fever - shaking - chills with flu-like Sx - huddled in blanket and can't get warm - splenomegaly, hepatomegaly, cerebral ischemia, hypoglycemia, renal failure

malaria

- "flu"-like Sx - fever - bradycardia - GI bleeding - jaundice - hypotension - delirum - ELISA - IgM

yellow fever

- high fever (biphasic)* - HA - myalgia/athralgia - petechia/erythematous rash on torso* due to thinned blood - may maintain use of acetominophen

Dengue fever

- 104-106 deg F* - disorientation* - HA - Vertigo - fatigue - LOC - convulsions - tachycardia (without incr in BP) - flashed, hot, dry skin*

Heatstroke

- perspiration - fatigue - weakness - anxiety - COLD,CLAMMY skin, slow pulse rate - 101-105 deg F

heat exhaustion

- excessive sweating (may begin in extremities or start in abdomen) - athlete/working outdoors in dry environment

heat cramps

``` -child (fatty liver, severe encephalopathy) -related to aspirin administration -high fever, HA, vomiting, confusion -hyperactive reflexes, encephalitic stupor -coma, edema, respiratory arrest -dilated pupils, deepening coma -seizures, organ failure, death ```

Reye's syndrome

- beta-hemolytic infection of pharynx - skin lesions (erythema marginatum) - Sydenham's chorea - increase in ESR - Tx: penicillin, salicylates (fever, joint pain)

Rheumatic fever

- Group A streptococcal infection (similar to strept pharyngitis) - abdominal rash/lateral to chest* - high-grade fever* - sore throat* - "strawberry tongue"* (deafness if unTx) - Tx: penicillin/erythromycin/ salicylates (fever)

scarlet fever

- severe dysesthesia (abnormal sensation) - irresistible leg movements provide temporary relief - sleep deprivation - chronic muscle cramp (that does not respond to musculosk therapies) - Tx: carbidopa, levodopa (Parkisonon's meds)

restless leg syndrome

- sudden sleeping episodes during day (sleep/naps for 3 months) - drop-attacks - excessive daytime sleepiness - sudden muscle weakness - Tx: methylphenidate, anticholinergic drugs

narcoplepsy

- progressively deeper and faster breathing followed by gradual decrease resulting in temporary apnea/eponymic resp abnormality - seen in patients with heart failure, strokes, hypernatremia, brain tumors, metabolic encephalopathy - may occur at high altitudes in sleep - reduction of weight & sleeping on one side may help

Cheyne-Stokes respiration

Quick, shallow breaths (equal) followed by regular periods of apnea caused by damage to pons due to strokes/trauma (associated with strokes, trauma, opioid use)

Biot's breathing

Deep, labored, gasping breathing (form of hyperventilation)

Kussmaul breathing

``` Anemia that has: -decreased MCV -serum [Fe] normal -decreased TIBC (total iron binding capacity) MC genetic disorder-->gen couseling 2nd MC anemia in humans young -Increased RBC -decreased MCV -normal serum ferritin -elevated reticulocytes Tx: hemoglobin electrophoresis ```

Thallassemia minor

- death within 2 yrs of life - asymptomatic - genetic counsel needed - microcytic, hypochromic anemia

Thallassemia major

Anemia that has: - decreased MCV - decreased serum [Fe] and TIBC - increased ferritin - normal RDW 75%: normocytic, normochromic 25%: microcytic, decreased hematocrit, decreased TIBC, normal RDW & ferritin

Anemia of chronic disease

``` Anemia that has: -decreased MCV -decreased serum [Fe] & ferritin -increased TIBC MC hematological disorder o Fatigue o Orthopnea o HA o Dizziness o Pre-Syncope o Decreased ferritin o Increased TIBC o Decreased % of transferrin saturation Tx: ferrous sulfate ```

Iron-deficiency anemia

Lab values of: | -increased MCV (>130 fL)

B12 and/or folate deficiency

Increased MCV (+) anti-IF antibodies (+) Schilling's test

Pernicious anemia

Increased MCV Increased LDH, bilirubin Normal RDW

Hemolytic anemia

```  Complaints of general weakness  SOB  Numbness/tingling (myelin synthesis)  Difficulty walking  Swollen tongue -elevated MCV -High methylmalonate & homocysteine ```

Vit B12 def

- Generalized fatigue - (Alcoholic/pregnant) - elevated MCV - decreased hemoglobin - low serum/RBC - megaloblastic anemia

folic acid def

-Autosomal dominant -spherical cells (lacking in Spetrin) -decreased MCV -Increased MCHC -Normal hematocrit -increased direct bilirubin (-) Coomb's test Management: folate

Hereditary spherocytosis

- Autosomal recessive - (Valine substituted for Glu in beta chain of hemoglobin A) - 1st yr of life - jaundice - splenomegaly - poor-healing lower tibial ulcers - nucleated RBCs - Howell-Jolly bodies - elevated WBCs - elevated indirect bilirubin - Hemoglobin S

sickle cell anemia

-acute onset of fatigue -jaundice -splenomegaly -immune thrombocytopenia present (Evan's syndrome) (+) direct Coomb's test -nucleated RBCs -increased indirect bilirubin Tx: prednisone/high dose IV immunoglobulin

Autoimmune hemolytic anemia

o Fatigue & weakness o Predisposition to infection (neutropenia) o Bleeding tendencies (decrease in platelets) o Splenomegaly o Hepatomegaly o Pallor o Lymphadenopathy o Pancytopenia (Decreased RBCs, WBCs, and platelets) o normal MCV Tx: high dose immunosupp/bone marrow transplant

aplastic anemia

 Paleness  Fatigue  Dizziness  Hepatomegaly/splenomegaly (iron buildup could lead to heart disease, liver damage, and/or kidney failure) ``` • Labs: (congenital) o Hypochromic, microcytic RBCs (pica?) o Elevated serum Fe o Increased ferritin o High transferrin saturation o Normal-to-decreased TIBC o 20-30% hematocrit o Prussian Blue staining marks ringed sideroblasts -decreased MCV -normal/decreased serum [Fe] & ferritin -increased RDW ```

siderblastic anemia

- malaise - fever - HA - Lesion first appear on trunk (then spread to face & extremities) - macropapules-->vesicles-->pustules-->crusting

varicella (chickepox)

- high fever (104-105 deg F) - Koplik spots on mouth - rash appears on face first, spreads to trunk & extrem

Rubeola (measles)

- begins as fine pink rash on face - may be on trunk and extrem - rash disappears after one day

Rubella (german measles)

- 6-18 months - high-grade fever (103-105 deg F) for 5 days - faint, macular (non-itchy) rash on trunk

Roseola (Exanthema subitum)

- extreme itching on face, neck, upper trunk, hands & wrists, knees, and elbows - lichenification - if untreated can lead to increased patches of diffuse hair loss

eczema

- silver scales/red plaques on scalp | - extensor surfaces of extrem (pitting of fingernails, arthritis of fingers & SI joint)

psoriasis

- dry or oily yellowing scaling of scalp, body folds, presternal areas - (chronically in hospitals & immunocompromised)

seborrheic dermatitis

-oval shaped eruptions -women -spring & fall months (goes away in 1-2 mo)

Pityriasis rosea

- Kerotogenous lesions on feet - oral ulcers - uveitis - conjunctivitis

Reiter's syndrome

- uveitis - conjunctivitis - bamboo spine, trolley-track sign - conjunctivitis/iritis - T/L ROM - seroneg arthropathy

- scales (silvery-white) on extensor surfaces | - pitting of nails

Psoriatic arthritis

-Subcutaneous nodules on extensor surfaces

- malar erythema - rash - hair loss - oral ulcers - lymphadenopathy - non-specific joint pain - low grade depression - elev anti-nuclear antibodies

SLE

atropic, edematous thickening of skin

scleroderma

- discoloration of upper eyelids - weak anterior thigh/quads due to incr fibrosis/rigidity of skin - elev CPK - abnormal calcif via X-ray

dermatomyositis

- asymmetry - border irregularity - color variation - diameter >6mm - inflammation - bleeding - crusting - ulceration - sensory change - elderly/diabetic

malignant melanoma

- fair-skinned young adults - chronic sun exposure - lesions appear "pearly"/translucent papules/nodules

basal cell carcinoma

-small, red, hard, ulcerating nodules

squamous cell carcinoma

-"slapped cheek"

erythema infectiosum

- "seven-year itch" - water-related infection - intense itching - immunocompromised

scabies

- "flesh-eating bacteria" - intense pain - redness/necrosis

necrotizing fascitis

- itchy water-filled blisters | - gluten sensitivity

dermatitis herpetiformis

- cutaneous fungi infection affecting people in warm environ | - hypopigmentation

tinea versicolor

- flesh-colored, dome shaped lesions (1-5 mm in diameter) - leads to eczema - Sexually transmitted poxvirus

Molluscum contagiosum

- pruritic inflammation form of eczema | - hay fever asthma

atopic dermatitis

- common wart | - raised with roughened surface

Verruca vulgaris

- localized rash | - exposure to allergen/irritant (poison ivy, sumac, kerosene, acetone)

contact dermatitis

- skin color change (brownish-tan appearance without sun exposure) without lesions or itching - signs of fatigue

Addison's disease

major mechanism that involvesexcessive consumption of a poorly digested material such as sorbitol/mannitol diarrhea

osmotic

- chronic, voluminous epistaxis | - form of herditary hemorrhagic telangiectasia

Rendu-Osler-Weber syndrome

ddx2 overall Flashcards

(237 cards)