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PACES 2.0 > Differential Diagnoses > Flashcards

Differential Diagnoses Flashcards

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1
Q

Bilateral ptosis

A

Myotonic dystrophy
Myasthenia gravis
Congenital

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2
Q

Unilateral ptosis

A

III nerve palsy
Horner’s syndrome

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3
Q

Cerebellar syndrome

A

PASTRIES

Paraneoplastic cerebellar syndrome
Alcohol
Sclerosis
Tumour
Recessive (Friedreich’s ataxia, ataxia telangiectasia) OR dominant (spinocerebellar ataxia)
Iatrogenic (phenytoin)
Endocrine
Stroke

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4
Q

Cerebellar signs with neuropathy

A

ETOH
Friedreich’s ataxia

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5
Q

Cerebellar signs with optic atrophy

A

MS
Friedreich’s ataxia

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6
Q

Spastic paresis

A

MS
Spinal cord compression
Myelopathy
Trauma
MND

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7
Q

Charcot joint (neuropathic arthropathy)

A

Tabes dorsalis - hip and knee
Diabetes - foot and ankle
Syringomyelia - elbow and shoulder

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8
Q

Tremor

A

Resting
- Parkinsonism

Postural
- benign essential tremor
- dystonic tremor
- physiological (anxiety, caffeine, hyperthyroid, ETOH withdrawal)

Intention
- ipsilateral cerebellar lesion

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9
Q

Bilateral facial weakness

A

GBS
Sarcoidosis
Myasthenia gravis
Lyme disease
Syphilis

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10
Q

Unilateral facial weakness

A

MS
Stroke
Tumour
Acoustic neurons
Cholesteatoma
Ramsay Hunt syndrome
Bell’s palsy

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11
Q

Enlarged nerves and peripheral neuropathy

A

Neurofibromatosis
Hereditary motor and sensory neuropathy
Leprosy
Amyloidosis
Acromegaly
Refsum’s disease

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12
Q

Horner’s syndrome

A

MS
Stroke
Syrinx
Aneurysm
Trauma
Pancoast’s tumour

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13
Q

Oculomotor (III) nerve palsy

A

Mononeuritis multiplex
Midbrain infarction
Midbrain demyelination (MS)
Migraine
Posterior communicating artery aneurysm
Cavernous sinus pathology
Cerebral uncus herniation

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14
Q

Optic atrophy

A

PALE DISCS

Pressure (tumour, glaucoma, Paget’s)
Ataxia (Friedreich’s ataxia)
Leber’s
Dietary (B12), Degenerative (retinitis pigmentosa)
Ischaemia (central retinal artery occlusion)
Syphilis and other infections
Cyanide and other toxins
Sclerosis (MS)

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15
Q

Retinitis pigmentosa

A

Congenital (AR)
Acquired (post-inflammatory retinitis)

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16
Q

Retinal artery occlusion

A

Embolic
- carotid plaque rupture
- cardiac mural thrombus
Giant cell arteritis

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17
Q

Retinal vein occlusion

A

HTN
Hyperglycaemia
Hyperviscocity
High intraocular pressure

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18
Q

Chest pain

A

Myocardial ischaemia
PE
Pneumonia
Pericarditic
MSK
Oesophageal reflux/spasm

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19
Q

Pericarditis with effusion

A

Acute pericarditis
PE
Pneumonia
MSK
MI

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20
Q

Hypertension

A

Essential
Renal
- CKD secondary to glomerulonephritis, ADPKD, renovascular disease
Endocrine
- Conn’s, Cushing’s, acromegaly, phaeochromocytoma
Aortic coarctation
Pre-eclampsia

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21
Q

Optic disc swelling

A

Papilloedema
- raised ICP (SOL, benign ICP, CST)
Papillitis/optic neuritis
- MS
Accelerated phase hypertension
Central retinal vein occlusion
Anterior ischaemic optic neuropathy
- GCA

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22
Q

Ataxia

A

Friedreich’s ataxia
Vestibular
- labyrinthitis, vestibular neuritis
Stroke
MS
Drug/alcohol

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23
Q

Headache

A

Bacterial meningitis
SAH
Migraine
Trigeminal neuralgia
Cluster headache
Medication overuse headache
Temporal arteritis
Intracranial haemorrhage
Cerebral venous sinus thrombosis
Malignant hypertension

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24
Q

Causes of thunderclap headache

A

SAH
Meningitis
Intracranial haemorrhage
Cerebral venous sinus thrombosis
Malignant hypertension

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25
Reduced GCS
Intracranial pathology Diabetic ketoacidosis Meningitis Alcohol/drug intoxication
26
Syncope
Cardiac Neurological Orthostatic hypotension Vasovagal Psychogenic non-epileptic spells
27
Cardiac syncope
Brady or tachycardia Bradycardia: Post-op SAVR or TAVI Lyme disease Sarcoid Obstructive cardiac lesion AS MS HOCM PH
28
Neurological syncope
Epilepsy Vertebrobasilar insufficiency ETOH Diabetes
29
Vasovagal syncope
Stress Cough Micturation Defecation
30
Fall and fragility fracture
Osteoporosis Bone metastasis Secondary hyperparathyroidism (CKD)
31
Dyspnoea
Asthma COPD PE Pneumothorax Anaemia Respiratory tract infection Anaphylaxis
32
Haemoptysis
PE Pneumonia Pulmonary oedema Bronchial carcinoma
33
Persistent fever
Infection - endocarditis Drug-induced Malignancy Inflammatory disease Factitious
34
Anaemia
Dietary - iron, B12, folate Chronic bleeding - GI, PV Coeliac IDA Inherited haemoglobinopathy
35
Jaundice in PSC
Progression of PSC to cirrhosis Development of new biliary stricture Cholelithiasis Cholangiocarcinoma Hepatocellular carcinoma Gallbladder cancer Bowel cancer
36
Bloody diarrhoea and weight loss
Crohn’s disease - Yersinia, tuberculosis, lymphoma, UC Ulcerative colitis - Crohn’s, infection, ischaemia, drugs, radiation IBS (no blood)
37
Bloody diarrhoea in traveller
Campylobacter E. Coli producing Shiga-like toxin Entamoeba histolytica
38
Non-bloody diarrhoea in traveller
Enterotoxigenic E. coli (traveller’s diarrhoea) Salmonella Shigella Yersinia Norovirus Rotavirus Giardia lambia Cryptosporidium Clostridium difficile Staphylococcus aureus
39
Swollen calf
DVT Cellulitis Chronic venous insufficiency Ruptured Baker’s cyst Muscular strain
40
Leg ulcer
Venous Arterial Diabetic
41
Hyperextensible joints
Pseudoxanthoma elasticum - plucked chicken skin - blue sclerae - retinal angioid streaks - macular degeneration - premature coronary artery disease Ehlers-Danlos - no premature coronary disease - family history more apparent
42
Painful swollen joints
Rheumatoid Psoriatic Osteoarthritis Gout Septic arthritis
43
Hypercalcaemia
Primary hyperparathyroidism Malignancy - multiple myeloma - solid organ tumours with bony metastases - solid organ tumours with production of PTH-related protein Medications - thiazide diuretics - vitamin D and/or calcium supplements - lithium Sarcoidosis Addison’s disease Hyperthyroidism Prolonged immobility
44
Xanthomata
Hypercholesterolaemia - tendon xanthomata, xanthelasma, corneal arcus Hypertriglycerideamia - eruptive xanthomata and lipaemia retinalis Hypothyroidism Nephrotic syndrome Alcohol Cholestasis
45
Goitre
Tender - thyroiditis Non-tender - Grave’s disease - toxic multinodular goitre - carcinoma - adenoma
46
Amenorrhoea
Primary: Genetic - Turner’s syndrome Secondary: Pregnancy Post-partum and breastfeeding PCOS Premature ovarian failure Pituitary adenoma (prolactinoma most common) Pills Eating disorders
47
Cushing’s syndrome
ACTH dependent: Pituitary adenoma - Cushing’s disease Ectopic secretion of ACTH - non-pituitary tumour (bronchigenic carcinoma) ACTH independent: Iatrogenic - exogenous steroids Adrenocortical adenomas or carcinomas
48
Proximal myopathy
Inherited: - myotonic dystrophy - muscular dystrophy Endocrine: - Cushing’s syndrome - hyperparathyroidism - thyrotoxicosis - diabetic amyotrophy Inflammatory: - polymyositis - rheumatoid arthritis Metabolic: - osteomalacia Malignancy: - paraneoplastic - LEMS Drugs: - alcohol - steroids
49
Causes of chronic liver disease
3 Cs and 4 Is Cirrhosis - alcohol most common Carcinoma Congestion - CCF Infectious - blood borne viruses Immune - AIH, PBC, PSC Infiltrative - amyloid Iron - haemochromatosis
50
Transient neurological events
TIA Migraine Focal epilepsy Metabolic disturbances Transient global amnesia MS
51
Bilateral lower limb pain
Peripheral vascular disease Sciatica Osteoarthritis of hip and knee Cauda equina syndrome Anterior tibial compartment syndrome
52
Sacroiliac joint pain and stiffness
Ankylosing spondylitis Psoriatic spondyloarthropathy IBD-related spondyloarthropathy Scheuermann’s disease Diffuse idiopathic skeletal hyperostosis
53
Radiographic sacroiliac joint abnormalities
Ankylosing spondylitis Osteitis condensans ileii Degenerative Infection Gout Hyperparathyroidism Paget’s disease Paraplegia Neoplastic metastases
54
Neuropathic ulcers
Diabetes Leprosy Tabes dorsalis Amyloidosis Alcoholic neuropathy Hereditary neuropathies Drugs Deficiencies - B12, thiamine
55
Thyrotoxicosis
Thyroiditis Grave’s disease Toxic multinodular goitre Drug-induced Gestational Factitious Ovarian tumour Recovering leukaemia and HIV
56
Solitary thyroid nodule
Thyroid cyst Thyroid adenoma Thyroid carcinoma Metastatic cancer Lymphoma Sarcoma Parathyroid cyst
57
Macroglossia
Acromegaly Amyloidosis Hypothyroidism Down’s syndrome
58
Male infertility and hypogonadism
Klinefelter’s syndrome Kallman’s syndrome Testicular disease Pituitary disease Haemochromatosis Fragile X
59
Scarring alopecia
Discoid lupus Lichen planus Tinea capitis
60
Bullous lesions
Cellulitis/bullous impetigo Arthropod bites Drug-induced Bullous pemphigoid Pemphigus vulgaris Epidermolysis bullosa Epidermolysis bullosa acquisita Stephen-Johnson syndrome Toxic epidermal necrolysis
61
Polyneuropathy
Acute (all predominantly motor) - GBS - porphyria - diabetic amyotrophy - lead poisoning Subacute - paraprotein (IgM) - paraneoplastic (anti-hu or anti-CV2) - infection (HIV, Lyme disease, leprosy) - immune (CIDP) - metabolic (DM, renal, B12) Chronic - HMSN (CMT)
62
Neuromuscular junction disorders
Myaesthenia gravis Lambert Eaton myaesthenic syndrome Botulism
63
Myopathy
Toxic - drugs (statins, steroids) - alcohol Metabolic - osteomalacia - hypo/hyperthyroidism Infection - HIV - Hep B/C - influenza - enterovirus Inflammatory - polymyositis - dermatomyositis - inclusion body myositis Inherited - Duchenne/Becker - myotonic - FSHD - limb girdle Congenital Metabolic Channelopathy
64
Combined UMN and LMN
MND Cervical myeloradiculopathy Freidreich’s ataxia B12 deficiency
65
Bihilar lymphadenopathy
Sarcoidosis Infection - TB, mycoplasma, HIV, histoplasmosis Malignancy - lymphoma, lung cancer, mets Pneumoconiosies - Silicosis, berylliosis
66
Erythema nodosum
Infection - streptococcus, TB etc Drugs - contraceptive pill, penicillin, sulphonamides (antibiotics, diabetic drugs, diuretics), phenytoin Sarcoidosis Inflammatory Bowel Disease Behcet’s disease Hodgkins lymphoma, leukaemia Pregnancy Whipple disease Sweet syndrome Idiopathic
67
Low calcium
Hypoparathyroidism (Low Ca, low PTH, Low Mg, raised P, normal ALP) Post-thyroidectomy/parathyroidectmy/radiation to neck/RI for thyroid/radical neck dissection Abnormal magnesium Infiltration eg. Haemochromatosis, thalassaemia, wilsons, mets, granulomatous Autoimmune Genetic eg. abnormal parathyroid development, Digeorge Idiopathic PTH resistance (Pseudohypoparathyroidism) Renal Disease Vitamin D deficiency Bisphosphonates, calcitonin, phenytoin Acute pancreatitis Blood transfusion Artefact (raised K+, low Mg, Low ALP) Rhabdomyolysis Tumour lysis Hyperphosphatemia
68
Acute diarrhoea
Infection - virus (most common) - bacteria (campylobacter most common) - parasite (cryptosporidium, giardia) Drugs - laxatives, allopurinol, metformin, PPI, abx etc Anxiety Allergies Appendicitis Pelvic radiation treatment Intestinal ischaemia
69
Chronic diarrhoea
IBS Diet - FODMAP malabsorption, artificial sweeteners, caffeine, alcohol IBD Microscopic colitis Coeliac disease Lactose intolerance Pancreatic insufficiency Colorectal cancer Constipation with faecal impaction Infection - giardia, amoebiasis HIV SBOS Radiation Cystic fibrosis Hormone secreting tumour
70
Bloody diarrhoea
Infections - bacteria (campylobacter, salmonella, E. coli, cholera, shigella, yersinia, C. Diff) - viruses (cytomegalovirus) - parasites (entamoeba histolytica, schistosomiasis) IBD Anal fissures Haemorrhoids Colorectal cancer
71
Marfan-like body habitus
Marfan’s syndrome Homocysteinuria MEN 2b - mucosal neuromas, medullary thyroid cancer, phaeochromocytoma Ehler’s Danlos syndrome MASS phenotype
72
Weakness
Neuromuscular: cord/plexus/root/nerve/NMJ Muscular (myopathies) - Inflammatory: polymyositis/dermatomyositis Other connective tissue disease eg. SLE, vasculitis, RA, systemic sclerosis. Cancer paraneoplastic: carcinomatous neuromyopathy) Drugs - statins steroids Infections (bacterial infections, HIV, CMV, EBV, Hepatitis) Endocrine - thyroid, Addison’s, osteomalacia, cushings, acromegaly, diabetic amyotrophy Toxins - alcohol Metabolic - renal/liver failure - electrolyte disturbance) Miscellaneous - inclusion body myositis - rhabdomyolysis - sarcoidosis - mitochondrial myopathy - muscular dystrophy Not true weakness: Polymyalgia rheumatica - pain and stiffness Fibromyalgia - pain, fatigue, stiffness, sleep disturbance OA/rotator cuff problem Fatigue/malaise/depression
73
Myaesthenia gravis
LEMS Mitochondrial disease - Kearn’s sayres Botulism Miller-Fisher syndrome
74
Complex ophthalmoplegia
Myaesthenia gravis Thyroid eye disease Myopathies - oculopharyngeal muscular dystrophy Mononeuritis multiplex Mitochondrial disease - Kearn’s Sayres Miller fisher syndrome Cavernous sinus pathology Wernickes encephalopathy Progressive supranuclear palsy
75
Abdominal causes of clubbing
IBD Coeliac disease Cirrhosis HCC
76
Palmar erythema
Chronic liver disease Rheumatoid arthritis Thyrotoxicosis Pregnancy Polycythemia
77
Gynaecomastia
Puberty End of male reproductive lifespan Testicular atrophy Tumour Liver disease Cystectomy Klinefelter syndrome Aldosterone Spironolactone Digoxin
78
Massive splenomegaly
CML Myelofibrosis Gaucher’s storage disease Chronic malaria Kala-azar
79
Moderate splenomegaly
Myelo/lymphoproliferative disorders Gaucher’s disease Amyloidosis
80
Mild splenomegaly
Myelo/lymphoproliferative disorders Portal hypertension Infections (IE, EBV, viral hepatitis) Haemolytic anaemia Autoimmune (SLE)
81
Hepatosplenomegaly
Chronic liver disease with portal hypertension Haematological - myeloprolipherative - lymphoma/leukaemia - pernicious anaemia - sickle cell Infection - viral hepatitis, EBV, CMV Infiltration - amyloidosis - sarcoidosis Connective tissue disorders - SLE Acromegaly Thyrotoxicosis
82
Flaccid paraparesis
Anterior horn cell disease Cauda equina Lumbrosacral plexopathy Motor neuropathies - GBS, CIDP - infection (HIV, Lyme etc) - toxins - diabetes amyotrophy, porphyria - drugs - CMTD NMJ disorders - MG, LEMS - botulism Myopathies - polymyositis, dermatomyositis - other CTD - paraneoplastic - statins and steroids - thyroid - alcohol - renal, electrolyte imbalance Spina bifida
83
Spastic paraparesis and sensory level
Cord compression Cord infarction Transverse myelitis
84
Spastic paraparesis and dorsal column loss
Demyelination Friedreich’s ataxia SACD of the cord Syphilis Parasagittal meningioma Cervical myelopathy
85
Spastic paraparesis and spinothalamic loss
Syringomyelia Anterior spinal artery infarction
86
Spastic paraparesis and cerebellar signs
Demyelination Friedreich’s ataxia SACD of the cord Arnold Chiari malformation Syringomyelia
87
Spastic paraparesis and small hand muscle wasting
Cervical myelopathy MND Syringomyelia
88
Spastic paraparesis and absent ankle jerk
MND Friedreich’s ataxia SACD of the cord Syphilis Cervical myelopathy and peripheral neuropathy Conus medullaris
89
Spastic paraparesis and UMN signs in UL
Cervical myelopathy Bilateral strokes
90
Bilateral cerebellar syndrome
Demyelination Paraneoplastic Strokes/SOLs MSA Drugs - phenytoin, carbamazepine, lithium Alcohol Metabolic - hypothyroidism, Wilson’s, coeliac, B12 Infection Miller Fischer syndrome Friedreich’s ataxia Ataxic telangiectasia Spinocerebellar ataxias Neurofibromatosis
91
Unilateral cerebellar syndrome
Demyelination Posterior circulation stroke SOL Neurofibromatosis Lateral medullary syndrome Ataxic hemiparesis following lacunar stroke MSA

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