Professional Documents
Culture Documents
Quizlet
Quizlet
1. Headache DDX
- Migraine (complicated)
- Tension headache
- Cluster headache
- Pseudotumor cerebri
- Trigeminal neuralgia
- CNS vasculitis - Temporal Arteritis
- Subarachnoid hemorrhage (SAH)
- Partial seizure
- Intracranial neoplasm
- Sinusitis
2. Migraine Characteristics
Symptoms
- Unilateral throbbing
- Photophobia
- Sonophobia
- Aura
- Recurrent
Physical Exam
- No fever
- No weakness in extremities. -Numbness on one site of the body.
3. Cluster Headache
-Unilateral periorbital pain, often accompanied by ipsilateral nasal congestion, rhinorrhea, lacrimation,
redness of the eye, and/or Horner's syndrome.
- Episodes of daily pain occur in clusters.
- Sudden and intense.
- Last a couple of hours and gone.
- Recurrent same time of day.
- Often awaken patients at night.
- Rarely occurs in women (similarity seen in women is termed "chronic paroxysmal hemicrania").
Physical Exam
- Lacrimation.
- Blushing of Face.
4. Chronic Paroxysmal
Hemicrania
Symptoms
- Recent upper respiratory infection.
- Pain in cheek below eye.
- Dull, constant ache, worse leaning over.
- Nasal discharge and stuffiness.
- Rare cause of headache (w/o other symptoms).
Physical Exam
- Tenderness to palpation of maxillary sinus.
- No weakness in extremities.
7. Tension Headache
Symptoms
- Usually bilateral (bandlike) and squeezing.
- Last hours to days.
- Recurrent.
- Constant, not throbbing.
- Associated with stress .
- Gets worse as the day progresses.- Better with massage
Physical Exam
- Normal Vital Signs.
- Normal Neuro Exam.
8. Subarachnoid Bleed/Hemorrhage Symptoms
- Headache
- Syncope
- Very severe intensity
- First episode
- Vomiting
Physical Exam
- Mental status change
- Stiff neck
9. Intracranial Mass Lesion Symptoms
- 1/3 of patients with brain tumors present with primary complaint = headache.
- Headache = non-specific => mimics migraine.
- Certain brain tumors may have familial basis.
Physical Exam
- Mental status changes.
- Ataxia.
- Focal weakness.
- Visual Changes.
10. Psesudotumor Cerebri
Symptoms
- Headaches can be focal but usually accompanied by diplopia and other visual symptoms.
Physical Exam
- Should reveal papilledema (but can be normal during the first few days after onset of illness).
11. Trigeminal Neuralgia (TN) (aka tic - Pain accompanied by brief facial spasm or tic.
douloureux) - Pain distribution unilateral, follows branch of CN V (maxillary (V2) or mandibular (V3))
sensory distribution .
- P/E eliminates alternative diagnoses.
12. Depression headache Symptoms:
- Headaches may be worse on waking up in morning.
- Associated with other depression symptoms.
13. Glaucoma (closed angle) Symptoms:
- Pain centered over eye.
- First episode.
Physical Exam:
- Red Eye.
- Decreased visual acuity .
- Dilated pupil.
14. Confusion/Memory Loss DDX - Alzheimer's disease.
- Vascular Dementia (Vascular Multi Infarct Dementia).
- Normal Pressure Hydrocephalus (NPH).
- Creutzfeld-Jakob.
- Subdural Hematoma (SDH).
- Hypoglycemia.
- Depression with Pseudo Dementia.
- Hypothyroidism.
- Vit B12 deficiency.
15. Dementia vs Delirium
Hypoglycemia Mnemonic:
T - Tachycardia.
I - Irritability.
R - Restless.
E - Excessive Hunger.
D - Diaphoresis/Depression.
- Autonomic: Anxiety, Palpitation, Sweating, Tingling, Trembling.
- Neuroglycopenia: Irritability, drowsiness, dizziness, blurred vision, difficulty with speech,
confusion, feeling faint.
24. Subdural Hematoma
Symptoms:
- History of Trauma.
- On warfarin.
- Headache.
Physical Exam:
- Mental status changes.
- Ataxia.
- Focal weakness.
- Visual Changes.
25. Depression with - Patient often tends to emphasize disability related to memory loss much more than patients
Pseudodementia experiencing true dementia.
- Appears to have dementia.
- Unable to remember correctly.
- Cannot calculate well.
- Complains, bitterly, of lost cognitive abilities or skills.
- High risk of progressing to dementia
- Depression or mild depressive symptoms can be comorbid.
Clues:
- Recent weight loss.
- Worsening sleep.
- Frequent crying spells.
- Self-deprecating comments.
- Recent-onset behavior changes (social withdrawal, psychomotor agitation, extreme negativism).
26. Vitamin B12 Deficiency
Symptoms:
- Lower Energy/Fatigue.
- Depression/Anxiety.
- Muscle pain.
- Irritability.
- Hearing and Vision problems.
- Mood disorders.
- Memory loss.
- Sexual problems/infertility.
27. Depressed Mood - Major Depressive Disorder.
DDX - Bereavement Disorder.
- Bipolar I and II Disorders.
28. Normal - 6 months - 18 months (normal).
Bereavement - Reaction to death of a loved one.
- Regards "depressed mood" as normal.
- May seek relief of insomnia or anorexia.
- Follows Major loss/event → normal → Patient relates sadness to loss → Intense sadness, pain.
- No significant loss of self-esteem.
DSM - V
- "Symptoms lasting less than 2 months since death of loved one" has been eliminated.
- Bereavement becomes Depression if suffering, feelings of worthlessness, suicidal ideation, poorer somatic
health, worse interpersonal and work functioning.
- Examples: Isolation of self from others, Work/marital/familial issues, patient planning to "meet" with dead
loved one (suicide), severe weight loss (ex. 25 lbs in 1 month not by medical condition).
29. Major Depressive
Disorder (MDD)
Last ≥ 2 weeks with ≥ 5 symptoms and MUST Include Depressed Mood or Anhedonia (loss of interest).
SIGECAPS
- Sleep disturbance (↑ or ↓).
- Interest Loss → MUST Include (or depressed mood).
- Guilt → Feeling worthless or inappropriately guilty .
- Energy Loss → Fatigue.
- Concentration Loss → impaired concentration or indecisiveness.
- Appetite (weight) changes (↑ or ↓).
- Psychomotor Changes (agitation or retardation).
- Suicidal ideation → thoughts of death.
30. Dysthymic Milder form of depression lasting at least 2 years → Not as severe or disabling.
disorder HE'S 2 SAD:
1. Hopelessness.
2. Energy loss or fatigue.
3. Self-esteem is low.
4. 2 years minimum of depressed mood most of day, for more days than not.
5. Sleep disorder (↑ or ↓).
6. Appetite change (↑ or ↓).
7. Decision-making or concentration impaired.
31. Bipolar
Disorder
Presence of at least 1 manic episode for at least 1 week (↑ Mood → cheerful, enthusiastic, Expansive or Irritable + ≥ 3
or 4 (if irritable) of 7 of DIGFAST)
- At least 2 years of hypomanic symptoms that DO NOT meet criteria for Manic Episode and numerous periods of
depressive symptoms that DO NOT meet the criteria for MDE
33. Psychosis - Schizophrenia.
DDX - Substance induced.
- Schizoaffective.
- Brief Psychotic Disorder.
- Psychosis sec. medical.
- Narcolepsy.
- Seizure.
34. Schizophrenia
(Psychosis DDX)
• Schizophrenia prototype is a patient who has psychotic symptoms and disturbed behavior lasting are present
for > 6 months → 2 of 5 symptoms →1. Delusions; 2. Hallucinations; 3. Disorganized behavior; 4. Disorganized
speech; and/or 5. Negative symptoms (flat affect, amotivation, etc.)
---
DSM-V Changes
- Two Criterion A symptoms now required for diagnosis
- One of criterion A symptoms must be one of three symptoms: Delusions, Hallucinations, or Disorganized
Speech
- Subtypes of Schizophrenia (Paranoid, Disorganized, etc.) are eliminated
35. Substance- Psychosis resulting from ingestion of medications, alcohol, illicit drugs, or may stem from the withdrawal of
induced alcohol or sedative drugs such as benzodiazepines
psychosis - Should be able to detect in work-up
(Psychosis DDX)
36. Schizoaffective - Mood episode and active phase symptoms of Schizophrenia occur together
Disorder - Proceeded and or followed by ≥ 2 weeks of delusions or hallucinations WITHOUT prominent mood symptoms
(Psychosis DDX) - Psychosis occurs concurrently with a mood episode
- Psychosis occurs without mood symptoms present
- Mood symptoms present for a substantial portion of the total duration of the illness (30% per some experts)
- Hallucinations or delusions present for ≥ 2 weeks in absence of prominent mood symptoms
- Types: (1) Bipolar Type (if mania → current or previous manic episode) or (2) Depressive Type (if only
depression)
DSM-V changes
Mood disorder must be present for more than the period of time the two Criterion A symptoms of Schizophrenia
has been found
37. Schizophreniform • > 1 month but < 6 months → symptoms last between 1 - 6 months
Disorder • Provisional diagnosis in patients who recovered
(Psychosis DDX) • Bizarre behavior, hallucination, paranoid, and delusion are present. However,
• Symptoms of schizophrenia i.e., usually 2 psychotic symptoms
38. Brief Psychotic Disorder (Psychosis DDX) Episode lasts: > 1 day but < 1 month with full remission
- Often precipitated by psychosocial factors
- Sudden onset of at least 1 positive symptom of schizophrenia
- Bizarre behavior, hallucination, paranoid, delusion
39. Dizziness DDX - Meniere's disease
- Orthostatic hypotension
- Drugs vs fluids
- Benign Positional Vertigo
- Vestibular Neuronitis
- Labyrinthitis
- Stroke
40. Ménière's Disease (Dizziness DDX) - Classically presents with recurrent episodic vertigo (usually lasting 1-8 hours) and
unilateral low-frequency hearing loss and tinnitus.
- Tinnitus and a sensation of aural fullness.
-Symptoms result from distension of the endolymphatic compartment of the inner
ear.
- Syphilis and heard trauma are two known causes.
41. Orthostatic hypotension due to dehydration - Risk factors = diuretics and diarrhea
(diarrhea, diuretic use) (Dizziness DDX)
42. Benign Paroxysmal Positional Vertigo Transient and brief vertigo following changes in head position but is not associated
(BPPV) (Dizziness DDX) with hearing loss. Dix-Hallpike Test causes nystagmus.
43. Vestibular Neuronitis (Dizziness DDX) - Can be a paroxysmal, single attack of vertigo, a series of attacks, or a persistent
condition which diminishes over two weeks.
-Acute onset of single episode that can last days.
- Associated with nausea, vomiting, and previous upper respiratory tract infections
- NO Hearing Loss - Generally has no auditory symptoms, unlike labyrinthitis.
- May also be associated with eye nystagmus.
-Pt falls down toward side of lesion. abnormal head thrust test.
- Due to inflammation of the vestibular nerve.
44. Labyrinthitis (Dizziness DDX) - Frequently follows viral infection (usually URI) and is accompanied by hearing loss
and tinnitus, but vertigo is usually continuous and lasts several days to a week
- HEARING LOSS
45. Acoustic Neuroma (Dizziness DDX) - More commonly causes continuous dysequilibrium rather than episodic vertigo
- Central lesions are unlikely in patients with vertigo, hearing loss and an otherwise
normal neurological exam
- Must r/o intracranial mass lesion in any patient with unilateral hearing loss.
46. Perilymphatic Fistula (Dizziness DDX) - Rare cause of vertigo and sensorineural hearing loss.
- Usually resulting from head trauma or extensive barotrauma.
- Episodes of vertigo are fleeting, generally lasting seconds.
47. Loss of Consciousness (LOC) DDX - Seizure, grand mal
- Vasovagal
- Cardiac arrhythmia
- Drug/orthostatic
- Convulsive syncope
- Aortic stenosis
48. Seizure Summary
(Syncope/LOC DDX)
Physical Exam
- Heart Murmur
57. Numbness/Weakness DDX - TIA
- Stroke
- Guillain Barre
- MS
- DM peripheral
- Myasthenia Gravis
- Todds Paralysis
58. Signs and Symptoms of
Stroke
(Numbness/Weakness DDX)
- Symptoms = burning foot paresthesias, that are worse at night and loss of ankle reflexes
-diabetic microvascular injury involving small blood vessels that supply nerves (vasa nervorum)
-Diabetic neuropathy include third nerve palsy; mononeuropathy; mononeuropathy multiplex;
diabetic amyotrophy; a painful polyneuropathy; autonomic neuropathy; and thoracoabdominal
neuropathy.
62. Myasthenia Gravis (MG)
(Numbness/Weakness DDX)
TRAUMA
T - Traumatic event exposure
R - Re-experience (1+)
A - Avoidance (3+)
U - Unable to function
M - Month or more of symptoms
A - Arousal increased (2+)
67. Generalized Anxiety Disorder (GAD)
(Fatigue/Sleepiness DDX)
Worry WARTS
- Wound up
- Worn-out
- Absent minded
- Restless
- Touchy
- Sleepless
68. Adjustment Disorder (Fatigue/Sleepiness - Stress-related, short-term, nonpsychotic disturbance
DDX) - Disproportionately overwhelmed or overly intense in their responses to given
stimuli (divorce, new baby, move etc...)
- Begins w/in 3 months of stressor and symptoms lessen within 6 months upon
stressor removal or new adaptation occurs
69. Hypercalcemia (Fatigue/Sleepiness DDX)
- Usually primary hypothyroidism - ↓ Thyroid hormone (TH) but secondary = ↓ TSH secreation
or tertiary = ↓ TRH secretion
- In USA MCC - Autoimmune thyroid disease = Hashimoto thyroiditis
• Symptoms/Sings → AABBCDDEEFG H
- Arthralgia and Weakness/ Paresthesias/ Muscle Cramps → Peripheral Neuropathy and
Carpal Tunnel Syndrome
- Anorexia → Decreased Appetite
- Bowel → Constipation
- Bradycardia → Slow Heart Rate
- Cold Intolerance → Dressed Inappropriately for Ambient Temperature
- Depressed → Mental Clouding and Impaired Memory
- Delayed DTRs
- Energy → No Energy/Fatigue (Drowsiness)/ Lethargy→ Somnolence →Uninterested,
Immobile
- Eyebrows → Loss /thinning of lateral ⅓
- Facial →Periorbital puffiness
- Gain → Weight Gain
- Hair → Coarse/brittle hair, hair falling out
- Voice Hoarseness
- Swelling of face, hands, and legs
71. Obstructive Sleep Apnea (OSA)
(Fatigue/Sleepiness DDX)
- Breathing pauses can last from a few seconds to minutes. They may occur 30 times or more
per hour.
• Cessation for >10 seconds → ↓ O2 saturation → Episodes of breathing cessation for 10
seconds during sleep, 10 - 15 events per hour with ↓ O2 saturation
o Associated signs → Snoring, gasping, GI reflux (GERD), nocturia, excessive moving, night
sweats, morning headaches, daytime sleepiness, sleep attacks
o Psychological: Slow thought process, memory impairment, inattention
72. Diabetes Mellitus (Fatigue/Sleepiness
DDX)
Sleep deprivation is a general lack of the necessary amount of sleep. This may occur as
a result of sleep disorders, active choice or deliberate inducement such as in
interrogation or for torture.
75. Night Sweats DDX - Tuberculosis (TB)
- Acute HIV infection
- Lymphoma
- Leukemia
- Hyperthyroidism
76. Night Sweats Work- - PPD
Upvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvv - Chest X-ray (CXR)
- CBC with diff
- Sputum Gram Stain and Acid Fast Stain
- (Bronchoalveolar lavage (BAL))
77. Tuberculosis (TB) (Night
Sweats DDX)
- History: Chronic cough, Hemoptysis, Weight loss, Exposure to TB, Night Sweats
- Physical Exam: Fever, lung findings, low weight
78. Acute HIV Infection (Night
Sweats DDX)
• Primary/Acute HIV infection occurs 2 - 4 weeks after infection with the human immunodeficiency virus
(HIV).
• Virus is spread by:
- Breastfeeding (rarely)
- Contaminated blood transfusions and blood products
- Intravenous (IV) drug use with contaminated needles and syringes
- Passing through the placenta from the mother to the fetus
- Sexual contact
• HIV seroconversion (converting from HIV negative to HIV positive [HIV Abs detected in blood]),
occurs w/in 3 months of exposure (can be up to 1 year)
• Following the acute infection, there may be no further evidence of illness for the next 10 years.
79. Insomnia DDX - Stress
- Caffeine
- Major Depressive Disorder (MDD)
- Obstructive Sleep Apnea
80. Insomnia
• State of hyperarousal
• CC = Dissatisfaction with sleep quantity or quality, associated with ≥1 following symptoms:
- Difficulty initiating sleep. (In children, this may manifest as difficulty initiating sleep without caregiver
intervention.)
- Difficulty maintaining sleep, characterized by frequent awakenings or problems returning to sleep after
awakenings. (In children, this may manifest as difficulty returning to sleep without caregiver intervention.)
- Early-morning awakening with inability to return to sleep.
- ≥ 3 nights per a week for ≥ 3 months with adequate opportunity to sleep
- Caffeine0induced insomina = MC pharm cause of insomnia
- People w/ OSA, >50% complain of insomnia sx
81. Sore Throat DDX - Infectious mononucleosis
- Pharyngitis (bacterial (strep) or viral)
- Acute HIV infection
- Streptococcal tonsillitis/scarlet fever
- Atypical Pneumonia (Mycoplasma pneumonia)
82. Infectious
Mononucleosis (Sore
Throat DDX)
- Classical bacterial pneumonia begins with abrupt onset of fever, chills, pleuritic chest pain and
productive cough (sputum production)
- Pleuritic pain may signal lower respiratory tract infection (diagnosis confirmed via chest exam)
- Physical Exam: Fever, dullness to percussion, abnormal breath sounds, ↑ tactile fremitus
- Signs of pulmonary consolidation on physical exam are absent 2/3s of time
90. Atypical Pneumonia (Sore Throat • Anyone at any age can get walking pneumonia.
or Cough/SOB DDX) • Caused by Mycoplasma pneumoniae, Chlamydia pneumoniae, Legionella species
• M. pneumoniae is a common cause of mild pneumonia that usually affects people younger
than 40
• People who live and work in crowded places, i.e. schools, homeless shelters, prisons →
↑ risk contracting it
• Spread via resp. droplets → sx appear 15 - 25d after exposure to mycoplasma and develop
slowly over 2 - 4 days
• Symptoms include:
- Non-Productive Cough → may come in violent spasms but produce very little mucus
- Fever, Malaise Headache, Myalgia → Mild flu-like symptoms such as fever and chills
- Sore throat/Hoarseness
- Headache
- Tiredness
- Chest pain
- Lingering weakness may persist after other sx gone
History: Heartburn, Sour taste coming up to mouth, Pregnant, Better with Antacids
Physical Exam: No fever, No pleuritic pain, No abdominal pain
Severe chest pain is atypical presentation but not uncommon for GERD and may worsen with
recumbency overnight. Other atypical symptoms may include chronic cough, wheezing, or dysphagia
- Classic sx of GERD is heartburn, which may be exacerbated by meals
108. Angina (Chest Pain DDX) • Angina pectoris, chest pain d/t ischemia (lack of blood, hence O2 supply) of heart muscle
- One common form of Angina is chest pain or discomfort that occurs when your heart isn't getting
enough oxygen because of reduced blood flow to heart. It is usually a symptom of coronary heart
disease.
• Abdominal angina, postprandial abdominal pain that occurs in individuals with insufficient blood
flow to meet visceral demands
• Ludwig's angina, a serious, potentially life-threatening infection of the tissues of floor of mouth
• Prinzmetal's angina, a syndrome typically consisting of cardiac chest pain at rest that occurs in
cycles
• Vincent's angina, trench mouth, infection of the gums leading to inflammation, bleeding, deep
ulceration and necrotic gum tissue
• "Angina" (song) is also the name of a single by the Gothic metal band Tristania
109. Pericarditis (Chest Pain -Can occur as a complication of infections, immunologic conditions, or heart attack
DDX) - History: Pain better sitting up and leaning forward, Pleuritic pain, Started after viral URI
- Physical Exam: Cardiac rub, Fever
110. Costochondritis (Chest Pain - History: Sharp pain, Hurts with movement and twisting
DDX) - Physical Exam: Point tenderness causing the pain
111. Herpes Zoster (Chest Pain - History: Unilateral, paresthesia of skin unilateral dermatone
DDX) - Physical Exam: Unilateral blistering rash on a dermatome fever
112. Pulmonary Embolism (Chest - History: Pleuritic Chest pain, SOB, Unilateral swollen lower left, Hx of DVT in past, Not on warfarin
Pain DDX) - Physical Exam: Tachycardia, Tachypnea, No pain to palpation of chest wall, unilateral swollen leg
113. Aortic Dissection (Chest History: Ripping Chest Pain, Sudden onset, Pain may migrate to neck or back
Pain DDX) Physical Exam: Blood pressure difference between arms, Heart murmur (if aortic insufficiency), pulse
differences between sides
114. Acute Cardiovascular Illness (Mycoardial infarction, pulmonary - History: Vomiting, Chest pain, Back pain, SOB
embolism, aortic dissection) - Physical Exam: ↑ RR, Heart murmur, unequal pulse
115. Palpitation DDX - Hypoglycemia
- Cardiac Arrhythmias
- Hyperthyroidism
- Panic Attacks
- Pheochromocytoma
- Carcinoid Syndrome
- Angina
- Hyperventilation Episodes
- Generalized Anxiety Disorder
- Agoraphobia/Social Phobia
- Substance Abuse/Dependence
116. Hyperthyroidism (Palpitations DDX)
Symptoms
- Heat Intolerance → Excessive sweating and heat
intolerance
- Weight Loss → despite ↑ Appetite
- Diarrhea → Frequent bowel movements
- Nervousness
- Emotional Liability
- Poor Concentration
- Palpitations
- Swelling of Eyes
- Double of Vision
- Weakness and Fatigability
• Signs
- Dressed Inappropriately for Ambient Temperature
- Weight Loss
- Hyperactive
- Fidgety, Restless
- Tremors of hand
- Tachycardia/Afib
- Periorbital Edema
- Opthalmoplegia → Diplopia
- Exopthalmos/Proptosis
- Lid Retraction, Lid Lag
- With Graves' disease, eye signs such as stare, lid lag,
and exophthalmos
- Proximal Muscle Weakness
117. Panic Attacks (Palpitations
DDX)
PANIC DISORDER
- Recurrent unexpected panic attacks
- ≥ 1 of the attacks followed by ≥ 1 month of ≥ 1 of the following:
1. Persistent concern about additional attacks=Anticipatory anxiety
2. Worries about implications of attack or its consequences
3. Avoidance
• Panic Disorder without Agoraphobia
- Persistent worry/concern about additional attacks or their consequences
• Panic Disorder with Agoraphobia
- Meets criteria for panic disorder Fear/AVOIDANCE of situations where panic attacks might occur
118. Pheochromocytoma - Rare catecholamine-secreting tumor derived from chromaffin cells.
(Palpitations DDX) - Tumors arise outside the adrenal gland are termed extra-adrenal pheochromocytomas or
paragangliomas b/c of excessive catecholamine secretion
- May precipitate life-threatening hypertension or cardiac arrhythmias.
- Check Urine catecholamines
119. Carcinoid Syndrome - Serotonin overproduction
- Most commonly found in the foregut (35.6% cases) with lung, bronchus and trachea constituting 27.9%
cases.
Sx = Cutaneous flushing accompanied by sweating, GI hypermotility → causing diarrhea,
Bronchospasm
- Increased 5-HIAA excretion of in urine
120. Social Phobia (Palpitations • Marked fear/avoidance of social situations due to the possibility of embarrassment or humiliation
DDX)
121. Weight Loss DDX - Hyperthyroid
- Cancer
- HIV
- Diet
- Drugs
- Anorexia
- Malabsorption
122. Weight Gain DDX - Smoking cessation
- Drugs (Lithium)
- Hypothyroidism
- Cushing's Syndrome/Disease/Syndrome
- PCOS
- DM
- Atypical depression
- Familial
- Pregnancy
123. Dysphagia DDX - Esophageal cancer
- Plummer-Vinson
- Achalasia
- Esophagitis
124. Esophageal Cancer (Dysphagia • Squamous Cell Carcinoma (SCC).
DDX) - More common worldwide → d/t slow passage of food through esophagus
- Men >50, Asians. Upper 2/3 of esophagus → D/t: => Diet (Nitrosamines, ↓Vit. A, riboflavin): ↑
exposure to carcinogens (tobacco/alcohol)
=> Lifestyle (smoking, etOH),
=> Genetic (celiac, tylosis). p53 mutation (no KRAS/APC mutations)
=> Esophageal disease (Plummer-Vinson/Patterson Brown Kelly, achalasia).
- Sx: Dysphagia to solid foods, wt. loss, chest pain, cough.
- Spreads via LN. Exophytic, infiltrative, excavated
• Adenocarcinoma (ADC).
- More common in US. Median age 50. More common in whites. Lower 1/3 of esophagus
- All ADC due to Barret's esophagus Assoc'd with lifestyle (obesity + alcohol)
- Sx: Dysphagia to solid foods, wt. loss, chest pain, cough.
- Most = mucin producing. Poor prognosis.
- Surveillance in Barrett's esophagus = mandatory
125. Plummer-Vinson Syndrome - Can occurs in people with long-term (chronic) iron deficiency anemia
(Dysphagia DDX) - Condition have problems swallowing due to small, thin growths of tissue that partially block the
upper food pipe (esophagus)
- Difficulty swallowing
- Weakness
- Has been linked to esophageal cancer
126. Achalasia/Cardiospasm Incomplete relax of LES in response to swallowing.Esophagus dilates above LES.
(Dysphagia DDX) 1° - Myenteric plexus (Auerbach) ganglion cells absent in esophagus → ↓ LES relaxation
2° - Chagas disease: T. cruzi (can also cause acq'd megacolon) → ↑ LES Tone
CREST syndrome/scleroderma ("E" in CREST = Esoph. dysmotility)
127. Esophagitis (Dysphagia DDX) • Irritation or inflammation of the esophagus
• Can be painful and can make it hard to swallow
• Common symptoms of esophagitis include:
- Heartburn
- Pain when you swallow
- Trouble swallowing food or liquids
- Chest pain (may be similar to the pain of a heart attack)
- A cough.
• Sometimes it also causes:
- Nausea or vomiting
- Fever
- Belly pain
128. Scleroderma/CREST (Dysphagia
DDX)
129. Hiatal Hernia (Dysphagia DDX) Herniation of stomach through enlarged esophageal hiatus in diaphragm.
- 95% Axial/Sliding: Incompetent LES → bell-shaped dilation → gastric reflux epigastric pain,
heart burn, respiratory distress
130. Mallory Weiss Syndrome - Mucosa: longitudinal Lesions: tears @ esophageal-gastric junction. Acute.
(Dysphagia DDX) - Due to severe retching in alcoholics/bulemics.
- Inadequate relaxation of LES during vomiting → stretching/tearing @ esoph-gastric junction
- PAIN + Hematesis
131. Nausea/Vomiting DDX - Pregnancy
- Gastritis
- Hypercalcemia
- DM
- UTI
- Infection - Gatroenteroritis
- Bowel Obstruction (Large or Small)
132. Abdominal Pain DDX - Pancreatic Cancer
- Acute Pancreatitis
- Acute Cholecystitis
- Ascending Cholangitis
- Acute Hepatitis
- PUD
- Perforated ulcer
- Splenic rupture
- Intestinal Obstruction
- Mesenteric Ischemia
- Ovarian Torsion
- Diverticulitis
- Appendicitis
- IBS
- PID
- Stomach Cancer
- Func. Dyspepsia
133. Nephrolithiasis (Abd Pain Sudden onset, very severe and colicky, intermittent, not improved by changes in position, radiating
DDX) from the back, down the flank, and into the groin.
- Pain may be felt in the belly area or side of the back.
- Pain may move to groin area (groin pain) or testicles (testicle pain).
- Other symptoms can include:
--> Abnormal urine color
--> Blood in the urine
--> Chills
--> Fever
--> Nausea
--> Vomiting
Pyelonephritis = ascending UTI that reached kidney's pyelum (pelvis) --> severe infection = urosepsis
--> form of nephritis. It can also be called pyelitis
134. Pancreatic Cancer
(Ab Pain DDX)
Neisseria Gonorrhea
- Asymptomatic
- Urethritis (dysuria)
- Discharge (purulent)
- In men only: fever, sweating, proctitis, pharyngitis.
149. Dyspareunia (Painful Intercourse) DDX - Atrophic vaginitis
- Endometriosis
- Cervicitis
- Domestic Abuse
- Vaginismus
- PID
- Abuse
- Depression
- Vulvovaginitis
- Vulvodynia
150. Abuse DDX - Domestic Violence
- Osteogenesis Imperfecta
- Substance abuse
- Rape
- Consensual violent sex
151. Joint/Limb Pain DDX - Rheumatoid Arthritis (RA)
- Systemic Lupus Erythematosus (SLE)
- Domestic Violence
- Carpal Tunnel
- Psoriatic Arthritis
- Fracture
- Dislocation
- Osteoarthritis (OA)
- Septic Arthitis
- Stress Fracture
- Inflammation
- Peripheral Vascular Disease (PVD)
- Deep Vein Thrombosis (DVT)
- Myocardial Infarction (MI)
- Rhabdomyolysis
152. Differing presentation of RA vs. OA
OA - short morning stiffness but usually gets worse THROUGHOUT THE DAY
RA joints - hands, wrists, elbows, shoulders, ankles, hips, knees, CERVICAL spine
OA joints - DIP, PIP, weight bearing joints (hip, knee), ANY SPINE
MAJOR DISTINCTIONS:
RA - only cervical spine; no DIP; PIP
OA - lumbar or cervical spine; DIP; PIP
153. Low Back Pain DDX - Disk herniation
- Lumbar muscle strain
- Lumbar spinal stenosis
- Malingering
- Ankylosing Spondylitis
- Cancer
- AAA
154. Child with Fever - Sepsis
- Meningitis
- Pneumonia
- UTI
- Acute otitis Media
- URI
- Viral exanthem
- Gastroenteritis
- Volvulus
- Intussueption
- Food poisoning
155. Behavioral Problems DDX - ADHD
- Adjustment disorder
- ODD
- Childhood BPD
- Substance abuse
- Age appropriate behavior
156. Child with seizure -Simple febrile seizure
-Meningitis
-Hyponatremia
-UTI
-Occult bacteremia
157. Child with -Viral gastroenteritis
diarrhea -Bacterial diarrhea
-Malabsorption
-UTI
-Intussusception
-Bacteremia
158. Hand tremor -Parkinson's disease
-Essential tremor
-Physiologic tremor
-Drug induce tremor
-Psychogenic tremor
-Hyperthyroidism
159. Cough -Pneumonia
-Lung cancer
-COPD
-TB
-Lung abscess
-Atypical pneumonia
160. Child with noise -Foreign body aspiration
while breathing -Croup
-Epiglottis
-Laryngitis
-Retropharyngeal abscess
-Peritonsillar abscess
161. Acute otitis Fever, irritability, headache, apathy, disturbed or restless sleep, poor feeding/anorexia, vomiting, and diarrhea.
media Otalgia, URI is a risk factor.
162. Meningococcal Fever, lethargy, and a possible petechial rash suggest meningococcemia. Patients may also have headache,
meningitis vomiting, photophobia, neck
stiffness, and seizures. Meningococcal vaccinations are typically not given
until 11-12 years of age; is a severe,
rapidly progressive, and sometimes fatal infection.
163. Scarlet fever Fever, difficulty swallowing (possible pharyngitis), and a rash like a diffuse erythema with punctate, sandpaper-like
elevations that spare the area around the mouth. In addition, scarlet fever is more common among school-age
children.
164. Varicella Fever and rash, along with day care attendance, are consistent with this
infection. In varicella, lesions are present in various stages of development at any
given time (eg, red macules, vesicles, pustules, crusting), and the rash is intensely
pruritic.
165. Foreign body Sudden and dramatic onset of symptoms, especially when a foreign body (usually a toy or peanuts) is in the
aspiration vicinity before the patient develops symptoms, breathing noisily and is experiencing some shortness of breath,
both of which are consistent with aspiration of a foreign body.
166. Croup Common in children six months to three years of age, usually developing insidiously as a URI. Low-grade fever
for the a week, a characteristic barking cough is often present in croup.
167. Epiglottitis Occurs more frequently in children 2-6 years of age, and begins with Its hallmark feature, significant drooling
with symptomatic relief
while bending forward, hoarseness.
168. Retropharyngeal Patients are usually younger than six years of age. Lack stridor, voice is muffled, and drooling is often present.
abscess