Short cases DDx list in simple way to memories
محمد ال عبدالله
Short cases DDx
CVS
High JVP
Cardiac : RV failure ,TR,TS,,SVC obstruction
Pericardial : constrictive ,effusion
Systemic: fulid overload,hyperdynamic(fever,anemia,thyrotoxic,AV fistula,exercise,beri beri,hypoxia,hyperc apnea)
Collapsing pulse:
Cardiac: AR,arteiosclerotic aorta,PDA
Peripheral : arteriovenous aneurysm,hyperdynamic
Loud S1
Cardiac : MS,TS
Systemic: tachycardia ,hyperdynamic
Soft S1
MR,calcified mitral,LBBB,,1st degree heart block
Loud A2:AS,HTN,
Loud P2: Pulm HTN
SoftA2:calcified AV,AR
Soft P2: Pulm stenosis
MS:
Rheumatic
Congenital ,rare
MR
Acute:
Trauma or surgery
Infective : IE
Ischemic MI
Chronic:
Congenital
Rheumatic
Papillary dysfunction : CAD,CHF
CTD: RA,Anklosing spondylitis
MV prolapse
Degenerative
AS
Congenital : bicuspid
Rheumatic
Degenerative
AR
Acute
Valvular :IE
Aortic root:Dissecting
Chronic
Valvular :
Congenital
Rheumatic
CTD : Ankylosing
Aortic root
Congenital : marfan
CTD : RA,AS,
Infection: syphilis
Dissecting aneurysm
Degenerative
TR
Congenital :ebsteins anomaly
Rhumatic
Ischemic: MI
Infective :IE
Trauma
Functional :right ventricle failure
HTN
Essential
Secondary
Renal : RAS
Endocrine: cushing
Vascular : coartication
Hematologic :PV
Respiratory : OSA
CNS: high ICP
Medication: OCP,NSAIDs
Substance: alcohol
Hypertension fundscopy
1 silver wiring
2 AV nipping
3 cotton wall spots ,hard exudates
4 papilloedema
Oedema
Cardiac CHF
Pericardial : constrictive
Hepatic: cirrhosis
Renal:nephrotic
GI: malnourished ,malabsorption
Endocrine myxedema
Medications :CCB
Unilateral LL oedema
Trauma
Vascular DVT,lymph oedema ,hematoma
Infective cellulitis
CTD: baker cyst in RA
Superior vena caval obstruction
Intravascular thrombosis ( line thrombosis)
Extra vascular compressing:
Aortic aneurism
Rtrosternal mass ( lymphoma ,goiter ..)
Mediastinal lymphadenopathy
Lung cancer 90%
…………………………………………………………………
RS
Clubbing( not COPD,sarcoidosis )
Bilateral
Respiratory
Congenital :CF
Infective : broncheactasis ,abscesses
CTD: pulmonary fibrosis
Malignant : lung cancer(non small lung)
Mesothelioma
Cardiac: IE,cynotic congenital heart
GI: cirrhosis ,celiac,IBD
Endocrine: graves
Familial or idiopathic
Unilateral
Hemiplegic CVA
AV aneurysm
Arterial graft sepsis
Plural effusion
Transudate
Cardiac CHF
Renal: nephrotic
Liver failure
Endocrine : hypothyroid
Gynecological : Meigs
Exudate :
Pulmonary
Infective : pneumonia ,TB
Vascular PE
Malignant cancer primary o mets
CTD : sarcoidosis ,SLE,RA
GI: pancertitis ,sub nephric abscess ,esophageal rupture
Drugs: nitrofurantoin,bromocriptin,drugs cause lups
Radiation
Cracles
Early coarse: COPD
Late
Fine : lung fibrosis
Medium LVF
Coarse broncheactasis
Bronchial breathing
pneumonia
Localized collapse or fibrosis
Above effusion
Large cavity
Decrease breath sound
Air: pneumothorax ,emphysema
Fluid: effusion
Abnormal structure :tumor,pneumonia ,fibrosis
Nothing! Collapse
upper lobe pathology
Congenital: CF
Infective TB,
ILD: hypersensivity pneumoniaitis
CTD : Ankylosing ,sarcoidosis
Radiation
Lower lobe pathology
Infective: Aspiration,broncheactasis
ILD: IPF
CTD: RA,SLE
Occupation Asbestos
Peripheral lung pathology
BOOP, eos pneumonia
Broncheactasis
Congenital : CF,,alpha1 anti trypsin
Infective:
Bacterial TB
Viral : Mesales,HIV
Fungal Allegic pulm Aspiroglosis
Obestructive like:
Tumor
LN
Foreign body
COPD
........................................
GI
Hepatomegaly
Inflammatory
Infection
Viral : hepatitis,HIV
Parasite hydrated cyst
No infection
Drugs induced hepatitis
Cardiac : right heart failure
hematologic : hematologic malignancy ,thalassemia myloprolivrative
Malignant primary or secondary
Infiltrative :
Fatty: Alcholic,DM,Obesity
Non fatty Sarcoidosis ,amylodosis ,hemochromatosis
Tender liver
Infective hepatitis
Cardic : CHF
Vascular buddi chairi
Malignant : hepatoma
Pulsatile liver
TR
Hepatoma
Vascular malformation
Bilateral renal mass
Congenital : PCKD
Obestructive : hydronephrosis
Endocrine Acromegaly
Infiltrative : amylodosis
Unilateral
Obestructive : hydronephrosis
Vascular : renal vein thrombosis
Malignancy: renal cell carcinoma
Solatiry kidney
spleen not kidney
Site: 9'10,11 ribs
Notch : present
Edge : sharp
Finger below costal margin: no
Resonant : no
Movement with breathing : yes
Enlarge: toward Rt iliac fossa
Ballot able : no
Full flank and dull: no
Splenomegaly
Infection
Bact: IE
Viral : Infective mononucleosis
Parasite malaria
Vascular : portal HTN
CTD : SLE,vasculitis,RA
Infiltrating : Amylodosis ,sarcoidosis
Begnine hematologic : thalassemia
Malig hematologic : myloprolivrative ,leukemia ,lymphoma
Massive
CML
Mylofibrosis
Primary spleen lymphoma
Hairy cell leukemia
Kala azar
Malaria
Hepatosplenomegaly
Infection: Hepatitis
Hepatic : chronic liver disease
Hematologic : Myloprolivrative
Infiltrating : amylodosis
CTD: SLE
Endocrine : Acromegaly
Abdominal swilling
5f
Fluid Ascites
Fat obesity
Fetus pregnant
Fibroid
Fecesses ( constipation )
Ascites
Portal HTN
Sinsusoidal cirrhosis
Postsinsoidal Rt CHF,buddi chairi
Presinsuidal : schistosomiasis ,splenic or portal vein thrombosis
Non portal HTN
Medical Pertonial disease
Infective: TB peritonitis
CTD : vasculitis
Hypolalbumin: nephrotic
Malignant : carcinomas sis
Gynecological : miegs
Surgical : rupture viscous peritonitis ,pancertitis ,bowel Obestruction or infarction,postoperative lymphatic leak
Liver cirrhosis
Infective : Hepatitis viral
Alcoholic
Biliary : primary billiard cirrhosis
Cardiac CHF
Pericardic : constrictive
Vascular Buddi chairi
Metabolic : Wilson . Hemochromatosis
Autoimmune
NAFLD
Crypto genic
Jaundice
Congenital
Indirect :SCD, G6BD,Gilbert
Direct: Dubin Johnson
Acquired
Indirect
Hematologic :Hemolysis MAHA,B12, Folate
Drugs : rivabarin
Direct
Hepatic: hepatitis ,Anti TB,Alcohol
Cholestatic intrahepatic : OCP , primary billiary cirrhosis
Cholestatic extra hepatic : choliangitis ,choliangiocarcinoma
…………………………………………..
CNS
Horner synd
Eye: retro orbital lesion
Brain : brain stem lesion : lateral medullary syndrome
Neck: truama , thyroid malignancy ,carotid aneurysm
Spine : syringomyelia
Lung ( squamous lung cancer)
Small pupil
Medications : narcotic ,pilocarpine
pontine pathology
Sympathetic tract : Horner
Midbrain : argyll Roberson pupil ( accommodate but not to light ) syphlis
Anisocoria: 25% normal asymmetry
Normal : old age
Large pupil
Congenital
Trauma
Cerebral death
3 CN dysfunction
Medication : atropine ,cocaine
Aides pupil ciliary dysfunction if with absent knee and ankle reflex( Holmes adie) ;accommodate butter than light
Optic neuropathy (vision affected,unilateral,,pain, sudden)
Demyelination : MS
Ischemic : TEmporal angitis. DM
Metabolic : B12
Toxic : Ethambutol, Chloroquine
Infective :EBV
Papilloedema
( bilateral ,vision early normal,painless)
High ICP: SOL ,B IC HTN
High CSF PTN like GBS
Ischemic: HTN ,,central vein thrombosis
Inflammatory : optic neuritis ,meningitis
Respiratory : CO2 retention
Endocrine: thyroid eye disease
Intoxication : vit A, lead
Unilateral Disc edema
Vascular : retinal vein thrombosis
Inflammatory : optic neuritis
Comprisive : tumor
Infiltrative :TB ,Sarcodosis ,lymphoma
Unilateral papilloedema + contra lateral atrophy: Foster Kennedy syndrome
Ptosis
Dilated pupil: 3 rd nerve
Small pupil: Horner
Normal pupil
Normal old age
Fatage
Congenital : myotonica dystrophy
Endocrine : thyrotoxic myopathy
Neuromuscular : MG
Myopathy : Ocular myopathy
Infective: botulism ,snake bite
3rd nerve dysfunction
Central
Truma
Vascular
Demyelination
Vascular
Peripheral
Truma
Compressive ( pupil affected)
Aneurism,tumor ,infective
Ischemic : DM,Vasculitis
Cavernous sinus pathology
6th nerve dysfunction
Bilateral
Truma
High ICP
CTD: mononeuritis multiblex
Alcholic : wernicks encephalopathy
Unilateral
Centeral
Vascular
Tumour
Wernicks
MS
Prephiral
DM
Trauma
High ICP
7th nerve dysfunction
UMN
Vascular
Tumour
LMN
Pontine( vascular,Tumour,demyelination )
Post fossa(acoustic neuroma,meningioma)
Petrous temporal bone(bells,ramsay hunt,otitis media,fracture)
Parotid(sarcoidosis ,Tumour )
Bilateral
GBS
Sarcodosis
Mononeuritis multiblex
Multibe CNs dysfunction
Malignancy: nasopharyngeal cancer
Demyelination : GBS
Infective chronic meningitis :TB
Infiltrating : Sarcodosis
Brain stem lesion
Base of skull lesion
Trauma
Mononeuritis multiblex :DM
Peripheral neuropathy
Hereditary
Drugs: INH
Toxin heavy metals
Substance : Alcohol
Metabolic: DM,uremia
Immune: GBS
CTD SLE,PAN
Nutrition: B12
Malignancy: lung cancer
Predominant motor
GBS,CIDP
Charcot Marie tooth
Interment porphyria
DM
Lead
Diphtheria
Dapson induced
Predominant sensory
B12,B6
Syphlis,leprosy
DM
Alcholic
Uremic
Sjogren
Paraproteinemia
Carcinoma( paraneoplastic)
Painful
DM
Alcohol
B12,B6
Porphyria
Carcinoma
Arsenic poising
More Proximal
GBS
DM
Porphyria
With autonomic
DM
Amylodosis
GBS
Paraneoplastic
Sjogren
Mononeuritis multiblex
Acute(vascular)
DM,Vasculitis
Chronic
CTD: RA
Infeltrative Sarcodosis
Endocrine Acromegaly
Infective Leprosy,Lyme
Paraneoplastic Carcinoma
Bilateral leg weakness
Flaccid : LMN:myopathy,neuropathy
Spastic
Spinal cord
Compression :congenital : Av malformation
Infection TB
Neoplasm: extra medullary : mets
Intradural meningioma
Intramedullary glioma
Degenerative : disc prolapse
Trauma
Ischemic : anterior spinal A
Demyelination : MS
Infective: transver myelitis
Parasagital brain lesion: meningioma ,sagital sinus thrombosis
Proximal muscle weakness
Neuropathy : motor neuron,radiculopathy
Neuromuscular : MG
Myopathy
Hereditary : dystrophy
Immune: poly myosotis
Endocrine : Cushing,thyroid
Electrolytes :k
Metabolic: osteomalacia
Drugs: steroid
Sarcodosis
Malignant :paraneoplastic
Substance: Alchol
CTD: Mixed CTD
Tremor
Resting: parkinson
Action( thyrotoxic ,anxiety,drugs like salbutamol ,familial ,idiopathic)
Intensional: cerbellar
Flapping: liver,respiratory,renal and cardiac failure
Parkinson
Idiopathic parkinson disease
Drugs ( phenothiazine )
Toxin Co posing
Metabolic: Wilson
Infective: syphlis ,post encephalitis
Chorea
Congenital : Huntington
Infective : rheumatic fever
Metabolic wilson
Drugs: phenytoin
CTD : SLE
Ataxia
Unilateral
Infective : Abscess
Vascular : vertbrobasilary
Trauma
Demyelination :MS
Neoplastic : SOL,paraneoplastic
Bilateral
Hereditary : Fredric ataxia
Drugs : phenytoin
Substance : Alcohol
Endocrine : hypothyroid
Demyelination : MS
Large SOL,trauma
Paraneoplastic
Gaits
High stepping : distal weakness
Waddling :Proximal weakness
Shuffling,freezing ,hesitation: parkinson
Drunken,wide base: cerbellar
Scissor: hemiplagic
>>>>>>>>>>>>
Short cases
DDx general ,endocrine,rheumatology
Diagnostic face
Deep blue : Amiodarone
Moon : Cushing
Large supra orbital ridge: Cromegaly
Mask: parkinson
Frontal bladness,temporals atrophy, ptosis: myotonica dystrophy
Yellow skin,alopecia,thick skin: hypothyroid
Facial Rash
SLE
Dermatomyositis
Lupus pernio : Sarcodosis
Malar rash of MS
Diffuse goiter
Hereditary : inborn errors of thyroid hormone synthesis
Normal : pregnancy,postpartum: nontoxic simple
Immune : gravis,hashimoto
Inflammatory : subacute thyroditis
Nutrition: iodine def,or excess
Drugs: Amiodaron ,lithium
Malignant:lymphoma
Single nodule
Adenoma
Cyst
Carcinoma
Multinodular
TMNG
Hashimoto
Generalize lemphoadenopathy
Infective
Viral : HIV
Bact: TB, brucellosis
Parasite : toxoplasmosis
CTD: SLE
Infiltrating : Sarcodosis
Drugs: phenytoin
Hematologic malignancy
Malignancy mets
Nails
Blue: cyanosis,Wilson
Red: polycythemia ,CO poising
Yellow: yellow nail synd
Splint hemorrhage : IE,Vasculitis
Pale:anemia
White: low albumin
Transverse line: low albumin,chemotherapy ,sever illness
Oncholysis : thyrotoxicosis,psoriasis
Half and half: renal,liver failure
Erythema nodosum
Infective: viral,strep,salmonella,TB
Drugs: OCP,Penicillin
Pregnancy
Inflammatory : IBD
Malignancy : lymphoma
Sarcodosis
Pyoderma gangrenousm
Inflammatory : IBD
CTD : RA
Endocrine : DM,thyroid disorder
Hepatic: sclerosing choliangitis
Malignancy: lemphoplrifrative and myloprolivrative
Gynecomastia
Hereditary : klifenter
Normal: puberty ,old age
Drugs : spironolacton,digoxin,cimetidine
Endocrine
Hypopitutarisim
Testicular failure
Thyrotoxic
Hepatic: chronic liver disease
Malignancy: lung or liver cancer
Cataract
Congenital : myotonica dystrophy ,infection
Familial
Endocrine: DM,hypoparathyroid
Metabolic : Wilson ,malnutrition ,dehydration!
Drugs Steroid
trauma
Radiation
Others: smoking, cumulative sunlight exposure !
Rheumatoid hand
RA
SLE
Psoriatic
Gout
Osteoarthritis
Mono arthritis
Septic
Traumatic
Gout
Pseudo gout
Hemoarthrosis
Chronic
TB
Sero negative spondilioarthritis
Poly arthritis
Acute :
viral parpovirus 19
Menigiococcemia,rheumatic fever
Chronic
RA
Servo negative
OA
Gout,pseudo gout
CTD: SLE
Infection:lyme
Arthritis plus nodule
Mainly RA
SLE
Rhumatic fever
Sarcodosis
DM retinopathy
Nonproliferation
Dot blot hemorrhage
Hard exudate
Cotton wall soft exudate
Microaneursms
Dilated vein
Plus minus macula involvement
Proliferation
New vessels
Vitreous hemorrhage
Scar
Retinal detachment
Laser scar
Plus minus macula involvement
Hirsutism
Constitutional
Gyncologic :PCO
Endocrine: Cushing ,CAH,acromegaly
Drugs:minoxidil ,phyentoin ,steroid
Metabolic : porphyria cutanea tarda
Malignant: adrenal,ovarian Tumour
Pocket medicine .tally,old OSCE papers
Mohammed Alabdullah
Good luck