Cardiology
- chest pain, dyspnea, congested neck veinsbasal inspiratory crackles, splitiing
S2, S4 at apex, ejection systolic murmur at upper right sternal border
CHF due to aortic stenosis
- chest pain, dyspnea, congested neck veinsbasal inspiratory crackles, S3 at
apex
CHF due to ischemic cardiomyopathy
- RHD patient develops tachycardia, coughing, shortness of breath, irregular
rhythm
Rheumatic heart disease, mitral stenosis, AF.
- history of rheumatic fever, bilateral basal crepitations, pitched systolic
murmur propagated to axilla
Rheumatic heart disease, mitral valve disease, LSHF, predisposing factor: IE
- tachycardia, hypertension, palpable LV, loud S2, S3, S4
LSHF due to hypertensive cardiomyopathy
- severe retrosternal pain, elevated cardiac enzymes, depressed ST segment
acute non ST segment elevation MI
- chest pain when taking breath, FHMA, pericardium rub, elevated ST in all leads
viral pericarditis
- history of sore throat, fever, joint pain, pansystolic murmur
Rheumatic fever
- diabetic patient, epigastric pain not relieved by antacids, nausea, vomiting
inferior MI
Chest
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- dyspnea, chest tightness, cough, clear sputum, triggered by exercise
Bronchial Asthma
- dyspnea, cough, wheezes 1 hour after aspirin
aspirin induced asthma
- cough, yellow sputum, dyspnea, heavy smoker, hyper-resonance of lung,
expiratory wheezes
COPD
- acute dyspnea, shortness of breath, sitting too much time in bed or bus,
taking CCPs
pulmonary embolism
- tall, thin, sudden dyspnea, smoker, right sided chest pain
primary spontaneous pneumothorax
- yellow sputum, dullness, XCR: infiltration of left lower lobe
Community acquired pneumonia
- hemoptysis, chronic bronchitis, loss of weight, heavy smoker, clubbing
Bronchogenic carcinoma
- history of pneumonia, dullness, blunt costophrenic angles
Exudative pleural effusion
- dyspnea, dry cough, facial congestion, bluish tinge
Superior mediastinal syndrome
- COPD patient develops sudden stabbing chest pain
simple pneumothorax
Hepatology
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- acute condition few days ago, FHMA, jaundice, hepatomegaly, high ALT, high
bilirubin
Acute hepatitis
- history of blood transfusion, jaundice, shifting dullness, abdominal
distension, low albumin, high bilirubin
ascites caused by portal hypertension as a complication of cirrhosis
- jaundice, LL edema, shifting dullness, low albumin
Liver cirrhosis
- chronic HCV years ago, jaundice, ascites
liver cirrhosis due to HCV
- patient jaundicized and cachexic, hepatomegaly, distended GB, dilated biliary
ducts
Malignant obstructive jaundice
Neurology
**********
- old male, has all risk factors of atherosclerosis, developed Rt weakness,
right homonemous hemianopia, Rt facial weakness, Rt hypoglossal paralysis
Cerebrovascular stroke due to thrombosis of Lt MCA
- severe HTN, coma, repeated vomiting, no meningeal irritation
Intracerebral hemorrhage
- numbness in Rt arm resolve spontaneously
Transient ischemic attacks
- old woman, dizziness, vertigo, vomiting, numbness in Rt face and Lt arm
Cerebrovascular stroke in vertebrobasillar system most likely Rt PICA
- legs weak, then arms weak. this is rapid and flaccid. what is DD?
Guillan Barre s, myasthenia, myelopathy, collagen diseases
- if the same case + abscence of sensory loss and bilateral plantar response
Guillan Barre s
- throbbing headache in Lt temple with flashes of light
Migraine with aura
- sudden headache never felt before, nausea, vomiting, normal lab values
Subarachnoid haemorrhage
- headache, fever, neck rigidity, can't resist light or noise, trunk rash,
severe pain on extending knee
bacterial meningitis
- low back pain increased with coughing, loss of normal lumbar lordosis
mechanical dearrangement of lumbosacral spine due to prolapsed intervertebral
disc
- LL weakness, hesitancy of micturition, cough, hempysis
extramedullary compression of spinal cord at level of mid thoracic vertebrae due
to bronchogenic carcinoma
GIT
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- repeated epigatric pain with fullness for 5 years with no organic cause
functional dyspepsia
- heart burn for years developed dysphagia and bolus impaction
GERD. also esophageal cancer due to Barrett's esophagus
- recurrent epigastric pain when fasting awakes patient from sleep. microcytic
anemia
peptic ulcer complicated by bleeding as suggested by anemia
- patient receiving NSAIDs now vomiting small cup of blood
drug induced gastritis and possibly ulcer complicated by acute GIT bleeding
- several years cramping abd. pain with non-bloody stool, small amount,
partially relieved by defeacation
IBS
- bloody diarrhea, FHMA, vomiting, pallor, fissure, hemorrhoids, previous
radiotherapy. D.D?
ulcerative colitis, crohn's colitis, infectious colitis, ischemic colitis,
neoplasia, irradiation
- D.D of watery diarrhea?
osmotic and secretory diarrhea (discuss)
- non-bloody, semi-formed stool, greasy diarrhea, loss of weight
steatorrhea
- mention 4 main causes of dysphagia (in the case)
cancer esophagus, mediastinal syndrome, achalasia, cervical oseophytes
- large volume greasy diarrhea, contains undigested food
small bowel diarrhea with malabsorption
- abd. pain and diarrhea with visible blood, dilated air-filled colon
ulcerative colitis
- diabetic patient develops diarrhea. D.D?
autonomic neuropathy, bacterial, metformin induced, autoimmune
- the same case with history of ciprofloxacin intake
antibiotic associated colitis
- fever, night sweats, watery diarrhea, bowel thickness, enlarged mesenteric LNs
tuberculosis enteritis
- old patient, constipation, weight loss, blood in stool
cancer colon
- bright red blood in stool, positive family history of bleeding per rectum
Inherited familial polyposis syndrome
Endocrine
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- post-partum hge then can't lactate her baby, lack of hair growth
Sheehan's syndrome
- diabetic, facial fullness, high Na, low K, inverted cortisol rhythm
Cushing syndrome
- SLE patient receiving steroids then stopped it. now she is shocked
Adrenal crisis
- recurrent episodes of hypertension in middle age with headache and palpitation
pheocromocytoma
- change in ring and shoes size, coarse face, high prolactin
acromegaly
- obese male developed burning sensation in leg and cellulitis, nocturia
D.M
- Diabetic patient receiving insulin found comatosed. D.D?
hypoglycemic coma, DKA coma, CNS affection
- polyuria, polydyspsia then abd. pain, irritation, dehydration, vomiting
DKA
- Diabetic, burning leg, fundus micoaneurysm, high creatinine, normal kidney
size
microvascular comp. of DM: retinopathy, nephropathy, neuropathy
- fasting sugar 115, 2 hours postprandial 186
impaired glucose intolerance
- middle aged female, loss of weight, exophthalmus, thyroid swelling, hand
tremors
Grave's disease
- very low glucose, high insulin, high proinsulin
insulinoma
Hematology
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- pallor, fatigue, low Hb, low HCV
iron deficiency anemia
- pallor, fatigue, occult blood in stool, oesinophilia, reddish worms in
duodenum, low Hb, low MCV
iron deficiency anemia with oesinophilia due to hookworm infection
- low Hb, low RBCs, high MCV, low WBCs
megaloblastic anemia most likely pernicious anemia
- low Hb, reticulocytosis, Heinz bodies
G6PD deficiency
- low Hb, reticulocytosis, pain all over the body
Sicke cell anemia
- young female, low Hb, reticulocytosis
autoimmune hemolytic anemia
- low Hb, low WBCs, low platelets (or two of them), decreased bone marrow
cellularity
aplastic anemia
- splenomegaly, lymphadenopathy, very high lymphocytosis
CLL
- splenomegaly, myeloblasts, myelocytes
CML
- middle aged female, bleeding all over her body, very low platelets
Immune Thrombocytopenia
- prolonged fever, lymphadenopathy, hepatosplenomegaly
lymphoma
Rheumatology
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- malar rash, small joints pain, alopecia
SLE
- butterfly rash, pericardial rub, shortness of breath
SLE with pericardial effusion
- small joints pain, morning stiffness, numbness in Rt hand
RA. cause of numbness is carpal tunnel S
- patient with SLE developed LL edema and puffiness of eyelids
Lupus nephritis
- heartburn, fingers pain, Raynaud's, skin nodules, telangectasia, dyspnea,
central cyanosis, bilateral basal lung crepitations, hepatomegaly, LL edema
scleroderma
- diabetic patient developed swollen tender left foot. D.D?
septic arthritis, gouty arthritis, cellulitis
- the same case with history of thiazide intake
gouty arthritis
- very old woman diabetic with knee pain bilaterally. Rt knee is tender and
swollen
most probably osteoarthritis
- repeated oral aphthae, scrotal ulcers, positive pathergy test
Behcet's disease
Nephrology
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- anorexia, nausia, fatigue, high urea, high creatinine, hyperkalemia,
hypocalcemia
End stage renal failure
- severe 3 days diarrhea, oliguria, high creatinine, high urea
Pre-renal acute kidney injury
- LL edema, puffiness of eyelids, high albumin in urea, high cholesterol
Nephritic syndrome
- history of methicilline intake followed by oliguria, rash, fever
Methicilline induced interstitial nephritis
- history of sore throat, oliguria, high jugular venous pressure, blood and
proteins in urine
Acute post-stretococcal nephritic syndrome
- his father died of cerebrovascular accident. he developed painless hematuria
then renal failure
Polycystic renal disease
- history of taking gentamycin, NSAIDs then inability to pass urine
Acute kidney injury due to gentamycin, NSAIDs
- hypertension, protein in urine, high urea and creatinine
Chronic kidney injury
- 15 y old patient with high proteins in urine, low albumin in serum, LL edema,
puffy eyelids
Minimal change nephrotic S (suggested mainly by being younger than 18 years)
