Differential Diagnosis PDF

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Summary

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Description

Differential Diagnosis

Cardiovascular: Angina

MI

Characteristics/Expect ed history/Signs/Sympto ms

Expected physical exam findings

Expected/Typical findings of investigation

FBC ECG

Tight and crushing pain. Retrosternal pain, may radiate to jaw or left arm. Precipitated by effort, emotion, food & cold weather. Relieved by GTN which relaxes smooth muscle Pain at rest >20mins is MI until proven otherwise

Investigations needed

Pyrexia, JVP may be raised with inferior MI.

Serum cardiac markers

Management

O2, high dose aspirin, nitrates IV and/or oral,  blockers, statins, LMW heparin.

Increased WCC. Troponin increases within 6hrs following MI . ECG: changes following anatomical pattern of coronary vascular insufficiency

STEMI- O2, high dose aspirin, nitrates IV and/or oral,  blockers, statins, ACEi, urgent thrombolysis and/or primary angioplasty. NSTEMI- O2, high dose aspirin, nitrates IV and/or oral,  blockers, statins, ACEi, LMW heparin, consider early angiogram and/or primary

Notes

angioplasty. Pericarditis

Acute Aortic Dissection

Centrally located pain, may radiate to shoulders. Pleuritic (worse on inspiration). Sitting forward may help Tearing quality pain. Radiates to back and occasionally abdomen

Gastrointestinal Reflux oesophagitis

Peptic ulcer disease Oesophageal spasm Pulmonary

Burning pain. Retrosternal pain, may radiate to jaw or left arm. Related to meals, changes in posture such as bending or lying. Antacids may relieve Deep and gnawing Relieved by GTN which relaxes smooth muscle Anywhere in the thorax. Pleuritic (worse on inspiration)

Pyrexia. Friction rub may be auscultated

CXR

Occasionally peripheral pulses are absent. Hemiparesis can occur with aortic dissection

V/Q scan

Pulmonary angiography Oesophageal manometry

CT aortography Upper GI endoscopy

CXR-dissection of aorta may widen width, bulge to appear at right mediastinal border.

O2, analgesia, large bore IV access, crossmatch 6 units, urgent surgical referral.

PPIs and lifestyle modification, calcium antagonist e.g. nifedipine if spasm.

Pneumonia

Chest expansion decreased on the same side. Dullness to percussion in area of consolidation. Bronchial breath sounds audible over segment of consolidation. Localised areas of crepitations audible with lobar pneumonia.

Increased WCC. CXR- consolidation on chest film: confined to a lobe/widesread in bronchopneumonia

Pneumothorax

Trachea deviates from side of tension. Chest expansion decreased on the same side. Hyporesonance. Unilateral absence of breath sounds consistent with pneumothorax JVP may be raised. Hot, swollen, tender calf or thigh may give clue to underlying DVT.

CXR- line of pleura, with absence of lung markings distal.

Insert large venflon into 2nd intercostal space, mid clavicular line. O2 if breathless. Analgesia. Aspirate if moderate.

Non-specific ECG changes, tachy, right axis deviation, right ventricular strain and AF. CXRWedge shaped shadow of pulmonary embolus, occurs if pulmonary

LMW heparin (treatment dose) then warfarin. Thrombolysis if decreased BP, large bilateral clots or acutely dilated RV on echocardiogram

Pulmonary embolism

infarction resulted Musculoskeletal

due to moving of thorax

Chest wall injuries

Herpes zoster

Costochondritis Bornholm disease Secondary tumours of the rib Emotional Depression Anxiety

.

chest wall tenderness, friction rub may be auscultated Simple analgesia (NSAIDs) avoid strenuous activity until decreased pain Pyrexia. Unilateral chest wall tenderness confined to single or adjacent group of dermatomes, either central or spinal origin or peripheral nerves...