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1

27

OPD card

*** 3-4 DDx rule in / rule out

1.

2. rule in / rule out 2.1 Functional - depression, general anxietic disorder, somatization 2.2 Organic *** - Anemia

- extrapulmonary TB

- somewhere cancer

- Heart failure, COPD, CRF

- Endocrine DM, hypothyroidism, adrenal insuff, hypopituitarism

- post viral infection

- Drug induced antihypertensive, diuretics, chemo ***

2

steroid, antihypertensive, diuretics, chemo

17

OPD card


3

1.

2. rule in / rule out local systemic symptoms 2.1 acute febrile

Local infection : - respiratory tract infection URI, pneumonia

- genitourinary APN

- alimentary tract AGE, cholangitis - skin cellulitis, necrotizing fasciitis, abscess - CNS meningitis, encephalitis

Systemic infection : - malaria, typhoid, typhus, DHF, septicemia, leptospirosis meningococcemia

2.2 Prolong fever : TB, malaria, ricketsia, typhoid, drug fever, Hodgkins disease, deep seated abscess, malignancy HIV

4

18

OPD card

approach dysphagia key word 3 - - progressive intermittent - heartburn


1.

2. rule in / rule out *** odynophsgia ( candidiasis) 2.1 oropharyngeal disphagia neuromuscular stroke, ALS 2.2 esophageal disphagia 2.2.1 neuromuscular disorders : # intermittent diffuse esophageal spasm (DES) # progressive scleroderma / achalasia

2.2.2 mechanical obstruction

# intermittent lower esophageal ring # progressive stricture / cancer

2.3 GERD , somatization

5

14

OPD card


1.

2. rule in / rule out 2.1 Generalized edema -

- (nephritic, AGN, ESRD

- (cirrhosis) - hypothyroidism, Cushing syndrome - malnutrition (Kwashiorkor)

- ACEI, NSAIDS, steroid, pills, Amlodipine - anaphylaxis - pregnancy PIH

2.2 Local edema

- venous thrombosis DVT, SVCO

- lymphatic obstruction

- infection / inflammation

- trauma - tumors

- allergy

6

DVT

ACEI, NSAIDS, steroid, pills,amlodipine etc.

15

OPD card


1.

7

2. rule in / rule out 2.1 - aplastic anemia, bone marrow infiltration

- folate, B12, iron deficiency, erythropoietin - chronic diseases

2.2

- hemolysis - abnormal Hb

2.3 acute / chronic blood loss - GIB , hypermenorrhea

NSAIDS, steroid, chemo

8

9

OPD card

(frequency)


1. (nocturia) (polyuria)

2. rule in / rule out - DM - DI - BPH - UTI (urethritis, cystitis) dysuria

- atopic urethritis, postmenopausal syndrome - Drugs Lasix, HCTZ, coffee, alcohol - OAB (overactive bladder) - irritation trigone : calculi, tumors - psychogenic polydipsia

9

1

OPD card


1. organ

2. rule in / rule out 2.1 cardiac chest pain : AMI, (angina pectoris) ***

2.2 Non-cardiac chest pain : (skin) - herpes zoster chest wall - costochondritis, fracture rib pleural cavity pneumothorax, pleuritis, empyema thoracis Lung pneumonia, abscess, acute pulmonary embolism mediastinum - pericarditis, dissecting aorta, mediastinitis esophagus esophagitis, GERD, cancer psycho - anxiety ( organ related)

11

33

OPD card


1.

2. rule in / rule out # () *** 1 2 3 4 NMJ

5 # electrolytes imbalance , drug induced # () ***

1. Vascular (Stroke) ischemic, hemorrhagic

2. Trauma CSDH, ICH

3. Tumors primary / secondary

4. Infection brain abscess

5. Inflammation& demyelination MS, BGS

6. spinal cord injury, entrapment, tumor, ischemia

7. NMJ Myastinia gravis

8. Muscle myopathy, myositis

12

9. Electrolyte periodic hypokalemic paralysis

10. Metabolic hypoglycemia

11. Malingering, conversion

*** UMNs neuroanatomy lesion multiple sclerosis ***

SLE

steroid,

13

4

OPD card


1.

2. rule in / rule out 2.1 cardiac causes : - obstructive : aortic stenosis, HOCM - dysrhythmias : severe bradycardia, tachycardia

2.2 non cardiac causes : - vagovagal syncope * - postural hypotension : hypovolemia, - drug prasozin *** - heat syncope ()

2.3 psycho anxiety, malingering

14

***

2

OPD card

(Dyspnea)


1. organ

2. rule in / rule out 2.1 cardiac causes : CHF functional class*** (pericardium, cardiac muscle, valve, endocardium)

2.2 Respiratory causes : Upper airway FB, croup, subglottic stenosis, cancer

Lower airway asthma, COPD, bronchitis

Lung parenchyma pneumonia, fibrosis, contusion,

Pleural cavity pneumothorax, hemothorax, effusion

Lung vessels pulmonary embolism

15

Chest wall fracture rib, flail chest

Chest muscle and nerve myastinia gravis ***, GBS, phrenic nerve paralysis

2.3 psycho anxiety, somatization

FB

16

7

OPD card


1.

2. rule in / rule out 2.1 respiration causes : - URI, post nasal drip (sinusitis) *** post infectious cough - FB in trachea, bronchus *** - bronchitis, bronchiolitis, bronchiectasis, asthma, COPD, pneumonia, TB, lung cancer

2.2 cardiac causes : - cardiac asthma, pulmonary edema 2.3 GI causes GERD, LPR 2.4 Drugs and irritants ACEI **, smoking, allergy, chemical 2.5 psycho Tics

FB ( )

17

ACEI ***

8

OPD card


1.

2.

3. rule in / rule out 2.1 : pulmonary TB, bronchiectasis, bronchitis, lung cancer, lung abscess, fistula, embolism, vasculitis ( autoimmune) 2.2 : sinusitis, epistaxis, gingivitis, pharyngitis, GI bleeding 2.4 Drugs warfarin ***

18

Massive hemoptysis = > 200ml / 600ml /day

warfarin ***

31

OPD card


19

2. rule in / rule out 2.1 Primary headache migraine, tension, cluster (functional headache) (chronic non progressive) 2.2 Secondary headache organic headache

- sudden severe --- SAH ( > 40) - acute Intracranial hematoma, Gnathostomiasis

- chronic progressive tumor, abscess, hydrocephalus, chronic SDH

- fever febrile headache, meningitis, herpes encephalitis

- other post coital ,menstrual, drug induced headache ***

2.3 Extracranial toothache, TMJ, mastoid, sinusitis, temporal arteritis

2.4 Neuralgia trigeminal neuralgia, postherpetic neuralgia ***

Onset

20

30

OPD card


1. ( level and or content of consciousness)

2. rule in / rule out 2.1 -supratentorial lesion ---vascular (bleeding, infarction) tumor, trauma, infection, hydrcephalus, IICP, CSDH

-infratentorial lesion --- same -diffuse brain dysfunction --- encephalitis, SAH 2.2 - Metabolic --- hypo/hyperglycemia, hypoxia, hypertensive, hyponatremia, uremia, hepatic encephalopathy, hypercalcemia - Drugs /toxin BDZ, alcohol, , - systemic infection alteration of conscious

- Psycho malingering

21

steroids, antidepressants, AEDs,

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