Differential diagnosis

[maxmac]

Hi, I have some difficulty in formulating a list of differential diagnosis in this question:

A 59-year-old man present with one year history of increased urinary frequency and difficulty in voiding. He complained of fatigue and subjective weight loss.
Physical examination showed palpable suprapubic mass and blood test showed raised urea to 28mmol/L & serum creatinine to 375umol/L.

Thanks for your help!

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[Blade28]

Moving to Clinical Rotations.

 

[haveaniceday]

Hi, I have some difficulty in formulating a list of differential diagnosis in this question:

A 59-year-old man present with one year history of increased urinary frequency and difficulty in voiding. He complained of fatigue and subjective weight loss.
Physical examination showed palpable suprapubic mass and blood test showed raised urea to 28mmol/L & serum creatinine to 375umol/L.

Thanks for your help!

This shouldn't be too difficult, especially if you are an MS3 or above. Make categories when formulating a diff dx: tumor, infection, vascular, trauma...and go from there.

 

[SocialistMD]

Do you know what he has? I ask because I can think of at least 5 surgical problems right off the bat that fit this perfectly, which should make your DDx pretty easy to generate.

Are you on a medicine rotation? The way I always generated my DDx was to look at each symptom and include the DDx for each, as many hours watching House taught me one "classic" symptom could be all that is needed for that to be the diagnosis and the rest of the stuff could just be there to throw you off.

 

[Blade28]

I liked to use "VINDICATE" in med school:

Vascular
Infectious/Inflammatory
Neoplasm
Drugs
Idiopathic
Congenital
Autoimmune
Trauma
Endocrine

 

[Law2Doc]

as many hours watching House taught me

Don't forget the possibility that the pt is faking it -- as House says, "everybody lies".

 

[deleted162650]

When all else fails you can turn to Diagnosaurus. Its a free download for Palms, and its a lifesaver for IM rounds.

 

[fakin' the funk]

I liked to use "VINDICATE" in med school:
Vascular
Infectious/Inflammatory
Neoplasm
Drugs
Idiopathic
Congenital
Autoimmune
Trauma
Endocrine

I liked this mnemonic, and I modified it a bit to account for the many, many I's (I hate mnemonics with multiple things to remember for each letter), and to make them all etiologies. For example, "Endocrine" isn't really a etiology, but Toxic/Drug or Degenerative is. Mine ended up something like "VINDICATIT" or something similarly ridiculous and memorable.

 

[bjackrian]

I liked this mnemonic, and I modified it a bit to account for the many, many I's (I hate mnemonics with multiple things to remember for each letter), and to make them all etiologies. For example, "Endocrine" isn't really a etiology, but Toxic/Drug or Degenerative is. Mine ended up something like "VINDICATIT" or something similarly ridiculous and memorable.

I use VITAMIN D which added metabolic as a cause. Anyway, find something that works for you and it really does help to structure your thinking.

 

[JackBauERfan]

I use VITAMIN D which added metabolic as a cause. Anyway, find something that works for you and it really does help to structure your thinking.

I dont use it as much as I used to, but still do if its a hard dx to think of:

I WATCH DEATH
I for infection, W for withdrawal, a for acute metabolic, t for traumatic/thyroid, c for cns diseases, h for hypoxia, d for deficiencies (vitamin), E for endocrine (thyroid already done but can think of all of them here, adrenal, dm), A for autoimmune, T for toxins, and H for heavy metals

for syncope i use NACHOS
neurogenic (vasovagal), A for adrenal and acute metabolic (missed a lot), C for cardiac (MI, acs, aortic stenosis, other arrythmias), H for hypoxia, O for obstructive processes (pulmonary emboli), and S for rule out seizure

theres another mnemonic specific for hypercalcemia, VITAMIN TRAPS
V is vitaminosis A,D, I is infection, T is thyrotoxicosis, A is addisons, M is milk alkali, I is immobilization, N is neoplastic, T is trauma, R is rhabdo??, A is can't remember autoimmune maybe..i'll have to remember, P is Paget's disease of bone, S is sarcoidosis

 

[Tired]

Drug-seeking.

The diagnosis is always drug-seeking.

 

[Law2Doc]

Drug-seeking.

The diagnosis is always drug-seeking.

Agreed. Or lupus.

 

[geekOCD]

Agreed. Or lupus.

Agreed. Or Thyroid dysfunction!

 

[dynx]

Agreed. Or Thyroid dysfunction!

Dont forget TB...TB can look like ANYTHING.