CMS Differentials PDF

YEAR 1 CMS RESPIRATORY TRACT INFECTIONS (SORE THROAT) Red flag diagnoses in red * = sometimes Temperatur Oropharyngeal Exam Nasal Exam Cervical Lymph Nodes Eye Exam Lung Exam e Fever...

YEAR 1 CMS RESPIRATORY TRACT INFECTIONS (SORE THROAT) Red flag diagnoses in red * = sometimes Temperatur Oropharyngeal Exam Nasal Exam Cervical Lymph Nodes Eye Exam Lung Exam e Fever Dysphagia Severely tender lymph Drooling nodes - A Toxic Dysphonia appearance Distress Acute Epiglottis Inflammation of epiglot. *DO NOT USE TONGUE DEPRESSOR Fever Dysphagia, Ispilateral odynophagia leading otalgia to pooling of saliva Fetor breath - dDsphonia Peritonsilar Unilateral Abscess erythematous, enlarged tonsil - Exudate Uvular deviation to contralateral side Fever Drooling Neck stiffness Retropharyngeal Dysphonia Abscess Bulging of posterior wall of oropharynx Fever Dysphagia Enlarged and tender Abdominal Streptococcal Edema and erythema anterior cervical pain symptom Pharyngitis of tonsils and pharynx lymph nodes (do not do abd. Exam)  Non-adherent tonsilar/phharyngeal exudate Palatine petechiae* Infectious Low-grade Tonsillar exudates Posterior cervical Splenomegaly* Mononucleosis fever Palatine petechiae lymphadenopathy Afebrile or Posterior oropharynx Nasal Posterior cervical (Inspecting the (Lung exam low-grade mildly inflamed and congestion lymph nodes enlarged eyes for woulf be fever erythematous Rhinorrhea and tender conjuntivitis) normal in a Common Cold Nasal common cold) turbinates erythematous and swollen Fever Sore throat Nasal congestion Influenza Rhinorrhea Erythema Edema HEARING LOSS/OTALGIA * = sometimes Weber Test Rhinne Test Ear Exam Cervical Lymph Nodes Temperature Lateralization AC > BC Sensorineural Hearing Loss to unaffected side Lateralization BC > AC Pruritus, fullness Periauricular to affected Otorrhea* lymphadenopathy Otitis Externa side Pain on movement of (with conductive hearing Tragus, auricle (pinna) loss) Erythematous, oedematous, inflamed external ear canal  Lateralization BC > AC Otalgia Fever to affected Otorrhea* Otitis Media side Bulging, (with conductive hearing cloudy/erythematous, loss) immobile tympanic membrane with obscured bony landmarks JOINT PAIN * = sometimes Temperature Knee Exam Nutritional Status Exam Gait Assessment Fever* Pain Edema Septic Arthritis Erythema Warmth Immobility Morning pain/stiffness Erythema Gout Tophi* on pre patella bursae Pseudogout Morning pain/stiffness Symmetrical pain and Keratoconjunctivitis sicca stiffness (dry eyes) Morning stiffness Episcleritis/scleritis Boggy swelling Rheumatoid Arthritis Palpable synovial thickening Pain with pressure, movement Asymmetric joint Joint locking or instability Osteoarthritis pain/stiffness Pain worse with Swelling movement  Tenderness Bony enlargement (prolonged or severe) Pain on ROM, limited ROM Crepitus LOW BACK PAIN/RADICULOPATHY = sometimes Dermatomes Myotomes Reflexes Gait Assessment Straight Leg Raise Femoral Stretch Test Paresthesia of Weak knee Asymmetric Positive L2, L3, L4 anterior thigh, extension, hip patellar reflex (reproduction of Radiculopathy *medial calf* adduction, hip pain in anterior flexion thigh) Paresthesia of Weak big toe Asymmetric Foot drop and Positive lateral thigh, extension, foot medial inability to walk (reproduction of L5 lower lateral eversion and hamstring on heels pain at 30-60 Radiculopathy leg, dorsum of inversion, ankle reflex degrees) foot dorsiflexion, hip abduction Paresthesia of Weak plantar Asymmetric Heel drop and Positive sole, lateral foot flexion ankle reflex inability to walk (reproduction of S1 and ankle, on toes pain at 30-60 Radiculopathy fourth and fifth degrees) toes ABDOMINAL PAIN = sometimes Temperatur Blood Dermatological Abdominal Exam Nutritional Status Exam e Pressure Exam Fever Right lower quadrant pain on palpation Migrating from periumbilical area to right lower quadrant Appendicitis Rebound tenderness Rigidity McBurney’s point painful on palpation Distention Skin turgor test may show Bowel Increased bowel sounds dehydration (if bowel Obstruction obstruction is caused by constipation) Abdominal Pulsatile abdominal mass Hypotension Aortic Aortic bruit? Aneurism Mesenteric Pain on palpation Ischemia Postprandial pain  Severe lower quadrant pain (stabbing, Ectopic intermittent, does not radiate) Pregnancy Pelvic adnexal mass* Severe unilateral pain (usually right- sided) Ovarian Mild, intermittent* Torsion Tenderness and guarding on palpation Latero-uterine mass Pelvic Fever, chills Lower abdominal pain Inflammatory Adnexal tenderness Disease Dyspepsia (upper abdominal Pallor on assessment of Peptic Ulcer discomfort) conjunctival rim (anemia) Disease Fever Murphy’s sign positive Eyes may appear yellow Skin may appear Cholecystitis Right upper quadrant pain (jaundice) on assessment of yellow (jaundice) conjunctival rim Nephrolithiasi Excruciating back and flank pain s radiating to abdomen or groin Low-grade Pain radiates to back* fever Pain exacerbated in supine position Acute Guarding on palpation Pancreatitis Periumbilical bruising Flank bruising* Disabling mid-epigastic prostprandial Unintentional weight loss pain Chronic Pain radiates to back Pancreatitis Relieved by sitting forward Bloating* Fever* Left lower quadrant tenderness Diverticulitis Abdominal distention Rigidity on palpation IBS Pain  Bloating EPIGASTRIC/RETROSTERNAL PAIN Temperatur Abdominal Oropharyngeal Nutritional Dermatological Joint Exam Pulse e Exam Exam Status Exam Exam Epigastric Sour taste in burning mouth Dysphasia GERD Sore throat Hoarseness Globus sensation Barrett’s Epigastric pain Dysphagia Esophagus Epigastric pain Gastritis Dyspepsia Peptic Dyspepsia (upper Belching Ulcer abdominal Disease discomfort) Pain SIBO Bloating Fever Pain Aphthous Evidence of Pallor (indicating Finger clubbing My have Stomatitis (ulcers inflammato anemia) or Chron’s cramping on in mouth) ry episcleritis on Disease palpation arthrothapi assessment of es (edema) conjunctival rim  Hyperactive bowel sounds Tender on Ulcers in mouth Finger clubbing Ulcerative palpation Colitis Hyperactive bowel sounds Fever Hyperactive Skin turgor test Tachycar bowel sounds may show dia C. Difficile (diarrhea) dehydration (due to diarrhea) Bloating Signs of Dermatitis (notable absence malnutrition* herpetiformis: of pain) (ex. Pallor on Symmetric Celiac assessment of vesicles (may Disease conjunctival rim) coalesce), crusts, Weight loss* erosions, distributed over extensor surfaces Non- Bloating Aphthous May have Rash Celiac Pain Stomatitis (ulcers joint pain Gluten in mouth) Sensitivity EATING DISORDERS Heart Oropharyngeal Dermatological Cervical Lymph Pulse Blood Pressure Auscultation Exam Exam Node Exam Arrhythmia Bradycardia Hypotension Brittle hair Brittle nails Anorexia Hyperkeratosis Nervosa Lanugo (thin layer of hairs over skin)  Hyppotension Dental Scars or calluses on Enlarged parotid Bulimia Nervosa erosions/gum fingers or hands gland disease Pallor Brittle hair Avoidant/Restric Brittle nails tive Food Intake Hair loss Cold CARDIOVASCULAR DISEASE = sometimes Peripheral Blood Heart Lung Abdominal Nutritional Vitals Edema/Pul JVP Pressure Auscultation Auscultation Exam Status Exam ses Hypotensi Third heart Crackles Dyspnea Elevate Myocardial on sound d Infarction Palpitations Endocarditi Fever s Palpitation Dyspnea Edema Elevate Myocarditi Third heart Syncope present d s sound Murmurs Pericardial Pleural Tachycardia Distenti friction rub effusion Pulsus on (muffled paradoxus sound) (decrease BP Pericarditis on inspiration) Fever* (if infectious)  Asymmetr Asymmetri Pain in chest, Pale nail ic BP in c pulses in back or beds, palms Aortic upper upper abdomen of hands Dissection extremitie extremities (intense, (ischemia) s ripping) Tachycardia Edema Dyspnea present Pulmonary (deep vein Embolism thrombosis ) Cardiac Palpitations Dyspnea Irregular Arrhythmi Tachycardia pulses a Laterally Crackles Pulsus Elevate displaced alternans d Heart apical Edema Failure impulse present S3 heard Dermatological Peripheral Dermatomes Myotomes Pulses Bruits Exam Edema Numbness in Muscle weakness Ulcers on non- Palpable pulse Femoral artery lower limb in lower limb healing wounds abnormality bruit (or any Peripheral Skin feels cool lower limb bruit) Vascular Disease Pallor, cyanosis Nails appear brittle, rigid Deep Vein Paralysis or Collateral Pitting edema Thrombosis paresis of superficial veins Calf swelling > 3 affected leg visible cm compared to Cool too touch unaffected leg or entire leg swollen