approach to a patient with visual disturbance
TRANSCRIPT
APPROACH TO A PATIENT WITH VISUAL DISTURBANCE
Youtube linkhttps://youtu.be/j3LaPmp6B-M
Acute Onset Visual Disturbance
• Acute closed angle glaucoma
• Central retinal artery/vein occlusion
• Retinal detachment
• Anterior uveitis
• Vitreous haemorrhage
• Endophthalmitis
• Giant cell arteritis
• optic neuropathy
• Leber's hereditary optic neuropathy
• Amaurosis fugax
Chronic Onset Visual Disturbance
• Open angle glaucoma
• Cataracts
• Retinitis Pigmentosa
• Macular degeneration
• Diabetic or hypertensive retinopathy
• Optic nerve compression of any cause
• Nutritional and toxic optic neuropathies
Objectives:• Lets learn, how to differentiate among
different causes of visual distrubance
by asking simple questions, with the
help of simple mneumonics:
• P3MAFTOSA
• ODPARA
MEDICAL HISTORY SERIES PART 1
W h i t e S h a d o w
M e d i c c a l e d u c a i o n
Differential Diagnosis
APPROACH TO A PATIENT WITH DOUBLE VISION
Youtube linkhttps://youtu.be/rGiNBTgVAwo
Objectives• Lets learn,how to differentiate among
different causes of double vision by asking
simple questions, with the help of simple
mneumonics:
• P3MAFTOSA
• ODPARA
MEDICAL
HISTORY SERIES
PART 2
Monocular diplopia:Cataract Lens dislocation Macular diseaseCorneal disease
Binocular diplopia: Orbital cellulitisGraves ophthalmopathyKearns-sayre syndrome Myasthenia Gravis Cranial nerve palsies cavernous sinus syndrome Miller Fisher syndrome
Wernicke's encephalopathy
Acute Onset Diplopia:Acute closed angle glaucomaCentral retinal artery occlusionRetinal detachmentAnterior uveitis Vitreous haemorrhageEndophthalmitisGiant cell arteritisOptic neuropathyLeber's hereditary neuropathyStroke
Chronic Onset Diplopia:Open angle glaucomaCataractsRetinitis PigmentosaMacular degenerationDiabetic RetinopathyOptic nerve compression
MEDICAL HISTORY SERIES PART 3
W h i t e S h a d o w
M e d i c a l E d u c a t i o n
Youtube link:https://youtu.be/mpb4hR522PQ
APPROACH TO A PATIENT WITH HEADACHE
Chronic headache: Tension headache Giant cell arteritisChronically elevated ICP Chronic daily headacheBenign intracarcial hypertensionCervical SpondylosisSpace occupying lesion (abscess, tuberculoma, lymphoma, Tumor)DepressionCaffeine withdrawlAnalgesic over use HeadacheMedicines for example CCB , Nitrates , OCPs
Acute single episode:MeningitisEncephalitisSubarachnoid hemorrhage Head injuryCarotid artery dissectionEyes (Uveitis, Glaucoma)
Acute recurrent attacks:Migraine Cluster headacheGlaucomaTrigeminal neuralgia
APPROACH TO A PATIENT WITH COLLAPSE
Neurological causes
Cardiac Causes
Neurocardiogenic causes
Differential Diagnosis
Objectives
• Lets learn, how to differentiate among
different causes of collapse by asking simple
questions, with the help of mneumonics:
• P3MAFTOSA
• ODPARA
Other causes:
• Orthostatic hypotension-collapse
• Subclavian steal syndrome
• Hypoglycemia
• Anexiety
1
2
3
Seizure
Stroke
subarachnoid haemorrhage
Aortic stenosis
Hypertrophic obstructive
cardiomyopathy
Vasovagal syncope
Situational syncope
Carotid sinus hypersensitivity
MEDICAL HISTORY SERIES PART 4
W h i t e S h a d o w
M e d i c a l E d u c a t n
Youtube link:https://youtu.be/JIlsE-NQZQg
APPROACH TO A PATIENT WITH DIZZINESS
Vestibular end organs &
vestibular nerve• Ménière's disease
• Vestibular neuritis
(acute labyrinthitis)
• Benign positional vertigo
• Motion sickness
• Ototoxicity
(aminoglycosides)
• Herpes zoster oticus
(Ramsay Hunt syndrome)
Brainstem, cerebellum, &
cerebello-pontine angle
• Multiple Sclerosis
• Transient ischemic attack
• Hemorrhage
• Migraine
• Vestibular schwannoma
• Arnold-Chiari malformation
• Friedreich's ataxia
• Spinocerebellar ataxia
Other Causes
• Alcohol intoxication
• Perilymph Fistula
• cardiac syncope
• Orthostatic hypotension
• Vasovagal syncope
• Situational syncope
• Carotid sinus hypersensitivity
• Hypoglycemia
• Anxiety
MEDICAL HISTORY SERIES PART 5
Youtube link: https://youtu.be/WKpfHCtrOGo
Differential Diagnosis
APPROACH TO A PATIENT WITH JOINT PAINS
Youtube link:
https://youtu.be/qMGrRUveg68
Symmetrical Joint Pains1. Viral Causes
2. SYSTEMIC LUPUS ERYTHEMATOSUS
3. Rheumatoid arthritis
4. Vasculitis
Asymmetrical Joint Pains1. Sero-negative arthro-pathies
2. Gout
3. Rheumatic Fever
4. Malignancy
MEDICAL HISTORY SERIES PART 6
DIFFERENTIAL DIAGNOSIS
Mono-articular Joint Pains1. OSTEOARTHRITIS
2. Gout
3. Pseudo-gout
4. Septic arthritis
Poly-articular Joint Pains:
1. Osteoarthritis
2. SYSTEMIC LUPUS ERYTHEMATOSUS
3. Rheumatoid arthritis
4. Psoriatic Arthritis
Age ranging from 15 to 30years:• Herniated disc
• Trauma
• Seronegative Arthropathies (ankylosing
spondylitis)
Age limit of 30 to 50 years: • Degenerative spinal disease
• Herniated disc
• Cauda equina Syndrome
• Malignancy of the lung, or breast, or prostate
Age beyond 50 years of age:
• Degenerative spinal disease
• Osteoporosis
• Compression fracture
• Paget's disease
• Malignancy
• Myeloma
• Lumbar spinal stenosis
1
2
3
https://youtu.be/cZJCux-k4b8Youtube link:
MEDICAL HISTORY SERIES PART 7
APPROACH TO A PATIENT WITH BACK PAIN
W h i t e S h d o w
M e d i c a l
E d u c a t i o n
Differential Diagnosis
APPROACH TO A PATIENT WITH ABDOMINAL PAINMEDICAL HISTORY SERIES PART 8
https://youtu.be/f8XFJ35f8zw
Youtube link:
Differential
Diagnosis
APPROACH TO A PATIENT WITH ACUTE CONFUSION
Neurological causes: • Meningitis
• Subdural hematoma
• Stroke
• Seizures
• Encephalitis
Gastrointestinal causes: • Hepatic encephalopathy
• Clostridium difficile colitis
3
5
6Urinary tract infection
Respiratory causes:• Chest infection
• Pulmonary embolus
Psychiatric causes
MEDICAL HISTORY SERIES PART 9
1 4 Cardiac causes: • Congestive heart failure
• Myocardial infarction
• Arrhythmia
2
Differential Diagnosis
Youtube link: https://youtu.be/dl3HwTKitoI
APPROACH TO A PATIENT WITH BREATHLESSNESS
MEDICAL HISTORY SERIES PART 10
Youtube link:
https://youtu.be/rRGnXX-qM_s
APPROACH TO A PATIENT WITH CHEST PAIN
Youtube link:https://youtu.be/qJzph12WsgA
Respiratory causes:• Asthma
• Collapsed lung
• Pneumonia
• Pulmonary embolism
• Pulmonary hypertension
• Pneumothorax
• Malignancy
MEDICAL HISTORY SERIES PART 11
Cardiac causes:• Angina
• Myocardial infarction
• Aortic dissection
• Pericarditis
• Myocarditis
• Hypertrophic cardiomyopathy Gastrointestinal causes:• Peptic ulcer disease
• Gastroesophageal reflux
disease (GERD)
• Esophageal
spasm/rupture
• Pancreatitis
• Musculoskeletal pain • Nerve root pain• Panic attack
Others:
APPROACH TO A PATIENT WITH COUGH
MEDICAL HISTORY SERIES PART 12
Objective:• How to differentiate among
different causes of cough by
asking simple questions, using:
• P3MAFTOSA
• ODPARA • Cardiac failure
• Medicines
• GERD
• COPD
• Asthma
• Bronchiectasis
• Foreign body
• Pneumonia
• TB
• Cancer
• ILD
• Sarcoidosis
• Chronic Pulmonary Embolism
• https://youtu.be/Y-cE8bpaE-g
Respiratory causes:
Others:
Youtube link:
APPROACH TO A PATIENT WITH HEMATURIA
MEDICAL
HISTORY SERIES
PART 13
Differentail Diagnosis• Urinary tract or kidney infections
• Bladder or kidney stones
• Glomerulonephritis
• Benign prostatic hyperplasia
• Prostate cancer
• Sickle cell anemia
• Aspirin, cyclophosphamide, heparin
• Cancer (bladder or kidney)
• Kidney injury
• Vigorous exercise
Wegener's Granulomatosis
Systemic lupus erythematosus
Systemic sclerosis
Bleeding disorder
Youtube link: https://youtu.be/zJzoObWSErQ
APPROACH TO A PATIENT WITH LIMB WEAKNESS
Differential DiagnosisStroke
Herniated disc
Space-occupying lesions
Subarachnoid hemorrhage
Seizures
Todd's paresis
Carotid dissection
Spinal cord compression
Malignancy
Chronic fatigue syndrome (CFS)
Peripheral neuropathy
Polymyositis
Immobilization
Alcoholic myopathy
MEDICAL HISTORY
SERIES PART 14
Youtube link:
https://youtu.be/lIRHlEmN_K4
APPROACH TO A PATIENT WITH
MEMORY LOSS
Youtube link:https://youtu.be/-fVtBavPJd4
MEDICAL HISTORY
SERIES PART 15
Stroke
Subdural hematoma
Lewy body dementia
Delirium
Parkinson's disease
Parkinson Plus syndromes
Space occupying lesion
Alcohol-related dementia
Wilson's disease
Huntington's disease
Frontotemporal dementia
Normal pressure hydrocephalus
Alzheimer's disease
Ccortical basal degeneration
Creutzfeldt-Jakob disease
Motor neuron disease
Progressive supranuclear palsy
Vascular Dementia
Differential Diagnosis
APPROACH TO A PATIENT WITH MUSCLE WEAKNESS
MEDICAL HISTORY
SERIES PART 16Youtube link:
https://youtu.be/V4qEmlaiSlY • Space-occupying lesions
• Botulism
• Organophosphate poisoning
• Lead poisoning
• Hyperthyroidism
• Cushing's syndrome
• Guillain-Barre syndrome
• Peripheral nervous lesions
• Motor neuron disease
• Transverse myelitis
• Stroke
• Myasthenia gravis
• Addison's disease• Hypokalaemic periodic paralysis
• Hyperkalaemic periodic paralysis
• Dermatomyositis
• Malignancy
• Depression
Youtube link:https://youtu.be/2oYITsga6LQ
Intra-cardiac:Arrhythmia
Valvular heart disease
Structural heart disease
Pacemaker 1
2
3
Thyrotoxicosis
Pheochromocytoma
Hypoglycemia
Differential
Diagnosis
APPROACH TO A PATIENT
WITH PALPITATIONS
High-output State:Anemia
Pregnancy
Fever
Paget's disease
Pharmacological:Amphetamine
Cocaine
Caffine
Nicotine
Medications
MEDICAL HISTORY
SERIES PART 17
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