differentials

intensive care unit

Patient presents with abdominal pain. History indicates recent polyuria, polydipsia, and weight loss. Examination reveals dry mucous membranes and tachycardia. Labs reveal hyperglycemia, anion gap metabolic acidosis, and ketones in urine. Likely diagnosis?

• Diabetic Ketoacidosis (DKA)
• Insulin deficiency -> Hyperglycemia -> Osmotic diuresis -> Volume depletion -> Surge in hormones like glucagon, cortisol, and catecholamines
I: Workup? (3)
• BMP may reveal blood glucose greater than 250
• U/A may reveal presence of ketones in urine
• ABG may reveal pH less than 7.3
M: Treatment? (3)
• 1. ABCs, especially fluid resuscitation
• 2. Electrolyte management, especially potassium below 3.3 or 3.3-5.3
• 3. Insulin therapy, particularly to close the anion gap
• If pH is less than 6.9, consider bicarbonate
Resources
• UpToDate

[Ischemic Stroke Clinical Manifestation]. Likely diagnosis?

• Ischemic Stroke
M: Treatment? (1)
• Analgesics (e.g. NSAIDs, acetaminophen) along with reassurance that it should resolve within a few weeks

inpatient hospital floors

Acute chest pain. Incited by exertion/stress. Relieved with rest. Likely diagnosis?

• Stable Angina
M: First-line treatment? (+2 Others?)
• Beta-blockers. Other options include nondihydropyridine CCBs or nitrates.

Acute chest pain. Not relieved with rest or nitroglycerin. EKG reveals ST-depressions. Labs show negative cardiac enzymes. Likely diagnosis?

• Unstable Angina
M: Initial treatment? (5)
• MONA BASH: Nitrate, antiplatelets, beta-blocker, statin, and heparin
• Optional: Morphine if severe pain, oxygen if SaO2 less than 90, lasix if pulmonary edema without hypovolemia
M: Definitive treatment within 24-72 hours?
• Reperfusion (e.g. percutaneous coronary intervention)

Acute chest pain. Episodic and often occurs suddenly at night. Resolves spontaneously after several minutes. Likely diagnosis?

• Vasospastic (Prinzmetal) Angina
A: Risk factors? (3)
• Risk factors include cigarettes, cocaine, and triptans.
P: Mechanism?
• Intrinsic hypercontractility of coronary artery smooth muscles that leads to vasospasms
D: Possible finding on an EKG? (1)
• ST segment elevation
M: Treatment to abort an episode? (1)
• Nitroglycerin
M: Treatment for prophylaxis? (1)
• Calcium channel blockers (CCBs)

Acute chest pain. EKG reveals ST-depressions. Labs show elevated cardiac enzymes. Likely diagnosis?

• Non-ST Elevation Myocardial Infarction (NSTEMI)
• Subendocardial infarction
• 

Acute chest pain. EKG reveals ST-elevations. Labs show elevated cardiac enzymes. Likely diagnosis?

• ST Elevation Myocardial Infarction (STEMI
• Transmural infarction
• 

Palpitations. EKG reveals “early P waves that differ in morphology from normal sinus P waves”. Likely diagnosis?

• Premature Atrial Complexes
•