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APPROACH TO A PATIENT WITH VISUAL DISTURBANCE Youtube link https://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 White Shadow Mediccal educaion Differential Diagnosis

APPROACH TO A PATIENT WITH VISUAL DISTURBANCE

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Page 1: APPROACH TO A PATIENT WITH VISUAL DISTURBANCE

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

Page 2: APPROACH TO A PATIENT WITH VISUAL DISTURBANCE

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

Page 3: APPROACH TO A PATIENT WITH VISUAL DISTURBANCE

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

Page 4: APPROACH TO A PATIENT WITH VISUAL DISTURBANCE

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

Page 5: APPROACH TO A PATIENT WITH VISUAL DISTURBANCE

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

Page 6: APPROACH TO A PATIENT WITH VISUAL DISTURBANCE

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

Page 7: APPROACH TO A PATIENT WITH VISUAL DISTURBANCE

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

Page 8: APPROACH TO A PATIENT WITH VISUAL DISTURBANCE

APPROACH TO A PATIENT WITH ABDOMINAL PAINMEDICAL HISTORY SERIES PART 8

https://youtu.be/f8XFJ35f8zw

Youtube link:

Differential

Diagnosis

Page 9: APPROACH TO A PATIENT WITH VISUAL DISTURBANCE

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

Page 10: APPROACH TO A PATIENT WITH VISUAL DISTURBANCE

APPROACH TO A PATIENT WITH BREATHLESSNESS

MEDICAL HISTORY SERIES PART 10

Youtube link:

https://youtu.be/rRGnXX-qM_s

Page 11: APPROACH TO A PATIENT WITH VISUAL DISTURBANCE

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:

Page 12: APPROACH TO A PATIENT WITH VISUAL DISTURBANCE

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:

Page 13: APPROACH TO A PATIENT WITH VISUAL DISTURBANCE

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

Page 14: APPROACH TO A PATIENT WITH VISUAL DISTURBANCE

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

Page 15: APPROACH TO A PATIENT WITH VISUAL DISTURBANCE

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

Page 16: APPROACH TO A PATIENT WITH VISUAL DISTURBANCE

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

Page 17: APPROACH TO A PATIENT WITH VISUAL DISTURBANCE

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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