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8/14/2019 Cardio Class Case Presentation - Differentials and
Working Impression
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8/14/2019 Cardio Class Case Presentation - Differentials and
Working Impression
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Differential Diagnosis
Main Hx finding: nape pain, temporalheadache
Main PE finding: BP 160/90
Possibilities
Pain high BP (sympatheticactivation)
High BP pain (symptomatology of
HPN)
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8/14/2019 Cardio Class Case Presentation - Differentials and
Working Impression
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Main Differential Diagnoses
Differentials Rule In Rule Out
Musculoskeletal pain:bursitis, cervical spinearthritis,
myofascialpain syndrome,
fibromyalgia
Nape pain Is it exacerbated bymovement?Any stiffness?Any
inflammatory
S/Sx?Distribution(myofascial triggerpoints, widespread
infibromyalgia)?Deformity?
Psychogenic pain Nape pain, headache
Should not be
relieved by rest.More common infemales.Cardiovascular
causes: acutecoronary syndromes,pericarditis, aortic
dissection
Pain referred to nape
Headache (painabove the mandible)makes it unlikely.Normal X-ray,
ECG.
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8/14/2019 Cardio Class Case Presentation - Differentials and
Working Impression
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Main Differential Diagnoses
Differentials Rule In Rule Out
Pulmonary causes :TB
Pain referred to nape(apices and napeshare innervation).
Weight loss?S/Sx of infection?Normal X-ray.
Neurologic causes:
meningitis,intracranial tumor,hydrocephalus
Nape pain, headache
Neurologic S/Sx?
Neurologic cause:migraine
Headache asthrobbing, temporaldiscomfort; may alsoinvolve
nape.
Usually female.No aura (increasedtearing, photopsia)?
Hypertension, Stage 2
Nape pain
Temporal headache (2other distributions fronto-parietal
andoccipital spreadingover head)Blurring of vision
Dizziness
Cannot be ruled out.
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8/14/2019 Cardio Class Case Presentation - Differentials and
Working Impression
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Main Differential Diagnoses
Differential Rule In Rule Out
Dyslipidemia LDL > 100 mg/dL(162 mg/dL)TG > 150 mg/dL
(184mg/dL)
Cannot be ruled out.
Metabolic syndrome*Must fulfill at least 3out of 5 JNC7
criteria
BP of at least 130/85mmHgTG >150 mg/dL
Abdominal obesity male waistcircumference > 40in.?Fasting
glucose 105mg/dL (must be > 110mg/dL)HDL 55 (must be
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8/14/2019 Cardio Class Case Presentation - Differentials and
Working Impression
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Differential Diagnoses forHypertension
Differentials Rule In Rule Out
Renal: GN, RAS, renin-producing tumors,polycystic kidneys
Elevated BP reading GN RAS nomurmurs/bruits?Tumor
Polycystic kidney Endocrine: Cushings,oral contraceptiveuse,
thyrotoxicosis,myxedema,pheochromocytoma,acromegaly
Elevated BP reading
Cushings abdominalstriae, etc.?OCP Nottransgender usingOCP to
augmentbreasts?
Thyrotoxicosis,myxedema thyroidfunction tests?Acromegaly
appearance ofextremities, oral
glucose test?
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8/14/2019 Cardio Class Case Presentation - Differentials and
Working Impression
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Differential Diagnoses forHypertension
Differentials Rule In Rule Out
Vascular: coarctationof the aorta,polyarteritis nodosa,aortic
insufficiency
Elevated BP reading CoA BP readings ofother extremities?PAN
Aortic insufficiency
no heaves, thrills,murmurs and apexbeat not displaced; X-ray,
ECG normal.
Essential hypertension Elevated BP reading Most commonDiagnosis
of exclusion
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8/14/2019 Cardio Class Case Presentation - Differentials and
Working Impression
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Working Impression
Essential hypertension, t/c secondarycauses
Dyslipidemia, r/o metabolicsyndrome
