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DDX Flashcards

(58 cards)

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1
Q

DDX Hypercalcemia (6)

A
  1. Primary hyperparathyroidism
  2. Increased Bone turnover
    - Hyperparathyroid
    - Immobilization
    - Vit A intoxication
    • Thiazide diuretics
  3. Renal failure
  4. Familial Hypocalcuuric hypercalcemia
  5. Malignancy
    a. Metastatic like breast Ca
    b. PTH related (lung/kidney Ca)
    c. Hematologic (MM, Leukemia)
  6. Vit D related
    a. Vitamin D intoxicaton
    b. Granulomatous disease
    i. TB
    ii. Sarcoid
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2
Q

DDX Hypothyroidism (7)

A

Primary

  1. Thyroiditis: Hashimoto, post partum, irradiation
  2. Drugs: lithium, ASA, PTU
  3. Iatrogenic: Post ablative Graves/surgery
  4. Iodine deficiency
  5. Congenital: thryroid dysgenesis

Secondary

  1. Pituitary (tumor, Sheehans syndrome)
  2. Hypothalamic
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3
Q

DDX Dyslipidemia (8)

A

Primary
1. Genetic causes (Familial Hypercholesterolemia, Familial Combined Hyperlipidemia)

Secondary

  1. Obesity/Metabolic syndrome
  2. Diet
  3. Alcohol -elevated TGs
  4. Diabetes Mellitus
  5. Hypothyroidsim
  6. Chronic liver disease
  7. Monoclonal gammopathy
  8. Drug induced
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4
Q

DDX Thrombocytopenia

A
  1. Pseudothrombocytopenia
    a. Platelets clumped in vial due to inadequate coagulation; repeat in Na citrate/heparin
    b. Dilutional-massive RBC transfusion without PLT replenishment; pregnancy.
  2. Decreased production:
    a. Aplasia -aplastic anemia
    b. Infiltration -carcinoma, lymphoma, leukemia, fibrosis
    c. Toxins-drugs (gold, EtOH, TMP-SMX)
    d. Infection (rubella, HIV)
    e. Ineffective megakaryopoesis -Bl2/folate deficiency, myelodysplasia, EtOH
  3. Increased destruction:
    a. Immune -autoantibodies (ITP, SLE, some lymphomas), drug antibodies (quinidine, heparin, penicillin), infections (EBV, malaria, gram negative septicemia, HIV), suspected drug antibodies (thiazides, ASA, phenytoin), post-transfusion
    b. Nonimmune -DIC, pre-eclampsia, vasculitis, TTPIHUS
    c. Sequestration -Hypersplenism [Splenomegaly alone may dccrease pIt to 40 000 max. If lower, look for concomitant defects in production/destruction (lymphoma, autoimmune dz)]
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5
Q

DDX Meningitis

A

Meningeal Disorders
• Other infectious meningitides -CSF makes dx
o Aseptic (viral) -enteroviruses, mumps, CMV, HSV II, adenovirus, HIV
o Syphillis
o Fungal
o TB
• Meningeal neoplasm-neoplastic cells in CSF
• SAH

Parenchymal Disorders 
•	Viral encephalitis 
o	Often co-exists with viral meningitis 
o	Etiologies-arboviruses (mosquitoes), HSV I, HZV, EBV, rabies 
•	 Brain abscess 
•	Cerebral toxoplasmosis 
•	Bacterial endocarditis 
•	Toxic/metabolic encephalopathies 
•	Lyme Disease 
•	Post-infectious encephalomyelitis
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6
Q

DDX Acute renal failure

A

Prerenal

  1. Absolute decrease in effective blood volume
    a. Hemorrhage
    b. Bums
    c. Gl loss/Diarrhea
  2. Relative decrease in blood volume
    a. CHF (low cardiac output)
    b. Sepsis
    c. Liver failure/ Cirrhosis
    d. Third spacing
  3. Disordered autoregulation
    a. Meds: NSAIDs, ACEls/ARBs, Calcineurin inhibitors (cyclosporine, tacrolimus)
    b. Hypercalcemia

Renal

  1. Vascular
    a. Vasculitis (Post -infectious, Wegener’s, PAN, HSP, etc.)
    b. Malignant HTN
    c. Thrombotic microangiopathy
    d. Cholesterol emboli
    e. Large vessel disease
  2. Glomerular
    a. Acute glomerulonephritis (Post-infectious, Anti-basement membrane)
  3. Tubular
    a. Acute tubular necrosis (Ischemic vs Nephrotoxic)
    b. Exogenous: Aminoglycosides, Amphotericin B, Dyes, NSAIDs, ACEIs
    c. Endogenous: Hemoglobinuria, fuyoglobinuria, myeloma, uric acid, oxalate

Postrenal (especially if solitary kidney)

  1. Neurogenic
  2. Anatomic
    a. Ureter -Stones, Strictures
    b. Bladder -Prostatic hypertrophy, Bladder CA
    c. Urethra

** 70 -75% of cases are due to Prerenal and ATN

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7
Q

Precipitants/causes of DKA (7)

A
  1. Infection
  2. Infarction (stroke, MI)
  3. Ischemia
  4. Intra-abdominal (appendicitis, cholecystitis, peritonitis, pancreatitis)
  5. Iatrogenic (steroids, insulin dose)
  6. Incision
  7. Intoxication (ETOH, or other drugs)
  8. Initial presentation
  9. Insulin - Non compliance
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8
Q

DDX urethral discharge men (4)

A
  1. Neisseria Gonorrhea
  2. Chlamydia
  3. Non gonococcal urethritis (Chlaymydia)
  4. Syphilis
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9
Q

Causes of Urinary retention

A

Anatomic
1. Prostate: BPH, prostatitis, prostate Ca
2. Urethra: stricture/scarring, trauma
3. Other: Cystocele, fecal impaction, stone
Neurologic
4. Hypotonic bladder – DM, sacral cord lesions, spinal shock, disc herniation
5. Detrusor sphincter dysynergy – MS, suprasacral spinal cord lesions
6. Cauda Equina
Medications
7. Anticholinergic
8. Psychtopics
9. Narcotics
Infection
10. Infection: UTI can present as retention and overflow incontinence in elderly

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10
Q

Causes of Hematuria (10)

Hint: approach most common then Anatomic

A

Tumor, infection, Trauma, Stones
Peds: think GN and congenital anomalies

Pseudohematuria

  1. Dyes (beets, juices)
  2. Hemoglobin
  3. Myoglobin
  4. Drugs (Rifampin)
  5. Porphyria
  6. Menses

Pre-renal
7. Bleeding d/o, Anticoagulants, Sickle cell,

Tumor, infection, Trauma, Stones (Renal, ureter, bladder, urethra)

Renal
1.	Trauma
2.	Stones
3.	Carcinoma (RCC, TCC)
4.	Wilms Tumor
5.	Pyelonephritis
6.	Glomerulonephritis
7.	Intersitital Nephritis
8.	Tuberculosis
9.	PCOS
10.	Arteriovenous malformation
Ureter
11.	Stone
12.	Tumor
Bladder
13.	Cystitis
14.	Tumor
15.	Stones
16.	Polyps
Urethral
17.	Urethritis
18.	Stones
19.	Tumors
20.	Urethral stricture
21.	Granuloma
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11
Q

DDX unconscious patient

A

Drugs

  1. ETOH
  2. Toxins
  3. Amphetamines, Opiods, cocaine, TCA, OD’s
  4. Withdrawals

Infection

  1. Meningitis
  2. Encephalitis
  3. Sepsis

Metabolic

  1. Electrolytes (K, Na, Ca)
  2. TSH – thyrotoxicosis
  3. Adrenal insuff
  4. Hypoglycemia
  5. Hypoxia
  6. Hypercarbia
  7. Uremia

Structural

  1. Seizure
  2. Trauma (EDH, SDH, SAH, diffuse axonal injury, bilat cortical injury)
  3. SAH (non-traumatic)
  4. ICH
  5. Mass/ Incr ICP
  6. MI
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12
Q

Name 10 things that are dangerous causes of HA that dont show on CT

A
  1. CO poisoning
  2. Temporal arteritis
  3. Acute angle closure
  4. Cerebral venous thrombosis
  5. Cerebellar stroke
  6. Early stroke
  7. Late >6hr SAH
  8. Sential HA prior to index SAH
  9. Meningitis
  10. Encephalitis
  11. Optic neuritis
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13
Q

Causes of Parkinsonism (6)

A
  1. Drug induced (antipsychotics, antiemetics)
  2. Toxins: CO, organic solvents
  3. Head trauma
  4. Tumor
  5. Any brain lesion affecting striatonigral circuits
  6. Metabolic: hypoparathyroid, wilsons
  7. Infectious: Syphilus, Toxoplasmisos, prion disease
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14
Q

DDX Back pain (10)

A
  1. Trauma
  2. Cauda equina
  3. Cord compression (tumor, mass)
  4. Cancer, MM
  5. Discitis
  6. Osteomyelitis
  7. Epidural abcess
  8. Spinal stenosis
  9. Sciatica
  10. Spondylarthropathies (ankylosing spondylitis, reactive arthritis, enteropathic spondylitis)
  11. Ao Dissection
  12. AAA
  13. Pyelonephritis, renal colic, pancreatitis
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15
Q

What toxic ingestion can be diaylzed?

A 
ISTUMBLE
Isopropanol and other BBs (AANTS)
Salicyclates
Theophylline
Uremia
Methanol
Barbituates (phenobarbitol)
Lithium
Ethylene glycol

They have to have low protein binding, low molecular weight and water soluble (stays in blood) and low volume of distribution

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16
Q

DDx of hyperthermia?

A 
DINEEO
Drugs 
- cocaine
- sympathemetics (amphetamines)
- withdrawal sydromes
- Neuroleptic malignant syndrome
- Serotonin syndrome
- Anticholinergic syndrome
- Malignant hyperthermia

Infections

  • Meningitis
  • Encephalitis
  • Abscess
  • Sepsis
  • Typhoid, Malaria

Neurological

  • Hypothalamic stroke
  • Status epilepticus
  • Cerebral hemorrage

Environmental
- Heat, humidity

Endocrine

  • Pheochromocytoma
  • Thyroid storm
  • DKA

Oncologic
- Lymphoma, Leukemia

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17
Q

Ddx Non-AG metabolic acidosis?

A

HARDUP
or GI loss vs. Renal loss
Hyperalimentation - TPN
Acetazolamide
Renal tubular acidosis (Type I = distal, Type II = proximal, Type IV = hyporeninemic hypoaldosteronism)
Diarrhea
Uretosignmoid fistula (colon will waste bicarbonate)
Pancreatic fistula (because of alkali loss - the pancreas secretes a bicarbonate rich fluid)

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18
Q

Ddx High AG metabolic acidosis?

A 
MUDPILES
Methanol
Uremia
DKA
Paraldehyde/propylene glycol
Infection, Iron, Isoniazid
Lactate
Ethylene glycol
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19
Q

Ddx High Osmolar Gap?

A 
MAEDIE
Methanol
Acetone
Ethanol
Diuretics (mannitol, sorbitol)
Isopropanol
Ethylene glycol
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20
Q

Ddx VT (4)

A
  1. ACS
  2. Scarring (old infarct)
  3. Electrolytes (K, Ca, Mg)
  4. Hypoxia
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21
Q

DDx of Sick neonate (9)

A

Sepsis, Sepsis, Sepsis

T-Trauma (nonaccidental and accidental)
H-Heart disease/hypovolemia/hypoxia E-Endocrine (congenital adrenal hyperplasia, thyrotoxicosis)
M-Metabolic (electrolyte imbalance)
I-Inborn errors of metabolism: Metabolic emergencies
S-Sepsis (meningitis, pneumonia, urinary tract infection)
F-Formula mishaps (under- or overdilution) I-Intestinal catastrophes (volvulus, malrotation, intussusception, necrotizing enterocolitis) T-Toxins/poisons
S-Seizures

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22
Q

Causes of Afib (10)

A
  1. PE
  2. Ischemia
  3. Resp Dz - COPD
  4. Atrial enlargement
  5. TSH
  6. ETOH
  7. Sepsis
  8. HTN Cardiomyopathy
  9. Valvular dz
  10. CHF
  11. SSS
  12. Myocardial contusion
  13. Cardiac surgery
  14. Catecholamine excess
  15. Accessory pathway - WPW
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23
Q

Ddx Microcytic anemia (5)

A
  1. Fe Def anemia
  2. Thalassemia
  3. Anemia of Chronic dz
  4. Lead poisoning
  5. Sideroblastic anemia
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24
Q

Ddx Syncope (10)

Study These Flashcards
A

R/O seizure

  1. Neurologic:
    - Seizure
    - Stroke
    - Vasovagal
    - Situational syncope
    - Orthostatic HypoTN
    - Carotid sinus sensitivity
    - Autonomic neuropathy
  2. Cardiac:
    - Tachy or brady arrhythmia
    - AoStenosis
    - MI
    - HOCM
    - Cardiac Tamponade
    - Atrial myoma
    - Aortic dissection
    - WPW, ARVD, AVB,
  3. Pulmonary
    - PE
    - Hypoxia
    - Hypercapnia
  4. Non-cardiac:
    - hypovolemia
    - Drugs (ccb, bb, vasodilators, diuretics)
    - Autoimmune insuff (DM, AI, spinal cord lesion),
    - Hypoglycemia
    - Narcolepsy
    - Vertigo
25
Ddx Abdominal pain in peds (10)
1. Pyloric Stenosis 2. Malrotation 3. Mid gut volvulous (commonly rotates around SMA causing ischemia) 4. Appendicitis 5. Intusseception 6. Duodenal Atresia 7. Mesenteria adenitis 8. Constipation 9. Referred pain from pneumonia, UTI, Renal colic (RLL can mimic appy) 10. Gastroenteritis 11. PUD 12. DKA 13. Henoch-Schnlein purpura 14. Testicular Torsion (Check cremaster reflex) 15. Renal colic
26
Ddx normocytic anemia (3)
1. Anemia chronic disease 2. Hemolytic anemia 3. Acute hemorrage 4. Myelodysplasia 5. Infiltration (leukemia, myeloma, mets, infection) 6. Aplasia 7. Liver Dz 8. Uremia 9. Hyper/Hypothyroid 10. Treated nutritional def
27
Ddx macrocytic anemia (3)
1. Folate or B12 def 2. Reticulocytosis 3. ETOH 4. Liver Dz 5. Myelodysplasia 6. Drugs
28
Ddx Isolated elevated INR/PT? (3)
1. Warfarin 2. Vitamin K def 3. Liver Disease 4. Factor 7 def (inherited) 5. Factor 7 inhibitor
29
Ddx Elevated PTT (3)
1. Heparin 2. Hemophilias 3. vWF
30
Ddx Elevated INR and PTT (3)
1. Heparin and Warfarin 2. DIC 3. Liver disease 4. Deficiencies of prothrombin, fibrinogen, Factors V and X
31
Ddx agitated delirium (10)
DIMS DRUGS 1. Sympathemimometics/Stimulants: - Cocaine, amphetamines, methamphetamines - PCP, ketamine 2. Anticholinergics - Serotonin Syndrome - Sedative withdrawl syndrome INFECTION 3. Viral or bacterial meningitis, encephalitis METABOLIC/Endocrine 4. Hyponatremia, Hypercalemia 5. Hypoglycemia 6. Hypoxia 7. Uremia 8. Hyperammonia 9. Thyrotoxicosis STRUCTURAL 10. Trauma 11. Stroke 12. Hemorrhage 13. Mass
32
Ddx Fever in returning traveller (10)
1. Malaria 2. Typhoid 3. Dengue Fever 4. Meningitis 5. Rickettsial disease 6. Mononuecleosis (CMV, EBV) 7. Yellow Fever 8. Lassa Fever 9. Japanese encephalitis 10. Cysteriosis 11. Viral hemorragic fevers 12. Common infections (pnuemonia, UTI, gastroenteritis) 13. Hepatitis A,B,C 14. HIV 15. STIs- do GU exam
33
Ddx Vertigo (8)
1. Cerebellar stroke 2. Vertebrobasilar a. Insufficiency 3. Vertebral artery dissection 4. Multiple sclerosis 5. BPPV 6. Vestibular neuritis 7. Labyrinthitis 8. Ménière's disease
34
Ddx acute painful vision loss (5)
1. Acute angle closure glaucoma 2. Optic neuritis 3. Trauma 4. Uveitis 5. Temporal arteritis 6. Keratitis
35
Ddx painful red eye (8)
1. Acute angle closure glaucoma 2. Keratitis ( UV or ulceration) 3. Epi scleritis 4. Uveitis 5. Scleritis 6. Enopthalmitis 7. Conjunctivitis 8. Orbital cellulitis
36
Ddx acute painless vision loss (8)
1. Central retinal artery occlusion 2. Central retinal vein occlusion 3. Retinal detachment 4. Temporal arteritis 5. Amaurosis fugax (TIA) 6. Vitreous hemorrage 7. Macular degeneration (more insidious) 8. Optic neuritis (MS) 9. Papilledema 10. Opthalmic migraine 11. Vitreous detachment
37
Ddx hypertensive emergencies with 'toxicologic' characteristics (5)
1. Drug/Sympathomimetic OD 2. Anti-cholinergic 3. MAOI toxicity 4. Methylxanthine toxicity Non-toxicologic causes 5. Environmental hyperthermia 6. Febrile illness 7. Pheochromocytoma 8. Carcinoid syndrome 9. Thyroid Storm 10. Meningitis
38
Ddx Pinpoint pupils
1. Opiod overdose 2. Central pontine stroke (hemorrhage) 3. Organophosphate 4. Cholinergic syndrome (organophosphates) 5. Neurosyphilis apparently.. 6. Pilocarpine drops..
39
Ddx of Hyperkalemia (7)
1. Pseudohyperkalemia (due to hemolysis) 2. Decreased excretion - Renal failure - Renal secretory defects (interstitial nephritis, sickle cell) 3. Hypoaldosteronism: hyporeninism (type IV RTA) 4. Adrenal insuff 5. Drugs (spironolactone, Acei, NSAIDS) 6. K shift out of cells - Burns - Rhabdomyalysis - Hemolysis - Severe infection - Metabolic acidosis - Insulin deficiency 7. Hyperkalemic periodic paralysis 8. Drugs (digitalis toxicity, beta-adrenergic antagonists, suxx) 9. Iatrogenic
40
Ddx Bitemporal hemianopsia (3)
1. Pituitary tumor 2. Craniopharyngioma 3. Meningioma 4. Aneurysm of circle of willis 5. Metastatic carcinoma
41
Ddx Dyspnea (10)
CV 1. MI 2. CHF 3. Tamponade Pulmonary 4. PTX 5. Asthma 6. COPD 7. Pneumonia 8. PE 9. Aspiration 10. Anaphylaxis 11. Anemia 12. Acidosis
42
Ddx Hemoptysis (10)
1. Malignancy 2. Bronchiectasis 3. Lung abcess 4. Pulmonary AVM 5. CHF 6. Alveolar hemorrhage syndrome 7. Infection - Bacterial - Viral - TB - Fungal Inflammation 8. SLE 9. Goodpastures syndrome 10. Wegeners Granulomatosis
43
DDX intraocular HTN (>20mmHg) (3)
1. Glucoma 2. Suprachoroidal hemorrage 3. Retrobulbar space occupying tumor
44
Ddx Drug induced hyperthermia (7)
1. Malignant hyperthermia 2. NMS 3. Psychostimulants (cocaine, amphetamines,MDMA) 4. Anticholinergic toxicity 5. Serotonin syndrome 6. Salicyclate poisoning 7. Withdrawal syndromes (last 2 are more fever than hyperthermia)
45
Ddx severe HA (10)
1. SAH/ICH 2. Sub-dural hemorrage 3. Temporal arteritis 4. Meningitis 5. Migraine 6. Acute angle glucoma 7. Cerebral venous thrombosis 8. CO poisoning 9. Preeclampsia 10. Brain Tumor/ Increased ICP 11. Idiopathic intracranial HTN 12. Pseudotumor cerebri
46
Ddx Rash on palms and soles (6)
1. Syphilis (secondary) 2. Erythema multiforme/SJS (Drug rxn) 3. Hand, foot, mouth dz (Coksakie virus) 4. Rocky Mountain spotted fever 5. Kawasaki's 6. Atypical Measles 7. Toxic Shock syndrome 8. Meningococcemia may cause petichiae on the palms and soles. 9. Bacterial endocarditis with it's Janeway lesions and Osler's nodes. 10. Scabies 11. Tinea mannum 12. Atopic dermatitis
47
Ddx penile ulcer (3)
1. Syphilis 2. Herpes Simplex 3. Chancroid 4. Lymphogranuloma venereum 5. Bechet's syndrome 6. Neoplasm 7. Lichen Planus
48
Ddx Fever and ALOC
1. Infection - Sepsis - Meningitis - Encephalitis - Abcess - Tetanus - Typhoid - Malaria 2. Drug/Toxin - Psychostimulants(cocaine, amphetamines, MDMA) - Malignant hyperthermia - NMS - Anti-cholinergic syndrome - Serotonin syndrome - Salicyclate toxicity - Withdrawal syndromes 3. Neurologic - Hypothalamic stroke - Status Epilepticus - Cerebral hemorrage 4. Environmental - High temperature or humidity Endocrine - Thyroid storm - Pheochromocytoma - DKA 5. Oncologic - Lymphoma - Leukemia
49
Ddx ALOC (AEIOUTIPS)
``` A — Alcohol/Acidosis E — Endocrine Epilepsy Electrolytes (Na, K, Ca) I — Infection (Meningitis, Sepsis)/Insulin O — Oxygen, Opiates, Overdose U — Uremia T — Trauma/Toxins/Temperature I — Insulin/Infection P — Poisoning/Psychosis S —Stroke/Seizure/Space occupying lesions ``` Or DIMS Or Diffuse/Metabolic processes vs. Focal/ structural
50
4 categories of causes of mesenteric ischemia
1. Arterial mesenteric embolus (usu cardiac in origin) 2. Arterial mesenteric thrombus - 2ndary to atherosclerotic dz. 3. Venous mesenteric thrombus (least common) usu SMV - Thrombotic d/o (Factor V leiden, protein c/s, AT III) - Hypercoagulable state - Sickle cell crisis - Polycythemia 4. Non-occlusive - Hypovolemia/Shock - Pancreatitis - Sepsis - Drugs causing vasoconstriction
51
Ddx Vesiculobullous Rash (name 5, there are 10)
1. Herpes 2. Varicella 3. Dyshidrotic eczema 4. EM Major 5. SJS/TEN 6. SSSS 7. TSS 8. P. vulgaris 9. Meningococcemia/gonococcemia 10. Nec Fasc
52
Ddx Rash and joint pain (5)
1. HSP 2. Rockymountian spotted fever 3. Lyme Disease 4. Reactive arthritis/Reiter’s 5. Transient synovitis 6. Drug Reactions – including SJS/TEN 7. Rheumatic illnesses (SLE, IBD, Psoriatic, JIA, Ank spond…) 8. Dermatomyositis 9. Septic joint + sepsis
53
Ddx strawberry tongue (3)
1. Kawasaki 2. Scarlet fever 3. TSS/STSS
54
Ddx delirium (iwatchdeath)
I - Infectious: Sepsis, encephalitis, meningitis, syphilis, central nervous system abscess W -Withdrawal: Alcohol, barbiturates, sedative-hypnotics A- Acute metabolic: Acidosis, electrolyte disturbance, hepatic or renal failure, other metabolic disturbances (↑ or ↓ glucose,magnesium, calcium) T - Trauma Head trauma, burns C- CNS disease: Hemorrhage, stroke, vasculitis, seizures, tumor H- Hypoxia: Acute hypoxia, chronic lung disease, hypotension D- Deficiencies: Vitamin B12, hypovitaminosis, niacin, thiamine E- Environmental: Hypothermia, hyperthermia, Endocrinopathies (diabetes, adrenal, thyroid) A- Acute vascular: Hypertensive emergency, subarachnoid hemorrhage, sagittal vein thrombosis T- Toxins or drugs Medications, street drugs, alcohol, pesticides,industrial poisons (e.g., carbon monoxide, cyanide,solvents) H - Heavy metals Lead, mercury
55
Ddx ring enhancing lesion on CT with contrast (8)
``` DRMAGICL D - demyelinating disease (incomplete ring) R - radiation necrosis or resolving haematoma M - metastasis A - abscess G - glioblastoma multiforme I - infarct (subacute phase) C - contusion L - lymphoma ```
56
Ddx asterixis (3)
1. Hepatic encephalopathy 2. Hypercarbia 3. Uremic encephalopathy
57
DDX/ Great imitators of ruptured AAA | - when you diagnose these, think AAA...
1. Renal Colic 2. Diverticulitis 3. ACS 4. Perforated viscous 5. Bowel obstruction 6. Pancreatitis 7. Intestinal ischemia 8. Cholecyctitis 9. Appendicitis 10. MSK back pain
58
DDx Diplopia
Monocular: 1. Refractive error 2. Cataract/lens dislocation 3. Corneal scarring Biocular 1. NM junction - MG 2. Extra-ocular muscle restriction/entrapment - Orbital inflammation - Orbital tumor - Orbital Floor Fracture 3. Neuronal - Ischemia - DM - Aneurysm - Tumor - Graves opthalmopathy Complete CN 3 palsy - BAD CN 6 palsy - R/O incr ICP CN 4 palsy
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