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Differential Diagnosis

Main Hx finding: nape pain, temporal


headache
Main PE finding: BP 160/90

Possibilities –
• Pain  high BP (sympathetic
activation)
• High BP  pain (symptomatology of
HPN)
Main Differential Diagnoses
Differentials Rule In Rule Out
Musculoskeletal pain: Nape pain Is it exacerbated by
bursitis, cervical spine movement?
arthritis, myofascial Any stiffness?
pain syndrome, Any inflammatory
fibromyalgia S/Sx?
Distribution
(myofascial trigger
points, widespread in
Psychogenic pain Nape pain, headache fibromyalgia)?
Should not be
Deformity?
relieved by rest.
More common in
Cardiovascular Pain referred to nape females.
Headache (pain
causes: acute above the mandible)
coronary syndromes, makes it unlikely.
pericarditis, aortic Normal X-ray, ECG.
dissection
Main Differential Diagnoses
Differentials Rule In Rule Out
Pulmonary causes : Pain referred to nape Weight loss?
TB (apices and nape S/Sx of infection?
share innervation). Normal X-ray.
Neurologic causes: Nape pain, headache Neurologic S/Sx?
meningitis,
intracranial tumor,
Neurologic cause:
hydrocephalus Headache as Usually female.
migraine throbbing, temporal No aura (increased
discomfort; may also tearing, photopsia)?
involve
Hypertension, Stage 2 Nape nape.
pain Cannot be ruled out.
Temporal headache (2
other distributions –
fronto-parietal and
occipital spreading
over head)
Blurring of vision
Dizziness
Main Differential Diagnoses
Differential Rule In Rule Out
Dyslipidemia LDL > 100 mg/dL Cannot be ruled out.
(162 mg/dL)
TG > 150 mg/dL (184
mg/dL)
Metabolic syndrome BP of at least 130/85 Abdominal obesity –
*Must fulfill at least 3 mmHg male waist
out of 5 JNC7 criteria TG >150 mg/dL circumference > 40
in.?
Fasting glucose 105
mg/dL (must be > 110
mg/dL)
HDL 55 (must be <40
mg/dL in men)
Differential Diagnoses for
Hypertension
Differentials Rule In Rule Out
Renal: GN, RAS, renin- Elevated BP reading GN –
producing tumors, RAS – no
polycystic kidneys murmurs/bruits?
Tumor –
Endocrine: Cushing’s, Elevated BP reading Polycystic –kidney
Cushing’s abdominal

oral contraceptive striae, etc.?
use, thyrotoxicosis, OCP – Not
myxedema, transgender using
pheochromocytoma, OCP to augment
acromegaly breasts?
Thyrotoxicosis,
myxedema – thyroid
function tests?
Acromegaly –
appearance of
extremities, oral
glucose test?
Differential Diagnoses for
Hypertension
Differentials Rule In Rule Out
Vascular: coarctation Elevated BP reading CoA – BP readings of
of the aorta, other extremities?
polyarteritis nodosa, PAN –
aortic insufficiency Aortic insufficiency –
no heaves, thrills,
murmurs and apex
beat not displaced; X-
ray, ECG normal.
Essential hypertension Elevated BP reading Most common
Diagnosis of exclusion
Working Impression

• Essential hypertension, t/c secondary


causes
• Dyslipidemia, r/o metabolic
syndrome

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