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Symptoms and Signs – Differential Diagnosis of Visual loss
Sudden
Unilateral
Amaurosis fugax
Central retinal vein occlusion Central retinal artery occlusion Vitreous haemorrhage
Retinal detachment
Giant cell arteritis
Optic neuritis
Bilateral
Severe bilateral papilloedema (malignant hypertension, ii intracranial pressure)
Rapid progression of a lesion compressing the optic chiasm Bilateral infarcts of occipital lobes
Bilateral optic neuritis (rare)

Gradual
Cataracts
Glaucoma
Diabetic retinopathy
Macular degeneration (age-related) Optic nerve compression



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Symptoms and Signs – Differential Diagnosis of Vomiting
Drugs, poisoning, alcohol
Abdominal pathology (gastrointestinal, hepatic, gynaecological) Metabolidendocrine: diabetic ketoacidosis, Addisonian crisis, hypercalcaemia,
uraemia, pregnancy
Neurological: increased intracranial pressure (infection, space-occupying lesion,
benign intracranial hypertension), acute labyrinthitis Acute angle closure glaucoma



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Symptoms and Signs – Differential Diagnosis of Urgency
UTI
Bladder: stone, tumour, compression by pelvic mass
Prostate enlargement (BPH, cancer}
Genuine stress incontinence
detrusor instability
sensory urgency


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Symptoms and Signs – Differential Diagnosis of Urinalysis
Urine
colour Red/brown
Haematuria
Haemoglobinuria
Myoglobinuria
Beetroot
Porphyria
Phenazopyridine

Rare
White: pyuria, phosphate crystals
Green: methylene blue, amitryptiline, propofol Dark: obstructive jaundice, ochronosis, malignancy
Orange: rifampicin

Urine leukocyte esterase
Urinary tract infection Vaginal contaminant

Urine nitrite
Urinary tract infection Gross haematuria

Urine specific gravity
Increased
Dehydration (e.g. diarrhoea, vomiting) Diabetes mellitus
Adrenal insufficiency
Heart failure
Liver disease X-ray contrast

Decreased
Diabetes insipidus
Excessive hydration
Renal failure


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Symptoms and Signs – Differential Diagnosis of Urinary incontinence
Stress incontinence
Females: pelvic floor weakness/bladder neck descent (pregnancy, vaginal
delivery, obesity, menopause)
Males: prostate surgery (external urethral sphincter damage)
Urge incontinence
Detrusor instability (idiopathic, secondary to bladder outflow obstruction, loss of supra-spinal inhibition with UMN lesions, e.g. CVA, MS, cord compression: disc lesions/spinal tumours, spinal cord/head injury)
Bladder stone, tumour, infection (cystitis)
Continuous incontinence
Chronic retention/overdistension/overflow:
Outflow obstruction (see urinary retention)
Bladder atonia due to damage to 52, 53, 54 parasympathetic fibres in lower
spinal cord, caucfa equina or pelvis, diabetic autonomic neuropathy Fistula (e.g. vesicovaginal) secondary to obstructed labour, surgery,
malignancy, radiotherapy
Note: Detrusor instability and chronic retention/overdistension of bladder can
also cause stress incontinence.


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Symptoms and Signs – Differential Diagnosis of Acute Urinary Retention
Males
Prostatic hyperplasia/carcinoma
Obstruction of urethral lumen/bladder neck (stricture, stone, tumour, blood clot) Post-operative*
Medication:, e.g. anticholinergics, antidepressants, alcohol
Neurological: multiple sclerosis, spinal cord disease, e.g. injury/compression,
diabetic autonomic neuropathy
Females
Pelvic mass: fibroids, ovarian mass, pregnancy (and trauma of labour) Obstruction of urethral lumen/bladder neck (stone, tumour, blood clot)
Post-operative*
Medication:, e.g. anticholinergics, antidepressants, alcohol
Neurological: multiple sclerosis, spinal cord disease, e.g. injury/compression,
diabetic autonomic neuropathy



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Symptoms and Signs – Differential Diagnosis of Urinary tract obstruction
In the lumen: stones, tumour, blood clots, sloughed renal papillae (NSAIDs, diabetes mellitus, sickle cell)
In the wall: stricture (ureteridurethral), defective peristalsis, neuropathic bladder Pressure from the outside: prostatidpelvic mass, retroperitoneal fibrosis, phimosis



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Symptoms and Signs – Differential Diagnosis of Urine microscopy
Bacteria
Urinary tract infection
Asymptomatic bacteriuria
Contamination

​Casts Epithelial cell casts: acute glomerulonephritis, acute tubular necrosis
Fatty casts: moderate/heavy proteinuria
Granular casts, finely granulated: concentrated urine, diuretics (loop), exercise,
fever
Granular casts, densely granulated: glomerulonephritis, interstitial nephritis,
diabetic nephropathy, amyloidosis
Hyaline casts: same as finely granulated granular casts
Red cell casts: glomerulonephritis, vasculitis, malignant hypertension
Waxy casts: advanced renal failure
White cell casts: pyelonephritis, proliferative glomerulonephritis

Cells
White cells: UTI (pyelonephritis, cystitis, urethritis), pyuria without bacteriuria: culture inhibited by antibacterial agent or wrong growth condition for fastidious organisms, TB, renal/bladder calculi, glomerulonephritis, interstitial nephritis, analgesic nephropathy, chemical cystitis
Red cell
Tumour cells: Genitourinary malignancy e.g. bladder cancer, infiltration of renal
parenchyma e.g. lymphoma
Crystals
Calcium oxalate (dumbbell-shaped, envelope-shaped, needle-shaped) Calcium phosphate
Cystine (hexagonal shape)
Magnesium ammonium phosphate (coffin-lid-shaped)
Uric acid (rhombic plates, rosettes)





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Symptoms and Signs – Differential Diagnosis of Uveitis
Inflammatory/Connective tissue diseases: Seronegative spondylarthropathies: (reactive arthritis, enteropathic (inflammatory bowel disease), ankylosing spondylitis, psoriatic arthritis), sarcoidosis, Bechet's desease, juvenile chronic
arthritis
Infection: CMV, toxoplasmosis, post-operative infection, fungal, herpetic, TB,
syphilis, Toxocara
Ocular disease: e.g. sympathetic ophthalmitis, intraocular tumours


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Kembara Xtra 

Facts about medicine and its subtopic such as anatomy, physiology, biochemistry, pharmacology, medicine, pediatrics, psychiatry, obstetrics and gynecology and surgery.