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Symptoms and Signs – Differential Diagnosis of Atrophy Optic disc
Optic neuritis (MS)
Raised lntracranial pressure: 2' to long-standing papilloedema (e.g. tumours)
Toxic metabolic drugs: tobacco, alcohol, vitamin B12 deficiency, diabetes, ethambutol
Infection/infiltration: spread from sinuses, syphilis, sarcoid
Compression: intra-orbital (e.g. optic nerve tumours), tumour of pituitary or
sphenoid sinus, carotid aneurysm
Anterior ischaemic optic neuropathy
Trauma: orbital fracture, indirect trauma
Retinal disease: retinitis pigmentosa, macular degeneration
Occlusion of retinal artery
Raised Pressure inside the eye (glaucoma)
Hereditary: Leber's optic atrophy, hereditary ataxias, e.g. Friedreich's, DIDMOAD


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Symptoms and Signs – Differential Diagnosis of Ankle Oedema
Pitting, bilateral
Heart failure
Hypothyroidism
Iatrogenic: oestrogens, calcium channel blockers, fluid overload
Liver failure, other causes of hypoalbuminaemia: malnutrition, malabsorption,
nephrotic syndrome, protein-losing enteropathy
obstruction
Renal failure
Venous insufficiency: acute (prolonged sitting), chronic
Venous obstruction, e.g. pelvic mass, pregnancy, IVC/bilateral iliac vein
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Non-pitting Lymphoedema: primary, lymph node involvement: radiotherapy, infection
(filariasis), malignant infiltration, excision
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Symptoms and Signs – Differential Diagnosis of Nystagmus
Physiological: at the extreme lateral gaze
Pendular {to-and-fro movements have equal velocity): congenital
Jerky (slow-phase and fast phase are present):
Acute labyrinthitis, other inner ear (labyrinth/vestibular nerve) diseases, e.g.
Meniere's disease, benign positional vertigo (otoconial debris in semicircular
canals), vestibular neuronitis, acoustic neuroma
Brainstem/vestibular nuclei: vascular (CVA), inflammation (multiple sclerosis,
tumour), toxic (alcoholism)
Cerebellar disease (See Cerebellar signs)
Drugs (e.g. phenytoin)
Nystagmus is also seen in internuclear ophthalmoplegia (l adduction on the side
of lesion, nystagmus of the contralateral abducting eye)


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Symptoms and Signs – Differential Diagnosis of Nipple discharge
Blood-stained: intraductal carcinoma, intraductal papilloma, Paget's disease of the nipple
Milky: late pregnancy, lactation, puberty, hyperprolactinaemia
purulent: mastitis, breast abscess, TB (rare)
Yellow/green: duct ectasia, fibrocystic disease


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Symptoms and Signs – Differential Diagnosis of Night sweats
Symptoms and Signs – Differential Diagnosis of Infections: chronic infections, e.g. TB, subacute bacterial infections (e.g. endocarditis, osteomyelitis), others: HIV, histoplasmosis
Malignancy, e.g. lymphoma, solid tumours
Medications: GnRH agonists, antidepressants
Menopause



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Symptoms and Signs – Differential Diagnosis of Neck Swelling
Midline
Hard: bony tumour or plasmacytoma
Lymph nodes
Manubrium swelling:
Pulsatile: eroding aortic aneurysm
Rare: sublingual dermoid cyst, pharyngeal pouch, plunging ranula, subhyoid bursa, laryngeal/tracheal/oesophageal carcinoma
Soft: lipoma
Thyroglossal cyst
Thyroid gland swelling

Anterior triangle

Branchial cyst
Carotid body aneurysm
Carotid body tumour
Lymph nodes, cold abscess (TB)
Salivary gland {submandibular/parotid) swelling
Sternomastoid tumour

Posterior triangle
Cystic hygroma
Lymph nodes, cold abscess {TB)
Subclavian artery aneurysm
Tumour of clavicle


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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.