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Symptoms and Signs – Differential Diagnosis of Impotence
Psychological (patients may have morning erections)
Neurological: autonomic neuropathy (e.g. diabetes mellitus, uraemia), nerve damage after bladder neck/prostate surgery, multiple sclerosis Vascular disease (e.g. atherosclerosis)
Endocrine disorders: hypogonadism/androgen deficiency, hyperthyroidism, prolactinomas, acromegaly
Drugs: alcohol, antidepressants, beta -blockers, cannabis, diuretics (spirinolactone), major tranquilizers


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Symptoms and Signs – Differential Diagnosis of Hypothyroidism
Primary
Congenital: athyreosis, dyshormogenesis, iodide deficiency
Acquired:
Autoimmune (Hashimoto's thyroiditis}
Iatrogenic (surgery, radio-iodine, drugs, e.g. amiodarone, Lithium,
thionamides)
Iodide deficiency/excess

Secondary
Hypothalamidpituitary disease


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Symptoms and Signs – Differential Diagnosis of Hypotension
Septicaemia

Hypovolaemia:
Haemorrhage
GI loss
Renal loss (diuretic, diabetes mellitus, diabetes insipidus, post-obstructive
diuresis, acute renal failure
Cutaneous loss (exudative lesions, burns)
Adrenal insufficiency


Cardiovascular:
Any condition that reduced cardiac output, e.g. arrhythmias, reduced diastolic filling
(pericardial disease), myocardial disease, outflow obstruction

Postural hypotension
Volume depletion

Autonomic neuropathy:

Metabolic: diabetes mellitus, amyloidosis (rare}, drugs (tricyclics, L-dopa}

Inflammation: Guillain-Barre syndrome

Infection: HIV, syphilis

Tumours: paraneoplastic (e.g. small cell lung cancer}, hypothalamic

Degenerative: Parkinson's disease, multiple system atrophy, Shy-Drager
Syndrome

Familial dysautonomia (Riley-Day syndrome}

Drugs: Antihypertensives, diuretics, nitrates, antidepressants, sedatives

Leg vein insufficiency



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Symptoms and Signs – Differential Diagnosis of Hypophosphataemia
Redistribution into cells
Increased insulin e.g. recovery from diabetic ketoacidosis (treatment with insulin stimulates glycolysis and phosphate uptake by the cells), refeeding (e.g. in alcoholics)
Respiratory alkalosis (alkalosis stimulates glycolysis and phosphate uptake by the cells)
Hungry bone syndrome (following parathyroidectomy in patients with preexisting osteopenia): due to marked deposition of Ca2+ and phosphate in bone

Gastrointestinal
Phosphate binders, e.g. aluminum/magnesium-containing antacids
Diarrhoea (chronic)
Reduced Dietary intake

Renal
Hyperparathyroidism (1° & 2°):increased urinary excretion
Vitamin D deficiency/resistance (both by reduced GI absorption and by causing
hypocalcaemia and 2° hyperparathyroidism)
Hereditary hypophosphataemic rickets (X-linked, autosomal dominant), tumourinduced
osteomalacia
Osmotic diuresis, e.g. glycosuria
Fanconi syndrome



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Symptoms and Signs – Differential Diagnosis of Hypopyon
Trauma, surgery
Malignancy: necrosis of intraocular tumours/metastases (e.g. leukaemia,
lymphoma, retinoblastoma)
Inflammation: anterior uveitis (See Uveitis)
Infection: endophthalmitis, corneal ulcers



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Symptoms and Signs – Differential Diagnosis of Hypopituitarism
Vascular: pituitary apoplexy (infarction/haemorrhage), Sheehan's syndrome
Pituitary tumour
Pituitary surgery/radiation
Mutations: e.g. Pit-1, Prop-1
Infection: meningitis/encephalitis, syphilis (rare) Inflammation/infiltration: TB, sarcoidosis, lymphoma, abscess, histiocytosis X,
Hypothalamic: anorexia, severe exercise, starvation
haemochromatosis, lymphocytic hypophysitis


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Symptoms and Signs – Differential Diagnosis of Hypogammaglobulinaemia
Congenital
X-linked, or as part of a combined immunodeficiency state

Acquired
Leukaemia (CLL)
Lymphoma
Marrow hypoplasia, myeloclerosis
Myeloma
Nephrotic syndrome, malnutrition, malabsorption, protein-losing enteropathy
Uraemia, steroids, severe infections






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Symptoms and Signs – Differential Diagnosis of Hypoglycaemia
Addison's disease
Alcohol
Excess insulin (or diabetics not having a snack after insulin injection), sulphonylureas, salicylate, pentamidine, quinine
Liver failure
lnsulinomas, hepatomas, sarcomas
Malaria
Post-gastrectomy
Renal failure


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Symptoms and Signs – Differential Diagnosis of Hypocalcaemia
Vitamin D resistance
Vitamin D deficiency
Surgical (after thyroidectomy or parathyroidectomy)
Respiratory alkalosis
Renal failure
reduced Mg2+, Fe2+ overload, increase Cu2+ (Wilson's disease)
Reduced Dietary intake/malabsorption
Pseudohypoparathyroidism (resistance to PTH)
Pancreatitis (acute)
Others
Liver disease
Lack of sunlight
Increase Phosphate: chronic renal failure, phosphate therapy
Iatrogenic: bisphosphonates, calcitonin, citrated blood (massive transfusion)
Hypoparathyroidism
Hypoalbuminaemia
Congenital (DiGeorge's syndrome)
Autoimmune
Artifact (collecting blood into an EDTA tube)
Anticonvulsants (e.g. phenytoin)



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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.