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Symptoms and Signs – Differential Diagnosis of Cyanosis
Cyanosis
Central
Reduced Oxygen transfer due to lung disease: fibrosing alveolitis, severe pneumonia,
COPD, massive pulmonary embolism
R ---> L shunt (cyanotic congenital heart disease)
Methaemoglobinaemia, sulfhaemoglobinaemia
Acute: asthma, pneumothorax, inhaled foreign body, left ventricular failure
Peripheral
All causes of central cyanosis
Cold exposure
Raynaud's phenomenon
Arterial occlusion
Reduced Cardiac output e.g. shock, left ventricular failure
Cyanosis
Central
Reduced Oxygen transfer due to lung disease: fibrosing alveolitis, severe pneumonia,
COPD, massive pulmonary embolism
R ---> L shunt (cyanotic congenital heart disease)
Methaemoglobinaemia, sulfhaemoglobinaemia
Acute: asthma, pneumothorax, inhaled foreign body, left ventricular failure
Peripheral
All causes of central cyanosis
Cold exposure
Raynaud's phenomenon
Arterial occlusion
Reduced Cardiac output e.g. shock, left ventricular failure
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Symptoms and Signs – Differential Diagnosis of Dactylitis
Psoriatic arthritis
Gonococcal arthritis
Sickle cell (bone marrow infarction}
Sarcoid (bone cysts}
Psoriatic arthritis
Gonococcal arthritis
Sickle cell (bone marrow infarction}
Sarcoid (bone cysts}
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Symptoms and Signs – Differential Diagnosis of Deafness
Conductive
Eardrum: perforation, cholesteatoma (chronic otitis media)
Middle ear effusion (secondary to infection or malignancy)
Otosclerosis, ossicular abnormality
Wax in the canal
Sensorineural
Congenital: maternal rubella, eclampsia, perinatal hypoxia
Degenerative: presbyacusis
Genetic: e.g. Alpert syndrome, Waardenburg syndrome, DIDMOAD
Infection: measles, mumps, meningitis, syphilis (rare}
Meniere's disease, Paget's disease of bone
Toxic: aminoglycosides, cytotoxic drugs, frusemide
Trauma: noise, head injury, surgery
Tumour: acoustic neuroma
Conductive
Eardrum: perforation, cholesteatoma (chronic otitis media)
Middle ear effusion (secondary to infection or malignancy)
Otosclerosis, ossicular abnormality
Wax in the canal
Sensorineural
Congenital: maternal rubella, eclampsia, perinatal hypoxia
Degenerative: presbyacusis
Genetic: e.g. Alpert syndrome, Waardenburg syndrome, DIDMOAD
Infection: measles, mumps, meningitis, syphilis (rare}
Meniere's disease, Paget's disease of bone
Toxic: aminoglycosides, cytotoxic drugs, frusemide
Trauma: noise, head injury, surgery
Tumour: acoustic neuroma
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Symptoms and Signs – Differential Diagnosis of Delirium (acute confusional state)
Dementia
Drugs: opiates, anticholinergics, anxiolytics, anticonvulsants, corticosteroids, digoxin, dopaminergic agonists, recreational drugs
Epilepsy: status epilepticus, post-ictal states
Hypertensive encephalopathy
Hypoglycaemia
Hypoxia (respiratory/cardiac failure)
Infection: lntracranial (meningitis, encephalitis, abscess, cerebral malaria, neurocysticercosis}, Extracranial: chest infection, urinary infection (esp. elderly}, surgical wounds, IV lines
Inflammation: vasculitis
Metabolic: liver failure, renal failure, electrolyte imbalances (e.g. hyponatraemia, hypercalcaemia}, endocrinopathies, nutritional deficiencies (B 12, nicotinic acid,
thiamine}
Toxic: alcohol (withdrawal, Wernicke's encephalopathy}
Trauma: head injury, subdural haematoma
Tumour: space-occupying lesions
Vascular: intracranial bleeding, infarction, venous sinus thrombosis
Dementia
Drugs: opiates, anticholinergics, anxiolytics, anticonvulsants, corticosteroids, digoxin, dopaminergic agonists, recreational drugs
Epilepsy: status epilepticus, post-ictal states
Hypertensive encephalopathy
Hypoglycaemia
Hypoxia (respiratory/cardiac failure)
Infection: lntracranial (meningitis, encephalitis, abscess, cerebral malaria, neurocysticercosis}, Extracranial: chest infection, urinary infection (esp. elderly}, surgical wounds, IV lines
Inflammation: vasculitis
Metabolic: liver failure, renal failure, electrolyte imbalances (e.g. hyponatraemia, hypercalcaemia}, endocrinopathies, nutritional deficiencies (B 12, nicotinic acid,
thiamine}
Toxic: alcohol (withdrawal, Wernicke's encephalopathy}
Trauma: head injury, subdural haematoma
Tumour: space-occupying lesions
Vascular: intracranial bleeding, infarction, venous sinus thrombosis
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Symptoms and Signs – Differential Diagnosis of Dehydration
GI loss: diarrhoea, vomiting
Polyuria (e.g. diabetes mellitus, diabetes insipidus, hypercalcaemia)
Pyrexia/excess sweating
Reduced Fluid intake: severe illness, anorexia, malnutrition
GI loss: diarrhoea, vomiting
Polyuria (e.g. diabetes mellitus, diabetes insipidus, hypercalcaemia)
Pyrexia/excess sweating
Reduced Fluid intake: severe illness, anorexia, malnutrition
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Symptoms and Signs – Differential Diagnosis of Dysarthria
Defective co-ordination between the nerves: internuclear ophthalmoplegia
Extra-ocular muscle disease (dysthyroid eye disease, myasthenia gravis, ocular
myopathy, ocular myositis)
Orbital fracture
Defective co-ordination between the nerves: internuclear ophthalmoplegia
Extra-ocular muscle disease (dysthyroid eye disease, myasthenia gravis, ocular
myopathy, ocular myositis)
Orbital fracture
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Symptoms and Signs – Differential Diagnosis of Diplopia
Monocular
Originates from cornea or lens, e.g. cataract
Binocular
Cranial nerve palsies (111, IV, VI)
Monocular
Originates from cornea or lens, e.g. cataract
Binocular
Cranial nerve palsies (111, IV, VI)
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Symptoms and Signs – Differential Diagnosis of Dimorphic blood film
Liver disease
Mixed iron and B12'folate deficiency
Partially treat iron deficiency
Post-gastrectomy
Post-transfusion
Sideroblastic anaemia
Liver disease
Mixed iron and B12'folate deficiency
Partially treat iron deficiency
Post-gastrectomy
Post-transfusion
Sideroblastic anaemia
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Symptoms and Signs – Differential Diagnosis of Digital gangrene
Emboli
Inadvertent intra-arterial injection in IV drug users
Peripheral vascular disease, diabetes mellitus, Buerger's disease
Subclavian artery compression (e.g. cervical rib)
Vasculitis, e.g. rheumatoid arthritis, polyarteritis nodosa, cryoglobulinaemia
Vasospasm: Raynaud's phenomenon
Emboli
Inadvertent intra-arterial injection in IV drug users
Peripheral vascular disease, diabetes mellitus, Buerger's disease
Subclavian artery compression (e.g. cervical rib)
Vasculitis, e.g. rheumatoid arthritis, polyarteritis nodosa, cryoglobulinaemia
Vasospasm: Raynaud's phenomenon
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Symptoms and Signs – Differential Diagnosis of Diarrhoea
Endocrine: thyrotoxicosis, diabetes mellitus (autonomic neuropathy), VIPomas (Verner-Morrison syndrome)
Infection: Viral (rotavirus, astrovirus, adenovirus, small round structured virus), Camylobacter, Salmonella, Shigella, E. coli, Yersinia enterocolitica,
Inflammatory bowel disease
Malabsorption: small intestine disease/resection
Medication: laxatives, antibiotics
Overflow diarrhoea: secondary to constipation
Parasites (Cryptosporidia, Giardia, Entamoeba histolytica), AIDS (AIDS enteropathy, Cryptosporidia, Microsporidia, CMV)
Staphylococcus .aureus, Bacillus cereus, Clostridium botulinum, Clostridium perfringens, Clostridium difficile, Vibrio cholerae, Vibrio parahaemolyticus,
Endocrine: thyrotoxicosis, diabetes mellitus (autonomic neuropathy), VIPomas (Verner-Morrison syndrome)
Infection: Viral (rotavirus, astrovirus, adenovirus, small round structured virus), Camylobacter, Salmonella, Shigella, E. coli, Yersinia enterocolitica,
Inflammatory bowel disease
Malabsorption: small intestine disease/resection
Medication: laxatives, antibiotics
Overflow diarrhoea: secondary to constipation
Parasites (Cryptosporidia, Giardia, Entamoeba histolytica), AIDS (AIDS enteropathy, Cryptosporidia, Microsporidia, CMV)
Staphylococcus .aureus, Bacillus cereus, Clostridium botulinum, Clostridium perfringens, Clostridium difficile, Vibrio cholerae, Vibrio parahaemolyticus,