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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
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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
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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
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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
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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
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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
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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,
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