​Symptoms and Signs – Differential Diagnosis of Varicose Veins
CONDITIONS THAT CAN LEAD TO SUPERFICIAL VENOUS
STASIS OTHER THAN PRIMARY VALVULAR
INSUFFICIENCY
• Arterial occlusive disease
• Carcinoma
• Deep vein thrombophlebitis
• Diabetes
• Peripheral neuropathies
• Unusual infections

​Symptoms and Signs – Differential Diagnosis of Vertebral Compression Fractures
• Granulomatous diseases (e.g., tuberculosis)
• Hematologic/oncologic diseases (e.g., multiple myeloma, malignant neoplasm)
• Hyperparathyroidism
• Osteomalacia

​Symptoms and Signs – Differential Diagnosis of Ventricular Septal Defect
OTHER CAUSES OF SYSTOLIC MURMURS
• Mitral regurgitation
• Aortic stenosis
• Asymmetric septal hypertrophy
• Pulmonary stenosis

​Symptoms and Signs – Differential Diagnosis of Venous Leg Ulcers
• Basal cell carcinoma or squamous cell carcinoma
• Decubitus ulceration (due to pressure over a bone prominence)
• Diabetic ulceration (often secondary to neuropathy)
• Necrotic ulceration from infection
• Peripheral arterial disease (with ischemia and necrosis)
• Vasculitis (with erythema and bullae)

​Symptoms and Signs – Differential Diagnosis of Venous Lake
• Angiokeratoma
• Blue nevus
• Hemangioma
• Melanoma
• Melanosis of buccal mucosa

​Symptoms and Signs – Differential Diagnosis of Granulomatous Vasculitis
• Wegener’s granulomatosis
• Lymphomatoid granulomatosis
• Behçet’s syndrome
• Kawasaki’s disease (mucocutaneous lymph node syndrome)
PREDOMINANTLY SMALL-VESSEL DISEASE
Hypersensitivity Vasculitis (Leukocytoclastic Vasculitis)
• Henoch-Schönlein purpura
• Mixed cryoglobulinemia
• Serum sickness
• Vasculitis associated with connective tissue diseases (systemic lupus erythematosus [SLE], Sjögren’s syndrome)
• Vasculitis associated with specific syndromes: primary biliary cirrhosis, Lyme disease, chronic active hepatitis, drug-induced vasculitis
• Churg-Strauss syndrome
• Goodpasture’s syndrome
• Erythema nodosum
• Panniculitis
• Buerger’s disease (thrombophlebitis obliterans) Vasculitis, Diseases That Mimic Vasculitis
EMBOLIC DISEASE
• Infectious or marantic endocarditis
• Cardiac mural thrombus
• Atrial myxoma
• Cholesterol embolization syndrome
NONINFLAMMATORY VESSEL WALL DISRUPTION
• Atherosclerosis
• Arterial fibromuscular dysplasia
• Drug effects (vasoconstrictors, anticoagulants)
• Irradiation
• Genetic disease (neurofibromatosis, Ehlers-Danlos syndrome)
• Amyloidosis
• Intravascular malignant lymphoma
DIFFUSE COAGULATION
• Disseminated intravascular coagulation (DIC)
• Thrombotic thrombocytopenic purpura
• Hemolytic-uremic syndrome
• Protein C and S deficiencies, factor V Leiden mutation
• Antiphospholipid syndrome

​Symptoms and Signs – Differential Diagnosis of Ventricular Failure
LEFT VENTRICULAR FAILURE
• Systemic hypertension
• Valvular heart disease (aortic stenosis [AS], atrial regurgitation
[AR], mitral regurgitation [MR])
• Cardiomyopathy, myocarditis
• Bacterial endocarditis
• Myocardial infarction
• Idiopathic hypertrophic subaortic stenosis
RIGHT VENTRICULAR FAILURE
• Valvular heart disease (mitral stenosis)
• Pulmonary hypertension
• Bacterial endocarditis (right sided)
• Right ventricular infarction
BIVENTRICULAR FAILURE
• Left ventricular failure
• Cardiomyopathy
• Myocarditis
• Arrhythmias
• Anemia
• Thyrotoxicosis
• Arteriovenous fistula
• Paget’s disease
• Beriberi

​Symptoms and Signs – Differential Diagnosis of Urine Casts
• Acute tubular necrosis
• Allograft rejection
• Chronic renal disease
• Eclampsia
• Glomerulonephritis
• Heavy metal ingestion
• Hypothyroidism
• Interstitial nephritis
• Nephritic syndrome
• Nephrotic syndrome
• Normal finding
• Pyelonephritis

​Symptoms and Signs – Differential Diagnosis of Tumor Markers Elevation
Causes of elevated levels of tumor markers:
CARCINOEMBRYONIC ANTIGEN (CEA)
• Colonic cancer (higher levels if the tumor is more differentiated or is extensive or has spread to the liver)
• Lung or breast cancer; seminoma
• Cigarette smokers
• Cirrhosis, inflammatory bowel disease, rectal polyps, pancreatitis
• Advanced age
ALPHA-FETOPROTEIN
• Hepatocellular cancer: very high titers or a rising titer is strongly suggestive, but >10% of patients do not have an elevated level
• Hepatic regeneration (e.g., cirrhosis, alcoholic or viral hepatitis)
• Cancer of the stomach, colon, pancreas, or lung
• Teratocarcinoma or embryonal cell carcinoma (testis, ovary, extragonadal)
• Pregnancy
• Ataxia-telangiectasia
• Normal variant
PROSTATE-SPECIFIC ANTIGEN
• Prostate carcinoma (localized disease)
• Prostatic hyperplasia
• Prostatitis
• Prostatitic infarction
CANCER-ASSOCIATED ANTIGEN (CA19-9)*
• Pancreatic carcinoma (80% with advanced, well-differentiated cancer have an elevated level)
• Other gastrointestinal cancers: colon, stomach, bile duct
• Acute or chronic pancreatitis
• Chronic liver disease
• Biliary tract disease

​Symptoms and Signs – Differential Diagnosis of Turner’s Syndrome
• Noonan’s syndrome, an autosomally dominant inherited disorder also characterized by loose nuchal skin, midface hypoplasia, canthal folds, and stenotic cardiac valvular defects and affecting males and females equally; also have normal chromosome constitutions
• Other conditions in the differential diagnosis of loose skin, whether or not associated with edema:
• Fetal hydantoin syndrome (loose nuchal skin, midface hypoplasia, distal digital hypoplasia)
• Disorders of chromosome constitution (trisomy 21, tetrasomy 12p mosaicism)
• Congenital lymphedema (Milroy’s edema)