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Symptoms and Signs – Differential Diagnosis of Postmenopausal Bleeding
• Atrophic vaginitis
• Extragenital (GI, urinary)
• Hormone replacement therapy
• Neoplasm (uterine, ovarian, cervical, vaginal, vulvar)
• Polyp
• Tamoxifen
• Trauma
• Vaginal infection
• Atrophic vaginitis
• Extragenital (GI, urinary)
• Hormone replacement therapy
• Neoplasm (uterine, ovarian, cervical, vaginal, vulvar)
• Polyp
• Tamoxifen
• Trauma
• Vaginal infection
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Symptoms and Signs – Differential Diagnosis of Postpoliomyelitis Syndrome
• Adult spinal muscular atrophy
• Amyotrophic lateral sclerosis
• Cervical and lumbosacral radiculopathy
• Chronic inflammatory demyelinating polyneuropathy
• Connective tissue disease–associated myopathies
• Diabetic amyotrophy
• Entrapment neuropathies
• Inflammatory and metabolic myopathies
• Multifocal motor neuropathy with conduction block
• Vasculitis
• Adult spinal muscular atrophy
• Amyotrophic lateral sclerosis
• Cervical and lumbosacral radiculopathy
• Chronic inflammatory demyelinating polyneuropathy
• Connective tissue disease–associated myopathies
• Diabetic amyotrophy
• Entrapment neuropathies
• Inflammatory and metabolic myopathies
• Multifocal motor neuropathy with conduction block
• Vasculitis
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Symptoms and Signs – Differential Diagnosis of Post-traumatic Stress Disorder
• Acute stress disorder, if symptoms last between 48 hours and 4 weeks after trauma
• Adjustment disorders are distinguished from PTSD in that the precipitating stress is less catastrophic and the psychological reaction less specific.
• Delayed-onset PTSD, if symptoms develop >6 months after the event
• Major depression; up to 30% of primary care patients with depression also have PTSD
• Acute stress disorder, if symptoms last between 48 hours and 4 weeks after trauma
• Adjustment disorders are distinguished from PTSD in that the precipitating stress is less catastrophic and the psychological reaction less specific.
• Delayed-onset PTSD, if symptoms develop >6 months after the event
• Major depression; up to 30% of primary care patients with depression also have PTSD
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Symptoms and Signs – Differential Diagnosis of Postural Hypotension, Non-neurologic Causes
• Adrenal insufficiency
• Alcohol
• Aortic stenosis (impaired output)
• Constrictive pericarditis, atrial myxoma (impaired cardiac filling)
• Diabetes insipidus
• Diuretics and hypertensive agents
• Excessive heat
• Extensive burns
• GI hemorrhage
• Hemodialysis
• Pyrexia
• Rapid volume loss from diarrhea, vomiting
• Vasodilatory agents (e.g., nitrates)
• Adrenal insufficiency
• Alcohol
• Aortic stenosis (impaired output)
• Constrictive pericarditis, atrial myxoma (impaired cardiac filling)
• Diabetes insipidus
• Diuretics and hypertensive agents
• Excessive heat
• Extensive burns
• GI hemorrhage
• Hemodialysis
• Pyrexia
• Rapid volume loss from diarrhea, vomiting
• Vasodilatory agents (e.g., nitrates)
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Symptoms and Signs – Differential Diagnosis of Precocious Puberty
• GnRH-independent precocious puberty: congenital adrenal hyperplasia, adrenocortical tumors (males), McCune-Albright syndrome (females), gonadal tumors, ectopic human chorionic gonadotropin (hCG)–secreting tumors (chorioblastoma, hepatoblastoma), exposure to exogenous sex steroids, severe hypothyroidism
• Gonadotropin hormone–releasing hormone (GnRH)–dependent precocious puberty: idiopathic, CNS tumors, hypothalamic hamartomas, neurofibromatosis, tuberous sclerosis, hydrocephalus, post acute head injury, ventricular cysts, post CNS infection
• Most common diagnoses to consider: premature thelarche and premature adrenarche
• GnRH-independent precocious puberty: congenital adrenal hyperplasia, adrenocortical tumors (males), McCune-Albright syndrome (females), gonadal tumors, ectopic human chorionic gonadotropin (hCG)–secreting tumors (chorioblastoma, hepatoblastoma), exposure to exogenous sex steroids, severe hypothyroidism
• Gonadotropin hormone–releasing hormone (GnRH)–dependent precocious puberty: idiopathic, CNS tumors, hypothalamic hamartomas, neurofibromatosis, tuberous sclerosis, hydrocephalus, post acute head injury, ventricular cysts, post CNS infection
• Most common diagnoses to consider: premature thelarche and premature adrenarche
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Symptoms and Signs – Differential Diagnosis of Preeclampsia
• Acute fatty liver of pregnancy
• Appendicitis
• Diabetic ketoacidosis
• Gallbladder disease
• Gastroenteritis
• Glomerulonephritis
• Hemolytic-uremic syndrome
• Hepatic encephalopathy
• Hyperemesis gravidarum
• Idiopathic thrombocytopenia
• Nephrolithiasis
• Peptic ulcer disease (PUD)
• Pyelonephritis
• Systemic lupus erythematosus (SLE)
• Thrombotic thrombocytopenic purpura
• Acute fatty liver of pregnancy
• Appendicitis
• Diabetic ketoacidosis
• Gallbladder disease
• Gastroenteritis
• Glomerulonephritis
• Hemolytic-uremic syndrome
• Hepatic encephalopathy
• Hyperemesis gravidarum
• Idiopathic thrombocytopenia
• Nephrolithiasis
• Peptic ulcer disease (PUD)
• Pyelonephritis
• Systemic lupus erythematosus (SLE)
• Thrombotic thrombocytopenic purpura
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Symptoms and Signs – Differential Diagnosis of Premature Graying, Scalp Hair
• Ataxia-telangiectasia
• Chemical exposure (e.g., phenol/catechol derivatives, sulfhydryls, arsenic)
• Chronic and severe protein deficiency
• Down syndrome
• Hyperthyroidism
• Idiopathic
• Myotonic dystrophy
• Physical agents (e.g., ionizing radiation, lasers)
• Progeria
• Vitamin B12 deficiency
• Vitiligo
• Wermer’s syndrome
• Ataxia-telangiectasia
• Chemical exposure (e.g., phenol/catechol derivatives, sulfhydryls, arsenic)
• Chronic and severe protein deficiency
• Down syndrome
• Hyperthyroidism
• Idiopathic
• Myotonic dystrophy
• Physical agents (e.g., ionizing radiation, lasers)
• Progeria
• Vitamin B12 deficiency
• Vitiligo
• Wermer’s syndrome
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Symptoms and Signs – Differential Diagnosis of Premenstrual Dysphoric Disorder
• Dysthymic syndrome
• Hyperthyroidism
• Major depressive disorder
• Panic disorder
• Personality disorder
• Polycystic ovary syndrome
• Premenstrual syndrome
• Dysthymic syndrome
• Hyperthyroidism
• Major depressive disorder
• Panic disorder
• Personality disorder
• Polycystic ovary syndrome
• Premenstrual syndrome
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Symptoms and Signs – Differential Diagnosis of Progressive Supranuclear Palsy
• Cortical basal ganglionic degeneration: differentiated from PSP by presence of cortical sensory signs and asymmetric limb apraxia.
• Dementia with Lewy bodies (DLB): in PSP, visual hallucinations typically occur only if provoked by dopaminergic therapy; whereas in DLB, there are prominent visual hallucinations that may be spontaneous or provoked.
• Multiple systems atrophy: differs from PSP by the presence of prominent autonomic symptoms or cerebellar signs.
• Parkinson’s disease: differs from PSP in that the latter is characterized by prominence of early falls, tremor being unusual, and little response to levodopa.
• Cortical basal ganglionic degeneration: differentiated from PSP by presence of cortical sensory signs and asymmetric limb apraxia.
• Dementia with Lewy bodies (DLB): in PSP, visual hallucinations typically occur only if provoked by dopaminergic therapy; whereas in DLB, there are prominent visual hallucinations that may be spontaneous or provoked.
• Multiple systems atrophy: differs from PSP by the presence of prominent autonomic symptoms or cerebellar signs.
• Parkinson’s disease: differs from PSP in that the latter is characterized by prominence of early falls, tremor being unusual, and little response to levodopa.
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Symptoms and Signs – Differential Diagnosis of Prolactinoma
• Drugs: phenothiazines, methyldopa, reserpine, monoamine oxidase (MAO) inhibitors, androgens, progesterone, cimetidine, tricyclic antidepressants, haloperidol, meprobamate, chlordiazepoxide, estrogens, narcotics, metoclopramide, verapamil, amoxapine, cocaine, oral contraceptives
• Ectopic prolactin-secreting tumors (hypernephroma, bronchogenic carcinoma)
• Head trauma, chest wall injury, spinal cord injury
• Hepatic cirrhosis, renal failure, primary hypothyroidism
• Idiopathic hyperprolactinemia, stress, exercise
• Infiltrating diseases of the pituitary (sarcoidosis, histiocytosis)
• Polycystic ovary disease, pregnancy, nipple stimulation
• Drugs: phenothiazines, methyldopa, reserpine, monoamine oxidase (MAO) inhibitors, androgens, progesterone, cimetidine, tricyclic antidepressants, haloperidol, meprobamate, chlordiazepoxide, estrogens, narcotics, metoclopramide, verapamil, amoxapine, cocaine, oral contraceptives
• Ectopic prolactin-secreting tumors (hypernephroma, bronchogenic carcinoma)
• Head trauma, chest wall injury, spinal cord injury
• Hepatic cirrhosis, renal failure, primary hypothyroidism
• Idiopathic hyperprolactinemia, stress, exercise
• Infiltrating diseases of the pituitary (sarcoidosis, histiocytosis)
• Polycystic ovary disease, pregnancy, nipple stimulation
