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Symptoms and Signs – Differential Diagnosis of Nail Yellowing
• Bronchiectasis
• Chronic infections (TB, sinusitis)
• Immunodeficiency
• Lymphedema
• Nephrotic syndrome
• Pleural effusions
• Raynaud’s disease
• Rheumatoid arthritis
• Thyroiditis
• Tobacco abuse
• Bronchiectasis
• Chronic infections (TB, sinusitis)
• Immunodeficiency
• Lymphedema
• Nephrotic syndrome
• Pleural effusions
• Raynaud’s disease
• Rheumatoid arthritis
• Thyroiditis
• Tobacco abuse
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Symptoms and Signs – Differential Diagnosis of Narcissistic Personality
• Dysthymia and major depressive episode, which cause depressed mood and feelings of worthlessness without criticism or perceived slight
• Histrionic, borderline, antisocial, and paranoid personality disorders share common features and are often comorbid.
• Mania and hypomania, which are characterized by an episodic course and impairments
• Personality changes due to a general medical condition, including CNS processes in the frontal-temporal regions of the brain
• Substance-induced euphoria, especially cocaine abuse
• Dysthymia and major depressive episode, which cause depressed mood and feelings of worthlessness without criticism or perceived slight
• Histrionic, borderline, antisocial, and paranoid personality disorders share common features and are often comorbid.
• Mania and hypomania, which are characterized by an episodic course and impairments
• Personality changes due to a general medical condition, including CNS processes in the frontal-temporal regions of the brain
• Substance-induced euphoria, especially cocaine abuse
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Symptoms and Signs – Differential Diagnosis of Narcolepsy
• Chronic fatigue syndrome
• Depression
• Drugs and alcohol
• Hypothyroidism
• Inadequate sleep time
• Insomnia
• Seizures
• Sleep apnea
• Sleep fragmentation (multiple causes)
• Chronic fatigue syndrome
• Depression
• Drugs and alcohol
• Hypothyroidism
• Inadequate sleep time
• Insomnia
• Seizures
• Sleep apnea
• Sleep fragmentation (multiple causes)
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Symptoms and Signs – Differential Diagnosis of Nausea and Vomiting
• Abdominal trauma
• Anxiety, fear
• Carcinoma of GI tract
• CNS neoplasms
• Eye disorders
• Head trauma
• Infections (viral, bacterial)
• Intestinal obstruction
• Medications (e.g., NSAIDs, erythromycin, morphine, codeine, aminophylline, chemotherapeutic agents)
• Metabolic (e.g., uremia, electrolyte abnormalities, diabetic ketoacidosis [DKA], acidosis)
• Migraine headache
• Peptic ulcer disease (PUD)
• Pregnancy
• Psychiatric disorders (bulimia, anorexia nervosa)
• Radiation sickness
• Reye’s syndrome
• Severe pain
• Vestibular or middle ear disease
• Withdrawal from substance abuse (drugs, alcohol)
• Abdominal trauma
• Anxiety, fear
• Carcinoma of GI tract
• CNS neoplasms
• Eye disorders
• Head trauma
• Infections (viral, bacterial)
• Intestinal obstruction
• Medications (e.g., NSAIDs, erythromycin, morphine, codeine, aminophylline, chemotherapeutic agents)
• Metabolic (e.g., uremia, electrolyte abnormalities, diabetic ketoacidosis [DKA], acidosis)
• Migraine headache
• Peptic ulcer disease (PUD)
• Pregnancy
• Psychiatric disorders (bulimia, anorexia nervosa)
• Radiation sickness
• Reye’s syndrome
• Severe pain
• Vestibular or middle ear disease
• Withdrawal from substance abuse (drugs, alcohol)
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Symptoms and Signs – Differential Diagnosis of Neck and Arm Pain
• Acromioclavicular arthritis
• Angina pectoris
• Bicipital tendinitis
• Cervical disk syndrome
• Glenohumeral arthritis
• Infection (cellulitis, abscess)
• Pancoast tumor
• Rotator cuff syndrome
• Thoracic outlet syndrome
• Trauma, musculoskeletal strain
• Acromioclavicular arthritis
• Angina pectoris
• Bicipital tendinitis
• Cervical disk syndrome
• Glenohumeral arthritis
• Infection (cellulitis, abscess)
• Pancoast tumor
• Rotator cuff syndrome
• Thoracic outlet syndrome
• Trauma, musculoskeletal strain
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Symptoms and Signs – Differential Diagnosis of Myotonia
• Autosomal dominant disease
• Inflammatory myopathies (polymyositis)
• May be autosomal dominant or recessive (two distinct varieties)
• Metabolic muscle diseases
• Motor neuron disease
• Muscular dystrophies
• Myasthenic syndromes
• Myotonia congenita (Thomsen’s disease)
• Paramyotonia congenita
• The disease is limited to muscles and causes hypertrophy and stiffness after rest. Muscle function normalizes with exercise. There is no weakness. Symptoms are exacerbated by exposure to cold.
• Weakness and stiffness of facial muscles and distal upper extremities, especially or exclusively on cold exposure
• Autosomal dominant disease
• Inflammatory myopathies (polymyositis)
• May be autosomal dominant or recessive (two distinct varieties)
• Metabolic muscle diseases
• Motor neuron disease
• Muscular dystrophies
• Myasthenic syndromes
• Myotonia congenita (Thomsen’s disease)
• Paramyotonia congenita
• The disease is limited to muscles and causes hypertrophy and stiffness after rest. Muscle function normalizes with exercise. There is no weakness. Symptoms are exacerbated by exposure to cold.
• Weakness and stiffness of facial muscles and distal upper extremities, especially or exclusively on cold exposure
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Symptoms and Signs – Differential Diagnosis of Mumps
• Conditions that cause unilateral swelling: tumors, cysts, stones causing obstruction, strictures causing obstruction
• Drugs that cause parotid swelling: phenothiazines, phenylbutazone, thiouracil, iodides
• Other conditions that may occur with parotid enlargement or swelling: Sjögren’s syndrome, leukemia, diabetes mellitus (DM), uremia, malnutrition, cirrhosis
• Other viruses that may cause acute parotitis: parainfluenza types 1 and 3, coxsackieviruses, influenza A, cytomegalovirus (CMV)
• Suppurative parotitis
• Conditions that cause unilateral swelling: tumors, cysts, stones causing obstruction, strictures causing obstruction
• Drugs that cause parotid swelling: phenothiazines, phenylbutazone, thiouracil, iodides
• Other conditions that may occur with parotid enlargement or swelling: Sjögren’s syndrome, leukemia, diabetes mellitus (DM), uremia, malnutrition, cirrhosis
• Other viruses that may cause acute parotitis: parainfluenza types 1 and 3, coxsackieviruses, influenza A, cytomegalovirus (CMV)
• Suppurative parotitis
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Symptoms and Signs – Differential Diagnosis of Munchausen’s Syndrome
• Malingering: a clear secondary gain (e.g., financial gain or avoidance of unwanted duties) is present.
• Munchausen’s by proxy: a mother (86% of the time) or other caregiver induces illness in a child (52% between the ages of 3 and 13 years) for the purpose of obtaining medical attention without other secondary gain.
• Self-injurious behavior is common in many other psychiatric conditions (e.g., borderline personality disorder, psychoses, or nonfatal suicide attempt as may occur in depression); in those conditions, the patients confess the intentional self-harm and describe motivating factors.
• Somatoform disorders or hypochondriasis: similar presentations, but the disorder is not under the patient’s control.
• Malingering: a clear secondary gain (e.g., financial gain or avoidance of unwanted duties) is present.
• Munchausen’s by proxy: a mother (86% of the time) or other caregiver induces illness in a child (52% between the ages of 3 and 13 years) for the purpose of obtaining medical attention without other secondary gain.
• Self-injurious behavior is common in many other psychiatric conditions (e.g., borderline personality disorder, psychoses, or nonfatal suicide attempt as may occur in depression); in those conditions, the patients confess the intentional self-harm and describe motivating factors.
• Somatoform disorders or hypochondriasis: similar presentations, but the disorder is not under the patient’s control.
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Symptoms and Signs – Differential Diagnosis of Muscle Weakness
• Alcoholic myopathy
• Drug induced (e.g., statin myopathy)
• Electrolyte abnormalities (hypokalemia, hyperkalemia, hypophosphatemia, hypercalcemia, hypoglycemia)
• Endocrinopathies (e.g., adrenal insufficiency, hypothyroidism), diabetic neuropathy
• Impaired cardiac output (e.g., mitral stenosis, mitral regurgitation)
• Infections (polio, botulism, HIV, hepatitis, diphtheria, tick paralysis, neurosyphilis, brucellosis, TB, trichinosis)
• Inflammatory myopathies (e.g., collagen-vascular disease, rheumatoid arthritis [RA], sarcoidosis)
• Muscular dystrophies
• Myasthenia gravis, Lambert-Eaton syndrome
• Organophosphate or arsenic poisoning
• Other: motor neuron disease, mitochondrial myopathy, Ltryptophan (eosinophilia-myalgia), rhabdomyolysis, glycogen storage disease, lipid storage disease
• Pernicious anemia, other anemias, beriberi
• Physical deconditioning
• Psychiatric illness (depression, somatization syndrome)
• Steroid myopathy
• Uremia, liver failure
• Alcoholic myopathy
• Drug induced (e.g., statin myopathy)
• Electrolyte abnormalities (hypokalemia, hyperkalemia, hypophosphatemia, hypercalcemia, hypoglycemia)
• Endocrinopathies (e.g., adrenal insufficiency, hypothyroidism), diabetic neuropathy
• Impaired cardiac output (e.g., mitral stenosis, mitral regurgitation)
• Infections (polio, botulism, HIV, hepatitis, diphtheria, tick paralysis, neurosyphilis, brucellosis, TB, trichinosis)
• Inflammatory myopathies (e.g., collagen-vascular disease, rheumatoid arthritis [RA], sarcoidosis)
• Muscular dystrophies
• Myasthenia gravis, Lambert-Eaton syndrome
• Organophosphate or arsenic poisoning
• Other: motor neuron disease, mitochondrial myopathy, Ltryptophan (eosinophilia-myalgia), rhabdomyolysis, glycogen storage disease, lipid storage disease
• Pernicious anemia, other anemias, beriberi
• Physical deconditioning
• Psychiatric illness (depression, somatization syndrome)
• Steroid myopathy
• Uremia, liver failure
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Symptoms and Signs – Differential Diagnosis of Muscle Weakness, Lower Motor Neuron Versus Upper Motor Neuron
LOWER MOTOR NEURON
• Weakness, usually severe
• Marked muscle atrophy
• Fasciculations
• Decreased muscle stretch reflexes
• Clonus not present
• Flaccidity
• No Babinski’s sign
• Asymmetric and may involve one limb only in the beginning to become generalized as the disease progresses
UPPER MOTOR NEURON
• Weakness, usually less severe
• Minimal disuse muscle atrophy
• No fasciculations
• Increased muscle stretch reflexes
• Clonus may be present
• Spasticity
• Babinski’s sign
• Often initial impairment of only skilled movements
• In the limbs, the following muscles may be the only ones weak or weaker than the others: triceps; wrist and finger extensors; interossei; iliopsoas; hamstrings; and foot dorsiflexors, inverters, and extroverters
LOWER MOTOR NEURON
• Weakness, usually severe
• Marked muscle atrophy
• Fasciculations
• Decreased muscle stretch reflexes
• Clonus not present
• Flaccidity
• No Babinski’s sign
• Asymmetric and may involve one limb only in the beginning to become generalized as the disease progresses
UPPER MOTOR NEURON
• Weakness, usually less severe
• Minimal disuse muscle atrophy
• No fasciculations
• Increased muscle stretch reflexes
• Clonus may be present
• Spasticity
• Babinski’s sign
• Often initial impairment of only skilled movements
• In the limbs, the following muscles may be the only ones weak or weaker than the others: triceps; wrist and finger extensors; interossei; iliopsoas; hamstrings; and foot dorsiflexors, inverters, and extroverters
