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​Symptoms and Signs – Differential Diagnosis of  Ischemic Necrosis of Cartilage and Bone
• Burns
• Collagen-vascular disorders
• Dysbaric conditions (e.g., caisson disease)
• Endocrine/metabolic: ethanol abuse, glucocorticoid therapy, Cushing’s disease, diabetes mellitus (DM), hyperuricemia, osteomalacia, hyperlipidemia, storage diseases (e.g., Gaucher’s disease)
• Hemodialysis
• Hemoglobinopathies (e.g., sickle cell disease)
• HIV infection
• Idiopathic, familial
• Intravascular coagulation
• Irradiation
• Organ transplantation
• Pancreatitis
• Trauma (e.g., dislocation, fracture)
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​Symptoms and Signs – Differential Diagnosis of  Jaundice
PREDOMINANCE OF DIRECT (CONJUGATED) BILIRUBIN
• Extrahepatic obstruction
• Common duct abnormalities: calculi, neoplasm, stricture, cyst, sclerosing cholangitis
• Metastatic carcinoma
• Pancreatic carcinoma, pseudocyst
• Ampullary carcinoma
• Hepatocellular disease: hepatitis, cirrhosis
• Drugs: estrogens, phenothiazines, captopril, methyltestosterone,
Labetalol

PREDOMINANCE OF INDIRECT (UNCONJUGATED)
BILIRUBIN
• Hemolysis: hereditary and acquired hemolytic anemias
• Inefficient marrow production
• Impaired hepatic conjugation: chloramphenicol
• Neonatal jaundice
• Hereditary disorders: Gilbert’s syndrome, Crigler-Najjar syndrome
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​Symptoms and Signs – Differential Diagnosis of  Jaundice in the Adult Patient
PREHEPATIC CAUSES
• Unconjugated hyperbilirubinemia: excessive heme metabolism from hemolysis (e.g., sickle cell disease, spherocytosis, G6PD, immune hemolysis), ineffective erythropoiesis (e.g., thalassemia, folate, severe iron deficiency), or large hematoma reabsorption

INTRAHEPATIC CAUSES
• Unconjugated hyperbilirubinemia: disorders of enzyme metabolism such as Gilbert’s disease (common, benign), Crigler- Najjar syndrome (rare, severe), or drugs such as rifampin and probenecid
• Conjugated hyperbilirubinemia: intrahepatic cholestasis
• Viruses: hepatitis A, B, and C; Epstein-Barr
• Alcohol: alcoholic hepatitis, alcoholic cirrhosis
• Autoimmune: primary biliary cirrhosis, primary sclerosing cholangitis
• Drug induced: acetaminophen, penicillins, oral contraceptives, chlorpromazine (Thorazine), steroids (estrogenic or anabolic), some herbals
• Hereditary metabolic: hemochromatosis, Wilson’s disease, Dubin- Johnson and Rotor’s syndromes, α1-antitrypsin deficiency
• Systemic disease: sarcoidosis, amyloidosis, glycogen storage diseases, celiac disease, tuberculosis, Mycobacterium aviumintracellulare
• Other: sepsis, total parenteral nutrition, pregnancy, graft-versushost disease, environmental toxins

POSTHEPATIC CAUSES
• Conjugated hyperbilirubinemia: intrinsic or extrinsic obstruction of the biliary system
• Intrinsic blockage: gallstones, cholangitis, strictures, infection (e.g., cytomegalovirus, Cryptosporidium in AIDS patients, parasites cholangiocarcinoma, gallbladder cancer)
• Extrinsic blockage: pancreatitis, pancreatic carcinoma, pancreatic pseudocyst
• Pseudojaundice: caused by an excessive ingestion of foods containing beta-carotene (carrots, melons, squash); does not result in hyperbilirubinemia or scleral icterus
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​Symptoms and Signs – Differential Diagnosis of  Joint Pain, Anterior Hip, Medial Thigh, Knee
ACUTE
• Acute rheumatic fever
• Adductor muscle strain
• Avascular necrosis
• Crystal arthritis
• Femoral artery (pseudo) aneurysm
• Fracture (femoral neck or intertrochanteric)
• Hemarthrosis
• Hernia
• Herpes zoster
• Iliopectineal bursitis
• Iliopsoas tendinitis
• Inguinal lymphadenitis
• Osteomalacia
• Painful transient osteoporosis of hip
• Septic arthritis
SUBACUTE AND CHRONIC
• Adductor muscle strain
• Amyloidosis
• Acute rheumatic fever
• Femoral artery aneurysm
• Hernia (inguinal or femoral)
• Iliopectineal bursitis
• Iliopsoas tendinitis
• Inguinal lymphadenopathy
• Osteochondromatosis
• Osteomyelitis
• Osteitis deformans (Paget’s disease)
• Osteomalacia (pseudofracture)
• Postherpetic neuralgia
• Sterile synovitis (e.g., rheumatoid arthritis [RA], psoriatic,
systemic lupus erythematosus [SLE])
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​Symptoms and Signs – Differential Diagnosis of  Joint Pain, Hip, Lateral Thigh
ACUTE
• Herpes zoster
• Iliotibial tendinitis
• Impacted fracture of femoral neck
• Lateral femoral cutaneous neuropathy (meralgia paresthetica)
• Radiculopathy: L4–5
• Trochanteric avulsion fracture (greater trochanter)
• Trochanteric bursitis
• Trochanteric fracture
SUBACUTE AND CHRONIC
• Lateral femoral cutaneous neuropathy (meralgia paresthetica)
• Osteomyelitis
• Postherpetic neuralgia
• Radiculopathy: L4–5
• Tumors
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​Symptoms and Signs – Differential Diagnosis of  Polyarticular Joint Pain 
• Ankylosing spondylitis
• Fibromyalgia
• Osteoarthritis
• Psoriatic arthritis
• Rheumatoid arthritis (RA)
• Systemic lupus erythematosus (SLE)
• Viral syndrome (e.g., human parvovirus B19 infection)
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​Symptoms and Signs – Differential Diagnosis of  Joint Pain, Posterior Hips, Thigh, Buttocks
• Gluteal muscle strain
• Gluteal muscle strain
• Herpes zoster
• Ischial bursitis
• Ischial bursitis
• Ischial or sacral fracture
• Lumbar spinal stenosis
• Osteitis deformans (Paget’s disease)
• Osteoarthritis of hip
• Osteochondromatosis
• Osteomalacia (pseudofracture)
• Osteomalacia (pseudofracture)
• Osteomyelitis
• Postherpetic neuralgia
• Radiculopathy: L5-S1
• Radiculopathy: L5-S1
• Sciatic neuropathy
• Tumors
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​Symptoms and Signs – Differential Diagnosis of Jugular Venous Distention
• Cardiac tamponade
• Cardiomyopathy (restrictive)
• Chronic obstructive pulmonary disease (COPD)
• Constrictive pericarditis
• Goiter
• Pulmonary hypertension
• Right atrial myxoma
• Right-sided heart failure
• Superior vena cava syndrome
• Tension pneumothorax
• Valsalva maneuver
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Kembara Xtra 

Facts about medicine and its subtopic such as anatomy, physiology, biochemistry, pharmacology, medicine, pediatrics, psychiatry, obstetrics and gynecology and surgery.