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Symptoms and Signs – Differential Diagnosis of Folate Deficiency
• Acute cerebral folate deficiency
• Congenital folate malabsorption (rare)
• Decreased diet and increased requirements
• Decreased dietary intake
• Familial aplastic anemia (rare)
• Folate antagonists (e.g., methotrexate)
• Hereditary enzyme deficiencies involving folate
• Institutionalized individuals (e.g., psychiatric, nursing homes), chronic debilitating disease
• Intensive care unit setting
• Multiple effects on folate metabolism (e.g., alcohol, sulfasalazine, triamterene, pyrimethamine, trimethoprim-sulfamethoxazole, diphenylhydantoin, barbiturates)
• Pathologic (e.g., intrinsic hematologic diseases involving hemolysis with compensatory erythropoiesis, abnormal hematopoiesis, or bone marrow infiltration with malignant disease and dermatologic disease such as psoriasis)
• Physiologic (e.g., pregnancy and lactation, prematurity, hyperemesis gravidarum, infancy)
• Poverty and famine
• Prolonged feeding of infants with goat’s milk, special slimming diets or food fads (i.e., folate-rich foods not consumed), cultural or ethnic cooking techniques (i.e., food folate destroyed)
• Some drugs (controversial)
• Uncertain origin
• With mucosal abnormalities (e.g., tropical and nontropical sprue, regional enteritis)
• With normal intestinal mucosa
• Acute cerebral folate deficiency
• Congenital folate malabsorption (rare)
• Decreased diet and increased requirements
• Decreased dietary intake
• Familial aplastic anemia (rare)
• Folate antagonists (e.g., methotrexate)
• Hereditary enzyme deficiencies involving folate
• Institutionalized individuals (e.g., psychiatric, nursing homes), chronic debilitating disease
• Intensive care unit setting
• Multiple effects on folate metabolism (e.g., alcohol, sulfasalazine, triamterene, pyrimethamine, trimethoprim-sulfamethoxazole, diphenylhydantoin, barbiturates)
• Pathologic (e.g., intrinsic hematologic diseases involving hemolysis with compensatory erythropoiesis, abnormal hematopoiesis, or bone marrow infiltration with malignant disease and dermatologic disease such as psoriasis)
• Physiologic (e.g., pregnancy and lactation, prematurity, hyperemesis gravidarum, infancy)
• Poverty and famine
• Prolonged feeding of infants with goat’s milk, special slimming diets or food fads (i.e., folate-rich foods not consumed), cultural or ethnic cooking techniques (i.e., food folate destroyed)
• Some drugs (controversial)
• Uncertain origin
• With mucosal abnormalities (e.g., tropical and nontropical sprue, regional enteritis)
• With normal intestinal mucosa
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Symptoms and Signs – Differential Diagnosis of Folliculitis
• Acne vulgaris
• Cutaneous candidiasis
• Dermatophyte fungal infections
• Keratosis pilaris
• Miliaria
• Pseudofolliculitis barbae (ingrown hairs)
• Superficial fungal infections
• Acne vulgaris
• Cutaneous candidiasis
• Dermatophyte fungal infections
• Keratosis pilaris
• Miliaria
• Pseudofolliculitis barbae (ingrown hairs)
• Superficial fungal infections
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Symptoms and Signs – Differential Diagnosis of Bacterial Food Poisoning
• Parasitic gastroenteritis (Entamoeba histolytica, Giardia lamblia)
• Toxins (ciguatoxins, mushrooms, heavy metals)
• Viral gastroenteritis (Norwalk or rotavirus)
• Parasitic gastroenteritis (Entamoeba histolytica, Giardia lamblia)
• Toxins (ciguatoxins, mushrooms, heavy metals)
• Viral gastroenteritis (Norwalk or rotavirus)
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Symptoms and Signs – Differential Diagnosis of Foot Dermatitis
• Acquired plantar keratoderma
• Allergic contact dermatitis
• Dyshidrotic eczema
• Neuropathic foot ulcers (DM, poorly fitting shoes)
• Peripheral vascular insufficiency
• Psoriasis
• Sézary’s syndrome
• Tinea pedis
• Tylosis (mechanically induced hyperkeratosis, fissuring, and dryness)
• Acquired plantar keratoderma
• Allergic contact dermatitis
• Dyshidrotic eczema
• Neuropathic foot ulcers (DM, poorly fitting shoes)
• Peripheral vascular insufficiency
• Psoriasis
• Sézary’s syndrome
• Tinea pedis
• Tylosis (mechanically induced hyperkeratosis, fissuring, and dryness)
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Symptoms and Signs – Differential Diagnosis of Footdrop
• Dystonia
• L5 radiculopathy
• Myopathy
• Peripheral neuropathy
• Peroneal nerve compression
• Scapuloperoneal syndromes
• Sciatic nerve palsy
• Spasticity
• Dystonia
• L5 radiculopathy
• Myopathy
• Peripheral neuropathy
• Peroneal nerve compression
• Scapuloperoneal syndromes
• Sciatic nerve palsy
• Spasticity
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Symptoms and Signs – Differential Diagnosis of Foot Pain
• Arterial insufficiency, Raynaud’s phenomenon, thromboangiitis obliterans
• Calcaneal spur
• Decubitus ulcer
• Gout, pseudogout
• Infection (cellulitis, abscess, lymphangitis, gangrene)
• Inflammation (plantar fasciitis, Achilles tendinitis or bursitis, calcaneal apophysitis)
• Paronychia, ingrown toenail
• Thrombophlebitis, postphlebitic syndrome
• Trauma (fractures, musculoskeletal and ligamentous strain)
• Arterial insufficiency, Raynaud’s phenomenon, thromboangiitis obliterans
• Calcaneal spur
• Decubitus ulcer
• Gout, pseudogout
• Infection (cellulitis, abscess, lymphangitis, gangrene)
• Inflammation (plantar fasciitis, Achilles tendinitis or bursitis, calcaneal apophysitis)
• Paronychia, ingrown toenail
• Thrombophlebitis, postphlebitic syndrome
• Trauma (fractures, musculoskeletal and ligamentous strain)
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Symptoms and Signs – Differential Diagnosis of Forearm and Hand Pain
• Carpal tunnel syndrome
• Cubital tunnel syndrome
• Epicondylitis
• Herpes zoster
• Infection (cellulitis, abscess)
• Osteoarthritis
• Peripheral vascular insufficiency
• Tenosynovitis
• Trauma
• Carpal tunnel syndrome
• Cubital tunnel syndrome
• Epicondylitis
• Herpes zoster
• Infection (cellulitis, abscess)
• Osteoarthritis
• Peripheral vascular insufficiency
• Tenosynovitis
• Trauma
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Symptoms and Signs – Differential Diagnosis of Friedreich’s Ataxia
• Abetalipoproteinemia (Bassen-Kornzweig syndrome)
• Autosomal dominant cerebellar ataxia (spinocerebellar ataxia)
• Charcot-Marie-Tooth disease type (in early cases)
• Early-onset cerebellar ataxia with retained reflexes
• Severe vitamin E deficiency with malabsorption
• Abetalipoproteinemia (Bassen-Kornzweig syndrome)
• Autosomal dominant cerebellar ataxia (spinocerebellar ataxia)
• Charcot-Marie-Tooth disease type (in early cases)
• Early-onset cerebellar ataxia with retained reflexes
• Severe vitamin E deficiency with malabsorption
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Symptoms and Signs – Differential Diagnosis of Frostbite
• Cold immersion (trench) foot: caused by ischemic injury resulting from sustained severe vasoconstriction in appendages exposed to wet cold at temperatures above freezing
• Frostnip: transient tingling and numbness without associated permanent tissue damage
• Pernio (chilblains): a self-limited, cold-induced vasculitis of dermal vessels associated with purple plaques or nodules, often affecting dorsum of hands and feet and seen with prolonged cold exposure to above-freezing temperatures
• Cold immersion (trench) foot: caused by ischemic injury resulting from sustained severe vasoconstriction in appendages exposed to wet cold at temperatures above freezing
• Frostnip: transient tingling and numbness without associated permanent tissue damage
• Pernio (chilblains): a self-limited, cold-induced vasculitis of dermal vessels associated with purple plaques or nodules, often affecting dorsum of hands and feet and seen with prolonged cold exposure to above-freezing temperatures
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Symptoms and Signs – Differential Diagnosis of Frozen Shoulder
• Brachial neuritis
• Cervical disk disease
• Glenohumeral osteoarthritis
• Posterior shoulder dislocation
• Rotator cuff inflammation
• Ruptured rotator cuff
• Secondary causes of shoulder stiffness (prolonged immobilization after trauma or surgery)
• Superior sulcus tumor
• Brachial neuritis
• Cervical disk disease
• Glenohumeral osteoarthritis
• Posterior shoulder dislocation
• Rotator cuff inflammation
• Ruptured rotator cuff
• Secondary causes of shoulder stiffness (prolonged immobilization after trauma or surgery)
• Superior sulcus tumor
