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Symptoms and Signs – Differential Diagnosis of Thyroid-binding globulin (TBG)
Raised Level
Genetic
Pregnancy
Drugs (oestrogen, opiates, phenothiazines}
Acute viral hepatitis, acute intermittent porphyria
Reduced Level
Genetic
Malnutrition
Chronic liver disease
Nephrotic syndrome
Drugs (e.g. androgens, corticosteroids}
Acromegaly
Raised Level
Genetic
Pregnancy
Drugs (oestrogen, opiates, phenothiazines}
Acute viral hepatitis, acute intermittent porphyria
Reduced Level
Genetic
Malnutrition
Chronic liver disease
Nephrotic syndrome
Drugs (e.g. androgens, corticosteroids}
Acromegaly
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Symptoms and Signs – Differential Diagnosis of Tinnitus
Local
Presbycusis
Meniere's disease
Noise-induced
Ototoxic drugs, e.g. aminoglycosides, loop diuretics
Otosclerosis
Aneurysm s/AV malformations
Tumours: acoustic neuroma, glomus jugulare tumour, carotid body tumour Temporomandibular joint problems
Insects, e.g. maggots
General
Fever
CVS: hypertension, heart failure Haematological: j viscosity, anaemia CNS: multiple sclerosis
Drugs: aspirin, alcohol, quinine
Local
Presbycusis
Meniere's disease
Noise-induced
Ototoxic drugs, e.g. aminoglycosides, loop diuretics
Otosclerosis
Aneurysm s/AV malformations
Tumours: acoustic neuroma, glomus jugulare tumour, carotid body tumour Temporomandibular joint problems
Insects, e.g. maggots
General
Fever
CVS: hypertension, heart failure Haematological: j viscosity, anaemia CNS: multiple sclerosis
Drugs: aspirin, alcohol, quinine
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Symptoms and Signs – Differential Diagnosis of Sputum (purulent)
Upper respiratory source (acute sinusitis, rhinitis, bronchitis) Infection: pneumonia, TB, lung abscess
Bronchiectasis
Bronchopleural fistula
Upper respiratory source (acute sinusitis, rhinitis, bronchitis) Infection: pneumonia, TB, lung abscess
Bronchiectasis
Bronchopleural fistula
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Symptoms and Signs- Differential Diagnosis of ST segment
Depression
Myocardial ischaemia Myocardial infarction (posterior) Drugs (digoxin, quinidine) Ventricular hypertrophy
Elevation
Myocardial infarction (acute) Pericarditis
Prinzmetal angina
Left ventricular aneurysm
High take-off
Depression
Myocardial ischaemia Myocardial infarction (posterior) Drugs (digoxin, quinidine) Ventricular hypertrophy
Elevation
Myocardial infarction (acute) Pericarditis
Prinzmetal angina
Left ventricular aneurysm
High take-off
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Symptoms and Signs – Differential Diagnosis of Stature
Short stature
CGPD (constitutional growth and puberty delay), familial Syndromic: Turner's syndrome, achondroplasia, Prader-Willi
Psychosocial factors: child abuse, anorexia nervosa, emotional deprivation Endocrine factors:
Reduced Growth hormone: Hypopituitarism {e.g. pituitary tumour) Mutations: Pitl, PROP1, GHRH receptor
Cushing's syndrome and ii corticosteroids
Biologically inactive GH
GH resistance (GH-receptor mutation) Low levels of IGF1 {Laron dwarfism)
Reduced thyroid l hormones {hypothyroidism)
Nutritional factors
Systemic illness:
Gastrointestinal: malabsorption {coeliac disease, milk protein intolerance, inflammatory bowel disease)
Cardiovascular: congenital cyanotic heart disease Respiratory: cystic fibrosis
Renal: chronic renal failure
Short stature
CGPD (constitutional growth and puberty delay), familial Syndromic: Turner's syndrome, achondroplasia, Prader-Willi
Psychosocial factors: child abuse, anorexia nervosa, emotional deprivation Endocrine factors:
Reduced Growth hormone: Hypopituitarism {e.g. pituitary tumour) Mutations: Pitl, PROP1, GHRH receptor
Cushing's syndrome and ii corticosteroids
Biologically inactive GH
GH resistance (GH-receptor mutation) Low levels of IGF1 {Laron dwarfism)
Reduced thyroid l hormones {hypothyroidism)
Nutritional factors
Systemic illness:
Gastrointestinal: malabsorption {coeliac disease, milk protein intolerance, inflammatory bowel disease)
Cardiovascular: congenital cyanotic heart disease Respiratory: cystic fibrosis
Renal: chronic renal failure
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Symptoms and Signs – Differential Diagnosis of Tall stature
Familial
Syndromic {disproportionate):
Klinefelter's syndrome Marfan's syndrome Homocystinuria
Endocrine:
Excess GH {gigantism)
Excess thyroid hormones (thyrotoxicosis)
Excess sex steroids/precocious puberty {e.g. early phases of CAH, adrenal
tumours)
Familial
Syndromic {disproportionate):
Klinefelter's syndrome Marfan's syndrome Homocystinuria
Endocrine:
Excess GH {gigantism)
Excess thyroid hormones (thyrotoxicosis)
Excess sex steroids/precocious puberty {e.g. early phases of CAH, adrenal
tumours)
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Symptoms and Signs – Differential Diagnosis of Steatorrhoea
Small bowel disease/resection
Bacterial overgrowth {e.g. scleroderma, diverticulosis, autonomic neuropathy),
coeliac disease, Crohn's disease, ileocaecal TB, parasite infection {e.g. giardiasis, strongyloidiasis), intestinal lymphoma, radiation enteritis, Whipple's disease, tropical sprue
Small bowel disease/resection
Bacterial overgrowth {e.g. scleroderma, diverticulosis, autonomic neuropathy),
coeliac disease, Crohn's disease, ileocaecal TB, parasite infection {e.g. giardiasis, strongyloidiasis), intestinal lymphoma, radiation enteritis, Whipple's disease, tropical sprue
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Symptoms and Signs – Differential Diagnosis of Pancreatic insufficiency
Chronic pancreatitis, pancreatic cancer, cystic fibrosis
Chronic pancreatitis, pancreatic cancer, cystic fibrosis
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Symptoms and Signs – Differential Diagnosis of Biliary insufficiency
Biliary obstruction, primary biliary cirrhosis
Biliary obstruction, primary biliary cirrhosis
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Symptoms and Signs – Differential Diagnosis of Stridor
Partial obstruction of upper airways lntraluminal:
Foreign body, tumour
Intramural:
Infection: epiglottitis, croup in children, respiratory papillomata (HPV warts on
the larynx), retropharyngeal abscess
Laryngeal oedema (anaphylaxis, smoke inhalation)
Laryngeal carcinoma
Cricoarytenoid rheumatoid arthritis
Tracheal stenosis (following surgery/intubation/tracheostomy)
Extramural: Goitre
Lymphadenopathy
Partial obstruction of upper airways lntraluminal:
Foreign body, tumour
Intramural:
Infection: epiglottitis, croup in children, respiratory papillomata (HPV warts on
the larynx), retropharyngeal abscess
Laryngeal oedema (anaphylaxis, smoke inhalation)
Laryngeal carcinoma
Cricoarytenoid rheumatoid arthritis
Tracheal stenosis (following surgery/intubation/tracheostomy)
Extramural: Goitre
Lymphadenopathy
