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Symptoms and Signs – Differential Diagnosis of Ejaculation, Premature
• Anxiety disorder
• In as many as 25% of men with complaints of premature ejaculation, partner is anorgasmic.
• In young adolescents, premature ejaculation may be normally experienced as a consequence of heightened excitation.
• Anxiety disorder
• In as many as 25% of men with complaints of premature ejaculation, partner is anorgasmic.
• In young adolescents, premature ejaculation may be normally experienced as a consequence of heightened excitation.
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Symptoms and Signs – Differential Diagnosis of Ejection Sound or Click
• Aortic aneurysm
• Aortic regurgitation
• Aortic root dilatation
• Atrial septal defect
• Chronic pulmonary hypertension
• Pulmonary valve stenosis
• Systemic hypertension
• Tetralogy of Fallot
• Aortic aneurysm
• Aortic regurgitation
• Aortic root dilatation
• Atrial septal defect
• Chronic pulmonary hypertension
• Pulmonary valve stenosis
• Systemic hypertension
• Tetralogy of Fallot
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Symptoms and Signs – Differential Diagnosis of Elbow Pain
• Cervical disease (referred pain)
• Entrapment neuropathy
• Gout
• Infection
• Inflammatory arthritis
• Lateral or medial epicondylitis
• Loose body
• Olecranon bursitis
• Osteoarthritis
• Partial subluxation
• Shoulder disease (referred pain)
• Synovial osteochondromatosis
• Trauma
• Cervical disease (referred pain)
• Entrapment neuropathy
• Gout
• Infection
• Inflammatory arthritis
• Lateral or medial epicondylitis
• Loose body
• Olecranon bursitis
• Osteoarthritis
• Partial subluxation
• Shoulder disease (referred pain)
• Synovial osteochondromatosis
• Trauma
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Symptoms and Signs – Differential Diagnosis of Elevated Hemidiaphragm
• Aortic aneurysm
• Atelectasis
• Eventration
• Idiopathic
• Infectious process (pneumonia, empyema, TB, subphrenic abscess, hepatic abscess)
• Intra-abdominal mass
• Neoplasm (bronchogenic carcinoma, mediastinal neoplasm, intrahepatic lesion)
• Phrenic nerve dysfunction (myelitis, myotonia, herpes zoster)
• Pleurisy
• Pulmonary infarction
• Radiation therapy
• Rib fracture
• Substernal thyroid
• Trauma to phrenic nerve or diaphragm (e.g., surgery)
• Aortic aneurysm
• Atelectasis
• Eventration
• Idiopathic
• Infectious process (pneumonia, empyema, TB, subphrenic abscess, hepatic abscess)
• Intra-abdominal mass
• Neoplasm (bronchogenic carcinoma, mediastinal neoplasm, intrahepatic lesion)
• Phrenic nerve dysfunction (myelitis, myotonia, herpes zoster)
• Pleurisy
• Pulmonary infarction
• Radiation therapy
• Rib fracture
• Substernal thyroid
• Trauma to phrenic nerve or diaphragm (e.g., surgery)
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Symptoms and Signs – Differential Diagnosis of Arterial Emboli
• Sick sinus syndrome
• Prosthetic heart valve
• Paradoxical embolus from venous thrombosis
• Myocardial infarction (MI) with mural thrombi
• Left ventricular (LV) aneurysm
• Left atrial myxoma
• Endocarditis
• Congestive heart failure (CHF)
• Cardiomyopathy
• Atrial fibrillation
• Atheromatous ulcers of large blood vessels
• Aneurysms of large blood vessels
• Sick sinus syndrome
• Prosthetic heart valve
• Paradoxical embolus from venous thrombosis
• Myocardial infarction (MI) with mural thrombi
• Left ventricular (LV) aneurysm
• Left atrial myxoma
• Endocarditis
• Congestive heart failure (CHF)
• Cardiomyopathy
• Atrial fibrillation
• Atheromatous ulcers of large blood vessels
• Aneurysms of large blood vessels
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Symptoms and Signs - Differential Diagnosis of Emesis at Pediatric Age
INFANCY
Gastrointestinal Tract
• Congenital
• Regurgitation: chalasia, gastroesophageal reflux
• Atresia: stenosis (tracheoesophageal fistula, prepyloric diaphragm, intestinal atresia)
• Duplication
• Volvulus (errors in rotation and fixation, Meckel’s
diverticulum)
• Congenital bands
• Hirschsprung’s disease
• Meconium ileus (cystic fibrosis [CF]), meconium plug
• Acquired
• Acute infectious gastroenteritis, food poisoning
(staphylococcal, clostridial)
• Pyloric stenosis
• Gastritis, duodenitis
• Intussusception
• Incarcerated hernia: inguinal, internal secondary to old adhesions
• Cow’s milk protein intolerance, food allergy, eosinophilic gastroenteritis
• Disaccharidase deficiency
• Celiac disease: presents after introduction of gluten in diet; inherited risk
• Adynamic ileus: the mediator for many nongastrointestinal causes
• Neonatal necrotizing enterocolitis
• Chronic granulomatous disease with gastric outlet obstruction Non–Gastrointestinal Tract
• Infectious: otitis, urinary tract infection (UTI), pneumonia, upper respiratory tract infection, sepsis, meningitis
• Metabolic: aminoaciduria and organic aciduria, galactosemia, fructosemia, adrenogenital syndrome, renal tubular acidosis, diabetic ketoacidosis, Reye’s syndrome
• CNS: trauma, tumor, infection, diencephalic syndrome, rumination, autonomic responses (pain, shock)
• Medications: anticholinergics, aspirin, alcohol, idiosyncratic reaction (e.g., codeine)
CHILDHOOD
Gastrointestinal Tract
• Peptic ulcer: vomiting is a common presentation in children younger than 6 years.
• Trauma: duodenal hematoma, traumatic pancreatitis, perforated bowel
• Pancreatitis: mumps, trauma, CF, hyperparathyroidism, hyperlipidemia, organic acidemias
• Crohn’s disease
• Idiopathic intestinal pseudo-obstruction
• Superior mesenteric artery syndrome
Non–Gastrointestinal Tract
• CNS: cyclic vomiting, migraine, anorexia nervosa, bulimia
INFANCY
Gastrointestinal Tract
• Congenital
• Regurgitation: chalasia, gastroesophageal reflux
• Atresia: stenosis (tracheoesophageal fistula, prepyloric diaphragm, intestinal atresia)
• Duplication
• Volvulus (errors in rotation and fixation, Meckel’s
diverticulum)
• Congenital bands
• Hirschsprung’s disease
• Meconium ileus (cystic fibrosis [CF]), meconium plug
• Acquired
• Acute infectious gastroenteritis, food poisoning
(staphylococcal, clostridial)
• Pyloric stenosis
• Gastritis, duodenitis
• Intussusception
• Incarcerated hernia: inguinal, internal secondary to old adhesions
• Cow’s milk protein intolerance, food allergy, eosinophilic gastroenteritis
• Disaccharidase deficiency
• Celiac disease: presents after introduction of gluten in diet; inherited risk
• Adynamic ileus: the mediator for many nongastrointestinal causes
• Neonatal necrotizing enterocolitis
• Chronic granulomatous disease with gastric outlet obstruction Non–Gastrointestinal Tract
• Infectious: otitis, urinary tract infection (UTI), pneumonia, upper respiratory tract infection, sepsis, meningitis
• Metabolic: aminoaciduria and organic aciduria, galactosemia, fructosemia, adrenogenital syndrome, renal tubular acidosis, diabetic ketoacidosis, Reye’s syndrome
• CNS: trauma, tumor, infection, diencephalic syndrome, rumination, autonomic responses (pain, shock)
• Medications: anticholinergics, aspirin, alcohol, idiosyncratic reaction (e.g., codeine)
CHILDHOOD
Gastrointestinal Tract
• Peptic ulcer: vomiting is a common presentation in children younger than 6 years.
• Trauma: duodenal hematoma, traumatic pancreatitis, perforated bowel
• Pancreatitis: mumps, trauma, CF, hyperparathyroidism, hyperlipidemia, organic acidemias
• Crohn’s disease
• Idiopathic intestinal pseudo-obstruction
• Superior mesenteric artery syndrome
Non–Gastrointestinal Tract
• CNS: cyclic vomiting, migraine, anorexia nervosa, bulimia
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Symptoms and Signs – Differential Diagnosis of Empyema
• Collagen-vascular disease (particularly rheumatoid lung and systemic lupus erythematosus [SLE])
• Congestive heart failure (CHF)
• Malignant neoplasm involving the pleura
• Tuberculous pleurisy
• Uninfected parapneumonic effusion
• Collagen-vascular disease (particularly rheumatoid lung and systemic lupus erythematosus [SLE])
• Congestive heart failure (CHF)
• Malignant neoplasm involving the pleura
• Tuberculous pleurisy
• Uninfected parapneumonic effusion
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Symptoms and Signs - Differential Diagnosis of Viral Encephalitis
• Bacterial infections: brain abscess, toxic encephalopathies, TB
• Behçet’s syndrome
• Brucellosis
• Cat-scratch disease
• Cryptococcosis
• Leukemic or lymphomatous meningitis
• Lupus encephalitis
• Lyme disease
• Mollaret’s meningitis
• Multiple sclerosis (MS)
• Other metastatic tumors
• Protozoal infections
• Sjögren’s syndrome
• Syphilis
• Toxoplasmosis
• Vogt-Koyanagi-Harada syndrome
• Bacterial infections: brain abscess, toxic encephalopathies, TB
• Behçet’s syndrome
• Brucellosis
• Cat-scratch disease
• Cryptococcosis
• Leukemic or lymphomatous meningitis
• Lupus encephalitis
• Lyme disease
• Mollaret’s meningitis
• Multiple sclerosis (MS)
• Other metastatic tumors
• Protozoal infections
• Sjögren’s syndrome
• Syphilis
• Toxoplasmosis
• Vogt-Koyanagi-Harada syndrome
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Symptoms and Signs - Differential Diagnosis of Non Viral Causes of Encephalomyelitis
• Actinomycosis
• Behçet’s disease
• Brucellosis
• Carcinoma
• Cat-scratch disease
• Chlamydia
• Cryptococcus
• Drug reactions
• Ehrlichia
• Histoplasma
• Legionella
• Leptospirosis
• Listeria
• Lyme disease
• Mycoplasma
• Nocardia
• Plasmodium falciparum
• Q fever
• Relapsing fever
• Rocky Mountain spotted fever
• Subacute bacterial endocarditis
• Syphilis (meningovascular)
• Toxoplasma
• Trypanosomiasis
• Tuberculosis
• Typhus
• Vasculitis
• Whipple’s disease
• Actinomycosis
• Behçet’s disease
• Brucellosis
• Carcinoma
• Cat-scratch disease
• Chlamydia
• Cryptococcus
• Drug reactions
• Ehrlichia
• Histoplasma
• Legionella
• Leptospirosis
• Listeria
• Lyme disease
• Mycoplasma
• Nocardia
• Plasmodium falciparum
• Q fever
• Relapsing fever
• Rocky Mountain spotted fever
• Subacute bacterial endocarditis
• Syphilis (meningovascular)
• Toxoplasma
• Trypanosomiasis
• Tuberculosis
• Typhus
• Vasculitis
• Whipple’s disease
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Symptoms and Signs - Differential Diagnosis of Encephalopathy
• Akinetic mutism: these patients do not talk and do not move; there is little fluctuation in their state, and there is no asterixis.
• Aphasia: distinguished from encephalopathy by virtue of its representing a specific disorder of language rather than a global disturbance of cognitive function.
• Dementia: distinguished from encephalopathy by a history of slowly progressive cognitive decline over time (fluctuating cognitive function is rare except in diffuse Lewy body disease).
• Depression
• Hypersomnia
• Locked-in syndrome: may be distinguished from encephalopathy by the presence of fixed neurologic deficits (e.g., paralysis of all four limbs).
• Mania
• Psychosis: some overlap with encephalopathy because delusions and hallucinations may be common to both.
• Vegetative state from cerebral injury; these patients appear awake (eyes are open), but there is no content to their consciousness.
• Akinetic mutism: these patients do not talk and do not move; there is little fluctuation in their state, and there is no asterixis.
• Aphasia: distinguished from encephalopathy by virtue of its representing a specific disorder of language rather than a global disturbance of cognitive function.
• Dementia: distinguished from encephalopathy by a history of slowly progressive cognitive decline over time (fluctuating cognitive function is rare except in diffuse Lewy body disease).
• Depression
• Hypersomnia
• Locked-in syndrome: may be distinguished from encephalopathy by the presence of fixed neurologic deficits (e.g., paralysis of all four limbs).
• Mania
• Psychosis: some overlap with encephalopathy because delusions and hallucinations may be common to both.
• Vegetative state from cerebral injury; these patients appear awake (eyes are open), but there is no content to their consciousness.
