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​Symptoms and Signs – Differential Diagnosis of Vesiculobullous Diseases
• Bullous pemphigoid
• Dermatitis herpetiformis
• Diabetic blisters
• Epidermolysis bullosa acquisita
• Epidermolysis bullosa: simplex, junctional, dystrophic
• Erythema multiforme major (Stevens-Johnson syndrome)
• Erythema multiforme minor
• Herpes gestationis
• Herpes simplex
• Herpes zoster
• Hypersensitivity diseases
• Immunologically mediated diseases
• Impetigo
• Infectious diseases
• Inherited genetic disorders
• Metabolic diseases
• Mucous membrane pemphigoid
• Pemphigus (vulgaris, foliaceus, paraneoplastic)
• Porphyria cutanea tarda
• Pseudoporphyria
• Staphylococcal scalded skin syndrome
• Toxic epidermal necrolysis
• Varicella
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​Symptoms and Signs – Differential Diagnosis of Urine Casts
• Acute tubular necrosis
• Allograft rejection
• Chronic renal disease
• Eclampsia
• Glomerulonephritis
• Heavy metal ingestion
• Hypothyroidism
• Interstitial nephritis
• Nephritic syndrome
• Nephrotic syndrome
• Normal finding
• Pyelonephritis
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​Symptoms and Signs – Differential Diagnosis of Acute Tubulointerstitial Disease
DRUGS
• Antibiotics, penicillins, cephalosporins, rifampin
• Sulfonamides: cotrimoxazole, sulfamethoxazole
• Nonsteroidal anti-inflammatory drugs (NSAIDs): propionic acid
derivatives
• Miscellaneous: phenytoin, thiazides, allopurinol, cimetidine, ifosfamide
INFECTIONS
• Invasion of renal parenchyma
• Reaction to systemic infections: streptococcal, diphtheria,
hantavirus
SYSTEMIC DISEASES
• Immune mediated: lupus, transplanted kidney, cryoglobulinemias
METABOLIC
• Urate, oxalate
NEOPLASTIC
• Lymphoproliferative diseases
IDIOPATHIC
Tubulointerstitial Kidney Disease14
• Ischemic and toxic acute tubular necrosis
• Allergic interstitial nephritis
• Interstitial nephritis secondary to immune complex–related collagen-vascular disease (e.g., systemic lupus erythematosus [SLE], Sjögren’s syndrome)
• Granulomatous diseases (sarcoidosis, uveitis)
• Pigment-related tubular injury (myoglobinuria, hemoglobinuria)
• Hypercalcemia with nephrocalcinosis
• Tubular obstruction (drugs such as indinavir, uric acid in tumor lysis syndrome)
• Myeloma kidney or cast nephropathy
• Infection-related interstitial nephritis: Legionella, Leptospira
• Infiltrative diseases (e.g., lymphoma)
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​Symptoms and Signs – Differential Diagnosis of Tularemia
• Anthrax
• Atypical pneumonia
• Bacterial skin infections
• Cat-scratch disease
• Fungal infection: sporotrichosis
• Group A streptococcal pharyngitis
• Infectious mononucleosis
• Meningococcal infections
• Rickettsial infections
• Typhoid fever
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​Symptoms and Signs – Differential Diagnosis of Tumor Markers Elevation
Causes of elevated levels of tumor markers:
CARCINOEMBRYONIC ANTIGEN (CEA)
• Colonic cancer (higher levels if the tumor is more differentiated or is extensive or has spread to the liver)
• Lung or breast cancer; seminoma
• Cigarette smokers
• Cirrhosis, inflammatory bowel disease, rectal polyps, pancreatitis
• Advanced age
ALPHA-FETOPROTEIN
• Hepatocellular cancer: very high titers or a rising titer is strongly suggestive, but >10% of patients do not have an elevated level
• Hepatic regeneration (e.g., cirrhosis, alcoholic or viral hepatitis)
• Cancer of the stomach, colon, pancreas, or lung
• Teratocarcinoma or embryonal cell carcinoma (testis, ovary, extragonadal)
• Pregnancy
• Ataxia-telangiectasia
• Normal variant
PROSTATE-SPECIFIC ANTIGEN
• Prostate carcinoma (localized disease)
• Prostatic hyperplasia
• Prostatitis
• Prostatitic infarction
CANCER-ASSOCIATED ANTIGEN (CA19-9)*
• Pancreatic carcinoma (80% with advanced, well-differentiated cancer have an elevated level)
• Other gastrointestinal cancers: colon, stomach, bile duct
• Acute or chronic pancreatitis
• Chronic liver disease
• Biliary tract disease
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​Symptoms and Signs – Differential Diagnosis of Turner’s Syndrome
• Noonan’s syndrome, an autosomally dominant inherited disorder also characterized by loose nuchal skin, midface hypoplasia, canthal folds, and stenotic cardiac valvular defects and affecting males and females equally; also have normal chromosome constitutions
• Other conditions in the differential diagnosis of loose skin, whether or not associated with edema:
• Fetal hydantoin syndrome (loose nuchal skin, midface hypoplasia, distal digital hypoplasia)
• Disorders of chromosome constitution (trisomy 21, tetrasomy 12p mosaicism)
• Congenital lymphedema (Milroy’s edema)
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​Symptoms and Signs – Differential Diagnosis of Ulcerative Colitis
• Acute: Campylobacter, Yersinia, Salmonella, Shigella, Chlamydia, Escherichia coli, Clostridium difficile, gonococcal proctitis
• Bacterial infections
• Celiac sprue, collagenous colitis, irradiation enteritis, endometriosis, gay bowel syndrome
• Chronic: Whipple’s disease, TB, enterocolitis
• Crohn’s disease
• Diverticulitis
• Irritable bowel syndrome
• Ischemic bowel disease
• Neoplasm (intestinal lymphoma, carcinoma of colon)
• Protozoal and parasitic infections (amebiasis, giardiasis, cryptosporidiosis)
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​Symptoms and Signs – Differential Diagnosis of Urethral Discharge and Dysuria
• Cystitis
• Herpes simplex virus
• Interstitial cystitis
• Meatal stenosis
• Nongonococcal urethritis
• Prostatitis
• Trauma (foreign body, masturbation, horseback or bike riding) Urethritis, Gonococcal
• Urethritis (gonococcal, chlamydial, trichomonal)
• Vaginitis (candidiasis, chemical)
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