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Symptoms and Signs – Differential Diagnosis of Epiglottitis
• Retropharyngeal abscess
• Peritonsillar abscess
• Lingual tonsillitis
• Foreign body aspiration
• Diphtheria
• Croup
• Angioedema
• Retropharyngeal abscess
• Peritonsillar abscess
• Lingual tonsillitis
• Foreign body aspiration
• Diphtheria
• Croup
• Angioedema
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Symptoms and Signs – Differential Diagnosis of Epilepsy
• Transient ischemic attack (TIA)
• Syncope
• Psychogenic spells
• Paroxysmal vertigo
• Narcolepsy
• Migraine
• Hypoglycemia
• Drug reaction
• Arrhythmias
• Transient ischemic attack (TIA)
• Syncope
• Psychogenic spells
• Paroxysmal vertigo
• Narcolepsy
• Migraine
• Hypoglycemia
• Drug reaction
• Arrhythmias
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Pathology - Schizophreniform Disorder
The duration of persistent symptoms distinguishes between illnesses exhibiting symptoms of schizophrenia. Less than a month's worth of symptoms, typically brought on by stress, are classified as brief psychotic illness. Schizophreniform disorder is defined as more than one but fewer than six months of disordered behavior, involving social or vocational declines or unpleasant symptoms, including one month of psychotic symptoms. When symptoms last longer than six months, they are indicative of schizophrenia. A schizoaffective disorder diagnosis is indicated by the presence of both manic episodes and significant depression, or by the combination of both. Differentiating between schizoid and schizotypal personality disorders, which are a subset of axis II, and axis I diseases is crucial.
The duration of persistent symptoms distinguishes between illnesses exhibiting symptoms of schizophrenia. Less than a month's worth of symptoms, typically brought on by stress, are classified as brief psychotic illness. Schizophreniform disorder is defined as more than one but fewer than six months of disordered behavior, involving social or vocational declines or unpleasant symptoms, including one month of psychotic symptoms. When symptoms last longer than six months, they are indicative of schizophrenia. A schizoaffective disorder diagnosis is indicated by the presence of both manic episodes and significant depression, or by the combination of both. Differentiating between schizoid and schizotypal personality disorders, which are a subset of axis II, and axis I diseases is crucial.
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Pathology - Panic Attack
Pathophysiology
Palpitations, sweating, shaking, feeling of suffocation or shortness of breath, feeling of choking, chest pain or discomfort, nausea or abdominal distress, derealization or depersonalization, fear of losing control, fear of dying, paresthesias, chills, or hot flashes are just a few of the symptoms that can accompany a panic attack. There must be a time of extreme fear or discomfort during the attack, and at least four symptoms must appear suddenly and peak in less than ten minutes. When a young, healthy patient experiences chest pain and has otherwise normal findings, this should be taken into consideration, especially if there has been a precipitating event. In this instance, the disagreement might have set off the patient's attack. Frequent, unplanned panic attacks or a continual fear of experiencing a panic attack or its aftereffects are the hallmarks of panic disorder. The fear of public places, known as agoraphobia, may or may not accompany this. A specific phobia is defined by panic attacks that occur when one is exposed to particular situations. The presence of cocaine-induced myocardial ischemia, which can be detected by a urine drug panel and ECG, must be ruled out.
Pathophysiology
Palpitations, sweating, shaking, feeling of suffocation or shortness of breath, feeling of choking, chest pain or discomfort, nausea or abdominal distress, derealization or depersonalization, fear of losing control, fear of dying, paresthesias, chills, or hot flashes are just a few of the symptoms that can accompany a panic attack. There must be a time of extreme fear or discomfort during the attack, and at least four symptoms must appear suddenly and peak in less than ten minutes. When a young, healthy patient experiences chest pain and has otherwise normal findings, this should be taken into consideration, especially if there has been a precipitating event. In this instance, the disagreement might have set off the patient's attack. Frequent, unplanned panic attacks or a continual fear of experiencing a panic attack or its aftereffects are the hallmarks of panic disorder. The fear of public places, known as agoraphobia, may or may not accompany this. A specific phobia is defined by panic attacks that occur when one is exposed to particular situations. The presence of cocaine-induced myocardial ischemia, which can be detected by a urine drug panel and ECG, must be ruled out.
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Pathology - Post Traumatic Stress Disorder
Exposure to a terrible event that the person repeatedly relives is what defines post-traumatic stress disorder (PTSD). This could manifest as persistent dreams, intrusive memories, flashbacks, or strong reactions to outside stimuli. Additionally, patients will be more aroused and will avoid stimuli related to the incident. The degree of PTSD disruption will result in impairment in social, professional, or other critical domains of functioning.
Furthermore, the condition must not be the result of a substance (such as an illicit drug or medicine), a physical condition, or a worsening of an axis I (psychiatric) or axis II (personality) illness that already exists. This is true for all other psychiatric diagnoses. Given that generalized anxiety disorder and PTSD might have similar symptoms, a thorough medical history is crucial. It's crucial to remember that a significant percentage of PTSD patients with a military past also struggle with concurrent substance abuse.
As a result, screening for drug and alcohol use is crucial, and BZDs are typically not advised in this population.
Exposure to a terrible event that the person repeatedly relives is what defines post-traumatic stress disorder (PTSD). This could manifest as persistent dreams, intrusive memories, flashbacks, or strong reactions to outside stimuli. Additionally, patients will be more aroused and will avoid stimuli related to the incident. The degree of PTSD disruption will result in impairment in social, professional, or other critical domains of functioning.
Furthermore, the condition must not be the result of a substance (such as an illicit drug or medicine), a physical condition, or a worsening of an axis I (psychiatric) or axis II (personality) illness that already exists. This is true for all other psychiatric diagnoses. Given that generalized anxiety disorder and PTSD might have similar symptoms, a thorough medical history is crucial. It's crucial to remember that a significant percentage of PTSD patients with a military past also struggle with concurrent substance abuse.
As a result, screening for drug and alcohol use is crucial, and BZDs are typically not advised in this population.
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Pathology - Anorexia Nervosa
In order to satisfy the DSM-IV criteria, a patient has to be under 85% of their optimum body weight, have a distorted perception of their shape or weight, have an excessive fear of gaining weight, and have experienced amenorrhea for three months. In the therapeutic setting, a BMI of less than 17.5 kg/m2 is usually employed as the benchmark indicating an anorexic weight range because determining 85% of total body weight can be time-consuming. Low luteinizing hormone (LH) levels and suppression of normal hormone variations cause amenorrhea in anorexia nervosa. Anorexia can cause a number of consequences, such as osteoporosis, cachexia, cardiac arrhythmias, and even sudden death. One of these complications is lanugo, or thin body hair. The cutaneous abrasion on this patient may indicate self-induced vomiting. Anorexics may employ a variety of techniques to reach and stay below their target weight, such as bingeing, purging (eating laxatives, abusing diuretics, etc.), overexercising, and starving. Seizures, salivary gland enlargement, dental cavities, and electrolyte abnormalities—particularly hypokalemia—can all be consequences of purging. Individuals suffering from bulimia nervosa also experience purging and bingeing, but their body image is not distorted and they have a normal or high BMI.
Patients may also have body dysmorphic disorder, which is characterized by an isolated, distorted impression of a particular body portion.
In order to satisfy the DSM-IV criteria, a patient has to be under 85% of their optimum body weight, have a distorted perception of their shape or weight, have an excessive fear of gaining weight, and have experienced amenorrhea for three months. In the therapeutic setting, a BMI of less than 17.5 kg/m2 is usually employed as the benchmark indicating an anorexic weight range because determining 85% of total body weight can be time-consuming. Low luteinizing hormone (LH) levels and suppression of normal hormone variations cause amenorrhea in anorexia nervosa. Anorexia can cause a number of consequences, such as osteoporosis, cachexia, cardiac arrhythmias, and even sudden death. One of these complications is lanugo, or thin body hair. The cutaneous abrasion on this patient may indicate self-induced vomiting. Anorexics may employ a variety of techniques to reach and stay below their target weight, such as bingeing, purging (eating laxatives, abusing diuretics, etc.), overexercising, and starving. Seizures, salivary gland enlargement, dental cavities, and electrolyte abnormalities—particularly hypokalemia—can all be consequences of purging. Individuals suffering from bulimia nervosa also experience purging and bingeing, but their body image is not distorted and they have a normal or high BMI.
Patients may also have body dysmorphic disorder, which is characterized by an isolated, distorted impression of a particular body portion.
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Pathology - Obstructive Sleep Apnea
The hallmark of obstructive sleep apnea (OSA) is the patient's upper airway being functionally blocked for brief intervals during sleep. These pauses, or apnea moments, typically last 10 seconds or longer, and they cause a brief awakening from sleep as well as a drop in arterial oxygen saturation. Most of the time, patients are unaware of these disruptions while they are asleep, but they frequently wake up from a good night's sleep feeling lethargic and experiencing excessive daytime sleepiness for no apparent reason. Usually, if they snore loudly, their companion will also notice. Obese people are more likely to have OSA, which is commonly linked to hypertension. Although far less prevalent, narcolepsy also manifests as excessive daytime sleepiness and the infiltration of REM sleep elements during wakeful hours during the day. The most frequent symptoms are sleep attacks, which cause a patient to lose consciousness and fall asleep for prolonged intervals of 10 to 20 minutes. These can include cataplexy, a sudden decrease of muscular tone that can result in collapse from paralysis of all skeletal muscles, and they can happen at highly inopportune moments, including when driving. Inadequate sleep, jet lag, shift work (which throws off circadian rhythms), and restless legs syndrome are among factors that can cause daytime sleepiness.
The hallmark of obstructive sleep apnea (OSA) is the patient's upper airway being functionally blocked for brief intervals during sleep. These pauses, or apnea moments, typically last 10 seconds or longer, and they cause a brief awakening from sleep as well as a drop in arterial oxygen saturation. Most of the time, patients are unaware of these disruptions while they are asleep, but they frequently wake up from a good night's sleep feeling lethargic and experiencing excessive daytime sleepiness for no apparent reason. Usually, if they snore loudly, their companion will also notice. Obese people are more likely to have OSA, which is commonly linked to hypertension. Although far less prevalent, narcolepsy also manifests as excessive daytime sleepiness and the infiltration of REM sleep elements during wakeful hours during the day. The most frequent symptoms are sleep attacks, which cause a patient to lose consciousness and fall asleep for prolonged intervals of 10 to 20 minutes. These can include cataplexy, a sudden decrease of muscular tone that can result in collapse from paralysis of all skeletal muscles, and they can happen at highly inopportune moments, including when driving. Inadequate sleep, jet lag, shift work (which throws off circadian rhythms), and restless legs syndrome are among factors that can cause daytime sleepiness.
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Pathology - Somatization Disorder
Of the five somatoform illnesses, somatization disorder is a highly specific diagnosis. It involves a history of several medical symptoms that started before the age of thirty and persisted for a number of years, either requiring treatment or seriously impairing social or vocational functioning. Four pain symptoms (relating to at least four different sites or functions), two gastrointestinal symptoms (e.g., nausea, vomiting, diarrhea), one sexual or reproductive symptom (e.g., irregular menses, sexual dysfunction), and one pseudoneurological symptom (e.g., impaired coordination, weakness, double vision) that cannot be explained by a physical or laboratory examination are all required to be included in the complaints. Unlike factitious disorder, when the patient's aim is to seem to be ill, or malingering, where there are extrinsic incentives like financial gain, this condition's symptoms are the product of unconscious psychological variables and are not purposefully manufactured. Related disorders include conversion disorder, which is characterized by one or more neurologic symptoms impairing voluntary motor or sensory function, and pain disorder, which is primarily focused on pain at one or more anatomical sites.
Of the five somatoform illnesses, somatization disorder is a highly specific diagnosis. It involves a history of several medical symptoms that started before the age of thirty and persisted for a number of years, either requiring treatment or seriously impairing social or vocational functioning. Four pain symptoms (relating to at least four different sites or functions), two gastrointestinal symptoms (e.g., nausea, vomiting, diarrhea), one sexual or reproductive symptom (e.g., irregular menses, sexual dysfunction), and one pseudoneurological symptom (e.g., impaired coordination, weakness, double vision) that cannot be explained by a physical or laboratory examination are all required to be included in the complaints. Unlike factitious disorder, when the patient's aim is to seem to be ill, or malingering, where there are extrinsic incentives like financial gain, this condition's symptoms are the product of unconscious psychological variables and are not purposefully manufactured. Related disorders include conversion disorder, which is characterized by one or more neurologic symptoms impairing voluntary motor or sensory function, and pain disorder, which is primarily focused on pain at one or more anatomical sites.
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Pathology - Anterior Hypopituitarism
The secretion of many anterior pituitary tropins has diminished. Lesions to the pituitary gland, pituitary stalk, or hypothalamus may be the cause of the illness.
Pituitary tumors, brain tumors, granulomas, cysts, and other mass lesions can all induce hypopituitarism. It can also happen in situations when there are no mass lesions, such as in cases of trauma, ischemia, radiation therapy, or hereditary disorders. This patient's visual field deficits and headache indicate that there may be a mass lesion pressing on the optic chiasm, which is situated just above the pituitary gland. Secondary hypothyroidism (low TSH) is most likely associated with symptoms such as weight gain, constipation, weariness, skin lesions, hypercholesterolemia, and hypoactive reflexes. Reduced follicle-stimulating hormone (FSH) and leptin release is the cause of secondary amenorrhea.
Hypotension, hyponatremia, inability to handle stress, and low cortisol and adrenaline levels all point to an ACh shortage. Which tropin is involved would become clear with additional testing. In this instance, an MRI would most likely show a mass lesion. In the end, transsphenoidal tumor excision is used to treat this problem. Pituitary hormone replacement treatment is then administered. Although the patient does not currently have posterior pituitary involvement, following surgery, vasopressin replacement is probably going to be necessary.
The secretion of many anterior pituitary tropins has diminished. Lesions to the pituitary gland, pituitary stalk, or hypothalamus may be the cause of the illness.
Pituitary tumors, brain tumors, granulomas, cysts, and other mass lesions can all induce hypopituitarism. It can also happen in situations when there are no mass lesions, such as in cases of trauma, ischemia, radiation therapy, or hereditary disorders. This patient's visual field deficits and headache indicate that there may be a mass lesion pressing on the optic chiasm, which is situated just above the pituitary gland. Secondary hypothyroidism (low TSH) is most likely associated with symptoms such as weight gain, constipation, weariness, skin lesions, hypercholesterolemia, and hypoactive reflexes. Reduced follicle-stimulating hormone (FSH) and leptin release is the cause of secondary amenorrhea.
Hypotension, hyponatremia, inability to handle stress, and low cortisol and adrenaline levels all point to an ACh shortage. Which tropin is involved would become clear with additional testing. In this instance, an MRI would most likely show a mass lesion. In the end, transsphenoidal tumor excision is used to treat this problem. Pituitary hormone replacement treatment is then administered. Although the patient does not currently have posterior pituitary involvement, following surgery, vasopressin replacement is probably going to be necessary.
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Pathology - Acromegaly
Excess growth hormone (GH) secretion is the cause of amegaly.
Excess GH secretion from a pituitary adenoma is nearly always the cause. Prolactin secretion and TSH secretion disruption are frequently present together, yet the patient in question does not have these complicating issues. The pituitary mass's pressure on the optic chiasm causes headache and temporal hemianopia. GH primarily stimulates the liver and other tissues to secrete more IGF-1, which in turn promotes somatic growth. Giantantism occurs in young patients prior to the closure of the epiphyseal growth plates. Acromegaly is characterized by the unique expansion of the skull, hands, feet, and facial characteristics in mature humans. Internal organ growth also takes place, with cardiomegaly being of special concern. Although its cause is unknown, hypertension is a common occurrence in individuals with anemia. People with excess GH often have insulin resistance and may develop diabetes mellitus (DM), as this patient did. This is because GH is generally an anti-insulin hormone that helps to maintain blood glucose levels in response to stresses. Transsphenoidal microsurgery, which removes the pituitary adenoma, is the preferred treatment and is effective in about 70% of cases.
Excess growth hormone (GH) secretion is the cause of amegaly.
Excess GH secretion from a pituitary adenoma is nearly always the cause. Prolactin secretion and TSH secretion disruption are frequently present together, yet the patient in question does not have these complicating issues. The pituitary mass's pressure on the optic chiasm causes headache and temporal hemianopia. GH primarily stimulates the liver and other tissues to secrete more IGF-1, which in turn promotes somatic growth. Giantantism occurs in young patients prior to the closure of the epiphyseal growth plates. Acromegaly is characterized by the unique expansion of the skull, hands, feet, and facial characteristics in mature humans. Internal organ growth also takes place, with cardiomegaly being of special concern. Although its cause is unknown, hypertension is a common occurrence in individuals with anemia. People with excess GH often have insulin resistance and may develop diabetes mellitus (DM), as this patient did. This is because GH is generally an anti-insulin hormone that helps to maintain blood glucose levels in response to stresses. Transsphenoidal microsurgery, which removes the pituitary adenoma, is the preferred treatment and is effective in about 70% of cases.
