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Published on 07/06/2015 by admin

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Last modified 07/06/2015

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Hairy Tongue

• Oral hairy leukoplakia

• Candidiasis

• Lichen planus

Headache ¹³

• Vascular: migraine, cluster headaches, temporal arteritis, hypertension, cavernous sinus thrombosis

• Musculoskeletal: neck and shoulder muscle contraction, strain of extraocular or intraocular muscles, cervical spondylosis, temporomandibular arthritis

• Infections: meningitis, encephalitis, brain abscess, sepsis, sinusitis, osteomyelitis, parotitis, mastoiditis

• Cerebral neoplasm

• Subdural hematoma

• Cerebral hemorrhage/infarct

• Pseudotumor cerebri

• Normal-pressure hydrocephalus (NPH)

• Post lumbar puncture

• Cerebral aneurysm, arteriovenous malformations

• Post trauma

• Dental problems: abscess, periodontitis, poorly fitting dentures

• Trigeminal neuralgia, glossopharyngeal neuralgia

• Otitis and other ear diseases

• Glaucoma and other eye diseases

• Metabolic: uremia, carbon monoxide inhalation, hypoxia

• Pheochromocytoma, hypoglycemia, hypothyroidism

• Effort induced: benign exertional headache, cough headache, coital cephalalgia

• Drugs: alcohol, nitrates, histamine antagonists

• Paget’s disease of the skull

• Emotional, psychiatric

Headache, Acute ¹¹

DIFFERENTIAL DIAGNOSIS OF ACUTE HEADACHE

Evaluation of the first acute headache should exclude pathologic causes listed here before consideration of more common etiologies.

• Increased intracranial pressure (ICP): trauma, hemorrhage, tumor, hydrocephalus, pseudotumor cerebri, abscess, arachnoid cyst, cerebral edema

• Decreased ICP: after ventriculoperitoneal shunt, lumbar puncture, cerebrospinal fluid leak from basilar skull fracture

• Meningeal inflammation: meningitis, leukemia, subarachnoid or subdural hemorrhage

• Vascular: vasculitis, arteriovenous malformation, hypertension, cerebrovascular accident

• Bone, soft tissue: referred pain from scalp, eyes, ears, sinuses, nose, teeth, pharynx, cervical spine, temporomandibular joint

• Infection: systemic infection, encephalitis, sinusitis, others

• First migraine

Headache and Facial Pain ³⁷

VASCULAR HEADACHES

• Cluster headaches

• Episodic cluster headache (“cyclic cluster headaches”)

• Chronic cluster headaches

• Chronic paroxysmal hemicrania

HEADACHES ASSOCIATED WITH DEMONSTRABLE MUSCLE SPASM

• Headache caused by posturally induced or paralesional muscle spasm

• Headaches of sustained or impaired posture (e.g., prolonged close work, driving)

• Headaches associated with cervical spondylosis and other diseases of cervical spine

• Myofascial pain dysfunction syndrome (headache or facial pain associated with disorders of teeth, jaws, and related structures, or “temporomandibular joint [TMJ] syndrome”)

• Headaches caused by psychophysiologic muscle contraction (“muscle contraction headaches,” or tension type of headache associated with disorder of pericranial muscles)

HEADACHES AND FACIAL PAIN WITHOUT DEMONSTRABLE PHYSICAL SUBSTRATE

• Headaches of uncertain etiology: “tension headaches” (tension type of headache unassociated with disorder of pericranial muscles)

• Some forms of post-traumatic headache

• Psychogenic headaches (e.g., hypochondriacal, conversional, delusional, malingering)

• Facial pain of uncertain etiology (“atypical facial pain”)

COMBINED TENSION-MIGRAINE HEADACHES

• Episodic migraine superimposed on chronic tension headaches

• Chronic daily headaches: associated with analgesic or ergotamine overuse (“rebound headaches”)

• Not associated with drug overuse

HEADACHES AND HEAD PAINS CAUSED BY DISEASES OF EYES, EARS, NOSE, SINUSES, TEETH, OR SKULL

HEADACHES CAUSED BY MENINGEAL INFLAMMATION

• Subarachnoid hemorrhage

• Meningitis and meningoencephalitis

• Others (e.g., meningeal carcinomatosis)

Headache, Cluster

• Trigeminal neuralgia

• Temporal arteritis

• Postherpetic neuralgia

• Pheochromocytoma

Headache, Migraine

• Subarachnoid hemorrhage

• Cluster headache

• Chronic daily headaches (including drug rebound headaches)

• Arteriovenous malformation

• Intracranial mass lesion

Hearing Loss, Acute ²⁷

• Infectious: mumps, measles, influenza, herpes simplex, herpes zoster, cytomegalovirus (CMV), mononucleosis, syphilis

• Vascular: macroglobulinemia, sickle cell disease, Berger’s disease, leukemia, polycythemia, fat emboli, hypercoagulable states

• Metabolic: diabetes, pregnancy, hyperlipoproteinemia

• Conductive: cerumen impaction, foreign bodies, otitis media, otitis externa, barotrauma, trauma

• Medications: aminoglycosides, loop diuretics, antineoplastics, salicylates, vancomycin

• Neoplasm: acoustic neuroma, metastatic neoplasm

Heart Failure, Pregnancy

• Congenital valvular heart disease exacerbated by pregnancy

• Peripartum cardiomyopathy

• Untreated thyrotoxicosis

• Hypothyroidism

• Pulmonary hypertension

• Myocardial infarction

Hemarthrosis

• Anticoagulant therapy

• Thrombocytopenia, thrombocytosis

• Bleeding disorders (e.g., von Willebrand disease)

• Charcot’s joint

• Other: pigmented villonodular synovitis, hemangioma, synovioma, arteriovenous (AV) fistula, ruptured aneurysm

Hematuria

Use the mnemonic TICS:

• Trauma: blow to kidney, insertion of Foley catheter or foreign body in urethra, prolonged and severe exercise, very rapid emptying of overdistended bladder

• Tumor: hypernephroma, Wilms’ tumor, papillary carcinoma of the bladder, prostatic and urethral neoplasms

• Toxins: turpentine, phenols, sulfonamides and other antibiotics, cyclophosphamide, nonsteroidal anti-inflammatory drugs (NSAIDs)

• Infections: glomerulonephritis, TB, cystitis, prostatitis, urethritis, Schistosoma haematobium, yellow fever, blackwater fever

• Inflammatory processes: Goodpasture’s syndrome, periarteritis, post irradiation

• Calculi: renal, ureteral, bladder, urethra

• Cysts: simple cysts, polycystic disease

• Congenital anomalies: hemangiomas, aneurysms, arteriovenous malformation (AVM)

• Surgery: invasive procedures, prostatic resection, cystoscopy

• Sickle cell disease and other hematologic disturbances: hemophilia, thrombocytopenia, anticoagulants

• Somewhere else: bleeding genitals, factitious (drug addicts)

Hemochromatosis

• Hereditary anemias with defect of erythropoiesis

• Repeated blood transfusions

Hemolytic-Uremic Syndrome (HUS)

• The differential is vast, including all causes of bloody and nonbloody diarrhea, because the GI symptoms usually precede the triad of HUS.

• Thrombotic thrombocytopenic purpura

• Disseminated intravascular coagulation

• Prosthetic valve hemolysis

• Malignant hypertension

Hemophilia

• Other clotting factor deficiencies

• Platelet function disorders

• Vitamin K deficiency

• Anticoagulant overdose

Hemoptysis

CARDIOVASCULAR

• Pulmonary embolism/infarction

• Left ventricular (LV) failure

• Mitral stenosis

• Arteriovenous (AV) fistula

• Severe hypertension

• Erosion of aortic aneurysm

PULMONARY

• Neoplasm (primary or metastatic)

• Pneumonia: Streptococcus pneumoniae, Klebsiella pneumoniae, Staphylococcus aureus, Legionella pneumophila

• Bronchiectasis

• Fungal infections (aspergillosis, coccidioidomycosis)

• Parasitic infections (amebiasis, ascariasis, paragonimiasis)

• Vasculitis: Wegener’s granulomatosis, Churg-Strauss syndrome, Henoch-Schönlein purpura

• Goodpasture’s syndrome

• Trauma (needle biopsy, foreign body, right-sided heart catheterization, prolonged and severe cough)

• Cystic fibrosis (CF), bullous emphysema

• Pulmonary sequestration

• Pulmonary arteriovenous (AV) fistula

• Systemic lupus erythematosus (SLE)

• Idiopathic pulmonary hemosiderosis

• Drugs: aspirin, anticoagulants, penicillamine

• Pulmonary hypertension

• Mediastinal fibrosis

OTHER

• Epistaxis, trauma

• Laryngeal bleeding (laryngitis, laryngeal neoplasm)

• Hematologic disorders (clotting abnormalities, disseminated intravascular coagulation [DIC], thrombocytopenia)

Hemorrhoids

• Anal fistula

• Condylomata acuminata

• Hypertrophied anal papillae

• Rectal prolapse

• Rectal polyp

Hemosiderinuria

• Paroxysmal nocturnal hemoglobinuria (PNH)

• Chronic hemolytic anemia

• Hemochromatosis

• Blood transfusion

• Thalassemias

Henoch-Schönlein Purpura

• Polyarteritis nodosa

• Meningococcemia

• Thrombocytopenic purpura

• Viral syndrome

Hepatic Granulomas ¹

INFECTIONS

• Bacterial, spirochetal: TB and atypical mycobacterial infections, tularemia, brucellosis, leprosy, syphilis, Whipple’s disease, listeriosis

• Viral: mononucleosis, cytomegalovirus (CMV)

• Rickettsial: Q fever

• Fungal: coccidioidomycosis, histoplasmosis, cryptococcal infections, actinomycosis, aspergillosis, nocardiosis

• Parasitic: schistosomiasis, clonorchiasis, toxocariasis, ascariasis, toxoplasmosis, amebiasis

HEPATOBILIARY DISORDERS

• Primary biliary cirrhosis, granulomatous hepatitis, jejunoileal bypass

SYSTEMIC DISORDERS

• Sarcoidosis, Wegener’s granulomatosis, inflammatory bowel disease, Hodgkin’s disease, lymphoma

DRUGS/TOXINS

• Beryllium, parenteral foreign material (e.g., starch, talc, methyldopa, procainamide, allopurinol, α-silicone), phenylbutazone, phenytoin, nitrofurantoin, hydralazine

Hepatocellular Carcinoma

• Metastatic neoplasm to liver

• Benign liver tumors (adenomas)

• Focal nodular hyperplasia

• Hemangiomas

• Focal fatty infiltration

Hepatomegaly, by Shape of Liver ³⁹

DIFFUSELY ENLARGED AND IRREGULAR

• Metastatic disease

• Hydatid disease

• Polycystic liver disease

LOCALIZED SWELLINGS

• Riedel’s lobe (a normal variant; the lobe may be palpable in the right lumbar region)

• Large simple hepatic cyst

• Hydatid cyst

• Liver abscess (e.g., amebic abscess)

Hepatorenal Syndrome

• Prerenal azotemia: response to sustained plasma expansion is good (prompt diuresis with volume expansion).

• Acute tubular necrosis: urinary sodium >30, FE_Na >1.5%, urinary/plasma creatinine ratio <30, urine/plasma osmolality ratio = 1, urine sediment reveals casts and cellular debris; there is no significant response to sustained plasma expansion.

Hermaphroditism ⁴

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