Paget’s Disease of Bone

• Fibrous dysplasia

• Skeletal neoplasm (primary or metastatic)

• Osteomyelitis

• Hyperparathyroidism

• Vertebral hemangioma

Paget’s Disease of Breast

• Chronic dermatitis

• Florid papillomatosis of the nipple or nipple adenoma

• Basal cell carcinoma

• Contact dermatitis

• Seborrheic dermatitis

Pain, Midfoot

Pain, Plantar Aspect, Heel

• Plantar fasciitis

• Tarsal tunnel syndrome

• Neuroma

• Infection (osteomyelitis, septic arthritis, cellulitis) of foot

• Peripheral vascular insufficiency

• Plantar fascia rupture

Pain, Posterior Heel

• Achilles tendinitis

• Retrocalcaneal bursitis

• Retroachilles bursitis

• Infection (osteomyelitis, septic arthritis, cellulitis) of foot

• Peripheral vascular insufficiency

Palindromic Rheumatism ⁵

• Palindromic rheumatoid arthritis

• Essential palindromic rheumatism

• Crystal synovitis (gout, calcium pyrophosphate dihydrate [CPPD], pseudogout, calcific periarthritis)

• Lyme borreliosis, stages 2 and 3

• Sarcoidosis

• Whipple’s disease

• Acute rheumatic fever

• Reactive arthritis (rare)

Palmoplantar Hyperkeratosis

• Superficial skin infection

• Paraneoplastic acrokeratosis

Palpitations ³⁴

• Anxiety

• Electrolyte abnormalities (hypokalemia, hypomagnesemia)

• Exercise

• Hyperthyroidism

• Ischemic heart disease

• Ingestion of stimulant drugs (cocaine, amphetamines, caffeine)

• Medications (digoxin, β-blockers, calcium channel antagonists, hydralazines, diuretics, minoxidil)

• Hypoglycemia in type 1 diabetes mellitus (DM)

• Mitral valve prolapse

• Wolff-Parkinson-White (WPW) syndrome

• Sick sinus syndrome

Pancreatic Calcifications

• Chronic pancreatitis

• Hyperparathyroidism

• Metastatic neoplasm

• Pseudocyst

• Hereditary pancreatitis

• Cystadenoma

• Cystadenocarcinoma

• Cavernous lymphangioma

• Hemorrhage

• Acute pancreatitis (saponification)

Pancreatic Cancer (Exocrine)

• Common duct cholelithiasis

• Cholangiocarcinoma

• Common duct stricture

• Sclerosing cholangitis

• Primary biliary cirrhosis

• Drug-induced cholestasis (e.g., phenothiazines)

• Chronic hepatitis

• Sarcoidosis

• Other pancreatic tumors (islet cell tumor, cystadenocarcinoma, epidermoid carcinoma, sarcomas, lymphomas)

Pancreatitis, Acute

• Peptic ulcer disease (PUD)

• Acute cholangitis, biliary colic

• High intestinal obstruction

• Early acute appendicitis

• Mesenteric vascular obstruction

• Diabetic ketoacidosis (DKA)

• Pneumonia (basilar)

• Myocardial infarction (inferior wall)

• Renal colic

• Ruptured or dissecting aortic aneurysm

Pancreatitis, Chronic

• Pancreatic cancer

• Peptic ulcer disease (PUD)

• Cholelithiasis with biliary obstruction

• Malabsorption from other causes

• Recurrent acute pancreatitis

Pancytopenia ²¹

PANCYTOPENIA WITH HYPOCELLULAR BONE MARROW

• Acquired aplastic anemia

• Inherited aplastic anemia (Fanconi’s anemia and others)

• Some myelodysplasia syndromes

• Rare aleukemic leukemia (acute myelogenous leukemia)

• Some acute lymphoblastic leukemias

• Some lymphomas of bone marrow

HYPOCELLULAR BONE MARROW ± CYTOPENIA

• Q fever

• Legionnaires’ disease

• Mycobacteria tuberculosis

• Anorexia nervosa, starvation

• Hypothyroidism

Panic Disorder

MEDICAL CONDITIONS

• Endocrinopathies

• Hyperthyroidism

• Hyperparathyroidism

• Pheochromocytoma

• Carcinoid tumor

• Cardiac and respiratory diseases

• Arrhythmias

• Myocardial infarction

• Chronic obstructive pulmonary disease

• Asthma

• Metabolic

• Hypoglycemia

• Electrolyte imbalances

• Porphyria

• Seizure disorders

• Psychiatric disorders (NOTE: Panic attacks are common in a variety of psychiatric disorders. Panic disorder could be conceptualized as a phobia of the somatic sensations or situations that have become paired with panic attacks.)

• Phobias (e.g., specific phobia or social phobia)

• Obsessive-compulsive disorder (cued by exposure to the object of the obsession)

• Post-traumatic stress disorder (cued by recall of a stressor)

• Therapeutic (theophylline, steroids) and recreational (cocaine, amphetamine, caffeine, diet pills) drugs and drug withdrawal (alcohol, barbiturates, benzodiazepines)

Papilledema

• CNS infections (viral, bacterial, fungal)

• Medications (e.g., lithium, cisplatin, corticosteroids, tetracycline)

• Head trauma

• CNS neoplasm (primary or metastatic)

• Pseudotumor cerebri

• Cavernous sinus thrombosis

• Systemic lupus erythematosus (SLE)

• Sarcoidosis

• Subarachnoid hemorrhage

• Carbon dioxide retention

• Arnold-Chiari malformation and other developmental or congenital malformations

• Orbital lesions

• Central retinal vein occlusion

• Hypertensive encephalopathy

• Metabolic abnormalities

Papulosquamous Diseases ¹⁴

• Psoriasis

• Pityriasis rubra pilaris

• Pityriasis lichenoides

Paraneoplastic Neurologic Syndromes

• Lambert-Eaton myasthenic syndrome

• Myasthenia gravis

• Guillain-Barré syndrome

• Amyotrophic lateral sclerosis

• Dermatomyositis

• Carcinoid myopathy

• Cerebellar degeneration

• Encephalomyelitis

• Optic neuritis, uveitis, retinopathy

• Stiff-man syndrome

• Autonomic neuropathy

• Brachial neuritis

• Sensory neuropathy

• Progressive multifocal leukoencephalopathy

Paraneoplastic Syndromes, Endocrine ³⁷

• Hypercalcemia

• Syndrome of inappropriate secretion of antidiuretic hormone (SIADH)

• Hypoglycemia

• Zollinger-Ellison syndrome

• Ectopic secretion of human chorionic gonadotropin (hCG)

• Cushing’s syndrome

Paraneoplastic Syndromes, Nonendocrine ³⁷

CUTANEOUS

• Dermatomyositis

• Acanthosis nigricans

• Sweet’s syndrome

• Erythema gyratum repens

• Systemic nodular panniculitis (Weber-Christian disease)

RENAL

• Nephrotic syndrome

• Nephrogenic diabetes insipidus

NEUROLOGIC

• Subacute cerebellar degeneration

• Progressive multifocal leukoencephalopathy

• Subacute motor neuropathy

• Sensory neuropathy

• Ascending acute polyneuropathy (Guillain-Barré syndrome)

• Myasthenic syndrome (Eaton-Lambert syndrome)

HEMATOLOGIC

• Microangiopathic hemolytic anemia

• Migratory thrombophlebitis (Trousseau’s syndrome)

• Anemia of chronic disease

RHEUMATOLOGIC

• Polymyalgia rheumatica

• Hypertrophic pulmonary osteoarthropathy

Paranoid Personality Disorder

• Schizophrenia (paranoid type), delusional disorder (paranoid type), and mood disorder with psychotic symptoms: require presence of persistent positive psychotic symptoms such as delusions and hallucinations. To give an additional diagnosis of paranoid personality disorder (PPD), the personality disorder must be present before the onset of psychotic symptoms and must persist when the psychotic symptoms are in remission.

• Substance-induced paranoia, especially in the context of cocaine or methamphetamine abuse or dependence

• Personality changes due to a general medical condition that affects the central nervous system

• Paranoid traits associated with a sensory disability, for example, hearing impairment

• The most common co-occurring personality disorders are schizotypal, schizoid, narcissistic, avoidant, and borderline:

• Schizotypal personality disorder includes magical thinking and unusual perceptual experiences.

• Schizoid and borderline personality disorders do not have prominent paranoid ideation.

• Avoidant personality disorder includes fear of embarrassment.

• Narcissistic personality disorder includes the fear that hidden “flaws” or “inferiority” may be revealed.

Paraplegia

• Trauma: penetrating wounds to motor cortex, fracture-dislocation of vertebral column with compression of spinal cord or cauda equina, prolapsed disk, electrical injuries

• Neoplasm: parasagittal region, vertebrae, meninges, spinal cord, cauda equina; Hodgkin’s disease, non-Hodgkin’s lymphoma (NHL), leukemic deposits, pelvic neoplasms

• Multiple sclerosis (MS) and other demyelinating disorders

• Mechanical compression of spinal cord, cauda equina, or lumbosacral plexus: Paget’s disease, kyphoscoliosis, herniation of intervertebral disk, spondylosis, ankylosing spondylitis, rheumatoid arthritis (RA), aortic aneurysm

• Infections: spinal abscess, syphilis, TB, poliomyelitis, leprosy

• Thrombosis of superior sagittal sinus

• Polyneuritis: Guillain-Barré syndrome, diabetes, alcohol, beriberi, heavy metals

• Heredofamilial muscular dystrophies

• Amyotrophic lateral sclerosis (ALS)

• Congenital and familial conditions: syringomyelia, myelomeningocele, myelodysplasia

• Hysteria

Paresthesias

• Multiple sclerosis (MS)

• Nutritional deficiencies (thiamine, vitamin B₁₂, folic acid)

• Compression of spinal cord or peripheral nerves

• Medications (e.g., isonicotinic acid hydrazide [INH], lithium, nitrofurantoin, gold, cisplatin, hydralazine, amitriptyline, sulfonamides, amiodarone, metronidazole, dapsone, disulfiram, chloramphenicol)

• Toxic chemicals (e.g., lead, arsenic, cyanide, mercury, organophosphates)

• Diabetes mellitus (DM)

• Infections (HIV, Lyme disease, herpes zoster, leprosy, diphtheria)

• Charcot-Marie-Tooth syndrome and other hereditary neuropathies

• Guillain-Barré neuropathy

Parkinson’s Disease

• Multisystem atrophy: distinguishing features of autonomic dysfunction, including urinary incontinence, orthostatic hypotension, and erectile dysfunction; parkinsonism, cerebellar signs, and normal cognition

• Diffuse Lewy body disease: parkinsonism with concomitant dementia. Patients often have early hallucinations and fluctuations in level of alertness and mental status.

• Corticobasal degeneration: often begins asymmetrically with apraxia, cortical sensory loss in one limb, and sometimes alien limb phenomenon

• Progressive supranuclear palsy: tends to have axial rigidity greater than appendicular (limb) rigidity. These patients have early and severe postural instability. Hallmark is supranuclear gaze palsy that usually involves vertical gaze before horizontal.

• Essential tremor

• Secondary (acquired) parkinsonism

• Postinfectious parkinsonism: von Economo’s encephalitis

• Parkinson’s pugilistica: after repeated head trauma

• Iatrogenic: any of the neuroleptics and antipsychotics. The high-potency D₂ blocker neuroleptics are most likely to cause parkinsonism.

• Toxins (e.g., 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine [MPTP], manganese, carbon monoxide)

• Cerebrovascular disease (basal ganglia infarcts)

Parkinson’s Plus Syndromes

• Parkinson’s disease

• Shy-Drager syndrome

• Corticobasal degeneration

• Olivopontocerebellar atrophy

• Dementia with Lewy bodies

• Progressive supranuclear palsy

• Striatonigral degeneration

Paronychia

• Squamous cell carcinoma

Parotid Swelling ³

NONPAROTID SWELLING

• Hypertrophy of masseter muscle

• Lymphadenopathy

• Rheumatoid mandibular joint swelling

• Tumors of jaw

• Infantile cortical hyperostosis

Paroxysmal Cold Hemoglobinuria (PCH)

OTHER CAUSES OF RED OR BROWN URINE

• Beet ingestion

• Medications (e.g., phenazopyridine)

• Myoglobinuria

• Hematuria

OTHER CAUSES OF HEMOLYSIS

• Hemoglobinopathies

• Erythrocyte membrane defects

• Medications, toxins

• Microangiopathy

• Other forms of autoimmune hemolysis

Pediculosis

• Seborrheic dermatitis

• Scabies

• Eczema

• Other: pilar casts, trichonodosis (knotted hair), monilethrix

Pedophilia

• Psychosis: may present with unusual ideas or statements that may rarely be confused with pedophilia; but statements or behaviors of psychotic individuals are usually disorganized and relatively short-lived.

• Incest: some is not based in pedophilia but may instead reflect a dysfunctional family unit.

• Paraphilic sexual behavior in the setting of another condition, such as mental retardation, brain injury, or drug intoxication

Pelvic Inflammatory Disease

• Ectopic pregnancy

• Appendicitis

• Ruptured ovarian cyst

• Endometriosis

• Urinary tract infection (cystitis or pyelonephritis)

• Renal calculus

• Adnexal torsion

• Proctocolitis

Pelvic Mass

• Hemorrhagic ovarian cyst

• Simple ovarian cyst (follicle or corpus luteum)

• Ovarian carcinoma, carcinoma of fallopian tube, colorectal carcinoma, metastatic carcinoma, prostate carcinoma, bladder carcinoma, lymphoma, Hodgkin’s disease

• Cystadenoma, teratoma, endometrioma

• Diverticulitis, diverticular abscess

• Appendiceal abscess, tubo-ovarian abscess

• Ectopic pregnancy, intrauterine pregnancy

Pelvic Pain, Chronic ⁷

MUSCULOSKELETAL DISORDERS

• Myofascial pain syndrome

GASTROINTESTINAL DISORDERS

• Irritable bowel syndrome

• Inflammatory bowel disease

URINARY TRACT DISORDERS

• Interstitial cystitis

• Nonbacterial urethritis

Pelvic Pain, Genital Origin ²⁷

PERITONEAL IRRITATION

• Ruptured ectopic pregnancy

• Ovarian cyst rupture

• Ruptured tubo-ovarian abscess

• Uterine perforation

TORSION

• Ovarian cyst or tumor

• Pedunculated fibroid

INTRATUMOR HEMORRHAGE OR INFARCTION

• Ovarian cyst

• Solid ovarian tumor

• Uterine leiomyoma

INFECTION

• Endometritis

• Pelvic inflammatory disease (PID)

• Trichomonas cervicitis or vaginitis

• Tubo-ovarian abscess

PREGNANCY RELATED

First Trimester

• Ectopic pregnancy

• Abortion

• Corpus luteum hematoma

Late Pregnancy

• Placental problems

• Preeclampsia

• Premature labor

MISCELLANEOUS

• Primary dysmenorrhea

Pemphigus Vulgaris

• Bullous pemphigoid

• Cicatricial pemphigoid

• Behçet’s syndrome

• Erythema multiforme

• Systemic lupus erythematosus

• Aphthous stomatitis

• Dermatitis herpetiformis

• Drug eruptions

Penile Rash

• Herpes simplex 2

• Balanitis (Candida)

• Condylomata acuminata

• Molluscum contagiosum

• Scabies

• Pediculosis pubis

• Pearly penile papules

• Lichen nitidus

• Fox-Fordyce disease (follicular papules)

Peptic Ulcer Disease

• Gastroesophageal reflux disease (GERD)

• Cholelithiasis syndrome

• Pancreatitis

• Gastritis

• Nonulcer dyspepsia

• Neoplasm (gastric carcinoma, lymphoma, pancreatic carcinoma)

• Angina pectoris, myocardial infarction (MI), pericarditis

• Dissecting aneurysm

• Other: high small bowel obstruction, pneumonia, subphrenic abscess, early appendicitis

Perianal Pain ³⁹

• Fissure in ano

• Anal sepsis

Buy Membership for Internal Medicine Category to continue reading. Learn more here

Recent Posts

Meta

Categories

Search Engine

P

Share this:

Related

Related posts: