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Scarlet Fever

• Viral exanthems

• Kawasaki’s disease

• Toxic shock syndrome

• Drug rashes

Schistosomiasis

• Bacillary dysentery

• Bowel polyp

• Prostatic disease

• Genitourinary tract cancer

• Bacterial infections of the urinary tract

Schizophrenia

• Any medical condition, medicine, or substance of abuse that can affect brain homeostasis and cause psychosis: distinguished from schizophrenia by its relatively brief course and the alteration in mental status that could suggest an underlying delirium

• Other neurologic conditions (e.g., Huntington’s) that have psychosis as the initial presentation

• Other psychiatric disorders: source of greatest confusion

• Mood disorders with psychosis: indistinguishable from schizophrenia cross-sectionally but have a longitudinal course that includes full recovery

• Delusional disorder: has nonbizarre delusions and lacks the thought disturbance, hallucinations, and negative symptoms of schizophrenia

• Autism in the adult: has an early age at onset and lacks significant hallucinations or delusions

Seasonal Affective Disorder

• Major depressive disorder

• Minor depression or adjustment disorder

• Bipolar affective disorder

• Evaluate for substance use (especially alcohol)

• Medical illness or medications that may contribute to depression (e.g., endocrine disorders, neurologic disease)

Seborrheic Dermatitis

• Tinea capitis

• Contact dermatitis

• Atopic dermatitis

• Xerotic eczema

• Candidiasis

Seborrheic Keratosis

• Actinic keratosis

Seizures, Absence

• Complex partial seizures

• Daydreaming

• Psychogenic unresponsiveness

• Anxiety disorder

Seizures, Febrile

• Encephalitis

• Brain abscess

Seizures, Partial

• Transient ischemic attack (TIA)

• Psychogenic phenomena, anxiety disorder

Serotonin Syndrome

• Neuroleptic malignant syndrome

• Substance abuse (e.g., cocaine, amphetamines)

• Thyroid storm

• Alcohol and opioid withdrawal

Severe Acute Respiratory Syndrome (SARS)

• Legionella pneumonia

• Influenza A and B

• Respiratory syncytial virus

• Acute respiratory distress syndrome (ARDS)

Sheehan’s Syndrome

• Chronic infections

• HIV infection

• Sarcoidosis

• Amyloidosis

• Rheumatoid disease

• Hemochromatosis

• Metastatic carcinoma

• Lymphocytic hypophysitis

Shigellosis

• Bacterial gastroenteritis

• Dysentery caused by Entamoeba histolytica

• Enterotoxigenic Escherichia coli

• Viral gastroenteritis

• Pseudomembranous colitis

Shoulder Pain

WITH LOCAL FINDINGS IN SHOULDER

• Trauma: contusion, fracture, muscle strain, trauma to spinal cord

• Arthrosis, arthritis, rheumatoid arthritis (RA), ankylosing spondylitis

• Bursitis, synovitis, tendinitis, tenosynovitis

• Aseptic (avascular) necrosis

• Local infection: septic arthritis, osteomyelitis, abscess, herpes zoster, TB

Sialadenitis

• Salivary gland neoplasm

• Ductal stricture

• Sialolithiasis

• Decreased salivary secretion secondary to medications (e.g., amitriptyline, diphenhydramine, anticholinergics)

Sialolithiasis

• Lymphadenitis

• Salivary gland tumor

• Salivary gland bacterial (staphylococcus or streptococcus), viral (mumps), or fungal infection (sialadenitis)

• Noninfectious salivary gland inflammation (e.g., Sjögren’s syndrome, sarcoidosis, lymphoma)

• Salivary duct stricture

• Dental abscess

Sick Sinus Syndrome

• Bradycardia: atrioventricular (AV) block

• Tachycardia: atrial fibrillation

• Atrial flutter

• Paroxysmal atrial tachycardia

• Sinus tachycardia

Sinusitis

• Temporomandibular joint disease

• Migraine headache

• Cluster headache

• Dental infection

• Trigeminal neuralgia

Sjögren’s Syndrome

• Medication-related dryness (e.g., anticholinergics)

• Age-related exocrine gland dysfunction

• Mouth breathing

• Other: sarcoidosis, primary salivary hypofunction, irradiation injury, amyloidosis

Smell Disturbance

• Upper respiratory tract infection

• Nasal or paranasal sinus disease

• Exposure to noxious vapors

• Head trauma

• Dental caries, periodontal disease

• Medications

Somatization Disorder

• Undifferentiated somatoform disorder: one or more physical complaints that cannot be explained by a medical condition are present for at least 6 months. (NOTE: Somatization is more severe and less common.)

• Conversion disorder: there is an alteration or loss of voluntary motor or sensory function with demonstrable physical cause and related to a psychological stress or a conflict. (NOTE: With multiple complaints, the diagnosis of conversion is not made.)

• Pain disorder: distinguished from somatization disorder by the presence of other somatic complaints.

• Munchausen’s (factitious disorder) and malingering: the psychological basis of the complaints in somatization disorder is not conscious as in factitious disorder (Munchausen’s) and malingering, in which symptoms are produced intentionally.

Spinal Epidural Abscess

• Herniated disk

• Vertebral osteomyelitis and diskitis

• Metastatic tumors

Spinal Stenosis, Lumbar

• Osteoarthritis of the knee or hip

• Acute cauda equina syndrome, resulting from compression by epidural abscess or tumors

• Pain and weakness caused by multiple myeloma or osteomyelitis

• Intermittent claudication–peripheral vascular disease

• Peripheral neuropathy such as that caused by a herniated nucleus pulposus

• Scoliosis or spondylolisthesis

• Rheumatoid diseases: ankylosing spondylitis, Reiter’s syndrome, fibromyalgia

Spinocerebellar Ataxia

• Friedreich’s ataxia: differs from the SCAs in that inheritance is autosomal recessive, it almost always begins in childhood or adolescence, and it is associated with early lower limb areflexia.

• Sensory ataxias: differ from the SCAs in that the primary defect is not one of cerebellar function but of sensory inputs into the cerebellum. They can be the result of peripheral neuropathies or spinal cord disease that involves the posterior columns.

• Posterior fossa mass lesions

• Acquired vitamin E deficiency: differs from SCAs in that patients almost always have a clinically evident disorder of fat malabsorption.

• Toxin exposure (alcohol, phenytoin, organic mercury)

• Multiple sclerosis, other central nervous system inflammatory diseases: differ from SCAs in that ataxia, when present, usually presents acutely to subacutely.

• Paraneoplastic cerebellar degeneration: differs from SCAs in that the ataxia progresses relatively rapidly.

• Creutzfeldt-Jakob disease: differs from the SCAs in that the ataxia progresses relatively rapidly and is accompanied by dementia and myoclonus.

• Wilson’s disease: differs from the SCAs in that there is often accompanying parkinsonism, psychiatric manifestations, and hepatic dysfunction.

• Superficial siderosis: differs from the SCAs in that it also often produces sensorineural hearing loss, anosmia, dementia, and bladder disturbance.

• Mitochondrial encephalomyopathies

• Multiple systems atrophy: differs from the SCAs in that age at onset is usually later and parkinsonism, long tract signs, and orthostatic hypotension are often present.

Splenomegaly

• Hepatic cirrhosis

• Neoplastic involvement: cell-mediated lympholysis (CML), chronic lymphocytic leukemia (CLL), lymphoma, multiple myeloma

• Bacterial infections: TB, infectious endocarditis, typhoid fever, splenic abscess

• Viral infections: infectious mononucleosis, viral hepatitis, HIV infection

• Gaucher’s disease and other lipid storage diseases

• Sarcoidosis

• Parasitic infections (malaria, kala-azar, histoplasmosis)

• Hereditary and acquired hemolytic anemias

• Idiopathic thrombocytopenic purpura (ITP)

• Collagen-vascular disorders: systemic lupus erythematosus (SLE), rheumatoid arthritis (RA; Felty’s syndrome), polyarteritis nodosa

• Serum sickness, drug hypersensitivity reaction

• Splenic cysts and benign tumors: hemangioma, lymphangioma

• Thrombosis of splenic or portal vein

• Polycythemia vera, myeloid metaplasia

Splenomegaly and Hepatomegaly ³⁹

Causes of splenomegaly and hepatosplenomegaly:

MASSIVE SPLENOMEGALY

• Hematologic disease (e.g., chronic myeloid leukemia, myelofibrosis)

MODERATE SPLENOMEGALY

• The above causes

• Portal hypertension

• Hematologic disease (e.g., lymphoma, leukemia, thalassemia)

• Storage disease (e.g., Gaucher’s disease)

SMALL SPLENOMEGALY

• The above causes

• Infective (hepatitis, leptospirosis, malaria, bacterial endocarditis)

• Hematologic disease (e.g., hemolytic anemias, essential thrombocythemia, polycythemia rubra vera)

• Connective tissue diseases or vasculitis (e.g., rheumatoid arthritis, systemic lupus erythematosus, polyarteritis nodosa)

• Solitary cyst, polycystic syndrome, hydatid cyst

• Infiltration (amyloid, sarcoid)

HEPATOSPLENOMEGALY

• Chronic liver disease with portal hypertension

• Hematologic disease (e.g., myeloproliferative disease, lymphoma)

• Infection (e.g., acute viral hepatitis, infectious mononucleosis)

• Infiltration (e.g., amyloid, sarcoid)

• Connective tissue disease (e.g., systemic lupus erythematosus)

Splenomegaly, Children ²¹

DISORDERS OF THE BLOOD

• Hemolytic anemia: congenital/acquired

• Thalassemia

• Sickle cell disease

• Osteopetrosis

• Myelofibrosis, myeloid metaplasia, thrombocythemia

HEPATIC/PORTAL SYSTEM DISORDERS

• Acute/chronic active hepatitis

• Cirrhosis, hepatic fibrosis, biliary atresia

• Portal or splenic venous obstruction (Banti’s syndrome)

AUTOIMMUNE DISEASE

• Juvenile rheumatoid arthritis

• Systemic lupus erythematosus

• Autoimmune lymphoproliferative syndrome (Canale-Smith syndrome)

NEOPLASMS/CYSTS

• Lymphomas (Hodgkin’s and non-Hodgkin’s)

• Hemangiomas/lymphangiomas

• Congenital or acquired (post-traumatic) cysts

STORAGE DISEASES/INBORN ERRORS OF METABOLISM

• Lipidoses: Gaucher’s disease, Niemann-Pick disease, others

• Mucopolysaccharidoses

• Defects in carbohydrate metabolism: galactosemia, fructose intolerance

• Sea-blue histiocyte syndrome

MISCELLANEOUS DISORDERS

• Histiocytoses

• Reactive Langerhans cell

• Malignant sarcoidosis

• Congestive heart failure

• Familial Mediterranean fever

Spontaneous Miscarriage

• Normal pregnancy

• Hydatidiform molar gestation

• Ectopic pregnancy

• Dysfunctional uterine bleeding

• Pathologic endometrial or cervical lesions

Squamous Cell Carcinoma

• Keratoacanthomas

• Actinic keratosis

• Amelanotic melanoma

• Basal cell carcinoma

• Benign tumors

• Healing traumatic wounds

• Spindle cell tumors

Staphylococcal Scalded Skin Syndrome (SSSS)

• Erythema multiforme

• Scarlet fever

• Kawasaki’s disease

• Toxic epidermal necrolysis

• Graft-versus-host disease

Status Epilepticus

• Encephalopathic states

• Psychogenic unresponsiveness

Stomatitis, Bullous

• Erythema multiforme

• Erosive lichen planus

• Bullous pemphigoid

• Systemic lupus erythematosus (SLE)

• Pemphigus vulgaris

• Mucous membrane pemphigoid

Stomatitis, Dark Lesions (Brown, Blue, Black)

• Coated tongue: accumulation of keratin; harmless condition that can be treated by scraping

• Melanotic lesions: freckles, lentigines, lentigo, melanoma, Peutz-Jeghers syndrome, Addison’s disease

• Kaposi’s sarcoma: red or purple macules that enlarge to form tumors; seen in patients with AIDS

Stomatitis, Raised Lesions

• Verruca vulgaris

• Condyloma acuminatum

• Pyogenic granuloma

• Retention cyst

Stomatitis, White Lesions

• Candidiasis (thrush)

• Leukoedema: filmy opalescent-appearing mucosa, which can be reverted to normal appearance by stretching. This condition is benign.

• White sponge nevus: thick, white corrugated folds involving the buccal mucosa; appears in childhood as an autosomal dominant trait; benign condition

• Darier’s disease (keratosis follicularis): white papules on the gingivae, alveolar mucosa, and dorsal tongue; skin lesions also present (erythematous papules); inherited as an autosomal dominant trait

• Chemical injury: white sloughing mucosa

• Nicotine stomatitis: whitened palate with red papules

• Lichen planus: linear, reticular, slightly raised striae on buccal mucosa; skin is involved by pruritic violaceous papules on forearms and inner thighs

• Discoid lupus erythematosus: lesion resembles lichen planus

• Leukoplakia: white lesions that cannot be scraped off; 20% are premalignant epithelial dysplasia or squamous cell carcinoma

• Hairy leukoplakia: shaggy white surface that cannot be wiped off; seen in HIV infection, caused by Epstein-Barr virus (EBV)

Strabismus

• Refractive errors

• Orbital tumors

• Brain and CNS dysfunction

Striae (Stretch Marks)

• Cushing’s disease

• Linear focal elastosis

• Focal dermal hypoplasia

Stridor, Pediatric Age ⁴

RECURRENT

• Allergic (spasmodic) croup

• Respiratory infections in a child with otherwise asymptomatic anatomic narrowing of the large airways

• Laryngomalacia

OTHER

• Gastroesophageal reflux

• Macroglossia, Pierre Robin syndrome

• Cri du chat syndrome

• Hysterical stridor

• Hypocalcemia

Stroke, Pediatric Age ²⁴

CARDIAC DISEASE

• Congenital: aortic stenosis, mitral stenosis, mitral prolapse, ventricular septal defects, patent ductus arteriosus, cyanotic congenital heart disease involving right-to-left shunt

• Acquired: endocarditis (bacterial, systemic lupus erythematosus [SLE]), Kawasaki’s disease, cardiomyopathy, atrial myxoma, arrhythmia, paradoxical emboli through patent foramen ovale, rheumatic fever, prosthetic heart valve

HEMATOLOGIC ABNORMALITIES

• Hemoglobinopathies: sickle cell disease

• Polycythemia

• Leukemia/lymphoma

• Thrombocytopenia

• Thrombocytosis

• Disorders of coagulation: protein C deficiency, protein S deficiency, factor V Leiden, antithrombin III deficiency, lupus anticoagulant, oral contraceptive pill use, pregnancy and the postpartum state, disseminated intravascular coagulation (DIC), paroxysmal nocturnal hemoglobinuria, inflammatory bowel disease (IBD) (thrombosis)

INFLAMMATORY DISORDERS

• Meningitis: viral, bacterial, tuberculosis

• Systemic infection: viremia, bacteremia, local head and neck infections

• Drug-induced inflammation: amphetamine, cocaine

METABOLIC DISEASE ASSOCIATED WITH STROKE

• Homocystinuria

• Pseudoxanthoma elasticum

• Fabry’s disease

• Sulfite oxidase deficiency

• Mitochondrial disorders: mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke (MELAS); Leigh syndrome

• Ornithine transcarbamylase deficiency

TRAUMA AND OTHER EXTERNAL CAUSES

• Child abuse

• Head trauma/neck trauma

• Oral trauma

• Placental embolism

• Extracorporeal membrane oxygenation (ECMO) therapy

Sturge-Weber Syndrome

• Klippel-Trénaunay-Weber syndrome (extensive capillary angiomas associated with dysplastic veins involving the limbs and trunk, often with hypertrophy of the affected extremity)

• von Hippel–Lindau disease (associated with capillary retinal angiomas, in contrast to cavernous angiomas seen in SWS)

Subarachnoid Hemorrhage

• Intraparenchymal hemorrhage

• Subarachnoid extension of an extracranial arterial dissection or intracerebral hemorrhage

• Meningoencephalitis (e.g., hemorrhagic meningoencephalitis caused by herpes simplex virus [HSV])

• Headache associated with sexual activity (e.g., coital/postcoital headache; usually acute onset of severe headache around time of orgasm)

Subclavian Steal Syndrome

• Posterior circulation transient ischemic attack (TIA) and stroke

• Upper extremity ischemia: distal subclavian artery stenosis/occlusion, Raynaud’s syndrome, thoracic outlet syndrome

Subdural Hematoma

• Epidural hematoma

• Subarachnoid hemorrhage

• Mass lesion

• Ischemic stroke

• Intraparenchymal hemorrhage

Sudden Death, Pediatric Age ⁴

SUDDEN INFANT DEATH SYNDROME (SIDS) AND SIDS “MIMICS”

• Long QT syndromes

• Inborn errors of metabolism

• Child abuse

• Myocarditis

• Duct-dependent congenital heart disease

CORRECTED OR UNCORRECTED CONGENITAL HEART DISEASE

• Aortic stenosis

• Tetralogy of Fallot

• Transposition of great vessels (postoperative atrial switch)

• Mitral valve prolapse

• Hypoplastic left heart syndrome

• Eisenmenger’s syndrome

CORONARY ARTERIAL DISEASE

• Anomalous origin

• Anomalous tract

• Kawasaki’s disease

• Periarteritis

• Arterial dissection

• Marfan syndrome

• Myocardial infarction

MYOCARDIAL DISEASE

• Myocarditis

• Hypertrophic cardiomyopathy

• Dilated cardiomyopathy

• Arrhythmogenic right ventricular dysplasia

MISCELLANEOUS

• Pulmonary hypertension

• Pulmonary embolism

• Heat stroke

• Anorexia nervosa

• Electrolyte disturbances

Syncope

• Recreational drugs/alcohol

• Psychological stress

• Vertebrobasilar transient ischemic attack (TIA) (usually manifested as diplopia, vertigo, ataxia but not loss of consciousness)

Syndrome of Inappropriate Antidiuresis

• Hyponatremia associated with hypervolemia (congestive heart failure, cirrhosis, nephrotic syndrome)

• Factitious hyponatremia (hyperglycemia, abnormal proteins, hyperlipidemia)

• Hyponatremia associated with hypovolemia (e.g., burns, GI fluid loss)

Syringomyelia

• Amyotrophic lateral sclerosis (ALS)

• Multiple sclerosis (MS)

• Spinal cord tumor

• Tabes dorsalis

• Progressive spinal muscular atrophy

Systemic Lupus Erythematosus

• Other connective tissue disorders (e.g., rheumatoid arthritis [RA], mixed connective tissue disease [MCTD], progressive systemic sclerosis)

• Metastatic neoplasm

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