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Here’s a portable, concise guide to differential diagnosis for over 900 signs, symptoms and clinical disorders. Differential diagnoses are listed both by presenting sign or symptom and by clinical ...

Here’s a portable, concise guide to differential diagnosis for over 900 signs, symptoms and clinical disorders. Differential diagnoses are listed both by presenting sign or symptom and by clinical disorder, so you can confirm your diagnosis accurately, completely, and quickly. This is a versatile, easy-to-use reference you’ll consult every day.

Portable and practical for the fast reference on the differential diagnosis of over 900 items encountered in both in-patient and out-patient settings.

• Organized alphabetically so you can find the exact disorder, sign, or symptom, fast.

• Presents differential diagnosis both by sign and symptom and by disorder so you can quickly locate the information you need.

• Includes not only the differential diagnosis of signs, symptoms, and laboratory abnormalities but also the differential diagnosis of over 500 clinical disorders.

• Lists diagnostic possibilities in declining order of incidence, helping you to focus on the likeliest diagnosis.

You won’t find another reference that gives you all this easy-to-find information and fits comfortably in your pocket.

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    Ferri's differential diagnosis 2e samplechapter Ferri's differential diagnosis 2e samplechapter Document Transcript

    • Ferri’ s DIFFERENTIAL DIAGNOSIS
    • Ferri’ s DIFFERENTIAL DIAGNOSIS A Practical Guide to the Differential Diagnosis of Symptoms, Signs, and Clinical Disorders Edition 2 Fred F. Ferri, MD, FACP Clinical Professor Alpert Medical School Brown University Providence, Rhode Island
    • Ferri’s Differential Diagnosis: A Practical Guide to the Differential Diagnosis of Symptoms, Signs, and Clinical Disorders, 2e Ferri  MOSBY An imprint of Elsevier 1600 John F. Kennedy Blvd. Ste 1800 Philadelphia, PA 19103‐2899  Copyright © 2011, 2006 by Mosby, Inc., an affiliate of Elsevier Inc.  All rights reserved. No part of this publication may by reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopy, recording, or any information retrieval system, without written permission from the publisher.  Original ISBN: 978‐0‐323‐07699‐9  This edition of Ferri’s Differential Diagnosis: A Practical Guide to the Differential Diagnosis of Symptoms, Signs, and Clinical Disorders, 2e by Fred F. Ferri, MD, FACP is published by an arrangement with Elsevier Inc.  Indian Reprint ISBN: 978‐81‐312‐2846‐3 First Reprinted in India 2011     Restricted South Asia Edition    This edition is for sale in Bangladesh, Bhutan, India, Maldives, Nepal,   Pakistan and Sri Lanka only.   This edition is not authorized for export outside these territories.   Circulation of this edition outside these territories is unauthorized and illegal.     Notice   Medical  Knowledge  is  constantly  changing.  Standard  safety  precautions  must  be  followed,   but  as  new  research  and  clinical  experience  broaden  our  knowledge,  changes  in  treatment   and  drug  therapy  may  become  necessary  or  appropriate.  Readers  are  advised  to  check  the   most  current  product  information  provided  by  the  manufacturer  of  each  drug  to  be   administered,  to  verify  the  recommended  dose,  the  method  and  the  duration  of   administration,  and  the  contraindications.  It  is  the  responsibility  of  the  practitioner,  relying   on  their  own  experience  and  knowledge  of  the  patient,  to  determine  dosages  and  the  best   treatment  for  each  individual  patient.  Neither  the  Publisher  nor  the  Authors  assume  any   liability for any injury and/or damage to persons or property arising from this publication.      The Publisher    Published by Elsevier, a division of Reed Elsevier India Private Limited.  Registered Office: 622, Indraprakash Building, 21 Barakhamba Road, New Delhi‐110001. Corporate Office: 14th Floor, Building No. 10B, DLF Cyber City, Phase‐II, Gurgaon‐122 002, Haryana, India.  Printed and bound in India at Sanat Printers, Kundli. 
    • PrefaceThe purpose of this handbook is to provide the clinician with a quickreference to the differential diagnosis, etiology, and classification ofclinical disorders, signs, and symptoms. These various differentialdiagnoses are readily available in general medical texts, but theinformation is often scattered and difficult to find. The second editionof this manual has been significantly expanded and now contains thedifferential diagnosis of over 1500 signs, symptoms, and clinicaldisorders, yet its small size easily fits in a lab coat pocket. To facilitateits use, each condition is listed alphabetically. Differential diagnosesare listed in order of decreasing frequency. This book differs from other differential diagnosis books becauseit lists not only the differential diagnosis of signs, symptoms, andlaboratory abnormalities but also the differential diagnosis of morethan 600 clinical disorders. For example, its user can rapidly locatethe differential diagnosis of “Calcifications on Chest X-ray” and fur-ther identify the differential diagnosis of “Silicosis,” “Tuberculosis,”and other diseases that can cause calcifications on chest x-ray, thusnarrowing down the correct diagnosis. This book is intended for use by medical students, physicians, andallied health professionals in need of a practical rapid referencecovering nearly every possible sign, symptom, and clinical disorderthat will be encountered in the daily practice of both in-patient andout-patient medicine. Fred F. Ferri, MD, FACP v
    • AcknowledgmentsThe author wishes to acknowledge the following physicians fortheir contribution to the creation of this handbook: Ruben Alvero,Michael Benetar, Jeffrey Borkan, George Danakas, Michael Dobbs,Mitchell Feldman, Glen Fort, Joseph Masci, Lonnie Mercier,Dennis Mikolich, Peter Petropoulos, Iris Tong, andWen-Chih Wu.COMMENTSComments from readers regarding this manual are always welcomeand can be forwarded to Dr. Ferri at Fred_Ferri@brown.edu. vii
    • ContentsAbdominal Distention 1 Abuse, Child 11Abdominal Pain, Abuse, Elder 12 Adolescence 2 Acanthosis Nigricans 12Abdominal Pain, Achalasia 12 Childhood 2 Aches and Pains, Diffuse 13Abdominal Pain, Chronic Achilles Tendon Rupture 13 Lower 2 Acidosis, Lactic 14Abdominal Pain, Diffuse 3 Acidosis, Metabolic 14Abdominal Pain, Epigastric 3 Acidosis, Respiratory 15Abdominal Pain, Infancy 4 Acne Keloidalis 16Abdominal Pain, Left Lower Acne Vulgaris 16 Quadrant 4 Acoustic Neuroma 16Abdominal Pain, Left Upper Acquired Immunodeficiency Quadrant 4 Syndrome (AIDS) 16Abdominal Pain, Nonsurgical Acrochordon 17 Causes 5 Acromegaly 17Abdominal Pain, Actinic Keratosis 17 Periumbilical 5 Actinomycosis 17Abdominal Pain, Poorly Localized 6 Acute Bronchitis 18Abdominal Pain, Acute Respiratory Distress Pregnancy 6 Syndrome (ARDS) 18Abdominal Pain, Right Lower Acute Scrotum 18 Quadrant 7 Addison’s Disease (PrimaryAbdominal Pain, Right Upper Adrenocortical Quadrant 7 Insufficiency) 19Abdominal Pain, Adnexal Mass 19 Suprapubic 8 Adrenal Masses 19Abdominal Wall Masses 8 Adynamic Ileus 20Abortion, Recurrent 9 Aerophagia (Belching,Abruptio Placentae 9 Eructation) 20Abscess, Brain 9 Agoraphobia 20Abscess, Breast 10 Airway Obstruction, Pediatric Age 21Abscess, Liver 10 Akinetic/Rigid Syndrome 22Abscess, Lung 10 Aldosteronism, Primary 22Abscess, Pelvic 10 Alkalosis, Metabolic 22Abscess, Perirectal 11 ix
    • x CONTENTSAlkalosis, Respiratory 23 Aneurysms, ThoracicAlopecia 23 Aorta 35Alopecia, Androgenic 23 Angina Pectoris 35Alopecia Areata 24 Angioedema 35Altitude Sickness 24 Angioma (CherryAlveolar Consolidation 24 Angioma) 36Alveolar Hemorrhage 25 Angular CheilitisAlzheimer’s Disease (AD) 25 (Perlèche) 36Amaurosis Fugax 25 Anhidrosis 36Amblyopia 26 Anion Gap, Decrease 37Amebiasis 26 Anion Gap, Increase 37Amenorrhea 26 Anisocoria 37Amnesia 27 Ankle Fracture 38Amyloidosis 27 Ankle Sprain 38Amyotrophic Lateral Sclerosis Anorectal Fissure 38 (ALS) 27 Anorexia Nervosa 38Anaerobic Infections 28 Anovulation 38Anal Abscess and Fistula 28 Anthrax 39Anal Fissure 29 Antinuclear Antibody (ANA)Anal Fistula 29 Positive 39Anal Incontinence 29 Antiphospholipid Antibody Syndrome (APS) 39Anaphylaxis 29 Anxiety 40Androgen Excess, Reproductive- Age Woman 30 Aortic Dissection 40Anemia, Aplastic 30 Aortic Stenosis 40Anemia, Autoimmune, Aphthous Stomatitis (Canker Hemolytic 30 Sores) 41Anemia, Drug Induced 31 Appendicitis 43Anemia, Hypochromic 31 Appetite Loss in Infants and Children 43Anemia, Iron Deficiency 31 Arterial Occlusion 44Anemia, Low Reticulocyte Count 32 Arthritis and Abdominal Pain 44Anemia, Megaloblastic 32 Arthritis and Diarrhea 45Anemia, Pernicious 34 Arthritis and Eye Lesions 45Anemia, Sideroblastic 34 Arthritis and HeartAnergy, Cutaneous 34 Murmur 45
    • CONTENTS xiArthritis and Muscle Atrium Enlargement, Right Weakness 46 Atrium 57Arthritis and Rash 46 Attention-Deficit/HyperactivityArthritis and Subcutaneous Disorder (ADHD) 58 Nodules 46 Atypical Mole 58Arthritis and Weight Loss 47 Autistic SpectrumArthritis, Axial Skeleton 47 Disorder 58Arthritis, Fever, and Rash 47 AV Nodal Block 59Arthritis, Granulomatous 48 Babesiosis 59Arthritis, Juvenile, Bacillary Angiomatosis 59 Rheumatoid 48 Back Pain 60Arthritis, Monarticular and Back Pain, Children and Oligoarticular 48 Adolescents 60Arthritis, Pediatric Age 48 Back Pain, ViscerogenicArthritis, Polyarticular 50 Origin 61Arthritis, Psoriatic 50 Baker’s Cyst 61Arthritis, Rheumatoid 50 Balanitis 61Arthritis, Septic 51 Ballism 61Asbestosis 51 Barrett’s Esophagus 62Ascites 51 Bartter’s Syndrome 62Aspergillosis 52 Basal Cell Carcinoma 62Asthenia 52 Basophilia 62Asthma 52 Becker’s Nevus 63Asthma, Childhood 53 Behçet’s Syndrome 63Ataxia 54 Bell’s Palsy 63Ataxia, Acute or Recurrent 54 Bile Duct, Dilated 64Ataxia, Chronic or Bipolar Disorder 64 Progressive 55 Bites and Stings,Ataxia-Telangiectasia 55 Arachnids 64Atelectasis 55 Bites and Stings,Atrial Fibrillation 56 Insect 65Atrial Flutter 56 Bites, Snake 65Atrial Myxoma 56 Bite Wounds 65Atrial Septal Defect (ASD) 57 Bladder Cancer 65Atrioventricular Nodal Blastomycosis 65 Block 57 Bleeding, Lower GI 66
    • xii CONTENTSBleeding, Lower GI, Breathing, Noisy 81 Pediatric 67 Bronchiectasis 81Bleeding, Rectal 68 Bronchitis, Acute 82Bleeding Time Elevation 69 Brown Urine 82Bleeding, Upper GI 69 Bruising 82Bleeding, Upper GI, Bruxism 83 Pediatric 70 Budd-Chiari Syndrome 83Blepharitis 71 Bulimia 83Blindness, Geriatric Age 71 Bullous Diseases 84Blindness, Monocular, Bullous Pemphigoid 84 Transient 71 Burning Mouth Syndrome 84Blindness, Pediatric Age 71 Burns 84Blisters, Subepidermal 74 Bursitis 85Body Dysmorphic Café au Lait Macule 85 Disorder 74 Calcification on ChestBone Lesions, Preferential Site Radiograph 85 of Origin 74 Calcifications, Cutaneous 85Bone Marrow Failure Calcium Stones 86 Syndromes, Inherited 75 Candidiasis 86Bone Marrow Fibrosis 76 Candidiasis, Vulvovaginal 86Bone Mineral Density, Carbon Monoxide Increased 77 Poisoning 87Bone Pain 77 Carcinoid Syndrome 87Bone Resorption 77 Cardiac Arrest,Bone Tumor, Primary Nontraumatic 87 Malignant 78 Cardiac Death, Sudden 88Borderline Personality Cardiac Enlargement 88 Disorder 78 Cardiac Murmurs 89Botulism 79 Cardiac Tamponade 90Bowen’s Disease 79 Cardioembolism 90Bradycardia, Sinus 79 Cardiogenic Shock 91Brain Neoplasm 79 Cardiomyopathy,Breast Cancer 80 Congestive 91Breast Inflammatory Cardiomyopathy, Dilated 91 Lesion 80 Cardiomyopathy,Breast Mass 80 Hypertrophic 92Breath Odor 80
    • CONTENTS xiiiCardiomyopathy, Chronic Inflammatory Restrictive 92 DemyelinatingCarpal Tunnel 92 Polyneuropathy (CIDP) 104Cataracts 92 Chronic ObstructiveCat-Scratch Disease 92 Pulmonary DiseaseCavernous Sinus (COPD) 104 Thrombosis 93 Churg-Strauss Syndrome 104Cavitary Lesion on Chest Chylothorax 105 Radiograph 93 Cicatricial Pemphigoid 105Celiac Disease 94 Cirrhosis, Primary Biliary 105Cellulitis 94 Claudication 106Cerebral Infarction Cloudy Urine 106 Secondary to Inherited Clubbing 106 Disorders 94 Cobalamin Deficiency 107Cerebrovascular Disease, Cocaine Overdose 108 Ischemic 95 Coccidioidomycosis 108Cervical Cancer 96 Colic, Acute Abdominal 108Cervical Disk Disease 96 Color Changes,Cervical Dysplasia 96 Cutaneous 110Cervical Polyp 96 Colorado Tick Fever 110Cervicitis 97 Colorectal Cancer 111Chagas’ Disease 97 Coma 111Chancroid 97 Coma, Normal ComputedCharcot’s Joint 97 Tomography 112Chest Pain, Children 97 Coma, PediatricChest Pain, Nonpleuritic 99 Population 113Chest Pain, Pleuritic 99 Condyloma Acuminatum 115Chickenpox (Varicella) 100 Congenital AdrenalCholangitis 100 Hyperplasia 115Cholecystitis 100 Congestive Heart Failure 116Cholelithiasis 101 Conjunctival Neoplasm 116Cholestasis 101 Conjunctivitis 116Chorea 102 Constipation 117Choreoathetosis 102 Constipation, AdultChronic Fatigue Patient 118 Syndrome 103 Contact Dermatitis (Contact Eczema) 119
    • xiv CONTENTSConversion Disorder 119 Dependent Personality 131Corneal Abrasion 119 Depression 131Corneal Sensation, de Quervain’s Decreased 119 Tenosynovitis 131Corneal Ulceration 120 Dermatitis, Atopic 132Cor Pulmonale 120 Dermatitis, Contact 132Costochondritis 120 Dermatitis Herpetiformis 132Cough 120 Dermatofibroma 133Craniopharyngioma 121 Dermatographism 133Creutzfeldt-Jakob Dermatomyositis 133 Disease 121 Dermatosis byCrohn’s Disease 121 Morphology 134Cryoglobulinemia 122 Dermatosis by Region 140Cryptococcosis 122 Dermoid Cyst 146Cryptorchidism 122 Diabetes Insipidus 146Cryptosporidiosis 123 Diabetes Mellitus 146Cubital Tunnel Diabetic Ketoacidosis 146 Syndrome 123 Diarrhea, Acute Watery andCushing’s Syndrome 123 Bloody 147Cutaneous Infections, Diarrhea, Tube-Fed Athletes 123 Patient 147Cutaneous Larva Migrans 124 Diffuse Interstitial LungCutis Laxa 124 Disease 148Cyanosis 124 Digitalis Overdose 148Cylindroma 125 Diphtheria 148Cysticercosis 125 Diplopia, Binocular 149Cystic Fibrosis 126 Diplopia, Monocular 149Cytomegalovirus Diplopia, Vertical 149 Infection 126 Discoid Lupus ErythematosusDaytime Sleepiness 127 (DLE) 150Decubitus Ulcer 127 Disseminated IntravascularDelirium 127 Coagulation (DIC) 150Delirium, Dialysis Patient 129 Diverticular Disease 150Dementia with Lewy Dizziness 150 Bodies 129 Drug Eruption 151Demyelinating Diseases 130 Dry Eye 152
    • CONTENTS xvDumping Syndrome 152 Encephalopathy 165Dysfunctional Uterine Encephalopathy, Bleeding 152 Metabolic 166Dysmenorrhea 152 Encopresis 166Dyspareunia 153 Endocarditis, Infective 166Dyspepsia, Nonulcerative 154 Endometrial Cancer 167Dysphagia 154 Endometriosis 167Dyspnea 155 Enthesopathy 167Dystonia 156 Enuresis 168Dysuria 156 Eosinophilic Fasciitis 168Earache 156 Eosinophilic Pneumonia 168Echinococcosis 157 Eosinophiluria 168Eclampsia 157 Ephelides (Freckles) 169Ectopic Adrenocorticotropic Epicondylitis 169 Hormone (ACTH) Epidermoid Cyst (Sebaceous Secretion 157 Cyst, Epidermal InclusionEctopic Pregnancy 157 Cyst) 169Eczema Herpeticum 158 Epididymitis 169Edema, Children 158 Epiglottitis 170Edema, Generalized 159 Epilepsy 170Edema, Leg, Unilateral 159 Episcleritis 170Edema of Lower Epistaxis 170 Extremities 160 Epstein-Barr Infection 171Ehlers-Danlos Syndrome 160 Erectile Dysfunction,Ejaculation Disorders 160 Organic 171Ejaculation, Premature 160 Erosions, Genitalia 171Ejection Sound or Click 161 Erysipelas 172Elbow Pain 161 Erythema Multiforme 172Elevated Erythema Nodosum 172 Hemidiaphragm 161 Erythematous Annular SkinEmboli, Arterial 162 Lesions 173Emesis, Pediatric Age 162 Erythrasma 173Empyema 164 Erythroderma 173Encephalitis, Viral 164 Esophageal Cancer 174Encephalomyelitis, Nonviral Esophageal Perforation 174 Causes 164 Esophagitis 174
    • xvi CONTENTSEsotropia 174 Food Poisoning,Essential Tremor 175 Bacterial 188Exanthems 175 Foot Dermatitis 189Eyelid Neoplasm 176 Footdrop 189Eyelid Retraction 176 Foot Lesion, Ulcerating 189Eye Pain 177 Foot Pain 189Facial Pain 177 Forearm and Hand Pain 190Facial Paralysis 178 Friedreich’s Ataxia 190Factitious Disorder (Including Frostbite 190 Munchausen’s Frozen Shoulder 191 Syndrome) 178 Furuncle 191Failure to Thrive 179 Gait Abnormalities 191Fatigue 179 Galactorrhea 192Fatty Liver 180 Ganglia 192Fatty Liver of Pregnancy 180 Gardner’s Syndrome 192Felty’s Syndrome 181 Gastric Cancer 192Femoral Neck Fracture 181 Gastric Emptying,Fetal Alcohol Syndrome 181 Delayed 193Fever and Jaundice 181 Gastric Emptying,Fever and Rash 182 Rapid 193Fever in Returning Travelers Gastritis 193 and Immigrants 182 Gastroesophageal RefluxFever of Undetermined Origin Disease 194 (FUO), Possible Causes 184 Genital Discharge,Fibrocystic Breast Female 194 Disease 185 Genital Sores 194Fibromyalgia 185 Giant Cell Arteritis 195Fifth Disease 186 Giardiasis 195Filariasis 186 Gilbert’s Disease 195Finger Lesions, Gingivitis 195 Inflammatory 186 Glaucoma, ChronicFlank Pain 186 Open-Angle 196Flatulence and Bloating 187 Glaucoma, PrimaryFlushing 187 Angle-Closure 196Folate Deficiency 187 GlenohumeralFolliculitis 188 Dislocation 196
    • CONTENTS xviiGlomerulonephritis, Headache, Migraine 211 Acute 196 Headache, Tension Type 211Glomus Tumor 197 Head and Neck, Soft TissueGlossitis 197 Masses 212Glossodynia 197 Hearing Loss, Acute 212Glucocorticoid Heartburn and Deficiency 198 Indigestion 212Goiter 198 Heart Failure, Pregnancy 213Gonorrhea 199 Heat Illness 213Goodpasture’s Syndrome 199 Heel Pain 213Gout 199 Heel Pain, Plantar 214Granuloma Annulare 199 HELLP Syndrome 215Granuloma Inguinale 200 Hemarthrosis 215Granulomatous Hematemesis 215 Dermatitides 200 Hematuria 216Granulomatous Hematuria, Cause by Age and Disorders 200 Sex 217Granulomatous Liver Hemiparesis/Hemiplegia 217 Disease 202 Hemochromatosis 218Graves’ Disease 203 Hemolysis andGreen or Blue Urine 203 Hemoglobinuria 218Groin Lump 203 Hemolysis, Intravascular 218Groin Pain, Active Hemolysis, Mechanical 219 Patient 204 Hemolytic-Uremic SyndromeGuillain-Barré Syndrome 205 (HUS) 219Gynecomastia 205 Hemoperitoneum 219Hairy Tongue 206 Hemophilia 220Halitosis 206 Hemoptysis 220Hand-Foot-Mouth Hemorrhoids 221 Disease 206 Hemosiderinuria 221Hand Pain and Swelling 207 Henoch-SchönleinHeadache 207 Purpura 221Headache, Acute 208 Hepatic Coma 221Headache and Facial Hepatic Cysts 222 Pain 209 Hepatic Encephalopathy 222Headache, Cluster 211 Hepatic Granulomas 222
    • xviii CONTENTS Hepatitis, Acute 223 HIV Infection, Esophageal Hepatitis, Autoimmune 224 Disease 238 Hepatitis, Chronic 224 HIV Infection, Hepatic Hepatitis A 224 Disease 239 Hepatitis B 225 HIV Infection, Lower GI Tract Hepatitis C 225 Disease 240 Hepatitis D 225 HIV Infection, Ocular Manifestations 241 Hepatitis E 226 HIV Infection, Pulmonary Hepatocellular Disease 242 Carcinoma 226 Hoarseness 243 Hepatomegaly 226 Hodgkin’s Disease 244 Hepatomegaly, by Shape of Liver 227 Hookworm 244 Hepatorenal Syndrome 228 Hordeolum 244 Hermaphroditism 228 Horner’s Syndrome 244 Herpangina 229 Hot Flashes 244 Herpes Simplex, Genital 230 Human Granulocytic Ehrlichiosis 245 Herpes Simplex, Oral 230 Human Immunodeficiency Herpes Zoster 230 Virus Infection 245 Hiatal Hernia 230 Huntington’s Disease 246 Hiccups 231 Hydrocele 246 Hidradenitis Suppurativa 231 Hydrocephalus 247 Hip Pain, Children 232 Hydrocephalus, Normal Hip Pain, in Different Age Pressure 247 Groups 232 Hydronephrosis 247 Hirsutism 234 Hyperaldosteronism 248 Histoplasmosis 234 Hyperamylasemia 248 Histrionic Personality 235 Hyperbilirubinemia HIV Infection, Anorectal (Conjugated Bilirubin) 248 Lesions 235 Hyperbilirubinemia, HIV Infection, Chest Total 249 Radiographic Hyperbilirubinemia Abnormalities 236 (Unconjugated HIV Infection, Cognitive Bilirubin) 249 Impairment 237 Hypercalcemia 249 HIV Infection, Cutaneous Hypercalcemia, Malignancy Manifestations 237 Induced 250
    • CONTENTS xixHypercapnia, Persistent 250 Hypertriglyceridemia 264Hyperchloremia 250 HypertrophicHypercholesterolemia 251 Osteoarthropathy 264Hypercoagulable State, Hyperuricemia 265 Acquired 251 Hyperventilation,Hypercoagulable State, Persistent 265 Associated Disorders 252 Hyperviscosity, Serum 265Hypercoagulable State, Hypoalbuminemia 266 Inherited 253 Hypoaldosteronism 266Hypercortisolemia 254 Hypocalcemia 266Hyperemesis Gravidarum 254 Hypocapnia 267Hypereosinophilia 254 Hypochloremia 268Hypergastrinemia 255 Hypochondriasis 268Hyperglycemia 255 Hypogonadism 268Hyperhidrosis 256 Hypoimmunoglobu-Hyperimmunoglobu- linemia 269 linemia 257 Hypokalemia 269Hyperkalemia 258 Hypomagnesemia 270Hyperkinetic Movement Hyponatremia 271 Disorders 259 Hypo-osmolality, Serum 272Hyperlipoproteinemia, Hypo-osmolality, Urine 272 Primary 259 Hypophosphatemia 272Hypermagnesemia 259 Hypopigmentation 273Hypernatremia 260 Hypopituitarism 273Hyperosmolality, Serum 260 Hypoproteinemia 274Hyperosmolality, Urine 261 Hypotension, Postural 274Hyperparathyroidism 261 Hypothermia 274Hyperphosphatemia 261 Hypothyroidism 275Hyperpigmentation 262 Id Reaction 275Hyperprolactinemia 262 Idiopathic IntracranialHyperproteinemia 262 Hypertension 275Hypersensitivity Idiopathic Pulmonary Pneumonitis 263 Fibrosis 276Hypersplenism 263 IgA Nephropathy 276Hyperthyroidism 263 Iliac Fossa Pain, LeftHypertrichosis 264 Sided 276
    • xx CONTENTSIliac Fossa Pain, Right Joint Pain, Posterior Hips, Sided 276 Thigh, Buttocks 290Immune Thrombocytopenic Joint Swelling 290 Purpura 277 Jugular VenousImpetigo 277 Distention 291Impotence 278 Juvenile IdiopathicInappropriate Secretion of Arthritis 291 Antidiuretic Hormone 278 Kaposi’s Sarcoma 291Inclusion Body Myositis 278 Kawasaki’s Disease 292Incontinence, Fecal 279 Keloid 292Infertility, Female 279 Keratitis, Noninfectious 292Infertility, Male 280 Keratoacanthoma 292Influenza 281 Kidney Enlargement,Insomnia 281 Unilateral 293Insulinoma (Differential Knee Pain 293 Diagnosis of Fasting Knee Pain, in Different Age Hypoglycemia) 281 Groups 294Interstitial Cystitis 282 Korsakoff’s Psychosis 295Intestinal Labyrinthitis 295 Pseudo-obstruction 282 Lactose Intolerance 296Intracranial Lesion 283 Lambert-Eaton MyasthenicIntraocular Neoplasm 283 Syndrome 296Iron Overload 283 Laryngeal Cancer 296Irritable Bowel Laryngitis 297 Syndrome 284 Laryngotracheobronchi-Ischemic Colitis, tis 297 Nonocclusive 285 Lead Poisoning 297Ischemic Necrosis of Cartilage Left Axis Deviation 298 and Bone 285 Left Bundle Branch Block 298Jaundice 286 Leg Cramps, Nocturnal 298Jaundice in the Adult Leg Length Patient 287 Discrepancies 299Joint Pain, Anterior Hip, Leg Pain with Exercise 299 Medial Thigh, Knee 288 Leg Ulcers 300Joint Pain, Hip, Lateral Legg-Calvé-Perthes Thigh 289 Disease 301Joint Pain, Polyarticular 290 Leishmaniasis 301
    • CONTENTS xxiLentigo 301 Macrocytosis 311Leprosy 301 Macrothrombocytopenia,Leptomeningeal Lesions 302 Inherited 312Leptospirosis 302 Macular Degeneration 312Leukocoria 302 Malabsorption 312Leukocytoclastic Malaria 313 Vasculitis 302 Malignant Hyperthermia 313Leukoplakia, Oral Hairy (Oral Mallory-Weiss Tear 314 Hairy Cell Leukoplakia) 303 Mastocytosis (UrticariaLichen Planus 303 Pigmentosa) 314Lichen Sclerosus 303 Mastitis 314Lichen Simplex Mastoiditis 315 Chronicus 304 Measles (Rubeola) 315Limp 304 Meckel’s Diverticulum 315Limping, Pediatric Age 304 Mediastinal Masses orListeriosis 305 Widening on ChestLivedo Reticularis 305 Radiograph 315Liver Enzyme Elevation 305 Mediastinitis, Acute 316Liver Lesions, Benign, Often Meigs’ Syndrome 316 Confused with Melanocytic Nevi Malignancy 306 (Moles) 317Low-Voltage Melanoma 317 Electrocardiogram Melanonychia 318 (ECG) 306 Melasma (Chloasma) 318Lumbar Disk Syndrome 307 Memory Loss Symptoms,Lung Neoplasm, Primary 307 Elderly Patients 318Lyme Disease 307 Meniere’s Disease 319Lymphadenopathy 308 Meningioma 319Lymphangitis 310 Meningitis, Bacterial 319Lymphedema 310 Meningitis, Chronic 320Lymphocytopenia 310 Meningitis, Recurrent 320Lymphocytosis 311 Meningitis, Viral 320Lymphogranuloma Menopause 321 Venereum 311 Mesenteric Adenitis 321Lymphoma, Mesenteric Ischemia, Non-Hodgkin’s 311 Nonocclusive 321Lynch Syndrome 311
    • xxii CONTENTS Mesenteric Venous Mushroom Poisoning 332 Thrombosis 321 Myasthenia Gravis 332 Metabolic Syndrome 322 Mycosis Fungoides 333 Metastatic Neoplasms 322 Mydriasis 333 Metatarsalgia 323 Myelin Disorders 333 Microcephaly 323 Myelodysplastic Microcytosis 324 Syndrome 334 Micropenis 324 Myelopathy and Myelitis 334 Mild Cognitive Myocardial Ischemia 334 Impairment 325 Myocarditis 335 Miliaria 325 Myoclonus 335 Miosis 325 Myoglobinuria 336 Mitral Regurgitation 326 Myopathies, Infectious 336 Mitral Stenosis 326 Myopathies, Mitral Valve Prolapse 326 Inflammatory 336 Molluscum Contagiosum 326 Myopathies, Toxic 337 Mongolian Spot 326 Myositis, Inflammatory 337 Monoarthritis, Acute 327 Myotonia 338 Monocytosis 327 Myxedema Coma 339 Mononeuropathy 327 Nail Clubbing 339 Mononucleosis 328 Nail, Horizontal White Lines Morphea 328 (Beau’s Lines) 339 Morton’s Neuroma 328 Nail, Koilonychia 340 Motion Sickness 328 Nail, Onycholysis 340 Mucormycosis 329 Nail Pitting 340 Multifocal Atrial Nail Splinter Tachycardia 329 Hemorrhage 340 Multiple Myeloma 329 Nail Striations 341 Multiple Sclerosis (MS) 329 Nail Telangiectasia 341 Mumps 330 Nail Whitening (Terry’s Munchausen’s Syndrome 330 Nails) 341 Muscle Weakness 331 Nail Yellowing 341 Muscle Weakness, Lower Narcissistic Personality 342 Motor Neuron Versus Upper Narcolepsy 342 Motor Neuron 331 Nausea and Vomiting 342 Muscular Dystrophy 332 Neck and Arm Pain 343
    • CONTENTS xxiiiNeck Mass 343 Ocular Foreign Body 354Neck Pain 343 Odynophagia 354Necrobiosis Lipoidica 344 Onychomycosis (TineaNephritic Syndrome, Unguium) 354 Acute 344 Ophthalmoplegia 355Nephroblastoma 345 Opioid Dependence 355Nephrocalcinosis 345 Opsoclonus 355Nephrotic Syndrome 345 Optic Atrophy 356Neuroblastoma 346 Optic Neuritis 356Neurofibromatosis 346 Oral Mucosa, ErythematousNeurogenic Bladder 346 Lesions 356Neuroleptic Malignant Oral Mucosa, Pigmented Syndrome 347 Lesions 357Neurologic Deficit, Focal 347 Oral Mucosa, Punctate ErosiveNeurologic Deficit, Lesions 357 Multifocal 348 Oral Mucosa, WhiteNeuropathic Bladder 348 Lesions 357Neuropathies, Painful 348 Oral Ulcers, Acute 358Neuropathies with Facial Oral Vesicles and Ulcers 358 Nerve Involvement 349 Orbital Lesions, Calcified 358Neuropathy, Hereditary 349 Orbital Lesions, Cystic 359Neutropenia 350 Orchitis 359Neutrophilia 350 Orgasm Dysfunction 359Nevus Flammeus 350 Orofacial Pain 360Nevus of Ota and Ito 351 Orthostatic Hypotension 360Nipple Lesions 351 Osgood-Schlatter Disease 361Nocardiosis 351 Osler-Rendu-WeberNodular Lesions, Skin 351 Disease 361Nodules, Painful 352 Osteoarthritis 361Nonalcoholic Fatty Liver 352 Osteomyelitis 361Nummular Eczema 352 Osteoporosis 362Nystagmus 352 Osteoporosis, SecondaryNystagmus, Monocular 353 Causes 362Obesity 353 Otitis Externa 363Obsessive-Compulsive Otitis Media 363 Disorder (OCD) 353 Otosclerosis 363
    • xxiv CONTENTS Ovarian Cancer 363 Parotid Swelling 376 Ovarian Mass 364 Paroxysmal Cold Ovulatory Dysfunction 364 Hemoglobinuria (PCH) 377 Paget’s Disease of Bone 365 Pediculosis 377 Paget’s Disease of Breast 365 Pedophilia 378 Pain, Midfoot 366 Pelvic Inflammatory Pain, Plantar Aspect, Disease 378 Heel 366 Pelvic Mass 378 Pain, Posterior Heel 367 Pelvic Pain, Chronic 379 Palindromic Rheumatism 367 Pelvic Pain, Genital Palmoplantar Origin 379 Hyperkeratosis 367 Pemphigus Vulgaris 380 Palpitations 368 Penile Rash 380 Pancreatic Calcifications 368 Peptic Ulcer Disease 381 Pancreatic Cancer Perianal Pain 381 (Exocrine) 368 Pericardial Effusion 381 Pancreatitis, Acute 369 Pericarditis 382 Pancreatitis, Chronic 369 Periodic Paralysis, Pancytopenia 369 Hyperkalemic 382 Panic Disorder 370 Periodic Paralysis, Papilledema 371 Hypokalemic 382 Papulosquamous Peripheral Arterial Diseases 371 Disease 382 Paraneoplastic Neurologic Peritoneal Syndromes 372 Carcinomatosis 383 Paraneoplastic Syndromes, Peritoneal Effusion 383 Endocrine 372 Peritonitis, Secondary 384 Paraneoplastic Syndromes, Peritonitis, Spontaneous Nonendocrine 372 Bacterial 384 Paranoid Personality Peritonsillar Abscess 384 Disorder 373 Periumbilical Swelling 385 Paraplegia 374 Pertussis 385 Paresthesias 374 Peutz-Jeghers Syndrome 385 Parkinson’s Disease 375 Pheochromocytoma 385 Parkinson’s Plus Phobias 385 Syndromes 375 Photodermatoses 386 Paronychia 376
    • CONTENTS xxvPhotosensitivity 386 Popliteal Swelling 397Pilar Cyst (Wen) 386 Porphyria Cutanea TardaPilonidal Disease 386 (PCT) 397Pinworms 387 Portal Hypertension 397Pituitary Adenoma 387 PostconcussivePityriasis Alba 388 Syndrome 398Pityriasis Rosea 388 PostmenopausalPlacenta Previa 388 Bleeding 398Plantar Fasciitis 388 Postpoliomyelitis Syndrome 398Pleural Effusions 389 Post-traumatic StressPleural Effusions, Malignant Disorder 399 Disease Associated 389 Postural Hypotension,Pneumonia, Bacterial 390 Non-neurologicPneumonia, Mycoplasma 390 Causes 399Pneumonia, Pneumocystis Precocious Puberty 399 jiroveci 390 Preeclampsia 400Pneumonia, Recurrent 391 Premature Graying, ScalpPneumonia, Viral 391 Hair 400Pneumothorax, Premenstrual Dysphoric Spontaneous 391 Disorder 401Poliomyelitis 391 Progressive SupranuclearPolyarteritis Nodosa 392 Palsy 401Polycystic Kidney Disease 392 Prolactinoma 401Polycystic Ovary Syndrome Pronator Syndrome 402 (PCOS) 392 Proptosis 402Polycythemia Vera 392 Proptosis and Palatal NecroticPolymorphous Light Ulcers 402 Eruption 393 Prostate Cancer 402Polymyalgia Rheumatica 393 Prostatic Hyperplasia,Polymyositis 393 Benign 402Polyneuropathy 394 Proteinuria 403Polyneuropathy, Drug Pruritus 403 Induced 395 Pruritus Ani 404Polyneuropathy, Pruritus Vulvae 404 Symmetric 396 Pseudocyanosis,Polyuria 396 Etiology 404
    • xxvi CONTENTS Pseudofolliculitis Barbae Pyogenic Granuloma 414 (Ingrown Hairs, Razor QT Interval Prolongation 414 Bumps) 405 Rabies 415 Pseudogout 405 Ramsay Hunt Syndrome 415 Pseudohermaphroditism, Rash, Febrile Child 415 Female 405 Rash, Pruritic, Child 415 Pseudohermaphroditism, Raynaud’s Phenomenon 416 Male 405 Rectal Mass, Palpable 416 Pseudoinfarction 406 Rectal Pain 417 Pseudomembranous Red Blood Cell Aplasia, Colitis 406 Acquired, Etiology 417 Pseudoxanthoma Red Eye 417 Elasticum 406 Red Hot Joint 418 Psittacosis 407 Red Urine 418 Psoriasis 407 Reiter’s Syndrome 418 Psychosis 407 Renal Artery Occlusion, Ptosis 408 Causes 418 Puberty, Delayed 409 Renal Cell Puberty, Precocious 410 Adenocarcinoma 419 Pulmonary Crackles 410 Renal Cystic Disorders 419 Pulmonary Embolism 410 Renal Failure, Intrinsic or Pulmonary Hypertension, Parenchymal Causes 419 Primary 411 Renal Failure, Postrenal Pulmonary Lesions 411 Causes 420 Pulmonary Nodule, Renal Failure, Prerenal Solitary 412 Causes 420 Pulseless Electrical Activity Renal Tubular Acidosis 421 (Electromechanical Renal Vein Thrombosis, Dissociation [EMD]), Causes 421 Differential Diagnosis 412 Respiratory Failure, Pulseless Electrical Activity, Hypoventilatory 422 Etiology 412 Restless Legs Syndrome 422 Pupillary Dilation, Poor Reticulocytosis 423 Response to Darkness 412 Retinitis Pigmentosa 423 Purpura 413 Retinoblastoma 423 Pyelonephritis 413 Retinopathy, Diabetic 423 Pyoderma Gangrenosum 413
    • CONTENTS xxviiRetinopathy, Seborrheic Keratosis 433 Hypertensive 424 Seizure 433Retropharyngeal Abscess 424 Seizures, Absence 434Reye’s Syndrome 424 Seizures, Febrile 434Rhabdomyolysis, Causes 424 Seizures, Partial 434Rheumatic Fever 425 Seizures, Pediatric 434Rheumatoid Arthritis 425 Septicemia 435Rhinitis 425 Serotonin Syndrome 436Rhinitis, Allergic 426 Severe Acute RespiratoryRhus Dermatitis (Poison Ivy, Syndrome (SARS) 436 Poison Oak, Poison Sexual Precocity 436 Sumac) 426 Sexually Transmitted Diseases,Rickets 426 Anorectal Region 437Right Axis Deviation 427 Sheehan’s Syndrome 437Rocky Mountain Spotted Shigellosis 437 Fever 427 Shoulder Pain 438Rosacea 428 Shoulder Pain byRoseola 428 Location 438Rotator Cuff Syndrome 428 Sialadenitis 439Rubella 428 Sialolithiasis 439Salivary Gland Sick Sinus Syndrome 439 Enlargement 429 Silicosis 440Salivary Gland Secretion, Sinusitis 440 Decreased 429 Sjögren’s Syndrome 440Salmonellosis 429 Sleep Apnea 440Sarcoidosis 430 Small Bowel Obstruction 441Scabies 430 Small IntestineScarlet Fever 430 Ulceration 441Schistosomiasis 431 Smallpox 442Schizophrenia 431 Smell Disturbance 442Scleroderma 431 Somatization Disorder 442Scrotal Pain 432 Sore Throat 443Scrotal Swelling 432 Spastic Paraplegias 443Seasonal Affective Spinal Cord Compression, Disorder 433 Epidural 444Seborrheic Dermatitis 433 Spinal Cord Dysfunction 444
    • xxviii CONTENTS Spinal Cord Ischemic Stroke, Young Adult, Syndromes 444 Causes 458 Spinal Epidural Abscess 445 ST-Segment Elevations, Spinal Stenosis 445 Nonischemic 459 Spinal Stenosis, Lumbar 445 Sturge-Weber Syndrome 459 Spinal Tumors 446 Subarachnoid Spinocerebellar Ataxia 446 Hemorrhage 459 Splenomegaly 447 Subclavian Steal Splenomegaly and Syndrome 459 Hepatomegaly 448 Subdural Hematoma 459 Splenomegaly, Children 448 Sudden Death, Pediatric Spontaneous Miscarriage 450 Age 460 Sporotrichosis 450 Sudden Death, Young Athlete 461 Squamous Cell Carcinoma 451 Swollen Limb 461 Staphylococcal Scalded Skin Syncope 462 Syndrome (SSSS) 451 Syndrome of Inappropriate Stasis Dermatitis 451 Antidiuresis 462 Status Epilepticus 452 Syringomyelia 462 Steatohepatitis 452 Systemic Lupus Erythematosus 462 Stevens-Johnson Syndrome 452 Tabes Dorsalis 463 Stomatitis, Blistery Takayasu’s Arteritis 463 Lesions 452 Tall Stature 463 Stomatitis, Bullous 453 Tardive Dyskinesia 464 Stomatitis, Dark Lesions Tarsal Tunnel Syndrome 464 (Brown, Blue, Black) 453 Taste and Smell Loss 465 Stomatitis, Raised Telangiectasia 465 Lesions 453 Tendinopathy 465 Stomatitis, Red Lesions 454 Testicular Failure 466 Stomatitis, White Lesions 454 Testicular Neoplasm 467 Strabismus 455 Testicular Pain 468 Striae (Stretch Marks) 455 Testicular Size Variations 468 Stridor, Pediatric Age 455 Testicular Torsion 468 Stroke 456 Tetanus 469 Stroke, Pediatric Age 456 Tetralogy of Fallot 469
    • CONTENTS xxixThoracic Outlet Toxic Shock Syndrome 478 Syndrome 469 Toxoplasmosis 479Thromboangiitis Tracheitis 480 Obliterans 470 Tremor 480Thrombocytopenia 470 Trichinosis 480Thrombocytopenia, Inherited Trichotillomania 481 Disorders 471 Tricuspid Stenosis 481Thrombocytopenia, in Trigger Finger 481 Pregnancy 472 Trochanteric Bursitis 481Thrombocytosis 472 Tropical Sprue 482Thrombophlebitis, Tuberculosis, Miliary 482 Superficial 473 Tuberculosis, Pulmonary 482Thrombosis, Deep Tubulointerstitial Disease, Venous 473 Acute 482Thrombotic Tubulointerstitial Kidney Thrombocytopenic Disease 483 Purpura 473 Tularemia 483Thyroid Carcinoma 473 Tumor Markers Elevation 484Thyroid Nodule 474 Turner’s Syndrome 485Thyroid Storm 474 Typhoid Fever 485Thyroiditis 474 Ulcerative Colitis 485Thyromegaly 474 Urethral Discharge andTick-Related Infections 475 Dysuria 486Tics 475 Urethritis, Gonococcal 486Tinea Barbae and Tinea Urethritis, Faciei 475 Nongonococcal 486Tinea Capitis 475 Uric Acid Stones 486Tinea Corporis 476 Urinary Retention, Acute 487Tinea Cruris 476 Urinary Tract Infection 487Tinea Pedis 476 Urine Casts 487Tinea Versicolor (Pityriasis Urine, Red 488 Versicolor) 477 Urolithiasis 489Tinnitus 477 Uropathy, Obstructive 489Torsades de Pointes 477 Urticaria (Hives) 490Tourette’s Syndrome 477 Uterine Bleeding,Toxic Epidermal Abnormal 490 Necrolysis 478 Uterine Myoma 491
    • xxx CONTENTSUveitis 491 Vulvovaginitis, Bacterial 504Vaginal Bleeding 491 Vulvovaginitis, EstrogenVaginal Bleeding, Deficient 504 Pregnancy 492 Vulvovaginitis, Fungal 504Vaginal Discharge, Vulvovaginitis, Prepubertal Girls 492 Prepubescent 504Varicocele 493 Vulvovaginitis,Varicose Veins 493 Trichomonas 505Vasculitis, Classification 493 Warts 505Vasculitis, Diseases That Mimic Weakness, Acute, Vasculitis 494 Emergent 505Venous Lake 495 Weakness, GradualVenous Leg Ulcers 495 Onset 506Ventricular Failure 495 Wegener’sVentricular Septal Defect 496 Granulomatosis 506Vertebral Compression Weight Gain 506 Fractures 496 Weight Loss 507Vertigo 496 Wernicke’sVesiculobullous Diseases 497 Encephalopathy 507Vesiculopustules, Newborn West Nile Virus Infection 507 Infants 498 Wheezing 508Vestibular Neuronitis 498 Wheezing, Pediatric Age 508Vision Loss, Acute, Whiplash 509 Painful 498 Whipple’s Disease 509Vision Loss, Acute, Wrist Pain 510 Painless 498 Wrist and Hand Pain, inVision Loss, Chronic, Different Age Groups 511 Progressive 499 Xanthoma 513Vision Loss, Monocular, Xerophthalmia 513 Transient 499 Xerosis 513Vitiligo 499 Xerostomia 514Vocal Cord Paralysis 500 Yellow Fever 514Volume Depletion 500 Yellow Urine 514Volume Excess 501 Zenkers Diverticulum 515Vomiting 501Vulvar Cancer 502 References 515Vulvar Lesions 502 Index 519
    • ABDOMINAL DISTENTION 1Abdominal DistentionNONMECHANICAL OBSTRUCTION• Excessive intraluminal gas• Intra-abdominal infection• Trauma• Retroperitoneal irritation (renal colic, neoplasms, infections, hemorrhage)• Vascular insufficiency (thrombosis, embolism)• Mechanical ventilation• Extra-abdominal infection (sepsis, pneumonia, empyema, osteomyelitis of spine)• Metabolic/toxic abnormalities (hypokalemia, uremia, lead poisoning)• Chemical irritation (perforated ulcer, bile, pancreatitis)• Peritoneal inflammation• Severe pain• Pain medicationsMECHANICAL OBSTRUCTION• Neoplasm (intraluminal, extraluminal)• Adhesions, endometriosis• Infection (intra-abdominal abscess, diverticulitis)• Gallstones• Foreign body, bezoars• Pregnancy• Hernias• Volvulus• Stenosis at surgical anastomosis, radiation stenosis• Fecaliths• Inflammatory bowel disease (IBD)• Gastric outlet obstruction• Hematoma• Other: parasites, superior mesenteric artery (SMA) syndrome, pneumatosis intestinalis, annular pancreas, Hirschsprung’s disease, intussusception, meconium
    • 2 ABDOMINAL PAIN, ADOLESCENCEAbdominal Pain, Adolescence27• Irritable bowel syndrome• Acute gastroenteritis• Appendicitis• Inflammatory bowel disease (IBD)• Peptic ulcer disease• Cholecystitis• Neoplasm• Other: functional abdominal pain, pelvic inflammatory disease, pregnancy, pyelonephritis, renal stone, trauma, anxietyAbdominal Pain, Childhood27• Acute gastroenteritis• Appendicitis• Constipation• Anxiety• Cholecystitis, acute• Intestinal obstruction• Pancreatitis• Neoplasm• Inflammatory bowel disease (IBD)• Other: functional abdominal pain, pyelonephritis, pneumonia, diabetic ketoacidosis (DKA), heavy metal poisoning, sickle cell crisis, traumaAbdominal Pain, Chronic Lower39ORGANIC DISORDERSCommon• Gynecologic disease• Lactase deficiency• Diverticulitis• Crohn’s disease• Intestinal obstructionUncommon• Chronic intestinal pseudo-obstruction• Mesenteric ischemia• Malignant neoplasm (e.g., ovarian carcinoma)
    • ABDOMINAL PAIN, EPIGASTRIC 3• Abdominal wall pain• Spinal disease• Testicular disease• Metabolic diseases (e.g., diabetes mellitus [DM], familial Mediterranean fever, C1 esterase deficiency [angioneurotic edema], porphyria, lead poisoning, tabes dorsalis, renal failure)FUNCTIONAL DISORDERSCommon• Irritable bowel syndrome• Functional abdominal bloatingUncommon• Functional abdominal painAbdominal Pain, Diffuse• Early appendicitis• Aortic aneurysm• Gastroenteritis• Intestinal obstruction• Diverticulitis• Peritonitis• Mesenteric insufficiency or infarction• Pancreatitis• Inflammatory bowel disease (IBD)• Irritable bowel• Mesenteric adenitis• Metabolic: toxins, lead poisoning, uremia, drug overdose, diabetic ketoacidosis (DKA), heavy metal poisoning• Sickle cell crisis• Pneumonia (rare)• Trauma• Urinary tract infection, pelvic inflammatory disease (PID)• Other: acute intermittent porphyria, tabes dorsalis, periarteritis nodosa, Henoch-Schönlein purpura, adrenal insufficiencyAbdominal Pain, Epigastric• Gastric: peptic ulcer disease (PUD), gastric outlet obstruction, gastric ulcer• Duodenal: PUD, duodenitis
    • 4 ABDOMINAL PAIN, INFANCY• Biliary: cholecystitis, cholangitis• Hepatic: hepatitis• Pancreatic: pancreatitis• Intestinal: high small bowel obstruction, early appendicitis• Cardiac: angina, myocardial infarction (MI), pericarditis• Pulmonary: pneumonia, pleurisy, pneumothorax• Subphrenic abscess• Vascular: dissecting aneurysm, mesenteric ischemia• Other: gastroenteritis, anxietyAbdominal Pain, Infancy27• Acute gastroenteritis• Appendicitis• Intussusception• Volvulus• Meckel’s diverticulum• Other: colic, traumaAbdominal Pain, Left Lower Quadrant• Intestinal: diverticulitis, intestinal obstruction, perforated ulcer, inflammatory bowel disease (IBD), perforated descending colon, inguinal hernia, neoplasm, appendicitis, adhesions• Reproductive: ectopic pregnancy, ovarian cyst, torsion of ovarian cyst, tubo-ovarian abscess, mittelschmerz, endometriosis, seminal vesiculitis• Renal: renal or ureteral calculi, pyelonephritis, neoplasm• Vascular: leaking aortic aneurysm• Psoas abscess• TraumaAbdominal Pain, Left Upper Quadrant• Gastric: peptic ulcer disease (PUD), gastritis, pyloric stenosis, hiatal hernia• Pancreatic: pancreatitis, neoplasm, stone in pancreatic duct or ampulla• Cardiac: myocardial infarction (MI), angina pectoris
    • ABDOMINAL PAIN, PERIUMBILICAL 5• Splenic: splenomegaly, ruptured spleen, splenic abscess, splenic infarction• Renal: calculi, pyelonephritis, neoplasm• Pulmonary: pneumonia, empyema, pulmonary infarction• Vascular: ruptured aortic aneurysm• Cutaneous: herpes zoster• Trauma• Intestinal: high fecal impaction, perforated colon, diverticulitisAbdominal Pain, Nonsurgical Causes• Irritable bowel syndrome• Urinary tract infection, pyelonephritis, salpingitis, pelvic inflammatory disease (PID)• Gastroenteritis, gastritis, peptic ulcer• Diverticular spasm• Hepatitis, mononucleosis• Pancreatitis• Inferior wall myocardial infarction• Basilar pneumonia, pulmonary embolism• Diabetic ketoacidosis (DKA)• Strain or hematoma of rectus muscle• Ruptured graafian follicle• Herpes zoster• Nerve root compression• Sickle cell crisis• Acute adrenal insufficiency• Other: acute porphyria, familial Mediterranean fever, tabes dorsalisAbdominal Pain, Periumbilical• Intestinal: small bowel obstruction or gangrene, early appendicitis• Vascular: mesenteric thrombosis, dissecting aortic aneurysm• Pancreatic: pancreatitis• Metabolic: uremia, diabetic ketoacidosis (DKA)• Trauma• Irritable bowel, anxiety
    • 6 ABDOMINAL PAIN, POORLY LOCALIZEDAbdominal Pain, Poorly Localized27EXTRA-ABDOMINAL• Metabolic: diabetic ketoacidosis (DKA), acute intermittent porphyria, hyperthyroidism, hypothyroidism, hypercalcemia, hypokalemia, uremia, hyperlipidemia, hyperparathyroidism• Hematologic: sickle cell crisis, leukemia or lymphoma, Henoch-Schönlein purpura• Infectious: infectious mononucleosis, Rocky Mountain spotted fever, acquired immunodeficiency syndrome (AIDS), streptococcal pharyngitis (in children), herpes zoster• Drugs and toxins: heavy metal poisoning, black widow spider bites, withdrawal syndromes, mushroom ingestion• Referred pain: • Pulmonary: pneumonia, pulmonary embolism, pneumothorax • Cardiac: angina, myocardial infarction, pericarditis, myocarditis • Genitourinary: prostatitis, epididymitis, orchitis, testicular torsion • Musculoskeletal: rectus sheath hematoma• Somatization disorder, malingering, hypochondriasis, Munchausen’s syndrome, functionalINTRA-ABDOMINAL• Early appendicitis, gastroenteritis, peritonitis, pancreatitis, abdominal aortic aneurysm, mesenteric insufficiency or infarction, intestinal obstruction, volvulus, ulcerative colitisAbdominal Pain, Pregnancy27GYNECOLOGIC (GESTATIONAL AGE IN PARENTHESES)• Miscarriage (<20 wk; 80% <12 wk)• Septic abortion (<20 wk)• Ectopic pregnancy (<14 wk)• Corpus luteum cyst rupture (<12 wk)• Ovarian torsion (especially <24 wk)• Pelvic inflammatory disease (<12 wk)• Chorioamnionitis (>16 wk)• Abruptio placentae (>16 wk)
    • ABDOMINAL PAIN, RIGHT UPPER QUADRANT 7NONGYNECOLOGIC• Appendicitis (throughout)• Cholecystitis (throughout)• Hepatitis (throughout)• Pyelonephritis (throughout)• Preeclampsia (>20 wk)Abdominal Pain, Right Lower Quadrant• Intestinal: acute appendicitis, regional enteritis, incarcerated hernia, cecal diverticulitis, intestinal obstruction, perforated ulcer, perforated cecum, Meckel’s diverticulitis• Reproductive: ectopic pregnancy, ovarian cyst, torsion of ovarian cyst, salpingitis, tubo-ovarian abscess, mittelschmerz, endometriosis, seminal vesiculitis• Renal: renal and ureteral calculi, neoplasms, pyelonephritis• Vascular: leaking aortic aneurysm• Psoas abscess• Trauma• CholecystitisAbdominal Pain, Right Upper Quadrant• Biliary: calculi, infection, inflammation, neoplasm• Hepatic: hepatitis, abscess, hepatic congestion, neoplasm, trauma• Gastric: peptic ulcer disease (PUD), pyloric stenosis, neoplasm, alcoholic gastritis, hiatal hernia• Pancreatic: pancreatitis, neoplasm, stone in pancreatic duct or ampulla• Renal: calculi, infection, inflammation, neoplasm, rupture of kidney• Pulmonary: pneumonia, pulmonary infarction, right-sided pleurisy• Intestinal: retrocecal appendicitis, intestinal obstruction, high fecal impaction, diverticulitis• Cardiac: myocardial ischemia (particularly involving the inferior wall), pericarditis• Cutaneous: herpes zoster• Trauma• Fitz-Hugh–Curtis syndrome (perihepatitis)
    • 8 ABDOMINAL PAIN, SUPRAPUBICAbdominal Pain, Suprapubic• Intestinal: colon obstruction or gangrene, diverticulitis, appendicitis• Reproductive system: ectopic pregnancy, mittelschmerz, torsion of ovarian cyst, pelvic inflammatory disease (PID), salpingitis, endometriosis, rupture of endometrioma• Cystitis, rupture of urinary bladderAbdominal Wall Masses39LUMPS ARISING IN THE SKIN AND SUBCUTANEOUS FAT(THAT COULD OCCUR ANYWHERE ON THE BODY)• Lipoma• Sebaceous cystLUMPS ARISING IN THE SKIN AND SUBCUTANEOUS FAT(SPECIFIC TO THE ANTERIOR ABDOMINAL WALL)• Tumor nodule of the umbilicus (secondary to intraperitoneal malignant neoplasm, also called Sister Mary Joseph nodule)LUMPS ARISING IN THE FASCIA AND MUSCLE• Rectus sheath hematoma (usually painful)• Desmoid tumor (associated with Gardner’s syndrome)HERNIA• Incisional: It has an overlying scar. The sac may be very much larger than the neck of the hernia.• Umbilical: The hernia is through the umbilical scar. Those presenting at birth commonly resolve in the first years of life.• Paraumbilical: The neck is just lateral to the umbilical scar. Patients usually present later in life.• Epigastric: It occurs in the midline between the xiphoid process and the umbilicus. They are usually small (<2 cm). They result when a knuckle of extraperitoneal fat extrudes through a small defect in the linea alba. Commonly irreducible and without an expansile cough impulse.• Spigelian: A rare hernia found along the linea semilunaris at the lateral edge of the rectus sheath, most commonly a third of the way between the umbilicus and the pubis.
    • ABSCESS, BRAIN 9DIVARICATION OF THE RECTI• Supraumbilical elliptical swelling of attenuated linea alba (no cough impulse)Abortion, Recurrent• Congenital anatomic abnormalities• Adhesions (uterine synechiae)• Uterine fibroids• Endometriosis• Endocrine abnormalities (luteal phase insufficiency, hypothyroidism, uncontrolled diabetes mellitus [DM])• Parental chromosome abnormalities• Maternal infections (cervical Mycoplasma, Ureaplasma, Chlamydia infection)• Diethylstilbestrol (DES) exposure, heavy metal exposure• Thrombocytosis• Allogenic immunity, autoimmunity, lupus anticoagulantAbruptio Placentae• Placenta previa• Cervical or vaginal trauma• Labor• Cervical cancer• Rupture of membranesAbscess, Brain• Other parameningeal infections: subdural empyema, epidural abscess, thrombophlebitis of the major dural venous sinuses and cortical veins• Embolic strokes in patients with bacterial endocarditis• Mycotic aneurysms with leakage• Viral encephalitis (usually resulting from herpes simplex)• Acute hemorrhagic leukoencephalitis• Parasitic infections: toxoplasmosis, echinococcosis, cysticercosis• Metastatic or primary brain tumors• Cerebral infarction
    • 10 ABSCESS, BREAST• Central nervous system (CNS) vasculitis• Chronic subdural hematomaAbscess, Breast• Sebaceous cyst with infection• Inflammatory carcinoma• Advanced carcinoma with erythema, edema, or ulceration• Hidradenitis of breast skin• Tuberculous abscess (rare)Abscess, Liver• Cholangitis• Cholecystitis• Diverticulitis• Appendicitis• Perforated viscus• Mesentery ischemia• Pulmonary embolism• PancreatitisAbscess, Lung• Bacterial (anaerobic, aerobic, infected bulla, empyema, actinomycosis, tuberculosis)• Fungal (histoplasmosis, coccidioidomycosis, blastomycosis, aspergillosis, cryptococcosis)• Parasitic (amebiasis, echinococcosis)• Malignant neoplasm (primary lung carcinoma, metastatic lung disease, lymphoma, Hodgkin’s disease)• Wegener’s granulomatosis, sarcoidosis, endocarditis, septic pulmonary emboliAbscess, Pelvic• Pelvic neoplasms, such as ovarian tumors and leiomyomas• Inflammatory masses involving adjacent bowel or omentum, such as ruptured appendicitis or diverticulitis
    • ABUSE, CHILD 11• Pelvic hematomas, as may occur after cesarean section or hysterectomyAbscess, Perirectal• Pilonidal disease• Crohn’s disease (inflammatory bowel disease [IBD])• Hidradenitis suppurativa• Tuberculosis or actinomycosis; Chagas’ disease• Cancerous lesions• Chronic anal fistula• Rectovaginal fistula• Proctitis—often STD associated—including syphilis, gonococcal, chlamydial, chancroid, condylomata acuminata• AIDS associated: Kaposi’s sarcoma, lymphoma, cytomegalovirus (CMV)• Neutropenic enterocolitisAbuse, ChildIn all categories, accidental injury is the most common entity to bedistinguished from abuse. Accidental injuries are most commonover bone prominences: forehead, elbows, knees, shins; soft, fleshyareas are more common for inflicted injury: buttocks, thighs, upperarms.BRUISING• Bleeding disorder (idiopathic thrombocytopenic purpura, hemophilia, leukemia, hemorrhagic disease of the newborn, von Willebrand disease)• Connective tissue disorder (Ehlers-Danlos syndrome, vasculitis)• Pigments (mongolian spots)• Dermatitis (phytophotodermatitis, nickel allergy)• Folk treatment (coining, cupping)BURNS• Chemical burn• Impetigo• Folk treatment (moxibustion)• Dermatitis (phytophotodermatitis)
    • 12 ABUSE, ELDERINTRACRANIAL HEMORRHAGE• Bleeding disorder• Perinatal trauma (should resolve by 4 wk)• Arteriovenous malformation rupture• Glutaric aciduriaFRACTURES• Osteogenesis imperfecta• Rickets• Congenital syphilis• Very low birth weight (osteopenia of prematurity)SEXUAL ABUSE• Normal variants• Lichen sclerosus et atrophicus• Congenital abnormalities• Urethral prolapse• Hemangioma• Non–sexually acquired infection (group A streptococcus, Shigella)Abuse, Elder• Advancing dementia• Depression or other psychiatric disorder• Malnutrition from intrinsic causes• Conscious nonadherence• Financial hardship• FallingAcanthosis Nigricans• Seborrheic keratosis• Hyperpigmented nevus (Becker’s nevus), linear epidermal nevus• Pemphigus vegetans• Lichen simplex chronicus• Confluent and reticulated papillomatosisAchalasia• Angina• Bulimia
    • ACHILLES TENDON RUPTURE 13• Anorexia nervosa• Gastritis• Peptic ulcer disease• Postvagotomy dysmotility• Esophageal disease: gastroesophageal reflux disease (GERD), sarcoidosis, amyloidosis, esophageal stricture, esophageal webs and rings, scleroderma, Barrett’s esophagus, Chagas’ disease, esophagitis• Diffuse esophageal spasm• Malignant neoplasm: esophageal cancer, infiltrating gastric cancer, lung cancer, lymphoma• Gastric bezoarAches and Pains, Diffuse25• Postviral arthralgias/myalgias• Bilateral soft tissue rheumatism• Overuse syndromes• Fibrositis• Hypothyroidism• Metabolic bone disease• Paraneoplastic syndrome• Myopathy (polymyositis, dermatomyositis)• Rheumatoid arthritis (RA)• Sjögren’s syndrome• Polymyalgia rheumatica• Hypermobility• Benign arthralgias/myalgias• Chronic fatigue syndrome• HypophosphatemiaAchilles Tendon Rupture• Incomplete (partial) tendo Achillis rupture• Partial rupture of gastrocnemius muscle, often medial head (previously thought to be “plantaris tendon rupture”)
    • 14 ACIDOSIS, LACTICAcidosis, LacticTISSUE HYPOXIA• Shock (hypovolemic, cardiogenic, endotoxic)• Respiratory failure (asphyxia)• Severe congestive heart failure (CHF)• Severe anemia• Carbon monoxide (CO) or cyanide poisoningASSOCIATED WITH SYSTEMIC DISORDERS• Neoplastic diseases (e.g., leukemia, lymphoma)• Liver or renal failure• Sepsis• Diabetes mellitus (DM)• Seizure activity• Abnormal intestinal flora• Alkalosis• HIV infectionSECONDARY TO DRUGS OR TOXINS• Salicylates• Ethanol, methanol, ethylene glycol• Fructose or sorbitol• Biguanides (phenformin, metformin [usually occurring in patients with renal insufficiency])• Isoniazid• Streptozocin• Nucleoside reverse transcriptase inhibitors (e.g., zidovudine, didanosine, stavudine)HEREDITARY DISORDERS• Glucose-6-phosphate dehydrogenase (G6PD) deficiency and othersAcidosis, MetabolicMETABOLIC ACIDOSIS WITH INCREASED ANION GAP(ANION GAP ACIDOSIS)• Lactic acidosis• Ketoacidosis (diabetes mellitus [DM], alcoholic ketoacidosis)
    • ACIDOSIS, RESPIRATORY 15• Uremia (chronic renal failure)• Ingestion of toxins (paraldehyde, methanol, salicylate, ethylene glycol)• High-fat diet (mild acidosis)METABOLIC ACIDOSIS WITH NORMAL ANION GAP(HYPERCHLOREMIC ACIDOSIS)• Renal tubular acidosis (including acidosis of aldosterone deficiency)• Intestinal loss of HCO3 (diarrhea, pancreatic fistula)• Carbonic anhydrase inhibitors (e.g., acetazolamide)• Dilutional acidosis (as a result of rapid infusion of bicarbonate- free isotonic saline)• Ingestion of exogenous acids (ammonium chloride, methionine, cystine, calcium chloride)• Ileostomy• Ureterosigmoidostomy• Drugs: amiloride, triamterene, spironolactone, β-blockersAcidosis, Respiratory• Pulmonary disease (chronic obstructive pulmonary disease [COPD], severe pneumonia, pulmonary edema, interstitial fibrosis)• Airway obstruction (foreign body, severe bronchospasm, laryngospasm)• Thoracic cage disorders (pneumothorax, flail chest, kyphoscoliosis)• Defects in muscles of respiration (myasthenia gravis, hypokalemia, muscular dystrophy)• Defects in peripheral nervous system (amyotrophic lateral sclerosis, poliomyelitis, Guillain-Barré syndrome, botulism, tetanus, organophosphate poisoning, spinal cord injury)• Depression of respiratory center (anesthesia, narcotics, sedatives, vertebral artery embolism or thrombosis, increased intracranial pressure)• Failure of mechanical ventilator
    • VOMITING 501Volume Excess1PRIMARY RENAL SODIUM RETENTION (INCREASEDEFFECTIVE CIRCULATING VOLUME)• Renal failure, nephritic syndrome, acute glomerulonephritis• Primary hyperaldosteronism• Cushing’s syndrome• Liver diseaseSECONDARY RENAL SODIUM RETENTION (DECREASEDEFFECTIVE CIRCULATING VOLUME)• Heart failure• Liver disease• Nephrotic syndrome (minimal change disease)• PregnancyVomiting• GI disturbances • Obstruction: esophageal, pyloric, intestinal • Infections: viral or bacterial enteritis, viral hepatitis, food poisoning, gastroenteritis • Pancreatitis • Appendicitis • Biliary colic • Peritonitis • Perforated bowel • Diabetic gastroparesis • Other: gastritis, peptic ulcer disease (PUD), inflammatory bowel disease (IBD), GI tract neoplasms• Drugs: morphine, digitalis, cytotoxic agents, bromocriptine• Severe pain: myocardial infarction (MI), renal colic• Metabolic disorders: uremia, acidosis/alkalosis, hyperglycemia, diabetic ketoacidosis (DKA), thyrotoxicosis• Trauma: blows to the testicles, epigastrium• Vertigo• Reye’s syndrome• Increased intracranial pressure• CNS disturbances: trauma, hemorrhage, infarction, neoplasm, infection, hypertensive encephalopathy, migraine
    • 502 VULVAR CANCER• Radiation sickness• Nausea and vomiting of pregnancy, hyperemesis gravidarum• Motion sickness• Bulimia, anorexia nervosa• Psychogenic: emotional disturbances, offensive sights or smells• Severe coughing• Pyelonephritis• Boerhaave’s syndrome• Carbon monoxide poisoningVulvar Cancer• Lymphogranuloma inguinale• TB• Vulvar dystrophies• Vulvar atrophy• Paget’s diseaseVulvar Lesions12RED LESIONInfection/Infestation• Fungal infection: Candida, tinea cruris, intertrigo, pityriasis versicolor• Sarcoptes scabiei• Erythrasma: Corynebacterium minutissimum• Granuloma inguinale: Calymmatobacterium granulomatis• Folliculitis: Staphylococcus aureus• Hidradenitis suppurativa• Behçet’s syndromeInflammation• Reactive vulvitis• Chemical irritation: detergent, dyes, perfume, spermicide, lubricants, hygiene sprays, podophyllum, topical 5-fluorouracil, saliva, gentian violet, semen• Mechanical trauma: scratching• Vestibular adenitis• Essential vulvodynia• Psoriasis• Seborrheic dermatitis
    • VULVAR LESIONS 503Neoplasm• Vulvar intraepithelial neoplasia (VIN): mild dysplasia, moderate dysplasia, severe dysplasia, carcinoma in situ• Vulvar dystrophy• Bowen’s disease• Invasive cancer: squamous cell carcinoma, malignant melanoma, sarcoma, basal cell carcinoma, adenocarcinoma, Paget’s disease, undifferentiatedWHITE LESION• Vulvar dystrophy: lichen sclerosus, vulvar dystrophy, vulvar hyperplasia, mixed dystrophy• VIN• Vitiligo• Partial albinism• Intertrigo• Radiation treatmentDARK LESION• Lentigo• Nevi (mole)• Neoplasm (vulvar)• Reactive hyperpigmentation• Seborrheic keratosis• Pubic liceULCERATIVE LESIONInfection• Herpes simplex• Vaccinia• Treponema pallidum• Granuloma inguinale• Pyoderma• TuberculosisNoninfectious• Behçet’s syndrome• Crohn’s disease• Pemphigus• Pemphigoid• Hidradenitis suppurativa
    • 504 VULVOVAGINITIS, BACTERIALNeoplasm• Basal cell carcinoma• Squamous cell carcinoma• Vulvar tumor <1 cm: condyloma acuminatum, molluscum contagiosum, epidermal inclusion, vestibular cyst, mesonephric duct, VIN, hemangioma, hidradenoma, neurofibroma, syringoma, accessory breast tissue, acrochordon, endometriosis, Fox-Fordyce disease, pilonidal sinus• Vulvar tumor >1 cm: Bartholin’s cyst or abscess, lymphogranuloma venereum, fibroma, lipoma, verrucous carcinoma, squamous cell carcinoma, hernia, edema, hematoma, acrochordon, epidermal cysts, neurofibromatosis, accessory breast tissueVulvovaginitis, Bacterial• Fungal vaginitis• Trichomonas vaginitis• Atrophic vaginitis• CervicitisVulvovaginitis, Estrogen Deficient• Infectious vulvovaginitis• Squamous cell hyperplasia• Lichen sclerosus• Vulvar malignant neoplasm• Vaginal malignant neoplasm• Cervical and endometrial malignant neoplasmVulvovaginitis, Fungal• Bacterial vaginosis• Trichomonas vaginitis• Atrophic vaginitisVulvovaginitis, Prepubescent• Physiologic leukorrhea• Foreign body
    • WEAKNESS, ACUTE, EMERGENT 505• Bacterial vaginosis• Gonorrhea• Fungal vulvovaginitis• Trichomonas vulvovaginitis• Sexual abuse• PinwormsVulvovaginitis, Trichomonas• Bacterial vaginosis• Fungal vulvovaginitis• Cervicitis• Atrophic vulvovaginitis• Waldenström’s macroglobulinemia• Monoclonal gammopathy of unknown significance (MGUS)• Multiple myeloma• Chronic lymphocytic leukemia• Hairy cell leukemia• LymphomaWarts• Molluscum contagiosum• Condyloma latum• Acrochordon (skin tags) or seborrheic keratosis• Epidermal nevi• Hypertrophic actinic keratosis• Squamous cell carcinomas• Acquired digital fibrokeratoma• Varicella zoster virus in patients with AIDS• Recurrent infantile digital fibroma• Plantar corns (may be mistaken for plantar warts)Weakness, Acute, Emergent27• Demyelinating disorders (Guillain-Barré, chronic inflammatory demyelinating polyneuropathy [CIDP])• Myasthenia gravis• Infectious (poliomyelitis, diphtheria)
    • 506 WEAKNESS, GRADUAL ONSET• Toxic (botulism, tick paralysis, paralytic shellfish toxin, puffer fish, newts)• Metabolic (acquired or familial hypokalemia, hypophosphatemia, hypermagnesemia)• Metals poisoning (arsenic, thallium)• PorphyriaWeakness, Gradual Onset• Depression• Malingering• Anemia• Hypothyroidism• Medications (e.g., sedatives, antidepressants, narcotics)• Congestive heart failure (CHF)• Renal failure• Liver failure• Respiratory insufficiency• Alcoholism• Nutritional deficiencies• Disorders of motor unit• Basal ganglia disorders• Upper motor neuron lesionsWegener’s Granulomatosis• Other granulomatous lung diseases (e.g., lymphomatoid granulomatosis, Churg-Strauss syndrome, necrotizing sarcoid granulomatosis, bronchocentric granulomatosis, sarcoidosis)• Neoplasms• Goodpasture’s syndrome• Bacterial or fungal sinusitis• Midline granuloma• Viral infectionsWeight Gain• Sedentary lifestyle• Fluid overload• Discontinuation of tobacco abuse
    • WEST NILE VIRUS INFECTION 507• Endocrine disorders (hypothyroidism, hyperinsulinism associated with maturity-onset diabetes mellitus [DM], Cushing’s syndrome, hypogonadism, insulinoma, hyperprolactinemia, acromegaly)• Medications (e.g., nutritional supplements, oral contraceptives, glucocorticoids)• Anxiety disorders with compulsive eating• Laurence-Moon-Biedl syndrome, Prader-Willi syndrome, other congenital diseases• Hypothalamic injury (rare; <100 cases reported in medical literature)Weight Loss• Malignant disease• Psychiatric disorders (depression, anorexia nervosa)• New-onset diabetes mellitus (DM)• Malabsorption• Chronic obstructive pulmonary disease (COPD)• AIDS• Uremia, liver disease• Thyrotoxicosis, pheochromocytoma, carcinoid syndrome• Addison’s disease• Intestinal parasites• Peptic ulcer disease (PUD)• Inflammatory bowel disease (IBD)• Food faddism• Postgastrectomy syndromeWernicke’s Encephalopathy• Thiamine deficiency, including alcohol abuse, malnutrition, and iatrogenic cause• Stroke, mass lesion, or trauma affecting upper brainstem, thalamus, and associated structuresWest Nile Virus Infection• Meningitis or encephalitis caused by more common viruses (e.g., enteroviruses, herpes simplex)• Bacterial meningitis
    • 508 WHEEZING• Vasculitis• Fungal meningitis (e.g., cryptococcal infection)• Tuberculous meningitisWheezing• Asthma• Chronic obstructive pulmonary disease (COPD)• Interstitial lung disease• Infections (pneumonia, bronchitis, bronchiolitis, epiglottitis)• Cardiac asthma• Gastroesophageal reflux disease (GERD) with aspiration• Foreign body aspiration• Pulmonary embolism• Anaphylaxis• Obstruction airway (neoplasm, goiter, edema or hemorrhage from trauma, aneurysm, congenital abnormalities, strictures, spasm)• Carcinoid syndromeWheezing, Pediatric Age4• Reactive airways disease • Atopic asthma • Infection-associated airway reactivity • Exercise-induced asthma • Salicylate-induced asthma and nasal polyposis • Asthmatic bronchitis • Other hypersensitivity reactions: hypersensitivity pneumonitis, tropical eosinophilia, visceral larva migrans, allergic bronchopulmonary aspergillosis• Aspiration • Foreign body • Food, saliva, gastric contents• Laryngotracheoesophageal cleft• Tracheoesophageal fistula, H type• Pharyngeal incoordination or neuromuscular weakness• Cystic fibrosis• Primary ciliary dyskinesia• Cardiac failure
    • WHIPPLE’S DISEASE 509• Bronchiolitis obliterans• Extrinsic compression of airways • Vascular ring • Enlarged lymph node • Mediastinal tumor • Lung cysts • Tracheobronchomalacia • Endobronchial masses• Gastroesophageal reflux• Pulmonary hemosiderosis• Sequelae of bronchopulmonary dysplasia• “Hysterical” glottic closure• Cigarette smoke, other environmental insultsWhiplash• Osteoarthritis• Cervical disk disease• Fibrositis• Neuritis• Torticollis• Spinal cord tumor• Temporomandibular joint (TMJ) syndrome• Tension headache• Migraine headacheWhipple’s DiseaseMALABSORPTION/MALDIGESTION• Celiac disease• Mycobacterium avium-intracellulare intestinal infection in patients with AIDS• Intestinal lymphoma• Abetalipoproteinemia• Amyloidosis• Systemic mastocytosis• Irradiation enteritis• Crohn’s disease• Short bowel syndrome• Pancreatic insufficiency
    • 510 WRIST PAIN• Intestinal bacterial overgrowth• Lactose deficiency• Postgastrectomy syndrome• Other cause of diarrheaSERONEGATIVE INFLAMMATORY ARTHRITISPERICARDITIS AND PLEURITISLYMPHADENITISNEUROLOGIC DISORDERSWrist PainMECHANICAL• Osteoarthritis• Ligament tear• Fracture• Ganglion• de Quervain’s tenosynovitis• Avascular necrosis (scaphoid, lunate)• Nonunion of scaphoid or lunate• NeoplasmMETABOLIC• Pregnancy• Diabetes• Gout• Pseudogout• Paget’s disease• Acromegaly• Hypothyroidism• HyperparathyroidismINFECTIOUS• Osteomyelitis• Septic arthritis• Cat-scratch disease• Tick bite (Lyme disease, babesiosis)• Tuberculosis
    • WRIST AND HAND PAIN, IN DIFFERENT AGE GROUPS 511NEUROLOGIC• Peripheral neuropathy• Nerve injury (median, ulnar, radial nerve)• Thoracic outlet compression syndrome• Distal posterior interosseous nerve syndromeRHEUMATOLOGIC• Psoriasis• RA• SLE, mixed connective tissue disorder (MCTD)• SclerodermaMISCELLANEOUS• Granulomatous (sarcoidosis)• Amyloidosis• Multiple myeloma• LeukemiaWrist and Hand Pain,in Different Age Groups8Common causes of wrist and hand pain in different age groups:CHILDHOOD (2–10 YEARS)Intra-articular• InfectionPeriarticular• Fracture• OsteomyelitisADOLESCENCE (10–18 YEARS)Intra-articular• InfectionPeriarticular• Trauma• Osteomyelitis• Tumors• Ganglion• Idiopathic wrist pain
    • 512 WRIST AND HAND PAIN, IN DIFFERENT AGE GROUPSEARLY ADULTHOOD (18–30 YEARS)Intra-articular• Inflammatory arthritis• InfectionPeriarticular• Peripheral nerve entrapment• Tendinitis• GanglionReferred• CervicalADULTHOOD (30–50 YEARS)Intra-articular• Inflammatory arthritis• Infection• Osteoarthritis• Periarticular• Peripheral nerve entrapment• TendinitisReferred• Cervical• Chest• CardiacOLD AGE (>50 YEARS)Intra-articular• Inflammatory arthritis• OsteoarthritisPeriarticular• Peripheral nerve entrapment• TendinitisReferred• Cervical• Chest• Cardiac
    • XEROSIS 513Xanthoma• Necrobiosis lipoidica• Rheumatoid nodules• Neurofibromas• Nodular elastoidosis• Granuloma annulare• Giant tumor of tendon sheath• Erythema elevatum diutinum• HistiocytosesXerophthalmia29MEDICATIONS• Tricyclic antidepressants: amitriptyline, doxepin• Antihistamines: diphenhydramine, chlorpheniramine, promethazine, and many cold and decongestant preparations• Anticholinergic agents: antiemetics such as scopolamine, antispasmodic agents such as oxybutynin chlorideABNORMALITIES OF EYELID FUNCTION• Neuromuscular disorders• Aging• ThyrotoxicosisABNORMALITIES OF TEAR PRODUCTION• Hypovitaminosis A• Stevens-Johnson syndrome• Familial diseases affecting sebaceous secretionsABNORMALITIES OF CORNEAL SURFACES• Scarring from past injuries and herpes simplex infectionXerosis• Ichthyosis• Stasis dermatitis• Asteatotic eczema• Nummular eczema• Eczema craquelé
    • 514 XEROSTOMIAXerostomia29MEDICATIONS• Tricyclic antidepressants: amitriptyline, doxepin• Antihistamines: diphenhydramine, chlorpheniramine, promethazine, and many cold and decongestant preparations• Anticholinergic agents: antiemetics such as scopolamine, antispasmodic agents such as oxybutynin chlorideDEHYDRATION• Debility• FeverPOLYURIA• Alcohol intake• Arrhythmia• DiabetesPREVIOUS HEAD AND NECK IRRADIATIONSYSTEMIC DISEASES• Sjögren’s syndrome• Sarcoidosis• Amyloidosis• HIV infection• Graft-versus-host diseaseYellow Fever• Viral hepatitis• Leptospirosis• Malaria• Typhoid fever• Hemorrhagic fevers (HF) with jaundice• Dengue (HF)• Valley fever• Crimean-Congo (HF)Yellow Urine• Normal coloration• Concentrated urine
    • REFERENCES 515• Use of multivitamin supplements• Diet rich in carrots• Use of cascara• Urinary tract infectionZenker’s Diverticulum• Achalasia• Esophageal spasm• Esophageal carcinoma• Esophageal webs• Peptic stricture• Lower esophageal (Schatzki’s) ring• Foreign bodies• CNS disorders (stroke, Parkinson’s disease, amyotrophic lateral sclerosis [ALS], multiple sclerosis [MS], myasthenia gravis, muscular dystrophies)• Dermatomyositis• InfectionReferences 1. Andreoli TE, ed: Cecil Essentials of Medicine, 5th ed. Philadelphia, WB Saunders, 2001. 2. Barkin RM, Rosen P: Emergency Pediatrics: A Guide to Ambulatory Care, 5th ed. St. Louis, Mosby, 1998. 3. Baude AI: Infectious Diseases and Medical Microbiology, 2nd ed. Philadelphia, WB Saunders, 1986. 4. Behrman RE: Nelson Textbook of Pediatrics, 16th ed. Philadelphia, WB Saunders, 2000. 5. Canoso J: Rheumatology in Primary Care. Philadelphia, WB Saunders, 1997. 6. Callen JP: Color Atlas of Dermatology, 2nd ed. Philadelphia, WB Saunders, 2000. 7. Carlson KJ: Primary Care of Women, 2nd ed. St. Louis, Mosby, 2003. 8. Carr A, Hamilton W: Orthopedics in Primary Care, 2nd ed. Philadelphia, Elsevier, 2005. 9. Conn R: Current Diagnosis, 9th ed. Philadelphia, WB Saunders, 1997.10. Copeland LJ: Textbook of Gynecology, 2nd ed. Philadelphia, WB Saunders, 2000.11. Custer JW, Rau RE: The Harriet Lane Handbook, 18th ed. St. Louis, Mosby, 2009.
    • 516 REFERENCES12. Danakas G, ed: Practical Guide to the Care of the Gynecologic/Obstetric Patient. St. Louis, Mosby, 1997.13. Goldberg RJ: The Care of the Psychiatric Patient, 2nd ed. St. Louis, Mosby, 1998.14. Goldman L, Bennet JC: Cecil Textbook of Medicine, 22nd ed. Philadelphia, WB Saunders, 2004.15. Goldman L, Braunwauld E, eds: Primary Cardiology. Philadelphia, WB Saunders, 1998.16. Goldstein BG, Goldstein AO: Practical Dermatology, 2nd ed. St. Louis, Mosby, 1997.17. Gorbach SL: Infectious Diseases, 2nd ed. Philadelphia, WB Saunders, 1998.18. Harrington J: Consultation in Internal Medicine, 2nd ed. St. Louis, Mosby, 1997.19. Henry JB: Clinical Diagnosis and Management by Laboratory Methods, 20th ed. Philadelphia, WB Saunders, 2001.20. Hoekelman R: Primary Pediatric Care, 3rd ed. St. Louis, Mosby, 1997.21. Hoffman R, Benz EJ, Shattil SJ, Furie B, Silberstein LE, Mc Glave P, Heslop H: Hematology, Basic Principles and Practice, 5th ed. Philadelphia, Churchill Livingstone, 2009.22. Kassirer J, ed: Current Therapy in Adult Medicine, 4th ed. St. Louis, Mosby, 1998.23. Khan MG: Rapid ECG Interpretation, Philadelphia, WB Saunders, 2003.24. Kliegman R: Practical Strategies in Pediatric Diagnosis and Therapy. Philadelphia, WB Saunders, 1996.25. Klippel J, ed: Practical Rheumatology. London, Mosby, 1995.26. Mandell GL: Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases, 5th ed. New York, Churchill Livingstone, 2000.27. Marx J, ed: Rosen’s Emergency Medicine: Concepts and Clinical Practice, 5th ed. St. Louis, 2002, Mosby.28. Moore WT, Eastman RC: Diagnostic Endocrinology, 2nd ed. St. Louis, Mosby, 1996.29. Noble J, ed: Primary Care Medicine, 3rd ed. St. Louis, Mosby, 2001.30. Nseyo UO: Urology for Primary Care Physicians. Philadelphia, WB Saunders, 1999.31. Palay D, ed: Ophthalmology for the Primary Care Physician. St. Louis, Mosby, 1997.32. Rakel RE: Principles of Family Practice, 6th ed. Philadelphia, WB Saunders, 2002.33. Schwarz MI: Interstitial Lung Disease, 2nd ed. St. Louis, Mosby, 1993.34. Seller RH: Differential Diagnosis of Common Complaints, 4th ed. Philadelphia, WB Saunders, 2000.35. Siedel HM, ed: Mosby’s Guide to Physical Examination, 4th ed. St. Louis, Mosby, 1999.
    • REFERENCES 51736. Specht N: Practical Guide to Diagnostic Imaging. St. Louis, Mosby, 1998.37. Stein JH, ed: Internal Medicine, 5th ed. St. Louis, Mosby, 1998.38. Swain R, Snodgrass S: Managing groin pain: even when the source is not obvious. Phys Sportsmed 1995;23:55–66.39. Talley NJ, Martin CJ: Clinical Gastroenterology, 2nd ed. Sidney, Churchill Livingstone, 2006.40. Wiederholt WC: Neurology for Non-neurologists, 4th ed. Philadelphia, WB Saunders, 2000.41. Wilson JD: Williams Textbook of Endocrinology, 9th ed. Philadelphia, WB Saunders, 1998.