Churchills Pocketbook of Differential Diagnosis

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B978-0-7020-3222-6.00006-7, 0000633SUBASH KC/NMC-15TH/2014ASCITESAscites is the accumulation of excess free fluid in the peritonealcavity.CAUSESHEPATIC• CirrhosisHepatic tumoursMALIGNANT DISEASECarcinomatosisAbdominal/pelvic tumour (primary or secondary)Pseudomyxoma peritoneiPrimary mesothelioma•CARDIACCardiac failureConstrictive pericarditisTricuspid incompetence•RENALNephrotic syndrome•PERITONITIS• TBSpontaneous bacterialVENOUS OBSTRUCTIONBudd–Chiari syndromeVeno-occlusive diseaseHepatic portal vein obstructionInferior vena cava obstruction•GASTROINTESTINALPancreatitis• MalabsorptionBile ascitesSection A
34 ASCITESHISTORYSUBASH KC/NMC-15TH/2014SymptomsPatients with ascites can present with abdominal discomfort,increasing abdominal girth, weight gain and ankle or sacralswelling.OnsetThe development of ascites is usually gradual, but suddenonset can result from acute decompensation of liver cirrhosis,malignancy, portal or splenic vein thrombosis and Budd–Chiarisyndrome.Past medical historyAny history of malignancy in the abdomen or pelvis is relevant;however, abdominal metastasis can also result in ascites,especially from breast, ovarian, prostatic, testicular andhaematological malignancies. Cirrhosis of the liver may resultfrom alcoholism, previous hepatitis, Wilson’s disease, primaryand secondary biliary cirrhosis and haemochromatosis. A previoushistory of TB should raise suspicion of secondarydisease.Associated symptomsShortness of breath can result from splinting of the diaphragm dueto tense ascites itself, or secondarily as part of the syndrome ofcardiac failure when it is the underlying cause.EXAMINATIONClassical findings are shifting dullness and a fluid thrill. Asliver disease and carcinomatosis account for 90% of the casespresenting with ascites, a detailed examination of all systemsis required. The next commonest causes are cardiac failure andnephrotic syndrome.InspectionEvidence of liver disease would be suggested by the presence ofjaundice, spider naevi, loss of body hair, gynaecomastia, palmarerythema and caput medusae. The jugular venous pressure (JVP) iselevated in the presence of cardiac failure, and a prominent n waveis seen with tricuspid regurgitation. Further elevation of the JVPon inspiration (Kussmaul’s sign) may be observed with a pericardialeffusion.PalpationCareful abdominal examination should be performed to look forpossible abdominal or pelvic tumours. ‘Dipping’ may be required
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Page 11 and 12: xAbbreviationsSUBASH KC/NMC-15TH/20
Page 13 and 14: xii CONTENTSOedema 343Oliguria 347P
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Page 17 and 18: 4 ABDOMINAL PAINSUBASH KC/NMC-15TH/
Page 19 and 20: 6 ABDOMINAL PAINFever■■Any rigo
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Page 23 and 24: 10 Abdominal SwellingsHISTORYSUBASH
Page 25 and 26: 12 Abdominal SwellingsSTOMACH• Ca
Page 27 and 28: 14 Abdominal SwellingsCAUSESABDOMIN
Page 29 and 30: 16 Abdominal Swellings■■LFTsLiv
Page 31 and 32: 18 Abdominal SwellingsHerniaIn infa
Page 33 and 34: 20 Abdominal SwellingsRETROPERITONE
Page 35 and 36: 22 Abdominal Swellings■■LFTsAlk
Page 37 and 38: 24Abdominal Swellings■■MSURed c
Page 39 and 40: 26 ANORECTAL PAINbelow the dentate
Page 41 and 42: 28ARM PAINThis section deals with p
Page 43 and 44: 30ARM PAINand paralysis. Pulses may
Page 45: 32Arm Swellingsnon-pitting oedema s
Page 49 and 50: 36 ASCITESSUBASH KC/NMC-15TH/2014pu
Page 51 and 52: 38Axillary SwellingsThe great major
Page 53 and 54: 40 Axillary SwellingsSUBASH KC/NMC-
Page 55 and 56: 42BackacheBackache is one of the mo
Page 57 and 58: 44 BackacheSUBASH KC/NMC-15TH/2014T
Page 59 and 60: 46 Backachemotor neurone signs belo
Page 61 and 62: 48 BackacheSUBASH KC/NMC-15TH/2014
Page 63 and 64: 50BREAST LUMPSA lump in the breast
Page 65 and 66: 52 BREAST LUMPSSUBASH KC/NMC-15TH/2
Page 67 and 68: 54BREAST PAINPain in the breast is
Page 69 and 70: 56 BREAST PAIN■■FNACBenign vers
Page 71 and 72: 58 Chest PainSUBASH KC/NMC-15TH/201
Page 73 and 74: 60 Chest PainSUBASH KC/NMC-15TH/201
Page 75 and 76: 62CLUBBINGClubbing is the selective
Page 77 and 78: 64 CLUBBINGFamily historyA family h
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Page 81 and 82: 68 COMASUBASH KC/NMC-15TH/2014CEREB
Page 83 and 84: 70 COMASUBASH KC/NMC-15TH/2014The o
Page 85 and 86: 72CONFUSIONConfusion is a behaviour
Page 87 and 88: 74 CONFUSIONSUBASH KC/NMC-15TH/2014
Page 89 and 90: 76CONSTIPATIONConstipation is a com
Page 91 and 92: 78 CONSTIPATIONearly and having dif
Page 93 and 94: 80ConvulsionsA convulsion is a seri
Page 95 and 96: 82 ConvulsionsGeneral examinationA
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84COUGHCough is a reflex explosive
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86 COUGHof asthma, and a fixed insp
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88CyanosisCyanosis is the abnormal
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90CyanosisAir entry is poor with ch
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92 DeafnessHISTORYSUBASH KC/NMC-15T
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SUBASH KC/NMC-15TH/201494 Deafness
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96 DIARRHOEASUBASH KC/NMC-15TH/2014
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98 DIARRHOEASUBASH KC/NMC-15TH/2014
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100 DIARRHOEASPECIFIC INVESTIGATION
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102 DIZZINESSSUBASH KC/NMC-15TH/201
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B978-0-7020-3222-6.00021-3, 0002110
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106 DYSPHAGIAMotor neurone diseaseM
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108 DYSPHAGIAGENERAL INVESTIGATIONS
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110 DYSPNOEASUBASH KC/NMC-15TH/2014
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112 DYSPNOEAAdded soundsWheezing ma
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B978-0-7020-3222-6.00023-7, 0002311
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116 EAR DISORDERSSUBASH KC/NMC-15TH
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118EAR DISORDERSReferred painExamin
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120 EYE DISORDERSHISTORYSUBASH KC/N
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122 EYE DISORDERSFluorescein staini
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124 Facial PainHISTORYSUBASH KC/NMC
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126 Facial Pain■■MRITumours - e
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128 Facial SwellingsHISTORYSUBASH K
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130 Facial SwellingsSUBASH KC/NMC-1
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132Facial UlcersMost facial ulcers
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134 Facial UlcersSUBASH KC/NMC-15TH
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136Faecal IncontinenceFaecal incont
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SUBASH KC/NMC-15TH/2014138 Faecal I
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140 FINGER LESIONSSUBASH KC/NMC-15T
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B978-0-7020-3222-6.00030-4, 0003014
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144 FINGER PAINHISTORYTraumaticTher
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146 FINGER PAINSUBASH KC/NMC-15TH/2
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148 FINGER PAIN■■CXR with thora
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150 Foot DeformitiesHISTORYSUBASH K
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152Foot PainPain in the foot is a c
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154 Foot PainOtherMetatarsalgia cau
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SUBASH KC/NMC-15TH/2014B978-0-7020-
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158 FOOT ULCERSHISTORYSUBASH KC/NMC
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160 FOOT ULCERS■■Nerve conducti
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162 GAIT ABNORMALITIESPast medical
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164 GAIT ABNORMALITIESSPECIFIC INVE
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166 GOITRESUBASH KC/NMC-15TH/2014Mu
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168 GOITRE■■Thoracic inlet X-ra
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170 Groin SwellingsSUBASH KC/NMC-15
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172 Groin SwellingsSUBASH KC/NMC-15
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174 Groin SwellingsObturator hernia
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176Gum DisordersDisorders of the gu
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178 Gum DisordersGENERAL INVESTIGAT
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180 GynaecomastiaHISTORYSUBASH KC/N
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182HaematemesisHaematemesis is the
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184 HaematemesisBleeding disordersT
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SUBASH KC/NMC-15TH/2014186 Haematem
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188 HaematuriaSUBASH KC/NMC-15TH/20
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190 Haematuria■■UreteroscopyTum
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192 HaemoptysisSUBASH KC/NMC-15TH/2
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194 HaemoptysisSUBASH KC/NMC-15TH/2
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196HalitosisHalitosis is a frequent
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198 Halitosis■■LaryngoscopyNaso
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200 HallucinationsHISTORYObtain a c
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202Hand DeformitiesImpairment of ha
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204 Hand DeformitiesSUBASH KC/NMC-1
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SUBASH KC/NMC-15TH/2014206 Hand Def
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208 HeadacheSUBASH KC/NMC-15TH/2014
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210 Headache■■U&EsHypertensive
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212HEMIPLEGIAHemiplegia is paralysi
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214 HEMIPLEGIA■■ESR infection,
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216 HEPATOMEGALYOTHERS•HISTORYCry
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218 HEPATOMEGALYSUBASH KC/NMC-15TH/
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220HiccupsHiccups (hiccoughs) are t
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222 HiccupsRespiratory examination
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224HirsutismHirsutism is the presen
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226 Hirsutismovarian syndrome. This
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228HypertensionHypertension is the
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230 HypertensionGENERAL INVESTIGATI
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232IMPOTENCEImpotence is failure in
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234 IMPOTENCEhypertension. Check fo
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236Intestinal ObstructionMechanical
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238 Intestinal ObstructionLarge bow
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240JaundiceJaundice is yellow disco
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242 JaundiceSUBASH KC/NMC-15TH/2014
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244 Jaundice■■MRCPBile duct ano
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246 JAW PAIN AND SWELLINGSHISTORYSU
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248 JAW PAIN AND SWELLINGSSUBASH KC
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250JOINT DISORDERSDisorders of join
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252 JOINT DISORDERSSUBASH KC/NMC-15
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254 JOINT DISORDERSand genital ulce
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256 JOINT DISORDERSare affected by
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258 JOINT DISORDERSSHOULDERCAUSESSU
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262 JOINT DISORDERS■■Aspiration
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264 JOINT DISORDERSEXAMINATIONSUBAS
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266 JOINT DISORDERSCarpal tunnel sy
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268 JOINT DISORDERSSPECIFIC INVESTI
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272 JOINT DISORDERSGENERAL INVESTIG
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276 JOINT DISORDERSbe a history of
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278 JOINT DISORDERS■■Joint aspi
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282KIDNEY SWELLINGSKidney swellings
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SUBASH KC/NMC-15TH/2014284 KIDNEY S
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286 LEG PAINNEOPLASTICOsteogenic sa
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288 LEG PAINInflammatoryPain in joi
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B978-0-7020-3222-6.00058-4, 0005829
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292 LEG SWELLINGSfailure, liver fai
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SUBASH KC/NMC-15TH/2014294 LEG SWEL
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296 Leg Ulcerspain suggests a neuro
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SUBASH KC/NMC-15TH/2014298 Leg Ulce
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300 Lip LesionsHISTORYSUBASH KC/NMC
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302 Lip LesionsSUBASH KC/NMC-15TH/2
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304LymphadenopathyLymphadenopathy i
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306 LymphadenopathyEXAMINATIONExami
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308MelaenaMelaena is the passage of
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310 MelaenaThere is usually no prec
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SUBASH KC/NMC-15TH/2014312 Melaena!
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314 Mouth UlcersHISTORYTraumaticDia
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316 Mouth UlcersSUBASH KC/NMC-15TH/
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318Muscle Weakness And WastingMuscl
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320 Muscle Weakness And WastingEXAM
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322Nail AbnormalitiesNail abnormali
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324 Nail AbnormalitiesAcquiredInfec
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326Nasal DischargeNasal discharges
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328 Nasal DischargeSUBASH KC/NMC-15
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B978-0-7020-3222-6.00067-5, 0006733
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332 NECK LUMPSneck, generalised inf
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334 NECK LUMPSPharyngeal pouchPrese
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336NECK PAINNeck pain is a common p
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338 NECK PAINEXAMINATIONSUBASH KC/N
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340NIPPLE DISCHARGEThis is a common
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SUBASH KC/NMC-15TH/2014342 NIPPLE D
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344 OEDEMA• BurnsAnimal bites/sti
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346 OEDEMAGENERAL INVESTIGATIONS■
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348 OLIGURIASUBASH KC/NMC-15TH/2014
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B978-0-7020-3222-6.00072-9, 0007235
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352 PALPITATIONSEarly age of onset
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354PENILE LESIONSPenile lesions are
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356 PENILE LESIONSsickle cell disea
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358 PENILE LESIONSSPECIFIC INVESTIG
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360 POLYURIAEXCESSIVE FLUID INTAKE
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364 POPLITEAL SWELLINGSSUBASH KC/NM
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366 POPLITEAL SWELLINGSGENERAL INVE
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368 Pruritus(due to the accumulatio
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370Pruritus AniPruritus ani is itch
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372 Pruritus AniThe infection often
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374Pyrexia of Unknown OriginMost py
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376 Pyrexia of Unknown OriginSUBASH
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378RASHESA rash is a change in the
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380 RASHESSUBASH KC/NMC-15TH/2014In
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382 RASHESSUBASH KC/NMC-15TH/2014
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384 RASHESSUBASH KC/NMC-15TH/2014Le
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B978-0-7020-3222-6.00080-8, 0008038
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388 RECTAL BLEEDINGHISTORYSUBASH KC
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390 RECTAL BLEEDINGUpper gastrointe
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392 RECTAL BLEEDINGUpper gastrointe
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394Scalp LesionsLesions on the scal
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B978-0-7020-3222-6.00082-1, 0008239
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398 Scrotal PainSUBASH KC/NMC-15TH/
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402 Scrotal SwellingsSUBASH KC/NMC-
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404 Scrotal SwellingsSUBASH KC/NMC-
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406SHOCKShock is an abnormality of
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408 SHOCKpneumothorax, while muffle
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410SplenomegalyThe spleen must be e
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412 SplenomegalySUBASH KC/NMC-15TH/
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414 SplenomegalySplenic vein hypert
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416SteatorrhoeaSteatorrhoea refers
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418 SteatorrhoeaSUBASH KC/NMC-15TH/
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420STRIDORStridor is a high-pitched
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422 STRIDORSUBASH KC/NMC-15TH/2014g
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424SWEATING ABNORMALITIESExcessive
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B9426 SWEATING ABNORMALITIESinfecti
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428 SYNCOPESUBASH KC/NMC-15TH/2014(
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B978-0-7020-3222-6.00090-0, 0009043
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432 THIRSTSUBASH KC/NMC-15TH/2014Ta
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434Throat ConditionsA sore throat i
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436 Throat ConditionsEXAMINATIONSUB
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438TirednessPersistent tiredness or
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440 Tirednesslifestyle. Is there an
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442Toe LesionsLesions of the toes a
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444 Toe Lesionsearly adult life, us
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446Tongue DisordersTongue disorders
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448 Tongue DisordersSUBASH KC/NMC-1
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450 Tongue Disorders■■HIV testH
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452 Tremorthyrotoxicosis may also c
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454Urethral DischargeAny inflammato
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456 Urethral DischargeSUBASH KC/NMC
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458Urinary IncontinenceUrinary inco
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460 Urinary Incontinencethe lower a
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462Urinary RetentionRetention of ur
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464 Urinary RetentionGENERAL INVEST
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466 Vaginal DischargeGENERAL INVEST
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468 Visual ProblemsDiabetic retinop
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B978-0-7020-3222-6.00101-2, 0010147
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472 Voice DisordersSUBASH KC/NMC-15
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474VomitingVomiting is the forceful
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476 VomitingSUBASH KC/NMC-15TH/2014
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478 VomitingSUBASH KC/NMC-15TH/2014
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480 Weight GainSUBASH KC/NMC-15TH/2
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484 Weight LossHISTORYGeneralThe ti
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486 Weight LossGENERAL INVESTIGATIO
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<PII>, <AID>492 Blood Urea Nitrogen
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B978-0-7020-3222-6.00107-3, 0010749
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496 HyperglycaemiaSUBASH KC/NMC-15T
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498HyperkalaemiaHyperkalaemia is an
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500HypokalaemiaHypokalaemia is a re
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502HypernatraemiaThe normal serum s
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504HyponatraemiaThe normal serum so
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506HypoglycaemiaHypoglycaemia is de
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B978-0-7020-3222-6.00113-9, 0011350
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510 HypocalcaemiaSUBASH KC/NMC-15TH
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512Metabolic AcidosisMetabolic acid
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514SUBASH KC/NMC-15TH/2014Metabolic
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B978-0-7020-3222-6.00118-8, 0011851
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518 Respiratory AlkalosisINVESTIGAT
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522 AnaemiaSYMPTOMS AND SIGNSSUBASH
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524 AnaemiaSUBASH KC/NMC-15TH/2014
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526Clotting DisordersCongenital dis
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B978-0-7020-3222-6.00121-8, 0012152
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530 LeucocytosisMISCELLANEOUSConvul
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532 Leucocytosis■■CTMalignancy.
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B978-0-7020-3222-6.00123-1, 0012353
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536 PolycythaemiaSYMPTOMS AND SIGNS
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538ThrombocytopeniaThrombocytopenia
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540ThrombocytosisThrombocytosis is
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IndexNote to index: For ease of use
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544 indexSUBASH KC/NMC-15TH/2014ank
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546 indexSUBASH KC/NMC-15TH/2014Bab
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548 indexSUBASH KC/NMC-15TH/2014cae
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550 indexSUBASH KC/NMC-15TH/2014cho
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552 indexSUBASH KC/NMC-15TH/2014dee
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554 indexSUBASH KC/NMC-15TH/2014‘
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556 indexSUBASH KC/NMC-15TH/2014Fri
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558 indexSUBASH KC/NMC-15TH/2014hae
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560 indexSUBASH KC/NMC-15TH/2014hyp
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562 indexSUBASH KC/NMC-15TH/2014iro
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564 indexSUBASH KC/NMC-15TH/2014liv
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566 indexSUBASH KC/NMC-15TH/2014mic
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568 indexSUBASH KC/NMC-15TH/2014non
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570 indexSUBASH KC/NMC-15TH/2014par
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572 indexSUBASH KC/NMC-15TH/2014por
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574 indexSUBASH KC/NMC-15TH/2014Rei
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576 indexSUBASH KC/NMC-15TH/2014scl
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578 indexSUBASH KC/NMC-15TH/2014ste
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580 indexSUBASH KC/NMC-15TH/2014thr
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582 indexSUBASH KC/NMC-15TH/2014vas
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