Differential Diagnosis Ferri's
Terms
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- Acute Respiratory Distress Syndrome: CC dyspnea, chest discomfort, cough, anxiety, caused by sepsis, aspiration or trauma
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Cardiogenic pulmonary edema
viral pneumonitis
Lymphangtic carcinomatosis - Anxiety (Generalized Anxiety Disorder) Presents in combo with other psych or medical prob. Most common cc, anxiety, fear, worry
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Cardiovascular and Pulmonary Disease
Hyperthyroidism
Parkinsons
Myasthenia gravis
Consequences of recreational drug use or withdrawal - Bronchitis (Acute) Leading cause is viral, cough worse in am, productive, low grade fever. Tx is sx management.
- Pneumonia, Asthma, Sinusitis, Bronchiolitis, Aspiration, Cystic fibrosis, Pharyngitis, Cough 2 to medications, Neoplasm, Influenza, Allergic aspergillosis, GERD, CHF in elderly, Bronchogenic neoplasm
- Depression (Major). F-M 2:1, familial. 5 of 9 sx for 2 weeks. 1 must be pers. depressed mood or anhedonia. Tx CBT, antidepressants. At 12 wks, psycho and meds equal effective.
- Anxiety, somatoform, Obsessive-Compulsive, Substance abuse, personality disorder, Bipolar depressive episode, premenstrual dysphoric disorder
- Gingivitis: Painless infalm of gums. Caused by bugs in plaque, poor hygeine,Tobacco, ETOH, HIV. Tx: remove plaque, debride,PCN, Clinda
- Gingival hyperplasia from phenytoin or nifedipine
- Influenza: Acute, Febrile. H/A, Myalgia, Anorexia, Malaise plus reapiratory sx. TxBed Rest, sx, tx with antiviral in first three days
- RSV (Respiratory Syncytial virus), adenovirus, parainfluenza , secondary bacterial pneumonia or mixed bacterial-viral pneumonia
- Labyrinthitis: Acute onset vertigo, N/V, hearing loss +/-. Tx bedrest, phenergan, meclizzine, prednisone, valacyclovir.
- Acute labyrinthine ischemia, bacterial and syphilitic labyrinthitis, fistula, benign positional vertigo, Meniere's syndrome, cholesteatoma, drug induced 8th nerve tumor, Head trauma.
- Laryngeal Carcinoma: CA includes vocal cords or Glottis, supraglottis and subglottis. Tx, surgery, radiation and chemo.
- Laryngitis, allergic and nonallergic rhinosinusitis, Gastropharengeal reflux, voice abuse to hoarseness, laryngeal papilloma, vocal cord paralysis 2 neuro or entrapment of recurrent laryngeal nerve by mediastinal compression, Tracheomalacia
- Laryngitis: Acute or Chronic inflamation of laryngeal mucous membraines. Tx rest voice, humidifier.
- Young children with signs of airway obst: Supraglottitis, laryngotrachiobronchitis, tracheitis, foreign body aspiration. Adults with persistent hoarseness consider noninfectios causes of laryngitis.
- Oral Hairy Leukoplakia: Painless, white, nonremovalbe lesion on side of tongue. Usually asymptomatic, resolves spontaniously, no malignancy potential. No tx needed.
- Candida albicans, lichen planus, idiopathic leukoplakia, white sponge nevus, dysplasia, squamous cell carcinoma
- Mononucleosis: Epstein Barr, 1-2 month incubation then prodrome of fever and chills and anorexia then triad of pharyngitis and fever and adenopathy. Tx is supportive and rest. Check Spleen.
- Hetrophilic negative infectious mono cause by CMV, bacterial and viral causes of pharyngitis, toxoplasmosis, acute retroviral syndrom of HIV, lymphoma
- Otitis Externa:Acute localized (furunculosis) and Impetigo and Erysipelas strep A and eczematous and Acute diffuse otitis externa (swimmers) and Otomycosis of ear canal and TM and chronic otitis externa and necrotizing otitis externa (malignant OE).Tx is
- Acute Otitis Media, Bullous myringitis, mastoiditis, foreign body, neoplasm
- Otitis Media AKA Acute suppurative or Purulent otitis media. Tx is symptomatic or Amoxicillin for uncomplicated OM, for pneumococcyl- TMX/SMX or better Mixifloxacin.
- Otitis Externa, referred pain from mouth, nasopharynx, tonsils, other parts of upper resp. tract
- Panic Disorder with or without Agoraphobia. Dx after two uncued panic attacks FB one month concern about having another. Tx is CBT, SSRI, Benzo in short term.
- Hyperthyroidism, hyperparathyroidism, pheochromocytoma, hypoglycemia, cardia arrhythmia, MI, COPD, Asthma, seizure, psychiatric disorder, drugs
- Aspiration Pneumonia. Elderly by H.Flu, Strep Pneumonia, E Coli Tx Levo.
- tuberculosis, gram negative pneumonia
- Bacterial Pneumonia. Infection in lung parenchyma, presentation varries with cause, age and clinical situation. TX Macrolides or Levo.
- Exacerbation of chronic bronchitis, PE or infarct, lung neoplasm, bronchiolitis, sarcoidosis, hypersensitivity pneumonitis, pulmonary edema, drug induced lung injury, viral, fungal, parasitic or atypical pneumonia, TB
- Mycoplasma Pneumonia. +/- fever, likes lower lobe, small pleural effucions. TX Emycin
- Chlamydophila , c.psittaci, legionella spp., coxiella burnetii, viral, Q fever, strep pneumoniae, pleurtic pain, PE or infarction
- Pneumocystic Pneumonia. A protazoa, Aids. TX TMP/SMX or pentamidine and prednison for three weeks.
- opportunistic, TB, Histoplasmosis, Cryptococcosis, non-opp: Bacterial,Viral,Mycoplasmal, Legionellosis.
- Viral Pneumonia. Influenza Virus, RSV, Adenovirus (hoarseness and pharyngitis. TX is mostly supportive and isolation in some cases.
- Bacterial, Atypical causes: Mycoplasm, Chlamydia, Coxiella, Legionnairs, ARDS, PE
- Allergic Rhinitis. allergy. pale or violet mucosa. TX includes allergy avoidance, air conditioning, remove pets.
- Infection- viral bacterial fungal. Vasomotos rhinitis, Septal obstruction, systemic like wegeners granulomatosis, hypothyroid
- Seasonal Affective Disorder. Recurrent fall and winter without spring and summer episodes for two years. TX is phototherapy. No clinical support for SSRIs.
- Major depressive disorder, minor or adjustment disorder, bipolar affective disorder, substance abuse, endocrine or neurologic disease
- Serotonin Syndrome. increased serotinin activty in CNS. Changes in mental status, alteration in neuromuscular and autonomic function. TX is stop SSRI. contro agitation, give serotonin antagonists, contro autonomic instability and hyperthermia. Antagonist
- Neuroleptic malignant syndrome, substance abuse, thyroid storm, infection , etoh and opioid withdrawal
- Severe Acute Respiratory Syndrome. Coronavirus. Travel. Incubation 2 to 10 days. Fever, Myalgia and Headache, dry nonproductive cough and diarrhea in some. A biphasic course with initial improvement followed by deterioration. TX is supportive care, quino
- Legionella pneumonia, Influenza A,B, RSV, ARDS
- Sinusitis. Acute is less than 30 days with resolution. Subacute is 30 to 90 days. Chronic lasts for more than 90 days. A recurrance is within a day day interval. TX is vasoconstrictor, decongestant, Amoxicillin, Emycin, TMP/SMX.
- Temporomandibular joint disease, migraine, cluster, dental infect, trigeminal neuralgia
- Stomatitis White lesions
- White Lesions: Leukoedema, white sponge nevus, Darier's, chemical injury, nicotine stomatitis, lichen planus, Discoid lupus erythematosus, leukoplakia, hairy leukoplakia
- Stomatitis Red lesions
- candidiasis, benign migratory glossitis, hemangioma, histoplasmosis, allergy, anemia, erythroplakia, burning tounge.
- Stomatitis Dark lesions
- coated tongue, melanotic lesion, varices, Kaposi sarcoma
- Stomatitis Raised lesions
- papilloma, verruca vulgaris, condyloma, fibroma, epulis, pyogenic granuloma, mucocele, retention cyst
- Stomatitis Blisters
- Primary Herpectic gingivostomatisis by HSV 1 or 2, recurrent intraoral herpes, pemphigus and pemphigoid, coxsackievirus group A, EM, Herpangina by echovirus, traumatic ulcer, primary syphilis, Perlench or angula cheilitis, recurrent aphthous stomatitis or canker sores,Behcet syndrome, Reiter's syndrome
- Tricyclic Antidepressant Overdose
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QRS prolonging drugs, disopyramide, procainamide, quinidine, cocaine, propranolol, quinine, chloroquine, dig, propoxyphene.
Hyperkalemis, ischemic heart disease, cardiomyopathy, conduction dysfunction - Breast Abscess. Painful red fluctuant abscess. Lactational cause. TX is nafcillin or cephalexin for cefazolin for subareolar.
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Inflammatory carcinoma;
Advanced carcinoma with erythema, edema, and/or ulceration;
Rarely, tuberculous abscess;
Hycracenitis of breast skin;
Subaceous cyst with infection - Blepharitis. inflam at eyelid margins. Chronic has fibrin exudate at base oflashes. TX is alkaline soap and hot compress. Topical ABX bacitracin, Emycin, for rosacea tetra and for resistance vanco ro cipro eye drops
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Keratoconjucitivitis sicca;
Eyelid malignancies;
Herpes Simplex;
Molluscum Contagiosum;
Phthiriasis palpebrarum;
Phthirus pubis;
Allergic;
Demodes Folliculorum (transparent mites) - Breast Cancer. Ductal or Lobular. BRCA 1 and 2
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Fibrocyctic changes;
Fibroadenoma;
Hamartoma - Cataracts. Clouding of the lens.
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Corneal lesions;
Retinal lesions-detached-tumors;
vitreous dissease- chronic inflamation - Conjunctivitis. Inflamatin of conjunctiva. Many causes, allergy, bacteria, virus
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Acute glaucoma;
corneal lesions;
Acute iritis;
Episcleritis;
Scleritis:
Uveitis;
Canalicular obstruction;
Red Eye - Corneal Abrasion. Loss of surface epithelial tissue caused by trauma.
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Acute angle glaucoma;
Herpes Ulcers and other corneal ulcers;
Foreign Body - Corneal Ulceration. Disruption of corneal surface or deeper layers from contact lens, infection, degeneration, or other.
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Pseudomonas and pneumonococcus;
Moraxella, Staphyloccocus, Strep;
Herpes;
Contact lens ulcers - Primary Closed Angle Glaucoma. elevated intraocular pressure, closure of filtration angle or circulating pathway of aqueous humor. TX Laser iridotomy, IV mannitol, Pilocarpine, BB
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High Pressure;
Optic nerve cupping:
Field loss;
Shallow Chamber;
Open angle;
Conjunctivitis;
Corneal disease-Keratitis;
Uveitis;
Scleritis;
Allergies;
Contact lens w/ Irritation - Hordeolum (Stye). Inflamation of eyelid from posterior meibomian or anterior Zeis glands. Most often Staphylococcus and strep. TX warm compress. Emycin ointment. Could be associated with blepharitis. External hordeolum points toward skin of liek and may
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Eye lid abscess;
Chalazion;
Allergy;
Conjunctivitis with edema;
Acute dacryocystitis;
Herpes Simplex;
Cellulitis of eye lid - Macular Degeneration. Loss of central vision due to damage to macula. Dry is ischemic and wet is leakage of fluid from blood vessels- usually age related MD or ARMD.
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Diabetic retinopathy;
HTN;
Histo;
Trauma w/ Scar - Mastitis. Inflam of breast from irritation or infection. TX warm comnpress, nursing, pain meds, Dicloxacillin.
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Plugged lactiferous ducts;
Breast Abscess;
Inflam BC;
Sx of Hyperprolactinemia - Glactorrhea;
other CA;
Systemic disease- Scarcoidosis- Wegners granulomatosis- Giant Cell arteritis- Polyarteritis nodosa- TB, Syphilis - Ocular FB
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Hx corneal FB seen;
Hemmorage-loss vision;
distorted anterior chamber- soft eye;
corneal abrasion;
corneal ulceration or laceration;
glaucoma;
herpes ulcers;
infection;
keratitis;
INTRA OCULAR FB - Optic Neruitis. inflamation of optic nerve and loss of vision. subacute, triad of loss of vision, pain and dyschromatopsia, red mostly. Unilateral abnormalities with a central scotoma. MS. No treatment, months to recover.
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Inflam diseases- MS, SLE;
Infections- Syphilis-TB-LYME-HIV-CMV-HSV;
Ischemic- Giant Cell Arteritis, occulsion;
Mass Lesion from CA pituitary;
Drusen;
Detachment of retina;
B12 deficiency - Diabetic Retinopathy
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Inflamatory disease;
Tumor;
Trauma;
Arteriosclerotic vas dis;
HTN;
Occulsion V,A - Uveitis. Inflammation of uveal tract- including iris, ciliary body, and choroid. May involve other closed structures as sclera, retina and vitreous humor. Sx are pain and photophobia. TX treat underlying disease, steroids.
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Glaucoma;
Conjunctivitis:
Retnal detach;
Retinopathy;
Keratitis;
Scleritis;
Episcleritis;
retinal blastoma - AIDS. HSV 1 deteriorqation of immune to secondary infctions and malignancies. TX: Combivir, efavirenz, ritonavir, travuda.
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TB;
Neoplasm;
Fungal-diseminated;
Malabsorption syndromes;
Depression;
Demyelination - Cervical CA. Penetration of basment membrane and infiltration of stroma of uterine cervix by malignanct cells. TX Hysterectomy
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Cervical polyp;
Prolapsed Uterine Fibroid;
Pre-invasive Cervical lesions:
Neoplasia Metastatic CA - Cervical Dysplasia. Atypical development of immature squamous epithelium but does not penetrate basement epithelial membraine. progressive loss of squamous differentiation. TX LEAP laser, 5FU
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Metaplasia;
Hyperkaratosis;
Condyloma;
Microinvasive CA;
Glandular Epithelial Abnormalities;
Adenocarcinoma insitu;
VIN;
VAIN;
Met. Tumor of cervix - Cervicitis. Infection either primary or secondary from Uterus or vagina. Usually asymptomatic, copious purulent or mucopurulent vaginal discharge. May have post coidal bleeding. causes Chlamydia and Gonorrhea. TX Cryosurgery, ceftriaxone, zithromax if pr
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Ca of cervis;
cervical erosion;
cerv. Metaplasia; - Balanitis. Inflammatin of superficial tissues of penis. Itching and pain. From poor hygeine, sex, allergy. TX warm bath, circumcision, tylenol, ABX ointment or steriods , severe cephalexin. Self limiting.
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Leukoplakia;
Reiter's Syndrome;
Lichen Planus;
Balanitis Xerotica Obliterans;
Psoriasis;
CA;
Erythroplasia of queyrat;
nodular scabies - Chancroid. Sexually transmitted painful genital ulceration and inflammatory inguinal adenopathy. More frequent in men 10:1. Unilateral lymphadenopathy 1 week after chancroid in 50% patients. TX Azithromycin, ceftriaxone.
- Syphilis, Herpes
- Chlamydia. Urthritis, epididymitis, cervicitis, acute salpingitis, often asymptomatic in women causing PID. TX Azithromycin, Doxycycline. Use Azithromycin 2gms po x 1 for coverage of Chlamydia and Gonorrhea.
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Gonorrhea;
Nongonococcal Urethritis; - Condyloma Acuminatum. Viral sexual disease of vulva, vagina, cervix caused by HPV. Types 6 & 11, non malignant, 16 & 18 increased risk of malignancy. TX Podophyllin, Trichloracetic acid, Fluorouracil, Cryotherapy, Interferon.
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Ab Anatomic varient;
Skin tags;
Dysplatic warts - Gonorrhea. Likes columnar and transitional epithelial cells. Urethritis, cervicitis, salpingitis. could be asymptomatic. RX Cefixime, axithromax
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Non gonococcal urethritis;
non gon mucopur cervicitis;
Chlamydia - Herpes Simplex. HSV 1 is mouth and HSV 2 is genital. Consititutional sx, fever, headache, lymphadenopathy, localized pain. TX Acyclovir
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Impetigo;
Bahcet's syndrome;
Coxsackies;
Syphilis;
Steven's J S;
Herpangina;
Aphthous stomatitis;
varicella;
Herpes Zoster - Human Immunodeficiency Virus HIV 1.
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Acute inf;
Mono;
Resp viral inf; Late symptoms similar to other wasting diseases - PID. Spectrum of inflammatory disorders. Lower Abd pain, have low threshhold for diagnosis, Uterine tenderness or adnexal tenderness or CMT, high temp, elevated ESR. TX Ofloxacin, Levo, cefoxitin.
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Ectopic Preg;
Appy;
Ruptured ovarian cyst;
Endometriosis;
UTI;
Renal stone;
Adnexal torsion;
Proctocolitis - Syphilis. Primary, secondary and latent. Painless chancre, 3 wk after exposure, flu like 4-6 weeks after primary lesion. Palms and soles. TX Penicillin G
- Herpes; Chancroid
- Urthritis, Gonococcal. Dysuria, urethral discharge or both. TX Ceftriaxone and Doxycycline
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NGU;
Herpes Simplex - Non Gono- Urthritis
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GCU;
Herpes Simplex;
Trichomoniasis - Vaginal Malignancy. 0 is in situ in epithelial only, 1 is limited to vaginal wall, 2 is also in subvaginal tissue but not pelvic wall, 3 is in pelvic wall.
- Vaginitis, other met CA
- Vaginismus- invol spasm of vagina, from trauma
- no diff, just workup
- Bacterial Vaginosis
- most common vaginal inf, by Gardnerella, 50% asympto, fishy odor, PH great 4.5, pos KOH wif
- Vulvar CA
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Lymphogranuloma Inguinal;
TB;
Dystrophy;
Atrophy;
Pagets - Vulvovaginitis- Bacterial. Grey homogenous fishy discharge, predominance of lactobacilli and high concentrations of anerobic bacteria. 50% asymptomatic. Gardnerella. Clue cells, PH greater than 4.5, + whiff test. RX Metronidazole.
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Fungal;
Trich;
Atrophic;
Cervicitis - Vulvovaginitis- Estrogen Deficient. Thinning and atrophic vulva and bagina. TX Premarin PO, patch, cream.
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Infectious;
Squamous Cell Hyperplasia;
Lichen sclerosus;
CA; - Vulvovaginitis- Fungal. Candida Albicans and Candida Tropicalis and torulopsis glabrata for nonalbicans. TX Fluconazole.
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Bacterial;
Trich;
Atrophic; - Vulvovaginitis- Prepubscent. Irritationand truama from lack of estorgen, absence of protetive hair and fat pad. TX avoid tight clothes, good hygiene, reassurance.
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Physiologic leukorrhea;
FB;
Bacterial;
Gonorrhea;
Fungal:
Trich;
Sexual Abuse;
Pin worms - Trichamonas Vulvovaginits. Lots of yellow, foul, discharge, itching, dysuria, dyspareunia, intense erythema, cervical petechiae. Asymptomatic in 50% of women and 90% of men. TX Metronidazole.
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bacterial;
fungal;
atrophic;
cervicitis -
Acoustic Neuroma:
High frequency hearing loss most common CC.. long term acoustic trauma or inherited as part of neurofibromatosis type 2. - Benign possitional vertigo;; Menier's;;Trigeminal neuralgia;;Other tumors;;
- Peritonsillar Abscess. acut infection in capsule of palatine tonsil and superior constrictor muscle of pharynx, complication of tonsillitis, group A Beta is most comon cause. Tx is surgical and ABX
- Tonsillitis, Infectious Mono, Peritonsillar cellulitis, retropharanygeal abscess, epiglottitis, dental abscess, lymphoma.
- Pertussis. bacterial of upper resp tract, intense cough. TX intensive supportive, Emycin, dexameth, cerf triaxone.
- Croup, Ppiglottitis, Foreighn body aspiration, Bacterial Pneumonia.
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Pharyngitis and Tonisllitis.
Inflamation of tonsils and pharynx, viral with most, but GABS also. TX is PCN or EMycin if Gonococcal ceftriaxone. - Sore throat, Thyroiditis, tonsillar hypertrophy.
- Retinal Detachment. Inner or neural layer of retina speparates from pigment epithelial layer. TX Immediate surgery.
- Hemorrhage or tumor
- Retinitis Pigmentosa. Pigment deterioration and loss of vision. Inherited problem. TX no proven therapy
- Syphilis, old inflamatory scars, old hemorrhage, diabetes.
- Retinal Hemorrhage. blood accumulation because of trauma, diabetes altitude. TX Laser.
- Melanoma, trauma, HTN, CV disease.
- Retinoblastoma. inherited neoplasm from nerual layer of retina, age 6mo to 1yr. White pupil, strabismus, glaucoma, Uveitis. TXREmoval of eye.
- Strabismus, retinal detachment, uveitis, other tumors.