differential diagnosis definitions

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Differential Differential Diagnosis Diagnosis Definitions Definitions Presented by M.A. Kaeser, Presented by M.A. Kaeser, DC DC Winter 2010 Winter 2010

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Differential Differential Diagnosis Diagnosis DefinitionsDefinitions

Presented by M.A. Kaeser, DCPresented by M.A. Kaeser, DC

Winter 2010Winter 2010

Acute AbdomenAcute Abdomen

• General name for the presence of General name for the presence of signs, symptoms of inflammation of signs, symptoms of inflammation of peritoneum (abdominal lining)peritoneum (abdominal lining)

www.templejc.edu

Bronchogenic CarcinomaBronchogenic Carcinoma

• More than 99% of malignant lung More than 99% of malignant lung tumors arise from the respiratory tumors arise from the respiratory epithelium and are termed epithelium and are termed bronchogenic carcinoma. This type bronchogenic carcinoma. This type of carcinoma can be diveded in two of carcinoma can be diveded in two main subgroups: small cell lung main subgroups: small cell lung cancer (SCLC) and non-small cell cancer (SCLC) and non-small cell lung cancer (NSCLC). lung cancer (NSCLC).

www.medstudents.com.br/pneumo/pneumo7/pneumo7.htm

Cauda EquinaCauda Equina

The spinal cord ends in the lumbar area and continues through the vertebral canal as spinal nerves. Because of its resemblance to a horse's tail, the collection of these nerves at the end of the spinal cord is called the cauda equina. These nerves send and receive messages to and from the lower limbs and pelvic organs.

Clinical ReasoningClinical Reasoning

• Clinical reasoning is a major Clinical reasoning is a major component of clinical competence component of clinical competence and is a dynamic process that occurs and is a dynamic process that occurs before, during, and after the before, during, and after the collection of data through history, collection of data through history, physical examination, imaging, and physical examination, imaging, and endoscopic and laboratory tests. endoscopic and laboratory tests.

www.annals.org

ComplicationComplication

• A secondary disease or condition A secondary disease or condition developing in the course of a developing in the course of a primary disease or conditionprimary disease or condition

www.merriam-webster.com

ContraindicationContraindication

• Something (as a symptom or Something (as a symptom or condition) that makes a particular condition) that makes a particular treatment or procedure inadvisabletreatment or procedure inadvisable

www.merriam-webster.com

DepressionDepression

• Most common psychological disorder that Most common psychological disorder that primary care practitioners will encounterprimary care practitioners will encounter

• More common than any other disorder More common than any other disorder (with the exception of hypertension) and (with the exception of hypertension) and is the 7is the 7thth most common outpatient most common outpatient diagnosis in family medicinediagnosis in family medicine

• Often undiagnosed and under-treatmentOften undiagnosed and under-treatment• 5% of population has major depression at 5% of population has major depression at

any given time any given time – Men 7-12% riskMen 7-12% risk– Women 20-25% risk Women 20-25% risk

• 83 billion dollars in US and 11.5 in UK83 billion dollars in US and 11.5 in UKFamily Medicine: Ambulatory Care & Prevention, ed. By Mengel, M.B., McGraw Hill Compaines Incorporated. New York, 5th edition, 2009.

Diabetic NeuropathyDiabetic Neuropathy

• Diabetic neuropathy is a common Diabetic neuropathy is a common complication of diabetes, in which nerves complication of diabetes, in which nerves are damaged as a result of high blood are damaged as a result of high blood sugar levels (hyperglycemia)sugar levels (hyperglycemia)

• On average, symptoms begin 10 to 20 On average, symptoms begin 10 to 20 years after the diabetes diagnosisyears after the diabetes diagnosis

• Approximately 50% of people with Approximately 50% of people with diabetes will eventually develop nerve diabetes will eventually develop nerve damage. damage. www.nlm.nih.govwww.nlm.nih.gov

EmbolismEmbolism

• The obstruction of a blood vessel by a The obstruction of a blood vessel by a foreign substance or a blood clot blocking foreign substance or a blood clot blocking the vessel the vessel

• Something travels through the Something travels through the bloodstream, lodges in a vessel and plugs it bloodstream, lodges in a vessel and plugs it

• Foreign substances that can cause Foreign substances that can cause embolism include an air bubble, amniotic embolism include an air bubble, amniotic fluid, a globule of fat, a clump of bacteria, fluid, a globule of fat, a clump of bacteria, chemicals (such as talc), and drugs (mainly chemicals (such as talc), and drugs (mainly illicit ones). illicit ones). www.medterms.com

HypothyroidismHypothyroidism• Results from insufficient production of thyroid Results from insufficient production of thyroid

hormoneshormones• Overt hypothyroidism found in 0.3-2% of populationOvert hypothyroidism found in 0.3-2% of population• 2:1 F:M2:1 F:M• Increased prevalence with ageIncreased prevalence with age• PrimaryPrimary

– Chronic autoimmune (Hashimoto’s) thyroiditisChronic autoimmune (Hashimoto’s) thyroiditis– Radioactive iodine therapyRadioactive iodine therapy– SurgerySurgery

• SecondarySecondary– Decreased pituitary secretion of TSHDecreased pituitary secretion of TSH

• Usually accompanied by other manifestations of pituitary Usually accompanied by other manifestations of pituitary hyposecretionhyposecretion

• Causes: postpartum pituitary necrosis (Sheehan’s syndrome) Causes: postpartum pituitary necrosis (Sheehan’s syndrome) and pituitary tumorsand pituitary tumors

Family Medicine: Ambulatory Care & Prevention, ed. By Mengel, M.B., McGraw Hill Compaines Incorporated. New York, 5th edition, 2009.

HyperthyroidismHyperthyroidism

• Results from elevated levels of thyroid hormonesResults from elevated levels of thyroid hormones• Less common than hypothyroidismLess common than hypothyroidism• 2% in women, 0.2% in men2% in women, 0.2% in men• 15% of cases are >60 y.o.15% of cases are >60 y.o.• Grave’s disease - 60-80% of hyperthyroidismGrave’s disease - 60-80% of hyperthyroidism• Disorders associated with hyperthyroidismDisorders associated with hyperthyroidism

– Grave’s diseaseGrave’s disease– Toxic multinodular goiter (Plummer’s disease)Toxic multinodular goiter (Plummer’s disease)

• Most common cause in >40 y.o.Most common cause in >40 y.o.– Toxic adenomaToxic adenoma

• Least common cause Least common cause – ThyroiditisThyroiditis

Family Medicine: Ambulatory Care & Prevention, ed. By Mengel, M.B., McGraw Hill Compaines Incorporated. New York, 5th edition, 2009.

IncontinenceIncontinence

• Inability to control excretions Inability to control excretions • Urinary incontinence is inability to Urinary incontinence is inability to

keep urine in the bladder keep urine in the bladder • Fecal incontinence is inability to Fecal incontinence is inability to

retain feces in the rectum retain feces in the rectum

www.medterms.com

IndicationsIndications

• In medicine, a condition which In medicine, a condition which makes a particular treatment or makes a particular treatment or procedure advisable procedure advisable

www.medterms.com

InfarctionInfarction

• The formation of an infarct, an area The formation of an infarct, an area of tissue death due to a local lack of of tissue death due to a local lack of oxygen oxygen

www.medterms.com

LymphadenopathyLymphadenopathy• Lymph nodes that are abnormal in size, consistency or numberLymph nodes that are abnormal in size, consistency or number• In childrenIn children

– M/C cause is infectious or benignM/C cause is infectious or benign• >40 y.o.>40 y.o.

– Malignant causes are more likelyMalignant causes are more likely• Less than 1 month is usually infectiousLess than 1 month is usually infectious• More than 1 month is abnormalMore than 1 month is abnormal• In association with constitutional symptoms (fatigue, fever, In association with constitutional symptoms (fatigue, fever,

weight loss, unusual rashes, or arthralgias) suggest weight loss, unusual rashes, or arthralgias) suggest malignancy, infection, autoimmune diseases, or serum malignancy, infection, autoimmune diseases, or serum sickness-like syndromesickness-like syndrome

• >1 cm = abnormal>1 cm = abnormal• Softer or fluctuant lymph nodes suggest infectious or Softer or fluctuant lymph nodes suggest infectious or

inflammatory causesinflammatory causes• Harder nodes suggest malignancyHarder nodes suggest malignancy• Pain suggests inflammatory, absence of pain suggests more Pain suggests inflammatory, absence of pain suggests more

serious condition or malignancyserious condition or malignancyFamily Medicine: Ambulatory Care & Prevention, ed. By Mengel, M.B., McGraw Hill Compaines Incorporated. New York, 5th edition, 2009.

MeningitisMeningitis

• Meningitis is an inflammation of the Meningitis is an inflammation of the membranes (called meninges) that membranes (called meninges) that surround the brain and spinal cordsurround the brain and spinal cord

• Meningitis may be caused by many Meningitis may be caused by many different viruses and bacteria different viruses and bacteria

• It can also be caused by diseases that It can also be caused by diseases that can trigger inflammation of tissues of can trigger inflammation of tissues of the body without infection (such as the body without infection (such as SLE and Behcet’s Disease) SLE and Behcet’s Disease) www.medicinenet.com

MetastasisMetastasis• The process by which cancer spreads from The process by which cancer spreads from

the place at which it first arose as a primary the place at which it first arose as a primary tumor to distant locations in the body tumor to distant locations in the body

• Metastasis depends on the cancer cells Metastasis depends on the cancer cells acquiring two separate abilities -- increased acquiring two separate abilities -- increased motility and invasiveness motility and invasiveness

• Cells that metastasize are basically of the Cells that metastasize are basically of the same kind as those in the original tumor same kind as those in the original tumor

• If a cancer arises in the lung and If a cancer arises in the lung and metastasizes to the liver, the cancer cells in metastasizes to the liver, the cancer cells in the liver are lung cancer cells. However, the the liver are lung cancer cells. However, the cells have acquired increased motility and cells have acquired increased motility and the ability to invade another organ. the ability to invade another organ. www.medterms.com

MyelopathyMyelopathy

• Disturbance or disease of the spinal Disturbance or disease of the spinal cordcord

• A disorder in which the tissue of the A disorder in which the tissue of the spinal cord is diseased or damagedspinal cord is diseased or damaged

medical-dictionary.thefreedictionary.com/

PneumoniaPneumonia

• A disease of the lungs characterized A disease of the lungs characterized especially by inflammation and especially by inflammation and consolidation of lung tissue followed consolidation of lung tissue followed by resolution and by fever, chills, by resolution and by fever, chills, cough and difficulty in breathingcough and difficulty in breathing

• Caused especially by infectionCaused especially by infection

www.merriam-webster.com

Primary CarePrimary Care

• Health care provided by a medical Health care provided by a medical professional (as a general practioner professional (as a general practioner or a pediatrician) with whom a or a pediatrician) with whom a patient has initial contact and by patient has initial contact and by whom the patient may be referred to whom the patient may be referred to a specialist for further treatmenta specialist for further treatment

medical-dictionary.thefreedictionary.com

Secondary CareSecondary Care

• The provision of a specialized The provision of a specialized medical service by a physician medical service by a physician specialist or a hospital on referral by specialist or a hospital on referral by a primary care physician a primary care physician

medical-dictionary.thefreedictionary.com

Teritiary CareTeritiary Care

• Treatment given in a health care Treatment given in a health care center that includes highly trained center that includes highly trained specialists and often advanced specialists and often advanced technology technology

medical-dictionary.thefreedictionary.com

Primary PreventionPrimary Prevention

• A program of activities directed at A program of activities directed at improving general well-being while improving general well-being while also involving specific protection for also involving specific protection for selected diseases, such as selected diseases, such as immunization against measles immunization against measles

medical-dictionary.thefreedictionary.com

Secondary PreventionSecondary Prevention

• A level of preventive medicine that A level of preventive medicine that focuses on early diagnosis, use of focuses on early diagnosis, use of referral services, and rapid initiation referral services, and rapid initiation of treatment to stop the progress of of treatment to stop the progress of disease processes or a handicapping disease processes or a handicapping disability disability

Tertiary PreventionTertiary Prevention

• A level of preventive medicine that A level of preventive medicine that deals with the rehabilitation and deals with the rehabilitation and return of a patient to a status of return of a patient to a status of maximum usefulness with a maximum usefulness with a minimum risk of recurrence of a minimum risk of recurrence of a physical or mental disorder physical or mental disorder

medical-dictionary.thefreedictionary.com

RadiculopathyRadiculopathy

• Disease of the spinal nerve roots Disease of the spinal nerve roots • Compression of the nerve root-the Compression of the nerve root-the

part of a nerve between vertebrae part of a nerve between vertebrae • This compression causes pain to be This compression causes pain to be

perceived in areas to which the perceived in areas to which the nerve leads. nerve leads.

medical-dictionary.thefreedictionary.com

SensitivitySensitivity

• Probability that the test is Probability that the test is positive when given to a group of positive when given to a group of patients with the diseasepatients with the disease

• A large sensitivity means that a A large sensitivity means that a negative test can rule out the negative test can rule out the diseasedisease. .

www.childrens-mercy.org/stats/definitions/sensitivity.htm

SpecificitySpecificity

• The probability that the test will The probability that the test will be negative among patients who be negative among patients who do not have the diseasedo not have the disease

• A large specificity means that a A large specificity means that a positive test can rule in the positive test can rule in the diseasedisease

www.childrens-mercy.org/stats/definitions/specificity.htm

StrokeStroke• Clinical syndrome consisting of the sudden or rapid Clinical syndrome consisting of the sudden or rapid

onset of a constellation of neurologic deficits that onset of a constellation of neurologic deficits that persist for more than 24 hours secondary to a vascular persist for more than 24 hours secondary to a vascular eventevent

• 33rdrd leading cause of death in the US leading cause of death in the US• Most common cause of disabilityMost common cause of disability• Most frequently cited reason for patients needing long-Most frequently cited reason for patients needing long-

term careterm care• 1/3 of stroke survivors will have permanent disability1/3 of stroke survivors will have permanent disability• ½ of the 4.4 million survivors will have no or little ½ of the 4.4 million survivors will have no or little

disabilitydisability• Two types of strokeTwo types of stroke

– IschemicIschemic– HemorrhagicHemorrhagic

Family Medicine: Ambulatory Care & Prevention, ed. By Mengel, M.B., McGraw Hill Compaines Incorporated. New York, 5th edition, 2009.

Vertebrobasilar Vertebrobasilar InsufficiencyInsufficiency

• Transient ischemia of the brain stem Transient ischemia of the brain stem and cerebellum due to stenosis of the and cerebellum due to stenosis of the vertebral or basilar arteryvertebral or basilar artery

• A disorder caused by decrease of A disorder caused by decrease of blood flow in the vertebral or basilar blood flow in the vertebral or basilar arteries due to atherosclerosis or arteries due to atherosclerosis or compression placed on the external compression placed on the external wall of the arterieswall of the arteries

• Symptoms may include loss of vision, Symptoms may include loss of vision, dizziness, or nausea dizziness, or nausea medical-dictionary.thefreedictionary.com