Differential Diagnosis

Differential Diagnosis • Medicine • Surgery • Ob/Gyn. • Ophth. • Paed. • Dental

Seventh Edition LC Gupta MD (Rad) MD (PSM) DMRE MAMS, D Sc (Hon)

• World record of writing 98 medical books • Millennium author of SARC Nations-2002 • BC Roy National Awardee-1986 New Delhi

Abhitabh Gupta MD (Physician) DMRE

New Delhi

Abhishek Gupta MD (Physician) DRM DNB

NMR Scanning and Research Centre Jalandhar

J AYPEE BROTHERS MEDICAL PUBLISHERS (P) LTD New Delhi

Published by Jitendar P Vij Jaypee Brothers Medical Publishers (P) Ltd EMCA House, 23/23B Ansari Road, Daryaganj New Delhi 110 002, India Phones: +91-11-23272143, +91-11-23272703, +91-11-23282021, +91-11-23245672 Fax: 91-011-23276490, +91-11-23245683 e-mail: [email protected] Visit our website: www.jaypeebrothers.com Branches • 202 Batavia Chambers, 8 Kumara Krupa Road, Kumara Park East, Bangalore 560 001, Phones: +91-80-22285971, +91-80-22382956, +91-80-30614073 Tele Fax : +91-80-22281761 e-mail: [email protected] • 282 IIIrd Floor, Khaleel Shirazi Estate, Fountain Plaza Pantheon Road, Chennai 600 008, Phones: +91-44-28262665, +91-44-28269897 Fax: +91-11-28262331 e-mail: [email protected] • 4-2-1067/1-3, 1st Floor, Balaji Building, Ramkote Cross Road, Hyderabad 500 095, Phones: +91-40-55610020, +91-40-24758498 Fax: +91-40-24758499 e-mail: [email protected] • 1A Indian Mirror Street, Wellington Square Kolkata 700 013, Phone: +91-33-22451926 Fax: +91-33-22456075 e-mail: [email protected] • 106 Amit Industrial Estate, 61 Dr SS Rao Road Near MGM Hospital, Parel, Mumbai 400 012 Phones: +91-22-24124863, +91-22-24104532, +91-22-30926896 Fax: +91-22-24160828 e-mail: [email protected] Differential Diagnosis © 2005, LC Gupta, Abhitabh Gupta, Abhishek Gupta All rights reserved. No part of this publication should be reproduced, stored in a retrieval system, or transmitted in any form or by any means: electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the editor and the publisher. This book has been published in good faith that the material provided by contributors is original. Every effort is made to ensure accuracy of material, but the publisher, printer and editor will not be held responsible for any inadvertent error(s). In case of any dispute, all legal matters to be settled under Delhi jurisdiction only. First Edition: 1984 Seventh Edition: 2005 ISBN 81-8061-414-X Typeset at

JPBMP typesetting unit

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Replika Press Pvt Ltd., 310 EPIP, HSIDC, Kundli, Sonipat (Haryana)

Contributors SR Gupta MD (Med) MD (Pharm) Ex. Prof Head Deptt of Medicine, Raipur (MP)

SK Sharma MD CMO (SG) BSF New Delhi

PG Raman MD Prof Head Deptt of Medicine MGM Medical College Indore (MP)

SK Sharma MD LLB Incharge Department of Emergency, Ram Manohar Lohia Hospital New Delhi

Puneet Rastogi MD DM (Card) GR Medical College Gwalior (MP) Sujata MS MCh DNB Plastic Surgeon Safdarjung Hospital New Delhi Dr N Mishra MBBS DTM&H Director BSF HQS New Delhi

Jad Aoun MD Beirut, Lebanon Ramesh Gupta Cardiologist New York Rachana Dayal MBBS DGO National Board of Examination New Delhi

Preface to the Seventh Edition The overwhelming response to the sixth edition of Differential Diagnosis from the students and general practitioners has encouraged us to develop the seventh edition. While retaining the text of all the topics discussed in the previous editions, we have made necessary corresponding revisions considered necessary in the context of fast changing scene in medical literature. Tables on differential diagnosis, i.e. differentiating tables, have been enlarged and updated. Special section on diagnosis based on the laboratory findings has been updated to help the practitioners and the students alike. A very significant additional feature in this edition is incorporation of sub section on causes of common dental diseases. We sincerely wish this fully revised and updated edition to be of much practical value to the readers, who will find it a valuable book of resource and a continuous companion for reference. In the last we have added the seventh section of `Syndromes’. We are thankful to all such conscientious readers who have sent us their suggestions and comments for improving the text and presentation. LC Gupta Abhitabh Gupta Abhishek Gupta

Preface to the First Edition The differential diagnosis is the medical art of distinguishing one disease from another, looking alike. During the era of adulteration it has become difficult to give a set of symptoms, signs and investigative findings to exclude those diseases which simulate the actual disease of the patient, i.e. the diagnosis. All this depends on the clinical acumen—capability of the physician. Knowledge of the differential diagnosis expedites the process of reaching a correct diagnosis thus avoiding lot of suffering to the patient. Keeping in view of the fact present handbook has been edited in three sections, first dealing with the differential diagnosis of signs/ symptoms, second enumerating the causes of common findings/ complaints and third differentiating certain diseases closely in a table form. We are sure that the presentation will be useful to postgraduates and physicians doing private practice or serving in villages. They will be able to save time and energy in revising the medical concepts at a glance.

Contents Section-1

COMMON SIGNS AND SYMPTOMS 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. 28. 29. 30. 31.

Acute Abdomen ...................................................................... 1 Chronic Abdomen .................................................................. 2 Amenorrhoea ........................................................................... 4 Anaemia .................................................................................... 4 Anorexia .................................................................................... 6 Ascites ....................................................................................... 7 Backache ................................................................................. 10 Bleeding Gums ...................................................................... 12 Blood Pressure ....................................................................... 14 Brain Death ............................................................................ 17 Clubbing of Fingers ............................................................. 23 Colic ......................................................................................... 24 Coma ........................................................................................ 25 Complexion and Colour of the Face ................................. 28 Conjunctiva ............................................................................ 29 Constipation ........................................................................... 30 Cough ...................................................................................... 30 Cyanosis .................................................................................. 34 Depression ............................................................................. 35 Diarrhoea ................................................................................ 38 Dysmenorrhoea ..................................................................... 40 Dyspareunia ........................................................................... 41 Dysphagia ............................................................................... 42 Dyspnoea ................................................................................ 44 Dysuria .................................................................................... 48 Electrocardiogram ................................................................. 50 Enlargement of Heart ........................................................... 53 Epistaxis .................................................................................. 56 Face Pain ................................................................................. 57 Fever ........................................................................................ 58 Foul Smell of Breath (Halitosis) ........................................ 64

xii 32. 33. 34. 35. 36. 37. 38. 39. 40. 41. 42. 43. 44. 45. 46. 47. 48. 49. 50. 51. 52. 53. 54. 55. 56. 57. 58. 59. 60. 61. 62. 63. 64. 65. 66. 67. 68.

Differential Diagnosis Fundus Changes .................................................................... 64 Haematemesis ........................................................................ 67 Haematuria ............................................................................. 71 Haemoptysis .......................................................................... 75 Hair .......................................................................................... 78 Headache ................................................................................ 80 Heart Burn .............................................................................. 82 Hemiplegia ............................................................................. 82 Jaundice .................................................................................. 84 Lips .......................................................................................... 88 Liver Enlargement ................................................................ 89 Lymph Node Enlargement .................................................. 92 Male Infertility ...................................................................... 96 Melaena ................................................................................. 112 Menorrhagia ........................................................................ 112 Metrorrhagia ........................................................................ 113 Oedema ................................................................................. 115 Pain in Ear ............................................................................ 116 Pain, Numbness, Tingling in a Limb .............................. 118 Painful Eye ........................................................................... 120 Painful Joints ....................................................................... 121 Palpitation ............................................................................ 123 Poisoning .............................................................................. 124 Pruritus Vulvae .................................................................... 131 Pulse ...................................................................................... 131 Pupil ...................................................................................... 135 Pyrexia of Long Duration .................................................. 136 Rigor ...................................................................................... 139 Saliva ..................................................................................... 141 Sleep ...................................................................................... 142 Sneezing ............................................................................... 143 Snoring .................................................................................. 143 Spinal Lesions ..................................................................... 144 Spleen Enlargement ........................................................... 161 Sputum .................................................................................. 164 Swelling in Right Hypochondrium ................................ 164 Swelling of Breast ............................................................... 166

Contents 69. 70. 71. 72. 73. 74. 75. 76. 77. 78. 79. 80.

xiii

Swelling Related to Bones ................................................ 167 Tenesmus .............................................................................. 169 Thyroid Swelling ................................................................ 170 Tongue ................................................................................... 171 Tremors .................................................................................. 176 Ulcer ....................................................................................... 185 Urine ...................................................................................... 186 Vaginal Discharge ............................................................... 188 Viral hepatitis ...................................................................... 190 Vomiting ............................................................................... 192 Vulval Swelling ................................................................... 195 Weight Loss .......................................................................... 197 Section-2

CAUSES MEDICINE AND SURGERY 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19.

AV Block ............................................................................... 200 Abdominal Fluid ................................................................. 200 Abdominal Reflexes ........................................................... 201 Abdominal Rigidity ........................................................... 201 Abnormal Mediastinal Mass ............................................ 202 Absent Knee Jerk ................................................................ 202 Acne—Drug Induced ......................................................... 202 Acute Confusional State .................................................... 203 Acute Dyspnoea in Infants and Young Children ......... 204 Acute Follicular Conjunctivitis ........................................ 204 Acute Renal Failure ............................................................ 204 Adult Respiratory Distress Syndrome ........................... 205 Agranulocytosis ................................................................... 205 Air under Diaphragm ........................................................ 206 Albuminuria ........................................................................ 206 Alopecia ................................................................................ 206 Anaemia ................................................................................ 207 Ankylosis .............................................................................. 208 Anuria ................................................................................... 208

xiv 20. 21. 22. 23. 24. 25. 26. 27. 28. 29. 30. 31. 32. 33. 34. 35. 36. 37. 38. 39. 40. 41. 42. 43. 44. 45. 46. 47. 48. 49. 50. 51. 52. 53. 54. 55. 56. 57.

Differential Diagnosis Aortic Regurgitation ........................................................... 208 Apex Beat—Variations ....................................................... 209 Aphakic Glaucoma ............................................................. 209 Aphasia ................................................................................. 210 Aplastic Anaemia ................................................................ 210 Appetite—Increased ........................................................... 211 Appetite—Diminished ...................................................... 211 Argyl Robertson’s Pupil .................................................... 212 Arterial Occlusion ............................................................... 212 Arthritis—Terminal Interphalangeal Joint .................... 213 Arthritis with Spondylitis ................................................. 213 Ascites ................................................................................... 213 Aseptic Fever ........................................................................ 214 Ataxia ..................................................................................... 215 Atrial Fibrillation ................................................................ 215 Attacks of Apnea—Newborn ........................................... 216 Basal Metabolic Rate .......................................................... 216 Basophilia ............................................................................. 217 Bed Wetting .......................................................................... 217 Bilateral Parotid Enlargement .......................................... 217 Bleeding in Liver Disease ................................................. 217 Bone-Bending ...................................................................... 218 Bone Metastasis ................................................................... 218 Bone Tumors ........................................................................ 218 Breath Sounds ...................................................................... 220 Breathing—Noisy ............................................................... 220 Breathlessness— According to Rate of Onset ............... 220 Calcification in Abdomen ................................................. 221 Cardiac Arrest ...................................................................... 221 Cardiac Dullness—Increased ........................................... 222 Cardiac Enlargement .......................................................... 222 Cardiac Obstructive Syncope ........................................... 222 Cardiomegaly—Right Ventricle ....................................... 223 Cardiomyopathies .............................................................. 223 Carotenaemia ....................................................................... 224 Carotid Pulse—Exaggerated ............................................. 224 Causes of GIT Bleeding ..................................................... 224 Charcot’s Joint (Neuropathic Arthritis) .......................... 226

Contents 58. 59. 60. 61. 62. 63. 64. 65. 66. 67. 68. 69. 70. 71. 72. 73. 74. 75. 76. 77. 78. 79. 80. 81. 82. 83. 84. 85. 86. 87. 88. 89. 90. 91. 92. 93. 94. 95.

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Chest Wall Tumors .............................................................. 226 Chorea ................................................................................... 227 Choreoathetosis ................................................................... 228 Chronic Active Hepatitis ................................................... 228 Chronic Intestinal Pseudo-obstruction ........................... 228 Chronic Liver Diseases ...................................................... 229 Chronic Renal Failure ........................................................ 229 Cirrhosis of Liver ................................................................ 230 Claudication ......................................................................... 230 Claw Hand ............................................................................ 231 Conjunctival Oedema (Chemosis) .................................. 231 Constipation ......................................................................... 231 Continuous Murmur .......................................................... 232 Convulsions ......................................................................... 232 Convulsions in Children ................................................... 233 Corneal Ring Lesion ........................................................... 233 Corneal Ring Ulcer ............................................................. 234 Cramp in Hand .................................................................... 234 Crepitus ................................................................................. 234 Cushing’s Syndrome .......................................................... 235 Cutaneous Manifestations of Internal Disease ............ 235 Dead Fingers ........................................................................ 237 Deafness ............................................................................... 237 Decreased Blood Glucose .................................................. 238 Decreased Bone Density (Osteomalacia) ....................... 238 Decreased Pulse Pressure .................................................. 238 Delayed Puberty ................................................................. 239 Delayed Sitting and Walking ........................................... 240 Delayed Union—Fracture ................................................. 240 Diaphragmatic Paralysis ................................................... 240 Diarrhoea Alternating with Constipation ..................... 241 Diarrhoea—Drug Induced ................................................ 241 Diastolic Murmur ............................................................... 241 Different Colours of Urine ................................................ 242 Difficulty in Sucking and Swallowing .......................... 242 Diffuse Abdominal Pain ................................................... 243 Diplopia ................................................................................ 243 Discharge from Breast ........................................................ 244

xvi 96. 97. 98. 99. 100. 101. 102. 103. 104. 105. 106. 107. 108. 109. 110. 111. 112. 113. 114. 115. 116. 117. 118. 119. 120. 121. 122. 123. 124. 125. 126. 127. 128. 129. 130. 131.

Differential Diagnosis Distension of Abdomen .................................................... 244 Drop Attacks ........................................................................ 244 Drugs Causing Liver Damage .......................................... 245 Drug Eruptions .................................................................... 245 Drug Induced Absorption Defect .................................... 246 Drug Induced Extrapyramidal Disease .......................... 246 Drug Induced SLE .............................................................. 247 Dupuytren’s Contracture ................................................... 247 Dwarfism .............................................................................. 248 Dysarthria ............................................................................. 248 Dysphagia ............................................................................. 249 Dysphagia—Intermittent .................................................. 249 Dyspnoea in Newborn ....................................................... 250 Dyspnoea Posture Related ................................................ 250 Dystonias .............................................................................. 250 ECG—Low Voltage ............................................................. 251 ECG-ST Segment—False Positive Exercise Response .............................................. 251 ECG-T Wave—Notched, Bifid .......................................... 251 Egg Shell Crackling ............................................................ 252 Elevation of Diaphragm .................................................... 252 Embolism—Cardiac Causes .............................................. 252 Empyema .............................................................................. 253 Enlarged Mediastinal Shadow ......................................... 254 Enlargement of Blind Spot ............................................... 254 Enuresis ................................................................................. 255 Eosinophilia ......................................................................... 255 Epigastric Pain ..................................................................... 255 Epigastric Pulsation ............................................................ 256 Erectile Impotence .............................................................. 256 Erythema Multiforme ........................................................ 256 Erythema Nodosum ............................................................ 257 Erythema of Fingers ........................................................... 257 Excessive Thirst ................................................................... 258 Exophthalmos ...................................................................... 258 Extrasystole .......................................................................... 259 Facial Palsy ........................................................................... 259

Contents

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132. Factors Precipitating Encephalopathy in Cirrhotic Patients ................................................................ 260 133. Failure of Urinary Excretion ............................................. 260 134. Falls in Elderly .................................................................... 261 135. Fasciculations ....................................................................... 261 136. Fat Embolism ....................................................................... 261 137. Fever with Rigor .................................................................. 262 138. Fingers—Shape ................................................................... 262 139. Fingers—Spindiriform Joints ........................................... 262 140. First Heart Sound ................................................................ 263 141. Fixed Eruptions ................................................................... 263 142. Folate Deficiency ................................................................ 263 143. Flushed Face ......................................................................... 264 144. Frequent Blinking ............................................................... 264 145. Frigidity ................................................................................ 264 146. Frozen Shoulder .................................................................. 265 147. Gait Abnormalities—Unilateral ...................................... 265 148. Galactorrhoea ....................................................................... 266 149. Gastric Dilatation ................................................................ 266 150. Gastrointestinal Bleeding ................................................. 266 151. General Backwardness ...................................................... 267 152. Generalised Pustules .......................................................... 267 153. Generalised Stiffness ......................................................... 268 154. Generalised Nephrocalcinosis ......................................... 268 155. Generalised Vesicles and Bullae ...................................... 269 156. Giddiness .............................................................................. 269 157. Gingivitis .............................................................................. 269 158. Glaucoma to be Suspected ................................................ 270 159. Glycosuria ............................................................................ 270 160. Gum Hyperplasia ................................................................ 270 161. Gynaecomastia .................................................................... 271 162. Haematemesis ...................................................................... 271 163. Haemolysis in G-6-PD Deficiency .................................. 272 164. Haemorrhagic Pericarditis ................................................ 272 165. Hair Loss ............................................................................... 273 166. Halitosis ................................................................................ 273 167. Hand—Shape ....................................................................... 273 168. Head Nodding ..................................................................... 274

xviii 169. 170. 171. 172. 173. 174. 175. 176. 177. 178. 179. 180. 181. 182. 183. 184. 185. 186. 187. 188. 189. 190. 191. 192. 193. 194. 195. 196. 197. 198. 199. 200. 201. 202. 203. 204. 205. 206.

Differential Diagnosis Headache .............................................................................. 274 Heart Block ........................................................................... 274 Heart Block—Bundle Branch Block Left ........................ 275 Heart Block—Intraventricular Conduction Defect ...... 275 Heart Sound—Fourth (S4) ................................................. 275 Heart Sound—Single (S2) .................................................. 275 Hemiplegia of Acute Onset .............................................. 275 Hemiplegia of Gradual Onset .......................................... 276 Hemiplegia— Recurrent but Transient .......................... 276 Hepatomegaly ...................................................................... 276 Hiccough ............................................................................... 277 Hirsutism .............................................................................. 278 Hoarseness of Voice ............................................................ 278 Homogeneous Opacity of One Hemithorax .................. 279 Homogeneous Rounded Opacity—Lung ....................... 279 Honeycomb Lung ............................................................... 280 Horner’s Syndrome ............................................................ 280 Hydrocephalus .................................................................... 280 Hyperamylasaemia ............................................................. 281 Hypercalcaemia ................................................................... 281 Hypercalciuria ..................................................................... 281 Hyperhidrosis ...................................................................... 282 Hypertension ....................................................................... 282 Hyperthyroidism ................................................................. 283 Hypertonia ........................................................................... 283 Hypertranslucency of Lung .............................................. 284 Hypertrichosis ..................................................................... 284 Hypertrophic Osteoarthropathy ...................................... 284 Hyperventilation ................................................................. 285 Hypoadrenalism .................................................................. 286 Hypoglycaemia .................................................................... 287 Hypomelanosis .................................................................... 287 Hypopigmented Patches ................................................... 288 Hypotelorism ....................................................................... 288 Hypotension—Chronic ...................................................... 288 Hypotension—Intermittent .............................................. 289 Hypothermia ........................................................................ 289 Hypothyroidism .................................................................. 290

Contents 207. 208. 209. 210. 211. 212. 213. 214. 215. 216. 217. 218. 219. 220. 221. 222. 223. 224. 225. 226. 227. 228. 229. 230. 231. 232. 233. 234. 235. 236. 237. 238. 239. 240. 241. 242. 243. 244.

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Hypotonia ............................................................................. 291 Hypouricemia ...................................................................... 291 Hypouricacidemia ............................................................... 291 Hypoventilation .................................................................. 292 Impotence—Due to Antihypertensive Drugs ............... 293 Impotence—Due to Diabetes Mellitus ........................... 293 Increased Appetite .............................................................. 293 Increased Blood Glucose ................................................... 293 Increased Bone Density ..................................................... 293 Increased SGOT .................................................................. 294 Increased Visibility of Cornea ......................................... 294 Increased Plasma Glucagon .............................................. 294 Inequality of Limb Length ................................................ 295 Infantile Convulsions ........................................................ 295 Insulin Resistance ............................................................... 296 Intention Tremor ................................................................. 296 Intracranial Calcification ................................................... 296 Intracranial Hypertension ................................................. 297 Intraorbital Calcification ................................................... 297 Inverted ‘T’ Wave ................................................................ 297 Involuntary Movements .................................................... 298 Iodine in Serum .................................................................. 298 Iritis ........................................................................................ 299 Irregular Bleeding per Vagina .......................................... 299 Irregularity of Pupil ........................................................... 300 Jugular Venous Distension ............................................... 300 Ketonuria .............................................................................. 300 Kidney Size .......................................................................... 301 Kinesias ................................................................................. 301 Knee-Instability .................................................................. 301 Kyphoscoliosis .................................................................... 301 Kyphosis ............................................................................... 302 Lack of Outer Third of Eyebrows .................................... 302 Lactic Acidosis ..................................................................... 303 Lagophthalmos .................................................................... 303 Lassitude ............................................................................... 303 Left Upper Quadrant Leg Ulcers ...................................... 304 Lengthened ‘QT’ Interval .................................................. 304

xx 245. 246. 247. 248. 249. 250. 251. 252. 253. 254. 255. 256. 257. 258. 259. 260. 261. 262. 263. 264. 265. 266. 267. 268. 269. 270. 271. 272. 273. 274. 275. 276. 277. 278. 279. 280. 281. 282.

Differential Diagnosis Leukopenia ........................................................................... 304 Leukoplakia ......................................................................... 305 Lightening Pains ................................................................. 305 Liver—Damage by Drugs .................................................. 306 Liver-Hepatitis, Chronic Persistent ................................. 306 Liver—Non-cirrhotic Fibrosis .......................................... 306 Local Muscle Wasting ........................................................ 306 Localised Lymphadenopathy ............................................ 307 Localised Oedema ............................................................... 307 Loss of Accommodation Reflex ....................................... 307 Loss of Consciousness ....................................................... 308 Loss of Memory ................................................................... 308 Loss of Smell ........................................................................ 308 Loss of Weight ..................................................................... 309 Loose Bodies—Joints .......................................................... 309 Lordosis ................................................................................. 310 Low/Flat ‘T’ Wave ................................................................ 311 Lung Collapse ...................................................................... 311 Lung—Localised Fibrosis .................................................. 311 Lung Metastases .................................................................. 312 Lung Resonance .................................................................. 312 Lymphoedema ..................................................................... 312 Male Infertility .................................................................... 313 Mandibular Joint—Clicking ............................................. 313 Mastomegaly ........................................................................ 313 Membranous Throat ........................................................... 314 Meningism ........................................................................... 314 Menorrhagia ........................................................................ 314 Menstruation—Precocious ................................................ 315 Metabolic Acidosis ............................................................. 315 Metabolic Alkalosis ............................................................ 315 Microcytic Anaemia ............................................................ 315 Micturition ........................................................................... 316 Miliary Mottling of Lung .................................................. 316 Monocular Diplopia ........................................................... 317 Monocytosis ......................................................................... 317 Monoplegia .......................................................................... 318 Mood Disorders .................................................................. 318

Contents 283. 284. 285. 286. 287. 288. 289. 290. 291. 292. 293. 294. 295. 296. 297. 298. 299. 300. 301. 302. 303. 304. 305. 306. 307. 308. 309. 310. 311. 312. 313. 314. 315. 316. 317. 318. 319.

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Mouth Breathing ................................................................. 319 Muscle Weakness ................................................................ 319 Muscle Weakness, Episodic .............................................. 319 Myalgias ............................................................................... 320 Myoclonias ........................................................................... 320 Myoclonus ............................................................................ 321 Nails ....................................................................................... 321 Neck Stiffness ...................................................................... 322 Neonatal Abdominal Distension ..................................... 322 Nephrocalcinosis ................................................................. 322 Nephrolithiasis .................................................................... 323 Nephrotoxic Agents ............................................................ 323 Neuropathic Arthritis ......................................................... 324 Neuropathy—Demyelinating ........................................... 324 Nipple Retraction ................................................................ 324 Nocturia ................................................................................ 324 Non-cirrhotic Hepatic Fibrosis ......................................... 325 Non-union of Fracture ....................................................... 325 Non-visualization of Gallbladder in Cholecystogram ................................................................... 325 Nutritional Anaemia .......................................................... 326 Oesophageal Varices .......................................................... 326 Oesophagitis ........................................................................ 326 Opisthotonos ....................................................................... 326 Oral Pigmentation .............................................................. 327 Orbital Pain .......................................................................... 327 Osteomalacia ........................................................................ 327 Osteoporosis ........................................................................ 328 Osteosclerosis ...................................................................... 329 Overventilation ................................................................... 329 Painful Hip in Children .................................................... 330 Painful Ophthalmoplegia ................................................. 330 Palpitation ............................................................................ 330 Pancreatitis ........................................................................... 331 Pancytopenia ........................................................................ 331 Papillary Necrosis ............................................................... 332 Papilloedema ....................................................................... 332 Paradoxical Pupillary Reaction ........................................ 333

xxii 320. 321. 322. 323. 324. 325. 326. 327. 328. 329. 330. 331. 332. 333. 334. 335. 336. 337. 338. 339. 340. 341. 342. 343. 344. 345. 346. 347. 348. 349. 350. 351. 352. 353. 354. 355. 356. 357.

Differential Diagnosis Paralytic Ileus ...................................................................... 333 Paraplegia ............................................................................. 333 Paresthesias .......................................................................... 334 Parkinsonism ....................................................................... 334 Parotid Swelling .................................................................. 334 Passing of Blood Per Rectum ............................................ 335 Pathological Fracture .......................................................... 335 Perianal Pain ........................................................................ 336 Periarticular Nodules ......................................................... 337 Pericardial Effusion ............................................................ 337 Pericarditis ........................................................................... 337 Peripheral Neuropathy ...................................................... 337 Peritonitis ............................................................................. 338 Perverted Appetite .............................................................. 339 Photophobia ......................................................................... 339 Phrenic Paralysis ................................................................. 339 Pigmentation of Eyelid ...................................................... 339 Pigmentation of Skin ......................................................... 340 Pigmented Retina ............................................................... 341 Pigmented Skin Lesion ...................................................... 341 Plantar Response ................................................................. 341 Pneumothorax ...................................................................... 341 Poliosis .................................................................................. 342 Polyarthritis due to Inflammation .................................. 342 Polyarteritis Nodosa ........................................................... 343 Polycythaemia ..................................................................... 343 Polyneuritis of Hand .......................................................... 344 Polyuria ................................................................................. 345 Poor Convergence ............................................................... 345 Portal Hypertension ........................................................... 346 Postprandial Hypoglycaemia ........................................... 346 Positive Kahn’s Test ............................................................ 347 Positive ‘LE’ Cells in Blood ............................................... 347 Positive Rheumatoid Factor .............................................. 347 Potassium Depletion .......................................................... 348 Precordial Thrills ................................................................ 348 Pregnancy Collapse IN ...................................................... 349 Pregancy Test—Positive ..................................................... 349

Contents 358. 359. 360. 361. 362. 363. 364. 365. 366. 367. 368. 369. 370. 371. 372. 373. 374. 375. 376. 377. 378. 379. 380. 381. 382. 383. 384. 385. 386. 387. 388. 389. 390. 391. 392. 393. 394.

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Priapism ................................................................................ 349 Prolonged Bleeding Times ................................................ 350 Prolonged QRS Interval .................................................... 350 Prostate—Nodular .............................................................. 350 Proteinuria ............................................................................ 350 Proximal Muscle Weakness of Leg .................................. 351 Proximal Myopathies ......................................................... 351 Pruritus .................................................................................. 351 Pruritus Ani .......................................................................... 352 Pruritus Vulvae .................................................................... 352 Pulmonary Eosinophilia .................................................... 352 Pulmonary Eosinophilia (Eosinophilic Pneumonitis) .............................................. 353 Pulmonary Oligemia .......................................................... 353 Pulse Pressure Increased ................................................... 354 Pulse Unequal ...................................................................... 354 Punched-out Areas in Bones of Extremities .................. 355 Purpura ................................................................................. 355 Pyogenic Liver Abscess ..................................................... 355 Pyuria—Sterile and Persistent ......................................... 355 Raised Alkaline Phosphatase ........................................... 356 Raised ESR ........................................................................... 356 Raised Platelet Count ......................................................... 357 Raised Serum Cholesterol ................................................. 357 Raised Uric Acid .................................................................. 357 Raynaud’s Phenomenon .................................................... 358 Recurrent Abdominal Pain ............................................... 358 Red Scaly Patches ............................................................... 359 Reflexes ................................................................................. 359 Reflexes—Diminished ....................................................... 359 Renal Hypertension ........................................................... 360 Renal Stones and Nephrocalcinosis ................................ 360 Respiratory Acidosis .......................................................... 361 Respiratory Alkalosis ......................................................... 361 Respiratory Acidulous Conditions .................................. 362 Respiratory Arrest ............................................................... 362 Respiratory Rate .................................................................. 362 Sacroiliitis ............................................................................. 363

xxiv 395. 396. 397. 398. 399. 400. 401. 402. 403. 404. 405. 406. 407. 408. 409. 410. 411. 412. 413. 414. 415. 416. 417. 418. 419. 420. 421. 422. 423. 424. 425. 426. 427. 428. 429. 430. 431.

Differential Diagnosis Salivation and Drooling .................................................... 363 Sclerosis ................................................................................ 364 Scoliosis ................................................................................ 364 Second Heart Sound ........................................................... 364 Secondary Diabetes ............................................................ 365 Segmental Myoclonus ....................................................... 365 Seizures ................................................................................. 365 Sexual Precocity .................................................................. 366 Shock ..................................................................................... 367 Short Stature (Proportionate) ........................................... 367 Short Stature having Short Limbs ................................... 368 Shoulder Pain ...................................................................... 368 Sideroblastic Anaemia ....................................................... 369 Single Red Hot Joint .......................................................... 369 Single Nodule in Lungs ..................................................... 369 Sinus Bradycardia ............................................................... 370 Size and Shape of Kidney ................................................. 370 Solitary Pulmonary Nodule .............................................. 371 Spinal Cord Compression ................................................. 371 Spontaneous Hyphema ..................................................... 372 Stiff Neck .............................................................................. 372 Stridor ................................................................................... 373 Sudden Death ...................................................................... 373 Supraventricular Tachycardia ........................................... 374 Sweating ............................................................................... 374 Swelling ................................................................................ 375 Swelling in Ileocaecal Region .......................................... 375 Swelling in Umbilical Region .......................................... 375 Swelling of Face .................................................................. 375 Syncope ................................................................................. 376 Syrinx .................................................................................... 376 Systolic Murmur ................................................................. 377 Tachycardia ........................................................................... 377 Taste ....................................................................................... 378 Telangiectasia ....................................................................... 378 Temperature of Hand ......................................................... 379 Tenderness of Chest ........................................................... 379

Contents 432. 433. 434. 435. 436. 437. 438. 439. 440. 441. 442. 443. 444. 445. 446. 447. 448. 449. 450. 451. 452. 453. 454. 455. 456. 457. 458. 459. 460. 461. 462. 463. 464. 465. 466. 467.

xxv

Tenderness of Spine ........................................................... 379 Tendon Reflexes .................................................................. 380 Tension of CSF Fluid .......................................................... 380 Thickened Nerves ............................................................... 381 Third Heart Sound .............................................................. 381 Thrombocytopenia ............................................................. 381 Tics ......................................................................................... 382 Tinnitus ................................................................................. 382 Toe Walking ......................................................................... 383 Transient Flitting Arthritis ................................................ 383 Transient Loss of Vision .................................................... 383 Tricuspid Regurgitation ..................................................... 384 Trismus .................................................................................. 384 Tunnel Vision (Peripheral Visual Constriction) ........... 384 Unilateral Glaucoma .......................................................... 385 Urinary Calculi .................................................................... 385 Urinary Retention ............................................................... 386 Vagina—Candidiasis .......................................................... 386 Vagina—Vaginismus .......................................................... 386 Valvular Aortic Stenosis .................................................... 387 Vasculitis—Nodular ........................................................... 387 Varicose Veins—Lower Limbs .......................................... 387 Vertebral Column—Rigidity ............................................ 388 Vertigo ................................................................................... 388 Virilism ................................................................................. 388 Vital Capacity Reduced ..................................................... 389 Vitamin B12 Deficiency ...................................................... 389 Vomiting ............................................................................... 390 Vomiting in Infancy ........................................................... 391 Wasting of Intrinsic Hand Muscles ................................. 391 Wasting of Muscles ............................................................. 392 Weight Gain ......................................................................... 392 Wheezing .............................................................................. 393 Xerosis ................................................................................... 394 Yawning ................................................................................ 394 Yellow Pigmentation .......................................................... 394

xxvi

Differential Diagnosis

PAEDIATRICS 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. 28. 29. 30. 31. 32. 33. 34. 35. 36.

Abdominal Pain .................................................................. 395 Acute Ataxia ......................................................................... 395 Acute Convulsions .............................................................. 396 Acute Renal Failure ............................................................ 397 Acute Visual Disturbance .................................................. 398 Agitation and Withdrawal ................................................ 399 Anaemia in Newborn ......................................................... 399 Aphasia ................................................................................. 400 Bilateral Nephromegaly in Newborn ............................. 400 Breath Holding Spasm ...................................................... 400 Cardiac Arrhythmias—AV Block ..................................... 401 Cardiac Arrhythmias .......................................................... 401 Catarrhal ............................................................................... 402 Cerebral Palsy ...................................................................... 402 Chest Pain ............................................................................. 403 Chronic Cough .................................................................... 403 Coma ...................................................................................... 404 Congestive Heart Failure ................................................... 405 Constipation ......................................................................... 406 Convulsions—Chronic ...................................................... 407 Cough .................................................................................... 407 Crying in Early Infancy ..................................................... 407 Cyanosis ................................................................................ 408 Delayed Bilestones ............................................................. 408 Delirium ............................................................................... 409 Developmental Ataxia ....................................................... 409 Diarrhoea—Acute ............................................................... 411 Dwarfism—Congenital ...................................................... 412 Dysphagia ............................................................................. 412 Earache .................................................................................. 413 Faecal Soiling ....................................................................... 413 Fever—Common Causes ................................................... 413 Hematemesis ........................................................................ 414 Head—Frontal Bossing ...................................................... 415 Haeadache ............................................................................ 415 Haemoptysis ........................................................................ 415

Contents 37. 38. 39. 40. 41. 42. 43. 44. 45. 46. 47. 48. 49. 50. 51. 52. 53. 54. 55. 56. 57. 58. 59. 60. 61. 62. 63. 64. 65. 66. 67. 68. 69. 70. 71. 72. 73.

xxvii

Hematuria ............................................................................. 416 Hoarseness of Voice in Infancy ........................................ 416 Intestinal Obstruction—Neonatal ................................... 417 Intracranial Raised Pressure ............................................. 417 Irritability ............................................................................. 417 Jaundice—Conjugated ....................................................... 418 Jaundice in Newborn ......................................................... 418 Joint Pain .............................................................................. 419 Joints Swollen ...................................................................... 419 Limping ................................................................................. 419 Liver—Cirrhosis .................................................................. 420 Lower Limb—Pain .............................................................. 421 Lymphadenopathy .............................................................. 422 Malabsorption Syndrome ................................................ 423 Mental Retardation with Enlarged Head ....................... 424 Myoclonic Spasms in Infants ........................................... 424 Napkin Rash ........................................................................ 425 Neck Mass ............................................................................ 425 Neonatal Convulsions ....................................................... 425 Neonatal Hypocalcemia ..................................................... 426 Nephrotic Syndrome .......................................................... 427 Neurologic Causes of Disorders of Micturition and Defecation .............................................. 427 Nonepileptical Paroxysmal Disorders ............................ 428 Obesity .................................................................................. 428 Obstructive Uropathy ........................................................ 428 Oedema ................................................................................. 429 Pancreatitis ........................................................................... 429 Peritonitis ............................................................................. 431 Pica ......................................................................................... 431 Pleural Effusion ................................................................... 431 Poor School Performance .................................................. 432 Preauricular Lymphadenopathy ...................................... 432 Pulmonary Oedema ............................................................ 432 Recurrent Pneumonia ........................................................ 433 Sexual Precocity .................................................................. 434 Shock ..................................................................................... 434 Sinus Bradycardia ............................................................... 435

xxviii 74. 75. 76. 77.

Differential Diagnosis

Sinus Tachycardia ............................................................... 435 Stiff Acute Neck .................................................................. 435 Temper Tantrums ................................................................ 436 Thumb Sucking ................................................................... 436

OBSTETRICS AND GYNAECOLOGY 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. 28. 29. 30. 31.

Abnormal Bleeding ............................................................ 436 Abortion ................................................................................ 437 Bleeding per Vaginum ....................................................... 438 Breast Tumors ...................................................................... 439 Carcinoma Breast—Risk Factors ...................................... 439 Chronic Endometritis ......................................................... 439 Collapse during Pregnancy ............................................... 440 Convulsions during Pregnancy ........................................ 440 Delayed Labour ................................................................... 440 Discharge from Nipples .................................................... 441 Dyspareunia ......................................................................... 442 Eclampsia .............................................................................. 442 Ectopic Pregnancy ............................................................... 443 Enlargement of Cervix ....................................................... 443 Fetus Stillbirth ..................................................................... 444 Frigidity ................................................................................ 444 Hypoplasia Breast ............................................................... 445 Infarction of Breast ............................................................. 445 Insufficiency of Placenta ................................................... 445 Intrauterine Death of Fetus ............................................... 446 Leucorrhoea .......................................................................... 446 Mastitis .................................................................................. 447 Maternal Death during Delivery ..................................... 447 Offensive Vaginal Discharge ............................................ 448 Oligohydraminos ................................................................ 448 Oligomenorrhoea ................................................................ 448 Positive Test of Pregnancy ................................................ 449 Pregnancy—High Risk ...................................................... 449 Pregnancy—Hypertension ................................................ 450 Pregnancy—Jaundice ......................................................... 450 Premature Labour ............................................................... 450

Contents 32. 33. 34. 35. 36. 37. 38. 39. 40. 41. 42. 43. 44. 45.

xxix

Premature Rupture of Membranes .................................. 451 Primary Amenorrhoea ....................................................... 451 Prolapse of Umbilical Cord .............................................. 452 Pruritus Vulvae .................................................................... 452 Recurrent Abortion ............................................................. 453 Retarded Fetal Growth ...................................................... 453 Salpingo-oophoritis ............................................................ 453 Uterine prolapse .................................................................. 454 Uterus—Fixed ...................................................................... 454 Uterus—Ruptured ............................................................... 454 Vaginal Discharge ............................................................... 455 Vaginismus ........................................................................... 456 Vaginitis ................................................................................ 456 Vulvitis .................................................................................. 457

EYE 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21.

Anterior Uveitis ................................................................... 457 Ageing Changes of Cornea ............................................... 457 Apparent Divergent Strabismus ...................................... 458 Atrophic Bulbi ..................................................................... 458 Band-shaped Keratopathy ................................................. 458 Bitot’s Spot ........................................................................... 458 Blink Reflexes ...................................................................... 459 Bloody Tears ......................................................................... 459 Blue Sclera ............................................................................ 459 Cataract ................................................................................. 460 Cataract due to Metabolic Disorder ................................ 460 Central Scotoma .................................................................. 460 Cicatricial Conjunctivitis .................................................. 461 Coarse Eyebrows ................................................................. 461 Coloboma of Iris ................................................................. 461 Colour Blindness ................................................................ 461 Congenital Cataract ............................................................ 462 Conjunctival Bleeding ....................................................... 462 Conjunctival Congestion/Ciliary Congestion ............... 463 Cornea ................................................................................... 464 Corneal Opacity in Infants ............................................... 464

xxx 22. 23. 24. 25. 26. 27. 28. 29. 30. 31. 32. 33. 34. 35. 36. 37. 38. 39. 40. 41. 42. 43. 44. 45. 46. 47. 48. 49. 50. 51. 52. 53. 54. 55. 56.

Differential Diagnosis Cotton Wool Spots on Retina ........................................... 465 Defective Colour Vision .................................................... 465 Dilated Episcleral Vessels ................................................. 465 Dilated and Tortuous Retinal Vessels ............................. 465 Diminished Corneal Sensation ........................................ 466 Elevated Intraocular Pressure with Normal Optic Disc .............................................................. 466 Enophthalmos ...................................................................... 466 Excessive Tears ..................................................................... 467 Eye Pain ................................................................................ 467 Fat Herniation into Lids .................................................... 468 Fixed Dilated Pupil ............................................................ 468 Frequent Change in Refraction ........................................ 468 General Narrowing of Retinal Arterioles ...................... 469 Glaucoma .............................................................................. 469 Granulomatous and Non-granulomatous Uveitis ........ 469 Granulomatous Uveitis ...................................................... 470 Hyperaemia of Iris .............................................................. 470 Hyperaemia of Lid Margin ............................................... 470 Infrequent Blinking ........................................................... 470 Iris Atrophy .......................................................................... 471 Iritis/Glaucoma/Conjunctivitis ........................................ 471 Irregular Anterior Chamber .............................................. 471 Keratitis ................................................................................. 472 Lids ........................................................................................ 472 Lipids Deposit at Macula .................................................. 474 Liquefaction of Vitreous .................................................... 474 Loss of Vision ...................................................................... 474 Macular Hemorrhage ......................................................... 475 Megalocornea and Buphthalmos ..................................... 475 Microaneurysm of Retina .................................................. 476 Miosis .................................................................................... 476 Mydriasis .............................................................................. 476 Neovascular Glaucoma ...................................................... 477 Night Blindness .................................................................. 477 No Reflex from Pupil ......................................................... 477

Contents 57. 58. 59. 60. 61. 62. 63. 64. 65. 66. 67. 68. 69. 70. 71. 72. 73. 74. 75. 76. 77. 78. 79. 80. 81. 82. 83. 84. 85. 86. 87. 88. 89. 90. 91. 92. 93. 94.

xxxi

Nodule at Limbus ............................................................... 478 Nystagmus ............................................................................ 478 Oculomotor Nerve Palsy ................................................... 479 Oedema of Orbit ................................................................. 479 Ophthalmoplegia ................................................................ 480 Optic Atrophy ...................................................................... 480 Optic Neuritis ...................................................................... 481 Painful Ocular Movements ............................................... 482 Painful Ophthalmoplegia ................................................. 482 Papillitis ................................................................................ 482 Paralysis of Accommodation ............................................ 482 Paralysis of Orbicularis ..................................................... 483 Peripheral Lesions of Fundus ........................................... 483 Photophobia ......................................................................... 483 Pigmentary Glaucoma ....................................................... 484 Pigmented Retina ............................................................... 484 Pinpoint Pupil ..................................................................... 484 Posterior Subcapsular Opacities in Lens ....................... 484 Proptosis ............................................................................... 485 Pseudo-lip Retraction ......................................................... 486 Pseudo-proptosis ................................................................. 487 Pseudopapilloedema .......................................................... 487 Phthisis Bulbi ...................................................................... 487 Ptosis ...................................................................................... 488 Ptosis of Upper Eyelid ....................................................... 488 Puffiness of Eyelids ............................................................ 489 Pupil Block ........................................................................... 489 Red Eye ................................................................................. 489 Retinal Haemorrhage ......................................................... 490 Retinal Vascular Tortuosity ............................................... 490 Retinal Hemorrhage ........................................................... 490 Ring Lesions of Cornea ..................................................... 491 Scleral Rigidity .................................................................... 491 Scleral Staphyloma ............................................................. 491 Scleral Thinning .................................................................. 491 Scleritis .................................................................................. 492 Soft Eyeball .......................................................................... 492 Solid Oedema of Lid .......................................................... 492

xxxii 95. 96. 97. 98. 99. 100. 101. 102. 103. 104. 105. 106. 107.

Differential Diagnosis

Subconjunctival Haemorrhage ........................................ 493 Systemic Diseases Causing Scleritis ............................... 493 Thickened Eyelids .............................................................. 493 Third, Fourth and Sixth Cranial Nerve Palsies ............. 494 Tortuosity of Conjunctival Vessels .................................. 494 Toxic Amblyopia ................................................................. 494 Unilateral Blindness ........................................................... 495 Unilateral Cataracts ............................................................ 495 Unilateral Glaucoma .......................................................... 495 Uveitis ................................................................................... 495 Vasoproliferative Retinopathy ......................................... 496 Vitreous Hemorrhage ......................................................... 496 White Reflex from Pupil ................................................... 496

DENTAL 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19.

Brown Lesions of Lips ....................................................... 497 Burning Sensation of Tongue ........................................... 497 Cauliflower Like Growth of Oral Cavity ....................... 497 Delayed Tooth Eruption .................................................... 497 Diffuse Facial Swelling ..................................................... 498 Disorder of Taste ................................................................. 498 Easily Bleeding Soft Tissue of Oral Cavity ................... 499 Elevated Lesions of Lip ..................................................... 499 Facial Nerve Palsy ............................................................... 499 Facial Nerve Paralysis ........................................................ 500 Flushing of Face .................................................................. 501 Generalised Red Conditions and Multiple Ulceration ............................................................ 501 Intraoral Brownish, Bluish or Black Conditions .......... 501 Intraoral Soft Tissue Swelling ......................................... 502 Loose Teeth ........................................................................... 502 Mandibular Joint Clicking ................................................ 502 Oral Fetor .............................................................................. 502 Oral Ulcer ............................................................................. 503 Parotid Gland Enlargement .............................................. 503

Contents 20. 21. 22. 23. 24. 25.

xxxiii

Primary Oral Condidiasis ................................................. 504 Non-scrapable White Lesions on Oral Mucosa ............ 504 Painful Salivary Gland ...................................................... 504 Sialorrhea ............................................................................. 505 Solitary Red Lesion ............................................................ 505 White Lesion of Lips .......................................................... 505 Section-3

DIFFERENTIATING TABLES 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22.

Acute Abdomen/Myocardial Infarction ......................... 506 Acute Gout and Acute Rheumatism ............................... 507 Adams-Stokes Syndrome/Epilepsy ................................. 508 Abdominal Pain due to Infectious Disorders ............... 509 Alopecia ................................................................................ 511 Amoebic and Bacillary Dysentery ................................... 513 Anaemia—Vitamin B12 Deficiency (due to Pernicious Anaemia) and Folate Deficiency ................. 514 Angina Pectoris ................................................................... 515 Angina on Effort and Coronary Thrombosis ................ 517 Ankylosing Spondylitis/Osteoarthritis/Gout ............... 518 Ankylosing Spondylitis vs Backache ............................. 519 Aortic Dissection/Myocardial Infarction ....................... 520 Arsenic Poisoning and Cholera ....................................... 521 Arterial and Venous Pulsation ......................................... 522 Arteriosclerosis Obliterans (ASO) and Burger’s Disease .................................................................. 523 Arthritis ................................................................................. 524 Atrial Fibrillation/Multiple Ectopics .............................. 525 Arthritis ................................................................................. 526 Ascites/Ovarian Cyst .......................................................... 527 Bacterial Pneumonia/Viral Pneumonia .......................... 528 Biliary and Portal Cirrhosis .............................................. 529 Bladder .................................................................................. 530

xxxiv 23. 24. 25. 26. 27. 28. 29. 30. 31. 32. 33. 34. 35. 36. 37. 38. 39. 40. 41. 42. 43. 44. 45. 46. 47. 48. 49. 50. 51. 52.

Differential Diagnosis

Bradycardia .......................................................................... 531 Bronchial Asthma and Tropical Eosinophilia ............... 532 Cardiac and Bronchial Asthma ........................................ 533 Central and Peripheral Cyanosis ..................................... 534 Cerebro-vascular Accident, Diabetic Coma and Uraemia ............................................................. 535 Cholera and Food Poisoning ............................................ 536 Chronic Bronchitis and Emphysema .............................. 537 Chest Diseases ..................................................................... 538 Chest Pain: Associated Signs ............................................ 540 Chronic Bronchitis, Emphysema, Bronchial Asthma ............................................................... 545 Chronic Gastric Ulcer and Chronic Duodenal Ulcer ................................................................... 546 Chronic Gastric Ulcer, Malignant Disease and Chronic Gastritis .......................................... 547 Colic ....................................................................................... 548 Chronic Mitral Regurgitation/Acute MR ....................... 549 Chronic Nephritis and Essential Hypertension ............ 550 Chronic Myeloid Leukaemia/ Chronic Lymphoid Leukaemia ......................................... 551 Conjugated and Unconjugated Bilirubin ...................... 553 Colitis .................................................................................... 554 Colubrine Poisoning and Viperine Poisoning .............. 555 Conjunctival Congestion/Ciliary Congestion ............... 556 Conjunctivitis, Iritis and Acute Glaucoma .................... 557 Diabetes ................................................................................ 558 Diastolic Murmurs—Apex ................................................ 560 Diastolic Murmurs—Second Interspace Right and Left (Base) ...................................... 562 Differentiating Clinical Features in Patients with Diarrhea ....................................................... 563 Different Types of Jaundice .............................................. 566 Differentiation between Natural and Criminal Abortion .............................................................. 568 Differential Diagnosis of Big Skull ................................ 569 Drug Addiction and Drug Habituation .......................... 570 Drunkenness and Concussion ......................................... 571

Contents 53. 54. 55. 56. 57. 58. 59. 60. 61. 62. 63. 64. 65. 66. 67. 68. 69. 70. 71. 72. 73. 74. 75. 76. 77. 78. 79. 80. 81. 82. 83. 84. 85. 86. 87.

xxxv

Ear Discharge ....................................................................... 572 Endogenous Depression/Neurotic Depression ............. 573 Effort Angina/Acute Infarction ........................................ 574 Extrinsic Asthma/Intrinsic Asthma ................................. 576 Episodic Thoracic Pain ....................................................... 577 Endocardial and Pericardial Murmurs ........................... 579 Fallot’s Tetralogy and Fallot’s Triad ................................. 580 Functional Mitral Incompetence ...................................... 581 Gall Bladder Swelling/Kidney Swelling ....................... 582 Gaucher’s Disease/Niemann-Pick Disease/Hand-Schüller-Christian Disease .................... 583 Genital Ulcers ...................................................................... 584 Haemoptysis and Haematemesis ..................................... 585 Hepatitis A/Hepatitis B ...................................................... 586 Headaches ............................................................................. 588 Heat stroke/Heat Exhaustion/Heat Cramps ................... 592 Hematuria ............................................................................. 593 Hysterical and Organic Convulsions .............................. 594 Hepatitis E/Hepatitis Virus ............................................... 595 Hysterical fit and Epileptic Fit ......................................... 596 Hyperglycaemic and Hypoglycaemic Coma ................. 597 Hospital-acquired Infections ............................................ 598 Hypovolemic Shock and Septic Shock ........................... 603 Immunity .............................................................................. 604 Infective Hepatitis and Serum Hepatitis ....................... 605 Innervation of Reflexes ..................................................... 606 Irregular Tachycardia ......................................................... 607 Lesions of Conus Medullaris/ Cauda Equina Lesions ....................................................... 608 Lobar Pneumonia and Broncho-pneumonia ................. 609 Lower Urinary Tract Obstruction ..................................... 610 Lungs of Infant Before Respiration and after Onset of Respiration .......................................................... 611 Middle Aortic Syndrome/Congenital Syndrome ......... 612 Loose Motions ..................................................................... 613 Marasmus and Kwashiorkor ............................................ 614 Migraine ............................................................................... 615 Mitral Regurgitation/Tricuspid Regurgitation ............. 616

xxxvi

Differential Diagnosis

88. Mitral Incompetence/Aortic Stenosis ............................. 617 89. Mitral Regurgitation, VSD and Tricuspid Regurgitation ..................................................... 618 90. Migraine, Tension Headache, Psychotic Headache, Pressure Headache, and Temporal Arteritis .................. 619 91. Muscular Dystrophies ........................................................ 620 92. Nail Discolouration ............................................................ 621 93. Nasal Discharge .................................................................. 623 94. Papillitis and Papilloedema .............................................. 624 95. Non-cirrhotic Portal Fibrosis/Cirrhosis .......................... 625 96. Oedema of the Skin ............................................................ 627 97. Oedema or Skin or Tissue in Children ........................... 628 98. Organic Psychosis/Functional Psychosis ....................... 629 99. Osteoarthritis/Frozen Shoulder ....................................... 630 100. Pain in the Umbilical Region ........................................... 631 101. Peripheral Oedema ............................................................. 632 102. Petit Mal, Temporal Lobe Epilepsy and Grand Mal Epilepsy ................................................... 633 103. Peripheral Vascular Disease ............................................. 634 104. Pleural Effusion ................................................................... 635 105. Pericardial Effusion/Pleural Effusion ............................. 638 106. Poisoning .............................................................................. 639 107. Primary Haemostasis/Secondary Haemostasis ............. 641 108. Primary Pulmonary Hypertension and Multiple Pulmonary Emboli ............................................ 642 109. Prostatic diseases/PR Examination .................................. 643 110. Psychoneuroses and Psychoses ........................................ 644 111. Psychosis and Neurosis ..................................................... 645 112. Pyogenic Lung Abscess/Tubercular Abscess ................. 646 113. Regular Tachycardia ........................................................... 647 114. Rheumatoid Arthritis/Rheumatic .................................... 648 115. Rheumatic and Syphilitic Incompetence ....................... 649 116. Rheumatoid Arthritis and Osteoarthritis ....................... 650 117. Severe Abdominal Pain: Associated Symptoms and Signs .......................................................... 652 118. Sinus Bradycardia ............................................................... 655 119. Smallpox and Chickenpox ................................................ 656 120. Spleen Swelling/Kidney Swelling .................................. 657

Contents 121. 122. 123. 124. 125. 126. 127. 128. 129. 130. 131. 132. 133. 134. 135. 136. 137. 138. 139. 140. 141.

xxxvii

Sinus Tachycardia/Ventricular Tachycardia ................... 658 Stages of Dehydration ....................................................... 661 Strychnine Poisoning and Tetanus .................................. 662 Suicidal and Homicidal Hanging .................................... 663 Spleen Enlargement ........................................................... 664 True Insanity and Feigned Insanity ................................ 665 Suicidal and Homicidal Wounds ..................................... 666 Systolic Murmurs—Apex and Left Lower Sternal Border (LLSB) ................................... 668 Systolic Murmurs—Right Second Interspace ............... 670 Tachycardias ......................................................................... 672 Thyrotoxicosis ..................................................................... 674 Tonsillitis, Scarlet Fever and Diphtheria ....................... 675 Trigeminal Neuralgia, Atypical Facial Pain, Migraine, and Postherpetic Neuralgia ........................... 676 Upper Motor Lesion and Lower Motor Lesion ............. 677 True Bruise and Artificial Bruise ..................................... 678 Vascular Embolism, Thrombosis and Haemorrhage ....................................................................... 679 Vasovagal Fit, Hyperventilation Drop Attack, Stokes-Adams and Hypoglycaemia ................................ 680 Viral Pericarditis/Myocardial Infarction ........................ 681 Ventricular Ectopic/Atrial Fibrillation ............................ 682 Ventricular Septal Defect and Pulmonary Stenosis ..... 683 Viral Encephalitis and Tuberculous Meningitis ........... 684 Section-4

ESSENTIALS OF DIAGNOSIS 1. 2. 3. 4. 5. 6. 7.

Acne Vulgaris ....................................................................... 685 Acromegaly .......................................................................... 685 Acute Appendicitis ............................................................. 686 Acute Cholecystitis ............................................................. 686 Acute Gastritis ..................................................................... 686 Acute Glaucoma .................................................................. 687 Acute Miliary Tuberculosis ............................................... 687

xxxviii 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. 28. 29. 30. 31. 32. 33. 34. 35. 36. 37. 38. 39. 40. 41. 42. 43. 44. 45.

Differential Diagnosis

Acute Otitis Media ............................................................. 687 Acute Poliomyelitis ............................................................ 687 Acute Pyelonephritis .......................................................... 688 Acute Renal Failure ............................................................ 688 Addison's Disease ............................................................... 689 Alcoholic Liver .................................................................... 689 Amyloidosis ......................................................................... 689 Anaemia ................................................................................ 690 Angina Pectoris ................................................................... 690 Aortic Incompetence .......................................................... 690 Aortic Stenosis ..................................................................... 691 Asthma .................................................................................. 691 Atelectasis ............................................................................. 691 Atrial Septal Defect ............................................................ 692 Attention Deficit Hyperactivity Disorder ...................... 692 Bacillary Dysentery ............................................................ 693 Brief Reactive Psychosis .................................................... 693 Bronchiectasis ...................................................................... 693 Bronchogenic Carcinoma .................................................. 694 Bronchopneumonia ............................................................ 694 Cancer Cervix ....................................................................... 695 Cervicitis ............................................................................... 695 Chickenpox .......................................................................... 695 Chronic Alcoholism ............................................................ 696 Chronic Pyelonephritis ...................................................... 696 Conduct Disorder ................................................................ 697 Congenital Syphilis ............................................................ 697 Conjunctivitis ...................................................................... 698 Corneal Ulcer ....................................................................... 698 Cushing's Syndrome .......................................................... 698 Delirium ............................................................................... 699 Dementia .............................................................................. 699 Depression ........................................................................... 700 Diabetes Insipidus .............................................................. 700 Diabetes Mellitus ................................................................ 701 Dysmenorrhoea ................................................................... 701 Duodenal Ulcer ................................................................... 701 Eczema ................................................................................... 702

Contents 46. 47. 48. 49. 50. 51. 52. 53. 54. 55. 56. 57. 58. 59. 60. 61. 62. 63. 64. 65. 66. 67. 68. 69. 70. 71. 72. 73. 74. 75. 76. 77. 78. 79. 80. 81. 82. 83.

xxxix

Facial Palsy ........................................................................... 702 Fallot's Tetralogy ................................................................. 702 Fibroid Uterus ...................................................................... 703 Functional Enuresis ............................................................ 704 Gigantism ............................................................................. 704 Gonorrhoea .......................................................................... 704 Gout ....................................................................................... 705 Grand Mal Epilepsy ........................................................... 705 Herpes Zoster ....................................................................... 706 Hodgkin's Disease .............................................................. 706 Hypertension ....................................................................... 707 Hyperthyroidism ................................................................. 707 Hypothyroidism .................................................................. 708 Indian Childhood Cirrhosis ............................................. 708 Infantile Diarrhoea ............................................................. 709 Infective Endocarditis ........................................................ 709 Infective Hepatitis .............................................................. 710 Intestinal Amoebiasis ........................................................ 710 Intestinal Tuberculosis ....................................................... 710 Iritis ........................................................................................ 711 Kwashiorkor ........................................................................ 711 Major Depressive Episode ................................................ 711 Manic Episode ..................................................................... 712 Marasmus ............................................................................. 712 Measles ................................................................................. 713 Melancholic .......................................................................... 713 Menopause ........................................................................... 713 Mitral Incompetence .......................................................... 714 Mumps .................................................................................. 714 Myocardial Infarction ........................................................ 715 Nephrotic Syndrome .......................................................... 715 Opioid Withdrawal ............................................................. 715 Oppositional Defiant Disorder ........................................ 716 Osteoarthritis ....................................................................... 716 Paranoid Disorder ............................................................... 716 Panic Disorder ..................................................................... 717 Parkinsonism ....................................................................... 717 Patent Ductus Arteriosus ................................................... 717

xl 84. 85. 86. 87. 88. 89. 90. 91. 92. 93. 94. 95. 96. 97. 98. 99. 100. 101. 102. 103. 104. 105. 106. 107. 108. 109. 110. 111.

Differential Diagnosis Pericardial Effusion ............................................................ 718 Peripheral Neuritis ............................................................. 718 Petit Mal Epilepsy .............................................................. 719 Pleural Effusion ................................................................... 719 Pneumonia ........................................................................... 719 Pneumothorax ...................................................................... 720 Portal Cirrhosis .................................................................... 720 Pregnancy ............................................................................. 720 Psoriasis ................................................................................ 721 Psychosis ............................................................................... 721 Pyloric Obstruction ............................................................ 721 Rheumatic Fever ................................................................. 722 Rheumatoid Arthritis ......................................................... 722 Rickets ................................................................................... 723 Ringworm ............................................................................. 724 Scabies ................................................................................... 724 Schizophrenia ...................................................................... 724 Scurvy .................................................................................... 725 Subarachnoid Haemorrhage ............................................. 726 Tetany .................................................................................... 726 Trigeminal Neuralgia ......................................................... 727 Tubal Pregnancy .................................................................. 727 Tuberculosis ......................................................................... 728 Tuberculous Meningitis ..................................................... 728 Typhoid Fever ...................................................................... 729 Ulcerative Colitis ................................................................ 729 Ventricular Septal Defect .................................................. 730 Whooping Cough ................................................................ 730 Section-5

STAGING OF DISEASES Grading and Staging ..................................................................... 732 Grading of Symptoms .................................................................. 732 • Dyspnoea .................................................................................... 732 • Exertional Dyspnoea ................................................................ 733 Grading of Signs ............................................................................ 734

Contents

xli

• Clubbing ..................................................................................... 734 • Heart Sound ............................................................................... 734 • Hill's Sign ................................................................................... 734 • Joint Tenderness ........................................................................ 734 • Level of Consciousness ............................................................ 736 • Murmur ....................................................................................... 737 • Muscle Power ............................................................................. 737 • Nystagmus .................................................................................. 738 • Parasternal Heave ..................................................................... 738 • Plantar Response ....................................................................... 738 • Splenomegaly ............................................................................ 738 • Tendon Reflexes ........................................................................ 739 Grading of Diseases ...................................................................... 739 • Acne Vulgaris ............................................................................. 739 • Acute Mountain Sickness ........................................................ 741 • Acute Pancreatitis ...................................................................... 742 • Alcohol Intoxication ................................................................. 742 • Anaemia ...................................................................................... 743 • Aplastic Anaemia ...................................................................... 743 • Angina Pectoris .......................................................................... 743 • Adult Respiratory Distress Syndrome .................................. 744 • Asphyxia ..................................................................................... 744 • Barbiturate Poisoning .............................................................. 745 • Breast Cancer .............................................................................. 745 • Bronchial Asthma ...................................................................... 745 • Bronchogenic Carcinoma ......................................................... 746 • Carcinoma Cervix ...................................................................... 748 • Chronic Bronchitis .................................................................... 749 • Chronic Cor Pulmonale ........................................................... 750 • Circulatory Decompensation in Cirrhotic Ascites .............. 750 • Factor 8-Coagulant Acitivity ................................................... 750 • Dengue Fever ............................................................................. 751 • Diabetes ...................................................................................... 752 • Endometrial Carcinoma ........................................................... 755 • Ethylene Glycol Poisoning ...................................................... 755 • Grading of Glutethimide Intoxication ................................. 755 • Grading of Open Fracture ....................................................... 756 • Haemolysis According to Life-span of RBCs ...................... 757

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Differential Diagnosis

• Heart Failure .............................................................................. 757 • Hepatic Encephalopathy .......................................................... 758 • Hodgkin's Lymphoma .............................................................. 759 Modified Ann Arbor Staging (As 1971 staging with the addition of stage 3-1 and 3-2) .................................................... 759 • Hyperbilirubinaemia (Unconjugated) .................................. 760 • Hypoglycemia ............................................................................ 760 • Hypertension ............................................................................. 760 • Intelligence and Mental Retardation .................................... 763 • Intracranial Tension (Raised) .................................................. 764 • Jaundice ....................................................................................... 764 • Lathyrism .................................................................................... 764 • Chronic Lymphatic Leukaemia .............................................. 766 • Malnutrition ............................................................................... 767 • Multiple Myeloma .................................................................... 770 • Myasthenia Gravis .................................................................... 771 • Myocardial Infraction .............................................................. 772 Recovery after Nerve Injury ........................................................ 773 • Motor Recovery ......................................................................... 773 • Sensory Recovery (Precedes Motor Recovery) .................... 773 Nutrition Deficiency Syndrome ................................................. 773 Parkinsonism .................................................................................. 774 Patent Ductus Arteriosus ............................................................. 774 Plexogenic Pulmonary Arteriopathy ......................................... 774 Proteinuria ...................................................................................... 775 Pulmonary Hypertension ............................................................. 775 Pulmonary Stenosis ...................................................................... 776 a. Pulmonary Tuberculosis ........................................................ 777 b. Radiological Classification of Pulmonary Tuberculosis ............................................................................ 778 Rabies ............................................................................................... 778 Rheumatic Carditis ........................................................................ 779 Rheumatoid Arthritis .................................................................... 779 Sarcoidosis ...................................................................................... 781 • Radiologic Staging .................................................................... 781 Sickle Retinopathy (Proliferative) ............................................. 781 Shock ................................................................................................ 782 SLE .................................................................................................... 782

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Subarachnoid Haemorrhage ....................................................... 783 Syphilis ............................................................................................ 784 Tubercular Meningitis .................................................................. 784 Tetanus ............................................................................................. 785 Tuberculin Test ............................................................................... 786 Ventricular Premature Beats ........................................................ 786 Thyrotoxicosis (Wayne's Clinical Diagnostic Index) .............. 787 Ulcerative Colitis ........................................................................... 788 Ventricular Septal Defect ............................................................. 789 Yaws .................................................................................................. 790 Yellow Fever ................................................................................... 790 Severity of Psychological Stressors Scale—Adults ................ 791 Severity of Psychosocial Stressors Scale—Children and Adolescents ................................................................................... 791 Section-6

SYNONYMS Section-7

SYNDROMES 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12.

Achard Syndrome ............................................................... 804 Aortic Arch Syndrome ....................................................... 804 Arnold Chiari Syndrome ................................................... 804 Black Pleural Signs ............................................................. 804 Blind Loop Syndrome ........................................................ 804 Bantis Syndrome ................................................................. 805 Behcet’s Syndrome .............................................................. 805 Bernheim’s Syndrome ........................................................ 805 Bourneville Pringle Syndrome ........................................ 805 Burler-Albright Syndrome ................................................ 806 Caison Syndrome ................................................................ 806 Caplan Syndrome ............................................................... 806

xliv 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. 28. 29. 30. 31. 32. 33. 34. 35. 36. 37. 38. 39. 40. 41. 42. 43. 44. 45. 46. 47. 48. 49. 50.

Differential Diagnosis Carpenter Syndrome .......................................................... 806 Cervical Rib Syndrome ...................................................... 807 Cockyne Syndrome ............................................................ 807 Coffin Lowry Syndrome .................................................... 807 Conn’s Syndrome ................................................................ 807 Cushing’s Syndrome .......................................................... 808 Down’s Syndrome .............................................................. 808 Dumping Syndrome ........................................................... 808 Ebstein’s Syndrome ............................................................ 808 Eisenmenger Syndrome ..................................................... 809 Empty-Sella Syndrome ...................................................... 809 External Carotid Steal Syndrome .................................... 810 Fanconi’s Syndrome ........................................................... 810 Gardner’s Syndrome .......................................................... 810 Gaucher’s Syndrome .......................................................... 810 Hand and Foot Syndrome ................................................. 810 Hand-Schuller-Christian Syndrome ............................... 811 Herrmann Syndrome ......................................................... 811 Horner’s Syndrome ............................................................ 811 Hunter Syndrome ............................................................... 811 Hurler Syndrome ................................................................ 812 Hutchinson-Golford Syndrome ....................................... 812 Irritable Colon Syndrome ................................................. 812 Irritable Hip Syndrome ..................................................... 813 Jaccoud Syndrome .............................................................. 813 Kimmelsteil-Wilson Syndrome ....................................... 813 Klippel-Feil Syndrome ...................................................... 814 Larsen Syndrome ................................................................ 814 Laurence Moon-Biedl Syndrome ..................................... 814 Letterer-Siwe Syndrome .................................................... 814 Löffler’s Syndrome ............................................................. 815 Macleod Syndrome ............................................................. 815 Marfan’s Syndrome ............................................................ 815 Mikulicz’s Syndrome ......................................................... 816 Morgagni Syndrome .......................................................... 816 Morquios Syndrome .......................................................... 816 Nail-Patella Syndrome ....................................................... 816 Niemann-Pick Syndrome .................................................. 817

Contents 51. 52. 53. 54. 55. 56. 57. 58. 59. 60. 61. 62. 63. 64. 65.

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Paget’s Syndrome ................................................................ 817 Pancoast Syndrome ............................................................ 817 Pink Fallot’s Syndr ome ..................................................... 818 Simmond’s Syndrome ........................................................ 818 Simmond’s Syndrome ........................................................ 818 Sturge-Weber Syndrome ................................................... 819 Subclavian Steal Syndrome .............................................. 819 Trisomy-8 Syndrome .......................................................... 819 Turcot Syndrome ................................................................. 819 Turner’s Syndrome ............................................................. 820 Ullrich-Turner Syndrome .................................................. 820 `W’ Syndrome ...................................................................... 820 Wegener’s Syndrome .......................................................... 820 XXY Syndrome .................................................................... 821 Yellow Nail Syndrome ....................................................... 821 Section-8

INVESTIGATIONS 1. Blood Values ........................................................................ 822 • Serum Phosphorus ......................................................... 822 • Serum Triglyceride ......................................................... 822 • Serum Bilirubin .............................................................. 822 • Serum Calcium ................................................................ 823 • Serum Chloride ............................................................... 823 • Serum Cholesterol .......................................................... 823 • Serum Albumin .............................................................. 823 • Serum Globulin .............................................................. 824 • Nitrogen Compound ...................................................... 824 • Blood Urea ....................................................................... 824 • Blood Uric Acid ............................................................... 824 • Serum Alkaline Phosphatase ....................................... 825 • Serum Amylase ............................................................... 825 • Serum Iron ....................................................................... 825 • Serum Fibrinogen ........................................................... 825 • Oestrogens ....................................................................... 826 • Fasting Blood Sugar ....................................................... 826

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2. 3. 4. 5.

Differential Diagnosis • SGPT ................................................................................. 826 • SGOT ................................................................................ 826 • Lactic Acid Dehydrogenase (LDH) ............................. 827 • HDL Cholesterol ............................................................. 827 • Thyroxine Total T4 .......................................................... 827 • Triiodothyronine (T3) ..................................................... 827 • Carotene (Vit. A Retinol) ............................................... 827 • Lipase ................................................................................ 827 • Leukocytosis .................................................................... 827 • Eosinophilia ..................................................................... 828 • Lymphocytes .................................................................... 828 • Bleeding Time ................................................................. 828 • Prothrombin Time .......................................................... 829 • Platelet Count .................................................................. 829 • MCV .................................................................................. 829 • MCHC ............................................................................... 829 Urine Analysis ..................................................................... 829 Stool ....................................................................................... 834 Drugs ..................................................................................... 835 Common X-ray Findings of Chest Diseases ................................................................................ 838 • Chronic Bronchitis ......................................................... 838 • Bronchiectasis .................................................................. 838 • Primary Childhood Type of Tuberculosis ................. 839 • Chronic Pulmonary Tuberculosis ................................ 839 • Miliary Tuberculosis ...................................................... 839 • Emphysema ..................................................................... 840 • Primary Pneumonia ....................................................... 840 • Lung Abscess ................................................................... 840 • Pleural Effusion .............................................................. 840 • Pneumothorax ................................................................. 841 • Pulmonary Oedema ....................................................... 841 • Hodgkin's Disease .......................................................... 841 • Metastasis ......................................................................... 841 • Causes of Unilateral Hilar Enlargement .................... 842 • Bilateral Hilar Enlargement ......................................... 842 • Shifting of Mediastinum Towards Opposite Side ... 842 • Shifting of Mediastinum Towards Same Side ......... 842

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• Unilateral Elevation of Diaphragm ............................ 843 • Accentuated Interstitial Markings in Lungs ............. 843 • Honeycomb Lung ........................................................... 843 • Pulmonary Oedema—Bilateral .................................... 843 • Unilateral Pulmonary Oedema .................................... 844 • 0.5 to 2 mm Multiple Opacities ................................... 844 • Solitary Pulmonary Nodule ......................................... 844 • Homogeneous Opacity of One Lung .......................... 844 6. Chest ...................................................................................... 845 • Solitary Pleural Mass ..................................................... 845 • Pleural Based Parenchymal Nodules ......................... 845 • Multiple Pleural Densities Each Greater 2 mm ....... 845 • Pleural Effusion .............................................................. 845 • Pleural Effusion Large Cardiac Silhouette ................ 845 • Pleural Effuson with Subsegmental Atelectasis ...... 845 • Pleural Effusion with Hilar Enlargement .................. 846 • Pleural Effusion with Lobar Densities ....................... 846 • Pleural Thickening ......................................................... 846 • Pleural Calcification ...................................................... 846 • Elevated Diaphragm ...................................................... 846 • Shift of Mediastinum .................................................... 846 • Anterior Mediastinal Mass ........................................... 847 • Right Cardiophrenic Angle Mass ................................ 847 • Middle Mediastinal Mass ............................................. 847 • Hilar Masses .................................................................... 848 • Unilateral Hilar Adenopathy ....................................... 848 • Bilateral Hilar Adenopathy .......................................... 848 • Posterior Mediastinal Mass .......................................... 848 7. Atelectasis ............................................................................. 849 • Large Airway Obstruction ............................................ 849 • Small Airway Obstruction ............................................ 849 • Compressive Atelectasis ............................................... 849 • Passive Atelectasis .......................................................... 849 • Adhesive Atelectasis ...................................................... 849 • Cicatrization Atelectasis ................................................ 849 • Segmental and Lobal Densities ................................... 849 • Lobar Expansion ............................................................. 850 • Diffuse Coalescing Densities ....................................... 850

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8.

9. 10. 11. 12. 13. 14.

Differential Diagnosis

• Non-Cardiac Pulmonary Oedema ............................... 850 • Diffuse Fine Reticular Densities ................................. 851 • Fine Reticualr Pattern and Pleural Effusion ............. 851 • Fine Reticular Pattern and Hilar Adenopathy .......... 851 • Coarse Reticular Densities ........................................... 852 • Diffuse Fine Nodular Disease ..................................... 852 • Diffuse Fine Nodular Pattern in Afebrile Patient ... 852 • Diffuse Fine Nodular Pattern in Case of Fever ........ 852 • Multifocal Ill-defined Densities ................................. 853 • Multiple Nodular Masses with Sharp Borders ........ 853 • Solitary Nodules ............................................................. 853 • Hypertranslucent Lungs ................................................ 854 • Solitary Lucent Defect ................................................... 854 • Multiple Lucent Lesions ............................................... 854 • Cavitating Nodule .......................................................... 854 • Ill-defined Densities with Holes ................................. 855 X-ray Features of Arthritis ................................................. 855 • Osteoarthritis ................................................................... 855 • Pyogenic Arthritis .......................................................... 855 • Tuberculous Arthritis ..................................................... 856 • Rheumatoid Arthritis .................................................... 856 • Rheumatoid Arthritis in Children (Still's Disease) ................................................................ 856 • Gout ................................................................................... 857 • Psoriatic Arthritis ........................................................... 857 Intravenous Pyelography .................................................. 857 Causes of Urinary Tract ...................................................... 865 Kidney ................................................................................... 868 Barium Meal Studies .......................................................... 869 Gastrointestinal Tract ......................................................... 878 Practical Applications of ECG .......................................... 882 • Chamber Enlargement ................................................... 882 • Myocardial Ischaemia (Angina Pectoris) ................... 882 • Myocardial Infarction .................................................... 885 • Arrhythmias ..................................................................... 887 • Heart Block ...................................................................... 896 • Bundle Branch Block ..................................................... 898 • Drugs ................................................................................. 899

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• Electrolytes ....................................................................... 902 • Miscellaneous Conditions ............................................ 906 15. Treadmill Test in Coronary Artery Disease ................... 907 • Depression of the ST Sagment: Subendocardial Injury .................................................. 913 • Postmyocardial Infarction Treadmill Exercise Test ................................................. 917 Index ....................................................................................... 919