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Diagnosis: A Symptom-based Approach in Internal Medicine
CS Madgaonkar
CHAPTER 1:
Abdominal Distension
SYNOPSIS
DIFFERENTIAL DIAGNOSIS
Common
OCCASIONAL
RARE
INVESTIGATIONS—GENERAL
CBC
ESR
Urinalysis
Stools
LFTs
AXR
US Abdomen/Pelvis
INVESTIGATIONS—SPECIFIC
Tuberculin or PPD and Casino's Test
Serum Lipase
CT/MRI Scan
MRI Angiography
Diagnostic Paracentesis
Laparoscopy with Biopsy
Exploratory Laparotomy
CLINICAL NOTES
RED FLAGS
SELECTIVE GLOSSARY
Functional GI Disorders (FGIDs)7, 11, 12
Meigs Syndrome
Proctalgia Fugax
Rumination Syndrome
Spontaneous Bacterial Peritonitis (SBP)
CHAPTER 2:
Abdominal Pain
SYNOPSIS
DIFFERENTIAL DIAGNOSIS
Common
Occasional
Rare
INVESTIGATIONS—GENERAL
CBC
ESR
Urinalysis
Fecal Occult Blood
Blood Glucose
LFTs, Amylase, Lipase
Urea, Creatinine, Electrolytes
ECG
Pregnancy Test
US Abdomen
INVESTIGATIONS—SPECIFIC
HRCT Scan
MRI
Endoscopy
CXR—Upright View
AXR
Magnetic Resonance Cholangiopancreato-graphy (MRCP)
Endoscopic Ultrasound (EUS)
Radionuclide Scans
Angiography
Other Imaging
FNAC and Biopsy
Paracentesis
Laparoscopy
Surgical Exploration
CLINICAL NOTES
RED FLAGS
SELECTIVE GLOSSARY
CHAPTER 3:
Amenorrhea
SYNOPSIS
DIFFERENTIAL DIAGNOSIS
A—Primary Amenorrhea
Common
Occasional
Rare
B—Secondary Amenorrhea (Table 3.1)
Common
Occasional
Rare
INVESTIGATIONS—GENERAL
Pregnancy Test
US of Pelvis
TFTs
ESR
Blood Glucose
Urea, Creatinine, Electrolytes, LFTs
RF, ANA
INVESTIGATIONS—SPECIFIC
Physical Examination
Endocrine Hormone Assays
Serum Prolactin (PRL — Normal Reference — <25 ng/ml)
Serum LH, FSH
DEHA-S
Free Testosterone
Progestin Challenge (Withdrawal) Test
Estrogen-progestin Challenge (Withdrawal) Test
Dexamethasone Suppression Test
MRI/CT Scan — Brain
Karyotyping
Laparoscopy
Hysteroscopy
CLINICAL NOTES
RED FLAGS
SELECTIVE GLOSSARY
CHAPTER 4:
Anxiety
SYNOPSIS
DIFFERENTIAL DIAGNOSIS
Common
Occasional
Rare
INVESTIGATIONS—GENERAL
Blood Glucose
Thyroid Profile
ECG
INVESTIGATIONS–SPECIFIC
24-hour Urine for Catecholamines
Serum Insulin/C Peptide
24-hour Holter Monitor
CT Scan/MRI Pancreas
EEG
CLINICAL NOTES
RED FLAGS
CHAPTER 5:
Arthralgia and Arthritis
SYNOPSIS
DIFFERENTIAL DIAGNOSIS
Common
Occasional
Rare
INVESTIGATIONS—GENERAL
CBC
ESR, CRP
RF
Serum Uric Acid
X-rays
INVESTIGATIONS—SPECIFIC
ASO Titer
Blood Culture
ANA
Anti-double-stranded DNA (Anti-dsDNA) Antibody
Anti-Smith (Anti-Sm) Antibody
Cytoplasmic Antineutrophilic Cytoplasmic (C-ANCA) Antibody
Cyclic Citrullinated Peptide (CCP) Antibody
Human Leukocyte Antigen (HLA - B27) Typing
HLA DR4/ DR1 Typing
Serology
TFTs
US with Duplex Scanning
CT/MRI
Synovial Fluid Analysis
Synovial Biopsy (Diagnostic Arthroscopy)
CLINICAL NOTES
RED FLAGS
SELECTIVE GLOSSARY
CHAPTER 6:
Back Pain
SYNOPSIS
DIFFERENTIAL DIAGNOSIS
Common
Occasional
Rare
INVESTIGATIONS—GENERAL
CBC, ESR, CRP
Urinalysis
Spine X-ray
INVESTIGATIONS—SPECIFIC
Sr Calcium, Phosphorus, Alk Phosphatase, Acid Phosphate
Sr Uric Acid
PSA
Plasmoprotein Electrophoresis
Bence Jones Protein
CXR
US Abdomen
CT Spine
HRCT Abdomen
MRI Spine
Bone Scans (Technetium)
Upper GI Endoscopy
CSF Analysis
Electrodiagnosis
Histocompatibility Antigen Test (HLA-B 27)
Myelography, Discography, Diagnostic Selective Nerve Blockade
Bone Marrow Biopsy/Aspiration
CLINICAL NOTES
RED FLAGS
CHAPTER 7:
Breast Lump
SYNOPSIS
DIFFRENTIAL DIAGNOSIS
Common
Occasional
Rare
INVESTIGATIONS—GENERAL
CBC
ESR
LFTs
Serum Calcium
CXR
INVESTIGATIONS—SPECIFIC
Mammography
Digital Mammography
FNAC or FNA Biopsy (FNAB)††
US Breast
US Abdomen
MRI
Core-needle Biopsy
Excision Biopsy
Triple Diagnosis Test
Genetic Testing for Breast Cancer4
CLINICAL NOTES
RED FLAGS
CHAPTER 8:
Chest Pain
SYNOPSIS
DIFFERENTIAL DIAGNOSIS
Common
Cardiac
Gastrointestinal
Musculoskeletal
Pulmonary
Emotional/Psychiatric
Occasional
Rare
INVESTIGATIONS—GENERAL
CBC
Blood Glucose/Lipid Profile
ECG
CXR
Cardiac Enzymes
INVESTIGATIONS—SPECIFIC
Exercise ECG
Echocardiography — 2-D and Doppler10
HRCT/MRI
Ventilation-perfusion (V/Q) Scans
Myocardial Perfusion Imaging
Coronary Angiography
Intravascular Ultrasound (IVUS)
Multislice Computed Tomography (MSCT)/ 64-Slice Spiral Computed Tomography
GI Studies
PFTs
TFTs
CLINICAL NOTES
RED FLAGS
SELECTIVE GLOSSARY
CHAPTER 9:
Constipation
SYNOPSIS
DIFFERENTIAL DIAGNOSIS
Common
Occasional
Rare
INVESTIGATIONS—GENERAL
CBC
ESR
FOBT
Proctoscopy (Anoscopy)
Urea, Creatinine, Electrolytes
INVESTIGATIONS—SPECIFIC
Endocrine Panel
Serum Calcium
AXR
US Abdomen
Colonoscopy
Sigmoidoscopy/Barium Enema
MRI—Brain, Spine
Expanded Physiological Studies (Table 9.1)1
Rectal Biopsy
CLINICAL NOTES
RED FLAGS
SELECTIVE GLOSSARY
CHAPTER 10:
Convulsions
SYNOPSIS
DIFFERENTIAL DIAGNOSIS
Common
Occasional
Rare
INVESTIGATIONS—GENERAL
CBC
Blood Glucose
Serum Electrolytes
ECG
Neuroimaging
Biochemistry Panel
INVESTIGATIONS–SPECIFIC
CSF
EEG
Ambulatory EEG (aEEG)
Video-EEG Monitoring2,3
Toxicology (Serum and Urine) Screen
CLINICAL NOTES
RED FLAGS
CHAPTER 11:
Cough
SYNOPSIS
DIFFERENTIAL DIAGNOSIS
Common
Occasional
Rare
INVESTIGATIONS–GENERAL
CBC
Sputum
CXR
INVESTIGATIONS–SPECIFIC
PFTs
Pulse Oximetry
pH Studies
CT Chest/MRI
CT Sinus
Esophagogastroduodenoscopy (EGD)
Bronchoscopy
Purified Protein Derivative (PPD) Skin Test
HIV Serology
Culture of Nasopharyngeal Secretions/PCR‡.
CLINICAL NOTES
PFTs
RED FLAGS
CHAPTER 12:
Dementia
SYNOPSIS
DIFFERENTIAL DIAGNOSIS
Common
Occasional
Rare
INVESTIGATIONS—GENERAL
CBC
ESR
Urea, Creatinine, LFTs
Electrolytes—Sodium, Potassium, Calcium, Glucose
TFTs
Neuroimaging — CT/MRI
INVESTIGATIONS—SPECIFIC
Infection Screen
Vitamin B12 Assay
VDRL/Fluorescein Treponema Antibody (FTA-ABS)
HIV Serology
ANA, Anti-ds DNA
CSF
CXR/ECG
EEG
SPECT/PET
MR Angiography (MRA)
Brain and Meningeal Biopsy
Genetic Test
Neuropsychologic evaluation
CLINICAL NOTES
RED FLAGS
SELECTIVE GLOSSARY
CHAPTER 13:
Diarrhea
SYNOPSIS
DIFFERENTIAL DIAGNOSIS
Common
Occasional
Rare
INVESTIGATIONS—GENERAL
CBC
ESR
Blood Glucose
Metabolic Panel
HIV
INVESTIGATIONS—SPECIFIC
Fecal Leukocytes
Rectal Swab for c/s
FOBT
Stool for Protozoa
Stools for Clostridium Difficile Titer
Stool pH
Stool for ZN Stain (Modified)
Stool Chemical Analysis
Stool Fat (Sudan Stain)
TFTs
LFTs
Sigmoidoscopy with Biopsy and Culture
Colonoscopy or Barium Enema
US or CT Abdomen
Upper GI Barium Series
Laxative Abuse Detection
Urine 24 hr Collection for 5-HIAA Excretion
Serum Gastrin
Serum Calcitonin
CLINICAL NOTES
RED FLAGS
SELECTIVE GLOSSARY
CHAPTER 14:
Dyspepsia
SYNOPSIS
DIFFERENTIAL DIAGNOSIS
Common
Occasional
Rare
INVESTIGATIONS—GENERAL
CBC
ESR
FOBT and Parasites
ECG
Metabolic Panel
TFTs
LFTs, Amylase, Lipase
INVESTIGATIONS—SPECIFIC
EGD with or without Biopsy for H. Pylori (HP)
Tests for HP
US Abdomen or CT
Esophagography and upper GI Barium Meal Series
Esophageal Manometry
24-hour esophageal pH Manometry
Fasting Serum Gastrin
CLINICAL NOTES
RED FLAGS
SELECTIVE GLOSSARY
CHAPTER 15:
Dysphagia
SYNOPSIS
DIFFERENTIAL DIAGNOSIS
A—Oropharyngeal Causes
Common
Occasional
Rare
B—Esophageal Causes
Common
Occasional
Rare
INVESTIGATIONS—GENERAL
CBC, ESR
CXR
X-ray Neck-lateral view
INVESTIGATIONS—SPECIFIC
Barium Swallow (Barium Esophagography, or Modified Barium Swallow (MBS)
EGD
Esophageal Manometry (Stationary and Ambulatory)
Esophageal 24-hours pH Reflux Study‡‡6
Videofluoroscopic Swallowing Function Study (VSFS)‡‡
Radionucleotide Study7 (Tc-99m Sulfur Colloid Bolus)
CT Scan/MRI
Muscle Enzymes
TFTs
RF, ANA
Antiacetylcholine Antibodies
Genetic Analysis
CLINICAL NOTES
RED FLAGS
SELECTIVE GLOSSARY
CHAPTER 16:
Dyspnea—Acute
SYNOPSIS
DIFFERENTIAL DIAGNOSIS
Common
Occasional
Rare
INVESTIGATIONS—GENERAL
CBC
Blood Glucose, Electrolytes, Urinalysis
Peak Expiratory Flow Rate (PEFR)
ECG
CXR
X-ray Neck — Lateral View
Pulse Oximetry
Sr Cardiac Markers
INVESTIGATIONS—SPECIFIC
Sputum and Blood
Pulmonary Function Tests
Arterial Blood Gases (ABG)
Bronchoscopy
D-dimer
HRCT of Thorax
V/Q scan
BNP (Brain or B-type Natriuretic Peptide)
Echocardiography
Drug Screen
CLINICAL NOTES
RED FLAGS
CHAPTER 17:
Dyspnea—Chronic
SYNOPSIS
DIFFERENTIAL DIAGNOSIS
Common
Occasional
Rare
INVESTIGATIONS—GENERAL
CBC
Sputum
CXR
Pulse Oximetry
ECG
Metabolic Panel
Blood Chemistry
INVESTIGATIONS—SPECIFIC
PFT/Spirometry
Methacholine Challenge Test
Echocardiography
B-type Natriuretic Peptide (BNP)
HRCT
HRCT Angiography
V/Q Scan
24-hour Esophageal pH Monitoring
EMG and NCS
Noninvasive Cardiovascular Testing
Cardiopulmonary Exercise Testing (CPEx)
Bronchoscopy / Lung Biopsy
CLINICAL NOTES
RED FLAGS
SELECTIVE GLOSSARY
CHAPTER 18:
Facial Asymmetry and Weakness
SYNOPSIS
DIFFERENTIAL DIAGNOSIS
Common
Occasional
Rare
INVESTIGATIONS—GENERAL
CBC
Blood Glucose
VDRL
CXR
INVESTIGATIONS—SPECIFIC
CT Skull
MRI with Gadolinium
CSF
EMG/NCS
Lyme Titer
Lyme Titer
CLINICAL NOTES
RED FLAGS
SELECTIVE GLOSSARY
CHAPTER 19:
Facial Swelling
SYNOPSIS
DIFFERENTIAL DIAGNOSIS
Common
Occasional
Rare
INVESTIGATIONS–GENERAL
CBC
ESR
Urinalysis
Plasma Protein
Urea, Creatinine
Blood Glucose
CXR
INVESTIGATIONS—SPECIFIC
TFTs
ANA
Parotid Sialography
CT/MRI Brain
CT/MRI Lungs, Abdomen
CT/MRI PNS
Plasma/Urinary Cortisol
Muscle Biopsy (Bx)
CLINICAL NOTES
RED FLAGS
SELECTIVE GLOSSARY
CHAPTER 20:
Fever of Unknown Origin
SYNOPSIS
DIFFERENTIAL DIAGNOSIS
Common
Occasional
Rare
INVESTIGATIONS—GENERAL (TABLE 20.1)
CBC, PS.†
ESR
Culture
Urinalysis
PPD or Mantoux Test
CXR
Plain X-ray of Bones
US Abdomen, Pelvis
LFT
Sputum
Stool Microscopy and Culture
Blood Glucose
CSF
INVESTIGATIONS—SPECIFIC
HRCT Abdomen/Pelvis
Nuclear Imaging
FNAC and Directed Biopsies
Leg Doppler Imaging
Echocardiography
Serological Tests
HRCT Chest
Endoscopic Procedures
CLINICAL NOTES
RED FLAGS
CHAPTER 21:
Gait Disorders
SYNOPSIS
DIFFERENTIAL DIAGNOSIS
Common
Occasional
Rare
INVESTIGATIONS—GENERAL
CBC
ESR
X-ray
ECG
INVESTIGATIONS—SPECIFIC
MRI Brain/Spinal Cord
CT Brain
CSF
Serum Electrolytes
Muscle Enzymes
TFTs
RA factor and ANA
Serum B12 and Folate Levels
EMG/NCS
Genetic Testing
Drug Screen
Muscle Biopsy
CLINICAL NOTES
RED FLAGS
SELECTIVE GLOSSARY
CHAPTER 22:
Gastrointestinal Bleeding
SYNOPSIS
DIFFERENTIAL DIAGNOSIS
A—UGI BLEEDING
Common
Occasional
Rare
B—LGI BLEEDING
Common
Occasional
Rare
INVESTIGATIONS—GENERAL
CBC
Coagulation/Clotting Screen
Serum Chemistry/Serology
LFTs
ECG
EGD
INVESTIGATIONS—SPECIFIC
Sigmoidoscopy
Colonoscopy5,6
Angiography (Mesenteric)
Multidetector Computed Tomographic (MDCT) Angiography7–9
99m Tc RBC Scanning
Abdomen US/HRCT
Double-contrast Barium Enema
Small Bowel Imaging
Capsule Endoscopy10,11
Echocardiography
Laparotomy with Intraoperative Enteroscopy
CLINICAL NOTES
RED FLAGS
SELECTIVE GLOSSARY
CHAPTER 23:
Headache
SYNOPSIS
DIFFERENTIAL DIAGNOSIS
Common
Occasional
Rare
INVESTIGATIONS–GENERAL
CBC
ESR
Skull X-ray
X-ray PNS
INVESTIGATIONS–SPECIFIC
Blood Culture
Biochemistry
CXR/Spine X-ray
CT
CSF
MRI
Temporal Artery Biopsy
PET/SPECT Imaging
MR Angiography (MRA)
IOP
CLINICAL NOTES
RED FLAGS
SELECTIVE GLOSSARY
CHAPTER 24:
Hearing Loss
SYNOPSIS
DIFFERENTIAL DIAGNOSIS
Common
Occasional
Rare
INVESTIGATIONS—GENERAL
CBC
ESR
Blood Glucose
Serology for Syphilis
TFTs
INVESTIGATIONS—SPECIFIC
Pure Tone Audiometry
Speech Audiometry
Tympanometry
CT Scan of the Temporal Bones (without ontrast)
MRI of the Head (Gadolinium-enhanced)
Brainstem Auditory Evoked Responses (BAERs)
Electrocochleography
CLINICAL NOTES
RED FLAGS
CHAPTER 25:
Hematuria
SYNOPSIS
DIFFERENTIAL DIAGNOSIS
Common
Occasional
Rare
INVESTIGATIONS—GENERAL
CBC
ESR
Urine Dipstick
Urine Microscopy/Culture
US
X-ray KUB
INVESTIGATIONS — SPECIFIC
Multichemistry Profile
Hb Electrophoresis
HRCT—KUB
IVP/IVU
Cystoscopy
Urine for Schistosomiasis
Urine Cytology
Biopsy: Renal / Bladder/ Prostate
CLINICAL NOTES
RED FLAGS
SELECTIVE GLOSSARY
CHAPTER 26:
Hemoptysis
SYNOPSIS
DIFFERENTIAL DIAGNOSIS
Common
Occasional
Rare
INVESTIGATIONS─GENERAL
CXR
Bronchoscopy
Sputum Gram Stain, AFB Smear, Culture, and Cytology*
CBC
ESR
Coagulation Screen
Mantoux Test
ECG
Pulse Oximetry
INVESTIGATIONS─SPECIFIC
HRCT Scan
Multidetector CT (MDCT)1619
D-dimer
Echocardiography
V/Q Lung Scan
c-ANCA (Classical or Cytoplasmic Antineut-rophil Cytoplasmic Antibodies)
HIV
Lung Biopsy—(Bronchoscopic or Video-assisted Thorascopic Surgery, i.e. VATS).
CLINICAL NOTES
RED FLAGS
SELECTIVE GLOSSARY
CHAPTER 27:
Hiccups
SYNOPSIS
DIFFERENTIAL DIAGNOSIS
Common
Occasional
Rare
INVESTIGATIONS—GENERAL
CBC, Blood Film
ESR
Urea/creatinine
Electrolytes—Na, K, Ca
LFT
Fluoroscopy of Diaphragmatic Movement
CXR
ECG7
INVESTIGATIONS—SPECIFIC
EGD
US Abdomen
CT Scan Chest
MRI Brain9
Bronchoscopy
Echocardiography
CSF
CLINICAL NOTES
RED FLAGS
CHAPTER 28:
Insomnia
SYNOPSIS
DIFFERENTIAL DIAGNOSIS
Common
Occasional
Rare
INVESTIGATIONS—GENERAL
CBC
TFTs
ECG
Pulse Oximetry1–4
INVESTIGATIONS—SPECIFIC
Sleep Diary†
Polysomnography (Sleep Study)
Actigraphy5
CT/MRI Brain
Mini-Mental State Examination (MMSE) and Geriatric Depression Scale
Drug Toxicology Screen
CLINICAL NOTES
RED FLAGS
SELECTIVE GLOSSARY
CHAPTER 29:
Jaundice
SYNOPSIS
DIFFERENTIAL DIAGNOSIS
Common
Occasional
Rare
INVESTIGATIONS—GENERAL
CBC
ESR
Urinalysis2
Serum Bilirubin†
Serum Albumin
Prothrombin Time (PT)
Hepatic Transaminase Enzymes
Serum Alkaline Phosphatase (SAP)
Acute Viral Hepatitis Serology Markers (A, B, C and D)
Ultrasound (US)
INVESTIGATIONS—SPECIFIC
Serum Amylase
HIV Serology
CT Scanning
Endoscopic Retrograde Cholangiopancreato-graphy (ERCP)
Magnetic Resonance Cholangiopancreato-graphy (MRCP)
X-ray
Antimitochondrial Antibodies
Autoantibody Tests
Serum Copper/Ceruloplasmin
Serum Iron
Leptospirosis
Coombs’ Test
Liver Biopsy
CLINICAL NOTES
RED FLAGS
SELECTIVE GLOSSARY
CHAPTER 30:
Myalgia
SYNOPSIS
DIFFERENTIAL DIAGNOSIS
Common
Occasional
Rare
INVESTIGATIONS—GENERAL
CBC
ESR
Urine
CPR
CK (with Isoenzymes)
INVESTIGATIONS—SPECIFIC
FBG, PPBG
Calcium
Electrolytes
Sr Alkaline Phosphate
TFTs
ANA, RF
X-rays
EMG
NCS
MRI
Endocrine/Metabolic Panel
Muscle Biopsy/Genetic Analysis
CLINICAL NOTES
RED FLAGS
SELECTIVE GLOSSARY
CHAPTER 31:
Nausea and Vomiting
SYNOPSIS
DIFFERENTIAL DIAGNOSIS
Common
GI disorders
Occasional
GI disorders
Rare
INVESTIGATIONS—GENERAL
CBC
ESR
Urea, Creatinine, Electrolytes
LFTs, Amylase, Lipase
CXR
AXR
ECG
Blood Glucose
Serum Calcium
Urine
Pregnancy Test
INVESTIGATIONS—SPECIFIC
US Abdomen and Pelvis
HRCT Abdomen
CT Scan/MRI Head
Upper GI/Barium Enema X-rays
Nuclear Scintigraphy
Audiometry
Toxicology Screen
CLINICAL NOTES
RED FLAGS
SELECTIVE GLOSSARY
CHAPTER 32:
Pain—Chronic
SYNOPSIS
DIFFERENTIAL DIAGNOSIS
Common
Musculoskeletal Disorders
Neurological Disorders
Metabolic
Gastrointestinal Disorders
Psychological Disorders
Occasional
Rare
INVESTIGATIONS—GENERAL
CBC
ESR or CRP
Blood Glucose
Serum Calcium/Alkaline Phosphatase
Urea, Creatinine, Electrolytes
CPK
INVESTIGATIONS—SPECIFIC†
X-ray/CT Scan
MRI
Bone Scan
NCS/EMG
Cancer Screen/Tumor Markers
CLINICAL NOTES
RED FLAGS
SELECTIVE GLOSSARY
CHAPTER 33:
Palpitation
SYNOPSIS
DIFFERENTIAL DIAGNOSIS
Common
Occasional
Rare
INVESTIGATIONS—GENERAL
ECG
CBC
Blood Glucose
INVESTIGATIONS—SPECIFIC
Ambulatory ECG (AECG) Recording2/Holter Monitoring (Table 33.1)
Electrophysiological Studies (EPS)3
Continuous —Loop Event Recorder
Continuous Mobile Cardiac Outpatient Telemetry (MCOT)4
Pacemaker Evaluation
Exercise ECG/TMT
Echocardiography
TFTs
Urea, Creatinine, Electrolytes
Urine
Drug Levels
CLINICAL NOTES
RED FLAGS
SELECTIVE GLOSSARY
CHAPTER 34:
Polyuria
SYNOPSIS
DIFFERENTIAL DIAGNOSIS
Common
Occasional
Rare
INVESTIGATIONS—GENERAL
Urinalysis
CBC
Blood Glucose
24-hour Urine Specimen
Serum Urea, Creatinine, Electrolytes
Serum Calcium
Ultrasound
INVESTIGATIONS—SPECIFIC
24-hour Urinalysis
Water Deprivation Test§
Plasma Vasopressin (ADH)
US of Neck
CT/ MRI
Renal Biopsy
CLINICAL NOTES
RED FLAGS
SELECTIVE GLOSSARY
CHAPTER 35:
Pruritus
SYNOPSIS
DIFFERENTIAL DIAGNOSIS
Common
Occasional
Rare
INVESTIGATIONS—GENERAL
CBC
Urinalysis
Stool Examination
Microscopy of Skin Scrapings
Potassium Hydroxide (KOH) 10-20% Mounts
Blood Glucose
Serum Calcium
LFTs
Blood Urea, Creatinine, Electrolytes
TFTs
CXR
INVESTIGATIONS—SPECIFIC
Serum Ferritin
Serology
Serum Protein Electrophoresis
Urine for 5-Hydroxyindoleacetic Acid (5-HIAA)
Antimitochondrial Antibody
US Abdomen
HRCT—Chest and Abdomen
ERCP (Endoscopic Retrograde Cholangio-pancreatography)
Lymph Node Biopsy
Bone Marrow Aspirate and Biopsy
Skin Biopsy for Direct Immunofluorescence with Special Stains
Radioallergosorbent Tests (RASTs) or Patch Test
Tumor Markers
CLINICAL NOTES
RED FLAGS
SELECTIVE GLOSSARY
CHAPTER 36:
Red eye
SYNOPSIS
DIFFERENTIAL DIAGNOSIS
Common
Occasional
Rare
INVESTIGATIONS—GENERAL
ESR
Blood Glucose
INVESTIGATIONS—SPECIFIC
Gram's Stain of Conjunctival Exudates
Culture of Exudate
Immunofluorescent PCR Tests
Orbital USs
Orbital CT Scan
RF, ANA
HLA-B27
Syphilis Serology
CLINICAL NOTES
RED FLAGS
SELECTED GLOSSARY
CHAPTER 37:
Sexual Dysfunction
SYNOPSIS
DIFFERENTIAL DIAGNOSIS (TABLE 37.2)
Common
Occasional
Rare
INVESTIGATIONS—GENERAL
Blood Glucose
Lipid Profile
TFTs
Chemistry Panel
Serum Testosterone-free (AM Sample)
Microscopy/Culture
INVESTIGATIONS—SPECIFIC
Serum Prolactin (PRL)
LH and FSH
Nocturnal Penile Tumescence (NPT)
Intracavernosal Injection and Sexual Stimulation
Penile Duplex US
Perineal and Clitoral Electromyography
Pelvic Arteriography
US Testis and Pelvis
CT/MRI Scan
CLINICAL NOTES
RED FLAGS
SELECTIVE GLOSSARY
CHAPTER 38:
Sweating Abnormalities
SYNOPSIS
DIFFERENTIAL DIAGNOSIS
A—Hyperhidrosis
Common
Occasional
Rare
B—Hypohidrosis and Anhidrosis
Common
Occasional
Rare
INVESTIGATIONS—GENERAL
CBC
ESR
TFTs
Blood Glucose
Urea, Electrolytes
Purified Protein Derivative (PPD)
HIV
CXR
INVESTIGATIONS—SPECIFIC
Blood Culture
Iodine Starch Test
Urinary Catecholamines
Urinary 5-Hydroxyindoleacetic Acid (5-HIAA)
Biopsy
Sudomotor Testing9
CLINICAL NOTES
RED FLAGS
SELECTIVE GLOSSARY
CHAPTER 39:
Swelling of the Legs
SYNOPSIS
DIFFERENTIAL DIAGNOSIS
Common
Occasional
Rare
INVESTIGATIONS—GENERAL
CBC
Urinalysis
Serum Protein (Total)
Lipid Profile3
LFT
TFTs
ECG
INVESTIGATIONS—SPECIFIC
Duplex US (Compression US) with Doppler
D-dimer Test
Brain Natriuretic Peptide (BNP)
Magnetic Resonance Venography § (MRV)
US/CT Abdomen/Pelvis
Echocardiogram
Serology for Hypercoagulability State9
Biopsy
CLINICAL NOTES
RED FLAGS
SELECTIVE GLOSSARY
CHAPTER 40:
Syncope
SYNOPSIS
DIFFERENTIAL DIAGNOSIS
Common
Occasional
Rare
INVESTIGATIONS—GENERAL
ECG
Blood Glucose
CBC
Urea, Creatinine, Electrolytes
INVESTIGATIONS—SPECIFIC
CXR
Cardiac Enzymes
Stress ECG
Echocardiography
Holter Monitor
Carotid Doppler US
CT/MRI Brain
Head-up Tilt-Testing
Electrophysiology Study (EPS)
Implantable Loop Recorder (ILR)
Electroencephalography (EEG)
Psychiatric Evaluation
CLINICAL NOTES
RED FLAGS
SELECTIVE GLOSSARY
CHAPTER 41:
Tingling and Numbness
SYNOPSIS
DIFFERENTIAL DIAGNOSIS
Common
Occasional
Rare
INVESTIGATIONS─GENERAL
CBC
ESR
Blood Glucose, Urea, Creatinine, Electrolytes
CXR
X-ray
INVESTIGATIONS─SPECIFIC
TSH
Rheumatology Screen
Angiotensin-converting Enzyme Level
Urine for Porphobilinogen
Nerve Conduction Study (NCS)
CT/MRI
Nerve Biopsy
Lyme Titer
HIV
Serum B12 and Folate Levels
CSF Analysis
Serum Protein Electrophoresis and Immuno-fixation
Toxic Screen
Genetic Test
CLINICAL NOTES
RED FLAGS
CHAPTER 42:
Tinnitus
SYNOPSIS
DIFFERENTIAL DIAGNOSIS
Common
Otologic
Nonotologic
Physiological
Occasional
Rare
INVESTIGATIONS—GENERAL
CBC, ESR
FBG, PPBG
Audiogram
Tympanogram
INVESTIGATIONS—SPECIFIC
Biochemistry
TFTs
CT Scan
MRI Scan
MRI Cerebral Angiography
X-ray
CSF
Brainstem Evoked Potentials
CLINICAL NOTES
RED FLAGS
SELECTIVE GLOSSARY
CHAPTER 43:
Tiredness
SYNOPSIS
DIFFERENTIAL DIAGNOSIS
Common
Occasional
Rare
INVESTIGATIONS—GENERAL
CBC
ESR
Blood Glucose
LFTs
Urea, Electrolytes and Creatinine
TFTs
Pregnancy Test
INVESTIGATIONS—SPECIFIC
CXR
Chronic Infection Screening
HIV and VDRL Serology
RF and ANA
Plasma Cortisol (8 AM-10 AM Specimen)
Muscle Enzymes CK, CK-MB
Tensilon (Edrophonium) Test
EMG
Muscle / Tissue Biopsy
Bone Marrow Biopsy/Aspirate
MRI Brain
Polysomnography (Sleep Study)
Cancer Screening
CLINICAL NOTES
RED FLAGS
SELECTIVE GLOSSARY
CHAPTER 44:
Urinary Frequency
SYNOPSIS
DIFFERENTIAL DIAGNOSIS
Common
Occasional
Rare
INVESTIGATIONS—GENERAL
Urinalysis
Quantitative Culture for Bacteriuria
Suprapubic Aspiration/ Catheterization
CBC
Blood Glucose
Urea, Creatinine
Electrolytes
Pregnancy Test
INVESTIGATIONS—SPECIFIC
Urine Culture
US of Kidneys, Ureter, and Bladder (KUB)
CT Scan of KUB
Intravenous pyelography (IVP) or Intravenous Urography (IVU)***
MRI Brain/Spine
Cystoscopy
CLINICAL NOTES
RED FLAGS
SELECTIVE GLOSSARY
CHAPTER 45:
Urticaria and Angioedema
SYNOPSIS
DIFFERENTIAL DIAGNOSIS
Occasional
Rare
INVESTIGATIONS—GENERAL
CBC
ESR
Urinalysis
Stools
INVESTIGATIONS—SPECIFIC
Challenge Testing for Physical Urticaria
Throat and Urine Culture
Multichemistry Screening Panel
TFTs
Serology
Skin Prick Test or Patch Test
Serum Immunoglobulin Analysis
Autologous Serum Skin Test (ASST)6
Serum Complement1
Cold Agglutinins and Cryoproteins
ANA
Skin Biopsy
CLINICAL NOTES
RED FLAGS
SELECTIVE GLOSSARY
CHAPTER 46:
Vaginal Bleeding— Abnormal
SYNOPSIS
DIFFERENTIAL DIAGNOSIS
Common
Occasional
Rare
INVESTIGATIONS—GENERAL
Pregnancy Test
CBC
Coagulation Profile
Blood Sugar
Pap Smear
Cervical Culture
Thyroid Function Test
INVESTIGATIONS—SPECIFIC
Pelvic US
Transvaginal Ultrasound (TVUS)
Saline Infusion Sonography (SIS): Conventional and 3D-SIS
Hysteroscopy
Coagulation Profile
Serum Progesterone
LH, FSH
Prolactin (PRL)
Serum Testosterone, Free Testosterone, 17-Hydroxyprogesterone
Urinary Gonadotropins
Abdominal CT Scan
MRI of Pituitary
Endometrial Biopsy (EMB)
CLINICAL NOTES
Pelvic Examination
Digital Rectal Examination (DRE) and Proctoscopy
RED FLAGS
CHAPTER 47:
Vertigo
SYNOPSIS
DIFFERENTIAL DIAGNOSIS
Common
Occasional
Rare
INVESTIGATIONS—GENERAL
CBC
ESR
INVESTIGATIONS—SPECIFIC
Audiometry
CT Head
MRI and Angiography
Brainstem Evoked Response (BSER)
Carotid Doppler Ultrasound
ECG/Holter Monitor
EEG
X-ray Cervical Spine
CLINICAL NOTES
RED FLAGS
SELECTIVE GLOSSARY
CHAPTER 48:
Vision Loss—Gradual
SYNOPSIS
DIFFERENTIAL DIAGNOSIS (TABLE 48.1)
Common*
Occasional
Rare
INVESTIGATIONS—GENERAL
CBC
ESR
Blood Glucose/HbA1C
Lipid Profile
Coagulation Screen
TFTs
IOP (Tonometry)
Visual Field (Perimetry)
INVESTIGATIONS—SPECIFIC
Fluorescein Angiography
US of Eye and Orbits
CT Scan Skull, Orbits/MRI Brain
Carotid Doppler Scan
Echocardiogram
Visual Evoked respons (VER)
Temporal Artery Biopsy
CLINICAL NOTES
Fluorescein Angiography
RED FLAGS
CHAPTER 49:
Vission Loss—Sudden
SYNOPSIS
DIFFERENTIAL DIAGNOSIS
Common
Occasional
RARE
INVESTIGATIONS—GENERAL AND SPECIFIC
CLINICAL NOTES
RED FLAGS
SELECTIVE GLOSSARY
CHAPTER 50:
Weakness in the Arms and Legs
SYNOPSIS
DIFFERENT DIAGNOSIS
Common
Occasional
Rare
INVESTIGATIONS–GENERAL
CBC
ESR
Blood Glucose
Thyroid Function Tests
CT Scan Brain
X-ray Skull, Cervical and Lumbosacral Spine
CXR
INVESTIGATIONS–SPECIFIC
Creatine Kinase (Total)–(CK)
Serum Acetylcholine Receptor Antibody Titer
ANA
Tensilon (Edrophonium chloride) Test
Urine
CT–Thorax
MRI–Cervical and Lumbosacral Spine
Magnetic Resonance Angiography (MRA)
US (Duplex Scanning) of Carotid and Vertebral Arteries in the Neck
CSF Analysis
Nerve Conduction Study (NCS)
Electromyography (EMG)
Muscle Biopsy
CLINICAL NOTES
RED FLAGS
CHAPTER 51:
Weight Loss
SYNOPSIS
DIFFERENTIAL DIAGNOSIS
Common
Occasional
Rare
INVESTIGATIONS—GENERAL
CBC
ESR
Urinalysis
Blood Glucose
HIV
Urea, Creatinine, Electrolytes
Tuberculin or PPD Test
LFTs
TFTs
Serum Calcium
CXR
Stool
INVESTIGATIONS—SPECIFIC
US abdomen/ Pelvis
Endoscopy
CT / MRI Abdomen
Fecal Fat
Antigliadin Antibodies
Other Screening Procedures
CLINICAL NOTES
RED FLAGS
SELECTIVE GLOSSARY
REFERENCES
NOTE
INDEX
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