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DifferentialDiagnosisInPrimaryCare 4thEdition

DifferentialDiagnosisInPrimaryCare 4thEdition

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Published by ahmad alsanousy

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Published by: ahmad alsanousy on Aug 08, 2009
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10/01/2012

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Authors:Collins,R.DouglasTitle:
DifferentialDiagnosisinPrimaryCare,4thEdition
Copyright©2008LippincottWilliams&Wilkins
>TableofContents>P>PalloroftheFace,Nails,orConjunctiva
PalloroftheFace,Nails,orConjunctiva
Pallorisalmostinvariablycausedbyanemiaandisbestanalyzedwiththeapplicationof
pathophysiology.
Anemiamaybecausedbydecreasedproductionofblood,increaseddestructionofblood,orlossofblood.
Decreasedproduction
resultsfrompoornutritionparticularly,poorabsorptionorintakeofB
12
(perniciousanemia),iron(irondeficiencyanemia),andfolicacid(malabsorptionsyndrome).Itmayalsoresultfromsuppressedbonemarrow(aplasticanemia)orinfiltratedbonemarrow(leukemiaormetastaticcarcinoma).
Increaseddestruction
iscausedbyhemolysisfromintrinsicdefectsintheredcells(e.g.,sicklecellanemiaandthalassemia)orextrinsicdefectsinthecirculation(autoimmunehemolyticanemiaofmanydisorders).
Bloodloss
mayresultfrompepticulcersandcarcinomasofthegastrointestinal(GI)tract,excessivemenstruationormetrorrhagiafromtumorsof theuterus,ordysfunctionaluterinebleeding.Thesearetheprincipalcausesofanemia,butthereaderwillbeabletothinkoseveralmore.Whatisimportanthereistohaveasystematicmethodtorecallthem.Ifanemiaisruledout,thelessfrequentcausesofpallorshouldbeconsidered.Shock,congestiveheartfailure(CHF),andarteriosclerosiscausepallorbypoorcirculationofbloodtotheskin.Patientswhohavehypertensionmaybepalefromreflexvasomotorspasmsofthearteriolessupplyingtheskin.Aorticregurgitationandstenosis,aswellasmitralstenosis,causepallorforthesamereasons,butthemalarflushofmitralstenosismaynegatethis.Thereasonthattuberculosis,rheumatoidarthritis,carcinomatosis,andglomerulonephritiscausepallorevenwhentheirvictimsarenotanemicorhypertensiveisnotknown.
ApproachtotheDiagnosis
ABCAmberCHMConverterTrialversion,http://www.processtext.com/abcchm.html
 
Theapproachtothediagnosisofpallorisobviouslytocheckforanemiafirst;thentoexaminefortheotherchronicdisorders.Chestx-ray,electrocardiogram(ECG),sedimentationrate,andacheckforrheumatoidfactorareallappropriateinspecificcases.
OtherUsefulTests
Completebloodcount(CBC)(anemia)Sedimentationrate(chronicinfection)Chemistrypanel(anemiaofliverandkidneydisease)SerumB
12
level(perniciousanemia)Serumfolicacidlevel(folicaciddeficiency)Serumironandferritinlevels(irondeficiencyanemia)Stoolforoccultblood(GIbleeding)Stoolforovaandparasites(anemiaduetoparasiteinfestation)Serumhaptoglobins(hemolyticanemia)Antinuclearantibody(ANA)analysis(collagendisease)Bonemarrowexamination(aplasticanemia)
ABCAmberCHMConverterTrialversion,http://www.processtext.com/abcchm.html
 
Authors:Collins,R.DouglasTitle:
DifferentialDiagnosisinPrimaryCare,4thEdition
Copyright©2008LippincottWilliams&Wilkins
>TableofContents>P>Palpitations
Palpitations
Becauseanxietyisthecommoncauseofpalpitations,thereisatremendoustemptationtojumptothisconclusionasthecauseinanotherwisehealthy-lookingindividual.Ifweusethemnemonic
VINDICATE
,wemayavoidamisdiagnosisinmanycases.
V—Vascular
causeshelptorecallaorticaneurysms,arteriovenousfistulas,anemia,posturalhypotension,migraine,andcardiacdisorderssuchasaorticregurgitation,aorticstenosis,tricuspidinsufficiency,CHF,andvariousarrhythmias(seepage77).
I—Inflammation
remindsusoffever,pericarditis,subacutebacterialendocarditis(SBE),andrheumaticfever.
N—Neoplasms
arenotusuallyassociatedwithpalpitations.
D—Deficiency
ofthiaminecanleadtoberiberiheartdiseaseresultinginpalpitations.
I—Intoxication
promptsustorecallthatalcohol,tobacco,coffee,softdrinks,andteacancausepalpitations.Itshouldalsoremindusthatpalpitationsarecommonsideeffectsofmanydrugs,includingdigitalis,aminophylline,sympathomimetics,ganglionicblockingagents,nitrates,andotherdrugs.
C—Congenital
disordersthatmaycausepalpitationsincludepatentductus,ventricularseptaldefect,andhiatalhernia.
A—Anxiety
isacommoncauseofpalpitations.
T—Trauma
causespalpitationsbyinducingthereleaseofepinephrine,butthereisnodiagnosticdilemmainthesecases.
E—Endocrine
disordersthatcausepalpitationsincludethyrotoxicosis,pheochromocytoma,menopausal
ABCAmberCHMConverterTrialversion,http://www.processtext.com/abcchm.html

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