Differential Diagnosis: A guide to symptoms and signs of common diseases and disorders, presented in systematic form

298 Pages·1981·4.62 MB·English

by  Alexander D. G. Gunn MRCGP

Differential
Diagnosis
Differential
Diagnosis
A guide to symptoms and signs of
common diseases and disorders,
presented in systematic form
Alexander D. G. Gunn
MRCOP, DObstRCOO, DPH
Director, University Health Services
University of Reading
United Kingdom
MTaUMITED
International Medical Publishers
Published by
MTP Press Limited
Falcon House
Lancaster, England
Copyright © 1981 A. D. G. Gunn
Softcover reprint of the hardcover 1st edition 1981
First published 1981
All rights reserved. No part of this publication
may be reproduced, stored in a retrieval system,
or transmitted in any form or by any means,
electronic, mechanical, photocopying, recording
or otherwise, without prior permission from the
publishers
British Library Cataloguing in Publication Data
Gunn, Alexander
Differential diagnosis
I. Diagnosis, Differential
I. Title
616.07'5 RC71.5
ISBN-13: 978-94-009-8062-4 e-ISBN -13: 978-94-009-8060-0
DOl: 10.1007/978-94-009-8060-0
Contents
Foreword 7
1 Introduction - how to use this book for reference 9
2 The medical history 13
3 The cardiovascular system 17
4 The respiratory system 37
5 The gastrointestinal system 59
6 The digestive system (liver, biliary tract and
pancreas) 93
7 The urinary system 117
8 The central and peripheral nervous system 137
9 The skeletal system 171
10 The skin 185
11 The endocrine-hormonal system 195
12 The nutritional system and acid-base balance 215
13 The blood and lymphatic system 241
14 The psychological system 265
15 The common infections 281
Index 295
5
List of Differential Diagnosis Tables
Central chest pain 34
m
~~
Difficulty in breathing: dyspnoea 52
Chest pain on breathing 54
Vomiting due to gastrointestinal disorders 84
Diarrhoea - 1 86
Diarrhoea - 2 88
Abdominal pain due to gastrointestinal disorders 108
Ascites due to hepatic diseases 112
Pain on urination 128
Haematuria 130
Oliguria and anuria 134
Loss of consciousness 166
Joint pains 180
Skin rashes 190
Specific endocrine problems 212
Vitamin deficiency 236
Electrolyte and acid-base disturbance 238
Anaemia 260
Anxiety and depression 276
Common infections 290
6
Foreword
This book is designed for use by medical students, nurses,
young practitioners, internists, family physicians and all those
initially involved with the problem of diagnostics. It is struc
tured to provide a concise logical approach to the diagnosis of
common illness and disorders in adults. The elucidation of an
illness cause is not easy for the inexperienced. Although text
books and guidance notes can be referred to for clarification of
assembled thought - once a medical history has been taken - a
system-orientated reference guide has considerable value for
aiding and checking the logic of diagnosis.
It is hoped that this book will fulfil that purpose. It could not
have been written without the help of R. G. Brackenridge's
Essential Medicine (1979, MTP, Lancaster, England), and
J. Fry's Common Diseases (1979, MTP, Lancaster, England),
to which the reader is referred and to which generous acknow
ledgement is made. The tables of Differential Diagnosis that
follow Chapters 3-7 are adapted from some that have
appeared in Handbook of Differential Diagnosis, vols 1-3,
published by Rocom Press, Hoffman La Roche Inc., New
Jersey, 1968-1974 - an invaluable publication now unfortun
ately out of print, and permission to do so is gratefully apprec-
7
8 DIFFERENTIAL DIAGNOSIS
iated. Finally without the stimulus and encouragement of
Mr David Bloomer (MTP) and the particular assistance of
Mrs J. C. Robinson, this book would never have been written.
ALEXANDER D. G. GUNN
Reading, Berks, UK
1981
Chapter 1
Introduction - How to Use
this Book for Reference
A guide to differential diagnosis, unless it ran to several
volumes, could never encompass all aspects of every known
form of disorder or disease. The common disorders and ill
nesses, however, wherever they are met, share the specific
characteristics of common symptoms and signs that can be
elicited in taking the patient's history and in the physical
examination that follows. In general an illness will affect one
or other of the patient's major physical systems and this book
provides reference systematically to the common disorders and
illnesses - by listing the symptoms and signs and describing the
routine diagnostic investigations. As a revision course in
preparing for examinations, the major differential aspects of
diagnoses are listed in the text and tabled at the end of the
relevant chapters. As a guide to the key laboratory investig
ations in diagnosis, the chapters and the tables detail the
routines that would apply in confirming the suspicion formed
by examination of the patient. No book, however, will ever
replace the wisdom gained by experience in the practice of
medicine and all practitioners will need to constantly update
their knowledge of medical science by continued reading of the
9
10 DIFFERENTIAL DIAGNOSIS
relevant literature. This book, therefore, is a guide, logically
presenting information about illness and disorder that enables
the doctors or students of medicine and nursing newly in
practice to check and constantly improve their diagnostic
ability.
When a patient's history has been taken, the first step in the
clinical reasoning process is to decide which of the findings
that have been elicited are relevant to the discovery of the
possible disease. The initial symptoms are those which are
presented by way of verbal communication; other symptoms
are elicited and the signs of disorder are detected by the
physical examination - but this has to be done in a routine
manner in order to ask the specific cross-checking questions.
Differential diagnosis is essentially a process of logical thought
- not dissimilar from a mental flow chart as written for
computer programming. Focusing on a system disorder
enables the clinician to consider all the likely possible causes
and to reflect on the necessary laboratory tests for ultimate
confirmation. Sixty per cent of the diagnosis is made at the
history-taking stage in the experienced - since the practice of
medicine is essentially that of problem analysis. The patient
presents with the problem, the clinician has to know, or define,
its common causes, be aware of its more probable cause in that
specific patient, and to ascertain through examination and
laboratory testing the specific cause for that particular patient
- in order to provide any form of therapeutic advice or
management. It is a process of systematically testing hypo
theses.
The first hypothesis, therefore, is the patient claiming that
there is a system disorder. Each chapter of this book opens
with a brief survey of the frequency of such system illnesses
and their broadest epidemiological pattern. The diagnoses of
common disorders, however, depend on certain particular
types or forms of clinical investigation - be it blood test, urine
examination, X-ray etc., and these are listed to act as an aide
memoire for the clinician. The common relevant symptoms are
then listed, to be followed by further discussion of the appro
priate tests. Thus, before reaching the text detailing the
disorders themselves, the reader is primed with the basis of
problem-solving knowledge. The common disorders and
INTRODUCTION 11
diseases are then described and detailed, with causes and the
specific symptoms and signs listed. Recommendations with
regard to further investigations are made where appropriate.
The pattern of the text, therefore, is that of initial broad
consideration of the diseases, epidemiologically, followed by
clinical and diagnostic detail.