Essential Lists of Differential Diagnoses for MRCP

with Diagnostic Hints

Fazal-I-Akbar Danish

• Publisher: CRC Press
• Year: 2017
• eBook ISBN: 9781315346472
• Edition: 1
• Topic: Medicine
• Subtopic: Medical Theory, Practice & Reference

Differential diagnosis texts for the MRCP can overload candidates with detailed information, making revision seem difficult and overwhelming. In contrast, this book avoids exhaustive lists of often rare causes and concentrates instead on a maximum of five of the most common causes in terms of prevalence for each scenario, making revision more structured and manageable. The book includes diagnostic hints - clinical or lab clues that point towards a specific diagnosis - and a unique chapter on key ECG causes and features. Although primarily intended for MRCP Part I & II and FCPS (Pakistan) Part II candidates, this book will also be useful for undergraduate students preparing for finals.

1 General physical examination

Thin, wasted, cachectic:

• 1 Low calorie intake (d/t anorexia nervosa; alcoholism; drug abuse; prolonged systemic illness, e.g. COPD).
• 2 Tuberculosis.
• 3 Malignancy.
• 4 Thyrotoxicosis.
• 5 AIDS.

Fingernail abnormalities:

• 1 Clubbing. Acute/chronic paronychia.
• 2 Nail fold infarcts (d/t vasculitis).
• 3 Lines (Beau’s; longitudinal; Muehrcke’s; Mee’s; Terry’s).
• 4 Splinter haemorrhages.
• 5 Yellow nails.
• 6 Nail pitting.
• 7 Koilonychia.
• 8 Onycholysis.
• 9 Onychomadesis (shedding of nail).

Clubbing:

• 1 Respiratory disease (malignancy; infection [lung abscess, empyema]; bronchiectasis; fibrosing alveolitis).
• 2 Cardiac disease (congenital cyanotic heart disease [Fallot’s tetralogy, transposition of the great arteries]; acyanotic heart disease, i.e. PDA with ‘reversal of shunt’ [clubbing only in the toes]; infective endocarditis).
• 3 Subclavian artery aneurysm (clubbing is unilateral).
• 4 GIT disease (cirrhosis; PBC; IBD; malabsorption – coeliac disease, Whipple’s disease).

Cyanosis (non-oxygenated Hb >5 g/dL):

• 1 Peripheral cyanosis:¹
  • a Shock (hypovolaemic; cardiogenic; septic d/t gram-negative organisms usually).
  • b Cold weather (Raynaud’s phenomenon).
  • c Arterial/venous occlusion (d/t atheroma or small-vessel disease in diabetes).
• 2 Central cyanosis:²
  • a Respiratory failure.
  • b Congenital heart disease (Fallot’s tetralogy; transposition of the great arteries; PDA with reversal of shunt/Eisenmenger’s syndrome [→ differential cyanosis]; tricuspid atresia; Ebstein’s anomaly; pulmonary AV fistula).
  • c Haemoglobin abnormalities:
    • i Methaemoglobinaemia (congenital; acquired – drugs like nitrates and sulfonamides).
    • ii Sulphaemoglobinaemia (drugs like nitrates and sulfonamides).
    • iii Hb M disease.
    • iv NADH diaphorase.

Signs of dehydration:

• 1 ↓ skin elasticity.
• 2 Rapid, low-volume (thready) pulse.
• 3 ↓ BP (postural or persistent hypotension).
• 4 Sunken eyes.
• 5 Dry tongue.
• 6 ↓ urine output.

Koilonychia:

• 1 Iron-deficiency anaemia.
• 2 Rarely d/t IHD/syphilis.

Onycholysis:

• 1 Psoriasis.
• 2 Hyperthyroidism.

Beau’s lines (transverse furrows):

• 1 Any severe illness.

Onychomadesis (shedding of nail):

• 1 Any severe illness.

Longitudinal lines:

• 1 Lichen planus.
• 2 Alopecia areata.
• 3 Darier’s disease.

Muehrcke’s lines (white-coloured paired parallel transverse bands):

• 1 Hypoalbuminaemia.

Mee’s lines (single, white transverse band):

• 1 Organ failure (heart/renal).
• 2 Hodgkin’s lymphoma.
• 3 Arsenic poisoning.

Nail pitting:

• 1 Psoriasis.
• 2 Alopecia areata.

Yellow nails:

• 1 Bronchiectasis.
• 2 Hypoalbuminaemia.
• 3 Lymphoedema.

Terry’s nails (nail tips having dark pink or brown bands):

• 1 Old age (>75 yr).
• 2 CCF.
• 3 Cirrhosis of liver.
• 4 DM.
• 5 Malignancy.

Nail fold infarcts (d/t vasculitis) – dark blue-black areas in the nail folds:

• 1 SLE.
• 2 Subacute bacterial endocarditis (Osler’s nodes).

Hand ...

Table of contents

• Cover
• Title Page
• Copyright Page
• Table of Contents
• Preface
• Contributors
• About the author
• 1 General physical examination
• 2 Cardiology
• 3 ECG
• 4 Pulmonology
• 5 Gastroenterology and hepatology
• 6 Neurology
• 7 Haematology
• 8 Nephrology
• 9 Endocrinology
• 10 Infectious diseases
• 11 Clinical pharmacology
• 12 Rheumatology
• 13 Dermatology
• 14 Ophthalmology
• 15 Psychiatry
• 16 Ear, nose and throat (ENT)
• 17 Obstetrics and gynaecology
• 18 Paediatrics
• 19 Procedures
• 20 Miscellaneous
• Acronyms
• Index