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MW Secret Files/DC 3 Investigation.Pdf Dr. Warwick Carter DOCTOR’S COMPANION Section Three - Investigation SECTION THREE INVESTIGATION The Pathology Tests and Clinical Signs that will Confirm a Diagnosis and the Differential Diagnoses of Diseases © Warwick Carter Investigation - 1 DOCTOR’S COMPANION Section Three - Investigation FORMAT Suspect Diagnosis [Abbreviation] (Alternate Name) Test: The pathology tests (biochemistry, haematology, cytology and bacteriology) that should be considered when a history and examination indicate that this is a probable diagnosis. The result that may be expected with this diagnosis is shown in (brackets) after each test. Physiological, electrophysiological (eg: ECG) and radiological tests are not always included. See Pathology section four for the explanation and interpretation of these tests Sign: Signs (not symptoms), methods of examination and clinical findings that may be useful in the diagnosis of, or may be found in association with, this disease or syndrome. See Symptoms section two for the explanation and interpretation of these signs DD: Differential diagnoses. Other diseases with which this diagnosis may be confused Phys: The basic physiology of the disease, to enable the reason for abnormal pathology tests or signs to be better understood See also Other Entries or Sections of Significance Abbreviation See Suspect Diagnosis Alternate Name See Suspect Diagnosis PLEASE NOTE See Section 2 for explanation and interpretation of Signs. See Section 4 for explanation and interpretation of Tests. Investigation - 2 DOCTOR’S COMPANION Section Three - Investigation INVESTIGATIONS Abortion, Recurrent (Miscarriage, Recurrent) Test: Any abnormal result in the following tests may indicate a possible cause: S.ANA, S.anti-DNA antibodies, S. ENA, cardiolipin antibodies, factor V Leiden antibodies, B.LE cells, S.LH, parental karyotype, TFT, GTT, vaginal swab M/C/S, hysterosalpingogram See also Symptoms section one: Abortion, Recurrent Abscess Test: Choose antibiotic or antifungal on result of pus M/C/S or abscess wall biopsy & culture. Other tests to be considered include FBC, ESR, CRP, amoebic antibodies Sign: Fluctuant mass DD: Bacterial, fungal, helminthic or amoebic causes; cyst, hernia Achilles Tendon Rupture Sign: Calf squeeze test DD: Tendon avulsion, sprain Acquired Immune Deficiency Syndrome [AIDS] Test: Group I (acute infection) S.HIV-3 (HTLV-3) antibodies (+), S.p24 antigen (+), S.p24 antibody (–), Hb (N), ESR (H or N), B.lymphocytes (H), B.neutrophils (N), platelets (N), S.immunoglobulins (N), S.complement (N or H) Group II (asymptomatic) S.HIV-3 (HTLV-3) antibodies (+), S.p24 antigen (–), S.p24 antibody (+), Hb (N), ESR (N), B.lymphocytes (N), B.neutrophils (N), platelets (N), S.immunoglobulins (H), S.complement (H) Group III (persistent generalised lymphadenopathy) S.HIV-3 (HTLV-3) antibodies (+), S.p24 antigen (–), S.p24 antibody (+), Hb (N), ESR (N), B.lymphocytes (N), B.neutrophils (N), platelets (N), S.immunoglobulins (H), S.complement (H) Group IV (AIDS related complex) S.HIV-3 (HTLV-3) antibodies (+), S.p24 antigen (+), S.p24 antibody (+), lymphocyte CD4 (L), Hb (L), ESR (H), B.lymphocytes (L), B.neutrophils (L), platelets (L), S.immunoglobulins (H), S.complement (H) Group V (AIDS) Investigation - 3 DOCTOR’S COMPANION Section Three - Investigation S.HIV-3 (HTLV-3) antibodies (+), S.p24 antigen (+), S.p24 antibody (–), lymphocyte CD4 (L), Hb (VL), ESR (VH), B.lymphocytes (VL), B.neutrophils (VL), platelets (VL), S.immunoglobulins (H), S.complement (VH) Sign: Fever, skin nodules, adenitis, splenomegaly, oral candidiasis, hairy leucoplakia, sarcomas, absent reflexes DD: Idiopathic lymphadenopathy syn., viraemia, fungaemia, metastatic carcinoma, other causes of reduced immunity (see separateentry) Phys: Caused by human immunodeficiency virus (HIV). Transmitted by blood and semen. Occurs mainly in homosexuals, IV drug users and blood product recipients. Eventual mortality close to 100% but may be kept in early stages for prolonged period by appropriate medication Acromegaly Test: S.growth hormone (H, remains H with GTT), S.IGF-1 (H), thyrotrophin releasing hormone test (AB), GTT (H), S.phosphorus (H or N) DD: Gigantism, hypothyroidism, phenytoin therapy Phys: Due to excessive secretion of growth hormone by an adenoma of the pituitary Actinomycosis (Lumpy Jaw) Test: Pus culture (+ for A. israeli ), lesion biopsy (+), sputum culture (+ or N), pus microscopy (`sulfur granules' seen), ESR (H), WCC (H), Hb (L) Sign: Hepatomegaly, cachexia (abdominal) DD: Cellulitis, bacterial abscess, TB, malignancies Phys: Due to infection of jaw (often via decayed teeth) or other areas by Actinomycoses israeli, which is an anaerobic bacterium Acute Leukaemia See Leukaemia, Acute Addiction See Alcoholism; Narcotic Addiction Addison's Disease (Chronic Hypoadrenocorticism) Test: P.cortisol (fails to increase after IM or IV ACTH - synacthen test), S.ACTH (H), S. aldosterone (L), S.sodium (L), S.potassium (H), S.adrenal cell Investigation - 4 DOCTOR’S COMPANION Section Three - Investigation antibodies (+), S.HLA-DR3 (+), BUN (H), B.neutrophils (L), B.lymphocytes (H), haematocrit (H), B.glucose (L) Sign: Cachexia, hypotension, nail discolouration, pigmentation, Rogoff's sign, alopecia (groin and axilla), Thorn's sign DD: Haemochromatosis, porphyria, thyrotoxicosis, anorexia nervosa, malnutrition, malignancy, renal disease, malabsorption, anaemia, postural hypotension, anxiety, stress, hepatic cirrhosis, sprue, myasthenia gravis, polyglandular autoimmune syndrome Phys: A deficiency in cortisol and/or aldosterone production by the adrenal cortex Adenitis (Swollen and Inflamed Lymph Nodes) Test: WCC(AB), ESR (H), specific viral serology (N or AB), chest x-ray (N or AB), ultrasound scan (AB), lymph node biopsy (AB) DD: Viral, bacterial or fungal disease of affected region, infectious mononucleosis, carcinoma, leukaemia, brucellosis, toxoplasmosis, encephalitis, otitis, conjunctivitis, pharyngitis, measles, mumps, rubella, hepatitis, sarcoidosis, STDs, TB, Hodgkin's disease, reaction to foreign body, cytomegalovirus infection, allergic reaction, mesenteric adenitis, sialadenitis Phys: Lymph nodes in many areas of the body may become enlarged and inflamed from a vast range of illnesses that may affect anatomical areas significantly removed from the swollen nodes Adrenal Hyperplasia See Cushing Syndrome Adrenal Insufficiency See Addison’s Disease AIDS See Acquired Immune Deficiency Syndrome Alcoholism Test: S.ethanol (H or N), S.ALT (<300u/L), AST:ALT ratio (>2), S.GGT (H), B. carbohydrate-deficient transferrin (H), S.glucose (L), U.glucose (+), , MCV (H, N after alcohol ceased for one month), S.platelets (L, N after alcohol ceased for 0ne month), prothrombin time (N or H), S.AST (H), S.urate (H), S.triglycerides (H) Investigation - 5 DOCTOR’S COMPANION Section Three - Investigation Sign: Nystagmus, postural tremor, biceps jerk and other reflexes DD: Drug intoxication or overdose, cerebral injury, CVA, diabetic coma, psychiatric disorders Phys: Habitual excessive alcohol intake causes liver damage and inability to mobilise glucose from storage Aldosteronism See Conn Syndrome Alkaptonuria Test: U.Homogentisic acid (+), Sign: Urine that darkens on standing DD: Rheumatoid arthritis, ankylosing spondylitis, other causes of pigmented skin (see Section one: Pigmentation of Skin, Excess) Phys: Rare inherited disorder of tyrosine metabolism causing arthritis and pigmentation Allergic Rhinitis (Hay Fever) Test: RAST test for specific allergen Igs (+), nasal mucus microscopy (eosinophils present), skin tests for common allergens (+), B.eosinophils (H), S.IgE (H) DD: Polycythaemia rubra vera, coryza, vasomotor rhinitis, noxious fumes, viral and bacterial infections Phys: Wind borne pollens contacting the nasal mucosa release proteins that act as allergens, causing the release of histamine and hypersecretion by the nasal mucosa of thin watery mucus Allergy Test: RAST (+), S.IgE (H), intradermal skin test (+), S.tryptase (H in anaphylaxis), S.Complement (H in anaphylaxis) Sign: Dermographia, geographic tongue Phys: Allergy reactions may present in any major system depending on allergen and site of entry. Clinical diagnosis is more important than tests. Diseases with an allergic component include asthma, bronchitis, coryza, colitis, dermatitis, eczema, hay fever, cluster headaches, migraine, diarrhoea Investigation - 6 DOCTOR’S COMPANION Section Three - Investigation Alopecia Test: Following tests to screen for a cause of alopecia should be considered : B.Cold agglutinins, B.iron studies, B.thyroid function tests, S.ENA, S.ANA, skin scraping fungal MCS. Phys: Many different medical and psychological conditions may be responsible. Alveolitis See Cryptogenic Fibrosing Alveolitis Alzheimer’s Disease Test: No specific diagnostic test. Tests to exclude other causes of dementia (eg. hypothyroidism) should be performed DD: Cerebrovascular insufficiency, depression, Parkinson’s disease, alcoholism, mental retardation, encephalopathy, Creutzfeldt-Jakob disease, hydrocephalus, social isolation, medications (eg. sedatives) Phys: Clinical diagnostic criteria are:- • Multiple cognitive deficits manifested by both - memory impairment - one or more of aphasia, apraxia, agnosia, or failure of planning or organising • Other causes of dementia excluded • Gradual onset and continuing decline • Decline from previous level of social function Amenorrhoea, Secondary Test: B.HCG, S.FSH, S.prolactin, S.progesterone, P.oestradiol, S.LH, TFT, x-ray of sella turcica. For interpretation, see
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