Dr.

Ahmados

Differential diagnosis of most common symptoms

Chest
Dyspnea

Airways

Laryngeal tumour
Foreign body
Asthma
COPD
Bronchiectasis
Lung cancer
Acute Bronchitis.(V-B)
Cystic fibrosis
Pulmonary fibrosis
Alveolitis

Others causes:
Anaemia, Metabolic acidosis ,
Obesity, Psychogenic

Chronic dyspnea :
1- Asthma precipitated by
allergens.
2- COPD
3- Pulmonary fibrosis
4- Pulmonary hypertension
5- LVF

Acute dyspnea :
with wheeze + cough :
1Exacerbation
of Asthma
2Exacerbation
of COPD
3Acute
bronchitis

4-

Parenchyma

Cardio

Pulmonary
circulation

Pleural

Pneumothorax
Pleural effusion
Diffuse Pleural fibrosis

Chest wall

Sarcoidosis
Neuromuscular
Tuberculosis
Pneumonia
Tumour (metastatic,
lymphangitis)

Acute LV

Pulmonary embolism
Pulmonary hypertension
Pulmonary vasculitis

Left ventricular failure

Mitral valve disease

Constrictive pericarditis
Pericardial effusion

Cardiomyopathy

Kyphoscoliosis
Ankylosing spondylitis

Causes of orthopnea :
Cardiac M.S. , LVF (left sided failure)
Chestsever asthmatic attack- emphysema
Abdomen tense ascites.

Myasthenia gravis
Neuropathies
Muscular dystrophies
Guillain-Barr syndrome

Causes of P.N.D :
1- Pulmonary edema due to LVF- CHF
2- Asthma .
3- Cardiac asthma .
4- COPD

Abdomen
1- Ascites escapes into Rt.lung
pleural effusion with dyspnea.
2- Tense Ascites
Cause mechanical orthopnea

failure.
5-

Pulmonary
embolism

6-

Pneumothora
x

7-

Inhaled body

Non central

Chest Pain
Acute chest pain:

Pleural (pleurisy)

Chest wall

1- Pneumothorax
2- Pulmonary infarction

Cardiac
1- Angina & MI
2- Dissecting aortic
aneurysm
3- Acute pericarditis

central

3- Infection:
- Pneumonia
- TB
- Bronchiectasis
- Lung abcess.
Chest
4- Malignancy:
1- Pneumothorax
- mesothelioma
2- Pulmonary embolism
- metastatic
3- Pleurisy
4- Oesophageal spasm
5- C.T. disease:
5- H. zoster
- R.arthritis
- SLE .

1- Malignancy:
- lung cancer
- mesothelioma
- bony metastases
2- Muscles:
- strains/tears
- Myositis
- Bornholm's disease
(Coxsackie B infection)
3- Ribs:
- costochondritis(Tietze's sy.)
- Periostitis
- Fracture .
4- Nerves:

1- Coronary HD :

angina

Myocardial infarction

Tracheal

Infection
Irritant dusts

Oesophageal

Oesophagitis
Oesophageal achalasia
Oesophageal spasm
Rupture

2- Pericardial disease:

Pericarditis

Pericardial effusion

Mediastinitis
Mediastinal emphysema.
Lymphadenopathy

3- Pulmonary embolism:

Massive Pulmonary mbolism

Pulmonary infarction
4- Aorta diseases:

Dissecting aneurysm of aorta

Aortic aneurysm

Mediastinal

Cardiac &
Great vessels

-Intercostal nerve compression

- herpes zoster

Referred Pain
- Gastritis & peptic ulcer
- Gall bladder disease
- Amebic liver abcess
- Subphernic abcess
- Peritonitis

- Cardiac neurosis.

5- Persistent cough/ dysp.

False haemoptysis : blood originating above level of vocal cords .

Hemoptysis
Hematological
causes :
1- Leukemia
2- Purpura
3- Anti-coagulation
4- Blood dyscrasias

Tumour:

Infection

Frank Haemptysis:
1- TB
2- Bronchogenic
Carcinoma
3- Bronchial
adenoma
4- Bronchiectasis

Vascular

1- bleeding from gum

2- Pharyngeal causes
3- Epistaxis, of blood is post. nares is inhaled & coughed up.
Bronchogenic carcinoma Vasculitis Wegener's granulomatosis
(Systemic dis.) Goodpasture's syndrome
Bronchial adnemoa
Acute bronchitis (main)
Bronchiectasis
Lung abscess
TB
Cystic fibrosis
Mycetoma
Pulmonary infarction
Arteriovenous malformation

Trauma

- Inhaled foreign body

- Chest trauma
- Iatrogenic:
bronchoscopic biopsy
transthoracic lung biopsy
bronchoscopic diathermy

LVF

Hematemesis

Frank :
M.S
Acute left ventricular
failure
Pulmonary infarction
-

Frothy blood tinged sputum :

- Acute pulmonary edema

Causes of upper GIT bleeding :

- Oesophagogastric varices
- Mallory-Weiss tear
- Gastric ulcer
- Duodenal ulcer
- Oesophagitis,gastritis, duodenitis
- Oesophageal or gastric cancer
- Profuse nose bleeds (false)
- Vascular malformation
N.B.
Bright red hematemsis occurs if :
1- Bleeding is massive.
2- Presence of hypochlorhydria

Pulmonary congestion
Pulmonary edema

sicca haemorrhagica.

Haematemesis is vomiting blood. The blood can be fresh

and red, or degraded by gastric pepsin, when it is dark in
colour and resembles 'coffee grounds'.

-Upper GIT bleeding results in melaena.

- Spurious melaena :
Ingestion of blood of epistaxis or haemoptysis.

Cough
Others :
1- Encephalitis &
meningitis
2- Hysterical

Acute
(<3 weeks)

with strido & horseness of voice )

asthma
Extrinsic
alveolitis
3-

Recurrent
pulmonary embolism
4Neurosis

5-

Mediastinal

Sydrome

6-

Chronic
(>8 weeks)

Whooping

cough.

Suppurative lung
diseases :
1- Bronchiectasis
2- Lung abcess

- Tracheitis ( brassy painful cough )

-Inhaled foreign body
-Inhaled irritants (dusts/fumes)
-GORD
-Asthma
-Post-viral bronchial hyperreactivity
-Rhinitis / sinusitis post nasal drip
-Cigarette smoking
-Drugs: ACE inhibitors
-Irritant dusts/fumes.

Causes of Paroxysmal dyspnea :

1- Pulmonary venous congestion
(with frothy sputum)
2- Pulmonary edema ( with frothy
pink sputum )

-Laryngitis (whooping, barking in character may

Bronchial

2-

Abnormal chest x-ray

- Pneumonia.
-Acute extrinsic allergic alveolitis.

throat)

Paroxysmal cough:
1-

Normal chest x-ray

-Acute episode of asthma.
- Viral infection
- Bacterial infection (acute bronchitis)
-Pharyngitis( expolsive , painful with sore

(Dry cough)
1- Subdiaphragmatic infection.
2- Vagal stimulation e.g.
gastroduodenal disease

3- Cardiac asthma. (with wheezy chest)

-Lung tumor.
-T.B
-Bronchiectasis.
-Interstitial lung disease.

The patients wakes up 1-2 hours after sleep with

marked dyspnea , cough, with frothy expectoration.

Cough of suppurative lung diseases ( or cavitary syndrome) :

- With huge amount of yellow-greenish fluid sputum ( > teecupful/day )
- Cough & expectoration is related to posture

3- Empyema with
brocho-pleural fistula

Types of sputum
Type
Serous

Others

Mucoid

Appearance
Clear, watery
Frothy, pink
Clear, grey
White, viscid
Yellow

Purulent

Cause
Acute pulmonary oedema
Alveolar cell cancer
Chronic bronchitis/COPD
Asthma
Acute bronchopulmonary infection
Asthma .
Long-Standing infection :

Palpitation
1- Rapid heart pain :
Sinus or paroxysmal tachycardia
2- Forcible heart contraction :
A.R M.S
3- Arrhythmias :
Extrasystole or A.F.
4- Cardiac neurosis.

Syncope

Rectal Bleeding
Haemorrhoids
Anal fissure
Colorectal polyps
Colorectal cancer
Inflammatory bowel disease
Ischaemic colitis

Dr.Ahmados

1- Cardiac syncope: (due to low COP )

Hemorrhage AS HF P.embolism & infarction
Massive M.infarction .
2- Neurocardiogenic syncope :
- Vasovagal attack: exposure to fear, emotions
- Stimulation of hypersensitive
3- Orthostatic syncope "postural" :
Autonomic neuropathy(DM) huge varicose veins
essential postural hypotension.
4- Neurological :
Transient ischemic attacks , hypertensive
encephalopathy sever anemia hypoglycemia F4

Complicated diverticular disease

Vascular malformation
Massive upper gastrointestinal
bleeding
Aorto-enteric fistula

Endometriosis in the rectum