Sandbox:Sahar: Difference between revisions

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[[File:Apple-core-sign-of-colonic-cancer-1.jpg|center|200px|thumb|Case courtesy of Dr Mohamed Mahmoud Elthokapy, Radiopaedia.org, rID: 91033]]
Aortic dissection is a life-threating disorder.<ref name="pmid34258355">{{cite journal |vauthors=Buras AL, Chern JY, Chon HS, Shahzad MM, Wenham RM, Hoffman MS |title=Major vascular injury during gynecologic cancer surgery |journal=Gynecol Oncol Rep |volume=37 |issue= |pages=100815 |date=August 2021 |pmid=34258355 |pmc=8259293 |doi=10.1016/j.gore.2021.100815 |url=}}</ref><ref name="ShihHo2021">{{cite journal|last1=Shih|first1=Chia-Wen|last2=Ho|first2=Shung-Tai|last3=Shui|first3=Hao-Ai|last4=Tang|first4=Chi-Tun|last5=Shih|first5=Chun-Che|last6=Chen|first6=Tzeng-Ji|last7=Lin|first7=Kuan-Chia|last8=Liang|first8=Chun-Yu|last9=Wang|first9=Kwua-Yun|title=Endovascular Aortic Repair is a Cost-Effective Option for In-hospital Patients with Abdominal Aortic Aneurysm|journal=Journal of the Chinese Medical Association|volume=Publish Ahead of Print|year=2021|issn=1726-4901|doi=10.1097/JCMA.0000000000000581}}</ref>
== Differential Diagnosis of Aortic Dissection ==
=== Differential Diagnosis of Aortic Dissection ===
The ddx includes:
{| class="wikitable"
|+
! colspan="4" |Aortic dissection DDX
|-
!Disease
!Histrory
!Physical exam findings
!
|-
!
!
!
!
|-
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|
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|-
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|}
<br />
==overview==
Syncope is classified into three types:
*Cardiac
*Vasovagal
*Neurogenic
{| class="wikitable"
! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" + |Differentiating diagnosis of Lymphoma
! colspan="5" style="background:#4479BA; color: #FFFFFF;" align="center" + |Symptoms
! colspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" + |Signs
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Diagnosis
! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" + |Additional Findings
|-
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Fever
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Rash
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Diarrhea
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Abdominal pain
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Weight loss
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Painful lymphadenopathy
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Hepatosplenomegaly
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Arthritis
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Lab Findings
|-
| style="background:#DCDCDC;" align="center" + |Autoimmune lymphoproliferative syndrome
|
|
|
|
|
|
|
|
|
|
|-
| style="background:#DCDCDC;" align="center" + |[[Lymphoma]]
| +
|–
|–
| +
| +
|–
| +
|–
|Increase [[ESR]], increased [[LDH]]
|[[Night sweats]], constant fatigue
|-
| style="background:#DCDCDC;" align="center" + |[[Brucellosis]]
| +
| +
|–
| +
| +
| +
| +
| +
|[[Lymphocytosis|Relative lymphocytosis]]
|[[Night sweats]], often with characteristic smell, likened to wet hay
|-
| style="background:#DCDCDC;" align="center" + |[[Typhoid fever]]
| +
| +
|–
| +
|–
|–
| +
| +
|Decreased [[hemoglobin]]
|Incremental increase in temperature initially and than sustained [[fever]] as high as 40°C (104°F)
|-
| style="background:#DCDCDC;" align="center" + |[[Malaria]]
| +
|–
| +
| +
|–
|–
| +
| +
|Microcytosis,
elevated [[LDH]]
|"Tertian" fever: paroxysms occur every second day
|-
| style="background:#DCDCDC;" align="center" + |[[Tuberculosis]]
| +
| +
|–
| +
| +
| +
|–
| +
|Mild normocytic [[anemia]], [[hyponatremia]], and
[[hypercalcemia]]
|[[Night sweats]], constant fatigue
|-
| style="background:#DCDCDC;" align="center" + |[[Mumps]]
| +
|–
|–
|–
|–
| +
|–
|–
|[[Lymphocytosis|Relative lymphocytosis]], serum [[amylase]]<nowiki/>elevated
|[[Parotid gland|Parotid]]<nowiki/>swelling/tenderness
|-
| style="background:#DCDCDC;" align="center" + |[[Rheumatoid arthritis]]
|–
| +
|–
|–
|–
|–
|–
| +
|[[ESR]] and [[CRP]] elevated, positive [[rheumatoid factor]]
|Morning stiffness
|-
| style="background:#DCDCDC;" align="center" + |[[SLE]]
|–
| +
|–
| +
| +
|–
|–
| +
|[[ESR]] and [[CRP]] elevated, positive [[ANA]]
|[[Fatigue]]
|-
| style="background:#DCDCDC;" align="center" + |[[Human Immunodeficiency Virus|HIV]]
|–
|–
|–
| +
| +
| +
|–
| +
|Leukopenia
|Constant fatigue
|}
CNS lymphoma must be differentiated from other causes of seizures, headache, and fever in immunocompromised patients such as disseminated tuberculosis and disseminated aspergillosis.
{| class="wikitable"
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Disease
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Differentiating signs and symptoms
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Differentiating tests
|-
| style="background:#DCDCDC;" align="center" + |Autoimmune lymphoproliferative syndrome
|
|
|-
| style="background:#DCDCDC;" align="center" + |[[Lymphoma|CNS lymphoma]]
|
*Patient is [[immunocompetent]]
*Focal symptoms indicative of a mass [[lesion]]
*[[Seizure]]
|
*Single solitary ring enhancing [[lesion]] on [[CT]] or [[MRI]]
|-
| style="background:#DCDCDC;" align="center" + |[[Disseminated tuberculosis]]
|
*Prior history of residence in an [[Endemic (epidemiology)|endemic]] area
*Chronic [[cough]], [[weight loss]], [[hemoptysis]]
|
*[[PCR]] of [[CSF]] for [[tuberculosis]]
*Mycobacterial culture of [[CSF]]
*[[Brain]] biopsy for [[acid-fast bacilli]] staining
*Culture and acid stain positive for [[acid-fast bacilli]]
*CXR shows [[Cavitation|cavitations]]
|-
| style="background:#DCDCDC;" align="center" + |[[Aspergillosis]]
|
*[[Pulmonary]] [[lesions]] in addition to [[CNS]] [[lesions]]
*Symptoms may include [[cough]], [[chest pain]], and [[hemoptysis]]
|
*[[CSF]] fungal culture, [[galactomannan]]
|-
| style="background:#DCDCDC;" align="center" + |[[Cryptococcosis]]
|
*Symptoms include [[cough]], [[chest pain]], and [[hemoptysis]]
|
*[[Cryptococcal infection|Cryptococcal]] [[antigen]] from [[CSF]] and [[serum]]
*[[CSF]] fungal culture
|-
| style="background:#DCDCDC;" align="center" + |[[Chagas disease]]
|
*History of residence in Central or  South America
*Acute infection is rarely symptomatic
*[[Encephalitis]] or focal [[brain]] [[lesions]]
*[[Myocarditis]]
*[[Chronic]] [[infections]] in [[immunocompromised]] patients develop into [[encephalitis]] with [[necrotic]] [[brain]] lesions causing a [[mass effect]]
|
*[[Trypanosoma cruzi]] in [[blood]], [[Tissue (biology)|tissue]], or [[CSF]], [[PCR]] of [[Tissue (biology)|tissue]] or [[body fluids]], and [[Serological testing|serologic tests]]
|-
| style="background:#DCDCDC;" align="center" + |[[Cytomegalovirus infection|CMV infection]]
|
*Most common [[CNS]] [[opportunistic infection]] in [[AIDS]] patients
*Presents with [[encephalitis]], [[retinitis]], progressive [[myelitis]], or [[polyradiculitis]]
*In [[disseminated disease]], it involves both the [[liver]] and kidneys
|
*[[Brain]] [[CT]]/[[MRI]]/[[biopsy]]: location of [[lesions]] is usually near the [[brain stem]] or periventricular areas
*[[PCR]] of [[CSF]] with detectable [[virus]] is diagnostic
*[[Brain biopsy]] with + [[staining]] for [[CMV]] or evidence of owl's eyes is also diagnostic, but it is rarely performed because of the location of [[brain]] lesions
|-
| style="background:#DCDCDC;" align="center" + |[[HSV|HSV infection]]
|
*[[Seizures]], [[headache]], [[confusion]] and/or [[urinary retention]] can be seen in [[disseminated disease]], which usually affects only the [[immunocompromised]] or acute [[infections]]
*In [[pregnant]] women, it may be associated with concurrent [[genital]]/[[oral]] [[lesions]]; can be spread to the [[neonate]] during acute infection in the mother, or via [[viral shedding]] in the [[birth canal]]
*[[Neonatal]] [[Herpes simplex virus|HSV]] can range from localized [[Skin and soft-tissue infections|skin infections]] to [[encephalitis]], [[pneumonitis]], and [[disseminated disease]]
|
*[[Brain]] [[CT]]/[[MRI]]/[[biopsy]]: location of [[lesions]] is usually the [[medial]] [[temporal lobe]] or the [[Orbital cavity|orbital]] surface of the [[frontal lobe]].
*[[PCR]] of [[CSF]] with detectable [[virus]] is diagnostic
|-
| style="background:#DCDCDC;" align="center" + |[[Chickenpox|Varicella Zoster infection]]
|
*Multifocal involvement has subacute course, usually only in [[immunosuppressed]], with [[headache]], [[fever]], focal deficits, and [[seizures]].
*Unifocal involvement is more typically seen in [[immunocompetent]] hosts, occurring after [[contralateral]] [[cranial nerve]] [[herpes zoster]], with [[Altered mental status|mental status changes]], [[TIA|TIAs]], and [[stroke]]
*[[Disseminated disease|Disseminated]] [[varicella zoster virus]] can occur in adults during primary [[infection]], presenting with [[pneumonitis]] and/or [[hepatitis]]
*Disease is a [[Vasculitis|vasculopathy]] with [[hemorrhage]] and [[stroke]]
|
*[[PCR]] of [[CSF]] with detectable [[virus]] is diagnostic
|-
| style="background:#DCDCDC;" align="center" + |[[Brain abscess]]
|
*Associated with [[sinusitis]] (abutting the sinuses) or with [[bacteremia]]
*Signs and symptoms includes [[fever]] and [[necrotizing]] [[brain]] [[lesions]] with [[mass effect]]
|
*[[CSF]] culture or culture of [[brain abscess]]
|-
| style="background:#DCDCDC;" align="center" + |[[Progressive multifocal leukoencephalopathy]]
|
*Symptoms are often more insidious in onset and progress over months. Symptoms include progressive [[weakness]], poor [[coordination]], with gradual slowing of [[mental]] function. Only seen in the [[immunosuppressed]]. Rarely associated with [[fever]] or other systemic symptoms
|
*[[Polymerase chain reaction|PCR]] of [[CSF]] for [[JC virus]]
*[[Biopsy]] reveals [[white matter]] [[lesions]] and not well-circumscribed [[lesions]].
|}
[[File:Bilateral-hip-avascular-necrosis-6.jpg|center|300px|thumb|Case courtesy of Dr Bahman Rasuli, Radiopaedia.org, rID: 90579]]
==Classification==
[[Syncope]] is classified into three components:
*[[Cardiac]]
**[[Neurogenic]]
*[[Vasovagal syncope|Vasovagal]]
<br />
{| class="wikitable"
|+
! colspan="4" |Classification of Syncope
|-
|'''Type'''
|Pathophysiology
|Treatment
|Additional information
|-
|
|
|
|
|-
|
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|
|
|}
<br />{{familytree/start |summary=Sample 1}}
{{familytree | | | | | | | | A01 |A01=syncope}}
{{familytree | | | | |,|-|-|-|^|-|-|-|-|.| | | }}
{{familytree | | | B01 | | | | | | | | B02 | | |B01=cardiac|B02=neurogenic}}
{{familytree | | | |!| | | | | | | | | |!| }}
{{familytree | | | C01 | | | | | | | | |!| |C01=C01}}
{{familytree | |,|-|^|.| | | | | | | | |!| }}
{{familytree | D01 | | D02 | | | | | | D03 |D01=D01|D02=D02|D03=D03}}
{{familytree | |!| | | | | | | | | |,|-|^|.| }}
{{familytree | E01 | | | | | | | E02 | | | E03 |E01=E01|E02=E02|E03=E03}}
{{familytree | | | | | | | | | | |!| | | | |!| }}
{{familytree | | | | | | | | | | F01 | | | F02 |F01=F01|F02=F02}}
{{familytree/end}}
[[File:Fl000816-300x300.jpg|center|200px|thumb|wikimedia commons|link=Special:FilePath/Fl000816-300x300.jpg]]
{| class="wikitable"
|+
!disease
! colspan="4" |
|-
|
|
|
|
|
|-
|
|
|
|
|
|-
|
|
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|}
Syncope is classified into three types.
[[File:Sheehan.jpg|center|200px|thumb|Wikimedia commons]]
{| class="wikitable"
|+
! colspan="4" |Syncope classification
|-
|Cardia
|
|
|
|-
|
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|
|
|-
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|
|
|}
==Syncope==
==Syncope is classified to three types:==
[[Syncope]] is classified into three types:
[[Syncope]] is classified into three types:
 
* [[Cardiac]]
 
* [[Neurogenic]]
 
* [[Vasovagal syncope|vasovagal]]
__NOTOC__
 
{{CMG}} {{AE}} {{Sahar}}
 
 
 
{{familytree/start}}<nowiki>{{familytree | | | | | | | | | A01 | | | | | |A01=Syncope}}
{{familytree | | | | | | | | | |!| | | | | | | | }}
{{familytree | | | | | | | | | B01 | | | | | |B01=B01}}
{{familytree | | |,|-|-|-|-|-|-|+|-|-|-|-|-|-|.| }}
{{familytree | | C01 | | | | | C03 | | | | |C02|C01=C01|C02=C02|C03=C03}}
{{familytree | | |!| | | | | | | | | | | | | |!| }}
{{familytree | | D01 | | | | | | | | | | | |D02|D01=D01'<br>D01''|D02=D02'<br>D02''}}
{{familytree | | |!| | | | | | | | | |,|-|-|-|+|-|-|-|-|.|}}
{{familytree | | E01 | | | | | | | | E02 | | E03 | | | E04 |E01=E01|E02=E02|E03=E03|E04=E04}}
{{familytree | | | | | | | | | | | | |!| | | |!| | | | |!| | }}
{{familytree | | | | | | | | | | | | F01 | | F02 | | | F03 |F01=F01|F02=F02|F03=F03}}
{{familytree/end}}
 
[[File:1196px-Rtbl400.gif|200px|center|Source:Wikimedia commons]]
 
 
==Syncope classifications:==
 
*Orthostatic:
 
*Cardiac
*Neurolgoic
 
<br />
{| class="wikitable"
|+
! colspan="5" |Syncope ddx
|-
|Clinical manifestations
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<br />
<references />

Latest revision as of 00:32, 12 August 2021

Syncope is classified into three types:

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