Sandbox: HS

Diseases	Laboratory Findings			Physical Examination					History and Symptoms
	Estrogen-to-androgen ratio	Cholesterol levels	WBC count	Tenderness	Enlargement	Nipple discharge	Lymphadenopathy	Other physical exam findings	Age of onset	Medication intake
Gynecomastia	↑			+/-	+			Round discrete mass felt under areola and usually bilateral.	Physiological gynecomastia is seen in newborns, adolescents and elderly	Pharmacological gynecomastia has hx of medication intake.
Pseudo gynecomastia				+/-	+			Increased adipose rather than glandular tissue on examination.
Breast Cancer				+/-; mostly painless	+	+	+	Usually painless mass	Middle age to elderly
Lipoma		↑		+/-	+			Soft and mobile.	Middle age to elderly
Sebaceous cyst					+			Asymmetric enlargement and swelling feels closer to the skin.
Mastitis			+	Tender	+/-	+/-	+/-	Systemic clinical features of infection.

• This table must include the cardinal manifestations of differential diagnosis and the list of diseases must be prioritize based on mortality rate and prevalences of the diseases. For example, if you want to write a differential diagnosis table for heat stroke, sepsis, malignant hyperthermia, neuroleptic malignant syndrome, and serotonin syndrome first, you need to mention the cardinal manifestations for these conditions as, hyperthermia and altered mental status. Second, prioritize your list based on disease mortality or prevalence then, create the table. You can find the example here.

Differential Diagnosis	Similar Features	Differentiating Features
Differential 1	On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].	On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].
Differential 2	On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].	On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].
Differential 3	On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].	On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].
Differential 4	On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].	On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].
Differential 5	On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].	On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].

Ductal hyperplasia, source:https://librepathology.org

Differential Diagnosis	Differentiating Features
Gynecomastia	Round discrete mass felt under areola and usually bilateral.
Pseudogynecomastia	Increased adipose rather than glandular tissue on examination.
Lipoma	Asymmetric breast enlargement.
Breast cancer	Nipple discharge, Axillary lymphadenopathy, usually nonpainful mass.
Sebaceous cyst	Asymmetric enlargement and swelling feels closer to skin.
Mastitis	Systemic s/s of infection.

ABC

def

DRUGS	MOA	SIDE
SDFA	SDFA	DSFA

papichul

Based on the androgen and estrog imabalance
Decreased testosterone	Increased estrogen

Based on the androgen and estrogen balance

• Decreased Testosterone

• Androgen-insensitivity syndrome
• Congenital anorchia
• Five alpha-reductase deficiency
• Hypopituitarism
• Kallman Syndrome
• Klinefelter Syndrome
• Renal Failure
• Testicular trauma
• Torsion of the testes
• Viral orchitis

• Increased Estrogens

• Adrenal cancer
• Chronic liver disease
• Extragonadal germ cell tumors
• Familial gynecomastia
• Hyperthyroidism
• Kidney carcinoma
• Liver cancer
• Lung carcinoma
• Malnutrition
• Other gastrointestinal (GI) tract carcinoma
• Stomach cancer
• Testicular cancer

references

{{{ stimulatory action }}}

{{{ Breast Tissue }}}

Inhibitory action

Right coronary artery

Androgens

Estrogen

Brachiocephalic a

R common carotid a

R subclavian a

L common carotid a

Internal carotid a

External carotid a

L subclavian a

Axillary a

Int. thoracic a

Progesterone (Thorax)

Bronchial as

Growth hormone and IGF-1

Celiac a

L gastric a

Common hepatic a

Splenic a

SMA

Renal as