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.