MSC

Symptoms

1 Abdominal pain

For further discussion, see:

2 Arthritis / Arthralgia

Also seen in:

3 Bleeding

For further discussion, see:

Platelet function defects bleed beneath epithelium (skin: petechia; mucosa: epistaxis, GI tract, hematuria, menorrhagia) and bleed immediately
       after the challenge
  • Epistaxis is also associated with hereditary hemorrhagic telangiectasia
  • Vascular defects also bleed immediately with the challenge.

Factor defects bleed into joint and deep soft tissue and with a delay after the challenge.

4 Chest Pain

For further discussion, see:

5 Cough

For further discussion, see:

6 Diarrhea

For further discussion, see:

7 Dysphagia

For further discussion, see:

8 Edema

For further discussion, see:

10 Fever / B Symptoms

Further discussion is under construction.

Fever of unknown origin (FUO) has a specific definition. The temperature has to be ≥ 101°F (i.e. ≥38.3°C), persist for more than 3 weeks, and      have no known cause after investigation.

The basic work up for FUO is:
  •   Blood cultures (especially for the HACEK, “culture-negative” group)
  •   Erythrocyte sedimentation rate or C-reactive protein (IL-6 cytokine)
  •   HIV antibody test and viral load
  •   Rheumatoid factor, anti-nuclear antibody (sensitive but not specific), creatinine phosphokinase (myositis)
  •   Heterophile antibody test (infectious mononucleosis)
  •   Tuberculin skin test or interferon-gamma release assay
  •   Serum protein electrophoresis (multiple myeloma)
  •   Computed tomography scan of abdomen and chest (masses, lymphadenopathy)
The 3 commonest causes are:
  •   Infection
    •   Virus: acute EBV infection (i.e. infectious mononucleosis, HIV, Hepatitis C)
    •   Bacteria: tuberculosis (most common infectious cause of FUO), abscesses, bacterial endocarditis
  •   Systemic rheumatic diseases (aka connective tissue diseases)
    •   Vasculitis (temporal arteritis is the most common immune cause of FUO), sarcoidosis, SLE, RA, polymyalgia rheumatica
  •   Malignancy
    •   Lymphoma & leukemia
    •   Renal cell carcinoma

11 Flank pain

For further discussion, see:
Colicky flank pain with hematuria is caused by a kidney stone until proven otherwise. Find the stone by imaging and collect it for identification.
Dull flank pain with white blood cell casts is acute pyelonephritis.

13 Headache

see:

14 Hematemesis / Melena

For further discussion, see:
The commonest source of melena is severe upper GI tract bleeding.

15 Hematochezia

For further discussion, see:

16 Hematuria

For further discussion, see:
Lower urinary tract, mostly bladder
  • Bladder stone
  • Infection
  • Neoplasm
Upper urinary tract, mostly kidney, see table below

17 Infertility

For further discussion, see:
Commonest causes of infertility:
  • PCOS
  • Tubal obstruction
  • Endometriosis

18 Jaundice

For further discussion, see:
Lower urinary tract, mostly bladder
  • Bladder stone
  • Infection
  • Neoplasm
Upper urinary tract, mostly kidney, see table below

19 Mental Changes / Coma

Further discussion is under construction.

20 Oliguria

For further discussion, see:

21 Palpitations

For further discussion, see:

22 Polyuria, Polydipsia

For further discussion, see:

23 Shortness of Breath

For further discussion, see:

24 Syncope

For further discussion, see:

25 Thrombosis (calf, hepatic vein)

Investigation of a deep vein thrombosis (DVT) is warranted for a hereditary hypercoagulable state with:
  • (+) Family history
  • Multiple episodes
  • Occurrence at a young age (e.g. <50 years)
  • Thrombosis in an unusual site (i.e. not lower leg)
Hereditary conditions: Factor V Leiden, Prothrombin G20210A, Protein C deficiency, Antithrombin deficiency
Acquired conditions: antiphospholipid syndrome, mucinous adenocarcinoma

26 Vomiting

For further discussion, see:

27 Weakness

For further discussion, see:
​Evaluation of weakness involves 3 steps:
  • True muscle weakness versus limitation from another cause such as pain or lassitude (i.e. lethargy or fatigue).
  • Localizing the level of involvement (i.e. CNS > corticospinal tracts > anterior horn cells > nerve roots > peripheral nerves > NMJ > muscle)
  • Diagnosis of a specific disease.

28 Weight Loss (unintentional, adult)

Further discussion is :

Defined as a loss of weight >5% of the usual weight. The term typically implies no known underlying chronic disease
  • Weight loss with increased appetite
    • Hyperthyroidism
    • Diabetes mellitus type I
    • Malabsorption
  • Weight loss with decreased appetite
    • Malignancy
    • GI disease (non-malignant)
      • Peptic ulcer disease (PUD)
      • Chronic inflammatory bowel disease (CIBD)
    • Psychiatric disorder
      • Depression
      • Eating disorder