SA Differential Diagnoses of Clinical Signs Flashcards
Alopecia
INFLAMMATORY: Infectious, Immune-mediated, Traumatic, Atrophic
NON-INFLAMMATORY: Hormonal, Other (less common)
Anuria & Oliguria
PRE-RENAL: dehydration, hypovolemia, hypotension
RENAL: Infectious, toxic (endo vs exo), ischemic (thrombi), immune-mediated
POST-RENAL: obstruction
Constipation
DIETARY
DRUGS
REFUSAL TO DEFECATE: pain in rectum vs orthopedic
BEHAVIOURAL & ENVIRONMENTAL
COLONIC OBSTRUCTION: intra vs extra luminal
COLONIC WEAKNESS:
- Systemic Dz: Hypercalcemia, hypothyroid, hypokalemia
- Local Neuro Dz: Spinal dz, pelvic nerve dz, dysautonomia, chronic stretch and damage
- Other: idiopathic megacolon in cats, severe dehydration
Coughing
UPPER: inflammatory, infectious, neoplastic, allergic, other
LOWER: inflammatory, parasitic, neoplastic, cardiovascular, non-cardiovascular pulmonary edema, allergic, other
ACUTE Diarrhea
DIET
PARASITES
INFECTIOUS: viral, bacterial, rickettsial
OTHER:
- Gastro: HGE, Intussusception, IBS, Foreign body
- Non- gastro: Toxins, Drugs, Pancreatitis, Hypoadrenocorticism, Peritonitis, Pyometra
CHRONIC Diarrhea
SMALL INTESTINAL: Food intolerance, IBD, Neoplasia, Parasitic, EPI, Obstruction/ Intussusception, Liver disease, Endocrine (hypoadreno, hypothyroid, hyperthyroid), Renal disease, Intestinal lymphangiectasia
LARGE INTESTINAL: Food Intolerance, IBD (4 types), Neoplasia, Parasitic
Epistaxis
LOCAL: Neoplasia, FB, Infectious (parasite, fungal), Dental dz + fistula, eosinophilic & lymphoplasmacytic rhinitis
SYSTEMIC: thrombocytopenia, thrombocytopathia (1 Vwb dz or 2 Uremia, multiple myeloma, NSAIDs), Coagulation factor deficits, acquired coagulopathies, systemic hypertension, increased capillary fragility
Fever of Unknown Origin
INFECTIOUS- bacteria, viral, fungal, rickettsial, protozoal
NEOPLASIA
IMMUNE-MEDIATED
INFLAMMATORY- Hypertrophic osteodystrophy, juvenile cellulitis, pancreatitis, panosteitis, panniculitis
OTHER- hyperthyroidism, certain Ab’s, metabolic bone dz, PSS, Shar-pei fever
Head Tilt
PERIPHERAL: otitis interna/ media, middle ear tumor, trauma, aminoglycoside toxicity, feline idiopathic vestibular dz, geriatric canine vestibular dz
CENTRAL: trauma/ hemorrhage, infectious inflammatory fever (RMSF, FIP, bacterial, protozoal, mycotic, rickettsial, distemper), granulomatous meningoencephalitis, neoplasia, vestibular infarct, thiamine deficiency, metronidazole toxicity, toxicity, degenerative dz (storage neuropathies, demyelinating dz), hydrocephalus
Horner Syndrome: Apply Phenylephrine eye drops –> No pupillary dilation (assume pre-ganglionic lesion)
FIRST ORDER (Central): Intracranial dz, C1-C3 spinal myelopathy
SECOND ORDER (Pre-ganglionic): T1-T3 spinal cord lesion, Thoracic dz, brachial plexus avulsion, skull based tumour
Horner Syndrome: Apply Phenylephrine eye drops –> Pupillary dilation (assume post-ganglionic)
THIRD ORDER (post-ganglionic): FeLV/FIV, otitis media/ interna, otic mass, retrobulbar injury/ mass, idiopathic (most common especially in Goldens)
Hyperthermia
FEVER
HEAT STROKE
Exercise hyperthermia- seizures, hypocalcemic tetany
Pathologic etiologies- hyperthyroidism, malignant hyperthermia
Icterus (Jaundice)
PRE-HEPATIC (hemolysis): autoimmune, infectious, toxic (drugs/ food), fragmentation, snake/ brown recluse spider, bee venoms
HEPATIC: cholangiohepatitis, cirrhosis, diffuse neoplasia, toxic hepatopathy, hepatic lipidosis, FIP, Parasitic
POST-HEPATIC biliary obstruction: pancreatitis, enteritis/ cholecystitis, trauma, neoplasia, calculus, stricture, mucocele, ruptured bile duct or gallbladder
Joint Swelling
TRAUMA
DEGENERATIVE JOINT DZ
NEOPLASIA
INFLAMMATORY INFECTIOUS: bacterial, fungal, lyme, rickettsial, leishmaniasis, anaplasmosis, mycoplasma, viral (calicivirus, canine distemper)
INFLAMMATORY NON-INFECTIOUS:
- Erosive: Rheumatoid arthritis, erosive polyarthritis of Greyhounds, Feline chronic progressive polyarthritis
- Non-Erosive: Immune-mediated polyarthritis, Systemic lupus erythromatosis, breed-specific arthritis syndromes, lymphocytic/ plasmacytic synovitis, Drug reactions (TMS in Doberman), Chronic infection causing secondary immune-mediated polyarthritis
Lameness
ORTHOPAEDIC: Trauma, Infectious, Immune-mediated polyarthritis, Degenerative (DJD, cruciate dz, hip dysplasia, elbow dysplasia), developmental (patellar luxation, OCD, panosteitis, HOD, avascular necrosis, ununited anconeal process, bone cysts, radial agenesis), Metabolic (panosteitis, HOD, diabetic neuropathy), Nutritional (Vit D deficiency), Neoplasia
MUSCLES: Trauma (contusion, strain, laceration, rupture, contracture), Inflammatory (polymyositis, dermatomyositis), Infectious (protozoal myositis)
TENDONS/ LIGAMENTS: Sprain/Strain, Hyperextension, Tear, Rupture
note:
strain = muscle-tendon injury
sprain = ligament injury
Pallor
ANEMIA:
- Regenerative: IMHA, erythrocyte parasite, fragmentation, oxidative injury, blood loss
- Non-regenerative: anemia of chronic disease, anemia of renal disease, FeLV, Endocrine (mild in hypoadreno and hypothyroid), Bone marrow suppression or toxicity
SHOCK:
- Cardiogenic: ↓ ventricular function, ↓ ventricular filling, outflow obstruction (intrathoracic tumors, stenosis, hypertrophic obstructive cardiomyopathy, heartworm disease, thrombosis, severe arrythmia)
- Non-cardiogenic trauma, hypovolemia, disruption in blood flow (sepsis, endotoxemia, hypotension)
Papules
Bacterial pyoderma Demodicosis Sarcoptes Hypersensitivity Pemphigus Early-stage neoplasia
Pustules
Bacterial pyoderma
Demodicosis
Pemphigus
Polyuria/ Polydipsia
Renal Insufficiency or failure Diabetes mellitus Hyperadrenocorticism and Hypoadrenocorticism Lower Urinary Tract Infection Pyometra Hypercalcemia Pyelonephritis Hypokalemia Iatrogenic (corticosteroids, diuretics, anti-convulsants, fluid therapy) Hyperthyroidism Hepatic Insufficiency Diabetes insipidus (central vs renal) Psychogenic drinking Renal glycosuria
Regurgitation
ESOPHAGEAL DISEASE: megaoesophagus, esophagitis, mechanical obstruction
ALIMENTARY DISORDER: pyloric outflow obstruction, GDV, hiatal hernia
NEUROPATHIES: peripheral neuropathies, CNS dz, Dysautonomia
NEUROMUSCULAR JUNCTION DISORDERS: myasthenia gravis, tetanus, botulism, Ach-ase toxicity
IMMUNE-MEDIATED DISORDERS: SLE, polymyositis, dermatomyositis
ENDOCRINE DISEASE: hypothyroidism, hypoadrenocorticism
Scaling & Crusting
Bacterial
Fungal
Parasitic
Protozoal: Leishmaniasis
Viral: FeLV
Allergic: Atopic dermatosis, hypersensitivity
Endocrine & Metabolic: hyperadrenocorticism, hypothyroidism
Immune-mediated: pemphigus, DLE, erythema multiforme
Keratinization Defects: secondary seborrhea, Vitamin-A response dermatosis, ear margin dermatosis
Environmental: solar dermatitis
Nutritional: Zinc-responsive, fatty acid deficiency
Other: cutaneous lymphoma, sebaceous adenitis, otitis externa
Seizure
INTRACRANIAL: Inflammatory dz, infectious dz, neoplasia, granulomatous meningoencephalitis, hemorrhage/ infarct (due to renal failure, hypothyroid, hyperthyroid, hypertension, septic emboli, neoplasia, coagulopathies, heartworm dz, vasculitis), congenital malformations, necrotizing meningoencephalitis, degenerative dz (metabolic storage diseases, leukodystrophies, hypomyelination disorders, spongy disorders)
EXTRACRANIAL: toxins, metabolic dz, hepatic dz, electrolyte disturbance (hypernatremia), severe uremia, hyperlipoproteinemia, hyperviscosity, hyperosmolarity, heat stroke, hypertension, hyperthyroid (cats), hypothyroid (dogs)
Strunguria/ Pollakuria
SMALL BLADDER: Cystitis Detrusor hyperspasticity Urethritis Urethral mass
LARGE BLADDER:
Lower Urinary Tract Obstruction- Functional vs Mechanical
Urinary Retention
Easy Catheterization:
- Normal Neuro Exam: cystic calculi or mass, detrusor areflexia from overdistention, reflex dyssyndergia
- Abnormal Neuro Exam: UMN, LMN, Dysautonomia
Difficult Catheterization:
Urethral spasm, urethral calculi, urethral stricture, urethral neoplasia, TCC, Urethral inflammation, Prostatic dz, mucoid/ crystalline plug (cats)
Stomatitis
- INFECTIOUS: FIV, FeLV, Feline calicivirus, Feline herpes, FIP, Bartonellosis, Canine distemper virus, Feline Panleukopenia, Candidiasis
- IMMUNOSUPPRESSIVE DZ
- FELINE EOSINOPHILIC GRANULOMA COMPLEX - allergies
- IDIOPATHIC FELINE GINGIVITIS/ STOMATITIS
- IMMUNE-MEDIATED dz: SLE, pemphigus, idiopathic vasculitis, toxic epidermal necrolysis
- UREMIC STOMATITIS/ CAUSTIC AGENT
- RADIATION-INDUCED
Syncope
NORMAL CEREBRAL PERFUSION:
Severe hypoxemia, hypoglycemia
CEREBRAL HYPOPERFUSION: take blood pressure reading
- NORMOTENSIVE: Cerebrovascular dz, cerebral vasoconstriction
- SYSTEMIC HYPOTENSION: Decreased cardiac output
– Loss of preload: cardiac tamponade, AV stenosis, hypovolemia, diuretics
– Outflow obstruction: aortic/ subaortic and pulmonic stenosis, pulmonary hypertension, pulmonary thromboembolism, myocardial infarction, hypertrophic & restrictive cardiomyopathy, SAM of mitral valve, heartworm dz, masses
– Arrhythmia:
Bradyarrhythmia: SSS, 3rd AV block, persistent atrial standstill, Beta Blockers, Ca channel blockers
Tachyarrhythmia: atrial fibrillation, atrial tachycardia, V-tach
– Loss of vascular resistance:
Drug therapy: ACE-inhibitors, Beta blockers, Ca channel blockers, hydralazine, nitrates, phenothiazines
Reflex syncope: orthostatic, post-exertion, micturition, defecation, cough, emotional distress, pain, carotid sinus hypersensitivity
ANS dz: 1 or 2 (DM, amyloidosis, paraneoplastic, chronic renal failure, autoimmune dz)
Cyanotic Heart dz: tetralogy of Fallot, reversed shunt
Tenesmus & Dyschezia
Intraluminal and Extraluminal Obstruction
Pharmaceuticals: opioids, diuretics leading to dehydration
Neurogenic:
– Systemic dz: hypercalcemia, hypothyroid, hypokalemia
– Local neuro dz: spiral dz, pelvic nerve dz, dysautonomia, chronic stretch and damage
– Other: idiopathic megacolon in cats, severe dehydration
recall: dysautonomia = dysfunction of the autonomic NS, this can happen in any part of the body but may be more apparent if digestive nerves are affected
Vision Loss, sudden (Blindness)
Corneal lesions: edema (trauma, glaucoma, immune-mediated keratitis), keratoconjunctivitis sicca, exposure keratitis, superficial keratitis (pannus), corneal melanosis (entropian, ectropian, lagophthalmos, facial nerve paralysis), cellular infiltrate, fibrosis/ scarring
Aqueous humor lesions: fibrin (anterior uveitis: many causes), hypopyon (immune-mediated, neoplastic, infectious, hyphema (trauma, blood-clotting deficiencies, hypertension, retinal detachment, neoplasia), lipid (hyperlipidemia with concurrent anterior uveitis
Lens lesions: cataracts (genetic, metabolic/ diabetic, nutritional, traumatic, toxic, retinal degeneration, hypocalcemia, electric shock, chronic uveitis, lens luxation)
Vitreous humor lesions: hemorrhage (trauma, systemic hypertension, clotting deficiency, neoplasia, retinal detachment), hyalitis (infectious, penetrating injury with cellular infiltrate)
Retinal lesions: glaucoma, SARD, progressive retinal atrophy, central progressive retinal atrophy, toxicity (fluoroquinolones in cats), hypertension, retinal detachment
Failure to transmit visual message: viral infections, mycoses, neoplasia, traumatic avulsion of optic nerve (traumatic proptosis), granulomatous meningoencephalitis, hydrocephalus, optic nerve hypoplasia, immune-mediated optic neuritis
Failure to interpret visual message: distemper, FIP, mycoses, granulomatous meningoencephalitis, trauma, heat stroke, hypoxia, hydrocephalus, hepatoencephalopathy, neoplasia, storage diseases, postictal, meningitis
Dysphagia
ORAL LESIONS: fractures, periodontitis, trauma, feline resorptive lesions, osteomyelitis, retrobulbar abscess/ inflammation, temporal-masseter myositis, stomatitis, glossitis, pharyngitis, gingivitis, tonsillitis, sialadenitis (immune-mediated dz, feline viral dz, foreign. bodies or granulomas, tooth root abscess, uremia, caustic chemicals), cleft palate, cricopharyngeal achalasia
OBSTRUCTIVE LESIONS: esophageal stricture/ FB, esophagitis, electric cord burns, neoplasia, inflammatory (abscess, polyp, granuloma), lymphadenopathy, eosinophilic granuloma, FB
NEUROMUSCULAR DISEASE: myasthenia gravis, acute polyradiculitis, masticatory myositis, tick paralysis, botulism, polymyositis, TMJ dz, rabies, trigeminal nerve paralysis or neuritis, neuropathies of CN 5, 7, 9, 10, 12, brain stem disease, tetanus, hypothyroidism
Hematochezia
ANAL DZ: perianal fistulas, anal sacculitis or abscess, stricture, neoplasia, perineal hernia, FB
RECTAL and COLONIC DZ:
Hemorrhagic gastroenteritis
Proctitis
Colitis: idiopathic, dietary allergy, IBD, stress, infectious (Campylobacter spp, Clostridial), Histoplasmosis, Pythiosis, Food allergy, trichomoniasis (cats)
Parvovirus
Parasites: whipworms, hookworms, coccidia
Neoplasia
Prolapsed rectum
Mucosal trauma: FB, pelvic fractures, iatrogenic (thermometers, enemas, fecal loops, rectal palpation)
Ileocecal intussusceptions
Hematuria
RENAL or LOWER UTD:
Inflammation/ infection, urolithiasis, obstruction, trauma, neoplasia, bleeding disorder, heat stroke, renal infarct, granulomatous urethritis, FLUTD, parasitism, drug-induced (cyclophosphamide), renal pelvic hematoma, vascular malformation, idiopathic, Pseudohematuria (myoglobin, hemoglobin, drugs, dyes)
EXTRAURINARY Dz:
Prostatic dz (infection, tumor, cyst, abscess)
Uterine dz (pyometra, proestrus, tumor, subinvolution of placental sites
Vaginal (trauma, neoplasia)
Estrus
Preputial/ penile (trauma, neoplasia)
Fecal Incontinence
NON-NEUROLOGIC Dz:
Colorectal Disease: IBD, Neoplasia, Constipation
Anorectal Dz: Perianal fistula, Neoplasia, Iatrogenic from previous anorectal surgery
Miscellaneous: decreased mentation, severe diarrhea, irritable bowel disease, old age
NEUROLOGIC Dz:
Sacral Spinal Cord Disease: diskospondylitis, neoplasia, degenerative myelopathy, congenital vertebral malformation, sacrococcygeal hypoplasia of Manx cats, sacral fracture, sacrococcygeal subluxation, lumbosacral instability, meningomyelitis
Peripheral Neuropathy: trauma, penetrating wounds, repair of perineal hernia, perineal uresthrostomy, hypothyroidism, diabetes mellitus, dysautonomia
Urinary Incontinence
BLADDER DISTENDED:
Neurogenic:
– LMN bladder: urine dribbling, large flaccid easy to express: S1-S3 or pelvic nerve damage
– UMN bladder: large firm bladder, difficult to express: L1 - L5 or damage to hypogastric nerve
Obstructive: Functional obstruction (reflex dyssynergia) Mechanical obstruction (uroliths, tumors, strictures, granulomatous urethritis, urethral inflammation, prostatic disease, mucoid or crystalline plug)
BLADDER NOT DISTENDED:
Dysuria/ pollakiuria absent: urethral spincter mechanism incompetence (middle to older aged spayed dogs), congenital (ectopic ureters, patent urachus)
Dysuria/ pollakiuria present: detrusor hyperreflexia (uroliths, UTI, urethral mass)
Melena
INGESTED BLOOD: oral lesions, nasopharyngeal lesions, pulmonary lesions, diet
PARASITISM: hookworms, protozoa
NEOPLASIA: adenocarcinoma, lymphoma, leiomyoma/sarcoma, mast cell tumor, gastrinoma, nasal or oral tumor
UPPER GI INFLAMMATION: gastritis, ulceration/ erosion, hemorrhagic gastroenteritis, IBD, FB, esophagitis
INFECTION: campylobacter, clostridium perfringens, salmonella, parvo, neorickettsia helmonthoeca, histoplasma, pythium, helicobacter
DRUGS: NSAIDs, glucocorticoids
MISCELLANEOUS: pancreatitis, liver failure, renal failure, hypoadrenocorticism, GI ischemia, polyps, coagulopathies (thrombocytopenia, factor deficiencies, rodenticide toxicity, DIC)
Nystagmus
PERIPHERAL VESTIBULAR DISEASE: horizontal nystagmus with NO change when head position moved. Fast phase toward normal side
– otitis media/ interna, feline idiopathic vestibular disease, canine geriatric vestibular disease, neoplasia, feline nasopharyngeal polyps in middle ear, granuloma, trauma (iatrogenic to ear cleaning), ototoxic drugs, neuropathy (hypothyroid, CN 8 dz)
CENTRAL VESTIBULAR DISEASE: horizontal, vertical or rotary nystagmus, which may change with varying head position
– trauma/ hemorrhage, infectious inflammatory (viral, rickettsial, fungal, toxoplasmosis, neosporosis), granulomatous meningoencephalitis, neoplasia, vascular infarct, thiamine deficiency, metronidazole toxicity, toxic (lead), degenerative disease (storage dz, neuronopathies, demyelinating diseases), hydrocephalus
Pruritus
ALLERGY: flea allergy, atopic, food allergy, contact dermatitis, mosquito-bite hypersensitivity, eosinophilic plaque (cats)
PARASITES: fleas, mites, lice
INFECTIOUS AGENTS: pyoderma, malassezia, dermatophytosis
BEHAVIOURAL: acral lick dermatosis, psychogenic alopecia
IMMUNE-MEDIATED: pemphigus foliaceus
DRUG
MISCELLANEOUS: cornification defects, superficial necrolytic dermatitis, tail dock neuroma, rhabditic dermatitis
Reverse Sneezing
Nasopharyngeal irritation, purpose is to move secretions and foreign material to the oropharynx to be swallowed
- Excitement, foreign bodies, nasal mites, viral infections and epiglottic entrapment of the soft palate
Sneezing and Nasal Discharge
Nasal and Upper Resp Disease
INFECTIOUS: viral, bacterial, fungal, parasitic
INFLAMMATORY: allergic rhinitis, lymphocytic-plasmacytic rhinitis, acquired nasopharyngeal stenosis, polyps
NEOPLASIA: adenocarcinoma, SCC, fibrosarcoma, osteosarcoma, chondrosarcoma, lymphoma, TVT
FOREIGN BODY
CONGENITAL: cleft palate, ciliary dyskinesia, nasopharyngeal stenosis, choanal atresia
DENTAL DISEASE: tooth root abscess, oronasal fistula
TRAUMA
VASCULAR MALFORMATION:
Systemic Disease
INFECTIOUS: canine distemper virus, kennel cough complex, pneumonia
HYPERTENSION: hyperthyroid, hyperadrenocorticism, renal disease, pheochromocytoma, hypothyroid, acromegaly, polycythemia, diabetes
COAGULOPATHIES: thrombocytopenia, RMSF, vWd, factor deficiencies, congenital (hemophilia A and B), acquired (Vitamin K rodenticide toxicity, DIC, hepatic failure)
VASCULITIS: toxic, inflammatory, immune-mediated (SLE), neoplastic, infectious (ehrlichiosis, FIP, RMSF, leishmaniasis
HYPERVISCOSITY: multiple myeloma, lymphoma, IgM macroglobulinemia,
Stupor and Coma
INCREASED INTRACRANIAL PRESSURE: encephalitis, meningitis, neoplasia, granulomas, abscess, vascular events (hemorrhage, embolism, ischemia), trauma, underlying metabolic injury (hypertension), developmental (hydrocephalus, storage diseases)
SYSTEMIC INFECTIONS: rabies, FIP, canine distemper, fungal, parasitic
CEREBRAL EDEMA: vasogenic (brain masses leading to breakdown of BBB), cytotoxic (hypoxia, neuroglycopenia), interstitial (hydrocephalus)
HERNIATION OF BRAIN TISSUES
EXTRACRANIAL CAUSES: hypoglycemia, hypernatremia, hyponatremia, DKA, uremic encephalopathy, severe hypothyroidism, heat stroke, toxins, hepatic disease, hyperadrenocorticism, erythrocytosis, hyperglobulinemia
Vomiting
GASTRIC DISEASE: gastritis, parasites, FB< obstruction, ulceration, neoplasia, GDV. hiatal hernia, motility disorders, pyloric stenosis
SMALL INTESTINE DZ: parasites, IBD, FB, bacterial overgrowth/ enteritis, HGE, neoplasia, viral enteritis (parvo, distemper), intussusception
LARGE INTESTINE DZ: colitis, obstipation, parasites
DIETARY: indiscretion, intolerance, allergy
DRUGS: chemo agents, antibiotics (erythromycin, tetracycline), NSAIDs, apomorphine, xylazine, penicillamine
EXTRA-GIT: pancreatitis, peritonitis, hepatobiliary dz, neoplasia, uremia, DM or DKA, hypercalcemia, hyperthyroidism, hypoadrenocorticism, hepatic dz, septicemia/ endotoxemia, pyometra, acid-base disorders, electrolyte disorders, hypertriglyceridemia, gastrinoma
INTOXICANTS: lots of inorganic, organic, plant toxins etc.
NEUROLOGICAL: epilepsy, tumor, meningitis, increased intracranial pressure, dysautonomia
