دانلود کتاب تشخیص الگوریتمی علائم و نشانه ها

The algorithms presented in these pages are, at the very least, a list of the most common disorders that may cause a given symptom or sign. As such, however, they are not all inclusive. Rare or unusual conditions are excluded; the reader is referred to other treatises of differential diagnosis, such as French’s Index of Differential Diagnosis, edited by I.A.D. Bouchier, H. Ellis, and P.R. Fleming, and Handbook of Difficult Diagnosis, edited by A.A. Louis, for a more complete list of diagnostic possibilities. The list of diagnostic possibilities is broken down by the presence or absence of additional symptoms and signs. The reader should be aware that any specific patient may not present with an additional symptom necessary for this analysis, and, therefore, the entire list of possibilities must still be entertained. Alternatively, the patient may present with the additional symptom but still have one of the other disorders on the diagnostic tree; therefore, at all times, the clinician should maintain an index of suspicion that the patient could have any one of the disorders listed on the page and not exclude any of the possibilities completely until a positive laboratory, x-ray, or tissue diagnosis is ready. For example: A 47-year-old white female reported progressive numbness and tingling and weakness of the lower extremities. Examination showed loss of vibratory and position sense in the lower extremities and positive Babinski’s sign. A tentative diagnosis of pernicious anemia was made. However, tests for serum B12 and folic acid were normal. Magnetic resonance imaging (MRI) of the thoracic spine showed a neurofibroma at the T6-7 level. From this example, one can see that had the clinician not kept an open mind about the entire list of diagnostic possibilities, he or she would not have ordered an MRI of the thoracic spine and would have missed the diagnosis.