Churchill’s Pocketbook of Differential Diagnosis by Andrew T. Raftery, Eric K. S. Lim, Andrew J. K. Ostor

By Andrew T. Raftery, Eric K. S. Lim, Andrew J. K. Ostor

Having the ability to make an accurate prognosis is among the key facets of each clinical student's and junior doctor's scientific education. Problem-based studying is more and more getting used to target the motives in the back of the presentation of a medical function. The 3rd variation of this best-selling e-book is packed jam-packed with details to assist the reader movement from a offering challenge to a correct analysis.

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Retroareolar erythema. Nipple retraction. Thick, creamy nipple discharge. Sebaceous cyst Mobile swelling fixed to the skin. May be a punctum. May be infected, with discharge and surrounding redness. Generalised swellings Generalised swelling of the breast may occur in pregnancy, lactation and puberty. It may also occur with mastitis, when the breast is enlarged, red, tender and hot. Swellings behind the breast These are rare. Tietze’s disease is the most common. There will be prominence and tenderness over the second, third and fourth costal cartilages.

TB Axillary artery aneurysm HISTORY Superficial Acute abscess This presents as a tender swelling in the skin. There may be a purulent discharge. Common in diabetics. Sebaceous cyst A sebaceous cyst will present as a firm swelling in the skin, often with a punctum. It may be tender if it becomes inflamed and there may be discharge from it. Lipoma This presents as a soft, lobulated swelling in the subcutaneous tissue. Hidradenitis suppurativa The patient presents with multiple tender swellings in the superficial tissue of the axilla, the infection occurring in the apocrine sweat glands.

Section A ■■ FBC, ESR Hb  Crohn’s disease, carcinoma. ESR  carcinoma, Crohn’s disease, ileo-caecal TB. WCC  appendicitis, diverticulitis. 22 Abdominal Swellings ■■ LFTs Alkaline phosphatase  with liver secondaries. ■■ US Ovarian lesions. Uterine lesions. Tubo-ovarian abscesses. Pregnancy. Ectopic pregnancy. Iliac artery aneurysms. Lymphadenopathy. Appendix mass. Crohn’s mass. ■■ AXR Obstruction. Dilated loops of bowel. ). Erosion of iliac bone – bone tumours. SPECIFIC INVESTIGATIONS ■■ bHCG Raised in pregnancy.

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