Differential Diagnosis Checklist


♠ Don’t miss
* Commonly missed
Diagnoses are listed in order of prevalence
Modified from John Ely et al's checklists

    • Abdominal and Pelvic Pain

      Dyspepsia (functional, ulcer, reflux)

      Viral gastroenteritis

      Constipation

      Medications (NSAIDs, iron)

      *Psychiatric (depression, sexual abuse)

      Irritable bowel syndrome

      Abdominal wall pain

      ♠Gallbladder disease

      ♠Pancreatitis

      ♠Diverticulitis

      ♠*Appendicitis

      ♠Kidney stone

      Herpes zoster

      Mittelschmerz

      ♠Hernia

      Gastroparesis

      ♠*Ectopic pregnancy, pregnancy complication

      Bacterial overgrowth

      ♠*Myocardial infarction

      Celiac disease

      Food poisoning

      ♠*Diabetic ketoacidosis

      ♠*Pneumonia, empyema

      Mesenteric lymphadenitis

      ♠Hepatitis, hepatic abscess

      ♠Bowel obstruction

      Giardia

      Endometriosis, adenomyosis

      ♠Ovarian cyst, ovarian torsion

      ♠Pelvic inflammatory disease, endometritis

      Leiomyoma, degeneration, torsion, infarction

      ♠*Intraabdominal tumor, lymphoma

      Bladder distension, urinary tract infection

      Dysmenorrhea

      ♠*Aortic dissection, ruptured aneurysm

      ♠Mesenteric ischemia, infarction

      ♠Subdiaphragmatic abscess

      ♠Perforated viscus, peritonitis

      Inflammatory bowel disease

      ♠Intussusception

      Carbohydrate malabsorption

      Acute pharyngitis

      ♠Sickle cell crisis

      ♠Lead poisoning

      Sphincter of Oddi dysfunction

      ♠Meckel's diverticulitis

      Abdominal migraine, abdominal epilepsy

      Narcotic bowel syndrome

      ♠Fitz-Hugh-Curtis syndrome

      ♠Hypercalcemia

      Radiculopathy (diabetes, cord tumor, tabes dorsalis)

      Periarteritis nodosa

      ♠Hyper or Hypothyroidism

      Eosinophilic gastroenteritis

      ♠Leukemia

      Epiploic appendagitis

      Superior mesenteric artery syndrome

      ♠Spleen wandering, abscess, infarction , rupture

      Hereditary angioedema

      Celiac artery compression

      Adrenal insufficiency

      Familial Mediterranean Fever

      Iliocostal friction syndrome

      ♠*Abdominal compartment syndrome

      *Mesenteric panniculitis

      Porphyria

      Budd-Chiari syndrome

      *ACE-inhibitor angioedema

      Hyperparathyroidism

      Black Widow Spider bite

    • Abnormal uterine bleeding

      Anovulatory bleeding, polycystic ovary syndrome

      Menorrhagia (idiopathic)

      Contraceptive related abnormal bleeding (oral contraceptives, depo-medroxyprogesterone, intrauterine device, progestin implant)

      Normal variations (postmenarchal, perimenopausal, premenstrual spotting, postmenstrual spotting, midcycle ovulatory bleeding)

      ♠Ectopic pregnancy

      ♠Intrauterine pregnancy complication

      ♠Endometrial cancer, hyperplasia

      Uterine polyps

      Uterine fibroids

      Adenomyosis

      ♠Endometritis

      Hyperprolactinemia

      Thyroid disease

      Drugs (anticoagulants, psychotropics)

      Coagulopathy (von Willebrand disease)

      Organ failure (late manifestation: kidney failure, liver failure)

    • Annular skin lesions

      Tinea corporis

      Xerotic eczema

      Granuloma annulare

      Urticaria

      Erythema multiforme

      Psoriasis

      Pityriasis rosea (herald patch)

      Nummular eczema

      Seborrheic dermatitis

      Arthropod bites

      Annular and gyrate erythemas

      Vasculitis

      Henoch-Schonlein purpura

      Lupus erythematosus (subacute cutaneous lupus)

      Annular lichen planus

      ♠Erythema chronicum migrans (Lyme disease)

      ♠Secondary syphilis

      Cutaneous sarcoidosis

      Acute febrile neutrophilic dermatosis (Sweet Syndrome)

      Annular elastocytic giant cell granuloma

      Superficial annulare centrifugum

      Interstitial granulomatous dermatitis

      Id (autoeczematous) reactions

      Kawasaki’s disease

      Eruptive xanthomas

      Eruptive histiocytomas

      ♠Erythema marginatum (Rheumatic fever)

      Porokeratosis

      Linear IgA bullous dermatosis

      ♠Leprosy

    • Anxiety, depression

      ♠Depression, agitated depression, bipolar disorder

      Anxiety (situational, generalized anxiety disorder)

      Panic disorder

      Alcohol

      ♠Hypoglycemia

      Medications (caffeine, nicotine, pseudoephedrine)

      Medication or substance withdrawal (alcohol,

      benzodiazepines)

      Illicit drugs (cocaine, amphetamines)

      Posttraumatic stress disorder

      ♠Serotonin syndrome

      ♠Thyroid disorder

      Paraneoplastic syndrome

      ♠Pulmonary embolus

      ♠Hypoxemia

      Attention Deficit Hyperactivity Disorder

      ♠Electrolyte imbalance

      ♠Hypercalcemia, hyperparathyroidism

      ♠*Delirium

      ♠*Domestic abuse

      Ehlers Danlos (Hypermobility syndrome)

      Postconcussion syndrome

      Multiple sclerosis

      Restless legs syndrome

      Wilson disease

      ♠Pheochromocytoma

    • Arthralgias

      Viremia (nonspecific, infectious mononucleosis, hepatitis, cytomegalovirus, fifth disease, rubella, mumps, varicella, human immunodeficiency virus)

      Osteoarthritis

      Fibromyalgia

      Reactive arthritis

      Polyarticular gout

      Pseudogout

      Polymyalgia rheumatica

      Ankylosing spondylitis

      Psoriatic arthritis

      Inflammatory bowel disease

      Rheumatoid arthritis

      ♠Hypothyroidism

      Lupus and drug-induced lupus

      Scleroderma

      Ehlers Danlos (Hypermobility syndrome)

      Systemic vasculitis

      Systemic sclerosis

      Polymyositis/dermatomyositis

      Still’s disease

      Behcet syndrome

      Disseminated gonococcemia

      Relapsing polychondritis

      Autoinflammatory disorders

      ♠Adrenal insufficiency

      ♠Lyme disease

      ♠Bacterial endocarditis

      Sarcoidosis

      Palindromic rheumatism

      Hyperlipoproteinemias

      ♠*Malignancy

      ♠Septic joint

      Sickle cell disease

      ♠Compartment syndrome

      ♠Acute myelopathy, radiculopathy, neuropathy

      Polyarteritis nodosa

      Wegener’s granulomatosis

      Amyloidosis

      ♠Rheumatic fever

      Familial Mediterranean Fever

      Whipple’s disease

    • Back Pain

      Musculoskeletal, osteoarthritis, degenerative disk disease

      Herniated disk

      Spinal stenosis

      ♠Gall bladder disease

      Compression fracture

      ♠Pyelonephritis

      Kidney stone

      Pancreatitis, ♠*Pulmonary embolus

      ♠*Pneumonia

      Psychiatric

      Herpes zoster

      Vitamin D deficiency

      Ankylosing spondylitis (sacroiliitis)

      ♠Polymyalgia rheumatica

      Prostatitis

      ♠Cauda equina syndrome

      Back mouse

      Pancreatic carcinoma

      Piriformis syndrome

      Ankylosing spondylitis (sacroiliitis)

      Ehlers Danlos (Hypermobility syndrome)

      ♠*Abdominal or thoracic aortic aneurysm

      ♠*Metastatic tumor

      ♠*Abdominal tumor

      ♠Penetrating ulcer

      ♠Infection (diskitis, osteomyelitis, spinal abscess)

      Iliocostal impingement syndrome

      Retroperitoneal fibrosis

    • Back Pain in Children

      Nonspecific musculoskeletal

      Viral myalgias

      Scheuermann’s kyphosis

      Spondylolysis, spondylolisthesis

      ♠Sickle cell crisis

      Scoliosis

      Psychiatric

      ♠Pyelonephritis

      Back mouse

      Herniated disk

      ♠Pneumonia

      ♠Leukemia or lymphoma

      Inflammatory spondyloarthropathies (ankylosing spondylitis,

      inflammatory bowel disease, reactive arthritis)

      ♠Trauma, vertebral fracture

      ♠Sacroiliac joint infection

      Syringomyelia

      Kidney stone

      ♠Discitis

      ♠Epidural abscess

      ♠Vertebral osteomyelitis

      Slipped vertebral epiphysis

      Juvenile intervertebral disc calcification

      ♠Tumor

    • Breast pain (mastalgia)

      Idiopathic mastalgia

      Cyclical (physiologic) breast pain

      Fibrocystic disease

      ♠Mastitis

      Chest wall pain

      Large pendulous breasts (Cooper’s ligament stretching)

      Caffeine, nicotine

      ♠Pregnancy

      Hormone replacement therapy

      Drugs (antibiotics, antidepressants, antipsychotics, estrogen,

      progesterone, clomiphene, antihypertensives,

      metronidazole, ketoconazole, spironolactone)

      Benign tumors

      ♠Inflammatory breast cancer

      Referred pain

      Trauma

      Psychiatric

      Herpes zoster

      Thrombophlebitis

      Macrocysts

      Ductal ectasia

      ♠Cancer

      ♠Myocardial infarction

      ♠Pulmonary embolus

      Gastroesophageal reflux disease

      Pleurisy, pericarditis

      Sickle cell disease

      Hydradenitis supprativa

      Prior breast surgery

      Spinal disorders

      Gall bladder disease

      Heart disease

      Post thoracotomy syndrome

    • Chest pain

      Chest wall pain

      Gastroesophageal reflux disease

      Pleurisy, pleuritis

      *Psychiatric

      Asthma

      ♠*Coronary disease (myocardial infarction, angina)

      ♠*Pulmonary embolus

      Herpes zoster

      ♠*Pneumonia, bronchitis

      ♠Pneumothorax

      Esophageal spasm

      Pericarditis, myocarditis

      Mitral valve prolapse

      Idiopathic chest pain

      ♠Acute chest syndrome (sickle cell anemia)

      ♠Tuberculosis

      ♠Aortic stenosis

      ♠*Dissecting aortic aneurysm

      ♠*Tumor

      Pulmonary hypertension

      ♠Esophageal rupture

      Precordial catch syndrome

      ♠Mediastinitis

      ♠*Spinal cord compression

    • Cold feeling

      Idiopathic

      Advanced age, thin woman

      Psychiatric (anxiety)

      ♠Hypothyroidism

      ♠Shock

      ♠Sepsis

      Raynaud's phenomenon

      Anemia

      Weight loss, malnutrition

      Chronic illness

      ♠Hypoglycemia

    • Constipation

      Functional (Idiopathic)

      Medications (anticholinergics. antidepressants, antipsychotics,

      opiates, iron, calcium channel blockers)

      Pregnancy

      Hypercalcaemia from any cause

      Diabetic neuropathy

      Depression

      Hypokalemia

      Anorexia nervosa

      Hypothyroidism

      Obstruction

      Multiple sclerosis

      Spinal cord injury

      Parkinson disease

      Myotonic dystrophy

      Systemic sclerosis

      Hirschprung disease

    • Cough

      Viral upper respiratory infection

      Postnasal drip

      Postinfectious, postviral cough

      Bronchitis

      Asthma, chronic obstructive pulmonary disease

      Gastroesophageal reflux

      *Drugs (angiotensin converting enzyme inhibitors, beta

      blockers, amiodarone)

      ♠*Pneumonia

      External or middle ear disease

      Aspiration, recurrent

      ♠*Pulmonary embolus

      ♠Pertussis

      Psychogenic

      ♠*Heart failure

      ♠Human immunodeficiency virus

      ♠*Lung tumor

      ♠Epiglottitis

      ♠Acute histoplasmosis

      Interstitial lung disease

      Bronchiectasis

      ♠Sarcoidosis

      ♠*Tuberculosis

      ♠Cystic fibrosis

      ♠Laryngeal tumor

      ♠Mitral stenosis

      ♠Foreign body

    • Cough, dyspnoea (infant, newborn)

      Viral upper respiratory infection

      Respiratory syncytial virus (RSV)

      Parainfluenza

      Transient tachypnea

      ♠Sepsis

      Bronchiolitis

      Infant respiratory distress syndrome

      Metapneumovirus

      Influenza

      ♠Pertussis

      ♠Pneumothorax

      ♠Pneumonia

      Asthma

      ♠Heart disease

    • Crying infant (Inconsolable)

      Idiopathic

      Colic

      ♠Infections (otitis media, viral illness, urinary tract infection,

      herpes stomatitis, meningitis, osteomyelitis, septic

      joint, thrush)

      Neonatal abstinence syndrome (maternal drug use)

      ♠Fracture

      Anal fissure

      Corneal abrasion

      Constipation

      Immunization reaction

      ♠Hair tourniquet syndrome (digits, penis)

    • Delirium

      ♠*Drugs (opioids, hypnotics, antipsychotics, antihistamines)

      *Psychiatric disorders

      ♠Alcohol

      ♠*Anemia

      ♠*Glucose disturbances

      ♠Serotonin syndrome

      ♠Trauma

      ♠Head injury

      ♠*Myocardial infarction

      ♠Carbon monoxide

      ♠Sepsis

      Serious illness

      ♠Electrolyte disturbance, Na, Ca, Mg, P

      ♠Thyroid disease

      ♠Hypoxia

      ♠Neuroleptic malignant syndrome

      ♠Hypertensive encephalopathy

      ♠Central nervous system infections (neurosyphilis, human

      immunodeficiency virus, herpes simplex)

      ♠Brain mass

      ♠Hypothermia

      ♠Hyperthermia

      ♠B12 deficiency

      ♠Folate deficiency

      ♠Thiamine deficiency

      ♠Liver failure

      ♠Stroke, intracranial hemorrhage

      ♠*Heart failure

      Fecal impaction, urinary retention

      ♠Renal failure

      Burns

      Postpartum psychosis

      ♠Adrenal disease

      ♠Porphyria

      ♠Nonconvulsive status epilepticus

    • Dementia, memory loss

      Alzheimer disease

      ♠Pseudodementia (depression)

      Mild cognitive impairment

      ♠Medications (antihistamines)

      Alcohol, Wernicke Korsakoff

      Vascular dementia

      Frontotemporal dementia

      Lewy body dementia

      Parkinson disease

      ♠Vitamin B12 deficiency

      ♠Hypothyroidism

      ♠*Delirium

      ♠Anoxia

      ♠Hypoglycemia

      ♠Head injury, subdural hematoma

      Transient global amnesia

      *Human immunodeficiency virus associated dementia

      Huntington disease

      ♠*Brain tumor

      Progressive supranuclear palsy

      ♠Structural brain disease

      ♠Hypercalcemia, hyperparathyroidism

      Prion disease (e.g., Creutzfeldt-Jacob)

      Dementia pugilistica

      Progressive multifocal leukoencephalopathy

      ♠Normal pressure hydrocephalus

      ♠Niacin deficiency

      Corticobasal degeneration

      Paraneoplastic syndrome

      ♠Whipple’s disease

    • Depigmentation, hypopigmentation of skin

      Vitiligo

      Tinea versicolor

      Idiopathic guttate hypomelanosis

      Postinflammatory hypopigmentation

      Pityriasis alba

      Halo nevi

      Chemically induced (phenols)

      Nevus depigmentosus

      Hypomelanosis of Ito

      Piebaldism

      Morphea

      Leukoderma

      Lichen sclerosis

      Tuberous sclerosis

      Albinism

      ♠Leprosy

    • Diarrhoea

      Viral gastroenteritis

      Irritable bowel syndrome

      *Drugs (antibiotics, caffeine, alcohol, magnesium, aminosalicylaes, NSAIDs, beta blockers, digoxin)

      Salmonella

      Shigella

      E. coli O157 H7

      Campylobacter

      Clostridium difficile

      Food poisoning

      Lactose intolerance, fructose intolerance

      Bacterial overgrowth (e.g., diabetes, blind loop after surgery)

      Diabetes

      Giardia

      Diverticular disease

      Microscopic colitis

      Entamoeba histolytica

      Cryptosporidium

      Inflammatory bowel disease

      Celiac disease

      Malignancy (colon, ovarian, carcinoid, pancreatic endocrine tumours [VIPoma, gastrinoma, somastisatinoma, PET releasing calcitonin, glucagonoma] thyroid medullary carcinoma, systemic mastocytosis)

      Thyrotoxicosis

      Yersinia

      Radiation colitis

      Ischemic colitis

      Fecal impaction with leakage

      Bypass operations

      Reduced bile salts (e.g., postcholecystectomy)

      Pancreatic insufficiency (pancreatitis, cystic fibrosis, cancer)

      Blastocystis hominis

      Scleroderma

      Toxic shock syndrome

      ♠*Human immunodeficiency virus

      Laxative abuse

      Cystic fibrosis

      ♠Whipple’s disease

    • Dizziness, ill-defined

      Vasovagal

      Benign paroxysmal positional vertigo

      Hyperventilation

      *Drugs (antihypertensives, antidepressants, gentamicin, furosemide, alcohol, illicit drugs)

      Panic attack

      Elderly multifactorial

      Orthostatic hypotension Subclavian steal

      Autonomic insufficiency Atrial myxoma

      Meniere's disease

      Vestibular neuronitis, acute labyrinthitis

      Valsalva

      ♠*Anemia

      Idiopathic

      ♠Arrhythmias

      ♠Hypoglycemia

      Psychiatric

      ♠Seizure, pseudoseizure

      ♠GI bleeding

      ♠Valvular heart disease, aortic stenosis

      ♠*Pulmonary embolus

      ♠*Myocardial infarction

      ♠Hypoxia

      ♠Aortic dissection

      ♠Acoustic neuroma

      Post-concussion syndrome

      Parkinson disease

      ♠Otitis media

      Barotrauma, ruptured oval window, perilymph leak

      Migrainous vertigo

      ♠Adrenal insufficiency, Addison's disease

      Otosclerosis

      Carotid hypersensitivity

      ♠Vertebral artery dissection

      ♠*Brain stem stroke

      Cough, micturition, defecation

      ♠Hypertrophic cardiomyopathy

      ♠Cardiac tamponade

      ♠Multiple Sclerosis

    • Dysphagia

      Esophageal spasm

      Lower esophageal ring (schatzke’s ring)

      Functional dysphagia

      Globus sensation

      Esophageal web

      Peptic stricture

      Esophageal diverticulum

      *drugs (anticholinergics, phenothiazines)

      Nutcracker esophagus

      Zenker’s diverticulum

      Sjogren’s syndrome

      Achalasia

      ♠*Stroke

      ♠*Tumor (intrinsic or extrinsic)

      Multiple sclerosis

      Parkinson’s disease

      Tardive dyskinesia

      Amyloidosis

      Cushing’s disease

      Wilson’s disease

      Amyotrophic lateral sclerosis

      Scleroderma

      Myasthenia gravis

      Guillain-Barre’ syndrome

    • Dyspnea, tachypnea, shortness of breath

      Asthma, chronic obstructive pulmonary disease

      Fever

      Deconditioning

      ♠*Pneumonia

      Physiologic dyspnoea of pregnancy

      Bronchitis

      *Psychiatric, hyperventilation, panic attack

      ♠*Heart failure

      ♠*Pulmonary embolus

      ♠*Myocardial infarction

      ♠Pneumothorax

      ♠Cardiomyopathy

      ♠Shock

      ♠*Anemia

      ♠*Tumor

      ♠Pleural effusion

      ♠Valvular heart disease

      ♠Pulmonary hypertension

      Interstitial fibrosis

      ♠Metabolic acidosis

      Drugs (aspirin)

      Arrhythmias, atrial fibrillation

      Abdominal distension, obesity

      ♠Cardiac tamponade

      ♠Upper airway obstruction

      Myasthenia gravis

      ♠Neuroleptic malignant syndrome

      ♠Hyperthyroidism

      ♠Foreign body aspiration

      ♠Increased intracranial pressure

      Wegener’s granulomatosis

    • Ear pain, otalgia

      Acute otitis media, otitis media with effusion

      TMJ syndrome Eagle's syndrome

      External otitis or external canal pustule

      Cerumen

      Viral myringitis

      Dental causes

      Pharyngitis

      Barotrauma

      Foreign body

      Idiopathic

      Cervical adenopathy

      Cellulitis, chondritis, perichondritis

      ♠Acoustic neuroma

      ♠*Myocardial infarction

      ♠Nasopharyngeal tumor

      ♠Temporal arteritis

      ♠Cholesteotoma

      Sinusitis

      Carotidynia

      Trauma

      ♠Mastoiditis

      Gastroesophageal reflux

      ♠Tumors (ear, nasopharyngeal)

      Bell's palsy

      Wegener's granulomatosis

      Cervical disc disease

      Ramsey Hunt syndrome

      Relapsing polychondritis

      ♠Malignant external otitis

      ♠Coronary disease

      ♠Thoracic aneurysm

      ♠*Psychogenic (depression, anxiety)

      ♠Thyroid tumor

      Salivary gland disorder

      Neuralgias (trigeminal, glossopharyngeal)

    • Edema, leg

      Venous insufficiency, dependency, garments

      Obstructive sleep apnoea (resulting in pulmonary hypertension)

      Cellulitis

      Stasis dermatitis

      *Drugs (NSAIDS, Ca channel blockers, steroids,

      antidepressants, beta blockers, clonidine,

      estrogen/progesterone)

      ♠Deep vein thrombosis

      ♠*Heart failure

      Baker's cyst rupture

      Ruptured gastrocnemius

      Complex regional pain syndrome

      ♠*Pelvic Tumor

      Idiopathic

      Hypoalbuminemia

      Cirrhosis

      Lymphedema

      Mechanical edema (post injury or surgery)

      Renal failure, nephrotic syndrome

      Heart valve disease (pulmonic, tricuspid)

      ♠Myxedema

      ♠Constrictive pericarditis

      Retroperitoneal fibrosis

    • Eye pain

      Conjunctivitis

      Corneal abrasion

      Foreign body

      Stye (hordeolum)

      Chalazion

      Blepharitis

      Scleritis, episcleritis

      ♠Angle-closure Glaucoma

      Migraine

      Entropion

      Migraine or cluster headaches

      ♠Ophthalmic zoster

      ♠Intracranial mass

      Optic neuritis (multiple sclerosis)

      ♠Giant cell arteritis

      Uveitis, iritis

      Optic neuritis

    • Eyelid swelling

      Bilateral

      Contact dermatitis

      Blepharitis

      Atopic dermatitis

      Rosacea

      Angioedema

      Systemic processes (myxedema, renal disease, congestive

      heart failure, superior vena cava syndrome)

      ♠Cavernous sinus thrombosis

      Unilateral

      ♠Orbital cellulitis

      Hordeolum, stye

      Chalazion

      ♠Herpes simplex

      ♠Herpes zoster ophthalmicus

      Dacryocystits

      Tumors

    • Facial flushing, hot flashes

      Emotional

      Menopause

      Alcohol

      Rosacea

      Drugs (calcium-channel blockers, nicotinic acid, levodopa,

      others)

      Heat exposure

      Exercise

      ♠Fever

      Foods (spicy foods, cured meats, monosodium glutamate)

      ♠Carcinoid

      Cluster headache

      ♠Serotonin syndrome

      Dumping syndrome

      ♠Bronchogenic carcinoma

      ♠Medullary thyroid carcinoma

      Sarcoidosis

      Hyperthyroidism

      Systemic mastocytosis

      ♠Pheochromocytoma

    • Facial pain

      Sinusitis

      Dental pain

      Temporomandibular joint syndrome

      Trigeminal neuralgia

      Herpes zoster

      Salivary gland disorders

      Migraine

      ♠Temporal arteritis

      ♠Glaucoma

      Persistent idiopathic facial pain

      Dacryocystitis

      ♠*Coronary disease

      ♠*Aortic aneurysm

      Recurrent painful ophthalmoplegic neuropathy

      Lung cancer

    • Falls in the elderly

      Multifactorial

      Balance disorder

      Idiopathic

      Environmental factors (new surroundings, walking surface

      hazards)

      Arthritis

      Muscle weakness

      ♠Acute illness

      Drugs (sedatives, hypnotics, antidepressants,

      antihypertensives)

      Alcohol

      Peripheral neuropathy (diabetes, B12 deficiency)

      Poor footwear

      Confusion, Dementia

      Vestibular dysfunction

      ♠Orthostatic hypotension

      Postprandial hypotension

      Vitamin D deficiency

      Visual disorder

      ♠Syncope

      Parkinson disease

    • Fatigue, malaise, vague symptoms

      Obstructive sleep apnea

      ♠Depression, anxiety Lupus

      Deconditioning ♠*Delirium

      *Drugs (beta blocker, clonidine) ♠Hypopituitarism

      Chronic fatigue syndrome, fibromyalgia ♠Botulism

      ♠*Infections (infectious mononucleosis, hepatitis, pneumonia, mastitis, urosepsis, cytomegalovirus, tuberculosis,

      endocarditis, human immunodeficiency syndrome,

      Lyme, Coccidiomycosis, Giardia)

      ♠Pregnancy

      ♠*Anemia Polyarteritis nodosa

      Vitamin D deficiency Black widow spider bite

      ♠Hypothyroidism, hyperthyroidism

      ♠Hypokalemia, hyponatremia

      ♠*Myocardial infarction

      Restless legs syndrome

      ♠Peripheral neuropathy (diabetes)

      ♠Cancer, lymphoma

      ♠Disturbance of calcium, phosphorus, magnesium

      ♠Polymyalgia rheumatica/Temporal arteritis

      Parkinson disease

      Hypogonadism

      ♠Celiac disease

      Pulmonary, hepatic, renal failure

      Pulmonary hypertension

      *Ehlers Danlos syndrome

      ♠*Heart failure, myocarditis

      Multiple sclerosis

      ♠Carbon monoxide

      Rheumatoid arthritis

      ♠Adrenal insufficiency, Addison’s disease

      Vitamin B12 deficiency

      ♠Guillain-Barré syndrome

      Post-Lyme disease syndrome

      Myasthenia gravis

      Wegener’s granulomatosis

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    • Fever (acute, uncertain source)

      ♠Infections (pulmonary, gastrointestinal, urinary, sinusitis, skin,

      *meningitis, bone, infectious mononucleosis, Lyme,

      cytomegalovirus, occult abscess, *human

      Immunodeficiency virus, malaria, mastitis, West Nile,

      endocarditis, leptospirosis, tuberculosis, hepatitis)

      ♠Polymyalgia rheumatica

      ♠*Malignancy, tumor lysis syndrome (lymphoma, leukemia,

      renal cell, liver)

      ♠*Myocardial infarction

      ♠*Pulmonary embolus, deep vein thrombosis

      Surgical site inflammation (seroma, hematoma)

      ♠Transfusion reaction

      ♠Stroke, subarachnoid hemorrhage, intracranial hemorrhage

      ♠Head trauma

      ♠*Brain tumor

      ♠Serotonin syndrome

      ♠Necrotizing fasciitis

      ♠Heat stroke

      Gout

      ♠Bowel ischemia, infarction

      ♠Hyperthyroidism

      Connective tissue disorder (autoimmune, lupus)

      Pancreatitis

      Toxic shock syndrome

      *Drugs (antibiotics, heparin, phenytoin)

      *Drug withdrawal (alcohol, opiates, barbiturates, benzodiazepines)

      ♠Malignant hyperthermia

      Sarcoidosis

      Inflammatory bowel disease

      ♠Neuroleptic malignant syndrome

      Periodic fever syndromes (PFAPA (periodic fever with

      aphthous stomatitis, pharyngitis and adenitis) Familial

      Mediterranean Fever, others)

      Factitious

      Wegener’s, polyarteritis nodosa

    • Flank pain

      Musculoskeletal

      ♠Kidney stone

      ♠Pyelonephritis, renal abscess

      ♠Diverticulitis

      Herpes zoster

      ♠*Pneumonia

      Influenza

      Polycystic kidney disease

      ♠*Ruptured aneurysm

      Renal infarction

      Renal tumor

      Papillary necrosis

      Slipping rib syndrome

      Iliocostal friction syndrome

      Loin pain hematuria syndrome

    • Genital skin lesion, genital ulcer

      Herpes simplex

      Behcet's disease

      ♠Cancer

      Trauma

      Drug reactions, fixed drug eruption

      Vestibulitis

      Bartholin abscess

      Lichen sclerosis

      Lichen simplex chronicus

      Psoriasis

      Lichen planus

      ♠Syphilis

      Chancroid

      Lymphogranuloma venereum

      Granuloma inguinale

      Primary Human immunodeficiency virus

      Cytomegalovirus

      Epstein-Barr virus

    • Groin pain

      Groin muscle pull

      Sports hernia

      Hip arthritis

      Labral tear

      Inguinal hernia

      Hip stress fracture

      Osteitis pubis

      Distal abdominal rectus strain

      Adductor longus rupture

      Hip osteonecrosis (glucocorticoid use)

      Hip synovitis

      Hip septic arthritis

    • Hair Loss

      Male pattern baldness

      Androgenetic alopecia (female pattern hair loss)

      Telogen effluvium (illness, pregnancy, weight loss)

      Alopecia areata

      Traction alopecia

      Medications (anticoagulants, anticonvulsants, hormones, antilipid

      agents, antihypertensives)

      Tinea capitis

      Trichotillomania

      Iron deficiency

      Thyroid dysfunction

      Discoid lupus

      Anagen effluvium (chemotherapy, radiation)

      Loose anagen syndrome

      Inherited disorders

      Primary cicatricial (scarring) alopecias

    • Headache

      Daily withdrawal headaches

      Migraine Reversible cerebral vasoconstriction syndrome

      Tension type headache Vasculitis

      Caffeine withdrawal Pituitary apoplexy

      *Drug adverse effect

      Sinusitis

      Viral syndrome, febrile illness

      Temporomandibular joint syndrome

      Cervical arthritis

      Spinal headache (post lumbar puncture)

      ♠Temporal arteritis

      ♠*Subarachnoid hemorrhage

      ♠Herpes Zoster

      Occipital neuralgia

      ♠Carbon monoxide

      ♠Acute severe hypertension

      Toxic exposures

      Postconcussion syndrome

      Idiopathic thunderclap

      ♠Preeclampsia

      ♠Glaucoma

      ♠*Meningitis/encephalitis/brain abscess

      ♠Cerebral aneurysm

      ♠*Domestic abuse

      ♠Subdural hematoma

      Neuralgias (e.g., trigeminal neuralgia)

      Pseudotumor cerebri (intracranial hypertension)

      Cluster headache

      ♠HSV encephalitis

      ♠*Brain tumor

      ♠*Stroke

      ♠Human immunodeficiency virus

      ♠Arterial dissections

      ♠Cerebral venous sinus thrombosis

      Spontaneous intracranial hypotension

    • Hearing loss (deafness)

      Presbycusis

      Cerumen

      ♠Otitis media, otitis externa

      Noise exposure

      ♠Acoustic neuroma

      Meniere's disease

      Otosclerosis

      ♠Sudden sensorineural hearing loss

      Viral cochleitis (herpes, influenza, mumps, others)

      ♠Drugs (aspirin, gentamicin, furosemide, cisplatin)

      ♠Stroke

      ♠Hereditary, congenital hearing loss

      Trauma, barotrauma

      ♠Cholesteatoma

      ♠Meningitis

      ♠Neoplasm

      Autoimmune hearing loss

      Stroke, transient ischemic attack

      Multiple sclerosis

      Diabetes

      ♠Lyme disease

      ♠Syphilis

      Superior semicircular canal dehiscence

    • Hematuria

      Transient unexplained hematuria

      ♠Urinary tract infection

      Stones

      Menstruation (contaminated urine)

      Exercise

      Trauma

      Benign prostatic hypertrophy

      Atrophic vaginitis

      ♠Tumor

      Prostatitis

      Radiation cystitis

      Factitious (finger stick)

      Glomerular disease (IgA nephropathy, hereditary nephritis,

      postinfectious glomerulonephritis)

      Hypercalciuria

      Polycystic kidney disease

      Urethritis

      Papillary necrosis (nonsteroidal antiinflammatory drug overuse,

      diabetes, sickle cell)

      Hyperuricosuria

      ♠Renal infarction

      Interstitial nephritis

      Medullary sponge kidney

      ♠Tuberculosis

      Wegener’s granulomatosis

      ♠Renal vein thrombus

      ♠Malignant hypertension

    • Hip pain

      Hip osteoarthritis

      Muscle strain

      ♠*Fracture (occult, pathologic, stress)

      Tendinitis

      Trochanteric bursitis

      Transient synovitis

      Lumbar disk disease

      Meralgia paresthetica

      Osteonecrosis, aseptic necrosis, avascular necrosis

      Aortoiliac vascular occlusive disease

      Sacroiliac joint disease

      Acute synovitis

      ♠Septic arthritis

      Metastatic tumor

      Primary bone tumor

      Herpes zoster

      ♠Osteomyelitis

      Legg Perthes disease

      ♠Slipped capital femoral epiphysis

      Idiopathic chondrolysis

      ♠Psoas abscess

      ♠Leukemia

      Sickle cell crisis

    • Hypotension, shock

      ♠Hemorrhage (trauma, GI bleeding)

      Hypovolemia

      Vomiting, diarrhea

      ♠Pancreatitis

      *Drugs (e.g., antihypertensives)

      ♠Cardiomyopathy

      ♠*Myocardial infarction

      ♠Aortic stenosis

      ♠Arrhythmias

      ♠Peritonitis

      ♠Anaphylaxis

      ♠*Pulmonary embolus

      ♠*Ruptured aneurysm

      ♠*Pneumothorax

      ♠*Sepsis

      ♠Aortic stenosis

      ♠Hypertrophic cardiomyopathy

      ♠Hypothyroidism

      ♠Cardiac tamponade

      ♠Addison's disease/Adrenal insufficiency/ hemorrhage

      ♠Atrial myxoma

    • Insomnia, sleep disturbance

      Primary insomnia (psychophysiologic)

      Depression

      Anxiety

      Poor sleep hygiene

      Obstructive sleep apnea

      Medications, substances (caffeine, nicotine, pseudoephedrine,

      cocaine, steroids, alcohol, others)

      Chronic lung disease

      Menopause

      Nocturia (diuretics, prostate hypertrophy, diabetes,

      incontinence, heart failure)

      Environment (noise, temperature)

      Jet lag

      Chronic pain

      ♠*Delirium

      Restless legs syndrome, nocturnal myoclonus

    • Leg pain, bone pain, extremity pain

      Arthritis

      ♠*Fracture, trauma, stress fracture

      ♠Gout

      Varicose veins

      ♠Cellulitis

      Shin splints

      Tendinitis

      ♠Deep vein thrombosis

      Lumbar disc disease

      Neuropathy (e.g., diabetic)

      Meralgia paresthetica

      Ruptured Baker's cyst

      Ruptured plantaris muscle

      Vitamin D deficiency

      ♠Compartment syndrome

      Claudication

      ♠Rhabdomyolysis

      Ehlers Danlos (Hypermobility syndrome)

      Complex regional pain syndrome

      Diabetic amyotrophy

      Chronic exertional compartment syndrome

      ♠Osteomyelitis

      ♠Arterial occlusion

      Gastrocnemius tear

      ♠Sickle cell crisis

      ♠Bone tumor

      ♠Leukemia

    • Limp in child

      Transient synovitis

      ♠Fractures (toddlers, stress, foot, abuse)

      Soft tissue trauma

      Growing pains

      Chondromalacia patellae

      Osgood-Schlatter's disease

      ♠Slipped capital femoral epiphysis

      Legg-Perthes

      Osteochondritis dessicans

      ♠Hip dysplasia

      ♠Tumors

      Conversion disorder

      ♠Leukemia

      ♠Septic arthritis

      ♠Osteomyelitis

      ♠Diskitis

      Muscular dystrophy

    • Lymphadenopathy

      Viral syndrome

      Infectious mononucleosis

      Cat scratch disease

      ♠Malignancy (lymphoma, leukemia, metastases)

      ♠Human immunodeficiency virus

      ♠*Tuberculosis, atypical mycobacteria

      ♠Tularemia

      Lupus

      ♠Fungal infection (histoplasmosis, coccidiomycosis,

      cryptococcis)

      Medications (phenytoin, serum sickness)

      ♠Brucellosis

      ♠Leptospirosis

      ♠Syphilis

      ♠Lyme disease

      Sacoidosis

      Amyloidosis

      Rubella

    • Mental status, acute change (coma, lethargy)

      ♠*Delirium

      Alcohol

      Psychosis

      Drug overdose

      ♠Hypoglycemia

      ♠*Intracranial hemorrhage

      Seizure (postictal)

      ♠Urinary Retention

      ♠Hypoxia

      ♠CO2 narcosis

      ♠*Pneumonia

      ♠Head trauma

      ♠Sepsis

      ♠Meningitis, encephalitis

      ♠Electrolyte abnormality

      Psychiatric

      ♠Hyperglycemic hyperosmolar state, diabetic ketoacidosis

      ♠*Heart failure

      ♠Status epilepticus

      ♠Hypotension

      ♠Brain stem stroke

      ♠Disturbance of Ca, Mg, Na, K, P

      ♠Thyroid disease (myxedema)

      ♠Heat stroke

      ♠Hypothermia

      ♠Liver failure (hepatic encephalopathy)

      ♠Renal failure (uremic encephalopathy)

      ♠Brain tumor with herniation

    • Mouth pain, burning mouth, burning tongue

      Burning mouth syndrome (idiopathic)

      Psychiatric disorders

      Aphthous stomatitis

      Xerostomia (drugs, connective tissue disease, old age, Sjogrens, radiation therapy, chemotherapy)

      ♠Nutritional deficiencies (vitamin B12, iron, folate, zinc, vitamin

      B6)

      Allergic contact stomatitis

      Geographic tongue

      Candidiasis

      Diabetes

      Denture-related pain

      Herpes stomatitis

      Thyroid abnormalities

      Menopause

      Lichen planus

    • Mouth ulcers

      Aphthous stomatitis

      Herpes simplex

      Trauma

      Oral candida

      Hand, foot, and mouth disease

      Herpangina

      ♠Primary Human Immunodeficiency Virus infection

      Drug reaction

      Behcet's disease

      Erythema multiforme

      Stevens Johnson syndrome

      Lichen planus

      Chicken pox

      Pemphigus, bullous pemphigoid

      Reactive arthritis

      ♠Squamous cell carcinoma

      Necrotizing ulcerative gingivostomatitis (Vincent’s

      fusospirochetal disease)

      Inflammatory bowel disease

      ♠Syphilis

    • Muscle cramps

      Idiopathic, ordinary, nocturnal

      Pregnancy

      Heat-induced (volume depletion, hyponatremia)

      Exercise induced cramps

      *Medications (nifedipine, inhaled beta agonists, thiazides, beta

      blockers, cisplatin, vincristine, oral contraceptives,

      others)

      Hemodialysis (volume and electrolyte shifts)

      Lower motor neuron (injury, amyotrophic lateral sclerosis,

      compression)

      Writer's cramp

      Diabetes

      Parkinson’s disease

      Hypocalcemia

      Ehlers Danlos (hypermobility) syndrome

      Hypomagnesemia

      Respiratory alkalosis

      Parkinson disease

      Peripheral vascular disease

      Hypokalemia

      Thyroid disease

      McArdle's disease (glycogen storage disease)

    • Myalgias, generalized

      Viral syndrome, infections

      Fibromyalgia

      ♠*Statins

      Influenza

      Vitamin D deficiency

      ♠Hypothyroidism

      ♠Polymyalgia rheumatica

      ♠Rhabdomyolysis

      Polymyositis, dermatomyositis

      *Psychiatric

      ♠*Domestic abuse

      ♠Lyme disease

      Ehlers Danlos (Hypermobility syndrome)

      ♠Adrenal insufficiency

      ♠*Human immunodeficiency virus

      ♠Hypophosphatemia

      Lupus

      Rheumatoid arthritis

    • Nausea, vomiting

      Gastroenteritis, gastritis

      *Drugs (opioids, iron, chemotherapy)

      ♠Pregnancy Cannabinoid hyperemesis

      Migraine ♠Diverticulitis

      ♠*Appendicitis ♠Carbon monoxide

      ♠Bowel obstruction ♠Addison's disease, adrenal insufficiency

      Gastroparesis (diabetes) ♠Serotonin syndrome

      Eating disorder Cyclic vomiting syndrome

      ♠Pyelonephritis Acute intermittent porphyria

      Irritable bowel syndrome Parathyroid disorders

      Vertigo Superior mesenteric artery syndrome

      Peptic ulcer disease

      Psychogenic vomiting, anxiety, depression

      Pain (especially visceral)

      Severe coughing

      Pancreatitis

      ♠Cholecystitis

      ♠Brain tumor

      Pseudotumor cerebri

      ♠*Pancreatic carcinoma

      ♠Hepatitis

      ♠*Myocardial infarction

      Crohn's disease

      ♠Glaucoma

      ♠*Human immunodeficiency virus

      Mesenteric ischemia

      ♠Lymphoma

      ♠*Intracranial hemorrhage

      ♠Intracranial abscess, meningitis

      Inner ear (e.g., labyrinthitis, Meniere's)

      ♠Uremia

      ♠*Diabetic ketoacidosis

      Lactose intolerance

      Food poisoning

      ♠Thyroid disorders xx

      ♠*Congestive heart failure

    • Neck pain

      Cervical sprain

      Osteoarthritis

      Cervical lymphadenitis

      Cervical disk disease

      Shoulder pathology

      Carotidynia

      Migraine

      Occipital neuralgia

      Torticollis

      ♠Subarachnoid hemorrhage

      Psychiatric

      Thyroiditis

      Fibromyalgia

      ♠Soft tissue space infections

      ♠*Myocardial infarction

      ♠Tumor

      Pericarditis

      ♠Meningitis

      ♠Ludwig's angina

      ♠Dissecting aneurysm thoracic aorta

      ♠Internal carotid artery dissection

      ♠Vertebral artery dissection

      ♠Transverse myelitis

      ♠Cervical osteomyelitis

    • Neck mass

      Reactive viral lymphadenopathy (upper respiratory infection,

      infectious mononucleosis, cytomegalovirus)

      Suppurative bacterial lymphadenopathy (strep throat, skin

      infection)

      Thyroid nodule

      Thyroglossal duct cyst

      Benign skin cyst

      Lipoma

      Cat scratch disease

      Dermoid cyst

      Branchial cleft cyst

      Laryngocele

      Tumor, primary or metastatic, lymphoma

      Human immunodeficiency virus

      Tularemia

      Vascular tumors and malformations

      Mycobacteria (scrofula)

      Systemic disease (sarcoid, Sjögren, Kimura, Castleman,

      Rosai-Dorfman)

      Lyme disease

      Mumps

      Chancroid

      Rat-bite fever

      Brucellosis

      Leptospirosis

      Lymphogranuloma venereum

      Typhoid fever

      Measles

      Rubella

      Histoplasmosis, coccidioidomycosis, cryptococcosis

      Toxoplasmosis, leishmaniasis

      Secondary syphilis

    • Numbness, sensory loss, neuropathy

      Diabetes

      Idiopathic peripheral neuropathy

      Compression neuropathy

      Disk disease

      Carpal tunnel syndrome

      Meralgia paresthetica

      Herpes Zoster

      ♠*Stroke

      Multiple sclerosis

      Alcoholism

      Psychiatric, hyperventilation syndrome

      Drugs (vincristine, amiodarone, lithium, others)

      Monoclonal gammopathy

      ♠Guillain-Barré syndrome

      ♠Hypothyroidism

      ♠Cauda equina syndrome

      ♠Multiple myeloma

      ♠Brain or cord tumor

      Amyloidosis

      ♠*Human immunodeficiency virus

      ♠Heavy metal poisoning (lead, mercury)

      Paraneoplastic syndrome

      ♠Hypocalcemia

      Chronic liver disease

      Renal insufficiency

      ♠Lyme disease

      ♠Vitamin B12, folate, B6 deficiency

      Hereditary neuropathies (e.g., Charcot-Marie-Tooth)

      Copper deficiency

      Porphyria

      ♠Leprosy (Hansen’s disease)

    • Pruritus

      Dry skin (xerosis)

      Atopic dermatitis

      Contact dermatitis

      Urticaria

      Bug bites

      Lichen simplex chronicus

      Scabies, lice

      Diabetes

      *Drugs (narcotics, calcium channel blocker,

      hydrochlorothiazide, angiotensin converting enzyme

      inhibitors, salicylates, chloroquine, allergic reaction,

      cholestasis, amphetamines, cocaine)

      Pregnancy, third trimester

      Photodermatitis

      Psychiatric (delusional parasitosis)

      Cholestasis

      Lichen planus

      Dermatitis herpetiformis

      Renal disease (uremia)

      Hepatitis C

      ♠Human immunodeficiency virus

      ♠Malignancy (Hodgkins lymphoma, polycythemia vera)

      ♠Thyroid disease

      ♠Hyperparathyroidism

      Neuropathic pruritus (diabetic neuropathy, genital neural

      impingement)

      *Iron deficiency anemia

      Bullous pemphigoid

      ♠Mycosis fungoides

      Grover disease

    • Rash, generalized

      Eczema, atopic

      ♠*Drug reaction Erythema nodosum

      Contact dermatitis Generalized granuloma annulare

      Insect bites ♠Toxic shock syndrome

      Viral exanthem Swimmer’s itch, Seabather’s eruption

      Urticaria ♠Meningococcemia

      Poison ivy ♠Rocky Mountain Spotted Fever

      Folliculitis ♠Secondary syphilis

      Seborrheic dermatitis Disseminated varicella zoster

      Tinea versicolor ♠Measles

      Psoriasis (plaque, pustular, erythroderm) ♠Rubella

      Tinea corporis Sweet's syndrome

      Guttate psoriasis Grover’s disease

      Candida Acute generalized exanthematous pustulosis

      Keratosis pilaris Dermatomyositis

      Pityriasis rosea Darier’s disease

      Lichen planus ♠Leprosy (Hansen’s disease)

      Roseola

      Scabies

      Numular eczema

      ♠Fifth Disease

      ♠Lyme disease

      Miliaria rubra (prickly heat), miliaria crystallina

      ♠Mycosis fungoides

      ♠Erythema multiforme

      Dermatitis herpetiformis

      Id reaction

      ♠Scarlet Fever

      ♠Stevens-Johnson syndrome

      ♠Kawasaki's disease

      Unilateral lateral thoracic syndrome

      Chicken pox (Varicella)

      ♠Human immunodeficiency virus acute exanthem

      Lupus (subacute cutaneous)

      Disseminated bullous impetigo

      Eruptive xanthomas

    • Red eye

      Viral conjunctivitis

      Allergic conjunctivitis

      Stye (hordeolum)

      Chalazion

      Blepharitis

      Dry eye syndrome (keratoconjunctivits sicca)

      Subconjunctival hemorrhage

      Contact lens over wear

      Episcleritis

      ♠Foreign body

      Corneal abrasion

      Trauma

      ♠Herpes zoster

      ♠Chlamydia

      ♠Bacterial conjunctivitis

      ♠Scleritis

      ♠Chemical burn

      ♠Iritis (acute anterior uveitis)

      ♠Keratitis, bacterial or viral

      ♠Acute angle closure glaucoma

      ♠Hyperthyroidism

      Cluster headache

    • Red skin patch

      Cellulitis

      Candida

      Eczema, atopic

      Nummular eczema

      Contact dermatitis

      Bug bite reactions

      Impetigo

      Psoriasis

      Tinea

      Pityriasis rosea herald patch

      ♠Basal cell carcinoma

      Discoid lupus

      Fixed drug eruption

      ♠Lyme disease

      ♠Mycosis fungoides

    • Rhinorrhea, nasal congestion

      Viral upper respiratory infection

      Allergic Rhinitis

      Vasomotor rhinitis

      Sinusitis

      Septal deviation

      Rhinitis of pregnancy

      Nasal polyps

      Rhinitis medicamentosa

      Adenoid hypertrophy

      Gustatory rhinitis

      Foreign body

      ♠Cerebrospinal fluid rhinorrhea

      Nonallergic rhinitis with eosinophilia syndrome

      Intranasal cocaine

      Medications (estrogen, progesterone, aspirin, nonsteroidal

      antiinflammatory drugs, clonidine, prazosin,

      doxazosin, beta blockers, calcium channel blockers,

      thiazides, angiotensin converting enzyme inhibitors,

      erectile dysfunction drugs, amitriptyline, risperidone,

      gabapentin)

      Atrophic rhinitis

      ♠Cystic fibrosis

      ♠Nasal tumors

      Ovulatory rhinitis

      ♠Hypothyroidism

      Wegener’s granulomatosis

      ♠Midline granuloma

      Sarcoidosis

    • Scrotal pain

      Idiopathic orchialgia

      Epididymitis

      Orchitis (e.g., mumps, viral, bacterial)

      Post-vasectomy pain syndrome

      Inguinal hernia

      Ureteral stone

      Hydrocele

      Varicocele

      ♠Testicular torsion

      Acute idiopathic scrotal edema

      Torsion of appendix testis

      ♠Fornier's gangrene

      ♠Testicular cancer

      Henoch Schonlein purpura

    • Seizure and seizure mimics

      Febrile seizures

      Breath holding spells (children)

      Imitators (vasovagal syncope, pseudoseizures (now called

      psychogenic nonepileptic events), transient ischemic

      attack, arrhythmia, migraine)

      Epilepsy (idiopathic)

      Alcohol and drug withdrawal (benzodiazepines)

      ♠Head trauma

      ♠Hypoglycemia

      ♠Hyponatremia

      Sandifer’s syndrome

      Parasomnias

      Tics

      ♠Hypoxia

      ♠*Stroke

      ♠Brain tumor

      ♠Meningitis, encephalitis

      Vasculitis (systemic lupus erythematosus)

      ♠Drug intoxication (cocaine, amphetamines)

      Uremia

      ♠Hypomagnesemia

      ♠Hypocalcemia

    • Shoulder pain

      Shoulder joint disease (rotator cuff tendinopathy, bicipital

      tendinitis, labral tear, adhesive capsulitis,

      glenohumeral arthritis, acromioclavicular joint arthritis,

      labral tear)

      Cervical radiculopathy (arthritis, disk, tumor)

      Fibromyalgia

      Biliary disease

      ♠*Myocardial ischemia, infarction

      ♠Intra-abdominal bleeding (ectopic, ruptured ovarian cyst)

      ♠*Pneumonia

      ♠Polymyalgia rheumatica

      Herpes zoster

      Brachial plexitis/neuritis (Parsonage-Turner syndrome)

      ♠*Lung tumor, Pancoast tumor

      ♠*Pulmonary embolus

      Psychiatric

      ♠Ruptured abdominal viscus

      ♠Ruptured spleen

      Avascular necrosis humeral head

      ♠Abdominal malignancy

      Pericarditis

    • Sinus tachycardia

      Anxiety, emotional stress

      Pain

      Recent physical exertion

      COPD

      ♠Infections, fever

      Pregnancy (10 to 20 BPM at term)

      *Drugs (alcohol, amitriptyline, amphetamines, anticholinergics,

      beta blocker withdrawal, bupropion, caffeine,

      cilostazol, cocaine, ephedrine, epinephrine,

      isoproterenol, nicotine)

      Diabetic cardiovascular autonomic neuropathy

      ♠*Myocardial infarction

      ♠*Pulmonary embolus

      ♠*Pneumonia

      ♠*Anemia

      ♠Hemorrhage

      ♠Hypotension, shock

      ♠Hypovolemia, dehydration

      ♠Hyperthyroidism

      ♠Hypoglycemia

      ♠Heart failure, pulmonary edema

      ♠Cardiomyopathy, myocarditis

      ♠Pericarditis

      ♠Acute mitral regurgitation

      ♠Pneumothorax

      ♠Aortic insufficiency

      ♠Hypoxia

      ♠Serotonin syndrome

      ♠Neuroleptic malignant syndrome

      Inappropriate sinus tachycardia

      Postural orthostatic tachycardia syndrome (POTS)

      Chronic nonparoxysmal sinus tachycardia

      ♠Pheochromocytoma

    • Sore throat, pharyngitis

      Viral pharyngitis

      Allergies

      ♠Group A streptococci

      Infectious mononucleosis

      Cytomegalovirus

      Influenza

      Thrush

      Uvulitis

      Smoking

      Dry air

      Reflux esophagitis

      ♠Peritonsillar abscess

      Mycoplasma

      ♠Angioedema

      Herpes simplex

      Acute thyroiditis

      ♠Retropharyngeal space infection

      ♠Submandibular space infection

      Arcanobacterium haemolyticum

      ♠Primary human immunodeficiency virus

      ♠Gonorrhea

      ♠Epiglottitis

      ♠*Repeated strangulation in domestic abuse

      ♠Chlamydia pneumoniae

      ♠Tularemia

      ♠Lemierre syndrome (Fusobacterium necrophorum)

      ♠Diphtheria

    • Stroke and stroke mimics

      ♠Ischemic stroke

      Migraine

      Benign headache

      Benign positional vertigo

      ♠Intracerebral hemorrhage

      ♠Subdural hemorrhage

      ♠Subarachnoid hemorrhage

      ♠Brain tumor

      Todd’s Palsy (following seizure)

      ♠Hypoglycemia

      ♠*Drug intoxication

      Syncope

      ♠Head trauma

      Labyrinthitis

      Peripheral neuropathy

      Psychiatric (conversion reaction)

      ♠Systemic infection

      ♠Central nervous system infection

      Multiple sclerosis

      ♠Hyponatremia

      Hepatic encephalopathy

      Guillain Barre’

      Transient global amnesia

      ♠Aortic dissection

      Acute renal failure

    • Sweating, excessive, hyperhidrosis, night sweats

      Excess environmental heat

      Idiopathic, benign

      Menopausal hot flashes

      Anxiety

      *Drugs (antidepressants, triptans, antipyretics, tamoxifen,

      raloxifene, alcohol, beta blockers, calcium channel

      blockers, omeprazole, opioids, tramadol, insulin,

      sulfonylureas, niacin, sildenafil)

      ♠Hyperthyroidism

      Gastroesophageal reflux disease

      ♠Tuberculosis

      ♠Human Immunodeficiency Virus

      ♠Endocarditis

      ♠Bacterial infections

      ♠Hepatitis C

      ♠Carcinoid

      ♠Hypoglycemia

      ♠*Malignancy (lymphoma, solid tumors)

      ♠*Stroke

      Autonomic dysreflexia

      Autonomic neuropathy

      Food additives

      Valley Fever (Coccidiomycosis)

      Mastocytosis

      Spinal cord injury

      ♠Pheochromocytoma

    • Syncope, near syncope

      Vasovagal (emotion, pain, fear, prolonged standing, heat,

      exertion, cough, micturition, no trigger)

      Orthostatic hypotension

      Hyperventilation

      *Drugs, alcohol

      Panic attack

      Autonomic insufficiency

      Valsalva

      ♠*Anemia

      ♠Arrhythmias

      ♠Hypoglycemia

      ♠Seizure, pseudoseizure

      ♠GI bleeding

      ♠Valvular heart disease, aortic stenosis

      ♠*Pulmonary embolus

      ♠*Myocardial infarction

      ♠Hypoxia

      ♠Aortic dissection

      ♠Adrenal insufficiency, Addison's disease

      ♠Long QT syndrome

      ♠Brugada syndrome

      ♠Hypertrophic cardiomyopathy

      Pulmonary hypertension

      ♠Carotid sinus sensitivity

      ♠Cardiac tamponade

      ♠*Cerebrovascular (TIA, stroke)

      ♠Atrial myxoma

    • Tinnitus

      Idiopathic

      Presbycusis

      Noise-induced hearing loss

      Meniere’s disease

      Drugs (aspirin, antibiotics, loop diuretics, chemotherapy)

      Temporomandibular joint disorder

      ♠Acoustic neuroma

      Congenital hearing loss

      Cochlear trauma, barotrauma

      ♠Vascular, pulsatile (arteriovenous malformation, bruit, fistula)

      Stroke

      Otosclerosis

      Multiple sclerosis

      Patulous eustachian tube

      Vestibular schwannoma

      ♠Glomus tumor

    • Tremor

      Physiologic tremor

      Essential tremor, familial tremor

      Anxiety

      Parkinson’s disease

      ♠Hyperthyroidism

      ♠Tardive dyskinesia

      Medications (bronchodilators, caffeine, steroids, lithium, sympathomimetics, antipsychotics, metoclopramide,

      tricyclics, valproic acid)

      Drug withdrawal (alcohol)

      Psychogenic tremor

      Orthostatic tremor

      ♠Cerebellar disease

      ♠Midbrain stroke

      Multiple sclerosis

      ♠Serotonin syndrome

      ♠Carcinoid

      Hepatic encephalopathy

      ♠Wilson's disease

      ♠Pheochromocytoma

    • Urinary symptoms (dysuria, frequency, urgency)

      ♠Urinary tract infection

      ♠Urethritis (chlamydia, gonococcus, unknown)

      Vaginitis

      Atrophic vaginitis

      Genital herpes

      Interstitial cystitis (painful bladder syndrome)

      Overactive bladder

      Idiopathic urgency incontinence

      Irritant urethritis

      Daytime frequency of childhood syndrome

      ♠Prostatitis

      Reactive arthritis (Reiter's syndrome)

      Hypercalciuria

      Psychiatric

      ♠Appendicitis

      ♠Diverticulitis

    • Vertigo

      Benign paroxysmal positional vertigo

      Meniere's disease

      Vestibular neuronitis, acute labyrinthitis

      ♠Acoustic neuroma

      Post-concussion syndrome

      ♠Otitis media

      Barotrauma, ruptured oval window, perilymph leak

      Migrainous vertigo

      Otosclerosis

      ♠Vertebral artery dissection

      Multiple sclerosis

      ♠*Brain stem stroke

      Psychiatric

      ♠Drugs (gentamicin, furosemide, phenytoin, aminoglycosides,

      diazepam, aspirin, alcohol)

    • Weakness

      Cachexia

      ♠Stroke

      Disuse atrophy

      ♠Hypokalemia

      ♠Rhabdomyolysis

      Drugs (cocaine, heroin, alcohol, corticosteroids, colchicine,

      antimalarial drugs, statins)

      ♠Hyponatremia

      Compression neuropathy (e.g., Saturday night palsy)

      Multiple sclerosis

      Myasthenia gravis

      Muscular dystrophy

      Peripheral neuropathy

      Polymyositis

      Dermatomyositis

      ♠Hypothyroidism

      Cushing’s syndrome

      Amyotrophic lateral sclerosis

      Inclusion body myositis

      ♠Hypophosphatemia

      ♠Hypocalcemia

      Viral infections

      ♠Lyme myositis

      ♠Trichinosis

      ♠Toxoplasmosis

    • Weight loss

      ♠Depression

      Chronic obstructive pulmonary disease

      *Drugs

      Dementia

      ♠*Malignancy, lymphoma

      Eating disorder

      Anorexia of aging

      *Diabetes

      ♠Hyperthyroidism

      ♠*Human immunodeficiency virus

      ♠*Tuberculosis

      ♠Adrenal insufficiency

      ♠Uremia

      Liver disease, hepatitis

      Heart failure

      Alcohol

      Illicit drugs

      Social factors (isolation, no money)

      Voluntary (exercise)

      Intestinal parasites

      ♠Celiac disease

      Malabsorption

      Swallowing disorders

      Valley fever (Coccidiomycosis)

      Lupus

      ♠Hypopituitarism

      Inflammatory bowel disease

      Wegener’s granulomatosis

      Polyarteritis nodosa

      ♠Whipple’s disease