.List of all conditions
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Abdominal epigastrium pain
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CBC with dif (anemia, dehydration);
Amylase, lipase (pancreatitis);
H.pylory breathing test (PUD);
Troponin/CK-MP (MI);
ALT/AST/bilirubin/ Alk.phos (Hepatic);
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Endoscopy with biopsy (PUD, Gastrites, GERD, Barret esophagus, Esophigal spasm);
ECG (MI, Pericardites);
CT with contrast (appendix, Aortic Dissetion);
Ab and chest xRay (Pneumonia, Aortic dissection);
FOBT (Mesenteric Ischemia);
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Vital signs; heart and lung exams; abdominal exam, including tenderness, guarding, rebound, Murphy’s sign, and CVA percussion; bowel sounds, aortic bruits.
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GI, Vascular, Cardio, Pneumo, GU;
History: Location, quality, intensity, duration, radiation, timing (relation to meals); associated symptoms (constitutional, GI, cardiac, pulmonary, renal, pelvic); exacerbating and alleviating factors; history of similar symptoms; history of abdominal surgeries, trauma, gallstones, renal stones, atherosclerotic vascular disease; medications (eg, NSAIDs, corticosteroids); alcohol and drug use; domestic violence, stress/anxiety, sexual history, pregnancy history.
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Abdominal mass
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CBC with dif;
ALT/AST/bilirubin/alk.phos;
hCG;
CA-125; CA-199; CEA;
Mantoux test;
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CT;
Endoscopy with biopsy;
ab US;
TV US;
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R/O:
Vital signs; abdominal exam, including tenderness, guarding, rebound, Murphy’s sign, psoas and obturator signs, and CVA percussion; bowel sounds, aortic bruits; pelvic exam (women).
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Vascular: AAA;
GU: renal cell carcinoma; overran cancer with history of ovarian cyst; pregnancy; pancreatic cancer; liver cancer;
GI: colon cancer; diverticulitis;
Musk: Herniation;
Pulmonary: TB;
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Abdominal pain abdominal wall
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Vital signs; heart and lung exams; abdominal exam, including tenderness, guarding, rebound, Murphy’s sign, psoas and obturator signs, and CVA percussion; bowel sounds, aortic bruits; rectal exam; pelvic exam (women).
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MSK; Infection;
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Abdominal Pain and Altered Bowel Habits
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CBC with dif (blood loss);
TSH, T3, T4 (thyroid disorders);
ESR/CRP (inflammation);
FOBT;
Stool for ova and parasites;
Stool leukocytes and culture;
AST/ALT/Bilirubin/ Alk phos;
Electrolytes;
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Endoscopy;
Colonoscopy (after 50 y);
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Vitals – fever, hypotension;
General survey – growth chart (children), hydration status – mucous membranes, tissue turgor, fontanel, peripheral perfusion, urine output;
Thyroid exam – thyroid enlargement;
Abdominal Exam – distention, bowel sounds, tenderness on palpation, palpate fecal impaction, herniation;
Rectal exam – skin excoriation, hemorrhoids, fissures, rectal prolapse, anal sphincter tone;
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Acute < 2 weeks;
Chronic > 2 weeks;
Psychogenic; Endocrine; Infection; Food related; GI; Oncology; Medication; Immunity;
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Abdominal pain and distension
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Abdominal pain diffuse
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Blood gas analysis (test metabolic alkalosis);
Lactate (tissue hypoxia: acute pancreatitis);
Troponin (MI);
Serum glucose (hypoglycemia);
CBC (appendicitis, dehydration, anemia);
Coagulation studies (e.g., INR, PT for surgery);
Electrolytes
LFTs (liver check)
Lipase, amylase (acute pancreatitis, lipase also PUD, intestinal abstraction)
Blood type and screen
ESR/CRP (IBD, peritonitis)
Urinalysis (UTI)
β-hCG urine test (pregnancy or ectopic pregnancy)
Cultures (UTI, sepsis)
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ECG (r/o Acute coronary syndrome)
CT abdomen with IV contrast (bowel perforation, small bowel obstruction, acute pancreatitis, acute pyelonephritis)
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Vital signs; heart and lung exams; abdominal exam, including tenderness, guarding, rebound, psoas and obturator signs; bowel sounds, aortic bruits; rectal exam; pelvic exam (women).
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Endocrine;
GI;
Toxines;
Vascular;
GU;
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Abdominal pain LLQ
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CBC, electrolytes, BUN, Cr, β-hCG;
UA;
CEA; CA-125;
ESR/CRP;
PAP test;
FOBT;
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AB US, transvaginal US, CT
Colonoscopy with biopsy;
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Vital signs; abdominal exam, including tenderness, guarding, rebound, Murphy’s sign, psoas and obturator signs, and CVA percussion; bowel sounds, aortic bruits; rectal exam; pelvic exam (women).
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- GI disorders (e.g. PUD, pancreatitis, IBD, appendicitis, gastroenteritis, IBS, diverticular disease, biliary tract disease);
- urinary tract disorders (e.g. UTI, renal calculi);
- gynecological disorders (e.g. PID, ectopic pregnancy, endometriosis);
- other: DKA, porphyria, hypercalcemia, medications (e.g. NSAIDs), alcohol, lead or iron intoxication; toxic ingestion, foreign body, psychogenic;
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Abdominal pain LUQ
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CBC with diff, blood culture, amylase/lipase,
troponin/CK-MB;
UA;
CEA;
ESR/CRP;
H.pylori;
D-dimer;
PAP test;
FOBT;
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ECG
AB US, CT
Colonoscopy with biopsy;
Endoscopy with biopsy
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Vital signs; heart and lung exams; abdominal exam, including tenderness, guarding, rebound, and CVA percussion; bowel sounds, aortic bruits.
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- GI disorders (e.g. PUD, pancreatitis, IBD, appendicitis, gastroenteritis, IBS, diverticular disease, biliary tract disease);
- urinary tract disorders (e.g. renal calculi);
- cardiovascular disorders (e.g. CAD, AAA, ischemic bowel);
- other: DKA, porphyria, hypercalcemia, medications (e.g. NSAIDs), alcohol, lead or iron intoxication; toxic ingestion, foreign body, psychogenic;
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Abdominal pain RLQ
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CBC, electrolytes, BUN, Cr, β-hCG;
UA;
CEA; CA-125;
ESR/CRP;
PAP test;
FOBT;
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AB US, transvaginal US, CT
Colonoscopy with biopsy;
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Vital signs; abdominal exam, including tenderness, guarding, rebound, Murphy’s sign, psoas and obturator signs, and CVA percussion; bowel sounds, aortic bruits; rectal exam; pelvic exam (women).
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- GI disorders (e.g. PUD, pancreatitis, IBD, appendicitis, gastroenteritis, IBS, diverticular disease, biliary tract disease);
- urinary tract disorders (e.g. UTI, renal calculi);
- gynecological disorders (e.g. PID, ectopic pregnancy, endometriosis);
- other: DKA, porphyria, hypercalcemia, medications (e.g. NSAIDs), alcohol, lead or iron intoxication; toxic ingestion, foreign body, psychogenic;
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Abdominal pain RUQ
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CBC with diff, blood culture, amylase/lipase, ALT/AST, bilirubin,
troponin/CK-MB;
UA;
CEA; AFP;
ESR/CRP;
H.pylori;
D-dimer;
PAP test;
FOBT;
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ECG;
AB US, CT of chest and AB, chest x-ray;
Colonoscopy with biopsy;
Endoscopy with biopsy
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Vital signs; heart and lung exams; abdominal exam, including tenderness, guarding, rebound, Murphy’s sign, psoas and obturator signs, and CVA percussion; bowel sounds, aortic bruits; rectal exam; pelvic exam (women).
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- GI disorders (e.g. PUD, pancreatitis, IBD, appendicitis, gastroenteritis, IBS, diverticular disease, biliary tract disease);
- urinary tract disorders (e.g. renal calculi);
- cardiovascular disorders (e.g. CAD, AAA, ischemic bowel);
- other: DKA, porphyria, hypercalcemia, medications (e.g. NSAIDs), alcohol, lead or iron intoxication; toxic ingestion, foreign body, psychogenic;
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Abdominal periumbilical pain
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CBC with dif (anemia, dehydration);
Amylase, lipase (pancreatitis);
H.pylory breathing test (PUD);
Troponin/CK-MP (MI);
ALT/AST/bilirubin/ Alk.phos (Hepatic);
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Endoscopy with biopsy (PUD, Gastrites, GERD, Barret esophagus, Esophigal spasm);
ECG (MI, Pericardites);
CT with contrast (appendix, Aortic Dissetion);
Ab and chest xRay (Pneumonia, Aortic dissection);
FOBT (Mesenteric Ischemia);
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Vital signs; heart and lung exams; abdominal exam, including tenderness, guarding, rebound, psoas and obturator signs; bowel sounds, aortic bruits.
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GI, Vascular, Cardio, Pneumo, GU;
History: Location, quality, intensity, duration, radiation, timing (relation to meals); associated symptoms (constitutional, GI, cardiac, pulmonary, renal, pelvic); exacerbating and alleviating factors; history of similar symptoms; history of abdominal surgeries, trauma, gallstones, renal stones, atherosclerotic vascular disease; medications (eg, NSAIDs, corticosteroids); alcohol and drug use; domestic violence, stress/anxiety, sexual history, pregnancy history.
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Abdominal suprapubic pain
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CBC with diff, electrolytes, BUN, Cr, β-hCG;
UA;
CEA; CA-125;
ESR/CRP;
PAP test;
FOBT;
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AB US, transvaginal US, CT;
Colonoscopy with biopsy;
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Vital signs; abdominal exam, including tenderness, guarding, rebound, psoas and obturator signs, and CVA percussion; bowel sounds, aortic bruits; rectal exam; pelvic exam (women).
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- GI disorders (e.g. PUD, pancreatitis, IBD, appendicitis, gastroenteritis, IBS, diverticular disease, biliary tract disease);
- urinary tract disorders (e.g. UTI, renal calculi);
- gynecological disorders (e.g. PID, ectopic pregnancy, endometriosis);
- other: DKA, porphyria, hypercalcemia, medications (e.g. NSAIDs), alcohol, lead or iron intoxication; toxic ingestion, foreign body, psychogenic;
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Acute Back pain
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MRI (R/O critical conditions)
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Vital signs; neurologic exam (especially L4–S1 nerve roots); back palpation and range of motion (although rarely of diagnostic utility); hip exam (can refer pain to the back); consider rectal exam.
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Location, quality, intensity, radiation, context (moving furniture, bending/twisting, trauma), timing (disturbs sleep); associated symptoms (especially constitutional, incontinence); exacerbating and alleviating factors; history of cancer, recurrent UTIs, diabetes, renal stones, IV drug use, smoking.
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Acute Cough
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Blood culture (bronchitis, pneumonia);
CBC with dif (infections);
BNP (CHF);
Sputum culture (infections: TB);
Consider throat swab;
D-dimer (PE);
Upper GI tests;
Serum/urinary antigen tests for pneumococcal pneumonia and Legionella;
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Chest x-Ray (pneumonia);
Pulse oximetry;
ABG;
Peak expiratory flow, PEF (Asthma, COPD);
Bronchoscopy (foreign body);
Chest CT (lung cancer, PE);
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Vitals + puls ox. – tachycardia, tachypnea, hyper/hypotensive, fever;
General appearance – signs of distress, LOC, sense of doom, restlessness;
HEENT - Exam of nasal mucosa, oropharynx – erythema, lymphadenopathy, examine pharynx;
Heart – JVP distention, murmurs, carotid bruits;
Respiratory – symmetric chest expansion, orthopnea, dullness/ consolidation, hyper resonance, wheeze, stridor, rales, rhonchi, intercostal retraction/ use of secondary respiratory muscles, dry or productive cough;
Peripheral vascular – cyanosis, clubbing, edema;
Wells criterias (PE);
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< 3weeks duration;
1. HIV;
2. Any fever? --> pneumonia.. no fever --> COPD, CKD-->CHF; lung cancer; PE; TB
Respiratory; Cardio; GI; Vascular;
Acute/subacute vs. chronic, increased frequency of cough if chronic, timing; presence/description of sputum, presence of hemoptysis; associated symptoms (constitutional, URI, postnasal drip, dyspnea, wheezing, chest pain, heartburn); exacerbating and alleviating factors, exposures; smoking history; history of lung disease, posttussive emesis, or heart failure; allergies; medications (especially ACE inhibitors).
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Acute diarrhea
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CBC (anemia or leukocytosis);
FOBT (blood in stool);
Stool (Ova and/or parasites);
Stool leukocytes (inflammatory diarrhea);
AST/ALT/bilirubin;
Stool culture (Identify bacteria, viruses, fungi, or parasites in stool often in the context of a suspected gastrointestinal infection) - expensive and have low sensitivity;
C. difficile toxin assay (unexplained diarrhea after three days of hospitalization);
Electrolytes;
Check WBC and RBC to eliminate infections:
With blood:
Campylobacter;
E.coli;
Salmonella;
Shigella;
Yersinia;
No blood:
Staph (with Vomiting);
B.Ceries (with Vomiting);
Giardia (campers) – ELISA antigens;
Crypto (HIV positive) <100CD4, modified acid fast stain;
Clost.Def.(after antibiotics) – toxin is diagnostic test, NOT CULTURE!!
V.parahem – shellfish;
Rotavirus – most common in young children;
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Assess the patient's degree of dehydration: dry mucous membranes, delayed capillary refill time, increased heart rate, and abnormal orthostatic vital signs.
Fever is more suggestive of inflammatory diarrhea.
The abdominal examination is important to assess for pain and acute abdominal processes.
A rectal examination may be helpful in assessing for blood, rectal tenderness, and stool consistency.
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Acute: <14 days
R/F: Diarrhea lasting > 3 days;
High fever (>39C)
Blood in stools;
Suspicion of IBD;
Frequent vomiting, signs of dehydration: little or no urine; very dry mouth and throat; feeling dizzy when standing up;
Immunosuppression.
Viral; parasitic; bacterial; food poisoning; HIV patient; recent travel;
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Acute dyspnea (SOB)
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CBC with dif, ferritin (Anemia, Pneumonia);
Blood culture;
TSH (Hypothyroid);
D-dimer (PE);
BNP (CHF);
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Echocardiography (Aortas Stenosis);
ECG (MI);
Peak expiratory flow, PEF (Asthma, COPD);
Chest x-ray (bronchiectasis, pneumonia);
CT scan (cancer, metastasis);
Endoscopy with biopsy (GERD);
x-Ray (Pneumonia);
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Vitals + puls ox. – tachycardia, tachypnea, hyper/hypotensive, fever;
General appearance – signs of distress, LOC, sense of doom, restlessness;
HEENT - Exam of nasal mucosa, oropharynx – erythema, lymphadenopathy, examine pharynx;
Heart – JVP distention, murmurs, carotid bruits;
Respiratory – symmetric chest expansion, orthopnea, dullness/ consolidation, hyper resonance, wheeze, stridor, rales, rhonchi, intercostal retraction/ use of secondary respiratory muscles, dry or productive cough;
Peripheral vascular – cyanosis, clubbing, edema;
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Always RO: COPD, Asthma, PE, CHF, Pneumonia
Location, quality, severity, radiation, duration, context (exertional, postprandial, positional, cocaine use, trauma); associated symptoms (sweating, nausea, dyspnea, palpitations, sense of doom, fever); exacerbating and alleviating factors (especially medications); history of similar symptoms; known heart or lung disease or history of diagnostic testing; cardiac risk factors (hypertension, hyperlipidemia, smoking, family history of early MI);
pulmonary embolism risk factors (history of DVT, coagulopathy, malignancy, recent immobilization);
R/O: thoracic aortic aneurism;
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Acute GI (rectal) bleeding
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CBC (anemia, dehydration);
Fecal occult blood (blood in stool);
AST/ALT/bilirubin/Alk Phos;
PTT/INR;
CEA;
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Colonoscopy with biopsy;
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Vitals – hypotensive, fever;
Abdominal exam – tenderness on palpation (LLQ), guarding, rebound tenderness;
Rectal exam – fissures, hemorrhoids, ulceration, inflammation/infection, warts, palpable mass;
Lymphadenopathy – inguinal chains;
Skin – Rashes;
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Melena vs. bright red blood; amount, duration; associated symptoms (constitutional, abdominal or rectal pain, tenesmus, constipation/diarrhea); menstrual cycle; trauma; history of similar symptoms; prior colonoscopy; medications (especially blood thinners); history of easy bleeding or atherosclerotic vascular disease, renal disease, aortic valve disease, liver disease, alcoholism, or abdominal aortic aneurysm repair; family history of colon cancer.
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Affective changes (behavioral)
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Altered mental status (acute condition, delirium)
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CBC; Basic metabolic panel; liver panel;
UA; blood culture; urinary toxicology;
ABG;
BUN/creatine; electrolytes;
Lumbar puncture (meningitis);
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ECG;
chest x-ray;
EEC (seizures);
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Pulse oximeter reading;
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Amenorrhea
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CBC, LH/FSH, cortisol, prolactin, TSH, beta-hCG, blood glucose, testosterones, estrogen
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AB US, ECG
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Vital signs; breast exam; complete pelvic exam.
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Endocrine; Food; Age; Pregnancy; MSK
Primary vs. secondary, duration, possible pregnancy; associated symptoms (headache, decreased peripheral vision, galactorrhea, hirsutism, virilization, hot flashes, vaginal dryness, symptoms of thyroid disease); history of anorexia nervosa, excessive dieting, vigorous exercise, pregnancies, D&Cs, uterine infections; drug use; medications.
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Ascites
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Causes:
- Liver cirrhosis (75%);
- Malignancy (10%);
- CHF (3%);
- Tuberculosis (2%);
- Pancreatitis (1%).
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Bleeding and Bruising
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Peripheral blood smear, CBC, PT/PTT, BUN/Creatinine, AST/ALT/bilirubin. Referred to a hematologist.
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Blurriness (Blurred Vision)
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Check any eye abstractions, head trauma;
Contact lens-related infection;
Check BP; fever
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Bone pain
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Breast lumps
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Breast pain
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Chest pain
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Troponin (MI);
D-dimer (PE);
CBC (WBC, anemia);
ESR/CRP (inflammatory process);
LFTs (biliary colic, referral pain);
Lipase, amylase(pancreatitis);
BNP(CHF);
Coagulation study: INR, PTT (may be necessary for surgery);
Blood culture, sputum culture(infections).
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ECG (MI check)
x-Ray of the chest (pulmonary edema)
Duplex US of the extremities (vein thrombosis)
CT chest with contrast (pulmonary effusion; pneumonia; pulmonary abscess, aortic dissection)
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Vital signs ± BP in both arms; complete cardiovascular exam (JVD, PMI, chest wall tenderness, heart sounds, pulses, edema); lung and abdominal exams; lower extremity exam (inspection for signs of DVT).
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R/O:
Cardio: MI; Pericarditis;
Vascular: Aortic dissection; PE;
Pulmonary: Lung Cancer; Pneumonia; Pneumothorax; Foreign body;
GI: Gastric cancer; Esophageal cancer,
MSK: Herpes zoster;
Psycho; Panic attack;
Location, quality, severity, radiation, duration, context (exertional, postprandial, positional, cocaine use, trauma);
associated symptoms (sweating, nausea, dyspnea, palpitations, sense of doom, fever);
exacerbating and alleviating factors (especially medications);
history of similar symptoms; known heart or lung disease or history of diagnostic testing; cardiac risk factors (hypertension, hyperlipidemia, smoking, family history of early MI);
pulmonary embolism risk factors (history of DVT, coagulopathy, malignancy, recent immobilization).
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Chronic abdominal pain in children
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Chronic Back Pain
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MRI (R/O critical conditions)
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Vital signs; neurologic exam (especially L4–S1 nerve roots); back palpation and range of motion (although rarely of diagnostic utility); hip exam (can refer pain to the back); consider rectal exam.
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Location, quality, intensity, radiation, context (moving furniture, bending/twisting, trauma), timing (disturbs sleep); associated symptoms (especially constitutional, incontinence); exacerbating and alleviating factors; history of cancer, recurrent UTIs, diabetes, renal stones, IV drug use, smoking.
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Chronic cough
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CBC: infection (neutrophilic leukocytosis in pneumonia, lymphocytosis in TB) or allergic etiology (e.g., eosinophilia in asthma);
Tuberculin skin test;
Sputum culture: suspected bacterial pneumonia, TB;
Nasopharyngeal swab/deep nasopharyngeal aspirate culture and PCR for pertussis: indicated in patients with subacute/chronic cough, esp. if associated with an inspiratory whoop and/or post-tussive vomiting
Blood culture: suspected pneumonia;
Arterial blood gas analysis: patients with dyspnea and those with suspected life-threatening causes of acute cough;
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Chest x-ray (pneumonia, TB)
x-ray of paranasal sinuses (sinusitis)
Chest CT (bronchiectasis (diagnostic test), lung cancer, foreign body aspiration)
Bronchoscopy (Foreign body aspiration, Lung cancer)
Spirometry: ddx obstructive lung disease (e.g., asthma, COPD) and restrictive lung disease (e.g., interstitial lung disease)
Bronchial challenge test (metacholine challenge test; bronchodilator reversibility test): ddx asthma from other obstructive lung disease
BNP, ECG, and ECHO: (CHF)
Endoscopy, 24-hour esophageal pH monitoring, and/or barium swallow: patients with chronic cough suspected to be due to GERD/achalasia that is not responsive to a trial of PPIs
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Vitals + puls ox. – tachycardia, tachypnea, hyper/hypotensive, fever;
General appearance – signs of distress, LOC, sense of doom, restlessness;
HEENT - Exam of nasal mucosa, oropharynx – erythema, lymphadenopathy, examine pharynx;
Heart – JVP distention, murmurs, carotid bruits;
Respiratory – symmetric chest expansion, orthopnea, dullness/ consolidation, hyper resonance, wheeze, stridor, rales, rhonchi, intercostal retraction/ use of secondary respiratory muscles, dry or productive cough;
Peripheral vascular – cyanosis, clubbing, edema;
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> 8 weeks duration;
1. HIV;
2. Any fever? --> pneumonia.. no fever --> COPD, CHF, CKD;
Acute/subacute vs. chronic, increased frequency of cough if chronic, timing; presence/description of sputum, presence of hemoptysis; associated symptoms (constitutional, URI, postnasal drip, dyspnea, wheezing, chest pain, heartburn); exacerbating and alleviating factors, exposures; smoking history; history of lung disease, posttussive emesis, or heart failure; allergies; medications (especially ACE inhibitors).
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Chronic diarrhea
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CBC (anemia);
CPR/ESR (inflammatory markers);
anti-tissue transglutaminase; total IgA (celiac);
Fat in stool --> fatty D;
calprotectin in high --> inflammatory D.: (IBD, C.dif, colitis, colon cancer) --> stool study;
non of them --> watery;
Fatty: AST/ALT/bilirubin;
AFP (liver cancer);
C. difficile toxin in stool (unexplained diarrhea after three days of hospitalization);
Giardia antigen in stool;
Elisa, WB (HIV);
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Colonoscopy with biopsy (colonic cancer, celiac, IBD);
CT (diverticulitis, IBD)
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Vital signs; relevant thyroid/endocrine exam; abdominal and rectal exams; ± female pelvic exam.
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Chronic: >30 days;
Any blood?
Frequency, color, odor, and volume of stools; presence of mucus or flatulence; whether stools float in bowl; duration of change in bowel habits; associated symptoms (constitutional, abdominal pain, bloating, tenesmus, sense of incomplete evacuation, melena or hematochezia); thyroid disease symptoms (eg, feeling hot, palpitations, weight loss); diet (especially fiber and fluid intake); medications (including recent antibiotics); sick contacts, travel, camping, HIV risk factors; history of abdominal surgeries, diabetes, pancreatitis; alcohol and drug use; family history of colon cancer.
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Chronic dyspnea (SOB)
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CBC with dif, ferritin (Anemia, Pneumonia);
TSH (Hypothyroid);
D-dimer (PE);
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Echocardiography (Aortas Stenosis);
ECG (MI);
Peak expiratory flow, PEF (Asthma, COPD);
Chest x-ray (bronchiectasis);
CT scan (cancer, metastasis);
BNP (CHF);
Endoscopy with biopsy (GERD);
x-Ray (Pneumonia);
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Vitals + puls ox. – tachycardia, tachypnea, hyper/hypotensive, fever;
General appearance – signs of distress, LOC, sense of doom, restlessness;
HEENT - Exam of nasal mucosa, oropharynx – erythema, lymphadenopathy, examine pharynx;
Heart – JVP distention, murmurs, carotid bruits;
Respiratory – symmetric chest expansion, orthopnea, dullness/ consolidation, hyper resonance, wheeze, stridor, rales, rhonchi, intercostal retraction/ use of secondary respiratory muscles, dry or productive cough;
Peripheral vascular – cyanosis, clubbing, edema;
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Always R/O: COPD, Asthma, PE, CHF, Pneumonia;
Obstructive: asthma, COPD, bronchiectasis, cystic fibrosis;
Restrictive: sarcoidosis, fibrosing lungs;
Chest walls: MG, AS
Effusion: pneumonia, malignancy, SLE, cirrhosis;
Trauma: rib fracture, pneumothorax;
ER: Lung cancer, PE (DVT), pneumonia, CHF, pericarditis;
Location, quality, severity, radiation, duration, context (exertional, postprandial, positional, cocaine use, trauma); associated symptoms (sweating, nausea, dyspnea, palpitations, sense of doom, fever); exacerbating and alleviating factors (especially medications); history of similar symptoms; known heart or lung disease or history of diagnostic testing; cardiac risk factors (hypertension, hyperlipidemia, smoking, family history of early MI); pulmonary embolism risk factors (history of DVT, coagulopathy, malignancy, recent immobilization).
R/O: thoracic aortic aneurism;
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Chronic GI (rectal) bleeding
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CBC;
Fecal occult blood;
AST/ALT/bilirubin/Alk Phos;
PTT/INR;
CEA;
Calprotectin (IBS>50, IBD>150);
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Colonoscopy;
If no source of bleeding found: Barium contrast study;
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Vital signs ± orthostatics; abdominal and rectal exams.
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Melena vs. bright red blood; amount, duration; associated symptoms (constitutional, abdominal or rectal pain, tenesmus, constipation/diarrhea); menstrual cycle; trauma; history of similar symptoms; prior colonoscopy; medications (especially blood thinners); history of easy bleeding or atherosclerotic vascular disease, renal disease, aortic valve disease, liver disease, alcoholism, or abdominal aortic aneurysm repair; family history of colon cancer.
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Confusion causes (chronic, dementia)
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CBC with dif (anemia, dehydration);
GGT (alcoholism);
BNP (CHF);
vitamin D, B12, folate, homocysteine in blood;
Electrolytes, BUN/creatinine (KI function);
Blood sugar (hypoglycemia);
Troponin - CK-MP (MI);
UA toxins (substance abuse);
VDRL/RPR (syphilis);
CD4 (HIV);
Serum calcium, serum glucose;
TSH (Hypothyroidism);
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CT of the head;
Dopier US of carotid artery;
ECG;
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Vital signs; complete neurologic exam, including mini-mental status exam and gait; general physical exam, including ENT, heart, lungs, abdomen, and extremities.
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Brain structure/trauma; anemia; hormones; infection; GU; vascular; cardio; psycho; substances/food!
Always include delirium and dementia for older patients;
Must include history from family members/caregivers when available. Detailed time course of cognitive deficits (acute vs. chronic/gradual onset); associated symptoms (constitutional, incontinence, ataxia, hypothyroid symptoms, depression); screen for delirium (waxing/waning level of alertness); falls, medications (and recent medication changes); history of stroke or other atherosclerotic vascular disease, syphilis, HIV risk factors, alcohol use, or vitamin B12 deficiency; family history of Alzheimer’s disease or other neurologic disorders.
MMSE, MOCA (best screening test), dementia quick screen (see sidebar)
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Constipation
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electrolytes (low K, high Ca, low Mg);
PTH (hyperparathyroidism -> high Ca -> constipation);
high TSH (low thyroid function);
FOBT (blood in stool);
Stool for fat;
CPR/ESR (inflammatory markers);
CEA; hCG; CA-125; AFP;
Urine toxicology;
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x-ray of abdomen (check abstraction);
CT of abdomen with IV and oral contract (malignancy);
Colonoscopy with biopsy (diverticulitis, colon cancer, tumor);
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Vital signs;
relevant thyroid/endocrine exam;
abdominal and rectal exams;
± female pelvic exam.
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Frequency, color, odor, and volume of stools; presence of mucus or flatulence; whether stools float in bowl; duration of change in bowel habits; associated symptoms (constitutional, abdominal pain, bloating, tenesmus, sense of incomplete evacuation, melena or hematochezia); thyroid disease symptoms (eg, feeling hot, palpitations, weight loss); diet (especially fiber and fluid intake); medications (including recent antibiotics); sick contacts, travel, camping, HIV risk factors; history of abdominal surgeries, diabetes, pancreatitis; alcohol and drug use; family history of colon cancer.
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Daytime Sleepiness
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Depressive symptoms (looks like depression)
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Developmental Disabilities
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Diplopia
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Dizziness
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CBC (dehydration, hypovolemia, anemia);
Electrolytes (acute renal failure);
hCG (r/o ectopic pregnancy);
Serology (syphilis);
Blood gases (hyperventilation);
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MRI (MS. brain stem dysfunction, acoustic neuroma, TIA);
CT w/o contrast (stroke);
CT (brain tumor, trauma);
Audiometry (Meniere's, Labirintus, perilymph fistula, cholesteatoma, salt retaining drugs);
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Vital signs; complete neurologic exam, including Romberg test, nystagmus, tilt test (eg, Dix-Hallpike maneuver), gait, hearing, and Weber and Rinne tests; ENT exam; cardiovascular exam.
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What the cause?
- Move in the bed: vertigo;
- Change position from sitting to standing: near-syncope;
- During walk: disbalance;
Hearing loss?
- Yes: peripheral (except BPPV);
- No: central;
Lightheadedness vs. vertigo, ± auditory symptoms (hearing loss, tinnitus), duration of episodes, context (occurs with positioning, following head trauma);
other associated symptoms (visual disturbance, URI, nausea);
neck pain or injury;
medications;
history of atherosclerotic vascular disease.
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Dysequilibrium
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Dysmenorrhea
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Dyspepsia
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All male and non-pregnant female adults with pain or discomfort felt to arise in the upper GI tract with symptoms of greater than 25% of days over the past 4 weeks
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Dysphagia
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Vital signs; head and neck exam; heart, lung, and abdominal exams; skin exam (for signs of scleroderma/CREST).
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Solids or liquids vs. both solids and liquids, ± progression, occurring at the beginning or middle of swallow; constitutional symptoms (especially weight loss); hoarseness, drooling, regurgitation of liquids vs. undigested food, odynophagia, GERD symptoms; medications; HIV risk factors; history of anxiety, smoking, Raynaud’s phenomenon.
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Dysuria (female)
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R/O pyelonephritis
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Dysuria (male)
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R/O pyelonephritis
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Ear pain
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Electrolyte Disorders
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Emergency conditions
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Epistaxis
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Eye pain
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Fatigue
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CBC with dif;
TSH;
Glucose in blood;
HbA1c
UA
Electrolytes, BUN/Cr;
BNP (CHF);
Monospot;
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Nocturnal pulse oximetry;
Sleep study;
ECG;
Whole body CT;
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Vital signs; ENT exam (conjunctival pallor, oropharynx/palate, lymphadenopathy, thyroid exam); heart, lung, abdominal, neurologic, and extremity (pallor, coolness at distal extremities) exams; consider rectal exam and occult blood testing.
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Always check:
CANCERS!
- Anemia (poor nutrition, vegan, heavy menses);
- Hypothyroid;
- DM;
Also: Cardio, Pulmonary, GI, GU, Infections, Endo!
Duration; sleep hygiene, snoring, waking up choking/gasping, witnessed apnea; overexertion; stress, depression, or other emotional problems; lifestyle changes, shift changes at work; diet, weight changes; other constitutional symptoms; symptoms of thyroid disease; history of bleeding or anemia; medications; alcohol, caffeine, and drug use.
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Fever
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CBC with differential
Blood glucose (low or high w/o DM -> sepsis or septic shock, not specific)
Electrolytes (baseline before antibiotics)
LFTs (liver function)
Coagulation studies (e.g., INR, PTT)
Urinalysis with microscopy (UTI)
If suspect sepsis:
Blood gas analysis
Serum lactate
Procalcitonin assay (biomarker for bacterial cause of sepsis)
ESR/CRP (inflammatory cause)
Blood cultures (at least 2 sets)
Additional cultures from other sites as indicated
Chest x-ray
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Flank pain
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Galactorrhea
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GU in males
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Gynecomastia
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Hair Loss (Alopecia)
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Hallucinations
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Headache
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CBC (anemia);
TSH (hypothyroid can make HA worse);
ESR, CRP (check inflammation, temporal artery);
Lumbar puncture (LP) with CSF analysis (cell count, protein, glucose,
Gram stain, PCR for specific pathogens, culture): meningitis;
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CT head without IV contrast.
Doppler U/S - carotid artery
Tonometry: if increased intraocular pressure is suspected;
EEG: for any form of suspected seizures or complex migraine;
Temporal artery biopsy: if GCA is suspected;
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Vital signs (Fever, high BP);
Inspection and palpation of entire head (trauma);
ENT inspection; including funduscopic
exam;
complete neurologic exam.
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ER VISIT:
Eye: glaucoma, uveitis, cluster;
Recurrent(chronic): migrain, tension, TMJ, cervical OA;
Vascular: SAH, ICH, temporal arteritis;
Infections: meningitis, encephalitis, systemic infection, sinusitis;
Systemic: anemia, anoxia, carbon monoxide poisoning, pre-eclampsia;
Intracranial pressure: tumor, abscess, HTN, pseudotumor cerebri;
Trauma: concussion, subdural hematoma, epidural bleeding;
Onset (acute vs. chronic), location (unilateral vs. bilateral), quality (dull vs. stabbing), intensity (is it the “worst headache of their life”?), duration, timing (does it disturb sleep?), presence of associated neurologic symptoms (paresthesias, visual stigmata, weakness, numbness, ataxia, photophobia, dizziness, auras, neck stiffness); nausea/vomiting, jaw claudication, recent trauma, dental surgery, sinusitis symptoms; exacerbating factors (stress, fatigue, menses, exercise, certain foods) and alleviating factors (rest, medications); patient and family history of headache; history of trauma.
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Hearing loss
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Blood glucose
CBC with differential
TSH, and/or syphilis testing depending on the suspected etiology): for patients with unexplained sensorineural hearing loss
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MRI or CT scan (of the posterior fossa): r/o acoustic neuroma
Audiometry: for patients without any obvious cause of hearing loss
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Whispered test: hearing loss
Rinne / Weber tests: hearing loss as conductive or sensorineural
Otoscopy: observation of external ear and tympanic membrane
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Heartburn
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Hematuria
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UA - first step (blood or not?);
Urine culture --> treat if (+);
if (-): BP, BUN/creatinine, urine protein, Urine cytology (look for abnormal cells: red cell casts?);
Referral to nephrologist;
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CT urogram, cystoscopy with biopsy (R/O bladder cancer, <40 y/o - must);
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Rectal exam
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R/O Bladder cancer and Renal Cell Carcinoma;
Amount, duration, ± clots; associated symptoms (constitutional, renal colic, dysuria, irritative voiding symptoms); point along the stream (initial vs. terminal vs. throughout); medications; history of vigorous exercise, trauma, smoking, stones, cancer, or easy bleeding; skin bruising (purpura).
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Hemolytic anemias
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CBC with dif; ferritin; serum iron; TIBC;
Peripheral blood smear;
B12/folate;
LDH (hemolytic anemias);
Hb electrophoresis;
PT/PTT; Platelets count;
Bone marrow biopsy;
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Hemoptysis
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Hoarseness
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Hypercalcemia
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Hypertension
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High serum Ca; high PTH; low serum phosphates: hyperparathyroidism;
High serum cortisol: Cushions syndrome;
Low TSH; high free T4: hyperthyroid;
High aldosterone-to-renin ratio, low serum K: Conn's syndrome;
If cause is not clear: electrolytes, BUN, creatinine, calcium, TSH,
urine albumin-creatinine ratio, fasting glucose;
Lipid panel (total cholesterol, high-density lipoprotein [HDL], triglycerides, low-density lipoprotein [LDL]).
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ECG;
Sleep study: sleep apnea;
24-hours blood pressure monitoring;
24-hours metanephrines: pheochromocytoma;
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Normal: systolic BP< 120 mm Hg and diastolic BP< 80 mm Hg;
Elevated: systolic BP 120-129 mm Hg and diastolic BP< 80 mm Hg;
Stage 1 hypertension: systolic BP 130-39 mm Hg or diastolic BP 80-89 mm Hg;
Stage 2 hypertension: systolic BP :I? 140 or diastolic BP~ 90 mm Hg;
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Check KI and Thyroid!
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Jaundice
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Bilirubin total and direct (conjugated)
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Low GI bleeding
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Dark stool;
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Low limb pain
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Lymphadenopathy
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CRP, ESR (severe inflammatory processes).
Infections, detection of pathogen (e.g., Monospot test in EBV, RPR/VDRL in syphilis, ELISA in HIV).
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Chest x-ray (TB), CT/MRI (if still not clear situation)
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R/F: non-tender; hard; fixed nodes; slow, progressive enlargement.
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Macrocytic anemia
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CBC with dif; ferritin; serum iron; TIBC;
Peripheral blood smear;
B12/folate;
LDH (hemolytic anemias);
Hb electrophoresis;
PT/PTT; Platelets count;
Bone marrow biopsy;
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Medication induced conditions
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Microcytic anemia
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CBC with dif; ferritin; serum iron; TIBC;
Peripheral blood smear;
B12/folate;
LDH (hemolytic anemias);
Hb electrophoresis;
PT/PTT; Platelets count;
Bone marrow biopsy;
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Monoarthritis (joint pain)
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Muscles Weakness
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Nasal discharge
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Allergy skin test;
Nasal smear – look for eosinophils in allergic rhinitis;
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CT – view nasal polyps, cysts, chronic mucosal thickening;
Nasal endoscopy – Dx chronic sinusitis, view nasal polyps;
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Vitals – fever, tachypnea, tachycardia;
HEENT – lymphadenopathy, erythema of nasal mucosa, discharge, pain on palpation of sinuses, foreign body visualized, nasal polyps, septal deviations, changes in hearing, changes in vision (complication of sinusitis is periorbital cellulitis);
Respiratory – breathing through mouth, adventitious breath sounds;
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Nausea and Vomiting
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Vital signs; ENT; consider funduscopic exam (increased intracranial pressure); complete abdominal exam; consider
heart, lung, and rectal exams.
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Acuity of onset, ± abdominal pain, relation to meals, sick contacts, possible food poisoning, possible pregnancy; neurologic symptoms (headache, stiff neck, vertigo, focal numbness or weakness); urinary symptoms; other associated symptoms (GI, chest pain); exacerbating and alleviating factors; medications; history of prior abdominal surgery.
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Neck mass
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Vital signs; HEENT exam; exam of lymph nodes, spleen, and tonsils; heart, lung, and abdominal exams.
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Onset, size, location, mobility, pain, movement with swallowing; obstructive symptoms (dysphagia, shortness of breath); other masses; associated symptoms (constitutional, hematologic, GI, endocrine, pulmonary); ill contacts.
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Neonatology/Newborn Issues
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Neuropathy
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Vital signs; neurologic and musculoskeletal exams; relevant vascular exam.
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Distribution (unilateral, bilateral, proximal, distal), duration, ± progression, pain (especially headache, neck or back pain); constitutional symptoms, other neurologic symptoms; history of diabetes, alcoholism, atherosclerotic vascular disease.
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Night sweats
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Vital signs; HEENT exam, including inspection of the throat and other areas for lymphadenopathy; heart and lung exam; abdominal exam for hepatosplenomegaly; skin exam; musculoskeletal exam for joint pain.
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Onset, duration, severity, frequency, timing, patterns (escalating, waxing, waning), precipitants (eg, food, medications); associated diseases and symptoms (fever, recent URIs, associated cough, hemoptysis, pleuritic chest pain); lymphadenopathy, rash, malaise, weight loss, itching, diarrhea, nausea/vomiting, early satiety, anorexia; presence of significant risk factors (eg, traveling to areas with endemic infections, IV drug use); alcohol history, sexual exposure, sick contacts, exposure to high-risk populations such as prisoners or homeless people; menstrual history, menopausal status, travel history.
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Nipple discharge
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HCG (r/o pregnancy)
Prolactin; TSH (TRH -> Prolactin and TSH)
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Unilateral milky discharge:
Mammogram (>30y/o); US <30 y/o)
CT or MRI
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R/F: spontaneous, unilateral, uniductal, bloody; breast mass. >40 y/o
Biopsy if suspect malignancy
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History: Color of discharge? Onset?
Nipple stimulation?
High domain?
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Normocytic anemia
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CBC with dif; ferritin; serum iron; TIBC;
Peripheral blood smear;
B12/folate;
LDH (hemolytic anemias);
Hb electrophoresis;
PT/PTT; Platelets count;
Bone marrow biopsy;
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Nutritional toxicology/deficiency
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Orthostatic Hypotension
|
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Always check the reason on orthostatic hypotension and R/O all critical conditions!
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Palmar erythema
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CBC;
ALT/AST and blood urea nitrogen/creatinine;
Hepatitis B and C virus serology;
Ferritin;
Fasting glucose;
TSH;
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Chest x-ray.
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Symmetrical (both hands);
Non-painful;
Non-itchy;
Slightly warm.
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Palpitation
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CBC (anemia);
Electrolytes;
TSH, FT4 (hyperthyroid);
Urine toxicology (drug abuse);
24-hour urinary catecholamines (pheochromocytoma);
Mental status exam;
Glucose (hypoglycemia);
5-HIAA (Carcinoma);
Referral to cardiologist;
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ECG (arrhythmia);
Echocardiography (mitral prolapse);
Holter monitor;
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Vital signs; endocrine/thyroid exam, including exophthalmos, lid retraction, lid lag, gland size, bruit, and tremor; complete cardiovascular exam.
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Gradual vs. acute onset/offset, context (exertion, caffeine, anxiety); associated symptoms (lightheadedness, loss of consciousness, chest pain, dyspnea, fever, sweating, pale skin, flushing, diarrhea);
hyperthyroid symptoms;
history of bleeding or anemia;
history of heart disease, hypertension, or diabetes.
Check all patients with arritmia (A-fib) for stroke!
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Penile discharge
|
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Periorbital swelling (Periorbital Edema)
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Peripheral edema (bilateral)
|
CBC, ALT/AST, BUN/creatinine;
UA: albumin/creatinine ratio;
Chest x-ray, ECG, echocardiogram;
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|
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Main problems:
- Cardio;
- Kidney;
- Liver;
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Pleural Effusion
|
Thoracocentesis;
|
x-ray:
- posteroanterior radiography in the presence of 200 mL of fluid;
- lateral radiography with as little as 50 mL of fluid.
US better compare with CT;
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Pleuritic Chest Pain (Pleurisy)
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Polyarticular Joint Pain
|
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Pregnancy
|
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Prereferral edema (unilateral or local)
|
Doppler US; D-Dimer;
|
|
|
Main problems:
- Cardio;
- Kidney;
- Liver;
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Rashes and lesions (pruritus)
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Rectal pain
|
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Red eye
|
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Seizure
|
Lumbar puncture;
Blood culture;
CBC with dif;
B1, Glucose in blood; electrolytes; NH3; Liver panel;
TSH; creatinine/BUN;
AED level;
Female: bHCG
Creatine Kinase may be high;
Lactate may be increased;
Prolactin when increased it's real sz;
Troponin can be increased;
|
CT / MRI
EKG --> r/o arrhythmia;
|
Any fever?
Genetic tests;
|
Check medication list!
|
Sleep problems (Insomnia)
|
|
Sleep study;
EEG;
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Vital signs; mental status exam; thyroid exam.
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Primary vs. secondary, duration, description (trouble falling asleep vs. multiple awakenings vs. early-morning awakening); daytime sleepiness; other medical problems keeping patient awake at night, such as arthritis (pain) or diabetes (polyuria); evidence of a common sleep disorder (eg, sleep apnea, restless leg syndrome); associated symptoms, including loud snoring, nightmares, and depression; caffeine, alcohol, medication, and recreational drug use; work or lifestyle (jet lag or shift work), stressors, sleep hygiene; presence of psychiatric symptoms (eg, grandiose delusions,
irritability).
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Smell / Taste Loss
|
|
|
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Sore Throat
|
CBC with diff;
Monospot test;
Throat culture – rapid streptococcal antigen;
Anti-EBV antibodies;
Liver enzymes;
|
Neck x-ray;
|
Vital signs; ENT exam, including oral thrush, tonsillar exudate, and lymphadenopathy; lung, abdominal (focusing on splenomegaly), and skin exams.
Vitals – signs of fever, respiratory distress, tachycardia, hypotension;
General survey – restlessness, stridor, difficulty breathing, inability to swallow, drooling;
HEENT – oral thrush, tonsilar exudate, lesions, edema, erythema, lymphadenopathy, conjunctivitis, tender thyroid;
Lung – consolidation, adventitious breath sounds;
Abdominal – focus on splenomegaly;
Skin – maculopapular rash;
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Duration, fever, other ENT symptoms (ear pain, nasal or sinus congestion), odynophagia, swollen glands, ± cough, rash; sick contacts, HIV risk factors.
|
Stridor
|
|
|
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Syncope
|
CBC (low Hb); BUN/creatinine, UA, electrolytes (KI); occult fecal blood test (intestinal blood loss); blood glucose (blood sugar)
|
ECG (for everyone), Echocardiography (heart structure), chest x-Ray (lung mass, pneumonia), ventilation/perfusion scan (PE), head image for neurological origin (CT, MRI); Doppler US (carotid artery)
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Clinic: sign of trauma (blood loss), sign of head trauma, lung auscultation, heart auscultation (murmur, arrhythmia), vitals (temp, BP, orthostatic hypotension, HR, BR, oxymetr).
|
|
Systemic Vasculitis
|
|
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Tongue Discoloration and Other Changes
|
|
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Tremor
|
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|
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Upper GI Bleeding
|
CBC (anemia);
Electrolytes;
AST/ALT/ bilirubin/ Alk Phos;
PTT/ INR;
|
Upper endoscopy with biopsy for H.pylori;
|
Vitals – hypotensive, fever;
ENT – lymphadenopathy, erythema of pharynx, ulcerations;
Abdominal – pain on palpation (periumbilical), bowel sounds, guarding, rebound tenderness;
Rectal – lesions, fissures, masses;
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Amount, duration, context (after severe vomiting, alcohol ingestion, nosebleed); associated symptoms (constitutional, nausea, abdominal pain, dyspepsia); medications (especially blood thinners, NSAIDs, and corticosteroids); history of peptic ulcer disease, liver disease, abdominal aortic aneurysm repair, easy bleeding.
Melina: sticky, very nasty-smelling, black stool;
Tachycardia (>15% of blood loss);
Orthostatic hypotension;
Cool clammy skin – risk of hypovolemic shock (30-40% of blood loss);
Iron and Bismuth supplement can cause dark stool!
R/F: Cocaine, Alcohol, Chemotherapy, NSAIDs
|
Upper Limb pain
|
|
|
|
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Urinary incontinence
|
UA, urinary culture: UTI
Creatinine/BUN: assess kidney function
|
Sonography
Cystoscopy: tumor
MRI: pelvic floor defects
|
|
|
Urinary problems in children
|
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Urinary problems in female
|
|
|
|
|
Vaginal bleeding
|
hCG (pregnancy);
CBC, Ferritin (anemia);
Endometrial biopsy;
|
Transvaginal ultrasonography;
|
Vital signs; abdominal exam; complete pelvic exam.
|
Pre- vs. postmenopausal status, duration, amount; menstrual history and relation to last menstrual period; associated discharge, pelvic or abdominal pain, or urinary symptoms; trauma; medications (especially blood thinners, contraceptives); history of easy bleeding or bruising; history of abnormal Pap smears.
|
Vaginal discharge
|
Wet mount, KOH prep;
“whiff test”; pH of vaginal fluid;
Cervical cultures;
|
|
Vital signs; abdominal exam; complete pelvic exam.
|
Amount, color, consistency, odor, duration; associated vaginal burning, pain, or pruritus; recent sexual activity; onset of last menstrual period; use of contraceptives, tampons, and douches; history of similar symptoms; history of STDs.
|
Vision loss
|
ESR/CRP;
CBC with dif;
Blood sugar; electrolytes;
|
Fluorescein angiogram;
Echocardiography;
Doppler U/S—carotid;
Intraocular tonometry;
Temporal artery biopsy;
Brain MRI;
|
Vital signs; cardiovascular, HEENT, funduscopic, and neurologic exams.
|
Acute vs. chronic, progression, ability to see light; associated symptoms (eye pain, discharge, itching, tearing, photophobia, redness, headache, weakness, numbness, floaters, sparks); history of cardiac, rheumatic, thrombotic, autoimmune, or neurologic disorders; jaw claudication, medications, trauma.
|
Weight gain
|
Vital signs; complete exam, including signs of Cushing’s syndrome (hypertension, central obesity, moon face, buffalo
hump, supraclavicular fat pads, purple abdominal striae); edema resulting from water retention in renal disease.
|
Abdominal US;
Lung x-ray;
CT scan (location of lipoma)
|
CBC with dif;
Albumin;
Electrolytes;
Creatinine/BUN;
ALT/AST;
24h urinary cortisol;
Blood sugar;
LH/FSH;
|
Amount, duration, timing (relation to medication changes, smoking cessation, depression); diet history; hypothyroid
symptoms (fatigue, constipation, skin/hair/nail changes); menstrual irregularity, hirsutism; medical history; alcohol
and drug use.
|
Weight loss
|
TSH;
CBC with dif;
Iron study;
Electrolytes;
Blood sugar;
UA;
Creatinine/BUN;
B12;
HIV ABs;
Blood glucose;
Stool fat test;
FOBT;
ESR;
|
Upper endoscopy, colonoscopy with biopsy;
Brain CT/MRI;
Abdominal US;
ECG;
Chest x-ray;
Whole body CT;
|
Vital signs; complete physical.
|
Cancer; GI (malabsorption, IBD); HIV; Endocrine(thyroid, DM, cortisol); Psycho (Substances, depression); Cardio; Resp(COPD); MSK(weakness-->immobility-->PE)
Amount, duration, ± intention; diet and exercise history;
body image, anxiety or depression; other constitutional symptoms;
hyperthyroid symptoms (palpitations, tremor, diarrhea);
family history of thyroid disease;
HIV risk factors;
tobacco, alcohol, and drug use;
medications;
history of cancer;
blood in urine or stool.
|
Wheezing
|
|
|
|
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Xerostomia (hyposalivation, dry mouth)
|
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