Differential Diagnoses

Confusion .............................................................................................................................................3
Falls ....................................................................................................................................................... 4
Fever ......................................................................................................................................................5
Fatigue ..................................................................................................................................................6
Anaemia ................................................................................................................................................7
Easy bruising/bleeding diathesis....................................................................................................8
Hypertension .................................................................................................................................... 10
Weight gain .........................................................................................................................................11
Weight loss ........................................................................................................................................ 12
Dizziness/vertigo ............................................................................................................................. 13
Acute/transient loss of consciousness ...................................................................................... 14
Loss of consciousness/coma ........................................................................................................ 15
Acute transient vision loss (amaurosis fugax) .......................................................................... 16
Acute persistent vision loss ........................................................................................................... 17
Progressive vision loss .................................................................................................................... 18
Red eye ............................................................................................................................................... 19
Acute weakness............................................................................................................................... 20
Progressive weakness..................................................................................................................... 21
Sensory loss ...................................................................................................................................... 22
Headache .......................................................................................................................................... 23
Goitre ................................................................................................................................................. 24
Chest pain ......................................................................................................................................... 25
Palpitations ....................................................................................................................................... 26
Dyspnoea (location)........................................................................................................................ 27
Dyspnoea (onset) ............................................................................................................................ 29
Chronic cough ................................................................................................................................. 30
Haemoptysis ...................................................................................................................................... 31
Wheeze .............................................................................................................................................. 32
Abdominal pain ................................................................................................................................ 33
Abdominal masses .......................................................................................................................... 34
Palpable liver..................................................................................................................................... 35
Splenomegaly (found in 3-12% of normal population)........................................................... 36
Anal pain ............................................................................................................................................ 37
Upper GI bleeding ........................................................................................................................... 38
Lower GI bleeding ........................................................................................................................... 39
Nausea and vomiting ......................................................................................................................40
Diarrhoea ............................................................................................................................................ 41
Constipation ..................................................................................................................................... 42
Jaundice ............................................................................................................................................ 43
Acute renal injury ............................................................................................................................ 44
Polyuria (urine output >3L/day) ................................................................................................... 45
Nocturia (>20-33% of urine output at night) ........................................................................... 46
Urinary incontinence/lower urinary tract symptoms ............................................................. 47
Haematuria ....................................................................................................................................... 48
Dysuria ............................................................................................................................................... 49
Groin/scrotal pain ........................................................................................................................... 50
Back pain ............................................................................................................................................ 51
Joint pain ........................................................................................................................................... 52
Shoulder girdle pain ........................................................................................................................ 53
Pelvic girdle pain .............................................................................................................................. 54
Limb pain ........................................................................................................................................... 55
Peripheral neuropathy ................................................................................................................... 56
Pitting oedema ................................................................................................................................. 57
Non-pitting oedema ....................................................................................................................... 58
Leg ulcers .......................................................................................................................................... 59
Lymphadenopathy .......................................................................................................................... 60
Inflamed sub/cutaneous patch (cellulitis-mimics) .................................................................. 61
Sub/cutaneous papule/nodule (skin abscess-mimics) ......................................................... 62
Confusion
delirium (acute) infection
medication/iatrogenic/toxic CNS depressants
metabolic hypoxia
hypercapnia
hyper/hypoglycaemia
hyper/hyponatremia
hyper/hypocalcaemia
uraemia and hepatic
encephalopathy
Cushing's/Addison's disease
hyper/hypothyroidism
hypopituitarism
environmental change
post-surgical
cardiogenic structural
functional
neurogenic trauma (e.g. concussion)
seizure

dementia (chronic) Alzheimer's disease

vascular dementia
frontotemporal dementia
Lewy Body dementia, Parkinson's disease
psychogenic depression, bipolar
schizophrenia
Falls
accidental
syncopal (see acute/transient loss of consciousness)
gait disorder antalgic MSK
waddling/myopathic proximal myopathy
• drugs: statins, corticosteroids,
alcohol
• disuse and deconditioning
• autoimmune
• metabolic: diabetes, thyroid,
Cushing's disease
stamping sensory neuropathy
high-stepping gait/foot peripheral neuropathy
drop • diabetes
• alcohol
• idiopathic
radiculopathy
ataxic/wide-based sensory neuropathy
cerebellar disease
• CVD
• drugs: acute alcohol intoxication
• cerebellar atrophy
• metabolic
shuffling/hesitation Parkinson’s disease
small vessel disease gait small vessel ischaemia (in the brain)
(Marche a petits pas) • usually due to long term hypertension
hemiplegic central hemisphere lesion
apraxic bilateral hemisphere lesion
spastic/scissoring spastic cerebral palsy
Fever
infective infection
abscess
osteomyelitis
tuberculosis
autoimmune/rheumatological rheumatoid arthritis
giant cell arteritis
polyarteritis nodosa
polymyalgia
rheumatica
neoplasia leukemia, lymphoma
iatrogenic/drugs drug fever
environmental
Fatigue
chronic disease COPD
cardiac failure
CKD
liver failure
infective HIV infection
EBV infection
tuberculosis
endocarditis
endocrine hyper/hypothyroidism
diabetes mellitus
adrenal insufficiency
haematological anaemia
rheumatological rheumatoid arthritis
SLE
Sjogren's syndrome
polymyalgia
rheumatica
fibromyalgia
neoplasia
neurogenic multiple sclerosis
sleep disorder obstructive sleep
apnoea
psychogenic depression
iatrogenic/drugs CNS depressants
Anaemia
microcytic normocytic macrocytic
• iron-deficiency • bone marrow failure • megaloblastic anaemia
anaemia • haemolytic anaemia • vitamin B12/folate
• haemoglobinopathy • anaemia of chronic deficiency
• sideroblastic anaemia disease • non-megaloblastic anaemia
• acute haemorrhage • myelodysplasia
• liver disease
• alcohol
• pregnancy
• hypothyroidism
Easy bruising/bleeding diathesis
endothelial congenital Ehlers-Danlos
defects syndrome
acquired vascular excess corticosteroids
purpura senile purpura
leukocytoclastic
vasculitis
vitamin C deficiency

platelet thrombocytopenia reduced production marrow aplasia (e.g. aplastic

defects
anaemia, radiation, drugs)
marrow infiltration (e.g.
malignancy, fibrosis)
drugs: gold, sulphonamides,
ethanol, thiazides
ineffective megakaryopoiesis
• vitamin B12/folate
deficiency
• myeloproliferative
disease
congenital
accelerated platelet immune SLE
removal non-Hodgkin
lymphoma
drugs: quinine,
heparin
infection (e.g.
HIV, measles)
transfusion
non- DIC, sepsis
immune haemolytic-
uraemic
syndrome
massive
haemorrhage

sequestration hypersplenism
idiopathic
thrombocytopenia

platelet function hereditary membrane

defect granule
von Willebrand
disease
 acquired drug: aspirin, NSAIDs
bone marrow
disorder
uraemia

coagulation congenital haemophilia A

defects haemophilia B
von Willebrand disease
acquired decreased production liver disease
vitamin K deficiency
inhibition iatrogenic
circulating inhibitor
increased DIC
consumption massive
haemorrhage
Hypertension
primary/essential
hypertension
endocrine primary renal disease (acute,
CKD)
renovascular hypertension
primary aldosteronism
pheochromocytoma
Cushing's syndrome
sleep disorder obstructive sleep apnoea
iatrogenic/medications/drugs
Weight gain
obesity
endocrine T2DM
hypothyroidism
Cushing's syndrome,
disease
pregnancy
psychogenic depression
bulimia nervosa
iatrogenic/drugs anti-psychotics
anti-depressants
anti-epileptics
anti-hyperglycaemics
Weight loss
GIT-related PUD
malabsorption (e.g. Coeliac disease)
IBD
endocrine T1DM
hyperthyroidism
adrenal insufficiency
neoplasia
infective HIV
tuberculosis
hepatitis C
advanced chronic congestive heart failure
disease chronic lung disease (pulmonary cachexia
syndrome)
chronic kidney disease
neurogenic stroke
ALS
Parkinson's disease
dementia
rheumatological rheumatoid arthritis
giant cell temporal arteritis
psychogenic depression
eating disorder
iatrogenic/drugs tobacco, alcohol
cocaine. amphetamines
Dizziness/vertigo
vertigo/otological
• less than weeks
• provoking factors
o spontaneous
o change of head position
o change of middle ear
pressure
• aggravating factors
o change of head position
• associated symptoms
o nystagmus
o with or without hearing
loss
non-specific dizziness
disequilibrium
• sense of imbalance primarily
when walking
presyncope
peripheral benign paroxysmal positional vertigo
vestibular neuritis (without hearing
loss), labyrinthitis (with hearing loss)
Meniere's disease
perilymph fistula
central migraine
cerebellar TIA/stroke
posterior fossa tumour
psychogenic
Parkinson's disease
visual impairment
cerebellar disorder
vestibular disorder
peripheral neuropathy
cervical spondylosis
MSK gait disorder
(see syncope)
Acute/transient loss of consciousness
autoregulatory postural
neurocardiogenic vasovagal/situational
cardiogenic structural (e.g. VHD, HOCM)
arrhythmia
functional (e.g. myocardial infarction, heart failure)
vascular hypovolemia
haemorrhagic stroke
TIA/ischaemic stroke (rarely)
PE (rarely)
metabolic hyper/hypoglycaemia
hypoxia
metabolic acidosis
neurogenic trauma (e.g. concussion)
seizure
autonomic dysfunction (e.g. with diabetes)
vertigo
• without loss of consciousness
sleep disorder narcolepsy with cataplexy
• without loss of consciousness
psychogenic anxiety and panic disorder
toxic/iatrogenic CNS depressants (e.g. alcohol, benzodiazepines, opioids,
TCAs)
anti-hypertensives
• diuretics
• beta-blockers
• alpha-blockers
• anti-arrhythmics
• calcium channels
anti-hyperglycaemic
• except for metformin
those affecting QTc interval
• anti-psychotics
• anti-emetics
Loss of consciousness/coma
space-occupying haemorrhagic stroke
lesions trauma
cerebral neoplasia
abscess
cysts (e.g. cysticercosis, third ventricular colloid cyst)
granuloma (e.g. sarcoidosis, TB)
neurogenic seizure (post-ictal state)
metabolic hypoxia
hypercapnia
hyper/hypoglycaemia
hyper/hyponatremia
hyper/hypocalcaemia
uraemia and hepatic encephalopathy
Cushing's/Addison's disease
hyper/hypothyroidism
hypopituitarism
infection meningitis
encephalitis
psychogenic
toxic/iatrogenic CNS depressants (e.g. alcohol, benzodiazepines, opioids,
TCAs)
CO poisoning
Acute transient vision loss (amaurosis fugax)
monocular vascular ischaemia/thromboembolism
giant cell arteritis
retinal vein occlusion
neurogenic optic neuropathy in MS
optic nerve compression
papilledema

binocular migraine
seizure
vertebrobasilar ischaemia
psychogenic
Acute persistent vision loss
media problems keratitis, uveitis
trauma, vitreous haemorrhage
retinal vasoocclusive disorder
• central retinal vein
occlusion
• central retinal artery
occlusion
retinal detachment
optic nerve ischaemia/thromboembolism
optic neuritis
giant cell arteritis
papilledema
chiasmic pituitary tumour
central TIA/stroke
psychogenic
Progressive vision loss
ocular refractive error
cataracts
vitreous haemorrhage
retinal age-related macular degeneration
diabetic retinopathy, diabetic macular
oedema
retinal detachment
optic nerve glaucoma
optic neuritis
papilledema
iatrogenic/drugs/nutritional
Red eye
painful diffuse lids normal conjunctivitis
lids abnormal blepharitis
ectropion
trichiasis
eyelid lesion

localised pterygium
corneal foreign body
ocular trauma
subconjunctival haemorrhage

non-painful corneal abnormal herpes simplex

bacterial/acanthamoebal
ulcer
marginal keratitis
foreign body corneal
abrasion
lids abnormal chalazion
blepharitis
herpes zoster
diffuse conjunctival injection viral conjunctivitis
allergic conjunctivitis
bacterial conjunctivitis
dry eyes
angle closure glaucoma
ciliary injection/scleral
involvement
anterior chamber involvement
Acute weakness
vascular TIA, ischaemic stroke, haemorrhagic stroke
acute coronary syndrome
• may present as weakness in elderly
neurogenic hemiplegic migraine
post-ictal weakness after seizure
MS, spinal cord lesion
Guillain-Barre syndrome, polio
myasthenia gravis
endocrine/metabolic anaemia
hyper/hypocalcaemia
hyper/hypokalaemia
hypoglycaemia
adrenal insufficiency
hypothyroidism, thyrotoxicosis
infective/inflammatory/rheumatological sepsis
SLE, rheumatoid arthritis, polymyalgia
rheumatica
iatrogenic/toxins/drugs CO poisoning
Progressive weakness
CNS stroke
space-occupying lesions
MS, ALS
spinal cord lesion
PNS (see peripheral neuropathy)
myopathy genetic, metabolic-related
medication-related, alcohol
endocrine
• hyper/hypothyroidism
• Cushing's syndrome
Sensory loss
CNS stroke
space-occupying lesion
MS
spinal cord lesion
• Brown-Sequard
syndrome
PNS (see peripheral neuropathy)
Headache
primary migraine
• with/without aura
• associated with
menstruation
tension headache
medication overuse headache
trigeminal autonomic cephalgia
• cluster headache
secondary space occupying lesion
• haemorrhagic stroke
• cerebral neoplasia
• abscess
trauma
meningitis, encephalitis
giant cell arteritis
Goitre
nutritional iodine deficiency
autoimmune Hashimoto thyroiditis
disease Grave's disease
familial/sporadic multinodular
goitre
neoplasia follicular adenoma
thyroid cancer
Chest pain
cardiological acute coronary syndrome
• myocardial infarction
• un/stable angina
cardiac tamponade
pericarditis
vascular aortic dissection
aortic aneurysm
respiratory pulmonary embolism
pneumonia
spontaneous pneumothorax
lung cancer
asthma
COPD
MSK trauma (e.g. fracture)
referred GIT
infective shingles (from herpes zoster
virus)
psychogenic anxiety and panic disorder
Palpitations
arrhythmia ectopic beats
• single pounding sensation
atrial flutter, atrial fibrillation
• irregular beats
supraventricular tachycardia
• rapid beats
• may be felt in neck
• may occur since childhood
• may be terminated by Valsalva, vagal
manoeuvres
ventricular tachycardia
• rapid and regular beats
psychogenic anxiety and panic disorder
somatization, depression
non-arrhythmic valvular heart disease
cardiogenic pacemaker syndrome
cardiomyopathy
atrial myxoma
high output states anaemia
pregnancy
Paget's disease
fever
metabolic hyperthyroidism: thyrotoxicosis
hypoglycaemia
sympathetic system stress, exercise
sympathomimetic agents
• beta blocker withdrawal
cocaine, amphetamines, nicotine, caffeine
Dyspnoea (location)
respiratory above vocal cords foreign body
nasal sinus disease/URTI
anaphylaxis
vocal cord palsy
neoplasia
below vocal cords asthma
COPD
bronchiectasis
cystic fibrosis
neoplasia
tracheal obstruction/stenosis
tracheomalacia
cricoarytenoid RA
parenchymal pneumonia
ARDS
ILD
• IPF
• sarcoidosis
• connective tissue
disease
• in/organic dust
pneumoconiosis
vasculature PE
chronic PTH
AV malformation
pulmonary arteritis
pleural pneumothorax
pleural effusion
mesothelioma
chest wall and obesity
nervous system kyphoscoliosis
trauma
ankylosing spondylosis
muscle disease (GBS,
polymyositis, MG, MND)
spinal cord lesion
hypothalamic lesion

cardiac acute coronary syndrome

VHD (esp. mitral valve disease), intra-cardiac shunt
CCF and LV failure
cardiomyopathy
pericardial effusion/pericarditis
metabolic/obstetric/haematological anaemia hypoxia
pregnancy
hyperthyroidism
acidosis
psychogenic anxiety and panic disorder
Dyspnoea (onset)
seconds-to- acute asthma attack
minutes anaphylaxis
pneumothorax
pulmonary oedema (i.e. orthopnoea, PND)
pulmonary embolism
foreign body
hours-to-days exacerbation of asthma, COPD, cardiac
failure
infection (e.g. pneumonia)
pleural effusion
metabolic acidosis
weeks-to-years interstitial lung disease, pulmonary
fibrosis
COPD
anaemia
pleural effusion
Chronic cough
respiratory asthma, COPD, cardiac failure
bronchiectasis
upper airway cough syndrome
• rhinitis, postnasal drip, sinus headache,
congestion
neoplasia: cancer
GIT GORD
iatrogenic ACE inhibitors
Haemoptysis
infective acute/chronic bronchitis
(common)
• small specks of blood
severe pneumonia with lung
abscess
tuberculosis
bronchiectasis
vascular pulmonary emboli
• with haemorrhagic
infarction
neoplasia lung cancer
Wheeze
upper airway foreign body
nasal sinus disease/URTI
anaphylaxis
vocal cord palsy
neoplasia
goitre
large airway asthma, COPD
tracheomalacia, tracheobronchomalacia
mucous plugs
• pneumonia
• cystic fibrosis
• bronchiectasis
neoplasia
mediastinal mass
small airway asthma, COPD
bronchiectasis
bronchiolitis, bronchiolitis obliterans
reactive airway disease
parenchymal scarring (i.e. sarcoidosis,
tuberculosis)
cardiac asthma/cardiac failure
Abdominal pain
hepatitis oesophagitis spleen
gall bladder gastritis • lymphoma/leukaemia
• cholelithiasis dyspepsia (achy pain)
• cholecystitis PUD (gastric, duodenum) • glandular fever (mild)
• choledocholithiasis pancreatitis pancreatitis
pancreatitis heart LLL lung
RLL lung
pyelonephritis gastroenteritis pyelonephritis
urolithiasis obstruction urolithiasis
• intussusception
• volvulus
• adhesions
Crohn's disease
appendicitis cystitis diverticulitis
colitis, IBD, IBS gynae colitis, IBD, IBS
ureters • PID, endometritis, ureters
gynae cervicitis gynae
• ectopic pregnancy • adenomyosis, • ectopic pregnancy
• PID, salpingitis leiomyoma • PID, salpingitis
• ovarian torsion • pregnancy • ovarian torsion
• ruptured ovarian o placental • ruptured ovarian cyst
cyst abruption • endometriosis
• endometriosis o miscarriage hernia
hernia o labour
Abdominal masses
hepatomegaly left lobe of liver splenomegaly
gallbladder enlargement cancer (gastric, transverse kidney
• common bile duct colon) cancer (pancreas, colon)
obstruction retroperitoneal
kidney lymphadenopathy
cancer (pancreas, colon) AAA
kidney AAA kidney
bowel bladder enlargement bowel
• appendiceal abscess uterine mass (e.g. fibroids), • faeces
• Crohn's disease pregnancy • Crohn's disease
ovarian cyst ovarian cyst • diverticulitis
cancer (caecal, carcinoid, ovarian cyst
ovarian) cancer (sigmoid, descending
lymphadenopathy colon, ovarian)
transplanted kidney lymphadenopathy
transplanted kidney
hernia (inguinal, femoral) hernia (inguinal, femoral)
ectopic testes ectopic testes
psoas abscess psoas abscess
lymphadenopathy lymphadenopathy
Palpable liver
hepatomegaly massive alcoholic liver disease
hepatocellular carcinoma, metastatic
cancer
right heart failure
moderate (above causes)
hemochromatosis
haematological (e.g. lymphoma,
leukemia)
fatty liver disease
infiltration (e.g. amyloid)
mild (above causes)
hepatitis
biliary obstruction
HIV infection

firm and irregular liver hepatocellular carcinoma, metastatic cancer

cirrhosis
tender liver hepatitis
rapid liver enlargement
• right heart failure
• Budd-Chiari syndrome (hepatic vein thrombosis)
hepatocellular carcinoma
hepatic abscess
pulsatile liver tricuspid regurgitation
hepatocellular carcinoma
Splenomegaly (found in 3-12% of normal
population)
massive chronic myeloid leukemia
myelofibrosis
moderate (above causes)
portal hypertension
lymphoma, leukaemia
thalassaemia
small (above causes)
other myeloproliferative
disorders
• polycythaemia rubra vera
• essential
thrombocytopenia
haemolytic anaemia
connective tissue disease
• rheumatoid arthritis
• SLE
• polyarteritis nodosa
Anal pain
intra-luminal haemorrhoids
fecal impaction
diarrhoea leading to
irritation
trauma
inflammatory proctitis
IBD
MSK levator ani syndrome
proctalgia fugax
coccydynia
structural anal fissure
anorectal fistula
perianal abscess
neoplasia anal cancer
Upper GI bleeding
oesophageal varices
Mallory-Weiss tear
reflux oesophagitis
gastric varices
PUD
portal hypertensive
gastropathy
duodenal PUD
haemobilia
vascular angiodysplasia/angioectasia
dieulafoy
ischaemic bowel disease
neoplasia
Lower GI bleeding
anorectal rectal varices, haemorrhoids
anal fissures
inflammatory IBD (Crohn's disease, ulcerative colitis)
infective gastroenteritis
degenerative diverticulosis
vascular angiodysplasia/angioectasia
ischaemic bowel disease, ischaemic
colitis
neoplasia
iatrogenic radiation proctitis
Nausea and vomiting
infective gastroenteritis
gastrointestinal obstruction
gastroparesis and other functional
disorders
dyspepsia
endocrine pregnancy
central migraine
increased ICP
labyrinthine disorders
psychogenic
toxic/medication chemotherapy
Diarrhoea
infective acute infection
chronic infection: persistent acute infection, Giardia,
Cryptosporidium
inflammatory IBD: UC, Crohn's disease
obstruction
functional IBS
malabsorption Coeliac disease
exocrine pancreatic insufficiency
lactose intolerance
neoplasia
iatrogenic/drugs/toxic medication
extensive GIT surgery
post-cholecystectomy diarrhoea
• from lack of bile acid reabsorption
Constipation
idiopathic primary constipation
structural/organic obstruction
Coeliac disease, lactose intolerance
ischaemic bowel disease
functional IBS
metabolic/endocrine hypercalcaemia, hyperkalaemia
hypothyroidism
diabetes mellitus associated autonomic
neuropathy
pregnancy
neurogenic Hirschsprung's disease
autonomic neuropathy
spinal cord injury, multiple sclerosis, Parkinson's
disease
neoplasia
iatrogenic/drugs/toxic opioid usage
psychogenic
Jaundice
pre-hepatic intra-hepatic post-hepatic
• impaired bilirubin • impaired conjugation • extrahepatic
production • Gilbert syndrome cholestasis/biliary obstruction
• haemolysis leading to unconjugated • choledocholithiasis
o hereditary hyperbilirubinemia • primary sclerosing
spherocytosi cholangitis
s • intrahepatic cholestasis • strictures
o G6PD • hepatitis • malignancy
deficiency o viral hepatitis o hepatic
o Wilson's o alcoholic o gallbladder cancer
disease hepatitis o cholangiocarcinom
o reabsorption o non-alcoholic a
of steatohepatiti o pancreatic
haematoma s o lymphoma
leading to unconjugated • drugs • pancreatitis
hyperbilirubinemia • pregnancy
• total parenteral
• impaired hepatic nutrition
bilirubin delivery • primary biliary
• cardiac failure cholangitis
leading to unconjugated leading to conjugated
hyperbilirubinemia hyperbilirubinemia
Acute renal injury
pre-renal renal post-renal
• cardiorenal • glomerular • stones
syndrome • non-proliferative • PUJ, pelvic brim,
• previous MI (structural) vs. insertion into bladder
• CCF proliferative (cellular) • calcium, struvite, uric,
• renal artery • primary vs. secondary cystine
stenosis • tubular/interstitial • other luminal ureter
• volume-induced • drug-induced obstruction
• hypotension o gentamicin • cast and cellular debris
• over-diuresis o quinolones • strictures
(thiazides) o NSAIDs • extra-luminal obstruction
• haemorrhage o lithium • malignancy (gynae,
• sepsis-induced • infective prostatic)
o pyelonephritis • other
o abscess anatomical/structural
• ischaemic abnormalities
o acute tubular
necrosis
• heme-mediated
o hemolytic uremic
syndrome
o rhabdomyolysis
• amyloid
o multiple myeloma
• renovascular
• ACE inhibitors
Polyuria (urine output >3L/day)
osmotic diuresis uncontrolled diabetes mellitus
urea diuresis
• azotaemia
• iatrogenic urea therapy for
hyponatremia
• protein/tissue catabolism
sodium diuresis
• volume expansion
• release of bilateral urinary obstruction
primary polydipsia
(psychogenic)
central diabetes insipidus idiopathic (most)
(ADH deficiency)
nephrogenic diabetes chronic lithium use
insipidus hypercalcaemia
iatrogenic diuretics
Nocturia (>20-33% of urine output at night)
oedematous states cardiac failure
liver failure
renal failure
sleep disorder obstructive sleep apnoea
iatrogenic/drugs alcohol and caffeine
intake (salt, water, protein)
diuretics
bladder storage storage overactive bladder syndrome
disorder symptoms UTI
bladder calculi
urothelial carcinoma
voiding from bladder outflow obstruction
symptoms • benign prostate enlargement, prostate
cancer
• bladder neck stenosis
• urethral stricture
• meatal stenosis (rarely)
from poor detrusor contractility
neurogenic spinal cord disorders
stroke
Parkinson's disease
diabetic autonomic neuropathy
Urinary incontinence/lower urinary tract
symptoms
stress incontinence
urge incontinence overactive bladder syndrome
UTI
bladder calculi
urothelial carcinoma
overflow incontinence from bladder outflow obstruction
• benign prostate enlargement, prostate
cancer
• bladder neck stenosis
• urethral stricture
• meatal stenosis (rarely)
from poor detrusor contractility
neurogenic spinal cord disorders
stroke
Parkinson's disease
diabetic autonomic neuropathy
neoplasia
Haematuria
infective UTI: pyelonephritis, cystitis
obstruction benign prostate enlargement
urethral strictures
urinary calculi
trauma
renal nephritic syndrome
neoplasia renal cell carcinoma
transitional cell carcinoma
squamous cell carcinoma
urothelial cell carcinoma
prostate acinar
adenocarcinoma
Dysuria
infection/inflammatory UTI: pyelonephritis, cystitis
prostatitis, urethritis, vulvovaginitis, balanitis, meatitis ,
epididymo-orchitis
sexually-transmitted infection
irritation
obstruction benign prostate enlargement
urethral stricture
bladder lithiasis, urolithiasis
neoplasia
spondyloarthropathy Behcet's syndrome
Reiter's syndrome
Groin/scrotal pain
infective epididymitis
structural testicular torsion
torsion of the appendix
testis
herniation: femoral,
inguinal
hip pain (see hip girdle pain)
referred pain urogenital
GIT pain
neurological
Back pain
mechanical vertebral fracture
spondylosis, degenerative disc
disease
spondylolisthesis
non-specific back pain
spinal stenosis
inflammatory rheumatoid arthritis
spondyloarthropathy
fibromyalgia
polymyalgia rheumatica
infective osteomyelitis
epidural abscess
neoplastic primary or secondary neoplasia
referred pain GIT
Joint pain
degenerative osteoarthritis
inflammatory rheumatoid arthritis
spondyloarthropathy
crystal
• gout
• pseudogout
infective/septic
arthritis
non-articular bursitis
tendinitis
capsulitis
muscle sprain
skeletal
• fracture
• osteomyelitis
• avascular
necrosis
neuropathic
Shoulder girdle pain
degenerative osteoarthritis
adhesive capsulitis
traumatic/mechanical rotator cuff syndrome
• rotator cuff arthropathy
instability of glenohumeral
joint
rheumatological polymyalgia rheumatica
fibromyalgia
Pelvic girdle pain
degenerative osteoarthritis
traumatic/mechanical skeletal
• fracture
• osteomyelitis
• avascular necrosis
obstetric pelvic girdle pain in
pregnancy
neuropathic
rheumatological polymyalgia rheumatica
fibromyalgia
Limb pain
mechanical muscle injury
• upper limb
o ruptured biceps
tendon
• lower limb
o hamstring tendonitis
o gastrocnemius head
o Achilles tendon
rupture
fracture
vascular peripheral vascular disease
• arterial insufficiency
• rupture of popliteal
aneurysm
DVT, thrombophlebitis
rheum complex regional pain syndrome
fibromyalgia
other ruptured Baker's cysts
referred nerve root compression from
spine
Peripheral neuropathy
traumatic
metabolic diabetes
toxins
• alcohol
• urea, ammonia
nutritional: vitamin B12
hypothyroidism
inflammatory Guillain-Barre syndrome
CIDP
iatrogenic chemotherapy (e.g.
vincristine)
infective shingles
poliovirus
Pitting oedema
generalised/bilateral malnutrition/starvation
liver failure, liver cirrhosis
renal failure, nephrotic syndrome
heart failure
septicaemia
pregnancy
disuse of calf muscle pump, frailty
venous obstruction (at and above abdomen)
iatrogenic (e.g. medications, excessive crystalloid infusion in ICU
patients)
unilateral deep venous thrombosis
venous incompetence
• damaged valves
• varicose veins
consider cellulitis
Non-pitting oedema
lymphoedema invasion by tumour
iatrogenic: surgery, lymph node
clearance
infection (e.g. Filariasis)
idiopathic
• lymphoedema praecox (<20yo)
• lymphoedema tarda (>40yo)
metabolic pre-tibial myxoedema with
hypothyroidism
Leg ulcers
vascular arterial ulcers (30%)
venous ulcers (50%)
endocrine diabetic ulcers
trauma pressure ulcers
(10%)
disruption
neoplasia
Lymphadenopathy
infective viral
• infectious mononucleosis from EBV
• HIV infection
• CMV
bacterial
• TB
• toxoplasmosis
• cat scratch disease (Bartonella henselae)
fungal, parasites
autoimmune/inflammatory SLE
rheumatoid arthritis
sarcoidosis
neoplasia lymphoma, leukaemia
metastatic cancer
• Virchow's node (e.g. stomach, gallbladder, pancreas,
kidneys, testicles, ovaries, lymphoma, prostate)
iatrogenic/drugs
Inflamed sub/cutaneous patch (cellulitis-
mimics)
infective necrotising fasciitis, toxic shock syndrome, gas gangrene
Lyme disease (erythema migrans)
herpes zoster
osteomyelitis, septic arthritis
inflammatory/atopic insect bite
contact dermatitis, drug reaction, vaccination-site reaction
vasculitis
gout
vascular deep venous thrombosis
thrombophlebitis
gravitational dermatitis/stasis dermatitis/venous eczema,
lipodermatosclerosis
lymphedema
Sub/cutaneous papule/nodule (skin abscess-
mimics)
local non-infective epidermal cyst
• may become
infected
infective folliculitis
skin abscess
inflammatory insect bite
signs of systemic rheumatoid nodule
disease gouty tophi
neoplasia lipoma
BCC