Condition | Symptoms | Physical findings | Supportive diagnostic studies |
Cardiopulmonary | |||
Congestive heart failure | Dyspnea on exertion, orthopnea, leg swelling | S3 gallop, inspiratory rales, elevated jugular venous distension, peripheral edema | Chest radiograph, echocardiogram |
Chronic obstructive pulmonary disease | Dyspnea, chronic cough, sputum production | Evidence of hyperinflation, wheezing, rales | Chest radiograph |
Sleep apnea | Snoring, interrupted breathing during sleep | Obesity, hypertension | Sleep study |
Endocrinologic/metabolic | |||
Hypothyroidism | Cold intolerance, weight gain, constipation, dry skin | Bradycardia, goiter, slow deep tendon reflex relaxation phase | Thyroid function tests |
Hyperthyroidism | Heat intolerance, weight loss, diarrhea, moist skin | Tachycardia, goiter, ophthalmopathy | Thyroid function tests |
Chronic renal disease | Nausea/vomiting, mental status changes, decreased urine | Hypertension, peripheral edema | Renal function tests/ serum electrolytes |
Chronic hepatic disease | Abdominal distention, gastrointestinal bleeding | Jaundice, palmar erythema, gynecomastia, splenomegaly, evidence of ascites | Hepatic function tests |
Adrenal insufficiency | Weight loss, salt craving, gastrointestinal complaints | Hypotension, hyperpigmentation, vitiligo | Morning cortisol/ACTH, ACTH stimulation test |
Electrolyte abnormalities | |||
Hyponatremia | Nausea, malaise, cognitive dysfunction | Generally normal exam | Serum sodium level |
Hypercalcemia | Anorexia, polydipsia/polyuria, nausea | Generally normal exam | Serum calcium/albumin levels |
Hematologic/neoplastic | |||
Anemia | Dizziness, weakness, palpitations, dyspnea | Tachycardia, pallor | Complete blood count |
Occult malignancy | Weight loss, localized symptoms may be present depending upon type | Variable | Variable depending upon type |
Infectious diseases | |||
Mononucleosis syndrome | Fever, sore throat, tender lymph nodes | Fever, exudate pharyngitis, tender cervical adenopathy | Complete blood/differential count, monospot |
Viral hepatitis | Fever, nausea/vomiting, abdominal discomfort | Fever, jaundice, tender hepatomegaly | Hepatic function tests, viral hepatitis serologies |
HIV infection | Weight loss, variable localized complaints | Variable physical findings | HIV serology |
Subacute bacterial endocarditis | Fever/chills, night sweats, myalgias | Fever, new (regurgitant) murmur, peripheral manifestations | Blood cultures, echocardiogram |
Tuberculosis | Fever/chills, night sweats, fatigue, weight loss | Cough, chest pain, dyspnea, hemoptysis | PPD/gamma-interferon assay, chest radiograph |
Rheumatologic | |||
Fibromyalgia | Chronic diffuse muscle pain | Multiple "tender points" on palpation | None |
Polymyalgia rheumatica | Aching/morning stiffness of shoulders, neck, and hips | Decreased range of motion of shoulders, neck, and hips | Erythrocyte sedimentation rate |
Psychological | |||
Depression | Sad mood, anhedonia, altered sleep, cognitive dysfunction | Generally normal exam | Screening test (eg, PHQ-2, PHQ-9) |
Anxiety disorder | Generalized nervousness, panic attacks, phobias | Tachycardia, muscle tension | Screening test (eg, GAD-7) |
Somatization disorder | Multiple chronic constitutional and localized complaints | Generally normal exam | Screening test (eg, SSS-8) |
Medication toxicity* | |||
Variable | Generally normal exam | None | |
Substance use¶ | |||
Variable | Generally normal exam | None |
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