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DDxPro
Possible Diagnoses
Addison disease
Addison disease
Fatigue
Weight loss
Hyperpigmentation
Hyperpigmentation in palmar surfaces
Hyperpigmentation increased by sunlight
Salt craving
Hyperkalemia
Hypotension
Postural hypotension
Dehydration
Abdominal discomfort
Abdominal pain
Gi disturbance
Nausea
Vomiting
Insidious onset
Increased thirst
Failure to thrive
Morning headache
Muscle weakness
Pancreatic cancer
Pancreatic cancer
Asthenia
Weight loss
Anorexia
Abdominal pain
Intermittent pain
Epigastric pain
Jaundice
Intermittent abdominal pain
New onset of diabetes mellitus
Nausea
Midepigastric pain
Upper abdominal pain
Radiate to back
Radiate to sides
Hepatomegaly
Vomiting
Courvoisier sign
Trousseau syndrome
Palpable periumbilical mass
Abdominal mass
Celiac disease
Celiac disease
Diarrhea with bulky
Floating stools
Foul-smelling stools
Weight loss
Autoimmune thyroid disease
Recurrent severe aphthous stomatitis
Flatulence
Diarrhea
Selective iga deficiency
Type 1 diabetes mellitus
Thyroid disease
Bloating
Fatigue
Dermatitis herpetiformis
Neurologic disorders
Osteoporosis
Atopic dermatitis
Esophagitis
Gastritis
Mucosal abnormality
Brucellosis
Brucellosis
Lethargy
Sweating
Weight loss
Arthralgia
Chills
Fever
Acute febrile illness
Night sweats
Joint swelling
Joint tenderness
Arthlargia
Arthlargia of hips
Arthlargia of knees
Arthlargia of spine
Malaise
Joint bursitis
Intermittent back pain
Pallor
Conjuctival contact with infected brucella material
Inhalation of infected aerosols
Systemic lupus erythematosus
Systemic lupus erythematosus
Arthralgia
Myalgia
Fatigue
Fever
Arthritis
Arthritis in hands
Arthritis in knees
Arthritis in wrists
Intermittent arthritis
Migratory arthritis
Nonerosive arthritis
Polyarticular arthritis
Symmetrical arthritis
Tenderness in joints
Tenderness in tendons
Anorexia
Malaise
Weight loss
Photosensitivity
Malar rash
Cholangitis
Primary sclerosing cholangitis
Associated with inflammatory bowel diseases
Anesthesia
Increased need for sleep
Lack of stamina
Lethargy
Listlessness
Poor energy
Symptoms of temporal lobe seizures
Muscle weakness
Proximal muscle weakness
Increasing cholestasis
Right upper quadrant pain
Jaundice
Fatigue
Fever
Complication ulcerative colitis
Absence of parenchymal kidney disease
Absence of shock
Amnesia
Anxiety
Diabetes
Type 1 diabetes mellitus
Polydipsia
Polyuria
Drowsiness
Fruity-smelling breath
Hyperglycemia
New onset of chronic polydipsia
Central nervous system involvment
Decreased visual acuity
Reduction of visual acuity
Visual disturbance
Visual loss
Visual symptoms
Weight loss
Diabetic ketoacidosis
Acute severe onset
Worsening polyuria
Low energy
Diabetic neuropathy
Distal symmetrical polyneuropathy
Enhanced thirst
Cirrhosis
Primary biliary cirrhosis
Malignancy
Portal hypertension
Urinary tract infection
Anesthesia
Burning sensation in extremities
Crawling sensation in extremities
Creeping sensation in extremities
Increased need for sleep
Lack of stamina
Lethargy
Listlessness
Numbness sensation in extremities
Paresthesia in entire hand
Paresthesia in wrist
Poor energy
Significant fatigue
Somatosensory symptoms
Symptoms of temporal lobe seizures
Tingling sensation in extremities
Concentration impairment
Chronic bacterial prostatitis
Chronic bacterial prostatitis
Bulk-related symptoms
Charcot triad
Constitutional symptoms
Cystitis
Cystitis symptoms
Fever
High grade fever
High-grade fever
Intermittent fever
Low grade fever
Mild fever
Pelvic pain
Perineal pain
Recurrent abdominal pain
Recurrent infection
Recurrent pain
Recurrent uti
Reynold pentad
Suprapubic pain
Symptoms onset six months
Adrenal crisis
Adrenal crisis
Shock
Abdominal pain
Back pain
Flank pain
Lower chest pain
Weakness
Meningococcemia
Circulatory failure
Hypovolemic shock
Vasodilatory shock
Fever
Primary adrenal insufficiency
Generalized tenderness
Fatigue
Lethargy
Anticoagulant
Antiphospholipid syndrome
Coagulopathy
Cytomegalovirus infection
Dehydration
Alcoholic liver disease
Alcoholic liver disease
Anorexia
Fatigue
Fever
Jaundice
Nausea
Right upper quadrant abdominal discomfort
Vomiting
Weight loss
Digital clubbing
Palmar erythema
Ascites
Splenomegaly
Asterixis
Confusion
Dupuytren contractures
Gynecomastia
Hematemesis
Leg swelling
Weight gain
Gastrointestinal bleeding
Ulcerative colitis
Ulcerative colitis
Rectal bleeding
Chronic diarrhea
Frequent discharge of mucus
Frequent diarrhea
Gross bleeding
Diarrhea
Physical signs of proctitis
Frequent bloody diarrhea
Feeling of incomplete evacuation
Abdominal tenderness
Bloody stools
Malnutrition
Weight loss
Constipation
Abdominal pain
Fever
Bloody diarrhea
Cramping abdominal pain
Pallor
Erythema nodosum
Fatigue
History, description of fatigue, PE
Evidence of physiologic fatigue
Treat Underlying Cause of Persistent Fatigue
Fatigue persists
Laboratory evaluation: CBC, thyroid-stimulating hormone, electrolytes, creatinine, liver enzymes, ESR
Abnormal results: evaluate and treat
Fatigue either resolved or appropriate to degree of abnormality
Fatigue greater than appropriate for disease
Persistent fatigue, no medical cause found
Psychosocial assessment
Psychiatric diagnosis identified: depression, anxiety disorder, somatoform disorder, other
Treat or refer
No specific psychiatric diagnosis identified
Symptomatic treatment: reorganize schedule, graduated activity/exercise ...
Criteria for chronic fatigue syndrome
Social/situational problem identified
Referral/treatment
Normal results: (CBC, thyroid-stimulating...)
Persistent fatigue, no medical cause found
Psychosocial assessment
Psychiatric diagnosis identified: depression, anxiety disorder, somatoform disorder, other
Treat or refer
No specific psychiatric diagnosis identified
Symptomatic treatment: reorganize schedule, graduated activity/exercise ...
Criteria for chronic fatigue syndrome
H/PE, Mental, Tests(CBC, ESR, ALT, Ca, PO4, BUN, TSH, UA...)
Social/situational problem identified
Referral/treatment
Fatigue resolved
Chronic medical disease or exposure identified
Disease-Specific Testing and Treatment
Risk factor for sexually transmitted or bloodborne disease
Testing for HIV, syphilis, and hepatitis B and C
Treat Abnormal Results
Normal results
Laboratory evaluation: CBC, thyroid-stimulating hormone, electrolytes, creatinine, liver enzymes, ESR
Abnormal results: evaluate and treat
Fatigue either resolved or appropriate to degree of abnormality
Fatigue greater than appropriate for disease
Persistent fatigue, no medical cause found
Psychosocial assessment
Psychiatric diagnosis identified: depression, anxiety disorder, somatoform disorder, other
Treat or refer
No specific psychiatric diagnosis identified
Symptomatic treatment: reorganize schedule, graduated activity/exercise ...
Criteria for chronic fatigue syndrome
Social/situational problem identified
Referral/treatment
Normal results: (CBC, thyroid-stimulating...)
Persistent fatigue, no medical cause found
Psychosocial assessment
Psychiatric diagnosis identified: depression, anxiety disorder, somatoform disorder, other
Treat or refer
No specific psychiatric diagnosis identified
Symptomatic treatment: reorganize schedule, graduated activity/exercise ...
Criteria for chronic fatigue syndrome
H/PE, Mental, Tests(CBC, ESR, ALT, Ca, PO4, BUN, TSH, UA...)
Social/situational problem identified
Referral/treatment
Geographic risk factors
Test for Lyme disease or coccidioidomycosis
Treat Abnormal Results
Normal results
Laboratory evaluation: CBC, thyroid-stimulating hormone, electrolytes, creatinine, liver enzymes, ESR
Abnormal results: evaluate and treat
Fatigue either resolved or appropriate to degree of abnormality
Fatigue greater than appropriate for disease
Persistent fatigue, no medical cause found
Psychosocial assessment
Psychiatric diagnosis identified: depression, anxiety disorder, somatoform disorder, other
Treat or refer
No specific psychiatric diagnosis identified
Symptomatic treatment: reorganize schedule, graduated activity/exercise ...
Criteria for chronic fatigue syndrome
Social/situational problem identified
Referral/treatment
Normal results: (CBC, thyroid-stimulating...)
Persistent fatigue, no medical cause found
Psychosocial assessment
Psychiatric diagnosis identified: depression, anxiety disorder, somatoform disorder, other
Treat or refer
No specific psychiatric diagnosis identified
Symptomatic treatment: reorganize schedule, graduated activity/exercise ...
Criteria for chronic fatigue syndrome
H/PE, Mental, Tests(CBC, ESR, ALT, Ca, PO4, BUN, TSH, UA...)
Social/situational problem identified
Referral/treatment
Findings consistent with fibromyalgia
CPK, CRP, ANA, RF
Normal results(CPK, CRP, ANA, RF)
Laboratory evaluation: CBC, thyroid-stimulating hormone, electrolytes, creatinine, liver enzymes, ESR
Abnormal results: evaluate and treat
Fatigue either resolved or appropriate to degree of abnormality
Fatigue greater than appropriate for disease
Persistent fatigue, no medical cause found
Psychosocial assessment
Psychiatric diagnosis identified: depression, anxiety disorder, somatoform disorder, other
Treat or refer
No specific psychiatric diagnosis identified
Symptomatic treatment: reorganize schedule, graduated activity/exercise ...
Criteria for chronic fatigue syndrome
Social/situational problem identified
Referral/treatment
Normal results: (CBC, thyroid-stimulating...)
Persistent fatigue, no medical cause found
Psychosocial assessment
Psychiatric diagnosis identified: depression, anxiety disorder, somatoform disorder, other
Treat or refer
No specific psychiatric diagnosis identified
Symptomatic treatment: reorganize schedule, graduated activity/exercise ...
Criteria for chronic fatigue syndrome
H/PE, Mental, Tests(CBC, ESR, ALT, Ca, PO4, BUN, TSH, UA...)
Social/situational problem identified
Referral/treatment
Abnormal results(CPK, CRP, ANA, RF)
Evaluate for specific illness
Daytime hypersomnolence, snoring, or other symptoms of sleep apnea
Refer for sleep disorders evaluation
No specific medical illness identified
Laboratory evaluation: CBC, thyroid-stimulating hormone, electrolytes, creatinine, liver enzymes, ESR
Abnormal results: evaluate and treat
Fatigue either resolved or appropriate to degree of abnormality
Fatigue greater than appropriate for disease
Persistent fatigue, no medical cause found
Psychosocial assessment
Psychiatric diagnosis identified: depression, anxiety disorder, somatoform disorder, other
Treat or refer
No specific psychiatric diagnosis identified
Symptomatic treatment: reorganize schedule, graduated activity/exercise ...
Criteria for chronic fatigue syndrome
H/PE, Mental, Tests(CBC, ESR, ALT, Ca, PO4, BUN, TSH, UA...)
Exclude case if another cause for chronic fatigue is found.
Classify case as either chronic fatigue syndrome or idiopathic chronic fatigue if fatigue persists or relapses for >6 months.
Social/situational problem identified
Referral/treatment
Normal results: (CBC, thyroid-stimulating...)
Persistent fatigue, no medical cause found
Psychosocial assessment
Psychiatric diagnosis identified: depression, anxiety disorder, somatoform disorder, other
Treat or refer
No specific psychiatric diagnosis identified
Symptomatic treatment: reorganize schedule, graduated activity/exercise ...
Criteria for chronic fatigue syndrome
H/PE, Mental, Tests(CBC, ESR, ALT, Ca, PO4, BUN, TSH, UA...)
Exclude case if another cause for chronic fatigue is found.
Classify case as either chronic fatigue syndrome or idiopathic chronic fatigue if fatigue persists or relapses for >6 months.
A. Classify as chronic fatigue syndrome if:
B. Classify as idiopathic chronic fatigue if:
Social/situational problem identified
Referral/treatment
Involuntary Weight Loss
Recent institution of diuretic
Observe Repeat weight at 1–2 mo
Stable weight
Usual follow-up
Documented further IWL
Complete history, mental status, examination, diet and appetite, routine cancer screening tests
Preexisting chronic illness known to cause IWL
Reevaluate and optimize therapy
Review prescription and over-the-counter medications for anorectic side effects
Eliminate or modify offending medications
History or examination findings suggestive of illnesses known to cause IWL
Focus evaluation directed by abnormal findings
No history or examination findings suggestive of cause
CBC, SMA 12 Urinalysis Thyroid-stimulating hormone level Chest x-ray Stool guaiacs
Normal findings(CBC,SMA...)
More detailed psychosocial history: Screen for depression, anxiety, eating disorders...
Probable psychosocial cause detected
Treat Appropriate(psychosocial cause)
No abnormalities detected(psychosocial cause)
Unexplained IWL
Follow at close intervals (high risk)
Abnormal findings(CBC,SMA...)
Follow-up abnormal values
No recent institution of diuretic
Complete history, mental status, examination, diet and appetite, routine cancer screening tests
Preexisting chronic illness known to cause IWL
Reevaluate and optimize therapy
Review prescription and over-the-counter medications for anorectic side effects
Eliminate or modify offending medications
History or examination findings suggestive of illnesses known to cause IWL
Focus evaluation directed by abnormal findings
No history or examination findings suggestive of cause
CBC, SMA 12 Urinalysis Thyroid-stimulating hormone level Chest x-ray Stool guaiacs
Normal findings(CBC,SMA...)
More detailed psychosocial history: Screen for depression, anxiety, eating disorders...
Probable psychosocial cause detected
Treat Appropriate(psychosocial cause)
No abnormalities detected(psychosocial cause)
Unexplained IWL
Follow at close intervals (high risk)
Abnormal findings(CBC,SMA...)
Follow-up abnormal values
Anorexia
History Physical examination, Laboratory tests
Non-medical cause
Social factors
Psychological disorders
Depression Dementia Alcoholism Drug abuse Psychosis Anxiety Bereavement
Age-related conditions
Decreased olfactory sense Hypogeusia Visual disorders Hearing disorders Dental disorders
Eating disorders
Medical disease
Medications
Sedatives & psychotropics Digoxin Laxatives Appetite suppressants Thiazide diuretics...
CNS disease
Endocrine disorders
Thyroid disease, Adrenal insufficiency, Diabetes, Hyperparathyroidism, Hypercalcemia
GI disorders
Malabsorption syndromes, Peptic ulcer, Biliary disease, Hepatitis, GERD...
Diagnostic tests: Stool for blood, fat, parasites Upper GI with small bowel follow-through...
Other medical diseases
Chronic infection Malignancy Cardiopulmonary disease Cerebrovascular disease Abdominal ischemia
Hypotension
Assess stability
Unstable
Basic/Advanced Cardiac Life Support protocol
Stable
Etiology
Cardiogenic
Acute ischemia
Urgent catheterization, IABP, Dobutamine, Other inotropes
Other
Inotropes, Treat underlying cause
Noncardiogenic
Vasodilatory
Fluids, Vasopressors
Obstructive
Thrombolysis, Thrombectomy
Hypovolemic
Fluids
Unclear