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DDxPro
Possible Diagnoses
Infectious mononucleosis
Infectious mononucleosis
Adenopathy
Lymphadenopathy
Fatigue
Low grade fever
Sweats
Dysphagia
Tonsillitis
Pharyngeal inflammation
Pharyngitis
Sore throat
Malaise
Splenomegaly
Posterior cervical lymphadenopathy
Palatal petechiae
Palatal petechiae with blotchy red macules
Palatal petechiae with streaky hemorrhages
Anorexia
Symmetrical lymphadenopathy
Chills
Ebv shedders
Multiple sclerosis
Multiple sclerosis
Fatigue
Weakness
Physical exhaustion
Bladder dysfunction
Detrusor hyperreflexia
Detrusor sphincter dyssynergia
Nocturia
Decreased libido
Heat sensitivity
Impaired genital sensation
Sexual dysfunction
Dorsal midbrain syndrome
Horizontal nystagmus
Nystagmus
Pendular nystagmus
Periodic alternating nystagmus
Skew deviation
Cerebellar dysarthria
Exercise-induced weakness
Recurrent attacks
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
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
Sarcoidosis
Sarcoidosis
Lung involvement
Fatigue
Asymptomatic bilateral hilar adenopathy
Lofgren syndrome
Eye lesions
Joint lesions
Skin lesions
Diffuse interstitial lung disease
Cough
Dyspnea
Dry eyes
Migratory polyarthralgia
Painful nodules on the anterior surface of the lower extremities
Palpitations
Fever
Weight loss
Chest pain
Malaise
Erythema nodosum
Heerfordt syndrome
Systemic sclerosis
Systemic sclerosis
Raynaud phenomenon
Gastrointestinal involvement
Puffy fingers
Soft tissue swelling
Swelling of the hands
Fatigue
Generalized arthralgia
Stiffness
Interstitial lung disease
Calcinosis cutis
Crest syndrome
Esophageal dysmotility
Pinched beak-like appearance of the nose
Reduced oral aperture
Sclerodactyly
Sclerotic skin on the abdomen
Sclerotic skin on the chest
Sclerotic skin on the shoulders
Sclerotic skin on the upper arms
Osteoarthritis
Osteoarthritis
Fatigue
Joint gelling
Sleep disturbance
Obesity
Aching joint pain
Aggravating by joint use
Apophyseal joints of lower cervical pain
Apophyseal joints of lower lumbar spine pain
Cervical spine pain
Constant joint pain
Dull joint pain
First carpometacarpal joints pain
First metatarsal phalangeal joints pain
Hand joints pain
Hips pain
Intermittent joint pain
Interphalangeal joints pain
Joint pain
Knees pain
Lower cervical pain
Chronic heart failure
Chronic heart failure
Shortness of breath
Dyspnea on exertion
Fatigue
Dyspnea occurring in the recumbent position
Orthopnea
Relieved by sitting upright
Relieved by sleeping with additional pillows
Cool peripheral extremities
Cyanosis of the lips
Cyanosis of the nail beds
Dyspnea at rest
Dyspnea exacerbated in the supine position
Peripheral edema
Symmetric peripheral edema
Atherosclerotic
Cardiomyopathy
Dyspnea awaken the patient from sleep
Metabolic syndrome
Nocturnal cough
Paroxysmal nocturnal dyspnea
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
Liver abscess
Pyogenic liver abscess
Fever
Fatigue
Abdominal pain
Hepatomegaly
Jaundice
Chills
Nausea
Vomiting
Right upper quadrant tenderness
Pleuritic pain
Shortness of breath
Weight loss
Cough
Severe pain
Right upper quadrant guarding
Right upper quadrant pain
Right upper quadrant rocking tenderness
Punch tenderness
Rebound tenderness
Last 5 to 26 days
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
Liver disease
Liver disease
Fatigue
Increased need for sleep
Lack of stamina
Lethargy
Listlessness
Malaise
Poor energy
Weakness
Abdominal distention
Afternoon fatigue
Fatigue after activity
Intestinal bleeding
Itching
Nausea
Poor appetite
Right upper quadrant pain
Intermittent fatigue
Abdominal pain
Bloating
Gynecomastia
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