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DDxPro
Possible Diagnoses
Chronic pelvic pain in women
Chronic pelvic pain in women
Impaired sleep
Pain-related insomnia
Poor sleep
Sleep disturbances
Constant pelvic pain
Episodic pelvic pain
Pelvic pain
Dysuria
Deep dyspareunia
Dyspareunia
Fatigue
Full bladder
Marital discord
Myalgia
Nausea related to pain
Opioid abuse
Opioid dependency
Somatic sensitivity
Stiffness of levator ani
Urinary frequency
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
Fibromyalgia
Fibromyalgia
Difficulty falling asleep
Difficulty getting back to sleep
Difficulty staying asleep
Light sleep
Low sleep efficiency
Low sleep quality
Nonrestorative sleep
Poor sleep
Waking in the early morning
Fatigue
Mid-afternoon fatigue
Morning fatigue
Bilateral musculoskeletal pain
Joint pain
Muscle pain
Musculoskeletal pain
Widespread musculoskeletal pain
Cognitive dysfunction
Chronic headache
Depression
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
Chronic fatigue syndrome
Chronic fatigue syndrome
Fibromyalgia
Altered cognition
Altered sleep
Difficulty sleeping
Unrefreshing sleep
Overwhelming fatigue
Sudden onset of fatigue
Exacerbated by excessive physical activity
Sore throat
Concentration impairment
Debilitating fatigue for more than 6 months
Diffuse fascial pain
Diffuse muscular pain
Diffuse tendon pain
Exertional exhaustion
Fatigue present for over 6 months
Generalized arthralgia without inflammation
Headache with onset after fatigue
Migraine
New-onset headache
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 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
Hereditary angioedema
Hereditary angioedema
Extremities skin swelling
Face skin swelling
Genitals skin swelling
Skin swelling
Exacerbating by oral contraceptives
Abdominal distension
Abdominal pain
Gastrointestinal colic
Nausea
Vomiting
Diarrhea
Exacerbating by stress
Skin sensation of fullness
Skin sensation of irritation
Skin tingling
Chicken-wire pattern of erythematous discoloration
Erythema marginatum
Erythematous discoloration
Exacerbating by bacteriuria
Exacerbating by bicycle riding
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
Hypothyroidism
Central hypothyroidism
Head irradiation
Men type 1
Neck irradiation
Traumatic brain injury
Hypogonadism
Pituitary hormone abnormalities
Cold intolerance
Fatigue
Weight gain
Muscle cramps
Weakness
Headache
Acromegaly
Adrenal insufficiency
Anorexia
Craniopharyngioma
Cretinism
Delayed sexual maturation
Dwarfism
Growth retardation
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
Klebsiella pneumoniae liver abscess
Fever
Right upper quadrant tenderness
Fatigue
Lack of stamina
Lethargy
Poor energy
Weakness
Chills
Abdominal pain
Nausea
Vomiting
Severe pain
Thrombophlebitis
Punch tenderness
Rebound tenderness
Hepatomegaly
Jaundice
Solitary lesion
Localized to right upper quadrant
5 to 26 days
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
Neck Pain
History Trauma Onset of pain Neurologic symptoms Features of inflammatory arthritis
Physical examination, Neurologic findings, Localization of painful areas
Imaging
Plain radiographs
MRI or CT, Electromyography, Laboratory tests
Irritable bowel syndrome
Patient with ABDOMINAL DISCOMFORT WITH ALTERED BOWEL MOTILITY
Rome diagnostic criteria for IBS (Table 1)
Positive
Physical examination
IBS subtype
Directed diagnostic testing, if necessary
Constipation
Osmotic Laxative, Fiber
Lubiprostone, tegaserod
Diarrhea
Loperamide Diphenoxylate
Alosetron
Negative
Consider other functional GI disorders
See Chronic Diarrhea (p 204) and Constipation (p 208)