Most Likely Diagnosis
cervical discharge, strawberry cervix
cervicitis
young adult with chronic lung disease (cough, sputum, hemoptysis, bronchiectasis, wheezing, dyspnea) and recurrent infection, sinus pain and polyps, + GI involvement
cystic fibrosis
dysuria (frequency, burning, urgency), suprapubic pain/discomfort, mild/absent fever
cystitis
diarrhea with blood and WBC in stool with HUS
e coli 0157:h7 > shigella
diarrhea with blood and WBC in stool with poultry
salmonella
profound hypotension, fever, confusion and coma
acute adrenal crisis
asthmatic pt with recurrent episodes of brown flecked sputum and transient infiltrates on CXR
allergic bronchopulmonary aspergillosis
daytime sleepiness and hx of loud snoring, headache, impaired memory and judgement, depression, htn, erectile dysfunction, "bull neck"
obstructive sleep apnea
pt with AIDS with dyspnea on exertion, dry cough and fever, CD4 <200
PCP
increased hat, ring, shoe size, carpal tunnel syndrome, obstructive sleep apnea, body odor, coarsening facial features and teeth widening, deep voice and macroglossia, colonic polyps and skin tags, arthralgias, hypertension, cardiomegaly and CHF, ED
acromegaly
jaundice, fever, weight loss, fatigue, dark urine, HSM, n/v, abdominal pain
acute hepatitis
dysuria with perineal pain, tender prostate on exam
acute prostatitis
acute onset shortness of breath, rales, JVD, s3 gallop, edema, orthopnea
acute pulmonary edema
central obesity, increased LDL and cholesterol, reduced lean muscle mass
adults with GH deficiency
recurrent episodes of watery eyes, sneezing, itchy nose, itchy eyes, inflammed or boggy nasal mucosa, pale or violaceous turbinates, nasal polyps
allergic rhinitis
rash with hypotension, tachycardia, shortness of breath, wheezing, swelling of lips/tongue/face, stridor
anaphylaxis
dyspnea with pallor, gradual over days to weeks
anemia
sudden swelling of the face, tongue, eyes, airway
angioedema
CHF with wide pulse pressure, wide bounding pulse, pulsation in nail bed, increased BP in legs, head bobbing
aortic regurgitation
angina, syncope, CHF, systolic crescendo-descrescendo murmur radiates to carotid
aortic stenosis
dyspnea with sudden onset, wheezing, increased expiratory phase
asthma
symptoms worse at night, nasal polyps, sensitivity to aspirin, eczema or atopic dermatitis, increased length of expiratory phase of respiration, increased use of accessory muscles
asthma
diarrhea with no blood or wbc in stool with vomiting
b cereus, s aureus
recurrent episodes with very high volume purulent sputum, hemoptysis, duspnea and wheezing, weight loss, anemia of chronic disease, crackles on lung exam, clubbing is uncommon, dyskinetic cilia syndrome
bronchiectasis
dyspnea with burning building or car, wood burning stove in winter, suicide attempt
carbon monoxide poisoning
pain in weight bearing joints, DIP>PIP, crepitations, short duration of stiffness
degenerative joint disease
extremely high volume urine and excessive thirst causing volume depletion and hypernatremia, can cause confusion, disorientation, lethargy, seizures and coma
diabetes insipidus
polyuria, polydipsia, polyphagia
diabetes mellitus
CHF with a history of alcohol, postviral myocarditis, radiation, doxorubicin, chagas
dilated cardiomyopathy
acute onset of fever and confusion
encephalitis
fever, new murmur/change in murmur, splinter hemorrhages, janeway lesions, osler nodes, roth spots in eyes, mycotic aneurysm in brain, hematuria, GN, conjunctival petechiae, splenomegaly, septic emboli to lungs
endocarditis
diarrhea with no blood or wbc in stool with camping/hiking and unfiltered fresh water
giardia
recurrent skin infections with staphylococcus
hyper IgE syndrome
acute symptomatic hypercalcemia with confusion, stupor, lethargy and constipation
hypercalcemia
fat redistribution, striae, easy bruising, osteoporosis, htn, menstrual disorders, erectile dysfunction, cognitive disturbance, polyuria
hypercortisolism
asymptomatic elevation in calcium levlels on routine blood testing, osteoporosis, nephrolithiasis, renal insufficiency, muscle weakness, anorexia, nausea, vomiting, abdominal pain, peptic ulcer disease
hyperparathyroidism
man with erectile dysfunction and decreased libido, rarely gynecomastia and galactorrhea
hyperprolactinemia
woman with galactorrhea, amenorrhea and infertility
hyperprolactinemia
dyspnea, chest pain, syncope and lightheadedness, sudden death in health athletes, sxs worse with exercise, dehydration and diuretics, murmur does not increase with expiration
hypertrophic cardiomyopathy
weakness, faituge, AMS, nausea, vomiting, anorexia, hypotension, hyponatremia, hyperkalemia
hypoadrenalism
facial nerve hyperexcitability, carpopedal spasm, perioral numbness, mental irritability, seizures, tetany
hypocalcemia
all bodily processes slowed down, increased menstrual flow
hypothyroidism
arthralgias, myalgias, cough, fever, headache, sore throat, nausea/vomiting/diarrhea especially in kids
influenza
dull, sore, squeezing pressure chest pain
ischemic chest pain
chronic infection over several weeks with large volume foul smelling sputum, hx of stroke, seizure, intoxication, intubation
lung abscess
round red lesion with pale center in area, oligoarthritis, mengingitis/encephalitis/CN palsy, cardiac problem
lyme disease
fever, headache, neck stiffness, photophobia
meningitis
dyspnea with recent anesthetic use, brown blood not improved with oxygen, clear lungs on auscultation, cyanosis
methemoglobinemia
CHF with holosystolic murmur radiates to axilla
mitral regurgitation
shortness of breth and CHF, dysphagia, hoarseness, a fib, hemoptysis, pregnant immigrant, diastolic murmur with opening snap
mitral stenosis
asymptomatic or atypical chest pain, palpitations, panic attack, no signs of CHF, mid systolic click, murmur just after click, murmur does not increase with expiration
mitral valve prolapse
redness, immobility, buling and decreased light reflex of tympanic membrane, pain common, fever, decreased hearing
otitis media
dyspnea with circumoral numbness, caffeine use, history of anxiety
panic attack
lower abdominal tenderness and pain, fever, cervical motion tenderness, leukocytosis
pelvic inflammatory disease
hypotension, tachycardia, distended neck veins, clear lungs
pericardial tamponade
sharp chest pain that changes in intensity with respirations and position of body, worsened by lying flat and improved by sitting up
pericarditis
pyelonephritis that does not resolve with appropriate therapy
perinephric abscess
leg pain in calves on exertion, relieved by rest, pain when walking up or down hills, severe disease with loss of hair follicles, sweat glands, sebaceous glands
peripheral artery disease
pain on swallowing, enlarge LN in neck, exudate in pharynx, fever, no cough, no hoarseness
pharyngitis
episodic HTN, headache, sweating, palpitations and tremor
pheochromocytoma
dyspnea with dullness to percussion at bases
pleural effusion
dyspnea with slower onset, fever, sputum, unilateral rales/rhonchi
pneumonia
fever and cough, severe with dyspnea, dullness to percussion, "bronchial" breath sounds
pneumonia
dyspnea with decreased breath sounds unilaterally, tracheal deviation
pneumothorax
dyspnea with signs of right heart failure, ascites, edema, JVD, enlargement of liver and spleen
restrictive cardiomyopathy
young african american woman with shortness of breath on exertion, occasional fine rales on exam, without wheezing, eerythema nodosum or LAD on cxr, also can have parotid gland enlargement, facial palsy, heart block, restrictive cardiomyopathy, CNS involvement, iritis and uveitis
sarcoidosis
rash on palms and soles, alopecia areata, mucous patches, condylomata lata
secondary syphilis
dyspnea with pulsus paradoxus, decreased heart sounds, JVD
tamponade
tabes dorsalis, general paresis, argyll robertson pupil, aortitis, gummas
tertiary syphilis
immunodeficiency with thrombocytopenia and eczema
wiskott-aldrich syndrome
male children with increased sinopulmonary infections, absence of tonsils, adenoids, LN or spleen, normal t cells
x-linked (brutons) agammaglobulinemia
diarrhea with blood and WBC in stool in pt with iron overload (hemochromatosis or blood transfusions)
yersinia
diarrhea with blood and WBC in stool, MCC
campylobacter
high BP + hypokalemia
primary hyperaldosteronism
dyspnea with long smoking history, barrel chest
COPD
shortness of breath worsened by exertion, intermittent exacerbations with increased cough, sputum often brought in by infection, barrel chest, muscle wasting and cachexia
COPD
recurrent sinopulmonary infections in adults, frequent bronchitis, pneumonia, sinusitis, otitis media, giardiasis, spruelike intestinal malabsorption, increased autoimmune diseases
CVID
increased incidence of shingles, herpes, TB, candidiasis, pna, kaposi sarcoma
HIV/AIDS
recurrent sinopulmonary infections, atopic diseases, anaphylaxis to blood transfusion, spruelike fat malabsorption, increase risk vitiligo, thyroiditis, RA
IgA Deficiency
recurrent sinopulmonary infections beginning at 6 months old, many infections you would see in AIDS
SCID
fever, cough, sputum, weight loss, hemoptysis, night sweats with hx of recent immigration, prisoner, HIV, healthcare worker, close contact, steroid use, hematologic malignancy, alcoholic, diabetic
TB
dysuria (frequency, burning, urgency), fever
UTI
LN with purulent material, apthus ulcers and inflammation of nares, granulomas can have obstruction of GI or urinary tract
chronic granulomatous disease
combination of staphylococcus, burkholderia, nocardia, aspergillus
chronic granulomatous disease
diarrhea with blood and WBC in stool with white and red cells in stool
clostridium difficile
dyspnea on exertion, orthopnea, peripheral edema, rales on lung exam, JVD, paroxysmal nocturnal dyspnea, S3 gallop
congestive heart failure
signs of right heart failure edema, ascites, enlargement of liver and spleen, JVD with calcification on CXR
constrictive pericarditis
diarrhea with no blood or wbc in stool with AIDS <100 cd4 cells
cryptosporidiosis
painless genital ulcer with heaped up indurated edges and painless adenopathy
primary syphilis
sudden onset shortness of breath with clear lungs and normal CXR, tachypnea, tachycardia, cough and hemoptysis, unilateral leg pain, pleuritic chest pain, fever
pulmonary embolism
dyspnea with sudden onset, clear lungs
pulmonary embolus
dyspnea, worse on exertion, fine rales or crackles on examination, loud P2, clubbing on fingers
pulmonary fibrosis
dyspnea and fatigue, syncope, chest pain, wide split S2, loud P2
pulmonary hypertension
dysuria, flank pain or CVA tenderness, high fever, occasional abdominal pain
pyelonephritis
urethral discharge, urinary frequency, burning
urethritis
sudden swelling of superficial layers of the skin, can be caused by insects, medications, pressure, cold, vibration
urticaria
fever, rising white count, new infiltrate on CXR, purulent secretions from endotracheal tube
ventilator associated pneumonai
diarrhea with blood and WBC in stool with shellfish and cruise ships
vibrio parahaemolyticus
diarrhea with blood and WBC in stool with shellfish, hx of liver disease, skin lesions
vibrio vulnificus
diarrhea with no blood or wbc in stool MCC
viral