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