Differential Diagnosis

·      Pleurisy: pleural rub, pain in the chest, sharp or stabbing, persistent cough, breathing difficulties, fever, dry cough or fever, fast breathing, shortness of breath

·      Pneumonia: crackles, rhonchi, egophony, whispered pectoriloquy, bronchophony, cough, fever, shortness of breath, chills, fatigue, loss of appetite, clammy skin, sharp pain in chest. Gradual onset, cough, recent hospitalization, mucoid, mucopurulent, rust/red sputum production, high fever, shortness of breath, night sweats, increased tactile fremitus, dullness over lungs, pleural rub, dullness, late crackles, bronchial breath sounds

·      Pulmonary Embolism: shortness of breath, chest pain, irregular heartbeat, dizziness, lightheaded ness, sweating, coughing, coughing up blood, dry cough, low SpO2

·      Pneumothorax: sudden chest pain, shortness of breath, fast breathing, shallow breathing, chest pressure, coughing, fast heart rate, low oxygen in the body. Asymmetrical chest excursion, unilateral tactile fremitus, chest wall crepitation, diminished breath sounds, hypotension

·      Bronchial obstruction: choking, gagging, sudden violent coughing, vomiting, noisy breathing or wheezing, struggling to breathe, turning blue.

·      Atelectasis: coughing, chest pain, a fast heart rate, dyspnea, tachypnea, bluish skin or lips, low SpO2.

·      COPD: trouble catching breath, wheezing, whistling sounds when breathing, ongoing cough with mucus, chest tightness, or heaviness, lack of energy, lung infections, unexpected weight loss, chest pressure, decreased bilateral tactile fremitus transmission in absence of air-filled lung tissue, thickening of chest wall, chronic cough, wheezing, frequent clearing of throat

·      Asthma: wheezing, shortness of breath, cough, chest tightness or pain, waking at night, chest pressure, fast heart rate, dry cough, with exercise or illness. Wheezing, mucoid/mucopurulent sputum, bronchospasm, prolonged expiration, decreased tactile fremitus, hyper resonant, low diaphragm, decreased vocal fremitus

·      Upper airway obstruction: stridor, agitation, cyanosis, choking, confusion, difficulty breathing, gasping for air, unconsciousness, crowing, whistling

·      URI: Rhonchi, cough, fever, hoarse voice, fatigue, red eyes, runny nose, sore throat, swollen lymph nodes, post-nasal drip, sinusitis, headache, inflammation of ear

·      Bronchitis: Rhonchi, cough, chest pain, fatigue, fever, shortness of breath, stuffy or runny nose, wheezing, headache. Green-yellow sputum, gradual onset, cough, smoking/secondhand smoke, sore throat, chest pain, rhonchus, wheeze, early crackle, rhonchi

·      Pulmonary edema: Crackles, trouble breathing, shortness of breath, wheezing, shallow breathing, pain in chest, fatigue, sweating, coughing, fast heart rate

·      Pleural effusion: egophony, pain in chest, sharp, fast breathing, shortness of breath, coughing, fevers, chills

·      Croup: barking cough, fever, hoarse voice, noisy or labored breathing, fatigue, nasal congestion, runny nose, shortness of breath, wheezing, sore throat

·      Emphysema: hyper resonance, decreased density, low-pitched, hollow-quality, mucoid/mucopurulent sputum, decreased excursion of diaphragm

·      Allergies: sudden onset with a trigger, itchy eyes, runny nose, nonproductive cough, wheezing.

·      Laryngeal Obstruction: narrowing or inappropriate obstruction of the vocal fold and/or the supraglottic structures in response to a trigger or stimulus, Stridor

·      CHF: wheezing, morning/nocturnal cough, shortness of breath, waking up short of breath at night, chest pain, heart palpitations, fatigue, edema, weight gain, need to urinate while resting at night, dizziness, bloating, loss of appetite

·      Acute Coronary Syndrome: chest pain or discomfort, nausea or vomiting, indigestion, shortness of breath, sudden/heavy sweating, racing heartbeat, feeling lightheaded or dizzy, pain in chest/arm/jaw, chest pressure

·      Angina: pressing, squeezing, crushing pain, pain in upper back/arms/neck/jaw/shoulders, shortness of breath, weakness, indigestion, burning in the chest

·      Pericarditis: pain in back, neck or shoulder, trouble breathing while laying down, dry cough, palpitations, anxiety, fatigue, fever, edema, sharp/stabbing/

·      Myocarditis: chest pain, fatigue, edema in lower extremities, rapid/irregular heartbeats, shortness of breath, lightheadedness, dizziness, shortness of breath on lying down

·      Cardiomyopathy: shortness of breath, chest pain, edema in extremities, swelling in neck vein, abnormal heart rhythm, bloating, fluid in abdomen, coughing, weight gain

·      Arrhythmias: fatigue, weakness, dizziness, lightheadedness, fainting, rapid heartbeat, shortness of breath, chest pain, sweating

·      Premature atrial contractions: heart palpitations, heart skipping a beat, dizziness, feeling faint

·      Ventricular tachycardia: fast heartbeat, dizziness, lightheadedness, chest pain, neck tightness, shortness of breath, fainting, cardiac arrest

·      Edema: swelling, shiny skin, feeling of leg heaviness, joint stiffness

·      Cellulitis: irritated area of skin, swelling, tenderness, pain, warmth, fever, chills, pus, red rashes, blister

·      Venous insufficiency: dull aching, leg swelling, pain that worsens when you stand and improves when you put your legs up, tingling sensation in the legs, varicose veins

·      DVT: throbbing pain, swelling in leg, warm skin around the painful area, red or darkened skin around the painful area, pain in calf/foot/leg

·      Peripheral arterial disease: pain, aching, heaviness, or cramping, pain improved with rest or with exercise, cool skin, loss of hair on the legs, ulcers, one foot may feel colder than the other

·      Headache: head usually hurts on both sides, dull,

·      Tension headache: head hurts on both side, pain is dull, pain may involve back part of the head or neck, mild to moderate pain, pain in muscles, usually bilateral, waxing and waning, neck and shoulder pain

·      Cluster headache: extreme sharp or stabbing pain, restlessness, tears, common in men, pain in eyes, pain around the eye that last for up to 1 hour, ipsilateral, ptosis, conjunctival edema, nasal stuffiness

·      Migraine: pain in face, dull, throbbing, dizziness, photophobia, sensitivity to noise, aura, nausea or vomiting, can last hours to days

·      Syncope: loss of consciousness

·      Bell Palsy: contralateral hemiplegia with ipsilateral facial palsy CN 7

·      Physiologic Tremor: 10 to 12 cycles per second,

·      Pathologic or resting Tremor: slower, Parkinson disease, present at rest and decreased with action, 3 to 6 cycles per second.

·      Intention Tremor: slow, 2 to 4 cycles per second, worsens with attempted movement; MS. Withdrawal from alcohol or caffeine.

·      Conjunctivitis (allergic, viral, bacterial): pink or red discoloration in one or both eyes, gritty feeling, itching, irritation, burning sensation, clear, thin discharge, stringy discharge, sensitivity to light, congestion, runny nose, sneezing, puffy eyes

·      Stye or Hordeolum: swelling of the eyelid, discharge, crusting along eyelid, light sensitivity, soreness and itching, eye tearing. Or Stye, is an infection of an oil gland at the edge of the eyelid. Usually caused by a bacterial staph infection and results in pain, swelling, and redness. Looks like a pus-filled or pimple at the edge of the eyelid.

·      Foreign Body: feeling like there is something in your eye, watery, red eye, scratchy feeling, blurred vision

·      Chemical Exposure: stinging, burning sensation, redness, pain, swelling of the eyelids, blurry vision, watery eyes

·      Dry eyes: dry, gritty, burning sensation, redness, watery or teary eyes, eye discomfort, sensitivity to light

·      Subconjunctival hemorrhage: doesn’t cause pain or swelling and doesn’t affect your vision

·      Blepharitis: eyelid inflammation, redness, swelling, painful tenderness, discharge from eye, burning, tearing, itching, light sensitivity, blurred vision

·      Cataracts: blurred vision, inability to see in dim light, seeing halos around lights, vision loss, double vision, cloudy vision, colors faded

·      Presbyopia: farsightedness, blurred vision, eye strain, headaches, hold reading materials further away to read

·      Glaucoma: eye pain or pressure, headaches, rainbow-colored halos, blurred vision, tunnel vision, nausea or vomiting, red eyes, vision loss

·      Nystagmus: blurry vision, balance problems, light sensitivity, dizziness, vertigo, CN 8

·      Diplopia: headache, nausea, weakness in your eyes or anywhere else, droopy eyelids, cross-eyed, pain when you move your eye

·      Ptosis: Condition in which the upper eyelid droops, sags or falls over the eye. It usually happens because the levator muscle – the muscle that lifts the eyelid – doesn’t work as it should. The condition can limit your vision or block it completely, depending on how much your lid droops.

·      Chalazion: Or an eyelid cyst, is a red, swollen bump on your eyelid that forms when an oil gland becomes blocked.

·      Cerumen impaction: hearing loss, earache, sense of ear fullness, itching in the ear, dizziness, ringing in the ears, cough

·      Tinnitus: ringing or buzzing noise in one or both ears

·      Vertigo: dizziness, problem focusing eyes, hearing loss, loss of balance, nausea and vomiting,

·      Perforated tympanic membrane (trauma or infection): hearing loss, ringing or buzzing in ear, earache, itching in ear, clear fluid, blood or pus leaking from ear, dizziness, fever, vertigo

·      Otitis Media: Infection of the middle ear, build-up of fluid behind the eardrum, unusual irritability, difficulty sleeping, pulling at ears, fever, fluid drainage, hearing difficulties, ear pain, headache, vertigo, fever, loss of appetite, nasal congestion, nausea, inflammation, ringing in ears

·      Otitis Externa: ear pain, itching and irritation around ear canal, redness and swelling of outer ear and ear canal, feeling of pressure and fullness inside the ear

·      Sinusitis (viral, bacterial, acute, chronic): thick, yellow, or greenish mucus from the nose, runny nose, postnasal drip, congestion, itching, pain in sinuses, tenderness, swelling of face, inflammation of ear, mouth breathing, fatigue, phlegm, throat irritation

·      Allergic rhinitis: runny nose, itchy eyes, congestion, sneezing, sinus pressure, red, watery eyes, pain in ears, loss of smell, coughing, fatigue, headache, throat irritation, puffy eyes

·      Deviated Septum: obstruction of one or both nostrils, nosebleeds, facial pain, noisy breathing during sleep, congestion, postnasal drip, headache, mouth breathing, loss of smell

·      Polyps: runny, stuffy nose, postnasal drip, not able to smell, not able to taste, facial pain, headache, pain in teeth, sense of pressure over forehead and face, snoring

·      Preseptal cellulitis: tenderness, swelling, warmth, redness or discoloration, fever

·      Leukoplakia: thickened white patches form on the gums, inside the cheeks, patches can’t be scraped off.

·      Mono: extreme fatigue, fever, sore throat, headaches, body aches, swollen lymph nodes in neck and armpits, swollen liver or spleen, rash, nausea, chills, pain with swallowing

·      Laryngitis: hoarseness, weak voice, voice loss, rawness of throat, sore throat, dry throat, dry cough, swollen lymph nodes

·      Influenza: fever, chills, cough, sore throat, runny or stuffy nose, muscle or body aches, headaches, fatigue, vomiting or diarrhea

·      Common cold: runny nose, nasal congestion, cough, sneezing, sore throat, headache, mild body aches, fever

·      Strep: sore throat, fever, swollen lymph nodes, red and swollen tonsils, petechiae on roof of mouth, white patches or streaks of pus on tonsils, pain with swallowing

·      Tonsilitis: red, swollen tonsils, white or yellow coating or patches on the tonsils, sore throat, difficult or painful swallowing, fever, tender lymph nodes, scratchy voice, bad breath, poor appetite, snoring congestion or runny nose, fatigue

·      Aphthous ulcer: painful sores inside the mouth, burning or tingling sensations

·      Thrush: white patches in the mouth, loss of taste, unpleasant taste in mouth, redness inside the mouth/throat, cracks at the corner of the mouth, can be due to corticosteroid inhaler

·      Peritonsillar abscess: fever, chills, headache, earache, difficulty swallowing, bad breath

·      Dysphagia: pain while swallowing, hoarseness, regurgitation, heartburn, dry mouth,

·      Hyperthyroidism: anxiety, hyperactivity, mood swings, difficulty sleeping, feeling tired, sensitive to heat, muscle weakness, protruding eyes, weigh loss, hair loss, tremor, irregular menstruation, diarrhea, fast heartrate

·      Hypothyroidism: tiredness, sensitive to cold, constipation, weight gain, dry skin, puffy face, hoarse voice, coarse hair, brittle nails, high cholesterol, sexual dysfunction, slow heart rate

·      GERD: heartburn, belching, nausea, regurgitation, bitter taste, discomfort in upper abdomen, dry cough.

·      Cholecystitis: bloating, nausea, vomiting, chills, fever, sweating, abdominal cramping, pain in the abdomen, shoulder or upper-right abdomen, loose light-colored bowel movements. Epigastric pain. On occasion during liver palpation, pain is elicited in the right upper quadrant during inspiration, and the patient suddenly stops inspiratory efforts = Murphy sign.

·      Hepatitis: pain or bloating in belly, dark urine, pale or clay-colored stools, fatigue, low grade fever, itching, jaundice, loss of appetite, nausea, vomiting

·      Appendicitis: Sudden pain that begins on the right side of the lower belly, pain that worsens with coughing, walking, or making other jarring movements, nausea and vomiting, loss of appetite, chills, fever, dull, sharp, mild, or severe, diarrhea. Often begins at the umbilicus. Pain from acute appendicitis travels from the umbilicus to the right lower quadrant approximately 1 to 3 hours after the initial event. Flexion of right thigh (right psoas muscle). In acute appendicitis, pain precedes the vomiting usually by a few hours. McBurney’s point, Rovsing sign, Psoas sign, Obturator’s sign.

·      Pyelonephritis: chills, fever, pain in your back/side/groin, nausea, vomiting, cloudy, dark, bloody or foul-smelling urine, painful urination, fast heart rate

·      Pancreatitis: pain in the abdomen or back, bloating, fat in stool, indigestion, nausea or vomiting, loss of appetite or sweating, fast heart rate or weight loss. Epigastric pain. Midback pain. Acute pancreatitis can cause severe pain that fainting may result. Pale and sweating. Grey Turner sign, massive ecchymoses in hemorrhagic pancreatitis.

·      Diverticulitis: Not in young adults/children. More common in older adults. Diarrhea and constipation frequently alternate in patients. Flexion of left thigh (left psoas muscle). Hypogastrium pain.

·      Constipation: fewer than three bowel movements a week, stool is dry/hard, difficult or painful to pass, stomach pain, bloated, nauseated

·      IBD: abdominal pain, diarrhea, hematochezia, urgency to have a bowel movement, rectal bleeding, weight loss, fever, anemia, malnutrition

·      Colitis: tenderness in the abdomen, weight loss, aches and pains in the joints, loss of appetite, fatigue, increased bowel frequency, anemia, hematochezia, abdominal cramps

·      Peptic Ulcer: pain in upper abdomen, burning, indigestion, nausea, passing excessive amounts of gas, vomiting, abdominal discomfort, fatigue,

·      Gastritis: stomach pain, burning, belching, indigestion, nausea, vomiting, loss of appetite, blood in vomit or stool

·      LLQ: constipation, UTI, gynecological, diverticulitis, cancer, inflammatory bowel disease, colitis.

·      RLQ: appendicitis, diverticulitis, UTI, IBD, Crohn’s

·      RUQ: cholecystitis, colic, GERD, liver, pancreatitis, abdominal aneurysm

·      LUQ: pancreatitis, aortic aneurysm, ulcer, gastritis, cancer, spleen

·      Costochondritis: occurs on the left side of breastbone, sharp/aching or pressure-like, affects more than one rib, can radiate to arms and shoulders, worsens when taking a deep breath, coughing, sneezing, or with any chest wall movement.

·      Rotator cuff injury: lifting over your head, grating or cracking sounds when moving arm, limited ability to move your arm, muscle weakness. Full can test (weakness/pain), Empty can test (pain/weakness), Drop arm test (pain patient drops arm), External rotation lag sign (arm drifts forward), Hornblower’s sign (unable to maintain position against resistance to external rotation), Lift off sign (inability to perform test), Belly Press test (inability to press against your hand), Hawkins-Kennedy Test (pain with internal rotation)

·      Tennis Elbow: pain in elbow or muscle, swelling or tenderness, stiffness, weakened grip. Affects the muscles that straighten your fingers and extend your wrist backwards. Mill’s test (pain over the lateral epicondyle)

·      Golfers elbow: pain and tenderness inner side of elbow, stiffness, weakness, numbness or tingling. Affects the muscles that curl your fingers and flex wrist. (pain over the medial epicondyle)

·      Bursitis: pain, stiffness or swelling, redness, hurts with movement.

·      Carpal Tunnel Syndrome: Compression of median nerve. Phalen’s test (numbness/tingling in thumb, index finger and lateral side of ring finger), Tinel Sign (tingling in thumb, index, middle, and lateral side of ring finger)

·      Osteoarthritis: pain of affected joints, stiffness, tenderness, loss of flexibility, grating sensation, swelling, can relate to weather

·      Greater trochanteric pain syndrome: pain at the side of the hip, pain that is sharp or intense, difficulty walking, joint stiffness, swelling and warmth of the hip joint, catching and clicking sensation.

·      Lumbar-sacral pain: sharp pain in lower back and hips, pain increases with movement, uneven leg lengths, stiffness, burning sensation, pain decreases with rest.

·      Meniscal Injury: popping sensation, swelling, stiffness, pain with twisting or rotating the knee, difficulty fully straightening the knee, locked feeling when trying to move the knee, difficulty walking or limited range of motion.

·      Sciatica: lower back pain radiates or spreads down the buttocks, pain extends from buttock down to your foot, numbness, weakness, foot numbness.

·      Scabies: Highly contagious skin infestation caused by Sarcoptes scabiei, parasites that burrow into skin and lay eggs. Presentation on forearms, waist band around hips, thighs, webs folds of the fingers, under breasts. Commonly found in homes or environments with bed sharing, overcrowding, or institutionalized people.

·      Psoriasis: Characterized by salmon-pink or beefy red plaques or pustules with overlying silverly scales. Commonly presents with complaints of itching or bleeding at plaque site. Found on face, palms, elbows, hairline/scalp, back, ankles, bottom of the feet. Plaques that are well demarcates from surrounding normal skin. Autoimmune disease.

·      Tinea Corporis: Caused by a fungal infection. Characterized by pruritic, circular or annular appearance, that is erythematous or hyperpigmented. Scaling patch or plaque that is advancing with a raised border. Signs and symptoms: spread by direct contact. Found in gyms and/or on athletes who participate in contact sports.

·      Tinea Vesicolor: Also called pityriasis versicolor. Underlying cause is yeast. Overgrowth of fungal infection (yeast) leads to discolored patches on the body.

·      Hives: Urticaria. The primary lesion is the wheal, or hive. In urticaria, the epidermis is normal. The dermis demonstrates papillary edema. Inflammatory cells may be found surrounding dilated blood vessels. Itching is a common complaint.

·      Cyst: An abnormal, usually noncancerous growth filled with liquid or a semisolid substance, sometimes causing pain.

·      Pityriasis Rosea: Characterized by diffuse, scaly erythematous papules and macules. Commonly referred to as the Christmas tree rash as this skin condition will have one large round or oval scaly patch or the “herald patch”. Herald patch usually is noticed first with diffuse rash occurring following.

·      Lupus: A long-lasting illness that can affect many parts of the body. A common sign is a rash over the cheeks and nose in the shape of a butterfly.

·      Molluscum Contagiosum: MCV virus causes chronic localized firm, dome shaped papules on the skin. Typically found on the trunk, axillae, the antecub, or behind the knee folds. Highly contagious and spread by person-to-person contact, sports, or touching an object with the virus on it.