DIFFERENTIAL DIAGNOSIS MANUAL

DIFFERENTIAL DIAGNOSIS MANUAL

Index

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Cardiovascular

• Bradycardia (pulse below 60 bpm)

• Cyanosis

  • Central cyanosis

  • Peripheral cyanosis

• Blood pressure difference

  • Difference in blood pressure or pulse between both arms

  • Difference in blood pressure or pulse between arms and legs

• Chest pain (see THORACIC PAIN)

• Leg pain while walking, intermittent claudication

• Thoracic pain

  • Acute chest pain, worsened by breathing or movement

  • Severe lower chest and/or upper abdominal pain (gastro)

  • Chest pain that frightens and intensifies within minutes

• Hypertension

• Hypotension

• Postural hypotension, hypotension when standing

• Severe hypotension

• Abnormal apex impulse

• Murmurs (on auscultation)

  • Abdominal and lumbar murmur

  • Diastolic murmur

  • Mid-systolic murmur

  • Pansystolic murmur

  • Murmurs not corresponding to systole or diastole

• Palpitations*

• Irregular pulse

• Pulse above 120 bpm (Tachycardia)

• Elevated jugular venous pressure

• Syncope

• Added heart sounds

• Tachycardias*

• Prominent veins in the legs with or without unilateral leg swelling

• Decreased pulse volume

• Elevated pulse volume

Endocrine & Metabolic

• Weight gain

• Thinness and cachexia

• Galactorrhoea

• Gynaecomastia

• Obesity

• Involuntary weight loss over weeks or months*

Gastrointestinal

• Silent abdomen without bowel sounds

• Dysphagia*

  • Dysphagia for liquids progressing to dysphagia for solids

  • Dysphagia for solids that do not stick, progressing to dysphagia for liquids

  • Dysphagia for solids that stick

• Abdominal pain on palpation

  • Pain on palpation localised in the lower right or left quadrants

  • Pain on palpation localised in the upper right quadrant

  • Pain on palpation localised in the upper left quadrant

  • Pain on palpation localised in the epigastrium or central abdomen

  • Pain on palpation localised in the hypogastrium (suprapubic area)*

• Abdominal pain

  • Acute abdominal pain in the upper abdomen*

  • Abdominal pain in the central abdomen

  • Abdominal pain in the hypogastrium, central and lower area

  • Abdominal pain in the lateral regions of the abdomen

  • Abdominal pain with vomiting and fever

  • Pain in different regions of the abdomen (see diagram)

• Sore throat

• Splenomegaly

  • Mild splenomegaly (less than 3 finger breadths)

  • Massive splenomegaly (greater than 5 finger breadths)

  • Moderate splenomegaly (3 to 5 finger breadths)

• Hepatomegaly

  • Irregular and non-tender hepatomegaly on palpation

  • Soft but non-tender hepatomegaly on palpation

  • Soft and tender hepatomegaly on palpation

• Jaundice

  • Hepatic jaundice due to a congenital enzyme defect

  • Hepatocellular jaundice, due to hepatitis or severe liver failure

  • Obstructive jaundice

  • Pre-hepatic jaundice due to haemolysis

• Anal inflammation

• Melena on rectal examination

• Abdominal mass

  • Abdominal mass in the lower right quadrant

  • Abdominal mass in the lower left quadrant

  • Abdominal mass in the epigastrium or umbilical regions

  • Abdominal mass in the hypogastrium (suprapubic area)

  • Unilateral abdominal mass in the upper right or left quadrant

  • Bilateral abdominal masses in the upper abdomen

• Dullness (on abdominal percussion)

  • Shifting dullness

  • Central abdominal dullness with resonance in the flanks

• High-pitched bowel sounds

• Fresh blood on rectal examination

• Vomiting

  • Isolated vomiting, unrelated to food intake, without headache

  • Vomiting shortly after eating

  • Vomiting with abdominal pain, unrelated to food intake, without fever (non-metabolic causes)

  • Vomiting with abdominal pain, unrelated to food intake, without fever (metabolic causes)

  • Vomiting with abdominal pain and fever

  • Vomiting with headache, unrelated to food intake, without abdominal pain

  • Vomiting with weight loss

  • Vomiting without weight loss

Genitourinary

• Secondary amenorrhoea

• Increased urinary frequency with or without dysuria

• Lumps (see Ulcers and Lumps)

• Purulent vaginal discharge

• Haematuria*

  • Painful haematuria with dysuria

  • Painless haematuria

• Urinary incontinence*

  • Isolated urinary incontinence without faecal incontinence

  • Urinary and faecal incontinence

• Faecal and urinary incontinence (preceding)

• Painful or large masses on pelvic examination

• Menorrhagia, heavy menstrual bleeding

• Enlarged prostate

• Enlarged prostate gland

• Urinary retention ()**

• Intermenstrual or postcoital bleeding

• Ulcers and Lumps

  • Ulcers and lumps on the cervix

  • Ulcers and lumps on the vulva

  • Lumps in the vagina

Haematological

• Clinical anaemia

• Purpura

• Purpura and petechiae

Lymphatic

• Axillary lymphadenopathy

• Generalised lymphadenopathies

• Localised lymphadenopathies in the groin

Musculoskeletal

• Hand arthropathy

• Muscle weakness

• Muscle pain and stiffness

• Pain or limitation of movement

  • Pain or limitation of movement Hip

  • Pain or limitation of movement Elbow

  • Pain or limitation of movement Neck

  • Pain or limitation of movement Back

    • Back pain with onset over days to months

    • Back pain with onset over years

    • Sudden onset back pain within seconds to hours

  • Pain or limitation of movement Shoulder

  • Pain or limitation of movement Hand

  • Pain or limitation of movement Leg

    • Leg pain while walking, intermittent claudication

    • Leg pain upon standing, relieved by lying down

  • Pain or limitation of movement Knee

• Monoarthritis

• Polyarthritis

• Abnormal arm and hand posture at rest

• Neck stiffness

Nervous & Psychiatry

• Acute stroke*

• Transient ischaemic attack

• Altered level of consciousness

• Speech disturbances

  
  

• Altered sensation in the upper limb

• Gait abnormality

• Abnormal muscle tone in the arm (e.g., spasticity)

• Anxiety

  • Anxiety in response to specific issues

  • Generalised anxiety

• Confusion

  • Acute confusion

  • Chronic confusion or cognitive problems

• Seizures

• Muscle weakness (e.g., focal)

  • Weakness around a leg joint

  • Shoulder and arm weakness without pain

  • Bilateral weakness in all foot movements

  • Weakness in small hand muscles

  • Arm and shoulder weakness

  • Jaw muscle weakness

  • Facial muscle weakness

• Depression

• Dysarthria

• Headache

  • Acute new-onset headache

  • Chronic and recurrent headache*

  • Subacute onset headache*

• Hemiparesis (weakness of arm and leg on the same side)

• Hyporeflexia (diminished reflexes)

• Hyperreflexia, brisk reflexes

• Muscle incoordination when rotating the wrist and touching the palm

• Multiple cranial nerve lesions

• Dizziness*

• Abnormal movements of the tongue, uvula, and pharynx

• Loss of sense of smell

• Spastic paraparesis

• Hearing loss

• Loss of peripheral visual field

• Loss of sensation in the face

• Visual loss

  • Sudden loss of central vision and visual acuity*

  • Gradual onset visual loss

• Diminished reflexes, hyporeflexia

• Decreased sensation

  • Decreased sensation in the hand (e.g., focal)

  • Decreased sensation in the leg

  • Decreased sensation in a dermatome of the arm

• Tremor

  • Fine hand tremor

  • Coarse hand tremor

• Vertigo*

Respiratory

• Chest wall abnormalities

• Crackles

  • Coarse crackles

  • Fine inspiratory crackles

• Tracheal deviation

• Respiratory difficulty (dyspnoea)

  • Acute with wheezing and cough

  • Acute respiratory difficulty, onset within seconds

  • Chronic respiratory difficulty

• Decreased bilateral chest expansion

• Decreased unilateral chest expansion

• Inspiratory stridor and wheezing

• Reddened pharynx

• Low respiratory rate, bradypnoea (< 10 breaths per minute)

• Vocal fremitus

  • Increased vocal fremitus

  • Reduced vocal fremitus

• Frank haemoptysis (blood in sputum)

• Orthopnoea and paroxysmal nocturnal dyspnoea

• Chest percussion

  • Hyperresonant chest percussion

  • Dull chest percussion but NOT stony dull

  • Dull and stony dull chest percussion

• Hoarseness

• Wheezing

  • High-pitched polyphonic expiratory wheezing

  • Monophonic expiratory wheezing

  • Monophonic inspiratory wheezing

• Decreased breath sounds

• Pleural rub

• Bronchial breathing

• Cough

  • Cough with pink, frothy sputum

  • Cough with expectoration

  • Persistent dry cough without sputum

Other Symptoms

• Fatigue, feeling tired all the time

• Fever

• Suspected hypothermia

Integumentary (Skin, Eyes, Ears, etc.)

• Nail abnormalities

• Abnormality of the vulvar skin

• Abnormality of the auricle (external ear)

• Nipple abnormalities

• Blisters

• Spider veins

• Striking facial appearance

• Lumps

  • Lump in the anterior triangle of the neck*

  • Lump in the posterior triangle of the neck

  • Lump in the groin

  • Lump in the supraclavicular area

  • Bilateral neck lumps, move with swallowing but not with the tongue

  • Breast lumps

• Clubbing

• Pain or limitation of skin movement

• Ear pain

• Erythema

• Photosensitivity rash

• Strabismus and diplopia due to ocular paralysis (neurological)

• Swelling

  • Bilateral leg and ankle swelling (cardiac)

  • Swelling of both ankles

  • Unilateral swelling of the leg and ankle

• Hyperkeratosis, scales, and plaques

• Hippocratic nails

• Hirsutism in women

• Inflammation

  • Parotid gland inflammation

  • Scrotal inflammation

  • Unilateral swelling of the calf or entire leg

• Iriditis (Anterior uveitis)

• Mouth lesions

• Terry’s lines

• Moles

• Macule

  • White macule

  • Brown macule

  • Red macule

• Pupil dilation without ptosis

• Pupil constriction without ptosis

• Nodules

  • Nodule in the anterior neck, moves with swallowing but not with the tongue

  • Solitary thyroid nodule

  • Nodules around the elbow

  • Facial nodules (not involving the parotid gland)

  • Submandibular nodules, do not move with the tongue or swallowing

  • Vasculitic nodules on the fingers

• Red eye

• Proptosis of the eye (exophthalmos)

• Eyelid ptosis

• Skin pigmentation

  • Hyperpigmentation of the skin

  • Hypopigmentation of the skin

  • Pigmentation of wrinkles, body flexures, and oral mucosa

• Papules

• Loss of body hair

  • Loss of body hair in specific areas

  • Diffuse loss of body hair

• Itching

  • Skin itching with lesions but no hives

  • Skin itching with hives

  • Skin itching without skin lesions

  • Scalp itching

• Pustules

• Ear discharge

• Skin tumours

• Skin ulcers

• Pressure ulcers

• Anterior uveitis (or Iriditis)

Laboratory Results

• Microscopic haematuria

• Asymptomatic proteinuria

• Glycosuria

• Elevated bilirubin in urine or plasma

• Hepatocellular jaundice

• Obstructive jaundice

• Hypernatremia

• Hyponatremia

• Hyperkalaemia

• Hypokalaemia

• Hypercalcaemia

• Hypocalcaemia

• Elevated alkaline phosphatase

• Elevated urea and creatinine

• Low haemoglobin

• Microcytic anaemia

• Macrocytic anaemia

• Normocytic anaemia

• Elevated ESR, CRP, or plasma viscosity