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Diagnostic Dilemmas and D/Dx

  1. fever and a rash in a sick person (lethal), often associated with multiple organ failure. (see also Evaluating the Febrile Patient with a Rash - August 15, 2000 - American Family Physician)
  2. fever with bilateral conjunctivities and +/-purulent discharge
  3. "Viral Syndrome" (influenza): fever and myalgias but no cough and no rash. See also fever and a rash in a sick person
  4. "Flu" with a widened mediastinum and impending death: Anthrax with necrotizing mediastinitus. Phone home and order the Cipro.
  5. afebrile 3 mo old infant who is “flat” (generalized weakness)
  6. Any weird complaint in an elderly person: do an ESR
  7. assymetric hearing loss -> acoustic neuroma
  8. appendicitis: cholecystitis, Crohn's, DKA, ectopic preg, GE, inguinal hernia, obstruction, Meckel's diverticulum, mesenteric adenitis, nephrolithiasis, ovarian torsion, PID, perforated CA colon, pneumonia, pyelo, sigmoid diverticiculum, testicular torsion tubo-ovaran abscess, acute porphyria
  9. asthma not responding to therapy
  10. atypical sciatica: piriformis syndrome
  11. child with progressive weakness
  12. Chronic Cough
  13. chronic debilitation in an elderly person: late generalized tuberculosis
  14. confusion + fever: infection, heat stroke, neuroleptic malignant syndrome, pheochromocytoma (less likely), hyperthyroid storm, CNS injury, drug ingestion, cholinergic poisoning.
  15. confusion + hyper-irritability + myoclonus: serotonin syndrome, drug OD (cocaine), malignant hyperthermia, malignant neuroleptic syndrome, other toxin, poisoning
  16. conjunctival (palpebral) polyp or soft granuloma with preauricular adenopathy: Parinaud’s Oculoglandular Syndrome
  17. diarrhea, dyspnea, cough: Legionnaire's Disease
  18. Facial numbness: MS, trauma incl dental, neoplasms in nasopharynx, sinusitis, syphilis, sarcoidosis and very weird local pressure items (carotid aneur, etc).
  19. Flushing
  20. History of trauma due to an MVA but no insurance forms: suspect assault, especially domestic.
  21. impotence, fatigue, joint pains: hemochromatosis
  22. infant born to a sick febrile mother: Listeriosis
  23. leukocytosis and hyperglycemia in a sick child: iron poisoning. lethargy, hypotension, tachycardia but low to no fever .. Iron tabs seen on x-ray.
  24. Palpitations and new AV block: Lyme carditis
  25. Parkinsonian features or movement disorder in young person: Wilson’s Disease
  26. pleuritic pain, low grade fever
  27. scrotal pain & swelling & pp protoplasm -> Fournier’s Gangrene (necrotizing fasciitis of perineum)
  28. sensory loss in the hands and spastic lower extremities in pt > 50 yo
  29. "Shingles" without a rash: Lyme radiculoneurpathy
  30. sub-acute confusion in a young person
  31. Swelling and pain around any joint, even in the absence of erythema or increased temperature - consider crystalline deposition (gout, pseudogout), or acute Lyme monarticular arthritis.
  32. swelling over the submandibular or sublingular area in children with fever: parotitis vs. Ludwig's Angina. LA kids sicker, can't open mouth, respiratory distress (emergency).
  33. upgoing toes and absent knee jerks: Friedrich’s Ataxia
  34. See unresponsive migraine
  35. Child < 1 year with persistent pharyngitis and malaise: retropharyngeal abscess

Author: John G. Faughnan.  The views and opinions expressed in this page are strictly those of the page author. Pages are updated on an irregular schedule; suggestions/fixes are welcome but they may take weeks to years to be incorporated. Anyone may freely link to anything on this site and print any page; no permission is needed for citing, linking,  printing, or distributing printed copies.