1- HEADACHE

2- DIZZINESS
3- HEARING LOSS
4- CONFUSION / FORGETFULNESS
5- LOC / SYNCOPE
6- WEAKNESS
7- FATIGUE
8- SORE THROAT
9- SOB / COUGH
10- HEMOPTYSIS
11- EPISTAXIS
12- CHEST PAIN
13- PALPITATIONS
14- WEIGHT LOSS
15- WEIGHT GAIN
16- DYSPHAGIA
17- NAUSEA / VOMITING
18- CONSTIPATION
19- DIARRHEA
20- UPPER GI BLEEDING
21- BLOOD IN STOOL
22- ABDOMINAL PAIN
23- HEMATURIA
24- INCREASED URINATION
25- DIFFICULTY URINATING
26- ERECTILE DYSFUNCTION
27- AMENORRHEA
28- ABNORMAL UTRERINE BLEEDING
29- VAGINAL DISCHARGE
30- DYSPAREUNIA
31- ABUSE
32- JAW PAIN
33- JOINT / LIMB PAIN
34- LEG PAIN
35- BACK PAIN
36- WRIST PAIN
37- ELBOW PAIN
38- SHOULDER PAIN
39- FOOT PAIN OR HEEL PAIN
40- ANXIETY
41- INSOMNIA
42- BLURRED VISION
43- TREMOR
44- FREQUENT FALLS
45- RASH
46- JAUNDICE
47- CHILD WITH FEVER
48- CHILD WITH RASH
49- CHILD WITH DIARRHEA / VOMITS
1-Headache
Sinusitis----XRay/CT-sinus
Temporal Arteritis- ESR, Temporal Artery Biopsy
Meningitis—LP-CSF analysis, CBC with diff
Brain Tumor-CT-head, MRI-Brain
Seizures- EEG
Pseudotumor cerebri-LP
Intracranial Hemorrhage/ Subarachnoid hemorrhage- CT-head, LP
Refractory errors-Snellen chart
Migraine/ Cluster headache/ Trigeminal neuralgia/ Tension headache/Depression.

2-Dizziness
Meniere’s disease- VDRL/RPR, Audiogram
Labyrinthitis/ Vestibular Neuronitis- Audiogram, Caloric test
Orthostatic hypotension—Orthostatic VS
BPV- Electronystagmography/ Dix-Hallpike Maneuver, Caloric test
TIA/Stroke-Doppler US-carotid
Acoustic Neuroma/ Brain stem or cerebellar tumor -MRI-Brain
Vertigo associated to cervical spine disease-XRay-Cervical Spine
Hypoglycemia- Glucose
Cardiac arrhythmia- ECHO, EKG
Anemia- CBC, Serum Iron, TIBC, Ferritin

3-Hearing Loss
Meniere’s disease- VDRL/RPR, Audiogram
Presbicusis/ Otosclerosis- CT of middle/inner ear
Eardrum damage/ Cerumen Impaction-Tympanometry
Acustic Neuroma- MRI Brain
Otitis Media—Culture of discharge
Drug-induced

4-Confusion/ Forgetfulness
In Old people
Alzheimer/ Lewy body dementia/ Creutzfeldt-Jakob disease - Brain Biopsy
Vascular Dementia/ Pseudodementia
Normal pressure Hydrocephalus-LP
TIA/Stroke- Doppler US-carotid
Chronic Subdural hemathoma- CT-head
Neurosyphilis- VDRL/RPR
B12 defficiency- Serum B12 level
Brain Tumor/ Brain abscess- MRI-brain

Confussion in Young People

Substance abuse- Urine Toxicology
Head trauma- Ct scan-head
Brain Tumor- MRI- brain
Hypoglycemia- Glucose
Meningitis/Brain abscess- LP-CSF analysis
Depression/ Malingering/Drug induced
AIDS Dementia-HIV ELISA/ CD4 Count/ Viral load
Confussion in Alcoholic patient
Wernicke Encephalopathy/Chronic subdural hemathoma/Head Trauma/ B12 defficiency
5-LOC/Syncope
Seizure/Convulsive syncope- EEG, Prolactin, MRI-brain
Stroke/TIA- Doppler US-carotid
Head Trauma/ Epidural (lucid interval) or Acute/Chronic Subdural hemathoma- CT-head
Subarachnoid/Intracraneal Hemorrhage- CT-head, LP
Normal Pressure Hydrocephalus/ Increase Intracranial Pressure- LP
Cardiac arrhythmia/ MI -EKG, CPK-MB, Troponin, Holter monitoring
Hypertrophy cardiomyopathy/Cardiac Tamponade/ Aortic stenosis /CHF- Echocardiogram
Aortic Dissection- Aortic Angiography
Hypoglycemia- Glucose, CBC, Electrolytes
Substance abuse/overdose- Urine Toxicology
Orthostatic hypotension- Orthostatic vital signs
Hysteria/Major depression/ Malingering/ Vasovagal Syncope
Drug induced (Diuretics, vasodilators, nitrates, channel blockers, Digoxine, Quinidine, TCA, alcohol,
cocaine, marijuana…)

6-Weakness
Myasthenia gravis- Tensilon Test (Edrophonium), Ach receptor antibodies in serum, Retinal evoked
potentials, EMG/Nerve conducting study
Guillain-Barre syndrome-- LP-CSF analysis, EMG/Nerve conducting study
Peripheral neuropathy (alcoholic/diabetic)-- EMG/Nerve conducting study
Multiple Sclerosis- SPEP/UPEP, MRI-brain
Seizure/ Todd’s paralysis (postictal paralysis)- EEG
TIA/Stroke- Doppler US-carotid
Chronic Subdural hemathoma /Subarachnoid hemorrhage- CT-head, LP
Brain Tumor/ Brain abscess- MRI-brain
Meningitis /Encephalitis- LP
Neurosyphilis- VDRL/RPR
B12 defficiency- Serum B12 level
Hypoglycemia- glucose
Hypocalcemia ( perioral and acral parestesias, tetany) - Calcium
Conversion disorder/Malingering

7-Fatigue
Hypothyroidism—TSH
Anemia- CBC, TIBC, serum iron, ferritin
TB-PPD, CXR, Sputum gram stain, AFB, culture
HIV- HIV ELISSA
Occult malignancy- FOBT, CT-abd, CXR
Obstructive Sleep apnea- Nocturnal Pulse Oximetry, Polysomnography
D.M- Glucose
D. Insipidus—Vasopressin Challenge test
Infectious Mononucleosis- Monospot test, Anti EBV antibodies, US-abd
Hepatitis- Hepatitis serology, ALT/AST, Bilirubine, Alkaline Phosphatase
SLE- ANA, anti ds-DNA
Depression/ Adjustment disorder/Chronic fatigue syndrome/PTSD
Myathenia Gravis-Tensilon Test, Ach receptor antibodies
8-Sore Throat
Infectious Mononucleosis- Monospot test, Anti EBV antibodies, Peripheral Smear, US-abd
Streptococcal Pharyngitis- throat culture, Rapid streptococcal antigen
Acute HIV infection- HIV ELISA
Secondary Syphilis- VDRL/RPR
Viral Pharyngitis/ Tonsillitis/ Posterior Nasal drip- CBC with diff

9-SOB/Cough
Astma/Exercise-induced Asthma-Spirometry, Metacholine challenge test
Pneumonia/TB/ Lung Lung Cancer- CXR, Sputum gram stain, AFB, culture/cytology, Bronchoscopy
Pulmonary embolism—V/Q scan
Atypical pneumonia (Mycoplasma/Legionella)-IgM detection for M.Pneumoniae, Urine Legionella Ag
URI- CBC with diff.
COPD (Bronchitis-Emphysema)-PFTs, sputum gram stain and culture
Pneumothorax/ Hemothorax - CXR
Valvular Disease/CHF/ CAD—EKG, Echocardiography, CXR

Other causes SOB/Cough

GERD-Esophageal PH monitoring, Endoscopy
Weneger Granulomatosis- c-ANCA antibodies
Panic Disorder/ Nervousness
Reactive airway disease/ Postnasal drip
Drug-induced (ACE inhibitors- prils)

In Children
Foreign body- CXR, Bronchoscopy
Whooping cough-(B.Pertussis)- Serological test, PCR
Cystic Fibrosis- Sweat chloride test
Epiglottitis- Neck X-ray

10-Hemoptysis
Lung cancer- CXR, CT-Chest, Bronchoscopy, sputum cytology
Tuberculosis- CXR, PPD, Sputum AFB
Pneumonia- CXR, Sputum (gram stain, culture)
Pulmonary embolism-V/Q scan
Bronchiectasis- Bronchoscopy, sputum(gram stain, culture)
Goodpasture’s syndrome- Antibasement membrane antibodies
Wegener’s Granulomatosis- ANCA-antibodies
Mitral stenosis- Echocardiogram
Bleeding disorder- PT/PTT
Pulmonary Arteriovenous malformation- Arteriogram
Foreign body/Trauma/ Epistaxis/Oropharyngeal bleeding
Hereditary hemorrhagic telangiectasia
HIV patient (Kaposi’s sarcoma, Cryptococcus)
Histoplasmosis/Coccidiodomycosis/ Blastomicosis- KOH preparation

11-Epistaxis
Nasal Trauma/Foreign body/ Nasopharyngeal Tumor/Septal perforation (Cocaine abuse)-Complete
rhinoscopy, CT scan
Hypertensive crisis/ Hereditary hemorrhagic telangiectasia
Coagulopaties(Hemophilia, Von Willebrand’s disease)-bleeding time and clotting time, Platelet count,
PT/PTT, Factor VIII assay
Liver disease-BUN
Vit C (Scurby) and Vit K deficiency

12-Chest pain
MI-EKG, CPK-MB, Troponin, Cardiac catheterization
Angina- Exercise stress test
Aortic dissection- Aortic angiography, MRI/MRA-aorta
Pericarditis-EKG
Pulmonary embolism-V/Q scan
Pneumothorax /Pneumonia- CXR
GERD - Esophageal pH monitoring
Peptic ulcer disease- Endoscopy
Esophageal spasm-Esophageal manometry
Esophageal rupture-Esophagogram with gastrograffin
Costochondritis/Muscle strains/Acute chest syndrome due to sickle cell

13-Palpitations
Cardiac arrhythmia-EKG, Holter monitor
Valvular disease- TEE (transesophageal echocardiography)
Angina/MI- EKG, CPK-MB, Troponin
Hyperthyroidism- TSH, T3, T4
Pheochromocytoma- 24 hr Urine catecholamine
Hypoglycemia-glucose
Panic Attack/Hyperventilation episodes/Anxiety
Pulmonary Embolism-V/Q scan
Carcinoid Tumor- 5HIAA
Drug induced (digitalics, vasodilators, cocaine, amphetamine, caffeine) - Urine toxicology

14-Weight loss
Hyperthyroidism- TSH, T3, T4, thyroid US
DM- glucose
TB-PPD, CXR, Sputum AFB
HIV- HIV ELISA
Occult Malignancy- FOBT. CXR, CT-abd
Malabsorption syndrome- D-Xilose test
Anorexia Nervosa/ Depression

15-Weight gain
Hypothyroidism- TSH, T3, T4, Thyroid US
Cushing’s syndrome- 24-hour urine free cortisol, Dexamethasone suppression test
Polycystic ovarian syndrome- Pelvic Exam, US-pelvis
Pregnancy- Urine B-hCG, US-pelvis
Smoking cessation/ Familiar Obesity/ Behavioral obesity/ Depression/Drug side effect

16-Dysphagia
Esophageal cancer/Esophagitis/ Esophageal strictures- Barium swallow, Endoscopy, CXR
Achalasia-Esophageal manometer, Barium swallow
Systemic sclerosis- Scl-70
GERD- Esophageal Ph monitoring, Upper Endoscopy
Plummer-Vinson syndrome-CBC, TIBC, serum iron, ferritin
Zenker’s diverticulum-Endoscopy
Goiter-US Thyroid
Foreign body/ Mediastinal tumor-CXR, CT-chest
Mitral valve stenosis- Echocardiogram

17-Nausea/Vomiting
Pregnancy-Pelvic Exam, Urine B-hCG, US-pelvis
Gastritis/ Gastroenteritis- CBC, Electrolytes, stool exam
Meningitis- LP-CSF analysis
UTI- UA, Urine culture
Labyrinthitis/ Vestibular Neuronitis- Audiogram
Brain Tumors- CT-head, MRI-Brain
With Abdominal pain:
PUD/GERD- Endoscopy, esophageal ph monitoring
Appendicitis- CBC with diff., US-Abd
Pancreatitis- Lipase, Amylase, AXR, US-Abd.
Hepatitis- Hepatitis serology, ALT/AST, bilirubine, Alkaline Phosphatase
Cholecystitis- US-abdomen
Intestinal obstruction- AXR
Diabetic Ketoacidosis-Glucose, electrolytes, Hb A1c
Myocardial ischemia- EKG, CPK-MB, Troponin
Others
Increased intracranial pressure- LP
Depression/ Bulimia/Psychogenic vomiting/Drug-induced

18-Constipation
Colon Cancer- DRE, FOBT, Colonoscopy, Barium Enema
Diverticulosis- Sigmoydoscopy
Hemorrhoids/ Anal fissure- Anoscopy
Hypothyroidism- TSH, T4,T3
Bowel Obstruction- AXR
Diabetic Autonomic Neuropathy- Glucose, Hb A1c
Drugs Induced/ Substance Abuse- Urine Toxicology
Functional constipation/ Irritable bowel syndrome/Low-fiber diet.

19-Diarrhea
Colon cancer- DRE, FOBT, Colonoscopy, Barium Enema
Ulcerative colitis/ Crohn disease-Barium Enema, Colonoscopy-biopsy, AXR
Infectious diarrhea (Food poisoning/Traveler’s diarrhea) - Stool for Leukocytes
GI parasitic infection (Giardiasis/ Amebiasis)- Stool for O&P, Giardia antigen in stool, Entamoeba
Hystolytica antigen
Pseudomenbranous colitis- C. Difficile Toxin in stool
Cryptosporidium/ Isospora infection- HIV ELISA, CD4 count, viral Load
Hyperthyroidism- TSH, T3, T4, Thyroid-US
Carcinoid Tumor- 5 HIAA
Small Bowel Lymphoma/ Zollinger-Ellison syndrome- CT- Abd.
Irritable bowel syndrome (IBS)/Lactose intolerance/ Malabsortion syndrome-D-Xilose test

20-Upper GI bleeding-hematemesis
Bleeding peptic ulcer (gastric or duodenal)-DRE, barium swallow, Upper Endoscopy, AXR
Gastritis (drug or alcohol induced)- Upper Endoscopy
Acute erosive Esophagitis/ Duodenitis/ Esophageal or Gastric cancer- Upper Endoscopy
Esophageal varices- CBC, AST/ALT/bilirubin/Alkaline Phosphatase, Upper Endoscopy
Mallory-Weiss tear- Upper Endoscopy
Coagulopathies / Vascular ectasias- PT/PTT
Aorto-enteric fistula-Angiography
Swallowed blood (nose bleed, oral lesion)-Munchausen syndrome or spurious (simulated)

21-Blood in stool- hematochezia or melena

Old people:
Colorectal cancer-DRE, FOBT, Barium Enema, Colonoscopy, CEA
Diverticulosis- Barium Enema, Colonoscopy
Colon Angiodysplasia - Mesenteric angiography
Aorto-enteric fistula-Angiography
Ischemic colitis/Mesenteric Thrombosis- Mesenteric Angiography

Young people:
Anal fissure-Anoscopy
Ulcerative colitis/ Crohn’s disease - AXR, Colonoscopy with biopsy
Gonoccocal proctitis/Rectal trauma- Anoscopy, culture
Childrens
Meckel’s diverticulitis - Technetium scan
Intussusception-Barium Enema
Others
Hemorrhoids/ Colonic Polyps / Coagulopathies/ Infectious enterocolitis/ Upper GI bleeding

22-Abdominal Pain
Epigastrium
Peptic Ulcer Disease/ Gastritis -Upper Endoscopy
Perforated ulcer- AXR
Pancreatic cancer-CT Abd
Pancreatitis- Amylase, Lipase
MI-EKG, CPK-MB, Troponin

RUQ
Acute hepatitis/ Hepatic Metastasis/ Fitz-hugh-Curtis syndrome- Viral Hepatitis Serology, LFTs
Rib fracture/Pneumonia-CXR
Biliary colic (cholelithiasis)/ Acute cholecystitis-US-abd, HIDA Scan
Choledocolithiasis/Ascending cholangitis/Sclerosing cholangitis- US-abd, ERCP, MRCP

LUQ
Splenic rupture - trauma/ Splenic infarction (sickle cell disease)- CT/US-abd
Rib fracture/Pneumonia-CXR

RLQ
Appendicitis- CBC with diff, Laparoscopy Crohn’s disease- Colonoscopy with biopsy

LLQ
Diverticulitis- CT-abd Ulcerative Colitis- Colonoscopy with biopsy

Billateral/Lower abdomen (Pelvis/Rectal Exam, urine BhCG, US-Pelvis/abd, Laparoscopy, UA)

Ovarian-testicular torsion/ Uterine leiomyoma torsion/ Rupture ovarian cyst/Mittelschmerz
Ectopic pregnancy/ Dysmenorrhea/ Spontaneus abortion /Salpingitis/ Endometritis/ PID
Abscess/Gastroenteritis/ Prostatitis/ Colorectal Cancer/Bowel infartion/perforation
Intestinal obstruction/ Strangulated hernia/ Volvulos/ Intussusception /Psychogenic pain
Mesenteric Lymphadenitis/ Mesenteric infarction/ Irritable bowel syndrome
Nephrolithiasis/ Pyelonephritis/ Cystitis

Flanks (right-left)
Nephrolithiasis/ Pyelonephritis/ Renal cell carcinoma-CT/ US-abd, AXR, UA, urine culture, IVP

23-Hematuria (Genitourinary exam)

Bladder cancer- Cystoscopy, urine cytology, U/S-bladder, CT- pelvis
Polycystic kidney disease/Renal cell carcinoma- U/S-Renal, CT- abdomen, IVP, BUN/Cr
Prostate cancer- PSA, transrectal US-prostate
Pyelonephritis/ UTI- UA, urine culture
Nephrolitiasis- AXR, US-abd, IVP
Coagulation disorder- CBC, PT/PTT
Acute Glomerulonephritis /Trauma

24-Increased Urination-polyuria
DM- Glucose, CBC, Electrolytes, BUN & Cr.
D. Insipidus- Vasopressin Challenge test
UTI- U/A, urine culture
Psychogenic polidypsia- Urine/serum Osmolarity
Drug induced (Diuretics)

25-Difficulty urinating
In males: BPH/ Prostate cancer- DRE, PSA, transrectal US-Prostate
Both:
Urolithiasis/ Bladder Stones/Bladder carcinoma- XR-abd/pelvis, Cystoscopy, urine cytology, IVP
UTI- UA, urine culture
Urethral Strictures
Drugs induced (anticholinergic)/ Diabetic Autonomic Neuropathy -CBC, Glucose, BUN/Cr.
Spinal Cord injured- CT or MRI head/ lumbar spine

26-Erectile Dysfunction
Drug-related ED/ Alcohol-related ED/ ED cause by Hypertension - Genital and DRE, Postage stamp
test, Doppler-U/S or scan of penile arteries
ED cause by D.Mellitus- Blood sugar, Hb A1c
Leriche syndrome(aortoiliac arteriosclerosis)- Doppler US- penis, lipid profile
Hypothyroidism- TSH, T3, T4
Hypogonadism (with hot flushes, diminish libido, fatigue) - Testosterone, FSH/LH, Prolactin,
MRI-Brian-looking for Pituitary or Hypothalamic lesion
Spinal cord injury- CT or MRI head/ lumbar spine
Depression/ Psychogenic ED
Peyronie’s disease-Physical exam

27-Amenorrhea (Pelvic and breast exam)

Primary- Secondary-Young- Old
Pregnancy- Urine B-hCG, U/S-pelvis
Hyperprolactinemia- Prolactin level
Anorexia nervosa/Anxiety-Stress-Exercise induced amenorrhea
Pituitary tumor/ Sheehan’s syndrome/ Hypopituitarism - MRI-brain
Polycystic ovarian syndrome/ Ovarian Dysgenesis or Agenesis - US-pelvis
Thyroid disease- TSH, T4, T3
Premature ovarian failure/ Menopause - LH/ FSH ratio
Cushing syndrome- 24 hr free cortisol, Dexamethasone suppression test
Outflow tract obstruction (imperforate hymen, transverse vaginal septum, agenesis of the vagina, cervix
or uterus…)/Asherman’s syndrome- hysteroscopy
Anovulatory cycle- Progesterone Challenge test
Adrenal hyperplasia /Ovarian or adrenal tumor - ACTH, Testosterone, DHEAS

28-Abnormal Uterine bleeding

Ectopic pregnancy/Spontaneous abortion/Molar pregnancy-Pelvic exam, urine hCG, quantit.serum hCG,
U/S-pelvis, Laparoscopy
Cervical Cancer- Pap smear, Colposcopy with biopsy
Dysfunctional uterine bleeding/ Endometrial Hyperplasia or cancer - Endometrial curettage w/biopsy
Uterine Leiomyoma/Endometrial-Cervical polyps -US-pelvis, Hysteroscopy
Cervicitis/Vaginitis-cervical culture
Hypothyroidism- TSH, T3,T4
Trauma (cervical laceration)/ Foreign body/Atrophic endometrium
IUDevice/OCPs/ Anticoagulants medications
Coagulation (von Willebrand’s disease, hemophilia, thrombocytopenia)-CBC, PT/PTT

29-Vaginal discharge- Pelvic exam, glucose, urine hCG

Vaginitis-candidal, - KOH preparation
Vaginitis-trichomonal- KOH preparation, wet mount
Bacterial vaginosis-Wet mount, Ph of vaginal fluid
Cervicitis(Chlamydia, gonorrhea)- Gram stain and Cervical culture, Chlamydia antigen test
Physiologic vaginal discharge

30-Dyspareunia- Pelvic exam

Atrophic vaginitis/ Vaginismus/ Vulvodynia
Cervicitis/ PID- Wet mount, KOH preparation, Ph of vaginal fluid, cervical culture, U/S-pelvis
Endometriosis- Laparoscopy, U/S-pelvis
Depression/ Domestic violence

31-Abuse -Pelvic exam

Domestic violence/ Osteogenesis imperfecta- XRays skeletal survey, CT-maxillofacial
Consensual violent sexual behavioral
Substance abuse- urine toxicology
Rape-KOH preparation, cervical culture, wet mount, HIV antibody, viral hepatitis serology, urine hCG

32-Jaw Pain
TMJ dysfunction/ Otitis media/ Parotid tumor
Dental abscess/ Trigeminal neuralgia/ Temporal arteritis
Sinusitis/ Rheumatoid Arthritis/ Osteoarthritis/ MI (Myocardial Infarction)
CBC with diff, ESR, Nerve conduction study, X rays- TMJ / sinuses, CT scan or MRI of head, Dental
workout, RF(Rheumatoid factor)
33-Joint/limb pain
Rheumatoid arthritis/SLE/ Arthritis associated with IBD
Osteoarthritis/ Psoriatic arthritis/ Septic arthritis/ Reiter’s arthritis
Gout /Pseudogout/ Lyme disease/ Parvovirus B19 infection
Disseminated gonorrhea/ Factitious disorder/ Malingering
Meniscal or ligament damage/Trauma
Myositis/ Polymyositis/Cellulitis
Rhabdomyolysis due to –statin drugs or clofibrate

CBC, ESR, RF, ANA, Anti-ds DNA, CPK, Uric acid, Lyme antibody,
Xray, CT/ MRI, Knee arthrocentesis and synovial fluid analysis (cell count, gram stain, crystals),
cervical, urethral and blood culture.

34-Leg pain
Ciatalgia/ Lumbar Spinal Stenosis- XR-Lumbar spine, MRI-Lumbosacral spine
Atherosclerotic vascular disease(Leriche’ disease)- Lipid profile
DVT/ Superficial venous thrombosis-Doppler US-lower Limbs
Obliterans Tromboangiitis-Angiography, Ankle-brachial index, Doppler US-lower Limbs
Diabetic neuropathy-Blood sugar, Hb A1c, CBC with differential
Trauma/Fracture- XRay
Muscle strain/ Baker cyst Rupture /Aquiles tendon Tear

35-Back pain
Spinal Stenosis/ Lumbar disc herniation/ Lumbar Sprain- MRI/CT- lumbar spine, EMG, NC studies
Pyelonephritis/Renal colic/ Peri-renal abscess- UA, urine culture, US-Abd, IVP, BUN/Cr
Ankylosing Spondilitis- X-ray-Lumbar spine, HLA B-27
Arthritis- RF, CBC with differential, ESR, Lumbar spine X-ray
Pancreatitis- Amylase, lipase----------Perforated ulcer- XRay-Abd.
Abdominal Aortic aneurysm rupture- US-abd
Bone metastasis- XR- Lumbar spine
Multiple Myeloma- XR- Lumbar spine, Serum protein Electrophoresis
Fracture (knee, leg, hip)/ Osteoporosis—Xrays, DEXA scan
Peripheral vascular disease- Ankle-brachial index
Vertebral canal Tumor/Vertebral compression fracture--MRI/CT-Lumbar spine
Malingering

36-Wrist pain
Carpal Tunnel Syndrome/Herniated cervical disc/ Thoracic outlet syndrome
Tenosynovitis/ Rheumatoid Arthritis/ Osteoarthritis/ Fracture/ Osteoporosis/ Median Nerve compression
in forearm or arm

XR/ MRI/CT scan-wrist/cervical spine, EMG, Nerve Conduction Studies, CXR, CBC With differential,
ANA, RF, DEXA scan

37-Elbow pain
Olecranon-Bursitis / Epicondylitis/ Elbow Dislocation/ Fracture/ Osteoporosis
Osteoarthritis/ Rheumatoid arthritis/ Septic arthritis

X-Ray/MRI/CT Scan- Elbow, Arthroscopy, Joint tap, CBC With differential, ANA, RF, DEXA scan

38-Shoulder pain
Shoulder dislocation/ Rotator cuff tear/ Shoulder fracture/ Osteoporosis
Bursitis/ Rheumatoid arthritis/ Osteoarthritis/ Septic Arthritis/ Malingering

X-Ray/ MRI –Joint, CBC with differential, ANA, RF, Nerve conduction studies,
Electromyography(EMG), Arthroscopy, DEXA scan, Arthroscopy, Joint tap

39-Foot pain or heel pain

Plantar faciitis/ Plantar wart / Hallux valgus / Calcaneal spurs/ Painful heel pad syndrome
Rheumatoid Arthritis /Gout/Heel fracture/ Stress fracture/ Foot sprain or strain

CBC with differential, Uric acid level, RF, X rays of ankle/foot, Doppler study-L/E(lower extremities)

40-Anxiety
Hyperthyroidism- TSH, T3, T4, Thyroid US
CHF/ MI/Cardiac arrhythmia- EKG, CPK-MB, Troponin, Echocardiogram
Hypoglycemia- Glucose, CBC, serum electrolytes
Drug use/ Drug withdrawal- Urine Toxicology
Pheochomocytoma-urine catecholamine
Depression/GAD/Phobia/Panic disorder
Malingering/ Hysteria/ Hypochondriasis/ Obsessive compulsive disorder

41-Insomnia
Age related sleep changes
Hyperthyroidism- TSH, T3, T4
Sleep apnea/ Circadian Rhythm sleep disorder –Polisomnography, Nocturnal Pulse Oximetry
Drugs induced- Urine Toxicology
Post-traumatic Stress disorder/ Major depression/ Anxiety disorder
Occult malignancy- CBC with differential, X-Ray-Chest, Endoscopies.
Chronic Pain syndrome/ Inadequate sleep hygiene

42-Blurred vision- Snellen chart test

Cataracts/ Macular degeneration- Fundoscopy exam
Open angle Glaucoma- Tonometry
Temporal Arteritis- ESR, Temporal artery biopsy
Hypertensive retinopathy/Diabetic retinopathy- CBC with differential, Blood sugar, lipid profile
Corneal injury- Slit lamp examination
Brain tumor- MRI- Brain
TIA- Doppler US- Carotid
Retinal Detachment (trauma)
Multiple sclerosis
Optic Neuritis/ Drug induced (Antihistaminic, mydriatics, digitalis)

43-Tremor
Parkinson’s Disease/Cerebellar Disease/Midbrain Lesion- Ct- head, MRI-Brain
Hyperthyroidism- TSH, T3, T4
Wilson’s disease- serum ceruloplasmin, AST/ALT, bilirubine
Hypoglycemia- Blood sugar
Pheochromocytoma- urine catecholamine
Essential tremor/ Physiologic tremor/Psychogenic tremor/Alcohol induced.
Drugs induced- Urine toxicology (Arsenic or mercury exposure-Heavy metal screen)
44-Frequent fall
Cerebellar disease /Parkinson’s Disease/ Brain tumor- Ct- head, MRI-Brain
Stroke /TIA- Doppler US- Carotid
Cardiac Arrhythmias- EKG/Echo
Benign positional vertigo-Electronystagmography, Dix-Hallpike maneuver
Vasovagal syncope/Orthostatic Hypotension- Orthostatic VS
Diabetic neuropathy- Blood sugar, CBC with differential, Serum electrolytes
Seizures-EEG
Drug induced- Urine toxicology

45-Rash
SLE- ANA, Anti ds DNA
RA- RF, CBC with differential
Infectious Mononucleosis-Monospot test, anti EBV antibodies
Photo dermatitis/Athopic dermatitis- Skin test allergen
Occupational exposure- Skin test allergen
Lyme’s disease- Lyme’s disease titer
HIV Infection-HIV ELISA
Drug induced
Rubella, Measles, Fifth Disease, Varicella, - Viral antibody and viral titers
Scarlet Fever- Rapid Streptococcal antigen, throat culture

46-Jaundice
Infectious hepatitis/Alcoholic hepatitis-Hepatitis serology, AST/ALT, bilirubine, Alkaline Phosphatase
Drugs induced hepatitis- Drug level (Acetaminophen)
Primary biliar cirrhosis- Antimitochondrial antibody
Choledocholithiasis/ Ascending cholangitis-ERCP
Infectious mononucleosis- Monospot test
Pancreatic cancer-US/CT-abd
Wilson’s disease- serum ceruloplasmin
Hemochromatosis-Liver biopsy

47-Child with fever- physical exam

Neonatal sepsis CBC, blood culture
Meningitis-LP-CSF analysis
Pneumonia- CXR
UTI- UA, urine culture
Acute Otitis Media- culture of discharge, pneumatic otoscopy
URI-CBC with diff.

48-With Rash
Meningitis/Measles/ Rubella/ Roseola/ Fifth disease/ Varicela/ Scarlet fever(Throat culture)
Exanthema subitum- viral antibodies and titers

49-With diarrhea/Vomits
Gastoenteritis(Viral, bacteria or parasitic)-stool leukocytes and culture, O&P
Food poisoning- CBC with differential, electrolytes,
UTI- UA, urine culture
URI- CXR
Volvulos/ Intussusception-AXR, Barium Enema