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Interactive Interview
"Headache Interactive"

FOCUSING PHYSICAL EXAMINATION

[see also: "COMMON SYMPTOMS: A GRID OF DIFFERENTIAL DIAGNOSIS FOR REVIEW" below]

In medical school, emphasis is usually given to a comprehensive "head to toes" physical exam, or at least a shortened "screening" version of such an assessment. This sort of exam is appropriate when admitting a patient to hospital, when seeing a new patient in general practice, for very non-focal symptoms such as fatigue and weight loss. But in daily outpatient medicine (and in some test situations), time is often limited to something like 15 minutes. A full exam is usually not possible, nor appropriate, nor efficient. The physician or student needs to TARGET the exam based on what has been learned from the history, and on the differential under consideration. often common sense is the guide. Here are some specific suggestions for a selection of presenting problems. Note that the following applies mainly to adults.

PRESENTING PROBLEM

SELECTED DIFFENTIAL DIAGNOSIS TO CONSIDER

TARGETED EXAM

CHEST PAIN

Extensive cardiac and pulmonary etiologies

Musculoskeletal causes

Zoster

Anxiety

Cardiac exam with palpation of pulse

Pulmonary exam

Palpation of anterior chest (looking for reproducible tenderness)

PALPITATIONS/"RACING HEART"

Cardiac arrhythmia

Hyperthyroidism

Anemia

Cardiac exam with palpation of pulse

Hyperthyroidism: palpate thyroid, warmth/moisture of skin; tremor; lid lag; brisk DTRs

Anemia: pallor of nails, of anterior rim of lower inner lid (though physical exam is not very sensitive for anemia)

PERSISTENT COUGH

Pulmonary etiologies

Allergic rhinitis

GERD

 

Pulmonary exam

Possibly nose and throat exam

Supraclavicular node palpation if smoking history

Evaluation for CHF if on the differential: cardiac exam, edema

SHORTNESS OF BREATH

Pulmonary etiologies

Cardiac etiologies

Anemia

Pulmonary exam

Cardiac exam and check for edema

Consider evaluation for signs of anemia

ABDOMINAL PAIN

Broad gastrointestinal differential

Thorough abdominal exam. If right upper quadrant tenderness consider Murphy's Sign. For marked pain and tenderness, consider checking for rebound or sensitivity to light percussion.

HEADACHE

Broad neurologic differential.

Multiple "classic" headache diagnoses have characteristic history features.

Palpation of the head including face/sinuses depending on location of headache.

Neuro exam which might include pupils, cranial nerves, pronator drift, fine finger movements,  symmetry of DTRs depending on the history.

DIZZINESS

Vertigo 

If suggestion of vertigo, inner ear/labyrinth disorders

Volume depletion ("dehydration" or from acute or chronic blood loss)

If some quality of vertigo, screen for hearing, eliciting nystagmus (the Dix-Hall Pike maneuver aka Barany maneuver).

Assess for orthostatic hypotension (BP drop by 20 mmHg or more, HR increase by 30 or more bpm) and perform cardiac exam depending on history obtained.

JOINT PAIN

Gout, DJD, Rheumatoid Arthritis, and of course many others.  Consider pattern (single joint or multi, central orperiperhal)

Inspection (for redness, swelling), palpation, range of motion of the involved joint.

For multi-joint symptoms, when a systemic disease must be considered, check for skin rash or nodules.

Brief general exam is applicable when systemic disease is being considered.

BACK PAIN

Common acute "strain" ; classic disc disease; spinal stenosis;  osteoporosis; rare: mets, infection.

Palpation, inspection, and ROM of the back.

Neuro exam might include straight-leg raising test, DTRs (patella, Achilles), strength esp. distal leg (foot dorsiflexion, plantar-flexion) if disc disease with nerve root impingement is suggested by history such as sciatic pain and/or paresthesia or weakness in leg, foot.

FATIGUE

Very broad differential including (but not limited to) anemia, malignancy, depression, fibromyalgia, autoimmune disease, HIV, cardiac etiologies

For this complaint, which is not typically a "15-minute" problem, exam needs to be shaped by hints from the history.

SYNCOPE

True syncope is usually of cardiovascular cause, such as dysrhythmia, heart block, vasovagal from fright or foul odor; pooling of blood and vasodilation from standing in one place esp. if warm.

True syncope refers to sudden collapse with loss of consciousness, spontaneous recovery without residual deficit and no visible seizure. Neuro exam will rarely be revealing.Exam should include cardiac auscultation (perhaps for a few minutes to detect any hint of dysrhythmia), postural vital signs.

SORE THROAT

Bacterial, viral, consider HIV depending on history.

Examine posterior oropharynx. Palpate for cervical nodes.

NEWLY IDENTIFIED HYPERTENSION

Essential versus secondary hypertension.

The most important factor is taking the blood pressure properly. Other parts of exam which can be relevant include:

·      Fundus (if examiner is competent)
·      Cardiac (especially for S4, apex beat)
·      Auscultation for carotid and abdominal bruits
·      Palpate for edema.

The vast majority of patients with mild to moderate hypertension won't have any findings, but some exam should be done thinking of possible target-organ findings, secondary causes, associations such as renal disease and cardiovascular disease.

PATIENT WITH KNOWN DIABETES

Think about eyes, neuropathy, kidneys, skin

·      Fundus (if examiner is competent)
·      Sensory exam esp. feet – vibratory, pinprick, microfilaments
·      Examine feet and lower legs for ulcers
·      Check for edema

 

DREXEL UNIVERSITY COLLEGE OF MEDICINE

COMMON SYMPTOMS: A GRID OF DIFFERENTIAL DIAGNOSIS FOR REVIEW

Rev. December 2018

Generally, for each diagnosis there appear first attributes of the symptom, then associated symptoms, then risk factors, then physical findings (in italics). This is a work-in-progress: more symptoms will be added in due course. The order of listing is Cardio-Pulmonary, GI, HEENT, Musculo-skeletal, general.

 BEWARE: This table represents obvious simplification and selection. Of course, few patients will show all the findings for a given diagnosis, and in turn few findings are entirely specific to one diagnosis!

Particularly common causes are in blue. Wherever possible, the listed attributes are supported by evidence obtained by publications since 1990. An asterisk (*) indicates that such literature is available for the complaint or at least some disorders causing the complaint. Otherwise, the listings reflect consensus or traditional teachings. The most indicative findings are in bold.

Prepared by Steven J. Peitzman, MD, FACP

December, 2018 (Based on initial document from December, 2007)

Please click HERE to get a printable PDF file of this grid

SYMPTOM

DIAG 1

DIAG 2

DIAG 3

DIAG 4

OTHER DXs

CHEST PAIN

Ischemic Heart Disease:Angina*
Exertional
Felt as pressure, weight, discomfort
Relieved by rest <6 minutes
Central in chest
Radiation to arm(s), jaw
Male, D.M, smoker, high lipids
Corneal Arcus
Ear-lobe crease
Carotid bruit

Ischemic Heart *Disease:Acute MI
Central in chest
Radiation to arm(s), jaw
Duration>30 minutes
Assoc: sweating, nausea
Same risk factors as angina
Physical findings of CHF (minority)

NON-Ischemic Causes [see also to the right]*
Not exertional
Described as sharp or stabbing
Related to position
Age < 40
Assoc. with dizziness, flushing
(Note: includes anxiety-induced chest pain, common and sometimes assoc. with hyperventilation)

Pericarditis

Pleuritic
Central in
chest
Radiates to arms, jaw
Fever
Rub
(Most are idiopathic/viral, but can be assoc. with cancer, autoimmune disease)

Dissecting Aortic Aneurysm

Acute Onset
Severe
"tearing" quality
Pulse deficits
Focal neuro finding

Chest Pain (Con't)

Other

esophageal-based (GERD, spasm)
Chest wall Inflammation

       

Palpitations/
Racing Heart

ANXIETY

Triggers (situations)
Other somatic complaints
Otherwise normal exam
Other indicators of stress or anxiety

Hyperthyroidism*

Sweats
Heat intolerance
Nervousness
Enlarged thyroid
Tremor of hands
Hyperactive DTRs
(note: fewer signs and symptoms in older age)
Heart rate >90  bpm except in >60-y-o

Panic Attack

Discreet episodes
Sweats
Shortness of breath/choked feeling
Shakiness
(these are DSM criteria)

Dysrhythmia *(esp PACs or PVCs, episodic A. Fib., Parox. Supraventricular Tachycardia)

Sudden onset/cessation
Sense of "flip-flop" or irregularity
Awareness in bed
Syncope or near-syncope
Sense of pounding in neck (for PST)
HR > 150 (ie, more than most sinus tach)
A waves in neck veins

Other Causes:

Anemia
Adrenergic drugs

COUGH,
PERSISTENT  (> 3 WEEKS), in otherwise well-seeming adult (note: mutifactorial causation is common)

Post-URI Airway Hyper-reactivity

History of acute URI

May go on for >4 weeks!

Sometimes wheezing

Asthma

Shortness of breath
Chest "tightness"
[But other sx may be absent in cough-variant asthma]
FH of asthma, allergy, or eczema Wheezing

POST-NASAL DRIP
(also called Upper Airway Associated Cough)

Patient aware of post-nasal drip
Chronic rhinitis
Response to nasal steroid

GERD

Heartburn, acid taste in mouth
[BUT, many or most patients lack GI symptoms.]
Response to anti-GERD Rx
? Hoarseness in some

COPD*: smoking history; dyspnea on exertion; wheezing; diffusely decreased breath sound intensity; early inspiratory crackles

Also:

Eosinophilic bronchitis
ACE inhibitor
Sarcoidosis
Lung Cancer
Tb
Bronchiectasis

SHORTNESS OF BREATH

Asthma

Episodic
Coughing
"Tight" feeling
Allergy, eczema
Wheezes

COPD

Exertional
Coughing
Cigarets
Wheezing
Quiet breath sounds
Early insp. crackles

CHF

Exertional
Positional(orthopnea)
Past MI
Hypertension
Edema
Crackles
NVD
S3

Anemia

Bleeding often GI
Headache
Fatigue
Pallor (conjunctival rim, nails)

Pneumothorax
Pneumonia
Pericardial  disease
Angina
Anxiety
Pleural fluid
Pulm. Embolus

ABDOMINAL PAIN, ACUTE

Appendicitis*

RLQ
Migration of pain Pain before vomiting
Local tenderness
Guarding, rebound
Fever

Cholecystitis*

RUQ or epigastric location
Vomiting
Pain radiation to shoulder
RUQ tenderness
Murphy Sign

Pancreatitis

Epigastric
Felt in back
Fever
Vomiting
Alcohol
Abdominal tenderness and Rebound

Diverticulitis

LLQ
Fever
History of constipation
Local tenderness & rebound

Ruptured Ectopic

Lower quadrant
Tenderness and rebound
Collapse
Vaginal bleeding
Missed period

ABDOMINAL PAIN, ACUTE (con't)

(5) OBSTRUCTION*

Crampy pain
Vomiting
Absence of b.m.
Past surgery
Hyperactive, high-pitched bowel sounds early, ileus later
Distention
Hyper-resonance

(6) PID

Lower quadrant pain
Discharge
Unprotected sex
Local peritoneal signs
Tender Cervix

(7) Perforated Stomach/Intestine

Generalized pain
Shocky
Hx of ulcer, NSAIDs,
Guarding, Rebound

(8)Kidney Stone

Typically begins in flank
Patient wants to move around
Radiation to genitals
Urgency/frequency
Hematuria
Sometimes vomiting
Lack of local findings on abdo exam; sometimes CVA tednerness

 

ABDOMINAL PAIN, RECURRENT

Irritable bowel syndrome*

"Crampy" pain
Relieved by bowel movement
Diarrhea and/or constipation
Sense of being "bloated"

Gall Bladder Disease*

RUQ or epigastric location
Vomiting
Pain radiation to shoulder
RUQ tenderness

GERD

"heartburn"
Worse supine
Worse with caffeine, "acid" foods, chocolate
Relieved by antacid
PE usually egative

ULCER

Epigastric
Periods of pain separated by months
Melena
Alcohol
Smoking

"Non-specific"
Pancreatitis
Recurrent obstruction

VOMITING, ACUTE
(almost always associated with nausea)

Gastroenteritis and especially ingestion of pre-formed toxin (see "diarrhea")

Bowel Obstruction

Pain, not highly localized
History past surgery
Abdo. Distention and tympani
High-pitched bowel sounds then ileus

Diseases of Major Abdominal Organs

Pancreatitis
Hepatitis
Cholecystitis
(usually associated with pain)

Drugs (selected)

Anti-neoplastic
Many antibiotics
Digoxin
Colchicine
Opiates
NSAIDs (not common)

Labyrinthitis/
Meniere's

Vertigo
Nystagmus

VOMITING, REPEATED without Pain as Major Symptom (ie not  pancreatitis, acute bowel obstruction)

Gastroenteritis

Associated with diarrhea
Pre-formed toxin as with staph shows vomiting>diarrhea
Sometimes fever (viral or bacterial)
Foods to ask about: eggs, pastry.

Hepatitis esp A

Contaminated food eg shellfish
Jaundice but may be absent esp. early
Tender liver (RUQ)
Dark urine

Early Pregnancy

Opportunity
Missed menses and Other signs of pregnancy

Medications  (see above)

Other Causes (selected)

Self-induced
Binge drinking
Drug withdrawal
Motion sickness
Uremia
Gastric outlet or emptying defect (eg diabetic gastroparesis)

HEADACHE

Migraine*

Unilateral
Pulsating
Nausea
Sens. to light or noise
4-72 hrs
+ Family Hx

Tension

Generalized
Absence of other findings

Meningitis*

Fever
Mental status change (esp. if bacterial)
Blunted mental status
Resistance to flexion of neck (bacterial)

Brain Tumor

Progressive
Worse bending over
+ Neuro findings

Head Injury
Intrancranial bleed
(if chronic: subdural)
Cluster Headache
Severe HBP
Caffeine overuse or withdrawl
Medication overuse headache

DIZZINESS
(Note: many cases are multi-causal especially in elderly persons)

Benign Positional (or "Positioning") Vertigo*

Fleeting vertigo and sometimes nausea with head movements
Esp. turning over in bed
nystagmus,  
provoked nystagmus (Dix-Hallpike maneuver)

Labyrinthitis

A single, extended period, days to weeks
Sometimes there has been a preceding viral syndrome
nystagmus
falls toward side of inner-ear lesion when walking

Hypovolemia and Postural Hypotension*

Feeling of faintness esp. on standing
Diarrhea, vomiting, blood loss
Increase in heart rate on standing>30 bpm
Drop in syst P >20 mmHg

Stroke/TIA (rare as cause of dizziness alone)

Sudden onset
Other neuro symptoms
Older age, risk factors for vasc.disease
Nystagmus of any type
Other neuro signs: eg, diplopia, speech disorder,
focal weakness

Other Causes

Meniere's Syndrome (triad of episodic vertigo, tinnitus, hearing loss)

Psychosomatic/ psychiatric

Migraine presenting as vertigo

SORE THROAT

Viral

URI  symptoms

Streptococcal*

Fever
NO cough
Nodes
Exudate

Mononucleosis

Persistence
Young adults Fatigue
Rash
Splenomegaly

 

Gonococcal
Peritonsillar abscess
Diphtheria


KNEE PAIN, acute with Swelling (non-traumatic)

Septic Joint

Fever
IV drug use
Gonorrheal symptoms
Fever, chills
Warm, red, swollen, tender

Gout

Extreme pain
Past symptoms in toe
Metabolic syndrome
On thiazide
Exquisite tenderness even to light touch (if classic)
Warm, swollen
Surrounding soft tissue swelling

Rheumatoid Arthrits (is usually bilateral)

Morning stiffness
Joint involvement elsewhere, esp. hands in PIP and MPs: swelling, tenderness

 

Pseudogout
Hemarthrosis in patient on Coumadin
Bursitis esp. pre-patellar

KNEE PAIN, subacute or chronic

Osteoarthritis

Older age
Morning stiffness but < 30 minutes
Pain felt medially in knee
Past injury to knee or leg (not needed)
Non-warm
Bony enlargement
Crepitus with ROM
Tenderness at medial joint line

Patello-Femoral Syndrome ("chondromalacia")

Age < 35 with exceptions
Pain especially on going up or down stairs
Pain, crepitus, or 'grittiness' with pressure on patella against femur

Bursitis

Pre-patellar: Repeated pressure on knee ("washerwoman"); redness & tenderness over lower patella.
Anserine: pain, tenderness medially 5-6 cm below joint line
With both, joint not really involved so no loss of ROM

Rheumatoid arthritis (see above)

Pain referred from hip-joint disease (clue: no findings at all in knee)

LOW BACK PAIN

Lumbo-Sacral "Strain"

Sudden onset
Otherwise well
Young or old
Improving within few days
No focal neuro. findings

Herniated Disc*

Sudden onset
Radicular symptoms:
"Sciatic" pain or leg paraesthesia
+ Straight-leg raise (+ means induces leg pain)
Neuro finding L4 – S1

Spinal Stenosis

Older Age
Chronic pain, often into legs
"Psuedo-claudication": pain with standing or walking, relief with sitting or bending forward

Spondylolysis/
spondylithesis

Adolescent
Follows sports activity
Sometimes with radiculopathy

Renal Colic (stone)

Severe
waxing/waning pain
Pt moves about
Refers to genitalia
Urinary frequency/urgency
Gross or microscopic hematuria
+ CVA tenderness

SHOULDER PAIN

Rotator Cuff Tendinitis*

Pain sensed in deltoid area
Pain worsen with abduction (esp. at or above horizontal, "painful arc").
Impingement signs may be positive

Rotator Cuff Tear*
(other than traumatic)

Pain felt in outer arm
Over 60 years of age
Positive "dropped arm sign"
Weakness and/or pain with attempt to raise outstretched arms against resistance (esp with thumbs pointed down)

Acromioclavicular Arthritis

Pain felt at "point" of shoulder, superiorly.
Tenderness at A-C joint
Pain worsens with full aDduction

Glenohumeral  arthritis (rare!)

Pain felt in outer arm
ROM very limited, including passive

Referred:

(Includes, ie, gall bladder disease; cervical spine disease; myocardial ischemia)

Suggested by maintenance of full ROM without worsening pain, no tenderness, suitable context such as appropriate age for angina or MI

ELBOW PAIN

Lateral Epicondylitis ("Tennis Elbow")

Pain in lateral elbow area, sometimes also wrist
Pain worsens with resisted dorsiflexion of wrist
Local tenderness over lateral epicondyle

Medial Epicondylitis

Pain in medial elbow area

Pain worsens with resisted plantarflexion of wrist
Local tenderness over Medial epicondyle

Olecranon bursitis

[causes: sustained pressure (eg elbow resting on desk long time); gout; infection; RA; hemorrhage]

Exam shows:

Cystic swelling over olecranon
May be red, warm
ROM at elbow maintained

Actual arthritis of elbow joint

[causes: RA, psoriatic; note: osteoarthtitis RARE in elbow!]

Pain, tenderness, almost always limitation of ROM—pt cannot straighten arm if there is true disease in elbow joint (as opposed to olecranon bursa or tendon insertions)!

Not many other causes!

FATIGUE
(prolonged)

Depression

Low mood
Lack of interest
Early awakening
Slowness, lack of affect

Sleep Apnea

Daytime drowsiness
Snoring
Obesity
M>F; Older>younger

Chronic Fatigue Syndrome

Muscle/joint aches
Headaches
Tender nodes

Hypothyroidism*

Cold intolerance
Constipation
Hoarseness
Bradycardia
Dry, coarse skin
Slowed ankle jerk

Other Causes

Medications (esp. anti-depressants)
Anemia
Heart Failure
Lung failure
Uremia (CKD)
Malignancy  
Chronic infection (eg TB, HIV)

DIARRHEA, ACUTE
(resource-rich regions)

VIRAL (Norwalk, norovirus, others)

Most common
Watery
Vomiting may also be present
No fever or mild
Benign abdominal exam

Pre-Formed Toxin

Rapid onset (<6 hours)
Staph: custards, meats, dairy; outbreaks
Vomiting usually predominates
No fever

B. Cereus: the same, from rice, meat

Bacterial, inflammatory

Fever
May be bloody
Salmonella (eggs, poultry, almost anything); Camp. Jejuni (poultry, pets); Shigella (fecal-oral); e. coli 0157-H7

Drug-Induced

Laxatives
Some antibiotics
Caffeine
Alcohol
Many anti-cancer drugs
Lactulose (used for liver failure; osmotic agent
Colchicine (for gout)
Proton Pump In hibitors (rarely)
And many others; above list is of some common examples

Other Causes

Anxiety
Hyperthyroidism
Protozoa
Giardia

DIARHEA, Chronic (> 4 weeks) or Recurrent Diarrhea

Certain infections: eg, giardia, ameba, cryptosporidium)

Recent travel
Abdominal pain
Fat-containing malodorous stools (giardia)
Weight loss

Inflammatory Bowel Disease (Ulcerative colitis, Crohn's)

Abdominal pain
Diarrhea is often bloody
Systemic manifestations (joints, skin, fever)

Irritable bowel disorder

Abdominal Pain
Diarrhea may alternate with constipation
"Bloating"
Mucus with stool

Malabsorption
(eg pancreatic insufficiency, lactase deficiency, celiac disease*)

Large amount of stool
Fat-containing malodorous stools
Diarrhea soon after a meal
(*symptoms may be minimal and varied; considered to be underdiagnosed.)

Other Causes (there are many!)

Drugs (see list above; consider laxative overuse, which pts sometimes do not easily reveal.

Hyperthyroidism
Anxiety

SYNCOPE*
(Syncope means a sudden brief loss of consciousness with spontaneous and complete recovery, that is, person wakes up without neurologic deficit.) Note: episodes of "near-syncope" – faintness but without full loss of consciousness – probably has very similar differential.

"Neurally mediated" including "vasovagal," faint or swoon  

Long history of recurrence
Otherwise healthy with no known heart disease
After traumatic or unpleasant event, sight, smell; severe pain
After prolonged standing, esp. if hot, crowded
Sometimes associated with palor, nausea
Post-meal (elderly)

Orthostatic hypotension

Occurs upon standing
Anti-hypertensive drugs
Occurs with standing after exertion
Occurs with bleeding, volume contraction of any cause

Orthostatics show drop in BP, or increase in heart rate >30, or pt feels dizzy on standing

Heart block or dysrhythmia

Known heart disease
History of palpitations esp. just before episode
Can occur with pt supine (ie, would speak against causes to the left)

Pulse irregularity and/or
HR <50 or >100
Murmur

Aortic Stenosis

Older age
History of sob
History of chest pain

Systolic murmur

NOTE: The following can cause l.o.c. but not usually defined as true syncope (because recovery is slow, residual findings, etc.)

Seizure (witnessed movement?)
Blood loss (GI symptoms?)
Posterior circulation TIA or stroke (focal neuro findings)
Pulmonary embolism (risk factors for DVT?)

ACUTE SWELLING OF ONE LOWER LEG, usually painful

Deep vein thrombosis

Tender
May be pitting
Risk factors include: recent immobility; recent surgery, trauma or serious illness; previous known DVT; cancer.

Cellulitis

Redness and warmth > swelling
Tender
Fever
Source eg: abrasion, cut, ulcer, bad tinea pedis.

Calf muscle "pull" or tear 

Relevant history
ecchymoses

Very inflamed knee joint

Focal tenderness, heat at knee joint
History of gout (note: gout has special tendency to induce surrounding soft tissue swelling

Popliteal cyst

EDEMA, BILATERAL PITTING (ie generalized edema)

CHF
Dyspnea; orthopnea; known heart disease or indicators of it on physical exam, ecg, etc. See: CHF under shortness of breath

Cirrhosis
Predominance of ascites; sharp liver edge; jaundice; hx of alcoholism

Nephrotic Syndrome
Sudsy or frothy urine; tendency to facial edema (puffiness)

Acute or Chronic Severe Renal Disease (ie low GFR, inability to excrete salt and water even if no nephrotic syndrome)

Constrictive pericarditis.
Severe lung disease
Extreme protein malnutrition

Menstrual Bleeding, heavy (note: falls under Abnormal Uterine Bleeding)
Pts may have symptoms of anemia.

Fibroids
Pelvic pain, pressure feeling.
Urinary frequency.
Enlarged uterus

Polyps

Often inter-menstrual bleeding
Usually otherwise without clear symptoms.
Risk factors: obesity; use of tamoxifen.

Uterine Cancer

Coagulation disorder (eg, Von Willebrand)

Bleeding elsewhere (eg, bruising, gums, mucosal if from low platelets or von Willebrand);
Family History
Chronic liver disease

 

A FEW MORE SYMPTOMS, BRIEFLY

Urinary frequency, urgency:

  • UTI
  • Diabetes
  • Prostatism (BPH)
  • Stones
  • Bladder Cancer
  • Psychosomatic
  • Pregnancy

Loss of Appetite:
(There are many causes. Here we refer to more than transient in duration)

  • Cancer
  • Uremia
  • Hepatitis and other liver disorders
  • Medications (eg chemo)
  • Depression
  • Chronic infections
     

 

This site was developed by Christof Daetwyler MD of the TIME (Technology in Medical Education) group at Drexel University College of Medicine