CHEST PAIN

CVS
IHD (angina, AMI) Vascular (dissection, thoracic aneurysm) Inflammatory (pericarditis, myocarditis)

Resp.
Infections (pneumonia, TB) PE Pleural space diseases (pneumothorax, pleural collection)

Gastro
Oesophageal (GORD, spasm, rupture) Other viscera (PUD, cholecystitis, pancreatitis)

MSK
Costochondritis (Tietzes) Fracture (ribs, sternum) Muscular pain

DYSPNOEA
CVS
AMI (sympathetic activation) APO (arrhythmia, AMI) Cardiomyopathies (IHD, HT, valvular, congenital, toxic, nutritional, infection, peripartum, infiltrative) Pericardial diseases (pericardial effusion, constrictive pericarditis) Obstructive (COPD, asthma, bronchiectasis) Restrictive (pulmonary fibrosis) Pleural space diseases (pneumothorax, pleural space collections) Infection (pneumonia, TB, fungal) Vascular (PE, vasculitides) Bronchial obstruction (malignancy, foreign body) Pulmonary HT (primary, secondary) Metabolic acidosis (DKA, lactic acidosis) Sepsis Breathing limited by pain (fractures, muscular strain, Tietzes) Chest wall deformities (kyphoscoliosis) Diaphragm (paralysis, abdominal mass/ascitic splinting) Neuromuscular (myasthenia gravis) Neurological (GBS)

Resp.

Metabolic

Musculoskeletal

Neurological

Psychogenic

PALPITATIONS
CVS
Arrhythmias (sinus, AF, atrial flutter, SVT, VT) AMI due to sympathetic activation Hypovolaemia/dehydration

Metabolic/systemic
Hypoglycaemia Sepsis Metabolic acidosis Shock

Haematological
Anaemia

Endocrine
Thyrotoxicosis

Psychogenic Miscellaneous
Large AV shunts Drugs (-agonists, -agonists, stimulants, diuretics)

COUGH
Acute
Infection
URTI (sinusitis, pharyngitis) LRTI (croup, pertussis) Pneumonia (typical, atypical)

Chronic
Infection (TB, pertussis, abscess) Obstructive
Asthma, COPD, bronchiectasis

PE CCF Drugs
ACEI

Restrictive
Pulmonary fibrosis

Malignancy Vascular
Vasculitides Chronic PE

Infiltrative (sarcoidosis) Misc.

GORD, aspiration, post-nasal drip

HAEMOPTYSIS
Airway pathology
Inflammatory (bronchitis, bronchiolitis) Malignancy Misc. (foreign body, airway trauma)

Pulmonary parenchymal pathology

Infection (TB, abscess, pneumonia, aspergilloma) Autoimmune (Goodpastures, ANCA-vasculitides) Lung contusions

Vascular pathology
PE, AVM, pulmonary venous HT

Others
Non-respiratory causes (epistaxis, haematemesis) Iatrogenic (pulmonary artery catheter, anticoagulation) Benign causes (bronchial adenomas, HHT)

SYNCOPE
Cardiopulmonary
Arrhytmias (HB, SSS, VT, VF) Aortic outflow obstruction (AS, HOCM) Massive AMI Myocardial restriction (tamponade, constrictive pericarditis) Massive PE

Vascular
Vasovagal Vertebro-basilar insufficiency

Situational syncope Postural hypotension

Autonomic dysfunction
Peripheral neuropathy Central (MS, parkinsons) Carotid sinus hypersensitivity Drugs (sympathetic blockers, dopamine agonists, L-DOPA) Dehydration, blood loss Drugs (diuretics) Apparent volume depletion (sepsis, anaphylaxis

Volume depletion

Mimickers
Neurologic (seizure, migraine) Metabolic (hypoglycaemia, hypoxia, anaemia)

HEADACHE
Haemorrhage (EDH, SDH, SAH, parenchymal) Infection (meningitis, encephalitis) Cerebral mass lesion (malignancy, abscess, parasitic) Primary (migraine, cluster, tension) Temporal arteritis Cervical pathology
Fracture, dislocation Degeneration, prolapse

Ocular problems (ill-fitting glasses) Sinusitis Intracranial HT (systemic HT, primary intracranial HT)

ACUTE DIARRHOEA
Secretory
Toxins (eg. V. cholera)

Osmotic
Lactose intolerance

Inflammatory
IBD exacerbation Infections (Shigella, C. difficile, Entamoeba, Salmonella, Campylobacter)

GIT mobility
Thyrotoxicosis, GI bleeds

CHRONIC DIARRHOEA
Chronic hepatic insufficiency Chronic pancreatic insufficiency Mucosal defects
Sprue (tropical, coeliac) Whipples disease Abetalipoproteinaemia IBD (esp. Crohns) Bile salt malabsorption

Bacterial overgrowth Gastric pathology (esp. achlorhydria)

JAUNDICE
Pre-hepatic
Congenital (Gilberts, Criggler-Najjar, Neonatal) Acquired (intravascular & extravascular haemolysis)

Hepatic
Congenital (Dubin-Johnson, Rotor) Acquired (acute liver failure, cirrhosis, fatty liver)

Post-hepatic
Obstructive
Intrahepatic (PBC, PSC) Extrahepatic (gallstones, malignancy, cholangitis, stricture)

Cholestatic (drugs, pregnancy)

HAEMATEMESIS & MELAENA

PUD Oesophageal varices Mallory-weiss tear Malignancy
Gastric Oesophageal Duodenal

Gastritis, oesophagitis (stress, drugs) Vascular malformations (angiodysplasia, GAVE, HHT, Dieulafoys, fistula) Rare causes (haemobilia, haemosuccus pancreaticus)