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Is there a family history of migraine or epilepsy? Migraine and epilepsy both present with abdominal pain.
Is the pain colicky or persistent? Chronic colicky abdominal pain may be due to chronic cholecystitis, cholelithiasis, ... DIAGNOSTIC WORKUP
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Is there an associated rash? Presence of a rash, whether it is macular or vesicular, especially if it is in a dermatomal distribution, would suggest herpes zoster. Occasionally, herpes zoster occurs without a rash and should still be ... DIAGNOSTIC WORKUP
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Is there dysuria or a vaginal or urethral discharge? These findings suggest prostatitis, urethritis, cystitis, bladder calculus, bladder carcinoma, vaginitis, and abscesses of Cowper's glands.
Is there a ... DIAGNOSTIC WORKUP
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Where is the pain located? If it is diffuse, one should consider pancreatitis, mesenteric artery occlusion, or ruptured peptic ulcer. In addition, another viscus may be perforated, such as a ruptured ectopic ... DIAGNOSTIC WORKUP
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Is the pain of acute onset or gradual onset? If it is acute onset, one must consider the possibility of epidural abscess, pyelonephritis, or other abdominal conditions as the cause of the back pain. If it is gradual ... DIAGNOSTIC WORKUP
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Is it unilateral or bilateral? Unilateral breast pain should make one think of an infectious process or advanced carcinoma. Bilateral breast pain should make one think of pregnancy. This may be a normal ... DIAGNOSTIC WORKUP
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Is the chest pain acute or chronic? If it is acute, one must consider acute myocardial infarction, pulmonary embolism, pneumothorax, pericarditis, and fractures. If the chest pain is chronic, one must ... DIAGNOSTIC WORKUP
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Is the extremity pain of acute or gradual onset? Acute onset would suggest arterial embolism, deep vein thrombophlebitis, and cellulitis. If there is a history of trauma, it would suggest a fracture, sprain, or torn ligament. ... DIAGNOSTIC WORKUP
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Is there limitation of motion of the joints? Limitation of motion of a joint would suggest not only various types of arthritis, fracture, or torn ligaments, but also inflammation of surrounding structures such as the bursa or tendons. For example, ... DIAGNOSTIC WORKUP
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Is there redness of the eye? Redness of the eye suggests definite eye pathology. Without redness, one should suspect disease in the adjacent structures or retrobulbar neuritis.
If there is redness, is there periorbital edema as well? ... DIAGNOSTIC WORKUP
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Is the pain constant or intermittent? Intermittent pain would suggest trigeminal neuralgia, cluster headaches, or atypical migraine. Constant pain would suggest any local abnormalities in the structures ... DIAGNOSTIC WORKUP
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Is there associated fever? The presence of fever along with chest pain should make one think of a perinephric abscess or pyelonephritis. Occasionally, however, hypernephroma can cause fever and flank pain, as can ... DIAGNOSTIC WORKUP
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Is there fever or localized erythema? Localized erythema would suggest phlebitis, gout, osteomyelitis, cellulitis, ingrown toenail, and paronychia. The presence of fever would make one suspect osteomyelitis and cellulitis ... DIAGNOSTIC WORKUP
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Are there abnormalities on inspection of the heel? Inspection of the heel may disclose an ulcer, foreign body, cellulitis, plantar wart, and other disorders.
Is the patient a child? Children often have Sever's disease (osteochondritis of ... DIAGNOSTIC WORKUP
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Is there a positive straight-leg raising test or other neurologic signs? The presence of positive straight-leg raising tests or other neurologic signs would suggest a herniated disk, a cauda equina tumor, or other neurologic disorders of the ... DIAGNOSTIC WORKUP
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Low back pain is the second most common cause of doctor visits in the U.S. and is the most common cause of disability. Up to 90% of the population will experience back pain during their lives. Studies show that, at any given time, up to 20% of the population is... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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Chronic pain is historically undertreated and underdiagnosed. It is defined as pain that persists beyond the recognized time for the body to heal (usually 4–6 weeks). Although acute pain serves a physiologic purpose, chronic pain without a... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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Lower abdominal pain is a common complaint that must be evaluated carefully and systematically to reach the appropriate diagnosis in timely manner. All diagnoses must be considered, with the most emergent etiologies rapidly ruled out, followed by a careful... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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Upper abdominal pain is a common presenting symptom. A complete differential diagnosis should be developed based on the organs in the upper abdomen in addition to the associated history and physical examination. Gallbladder disease and... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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In evaluating an acute abdomen, rebound tenderness is one of the most important signs of peritonitis. It is elicited by pressing deeply on the abdomen and then suddenly releasing pressure, which stretches the peritoneum and causes increased abdominal pain. Guarding and rebound... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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Breast pain (or mastalgia) is a common complaint that can often be diagnosed by a careful history and physical examination. Pain and tenderness may be normal during early pregnancy and before menses. Breast discharge, however, is rarely normal except in pregnant or lactating... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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The elbow joint is formed by the radius, ulna, and distal humerus. Trauma is a common cause of injury. Injuries frequently result from falling on an outstretched hand and may be associated with nerve injuries (axillary, radial, ulnar, and/or median nerves);... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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Pain and/or tenderness on the side of the trunk from the ribs to the ileum is often associated with renal disease; however, nonrenal etiologies are very common. Of course, renal disease should be strongly suspected in the case of costovertebral angle tenderness and concurrent... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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Jaw pain is a common presenting or incidental complaint; its etiology is often identified by a careful history and physical examination. In many cases, consultation with a dentist will aid in the diagnosis and treatment. In older patients (>55), be sure to rule out... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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Primary care physicians, rheumatologists, and orthopedists frequently encounter complaints about the knee. Because the range of illnesses affecting the knee varies greatly, a thorough history and physical exam are essential. Once a differential diagnosis is compiled, plain... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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Neck stiffness may be caused by inflammation, infection, or trauma. True nuchal rigidity is characterized by the inability to actively or passively touch the chin to the chest and is due to inflammation of the brain and spinal cord. A positive Brudzinski's... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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Pelvic pain is a common primary care complaint that should be distinguished as acute (<6 months) versus chronic (>6 months), and cyclic, noncyclic, or pregnancy-related. Gynecologic, urologic, and intestinal etiologies are common, but>... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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The shoulder is a complex arrangement of the humerus held loosely in place by ten muscles acting on the scapula, clavicle, and humerus, which form three articulations (acromioclavicular, glenohumeral, and sternoclavicular). Acute injuries are generally due to trauma (e.g.,... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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The wrist is composed of eight carpal bones that are held in alignment by a series of ligaments and cartilaginous connective tissue. Wrist pain is fairly common in primary care. Although carpal tunnel syndrome is one of the most common etiologies of wrist pain, pain and... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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Ankle pain is a common problem that generally occurs secondary to acute or chronic injury or degenerative joint disease. Ankle sprains, most commonly due to traumatic inversion injury, are the most common cause of ankle pain. In cases of trauma, the Ottawa rules are used to... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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Acute scrotal pain demands immediate attention. Although not every cause constitutes an emergency, testicular torsion must be discovered immediately to save the testicle. Testicular pain should be triaged to an emergency center with access to... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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Not all ear pain is otologic; the ears have rich sensory innervation from multiple nerves, and secondary pain is common. Most otologic ear pain has some associated physical findings; if none is present, a complete head and neck examination, including imaging, may be required to... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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Abdominal pain is a frequent complaint and associated with an enormous number of causes. Many causes of acute abdominal pain require surgical intervention, so a prompt diagnosis is needed. Diagnostic clues would include the location of the pain. Traditionally, the farther away the... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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Back pain is an uncommon complaint in children, but relatively more common in adolescents. Although relatively benign causes (such as muscular strain in adolescents) account for the majority of cases, some more severe causes should not be overlooked, especially... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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Chest pain is a frequent complaint in pediatrics, especially in the adolescent age group. Although rarely cardiac in etiology, this often represents the patient's/family's greatest fear. A careful history and physical exam, with attention to the needs of the patient/family and... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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Hip pain encompasses a broad differential that relies on a focused and detailed history to determine the acute and emergent diagnoses from the less urgent hip problems. The most urgent diagnosis to make is septic arthritis, and the most challenging etiologies to manage are... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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Knee pain is a common complaint that is readily evaluated by focusing on the anatomic structures. A focused history and exam will often give the diagnosis. Because hip pain can radiate to the knee, a thorough lower extremity exam should always be performed.
... Workup and Diagnosis ... Treatment
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... Many patients presenting with pain in the foot or toes have joint disease (see pages 341 and 343 for a discussion of these differentials). Other anatomic components of the foot and toes may cause pain as well, so a consideration of the differential diagnosis of foot and toe pain
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... Anatomy is the basic science that will open the door to this differential diagnosis. Visualizing the structures in the hypogastrium, one sees the abdominal wall, the bladder and urinary tract, the female genital tract, the sigmoid colon and rectum, the iliac vessels, the
... READ EXCERPTS »
... The GI tract is the only “organ” that really covers the abdomen from one end to the other. Anything that causes an irritation of all or a large portion of this “tube” may cause generalized abdominal pain. Thus, gastritis, viral and bacterial
... READ EXCERPTS »
... Nothing is more challenging to diagnose than a case of low back pain. That is why it is so important to have an extensive list of causes in mind before approaching the patient. Anatomy forms the basis for developing such a list ( Table 45 ).
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... An anatomic breakdown of the arm into its components is the key to a sound differential diagnosis in arm pain. Pain may be referred from more proximal portions of the extremity such as the shoulder (e.g., bursitis) or brachial plexus (e.g., cervical rib), so these areas must
... READ EXCERPTS »
... Division of the breast anatomically into various components is interesting but not worthwhile in the differential diagnosis of breast pain. It is rather more instructive and practical to use VINDICATE in developing a list of causes of this symptom.
V—Vascular
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... Hardly a day goes by in a busy practitioner’s office that he or she is not confronted with a patient complaining of chest pain. The main concern, of course, is to exclude an acute myocardial infarction, which is not an easy task in many cases. The practitioner frequently admits the
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... A painful elbow really does not require a detailed analysis of the anatomy to discover the various causes, almost all of which are bursal or bone and joint disorders. Of course, the skin may be involved by trauma and infection, just like the skin of the hands (see page 453).
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... By mental dissection of the epigastrium layer by layer from the skin to the thoracolumbar spine, one encounters all the important organs that are the sites of origin of epigastric pain ( Table 11 ). Anatomy, therefore, is the basic science used to develop
... READ EXCERPTS »
... Applying the mnemonic MINT to the various anatomic parts of the eye will aid in systematically developing a list of diagnostic possibilities for eye pain.
M—Malformations most certainly suggest glaucoma and all the refractive disorders
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... Visualize the structures of the face in a systematic fashion to develop a differential diagnosis of facial pain. With the skin, herpes zoster and carbuncles come to mind. Next, the internal maxillary artery suggests histamine cephalalgia and
... READ EXCERPTS »
... Most cases of flank pain are associated with inflammation of the kidney. As is shown in Table 29 , however, jumping to that conclusion in any given case may be hazardous.
FLANK PAIN
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... The anatomic components of the groin consist of the skin, subcutaneous tissue, fascia, lymph nodes, the femoral nerve, arteries and veins, and underneath, the hip bones. With these components in mind, it should be easy to develop a differential diagnosis of groin pain because most of the
... READ EXCERPTS »
... Visualize the anatomy when a patient presents with pain in the hand or fingers ( Table 31 ). The skin may show contact dermatitis, fungal infection, furuncle, cellulitis, or traumatic lesion. An insignificant wound may be infected; if there
... READ EXCERPTS »
... When confronted with a case of hip pain in an adult, the clinician is most likely to think of fracture or joint inflammation such as osteoarthritis, realizing however that there are many other possibilities ( Table 38 ). How can the clinician think of them on the spot?
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... An unreliable indicator of cancer, breast pain commonly results from benign breast disease. It may occur during rest or movement and may be aggravated by manipulation or palpation. (Breast tenderness refers to pain elicitedby physical contact.... History and physical examination ... Medical causes ... Special considerations ... Pictures
... READ EXCERPTS »
... Abdominal pain usually results from a GI disorder, but it can be caused by a reproductive, genitourinary (GU), musculoskeletal, or vascular disorder; drug use; or ingestion of toxins. At times, such pain signals life-threatening complications. ... Emergency interventions
... READ EXCERPTS »
... Arm pain usually results from musculoskeletal disorders, but it can also stem from neurovascular or cardiovascular disorders. (See Causes of local pain.) In some cases, it may be referred pain from another area, such as the chest, neck, or abdomen. Its... History and physical examination ... Medical causes ... Special considerations ... Pictures
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... Back pain affects an estimated 80% of the population; in fact, it's the second leading reason — after the common cold — for lost time from work. Although this symptom may herald a spondylogenic disorder, it may also result from a genitourinary, GI, cardiovascular, or... Emergency interventions ... History and physical examination ... Medical causes ... Other causes ... Special considerations
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... Chest pain usually results from disorders that affect thoracic or abdominal organs — the heart, pleurae, lungs, esophagus, rib cage, gallbladder, pancreas, or stomach. An important indicator of several acute and life-threatening cardiopulmonary and GI disorders, chest pain can... Emergency interventions ... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pictures
... READ EXCERPTS »
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Eye pain may be described as a burning, throbbing, aching, or stabbing sensation in or around the eye. It may also be characterized as a foreign-body sensation. This sign varies from mild to severe; its duration and exact location provide clues to the causative disorder.
... Emergency interventions ... History and physical examination ... Pictures
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... Pain in the flank, the area extending from the ribs to the ilium, is a leading indicator of renal and upper urinary tract disease or trauma. Depending on the cause, this symptom may vary from a dull ache to severe stabbing or throbbing pain, and may be unilateral or bilateral and constant or... Emergency interventions ... History and physical examination ... Medical causes ... Special considerations ... Pediatric pointers ... Pictures
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... Jaw pain may arise from either of the two bones that hold the teeth in the jaw — the maxilla (upper jaw) and the mandible (lower jaw). Jaw pain also includes pain in the temporomandibular joint (TMJ), where the mandible meets the temporal bone.
Jaw pain... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers
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... Although leg pain commonly signifies a musculoskeletal disorder, it can also result from a more serious vascular or neurologic disorder. The pain may arise suddenly or gradually and may be localized or affect the entire leg. Constant or intermittent,... History and physical examination ... Medical causes ... Special considerations ... Pediatric pointers ... Pictures
... READ EXCERPTS »
... Neck pain may originate from any neck structure, ranging from the meninges and cervical vertebrae to its blood vessels, muscles, and lymphatic tissue. This symptom can also be referred from other areas of the body. Its location, onset, and pattern help determine the... Emergency interventions ... History and physical examination ... Medical causes ... Special considerations ... Pediatric pointers ... Pictures
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... A common symptom of anorectal disorders, rectal pain is discomfort that arises in the anorectal area. Although the anal canal is separated from the rest of the rectum by the internal sphincter, the patient may refer to all local pain as rectal pain... History and physical examination ... Medical causes ... Special considerations ... Pediatric pointers ... Geriatric pointers
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... Throat pain — commonly known as a sore throat — refers to discomfort in any part of the pharynx: the nasopharynx, the oropharynx, or the hypopharynx. This common symptom ranges from a sensation of scratchiness to severe pain. It’s commonly accompanied by ear pain... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Pictures
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... Diffuse
Gastroenteritis
Peritonitis
Pancreatitis
Leukemia
Sickle cell crisis
Early appendicitis (may be
... READ EXCERPTS »
... Abdominal Disorders
Inflammatory disorders
Peritoneum
Peritonitis (chemical or bacterial)
... READ EXCERPTS »
... Functional, mechanical causes: postural imbalance
Anteroposterior (e.g., pregnancy)
Lateral (e.g., scoliosis, unequal leg lengths)
Trauma
... READ EXCERPTS »
... Skin and subcutaneous lesions [including adiposis dolorosa, thrombophlebitis of thoracoepigastric vein (Mondor's disease)]
Breast lesions
Fibroadenosis
Chronic
... READ EXCERPTS »
... Chest Wall Disease
Bony thorax
Costochondritis (Tietze's syndrome)
Rib fracture or tumor
... READ EXCERPTS »
... Fracture
Contusion
Acromial-clavicular joint separation or injuries
Rotator cuff tendinitis or impingement syndrome
Bursitis
... READ EXCERPTS »
... The striking feature of pain disorder is a persistent complaint of pain in the absence of appropriate physical findings. The symptoms are either inconsistent with the normal anatomic distribution of the nervous system or they mimic a disease (such as angina) in the... Causes and incidence ... Signs and symptoms ... Diagnosis ... Treatment ... Special considerations ... Pictures
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... Complex regional pain syndrome (CRPS), also known as reflex sympathetic dystrophy (CRPS1) or causalgia (CRPS2), is a chronic pain disorder that results from abnormal healing after an injury — either minor or major — to a bone, muscle, or... Causes and incidence ... Signs and symptoms ... Diagnosis ... Treatment ... Special considerations
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... An unreliable indicator of cancer, breast pain commonly results from benign breast disease. It may occur during rest or movement and may be aggravated by manipulation or palpation. (Breast tenderness refers to pain elicitedby physical contact... History and physical examination ... Medical causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Patient counseling ... Pictures
... READ EXCERPTS »
... Eye pain may be described as a burning, throbbing, aching, or stabbing sensation in or around the eye. It may also be characterized as a foreign-body sensation. This sign varies from mild to severe; its duration and exact location provide clues to the causative disorder.
Eye... Emergency interventions ... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Patient counseling ... Pictures
... READ EXCERPTS »
... Abdominal pain usually results from a GI disorder, but it can also be caused by a reproductive, genitourinary (GU), musculoskeletal, or vascular disorder; drug use; or ingestion of toxins. At times, such pain signals life-threatening complications.
Abdominal pain arises from... Emergency interventions ... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Pictures
... READ EXCERPTS »
... Arm pain usually results from musculoskeletal disorders, but it can also stem from neurovascular or cardiovascular disorders. (See Causes of localized arm pain, page 74.) In some cases, arm pain may be referred from another area, such as... History and physical examination ... Medical causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Patient counseling ... Pictures
... READ EXCERPTS »
... Back pain affects an estimated 80% of the population; in fact, it’s the second leading reason—after the common cold—for lost time from work. Although this symptom may herald a spondylogenic disorder, it may also result from a... Emergency interventions ... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Patient counseling ... Pictures
... READ EXCERPTS »
... Chest pain usually results from disorders that affect thoracic or abdominal organs—the heart, pleurae, lungs, esophagus, rib cage, gallbladder, pancreas, or stomach. An important indicator of several acute and life-threatening cardiopulmonary and GI disorders, chest pain... Emergency interventions ... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Patient counseling ... Pictures
... READ EXCERPTS »
... Facial pain may result from various neurologic, vascular, or infectious disorders. The most common cause of facial pain is trigeminal neuralgia (tic douloureux). In this disorder, intense, paroxysmal facial pain may occur along the pathway of a specific... History and physical examination ... Medical causes ... Special considerations ... Pediatric pointers ... Patient counseling ... Pictures
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... Pain in the flank, the area extending from the ribs to the ilium, is a leading indicator of renal and upper urinary tract disease or trauma. Depending on the cause, this symptom may vary from a dull ache to severe stabbing or throbbing pain, and may be unilateral or bilateral and... Emergency interventions ... History and physical examination ... Medical causes ... Special considerations ... Pediatric pointers ... Pictures
... READ EXCERPTS »
... Jaw pain may arise from either of the two bones that hold the teeth in the jaw—the maxilla (upper jaw) and the mandible (lower jaw). Jaw pain also includes pain in the temporomandibular joint (TMJ), where the mandible meets the temporal bone.
Jaw pain may... Emergency Interventions ... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers
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... Although leg pain commonly signifies a musculoskeletal disorder, it can also result from a more serious vascular or neurologic disorder. The pain may arise suddenly or gradually and may be localized or affect the entire leg. Constant or intermittent, it may feel dull, burning,... Emergency Interventions ... History and physical examination ... Medical causes ... Special considerations ... Pediatric pointers ... Patient counseling ... Pictures
... READ EXCERPTS »
... Neck pain may originate from any neck structure, ranging from the meninges and cervical vertebrae to its blood vessels, muscles, and lymphatic tissue. This symptom can also be referred from other areas of the body. Its location, onset, and pattern help determine its origin and... Emergency Interventions ... History and physical examination ... Medical causes ... Special considerations ... Pediatric pointers ... Pictures
... READ EXCERPTS »
... A common symptom of anorectal disorders, rectal pain is discomfort that arises in the anorectal area. Although the anal canal is separated from the rest of the rectum by the internal sphincter, the patient may refer to all local pain as rectal pain. ... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Patient counseling
... READ EXCERPTS »
... Throat pain—commonly known as a sore throat—refers to discomfort in any part of the pharynx: the nasopharynx, the oropharynx, or the hypopharynx. This common symptom ranges from a sensation of scratchiness to severe pain. It’s commonly... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Patient counseling ... Pictures
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... George R. Wilson
Approach Most patients seen with scrotal pain are adults and have either epididymitis (1) or varicocele. However, the patient presenting with testicular torsion represents a surgical emergency requiring rapid... History ... Physical examination ... Testing ... Diagnostic assessment
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... Jim Nuovo
Atypical chest pain is defined as pain that does not have a characteristic anginal quality (heaviness or squeezing sensation), precipitating factors (e.g., exertion), or location (substernal and radiating).
Approach ... History ... Physical examination ... Testing ... Diagnostic assessment
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... Marie K. Yamamotoya
Substernal chest pain requires a rapid and accurate assessment to identify potentially life-threatening events. Substernal chest pain of cardiac origin encompasses the entire clinical spectrum from typical... Approach ... History ... Physical examination ... Testing ... Diagnostic assessment
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... Stephen Davis
Approach Low back pain is a common problem with many causes. The differential diagnosis can be grouped into three over-lapping categories: urgent (“red flag”) diagnoses, structural (musculoskeletal) problems,... History ... Physical examination ... Testing ... Diagnostic assessment ... Pictures
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... Margaret A. Tryforos
Approach Evaluation of monarticular joint pain should differentiate inflammatory from degenerative conditions and clarify whether immediate treatment is needed to prevent permanent joint damage. Distinction... History ... Physical examination ... Testing ... Diagnostic assessment ... Pictures
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... Richard W. Emerine
Abdominal pain of varying causes, ranging from the functional to the organic, is one of the top ten outpatient complaints; it is the chief complaint for 5% to 10% of patients presenting to emergency departments (1).
... History ... Physical examination ... Testing ... Diagnostic assessment
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... Alicia J. Curtin
Calf pain, a common complaint that has many causes, can pose a challenge diagnostically.
Approach Assess potential risk factors and the chronology of events. Common causes of calf pain are listed in Table 12.2. ... History ... Physical examination (PE) ... Testing ... Diagnostic assessment ... Pictures
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... Albert A. Meyer
Approach A woman has an approximate 5% chance of having chronic pelvic pain in her lifetime (1). It is defined as an episodic or continuous pain that persists for 6 months or longer, sufficiently severe to have a... History ... Physical examination ... Testing (3) ... Diagnostic assessment
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... Meredith A. Goodwin and Elise M. Coletta
Approach The evaluation of hip pathology is challenging for several reasons. Compared with other joints, the hip is relatively inaccessible to palpation and evaluation. Hip... History ... Physical examination ... Testing ... Diagnostic assessment ... Pictures
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... Charles B. Eaton
Knee pain is a very common condition, ranking number seven in the National Ambulatory Care survey. It has been suggested that 90% of knee pain in patients can be diagnosed after an appropriate history and... Approach ... History ... Physical examination ... Testing ... Diagnostic assessment ... Pictures
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... Elise M. Coletta and Meredith A. Goodwin
Approach The differential diagnosis for neck pain can be thought of by pattern of onset (Table 12.8). Disease, which can originate in the neck, can be felt there or... History ... Physical examination ... Testing ... Diagnostic assessment ... Pictures
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... Hal S. Shimazu
Pleuritic pain is the characteristic pain of inflamed pleura (i.e., pleurisy—a term often used synonymously with pleuritic pain). Pleuritic pain arises from parietal pleura and is typically sharp, stabbing, unilateral, and... Approach ... History ... Physical examination ... Testing ... Diagnostic assessment ... Pictures
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... Gowri Anandarajah
Shoulder pain is the second most frequent orthopedic complaint seen in the primary care setting (1). The joint’s complex anatomy, versatile range of motion, and central location make accurate diagnosis a challenge.
... History ... Physical examination ... Testing ... Diagnostic assessment (3,4) ... Pictures
... READ EXCERPTS »
... Differential Overview
❑ Tendinitis
❑ Bursitis
❑ Tenosynovitis
❑ Myofascial pain
❑ Radicular pain ... Diagnostic Approach ... Clinical Findings ... Pictures
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... Diagnostic Overview
Upper Extremity
❑ Median nerve
❑ Ulnar nerve
❑ Radial nerve
&... Diagnostic Approach ... Clinical Findings ... Pictures
... READ EXCERPTS »
... Differential Overview
❑ Irritable bowel syndrome
❑ Peptic ulcer disease
❑ Cholecystitis
❑ Chronic pancreatitis
❑... Diagnostic Approach ... Clinical Findings
... READ EXCERPTS »
... Differential Overview
❑ Costochondritis
❑ Pneumonia
❑ Rib fracture
❑ Pulmonary embolism
❑ Pleurisy
❑... Diagnostic Approach ... Clinical Findings ... Pictures
... READ EXCERPTS »
... Differential Overview
❑ Chest wall pain
❑ Angina
❑ Unstable angina
❑ Myocardial infarction ... Diagnostic Approach ... Clinical Findings ... Pictures
... READ EXCERPTS »
... Differential Overview
Ear Pain
❑ Acute otitis media
❑ Acute otitis externa
❑ Eustachian dysfunction
❑... Diagnostic Approach ... Clinical Findings
... READ EXCERPTS »
... Differential Overview
❑ Maxillary sinusitis
❑ Dental infection
❑ Temporomandibular joint dysfunction
❑ Myofascial masseter pain ... Diagnostic Approach ... Clinical Findings ... Pictures
... READ EXCERPTS »
... Differential Overview
❑ Musculoligamentous strain
❑ Lumbar disc herniation
❑ Osteoarthritis
❑ Compression... Diagnostic Approach ... Clinical Findings ... Pictures
... READ EXCERPTS »
... Differential Overview
Pain Predominant
❑ Epididymitis
❑ Testicular torsion
❑ Prostatitis
❑... Diagnostic Approach ... Clinical Findings
... READ EXCERPTS »
... Differential Overview
Generalized/Periumbilical
❑ Gastroenteritis
❑ Obstipation
❑ Small bowel obstruction
❑ Large... Diagnostic Approach ... Clinical Findings ... Pictures
... READ EXCERPTS »
... Differential Overview
❑ Osteoarthritis
❑ Patellofemoral pain
❑ Collateral ligament sprain
❑ Meniscal tear
❑... Diagnostic Approach ... Clinical Findings ... Pictures
... READ EXCERPTS »
... Differential Overview
Ankle Pain
❑ Ankle sprain
❑ Fibular fracture
❑ Achilles tendinitis
❑... Diagnostic Approach ... Clinical Findings ... Pictures
... READ EXCERPTS »
... Differential Overview
❑Lateral epicondylitis
❑Olecranon bursitis
❑Medial epicondylitis
❑Bicipitoradialis tendinitis
❑Cubital tunnel... Diagnostic Approach ... Clinical Findings
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... Differential Overview
❑ Conjunctivitis
❑ Corneal abrasion
❑ Foreign body
❑ Sinusitis
❑... Diagnostic Approach ... Clinical Findings
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... Differential Overview
❑ Ureteral calculus
❑ Acute pyelonephritis
❑ Latissimus strain
❑ Perinephric abscess
❑ Renal... Diagnostic Approach ... Clinical Findings
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... Complex regional pain syndrome (CRPS), also known as reflex sympathetic dystrophy (CRPS1) or causalgia (CRPS2), is a chronic pain disorder that results from abnormal healing after an injury — either minor or major — to a bone, muscle, or nerve. The... Causes ... Signs and symptoms ... Diagnostic tests ... Treatment ... Special considerations
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... Abdominal pain usually results from a GI disorder, but can also be caused by drug use, ingestion of toxins, or disorders of the reproductive, genitourinary (GU), musculoskeletal, or vascular systems. At times, such pain signals life-threatening complications. ... Assessment ... History ... Physical examination ... Pediatric pointers ... Geriatric pointers ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching ... Pictures
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... Back pain affects an estimated 80% of the population and is the second leading cause of absence from work. Although this symptom may indicate a spondylogenic disorder, it may also result from a genitourinary, GI, cardiovascular, or neoplastic disorder. Postural... Assessment ... History ... Physical examination ... Pediatric pointers ... Geriatric pointers ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching ... Pictures
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... Disorders that affect thoracic or abdominal organs — the heart, pleurae, lungs, esophagus, rib cage, gallbladder, pancreas, or stomach — are typical causes of chest pain. It can also result from a musculoskeletal or hematologic disorder, anxiety, and drug therapy.... Assessment ... History ... Physical examination ... Pediatric pointers ... Geriatric pointers ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching ... Pictures
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... Eye pain may be described as a burning, throbbing, itching, aching, or stabbing sensation in or around the eye. It may also be characterized as a foreign-body sensation. This sign varies from mild to severe; its duration and exact location provide clues to the... Assessment ... History ... Physical examination ... Pediatric pointers ... Geriatric pointers ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching ... Pictures
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... Pain in the flank, the area extending from the ribs to the ilium, is a leading indicator of renal and upper urinary tract disease or trauma. Depending on the cause, this symptom may vary from a dull ache to severe stabbing or throbbing pain, and may be unilateral or bilateral... Assessment ... History ... Physical examination ... Pediatric pointers ... Medical causes ... Nursing considerations ... Patient teaching ... Pictures
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... Jaw pain may arise from either of the two bones that hold the teeth in the jaw — the maxilla (upper jaw) and the mandible (lower jaw). Jaw pain also includes pain in the temporomandibular joint (TMJ), where the mandible meets the temporal bone.
... Assessment ... History ... Physical examination ... Pediatric pointers ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching
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... Neck pain may originate from any neck structure, ranging from the meninges and cervical vertebrae to its blood vessels, muscles, and lymphatic tissue. This symptom can also be referred from other areas of the body. Its location, onset, and pattern help determine... Assessment ... History ... Physical examination ... Pediatric pointers ... Medical causes ... Nursing considerations ... Patient teaching ... Pictures
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... Abdominal pain usually results from a GI disorder, but it can be caused by a reproductive, genitourinary (GU), musculoskeletal, or vascular disorder; drug use; or ingestion of toxins. At times, such pain signals life-threatening complications.
Abdominal... Emergency Actions ... History ... Physical assessment ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Patient counseling ... Pictures
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... Arm pain usually results from musculoskeletal disorders, but it can also stem from neurovascular or cardiovascular disorders. In some cases, it may be referred pain from another area, such as the chest, neck, or abdomen. Its location, onset, and character provide clues to its cause. The... History ... Physical assessment ... Medical causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Patient counseling ... Pictures
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... Back pain affects an estimated 80% of the U.S. population; in fact, it’s the second leading reason — after the common cold — for lost time from work. Although this symptom may herald a spondylogenic disorder, it may also... History ... Physical assessment ... Medical causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Patient counseling ... Pictures
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... An unreliable indicator of cancer, breast pain commonly results from benign breast disease. Also known as mastalgia, breast pain may occur during rest or movement and may be aggravated by manipulation or palpation. (Breast tenderness refers to pain... History ... Physical assessment ... Medical causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Patient counseling ... Pictures
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... Chest pain usually results from disorders that affect thoracic or abdominal organs — the heart, pleurae, lungs, esophagus, rib cage, gallbladder, pancreas, or stomach. An important indicator of several acute and life-threatening... History ... Physical assessment ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Patient counseling ... Pictures
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... Eye pain, or ophthalmalgia, may be described as a burning, throbbing, aching, or stabbing sensation in or around the eye. It may also be characterized as a foreign-body sensation. This sign varies from mild to severe; its duration and exact... Emergency Actions ... History ... Physical assessment ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Patient counseling ... Pictures
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... Facial pain may result from various neurologic, vascular, or infectious disorders. The most common cause of facial pain is trigeminal neuralgia (tic douloureux). Typically paroxysmal and intense, facial pain may occur along the pathway of a specific... History ... Physical assessment ... Medical causes ... Special considerations ... Pediatric pointers ... Patient counseling ... Pictures
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... Pain in the flank, the area extending from the ribs to the ilium, is a leading indicator of renal and upper urinary tract disease or trauma. Depending on the cause, this symptom may vary from a dull ache to severe stabbing or throbbing pain, and may be unilateral or bilateral and... Emergency Actions ... History ... Physical assessment ... Medical causes ... Special considerations ... Pediatric pointers ... Patient counseling ... Pictures
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... Jaw pain may arise from either of the two bones that hold the teeth in the jaw — the maxilla (upper jaw) and the mandible (lower jaw). Jaw pain also includes pain in the temporomandibular joint (TMJ), where the mandible meets the temporal bone. (See ... Emergency Actions ... History ... Physical assessment ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Patient counseling ... Pictures
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... Although leg pain commonly signifies a musculoskeletal disorder, it can also result from a more serious vascular or neurologic disorder. The pain may arise suddenly or gradually and may be localized or affect the entire leg. Constant or intermittent, it may feel dull, burning, sharp,... Emergency Actions ... History ... Physical assessment ... Medical causes ... Special considerations ... Pediatric pointers ... Patient counseling ... Pictures
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... Neck pain may originate from any neck structure, ranging from the meninges and cervical vertebrae to its blood vessels, muscles, and lymphatic tissue. This symptom can also be referred from other areas of the body. Its location, onset, and pattern help determine its... Emergency Actions ... History ... Physical assessment ... Medical causes ... Special considerations ... Pediatric pointers ... Patient counseling ... Pictures
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... A common symptom of anorectal disorders, rectal pain is discomfort that arises in the anorectal area. Although the anal canal is separated from the rest of the rectum by the internal sphincter, the patient may refer to all local pain as rectal pain.
... History ... Physical assessment ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Patient counseling ... Pictures
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... Throat pain — also known as a sore throat — refers to discomfort in any part of the pharynx: the nasopharynx, the oropharynx, or the hypopharynx. This common symptom ranges from a sensation of scratchiness to severe pain.... History ... Physical assessment ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Patient counseling ... Pictures
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... Many diseasescause abdominal pain, and clinical dilemma is to distinguish life-threateningones from those that are mild and self-limited. Best way to approach diagnosis is toconsider age of child and whether pain is acute or chronic. ... Clinical Features and Diagnosis: Acute Abdominal Pain ... Diagnostic Approach: Acute Abdominal Pain ... Principal Causes of Chronic or Recurrent Abdominal Pain ... Diagnostic Approach: Chronic or Recurrent Abdominal Pain ... References
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...Although less common in children than inadults, a specific cause can frequently be identified. Principal Causes of Back Pain Congenital Spineanomalies Developmental Scoliosis Scheuermann ... Clinical Features and Diagnosis ... Diagnostic Approach ... References
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...Although chest pain is common complaint inchildren and adolescents, serious underlying disease presentingas chest pain is uncommon in this population. Principal Causes of Chest Pain Musculoskeletaldisorders Muscle ... Clinical Features and Diagnosis ... Diagnostic Approach ... References
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... An unreliable indicator of cancer, breast pain commonly results from benign breast disease. It may occur during rest or movement and may be aggravated by manipulation or palpation. (Breast tenderness refers to pain elicited by physical contact.) Breast... History and physical examination ... Medical causes ... Nursing considerations ... Patient teaching
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... Eye pain may be described as a burning, throbbing, aching, or stabbing sensation in or around the eye. It may also be characterized as a foreign-body sensation. This sign varies from mild to severe; its duration and exact location provide clues to the... History and physical examination ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching ... Pictures
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... Abdominal pain usually results from a GI disorder, but it can be caused by a reproductive, genitourinary (GU), musculoskeletal, or vascular disorder; drug use; or ingestion of toxins. At times, such pain signals life-threatening complications. ... History and physical examination ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching ... Pictures
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... Arm pain usually results from musculoskeletal disorders, but it can also stem from neurovascular or cardiovascular disorders. (See Causes of local pain, page 52.)
In some cases, it may be referred pain from another area, such as the chest,... History and physical examination ... Medical causes ... Nursing considerations ... Patient teaching ... Pictures
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... Back pain affects an estimated 80% of the population; in fact, it's the second leading reason—after the common cold—for lost time from work. Although this symptom may herald a spondylogenic disorder, it may also result from a... History and physical examination ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching
... READ EXCERPTS »
... Chest pain usually results from disorders that affect thoracic or abdominal organs—the heart, pleurae, lungs, esophagus, rib cage, gallbladder, pancreas, or stomach. An important indicator of several acute and life-threatening cardiopulmonary and GI disorders,... History and physical examination ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching ... Pictures
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... Pain in the flank, the area extending from the ribs to the ilium, is a leading indicator of renal and upper urinary tract disease or trauma. Depending on the cause, this symptom may vary from a dull ache to severe stabbing or throbbing pain, and may be unilateral or bilateral and... History and physical examination ... Medical causes ... Nursing considerations ... Patient teaching
... READ EXCERPTS »
... Jaw pain may arise from either of the two bones that hold the teeth in the jaw—the maxilla (upper jaw) and the mandible (lower jaw). Jaw pain also includes pain in the temporomandibular joint (TMJ), where the mandible meets the temporal bone. ... History and physical examination ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching
... READ EXCERPTS »
... Although leg pain commonly signifies a musculoskeletal disorder, it can also result from a more serious vascular or neurologic disorder. The pain may arise suddenly or gradually and may be localized or affect the entire leg. Constant or intermittent, it may... History and physical examination ... Medical causes ... Nursing considerations ... Patient teaching ... Pictures
... READ EXCERPTS »
... Neck pain may originate from any neck structure, ranging from the meninges and cervical vertebrae to its blood vessels, muscles, and lymphatic tissue. This symptom can also be referred from other areas of the body. Its location, onset, and pattern help... History and physical examination ... Medical causes ... Nursing considerations ... Patient teaching ... Pictures
... READ EXCERPTS »
... A common symptom of anorectal disorders, rectal pain is discomfort that arises in the anorectal area. Although the anal canal is separated from the rest of the rectum by the internal sphincter, the patient may refer to all local pain as... History and physical examination ... Medical causes ... Nursing considerations ... Patient teaching
... READ EXCERPTS »
... Throat pain—commonly known as a sore throat—refers to discomfort in any part of the pharynx: the nasopharynx, the oropharynx, or the hypopharynx. This common symptom ranges from a sensation of scratchiness to severe pain. It's commonly... History and physical examination ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching ... Pictures
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...
Many patients presenting with pain in the foot or toes have joint
disease (see pages 284 and 286 for a discussion of these differentials). Other anatomic components
of the foot and toes may cause pain as well, so a consideration of the ... Pictures
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...
The GI tract is the only “organ” that really covers the abdomen
from one end to the other. Anything that causes an irritation of all or a
large portion of this “tube” may cause generalized abdominal pain. Thus,
gastritis,... Pictures
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...
Nothing is more challenging to diagnose than a case of low back pain.
That is why it is so important to have an extensive list of causes in mind
before approaching the patient. Anatomy forms the basis for
developing... Pictures
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...
An anatomic breakdown of the arm into its components is the key
to a sound differential diagnosis in arm pain. Pain may be referred from
more proximal portions of the extremity such as the shoulder (e.g.,
bursitis) or brachial plexus (e.g., cervical rib... Pictures
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...
Division of the breast anatomically into various components is
interesting but not worthwhile in the differential diagnosis of breast pain.
It is rather more instructive and practical to use VINDICATE in
developing a list of... Pictures
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...
Hardly a day goes by in a busy practitioner’s office that he or she is
not confronted with a patient complaining of chest pain. The main concern,
of course, is to exclude an acute myocardial infarction, which is not an ... Pictures
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...
A painful elbow really does not require a detailed analysis of the
anatomy to discover the various causes, almost all of which are bursal or
bone and joint disorders. Of course, the skin may be involved by trauma and
infection, just like... Pictures
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...
By mental dissection of the epigastrium layer by layer from the skin to
the thoracolumbar spine, one encounters all the important organs that are
the sites of origin of epigastric pain (Table 11). Anatomy,
therefore, is the... Pictures
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...
Applying the mnemonic MINT to the various anatomic parts of the
eye will aid in systematically developing a list of diagnostic possibilities
for eye pain.
M—Malformations most certainly suggest glaucoma and all the
refractive... Pictures
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...
Visualize the structures of the face in a systematic fashion to develop
a differential diagnosis of facial pain. With the skin, herpes zoster
and carbuncles come to mind. Next, the internal maxillary artery ... Pictures
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...
Most cases of flank pain are associated with inflammation of the
kidney. As is shown in Table 29, however, jumping to that
conclusion in any given case may be hazardous.
...
Pictures
...
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...
The anatomic components of the groin consist of the skin, subcutaneous
tissue, fascia, lymph nodes, the femoral nerve, arteries and veins, and
underneath, the hip bones. With these components in mind, it should be easy
to... Pictures
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...
Visualize the anatomy when a patient presents with pain in the hand or
fingers (Table 31). The skin may show contact dermatitis,
fungal infection, furuncle, cellulitis, or traumatic lesion. An
insignificant wound may be infected; if there are streaks going up... Pictures
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...
When confronted with a case of hip pain in an adult, the clinician is
most likely to think of fracture or joint inflammation such as
osteoarthritis, realizing however that there are many other possibilities
(Table 38). How can the clinician think of them... Pictures
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...
Because most joints may be affected by the same etiologic processes, a
general discussion of the differential diagnosis of joint pain will be
undertaken, followed by a discussion of exceptions that apply to certain
joints.
Anatomic... Pictures
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... Author:
David Stockwell, MD
What To Do - Make a Decision
An important responsibility of physicians who care for children is treating
pain and suffering when possible. Several studies have documented that a ... Suggested Readings
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