Facial Pain

• Infection, abscess

• Postherpetic neuralgia

• Trauma, post-traumatic neuralgia

• Tic douloureux

• Cluster headache, “lower-half” headache

• Geniculate neuralgia

• Anxiety, somatization syndrome

• Glossopharyngeal neuralgia

• Carotidynia

Facial Paralysis ²⁹

INFECTION

• Bacterial: otitis media, mastoiditis, meningitis, Lyme disease

• Viral: herpes zoster, mononucleosis, varicella, rubella, mumps, Bell’s palsy

• Mycobacterial: TB, meningitis, leprosy

• Miscellaneous: syphilis, malaria

TRAUMA

• Temporal bone fracture, facial laceration

• Surgery

NEOPLASM

• Malignant: squamous cell carcinoma, basal cell and adenocystic tumors, leukemia, parotid neoplasms, metastatic tumors

• Benign: facial nerve neuroma, vestibular schwannoma, congenital cholesteatoma

IMMUNOLOGIC

• Guillain-Barré syndrome, periarteritis nodosa

• Reaction to tetanus antiserum

METABOLIC

• Pregnancy

• Hypothyroidism

• Diabetes mellitus (DM)

Factitious Disorder (Including Munchausen’s Syndrome)

• Malingering: falsifying an illness for a clear secondary gain (e.g., financial gain or avoidance of unwanted duties)

• Somatoform disorders or hypochondriasis: these disorders are produced unconsciously and are not intentionally produced.

• Self-injurious behavior is common in many other psychiatric conditions; in those conditions, the patients confess the intentional self-harm and describe motivating factors. The main intent is the self-harm and not to attain the patient role, as occurs in factitious disorder.

• Munchausen by proxy: a mother (86% of time) or other caregiver induces illness in a child (52% between the ages of 3 and 13 years) for the purpose of obtaining medical attention or some other psychological need. Mothers often have a history of somatoform, factitious, or personality disorder themselves.

Failure to Thrive

MALABSORPTION

• Cow’s milk protein allergy

• Cystic fibrosis (CF)

• Celiac disease

• Biliary atresia

INSUFFICIENT CALORIE INTAKE

• Parental neglect

• Feeding difficulties (CNS lesion, severe reflux, oromotor abnormalities)

• Use of diluted formula preparation

• Food shortage (poverty)

INCREASED NEEDS

• Hyperthyroidism

• Congenital heart defects

• Malignant disease

• Renal or hepatic disease

• HIV infection

IMPROPER UTILIZATION

• Storage disorders

• Amino acid disorders

• Trisomy 13, 21, 18

Fatigue

• Depression

• Anxiety, emotional stress

• Inadequate sleep

• Prolonged physical activity

• Pregnancy and postpartum period

• Anemia

• Hypothyroidism

• Medications (β-blockers, anxiolytics, antidepressants, sedating antihistamines, clonidine, methyldopa)

• Viral or bacterial infections

• Sleep apnea syndrome

• Dieting

• Renal failure, congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), liver disease

Fatty Liver

• Obesity

• Alcohol abuse

• Diabetes mellitus (DM)

• Acute fatty liver of pregnancy

• Medications (e.g., tetracycline, amiodarone, estrogen, methotrexate)

• Nonalcoholic steatosis

• Reye’s syndrome

• Wilson’s disease

Fatty Liver of Pregnancy

• Acute gastroenteritis

• Preeclampsia or eclampsia with liver involvement

• Hemolysis, elevated liver enzyme levels, and low platelet count (HELLP) syndrome

• Acute viral hepatitis

• Fulminant hepatitis

• Drug-induced hepatitis caused by halothane, phenytoin, methyldopa, isoniazid, hydrochlorothiazide, or tetracycline

• Intrahepatic cholestasis of pregnancy

• Gallbladder disease

• Reye’s syndrome

• Hemolytic-uremic syndrome (HUS)

• Budd-Chiari syndrome

• Systemic lupus erythematosus (SLE)

Felty’s Syndrome

• Drug reaction

• Myeloproliferative disorders

• Lymphoma/reticuloendothelial malignant neoplasms

• Hepatic cirrhosis with portal hypertension

Femoral Neck Fracture

• Osteoarthritis of hip

• Pathologic fracture

• Lumbar disk syndrome with radicular pain

• Insufficiency fracture of pelvis

Fetal Alcohol Syndrome

• Other causes of symmetric growth retardation including intrauterine infection and aneuploidy

• Aneuploidy (T21, T18, T13)

• Syndromes with overlapping features of FAS

• Fetal anticonvulsant syndrome

• Maternal phenylketonuria

• Toluene embryopathy

• Velocardiofacial syndrome

• Williams syndrome

• Dubowitz syndrome

• Cornelia de Lange syndrome

Fever and Jaundice

• Cholecystitis

• Hepatic abscess (pyogenic, amebic)

• Ascending cholangitis

• Pancreatitis

• Malaria

• Neoplasm (hepatic, pancreatic, biliary tract, metastatic)

• HIV infection (Cryptosporidium)

• Biliary ascariasis

• Toxic shock syndrome

• Yersinia infection, leptospirosis, yellow fever, dengue fever, relapsing fever

Fever and Rash

• Drug hypersensitivity: penicillin, sulfonamides, thiazides, anticonvulsants, allopurinol

• Viral infection: measles, rubella, varicella, erythema infectiosum, roseola, enterovirus infection, viral hepatitis, infectious mononucleosis, acute HIV infection

• Other infections: meningococcemia, staphylococcemia, scarlet fever, typhoid fever, Pseudomonas bacteremia, Rocky Mountain spotted fever, Lyme disease, secondary syphilis, bacterial endocarditis, babesiosis, brucellosis, listeriosis

• Serum sickness

• Erythema multiforme

• Erythema marginatum

• Erythema nodosum

• Systemic lupus erythematosus (SLE)

• Dermatomyositis

• Allergic vasculitis

• Pityriasis rosea

• Herpes zoster

Fever in Returning Travelers and Immigrants ²⁹

Differential diagnosis of some selected systemic febrile illnesses to consider in returned travelers and immigrants ^*

COMMON

• Acute respiratory tract infection (worldwide)

• Gastroenteritis (worldwide) [food-borne, water-borne, fecal-oral]

• Enteric fever, including typhoid (worldwide) [food, water]

• Urinary tract infection (worldwide) [sexual contact]

• Drug reactions [antibiotics, prophylactic agents, other] {rash frequent}

• Malaria (tropics, limited areas of temperate zones) [mosquitoes]

• Arboviruses (Africa, tropics) [mosquitoes, ticks, mites]

• Dengue (Asia, Caribbean, Africa) [mosquitoes]

• Viral hepatitis (worldwide)

• Hepatitis A (worldwide) [food, fecal-oral]

• Hepatitis B (worldwide, especially Asia, sub-Saharan Africa) [sexual contact] {long incubation period}

• Hepatitis C (worldwide) [blood or sexual contact]

• Hepatitis E (Asia, North Africa, Mexico, others) [food, water]

• TB (worldwide) [airborne, milk] {long period to symptomatic infection}

• STDs (worldwide) [sexual contact]

RARE

• Relapsing fever (western Americas, Asia, northern Africa) [ticks, lice]

• Hemorrhagic fevers (worldwide) [arthropod and nonarthropod transmitted]

• Yellow fever (tropics) [mosquitoes] {hepatitis}

• Hemorrhagic fever with renal syndrome (Europe, Asia, North America) [rodent urine] {renal impairment}

• Hantavirus pulmonary syndrome (western North America, others) [rodent urine] {respiratory distress syndrome}

• Lassa fever (Africa) [rodent excreta, person to person] {high mortality rate}

• Other: chikungunya, Rift Valley, Ebola-Marburg, others (various) [insect bites, rodent excreta, aerosols, person to person] {often severe}

• Rickettsial infections {rashes and eschars}

• Leishmaniasis, visceral (Middle East, Mediterranean, Africa, Asia, South America) [biting flies] {long incubation period}

• Acute schistosomiasis (Africa, Asia, South America, Caribbean) [fresh water]

• Chagas’ disease (South and Central America) [reduviid bug bites] {often asymptomatic}

• African trypanosomiasis (Africa) [tsetse fly bite] {neurologic syndromes, sleeping sickness}

• Bartonellosis (South America) [sandfly bite; cb] {skin nodules}

• HIV infection/AIDS (worldwide) [sexual and blood contact]

• Trichinosis (worldwide) [undercooked meat] {eosinophilia}

• Plague (temperate and tropical plains) [animal exposures and fleas]

• Tularemia (worldwide) [animal contact, fleas, aerosols] {ulcers, lymph nodes}

• Anthrax (worldwide) [animal, animal product contact] {ulcers}

• Lyme disease (North America, Europe) [tick bites] {arthritis, meningitis, cardiac abnormalities}

Fever of Undetermined Origin (FUO), Possible Causes

The most common causes are italicized.

• Malignant neoplasia (7%)

• Lymphoma and leukemia, renal cell carcinoma, hepatocellular carcinomas, other tumors metastatic to liver

• Noninfectious inflammatory disease (22%)

• Juvenile rheumatoid arthritis (younger patients)

• Temporal arteritis (elderly patients)

• Other vasculitis: polyarteritis nodosa, Takayasu’s arteritis, Wegener’s granulomatosis, mixed cryoglobulinemia, adult Still’s disease

• Other (4%)

• Drug-induced fever

• Inflammatory bowel disease

• Sarcoidosis

• Granulomatous hepatitis

• Deep venous thrombosis

• Alcoholic hepatitis

Fibrocystic Breast Disease

• If presenting as dominant mass or masses, exclude possible carcinoma

• Breast abscess

• If presenting with nipple discharge, differentiate from discharge of possible malignant origin

• Mastitis

• Mastodynia

Fibromyalgia

• Polymyalgia rheumatica

• Referred discogenic spine pain

• Rheumatoid arthritis (RA)

• Localized tendinitis

• Connective tissue disease

• Osteoarthritis

• Thyroid disease

• Spondyloarthropathies

Fifth Disease

• Juvenile rheumatoid arthritis (JRA) (Still’s disease)

• Rubella, measles (rubeola), and other childhood viral exanthems

• Mononucleosis

• Lyme disease

• Acute HIV infection

• Drug eruption

Filariasis

• Chronic lymphedema

• Milroy’s disease

• Postoperative scarring

• Lymphedema of malignant disease

Finger Lesions, Inflammatory

• Paronychia

• Herpes simplex type 1 (herpetic whitlow)

• Dyshidrotic eczema (pompholyx)

• Herpes zoster

• Bacterial endocarditis (Osler’s nodes)

• Psoriatic arthritis

Flank Pain

• Renal vein thrombosis

• Renal infarction

• Abdominal aortic aneurysm (AAA)

Flatulence and Bloating ³⁴

• Ingestion of nonabsorbable carbohydrates

• Ingestion of carbonated beverages

• Malabsorption: pancreatic insufficiency, biliary disease, celiac disease, bacterial overgrowth in small intestine

• Lactase deficiency

• Irritable bowel syndrome (IBS)

• Anxiety disorders

• Food poisoning, giardiasis

Flushing ²⁸

• Physiologic flushing: menopause, ingestion of monosodium glutamate (Chinese restaurant syndrome), ingestion of hot drinks

• Drugs: alcohol (with or without disulfiram, metronidazole, or chlorpropamide), nicotinic acid, diltiazem, nifedipine, levodopa, bromocriptine, vancomycin, amyl nitrate

• Neoplastic disorders: carcinoid syndrome, VIPoma syndrome, medullary carcinoma of thyroid, systemic mastocytosis, basophilic chronic myelocytic leukemia, renal cell carcinoma

• Anxiety

• Agnogenic flushing

Folate Deficiency ²¹

FOLATE MALABSORPTION

• With normal intestinal mucosa

• Some drugs (controversial)

• Congenital folate malabsorption (rare)

• With mucosal abnormalities (e.g., tropical and nontropical sprue, regional enteritis)

DEFECTIVE CELLULAR FOLATE UPTAKE

• Familial aplastic anemia (rare)

• Acute cerebral folate deficiency

INADEQUATE CELLULAR USE

• Folate antagonists (e.g., methotrexate)

• Hereditary enzyme deficiencies involving folate

DRUGS

• Multiple effects on folate metabolism (e.g., alcohol, sulfasalazine, triamterene, pyrimethamine, trimethoprim-sulfamethoxazole, diphenylhydantoin, barbiturates)

ACUTE FOLATE DEFICIENCY

• Intensive care unit setting

• Uncertain origin

Folliculitis

• Pseudofolliculitis barbae (ingrown hairs)

• Acne vulgaris

• Dermatophyte fungal infections

• Keratosis pilaris

• Cutaneous candidiasis

• Superficial fungal infections

• Miliaria

Food Poisoning, Bacterial

• Viral gastroenteritis (Norwalk or rotavirus)

• Parasitic gastroenteritis (Entamoeba histolytica, Giardia lamblia)

• Toxins (ciguatoxins, mushrooms, heavy metals)

Foot Dermatitis

• Tinea pedis

• Dyshidrotic eczema

• Tylosis (mechanically induced hyperkeratosis, fissuring, and dryness)

• Allergic contact dermatitis

• Psoriasis

• Peripheral vascular insufficiency

• Neuropathic foot ulcers (DM, poorly fitting shoes)

• Acquired plantar keratoderma

• Sézary’s syndrome

Footdrop

• Peripheral neuropathy

• L5 radiculopathy

• Peroneal nerve compression

• Sciatic nerve palsy

• Scapuloperoneal syndromes

• Spasticity

• Myopathy

• Dystonia

Foot Lesion, Ulcerating

• Cellulitis

• Plantar wart

• Squamous cell carcinoma

• Actinomycosis (Madura foot)

• Plantar fibromatosis

• Pseudoepitheliomatous hyperplasia

Foot Pain

• Trauma (fractures, musculoskeletal and ligamentous strain)

• Inflammation (plantar fasciitis, Achilles tendinitis or bursitis, calcaneal apophysitis)

• Arterial insufficiency, Raynaud’s phenomenon, thromboangiitis obliterans

• Gout, pseudogout

• Calcaneal spur

• Infection (cellulitis, abscess, lymphangitis, gangrene)

• Decubitus ulcer

• Paronychia, ingrown toenail

• Thrombophlebitis, postphlebitic syndrome

Forearm and Hand Pain

• Epicondylitis

• Tenosynovitis

• Osteoarthritis

• Cubital tunnel syndrome

• Carpal tunnel syndrome

• Trauma

• Herpes zoster

• Peripheral vascular insufficiency

• Infection (cellulitis, abscess)

Friedreich’s Ataxia

• Charcot-Marie-Tooth disease type (in early cases)

• Abetalipoproteinemia (Bassen-Kornzweig syndrome)

• Severe vitamin E deficiency with malabsorption

• Early-onset cerebellar ataxia with retained reflexes

• Autosomal dominant cerebellar ataxia (spinocerebellar ataxia)

Frostbite

• Other induced cold injuries including:

• Frostnip: transient tingling and numbness without associated permanent tissue damage

• Pernio (chilblains): a self-limited, cold-induced vasculitis of dermal vessels associated with purple plaques or nodules, often affecting dorsum of hands and feet and seen with prolonged cold exposure to above-freezing temperatures

• Cold immersion (trench) foot: caused by ischemic injury resulting from sustained severe vasoconstriction in appendages exposed to wet cold at temperatures above freezing

Frozen Shoulder

• Secondary causes of shoulder stiffness (prolonged immobilization after trauma or surgery)

• Posterior shoulder dislocation

• Ruptured rotator cuff

• Glenohumeral osteoarthritis

• Rotator cuff inflammation

• Superior sulcus tumor

• Cervical disk disease

• Brachial neuritis

Furuncle

• Folliculitis

• Pseudofolliculitis

• Foreign body reaction

• Acne

• Hidradenitis suppurativa

• Epidermoid cyst

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