Deafness:

• Outer ear: Wax/ foreign body, otitis externa
• Middle ear: ASOM, CSOM, Middle ear tumor, Otosclerosis, trauma, Eustachian tube block, Minier disease
• Inner ear: Labyrinthitis
• Sensorineural: Encephalitis, acoustic neuroma, drugs, B complex deficiency, atherosclerosis, presbycusis

Dementia

• Vascular: Diffuse small vessel disease
• Degenerative: Alzheimer's disease
• Neoplastic: Secondary deposits
• Traumatic: Chronic subdural hematoma
• Toxic/ Nutritional: Alcohol, Thiamine deficiency, B12 deficiency
• Infective: HIV, post encephalitis, prion disease
• Hydrocephalus

Dysphagia

• Pharyngeal: Acute pharyngitis, Ludwig angina, tonsillitis, peritonsillar abscess, foreign body impaction, Plummer Vinson syndrome
• Esophageal: Carcinoma, esophagus, achalasiacardia, pharyngeal pouch, retropharyngeal abscess, mediastinal mass, esophagitis, esophageal webs and rings
• Muscle weakness: Myasthenia gravis, motor neuron disease, amyotrophic lateral sclerosis, polymyositis, scleroderma, rabies, tetanus, diffuse esophageal spasm, pseudobulbar palsy
• Psychological- Globuspharyngeus

Dysuria

• Acute urethritis, gonorrhea, balanitis, trauma, acute prostatitis, prostatic carcinoma, acute cystitis, bladder stone

Flatulence/ Belching

• Rapid eating, gum chewing, ingestion of carbonated beverages, smoking, physical defects that impair normal swallowing (ill-fitting dentures, nasal obstruction), bacterial fermentation of undigested carbohydrate and protein, intestinal malabsorption, bacterial overgrowth syndrome, Giardia lamblia infection

Frequency of micturition

• Cystitis, small contracted bladder, bladder calculus, bladder carcinoma, cystocele
• BPH, incompetent internal urethral sphincter
• Urethritis, balanitis
• Psychogenic
• Pregnancy, compression from surrounding structures
• Polyuria (>2000ml)
• Cold weather
• Retention with overflow

Hemiplegia

• Cerebral thrombosis/embolism, cerebral bleed, hypertensive encephalopathy, brain tumor, meningitis, congenital, head injury, cerebral abscess, multiple sclerosis, hysteria

Hirsutism

• Idiopathic, PCOD, Menopause, Drugs (Anabolic steroids, phenytoin, minoxidil, steroids), anorexia nervosa, porphyria cutanea tarda, acromegaly, Cushing syndrome, hypothyroidism, ovarian tumor

Hoarseness of voice

• Laryngeal: Laryngitis, tuberculosis, diphtheria, tumors, trauma, edema of glottis
• Recurrent laryngeal nerve damage: Peripheral neuropathy, thyroid/neck surgery, carcinoma lung, mitral stenosis (Ortner syndrome)
• Skull base tumors, vascular accidents of brain stem, myxedema, myasthenia gravis, gastroesophageal reflux, cricoarytenoid arthritis, compression of larynx from outside, hysterical

Hyperpigmentation (Localized)

• Seborrheickeratosis, acanthosisnigricans, lentigo, nevus, melanoma, freckles, Cafe au lait spots, Drugs (Sulphonamides, barbiturates, tetracyclines, antimalarials, estrogen, phenytoin)

Hyperpigmentation (Diffuse)

• Primary cutaneous disorders
• Drugs: Busulfan, amiodarone, clofazine, inorganic arsenic, chlorpromazine, minocycline
• Endocrinopathy: Addison disease, Nelson syndrome
• Metabolic: Hemochromatosis, Megaloblastic anemia, porphyriacutaneatarda, pellagra
• Autoimmune: Biliary cirrhosis, scleroderma
• Others: POEM syndrome, Pregnancy

Impotency

• Anxiety, depression, abnormal sexual inclination, marital disturbance, deformities of penis, hypogonadism, hyperthyroidism, diabetes mellitus, spinal cord deformity, chronic alcoholism, stroke, pelvic/ perineal surgery, hypertension, smoking, COPD

Increased appetite

• Bulimia nervosa, diabetes mellitus, hyperthyroidism, steatorrhea, GI fistula, pregnancy, worm infestation

Involuntary movements

• Organic neurological lesions
• Metabolic abnormalities: Hepatic failure, renal failure, respiratory failure
• Drugs: Phenothiazines, reserpine, salbutamol
• Psychogenic

Jaundice

• Indirect hyperbilirubinemia:
  • Hemolytic anemia
  • Ineffective erythropoiesis- Ex: Megaloblastic anemia
  • Hereditary: Gilbert's syndrome, Crigler-Najjar syndrome
  • Decreased hepatic intake- Prolonged fasting, sepsis
  • Acquired transferase deficiency: Breast milk jaundice, drug inhibition (Ex: Chloramphenicol)
• Direct Hyperbilirubinemia:
  • Hepatic: Viral hepatitis, alcoholic liver disease, Wilson's disease, autoimmune hepatitis, cirrhosis of liver, Leptospirosis
  • Intrahepaticcholestasis: Primary sclerosingcholangitis, cholestasis of pregnancy, drug induced (paracetamol, OCPs, androgens, chlorpromazine), sepsis, Toxins (wild mushrooms, Jamaica bush tea), Congenital (Dubin Johnson/ Rotor syndrome)
  • Post hepatic: Obstructive jaundice

Joint Pain

• Acute suppurative arthritis, tuberculosis of joint, rheumatoid arthritis, rheumatic fever, Rieter disease, Gout, psoriatic arthritis, trauma, Osteoarthritis, hemophilic joints, loose bodies, brucellosis, hemochromatosis, sickle cell disease, autoimmune disorders, acute leukemia

Oliguria (<500ml urine/day)

• Rule out urinary retention by palpating for distended bladder and by passing Foley's catheter
• Physiological: Decreased fluid intake, loss of fluid by excess sweating
• Prerenal: CCF, Cirrhosis of liver, shock, dehydration
• Renal: Acute glomerulonephritis, acute tubular necrosis, renal cortical necrosis, renal vein thrombosis, HUS, TTP, DIC, hepatorenal syndrome, rhabdomyolysis
• Post renal: calculi, tumors

Oral ulcers

• Apthous ulcer, candidiasis, vincent's angina, herpes simplex, Crohn's disease, Celiac sprue, dermatological disorders, drugs, SLE, Behcet's disease, carcinoma of oral cavity

Palpitations

• Aortic regurgitation, mitral regurgitation, ASD, VSD, psychogenic (anxiety/depression), thyrotoxicosis, anemia, beriberi, fever, cor pulmonale, pheochromocytoma, drugs (sympathomimetics, nifedipine, salbutamol, coffee, tobacco, atropine), arrythmia, hypoglycemia

Paraplegia

• Injury to motor cortex, superior sinus thrombosis, cerebral malaria, parasagittal neoplasm. congenital hydrocephalus, multiple sclerosis. thrombosis of anterior cerebral artery, injury to spine, tumor of spine, Pott's disease, severe kyphoscoliosis, spondylosis, epidural abscess, Friedrich's ataxia, amyotrophic lateral sclerosis, lathyrism, Vitamin B12 deficiency, Diphtheric polyneuritis, Guillain Barre syndrome, muscular dystrophy, hysteria

Penile Sore

• Balanitis, herpes genitalis, syphilis, lymphogranuloma inguinale, soft chancre, tubercular ulceration, injury, carcinoma penis

Post-menopausal bleeding

• Carcinoma (vagina, vulva, cervix, endometrium), sarcoma of uterus, granulosa cell tumor of ovary, dysfunctional uterine bleeding, senile endometriosis, tubercular endometritis, cervical erosion, senile vaginitis, decubitus ulcer, retained foreign body, withdrawal of estrogen therapy, urethral carbuncle/ polyp, blood dyscrasias

Priapism

• Idiopathic, Sickle cell anemia, leukemia, spinal cord injury, drugs (anticoagulants, haloperidol, nefedipine, phenothiazines, prazocin), malaria, cocaine use

Pruritus

• Scabies, louse, dermatitis, lichen planus, prickly heat, urticaria, dermatitis herpetiformis, cutaneous T cell lymphoma, onchocerciasis, psoriasis, dry skin, senile pruritus, obstructive jaundice, azotemia, hyperparathyroidism, polycythemia, iron deficiency anemia, B symptom of lymphoma, drugs (morphine), psychiatric, simple uncleanliness, papular urticaria of pregnancy, HIV

Retention of urine

• Urethral stricture or calculus, prostatic congestion or inflammation, prolapse of uterus or fibroid, bladder atony due to over distention, post operative, after spinal anesthesia, spinal cord lesion, psychogenic, exposure to cold, anticholinergics

Stridor

• Congenital, foreign body, acute laryngitis, angioneurotic edema, laryngeal diphtheria, bilateral laryngeal paralysis, severe tracheal obstruction, cysts and tumors, tetany

Syncope:

• Vasovagal syncope (fear, pain, emotional stress,  injury), postural hypotension, carotid sinus syndrome, arrythmias, aortic stenosis, pulmonary stenosis, pulmonary embolism, , cardiac tamponade, constrictive pericarditis, hypertrophic obstructive cardiomyopathy, cyanotic congenital heart disease, IHD, atherosclerosis of vertebral artery, cervical spondylosis, migraine, trauma to head, acute blood loss, psychogenic, situational syncope, hyperventilation, hypoxia, anemia, hypoglycemia, hypovolemia, cough syncope, micturition syncope

Tinnitus

• Impacted wax, ASOM, CSOM, Menier's disease, otosclerosis, ototoxic drugs, acoustic neuroma, anemia, hypertension, hypotension, hypoglycemia, epilepsy, migraine, hyperthyroidism, noise induced hearing loss

Tremors

• Nervousness, essential tremors, alcohol induced tremors, alcohol withdrawal, thyrotoxicosis, drug induced (Salbutamol, imipramine, reserpine), hysterical, senile, parkinsonism

Ulcer (Skin)

• Mechanical trauma, burns, chemical injury, venous ulcer, arterial ulcer, trophic ulcer (neuropathy), tropical ulcer, diabetic ulcer, tubercular ulcer, lupus vulgaris, squamous cell carcinoma, basal cell carcinoma

Vaginal discharge

• Vaginitis, cervicitis, PID, Ca vulva, ca vagina, Ca cervix, ca endometrium, foreign body, leucorrhea, cervical erosions, uterine prolapse, acquired retroversion, pill use, vaginal adenosis

Vertigo

• Labyrinthitis, Menier disease, BPPV, vestibular neuronitis, vestibulotoxic drugs (gentamicin, anticonvulsants, quinine), head trauma, perilymph fistula, superior canal dehiscence syndrome, acoustic neuroma, vertebrobasilar insufficiency, posterio-inferior cerebellar artery aneurysm, basilar migraine, cerebellar diseases, multiple sclerosis, tumors of brain stem and 4th ventricle, epilepsy, cervical vertigo, Parkinson's disease, ocular muscle paralysis, travelling sickness, standing at un-accustomed heights, anxiety neurosis, hysteria, alcohol

Weight loss

• Anorexia nervosa, malignancy, hyperthyroidism, diabetes mellitus, pheochromocytoma, adrenal insufficiency, malabsorption syndrome, chronic CCF, COPD, chronic renal failure, HIV, tuberculosis and other chronic infections, parasitic infections, autoimmune disorders, drugs, dementia, depression, alcoholism, chronic colitis, peptic ulcer