BIOSOFT HELP FILES

See also under overweight and obesity

1)      Hypothyroidism

1)      Perception of weight loss – no objective weight loss but patient complains of weight loss when the patient feels having an appearance of haggard and wasted look, others say the person has lost weight and looks wasted, clinically significant weight loss is 2-pound loss in 1 month OR 5-10 pound loss in 6 months.

2)      Inadequate nutrition – risk factors – age, poverty, functional disability, drugs, number of meals, types of foods, portion size, taste of food, likes or dislikes of foods,

3)      Somatic depression syndrome

4)      Somatic anxiety syndrome

5)      Acute infections – acute gastroenteritis, UTI,

6)      Persistent vomiting – hiatus hernia, peptic ulcer disease, GERD

7)      Persistent diarrhea – malabsorption,

8)      Polyuria -

9)      Chronic infections – UTI, malaria,

10)    Chronic diseases – asthma, diabetes

11)    Rumination Syndrome –

1)      Unexplained persistent (that is more than 3 weeks) weight  loss (CXR to exclude lung Ca, UGIE to exclude upper GIT Ca)

2)      Weight loss in the elderly male (DRE and a PSA to exclude prostate Ca)

3)      Presence of terminal illness

4)      Presence of an active pressure ulcer

5)      Presence of nausea, vomiting, diarrhea

6)      Presence of fluid retention/edema

7)      Presence of underlying infection

8)      Losing weight despite excellent appetite and normal intake – inadequate caloric intake for the height and weight and activity level, unrecognized caloric expenditure for repetitive activity like wandering, movement disorders, large pressure ulcers, chronic underlying infections

(NCC-PC Referral Guidelines for Suspected Cancer  in Adults and Children)

(Illingworth 1983)

1)      Asthma

2)      Cow’s milk protein allergy

3)      Dye allergies – tartrazine

4)      Bronchiolitis

5)      Foreign body

6)      Recurrent viral croup

1)      Life-threatening attacks of asthma

2)      Treatment-resistant asthma

3)      Family history of TB

4)      Contact history of TB

1)      Carpal tunnel syndrome – repetitive occupational injury pattern indicating wrist trauma, hypothyroidism, pregnancy, diabetes,

2)      De Quervains’s tenosynovitis – point tenderness at the distal radial styloid, positive Finkelstein’s test,

3)      De Quervains’s tenosynovitis – RSI variant – pinching or grasping while the wrist is involved in radial and ulnar deviation movements,

4)      Cervical referred pain from cervical radiculopathy, thoracic outlet syndrome

5)      Radioulnar joint instability – pain at wrist, point tenderness over the radioulnar joint, grind test positive (while rotating the forearm compress distal ends of radius and ulnar at the joint),

6)      Arthritis – rheumatoid arthritis, and viral polyarthritis may initially affect wrist joint

7)      Ulnar nerve entrapment at Guyon’s canal – pain, paresthesiae, numbness in the lateral aspects of the ring and little fingers of the hand and weakness of the little finger, point tenderness at the Guyon’s tunnel, Tinel’s positive at the same site, sensory loss and weakness of abduction of the little finger of the hand,

8)      Hypothenar Hammer Syndrome – repeated trauma to the superficial palmar arch, blanching, pins and needles, coldness, pain, especially on exposure to cold, Allen’s test positive – clench the fist to blanch the palmar skin.  Occlude the radial artery at the wrist manually and then unclench the fist.  If the blood return is slower than normal the test is positive.

9)      Myofascial pain syndrome - palmar aspect of the wrist in opponents pollicis MFPS, palmar aspect pain spreading up and down in flexor carpi radialis and ulnaris palmar aspect pain spreading to forearm and to hypothenar eminence in pronator teres MFPS, anterior and posterior aspects of wrist pain starting from posterior chest wall scapular area spreading to the anterior shoulder, posteromedial aspect of arm in subscapularis MFPS.  See notes under myofascial pain syndrome for diagnostic criteria and treatment.

1)      Trauma and point tenderness at carpal bones (occult fractures identified by MRI, CT, or bone scan)

2)      Trauma and tenderness at anatomic snuff box (scaphoid fracture)

3)      Remote history of trauma and anatomic snuffbox tenderness OR point tenderness at hypothenar eminence just distal to the flexion crease of the wrist (nonunion of scaphoid or hook of hamate)

4)      Repetitive trauma and point tenderness at anatomic snuffbox OR at a point just proximal to the flexion crease of the wrist and distal to the ulna (avascular necrosis of scaphoid – Preiser’s disease or lunate – Kienbock’s disease)

5)      Ulnar wrist pain, pain out of proportion to the injury, weakness after a fall on outstretched hand, point tenderness at the hollow between the pisiform and the ulnar styloid, McMurray test positive (Put the hand into ulnar deviation, and make triquetrum slide over the head of the ulna by moving triquetrum up and down, which causes a pain or crepitus or click), supination lift test positive (ask the patient to keep hand flat palm down on the table and stand, pain weakness is a positive test),   (triangular fibrocartilage complex injury, MRI diagnostic)

6)      Trauma and wrist pain and instability with radioulnar grind test (compress and rotate the distal radioulnar joint, Xray widened distal radioulnar joint space)

7)      Trauma, wrist pain, point tenderness at the mid carpal region, painful and audible click with ulcer deviation (Carpal instability)

8)      Trauma, point tenderness at the scapholunate interval (Scapholunate dissociation)

9)      Acute injury to the wrist, excessive extension, ulnar or radial deviation, axial loading causes clicks, lunotriquetral shear test positive (Pronate the hand palm downwards, apply downward force over triquetrum just beyond the ulnar styloid, while exerting a palmar force upwards over lunate at the distal palmar crease),

10)    Fever, recent infection elsewhere, ill-looking, severe wrist pain, virtually immobilized wrist joint (acute septic arthritis)

(Forman et.al. 2005)