Diagnosis

DIAGNOSIS: Computer-Assisted Diagnosis Version 3.0

"Satus est initius mederi quam fini." (It is better to doctor at the beginning than at the end.) Erasmus

Dear Doctor:

Simply click on one or more symptoms, signs, and/or abnormal test results, and instantly get the most likely diagnoses listed in scored, decreasing probabilities.

This program helps you to remember the causes for various symptoms, signs, and test results. Furthermore, it recalls the diagnoses in their approximate order of occurrence.

Such a diagnosis list has obvious advantages. It reminds you of the more likely diagnosis(es), adds direction and focus to your patient evaluation, intuitively suggests treatments that should be started soon, and helps you to order only appropriate tests and appropriate procedures.

The algorithm is simple. A patient reports having a symptom such as nausea. The diagnosis program will be asked to list the causes for nausea in a decreasing order of prevalence. Here is the list (user has requested the top 40 possibilities):

Top 40 statistically most likely DXs, listed in descending probability (SCORE) are:

RANK    DIAGNOSIS                     SCORE
1   NAUSEA                                          100
2   WT. LOSS & ANOREXIA               95
3   ANOREXIA                                        95
4   GASTROENTERITIS                      90
5   GASTRITIS                                       90
6   ESOPHAGITIS                                 90
7   HYPERCHLORHYDRIA                  80
8   COMMON COLD                             70
9   INFLUENZA                                    70
10 GI/ABD IMAGING DEFEC             50
11 CHRONIC ILLNESS                       50
12 DIABETES MELLITUS                  20
13 MED/DRUG REACTION                20
14 DIABETIC KETOSIS                      20
15 INFECTION                                    15
16 BILIARY DISEASE                       10
17 PEPTIC DISEASE                       10
18 FOOD POISONING                       10
19 PARALYTIC ILEUS                       5
20 CONSTIPATION                           5
21 APPENDICITIS                             5
22 GASTROINTEST OBSTRUC      5
23 PSYCHIATRIC                               5
24 GASTRIC DILATATION                4
25 FEVER                                            4
26 HIATAL HERNIA                           4
27 MALIGNANCY                             4
28 FRIGHT                                         3
29 HYPOTHAL-PITUIT.DIS.             3
30 EXCESSIVE SMOKING               3
31 MIGRAINE                                      3
32 HI INTRACRAN PRESSUR        3
33 UREMIA/NEPHRITIS                    3
34 ANY ACUTE ILLNESS                 3
35 DIZZY/VERTIGO                           3
36 PYLORIC OBSTRUCTION          3
37 ALLERGY                                       3
38 PREGNANCY                                3
39 DUMPING SYNDROME              3
40 PANCREATITIS                            3
    172 Diagnoses considered/ 40 Requested/ 40 Listed.

Of 100 cases having nausea, the more likely causes have the higher scores, and the less likely causes have the lower scores. The clinician is more apt to be right if he considers the higher-scored diagnoses. But, if the diagnosis remains elusive, the clinician should: (1) review the higher-scored possibilities; and (2) consider additional lower-scored possibilities.

Some skeptics have said, “But you give a list of possibilities; I want the one correct diagnosis”! Those people are unrealistic. There is no way for a computer to consistently pick one correct DX. Other skeptics have said, “But you don’t know the real incidence of the diagnostic possibilities, and therefore your statistics are fallible.” I agree, I don’t know and NOBODY ELSE KNOWS. The incidence will vary depending on the type of practice, the geographical location, the season, and a myriad of other variables. That is why one can only (and should only) use approximations. My statistics are approximations. They are based on many years of study and experience plus thousands of opinions and publications by innumerable experts in the medical/surgical field. The doctor merely needs to know the approximate frequency so he can fine-tune the work-up. Other means will then be used to rule in- or rule out a specific disease.

DIAGNOSIS is extensive. This program includes the diagnoses to consider for hundreds of the more important symptoms, signs, and test results (SSTs), for example weakness, vomiting, depression, chest pain, hyponatremia, etc.; and more than 1440 diagnoses. However, in contrast to other programs, DIAGNOSIS does not confound the user with laborious and time-consuming multiple questions and templates, or arbitrary, ill-defined symptoms, physical findings, disease processes, etc. Furthermore, in addition to listing the diagnoses in decreasing order of probability, DIAGNOSIS also gives a numerical score to each diagnosis. Therefore, the doctor can quickly tell more accurately the likelihood of one diagnosis e.g. score of 90, over that of another diagnosis e.g. score of 20. DIAGNOSIS KEEPS IT SIMPLE!

Simply double click on DX, then click on- or type in the Sx, S, or Test result. The user can make multiple entries to help narrow down the list of probable diagnoses (the algorithm here is that scores for the same diagnosis on each list are added together, resulting in a higher total score). The list of more likely diagnoses will be produced within seconds. The list is easily printed to hard copy, copied to an electronic medical record or pasted to other destinations.

Doctors, hospitals, medical schools, government agencies, etc. around the world use DIAGNOSIS. It was probably the first computer-assisted diagnosis program commercially available. DIAGNOSIS goes directly to the problem, i.e. THE DIAGNOSIS. Additionally, available free on the Internet, are such sources as www.pubmed.gov which describes the disease, diagnosis, treatment, etc. Many other programs including textbooks, ICD/CPT codes, journals, etc. are kept up to date, and are inexpensively available on the Internet.

DIAGNOSIS is available on a 3.5" disk. If you are not completely satisfied with DIAGNOSIS, return the items within 30 days for a full refund. Price: $25.00.

U.S. currency, check or money order, payable to David E. Wade, M.D. and mail to the address below. Inexpensive updates (indicated as a new version) are made on the few occasions that a significant, documented, new disease is described, or when there are significant program improvements.

Yours truly,

David E. Wade, M.D.
466 S. Goodlett
Memphis, TN 38117

David E. Wade, M.D.
Author:
     WADE'S DIFFERENTIALS: an aid to diagnosis, Astor-Honor Inc., New York, 1971.
     COMPUTER-ASSISTED DIAGNOSIS SYSTEM, © Copyright 1983.
Board Certification, American Board of Medical Specialists:
     Internal Medicine 1966.
     Endocrinology & Metabolism 1972.

Computer-Assisted Diagnosis System.
(c) Copyright 1983 David E. Wade, M.D. All Rights Reserved.

INDEX FOR DIAGNOSIS

ABDOMINAL DISTENTION
ABDOMINAL PAIN, SEE PAIN
ACID INDIGESTION
ACIDOSIS
ADENOPATHY, LOCAL OR GENERALIZED
AGITATION, SEE ENCEPHALOPATHY
AGRANULOCYTOSIS
ALKALINE PHOSPHATASE HIGH
ALKALINE PHOSPHATASE LOW
ALOPECIA, SEE HAIR
AMBIGUOUS GENITALIA
AMENORRHEA/HYPOMENORRHEA
AMNESIA, SEE ENCEPHALOPATHY
ANDROGENS ELEVATED
ANEMIA
---ANEMIA PSEUDO-IRON DEFICIENCY
---HEMOLYSIS
---IRON DEFICIENCY is included in microcytic/hypochromic anemia
---MICROCYTIC HYPOCHROMIC ANEMIA
---MACROCYTIC ANEMIA
---NONSPECIFIC ANEMIA
---NORMOCYTIC NORMOCHROMIC
ANHYDROSIS
ANOREXIA
ANXIETY, SEE ENCEPHALOPATHY
APPETITE
-----INCREASED
-----DECREASED
APPREHENSION
ARM PAIN, SEE PAIN
ARRHYTHMIA
---ATRIAL FIBRILLATION
---BRADYCARDIA
---EXTRASYSTOLES
---HEART BLOCK
---TACHYCARDIA
ARTHRITIS/ARTHRALGIA
AUTOIMMUNE DISORDERS (DESTRUCTIVE/NOT HIV)

BACK PAIN, SEE PAIN
BAD BREATH, SEE MOUTH
BAD TASTE, SEE MOUTH
BALDNESS, SEE HAIR
BLEEDING, SEE BLOOD
BLINDNESS/POOR VISION, SEE EYE
BLOATING, ABDOMINAL
BLOOD
-----AGRANULOCYTOSIS
-----ANEMIA, SEE ANEMIA
-----EOSINOPHILIA
-----EOSINOPHILIA PLUS LUNG INFILTRATE
-----HEMOLYSIS
-----IN SKIN (ECCHYMOSIS, PURPURA, PETECHIAE)
-----IN STOOL (GI HEMORRHAGE)
-----IN SPUTUM
-----IN VOMITUS (GI HEMORRHAGE)
-----LEUKOPENIA
-----NASAL
-----NEUTROPENIA
-----PANCYTOPENIA
-----POLYCYTHEMIA
-----THROMBOCYTOPENIA
-----VAGINAL, EXCESSIVE/INAPPROPRIATE
BLOOD PRESSURE
-----HIGH
-----HYPOTENSION
----------MILD &/or ORTHOSTSTIC
-----SHOCK
BONE, WEAK (OSTEOPOROSIS and OSTEOMALACIA)
BREAST
-----GALACTORRHEA
-----GYNECOMASTIA
BREATH, MALODOROUS, SEE MOUTH
BRITTLE DIABETES MELLITUS
BRUISES, SKIN (ECCHYMOSIS, PURPURA)
BUN ELEVATED

CALCIFICATION
-----KIDNEY
-----NEPHROCALCINOSIS
CALCIUM
-----BLOOD, HIGH
-----BLOOD, LOW
CARDIAC, SEE HEART
CARPOPEDAL SPASM
CATARACTS
CEREBRAL FUNCTION IMPAIRED
CHEST PAIN, SEE PAIN
CHOLESTEROL ELEVATED
COMA/STUPOR
CONFUSION, SEE ENCEPHALOPATHY
CONSTIPATION
COUGH
CRAMP, MUSCLE, SEE MUSCLE

DEAFNESS and/or EAR NOISE
DELUSIONS, SEE ENCEPHALOPATHY
DEMENTIA, SEE ENCEPHALOPATHY
DENTAL, SEE MOUTH
DEPRESSION, SEE ENCEPHALOPATHY
DIABETES MELLITUS, CAUSES OF
-----INCLUDED IN GLUCOSE, HIGH (HYPERGLYCEMIA)
-----POOR CONTROL (BRITTLE DIABETES)
DIARRHEA
DIPLOPIA
-----BINOCULAR
-----MONOCULAR
DIZZINESS
DRY MOUTH
DRY SKIN
DWARFISM
DYSPHAGIA
DYSPNEA, SEE LUNG
DYSURIA

EAR, NOISE IN AND/OR DECREASED HEARING
ECCHYMOSIS, SEE SKIN
EDEMA, SEE FLUID
ENCEPHALOPATHY
      AMNESIA, ANXIETY, CONFUSION, DELUSIONS, DEMENTIA,
      DEPRESSION,HALLUCINATIONS, IMPAIRED INTELLIGENCE,
      IRRITABILITY, POOR MEMORY, NERVOUSNESS, NEUROSIS,
      PERSONALITY CHANGE, PSYCHOSIS.
      (The ranking &/or scoring may vary for these.)
      (Use COMA/STUPOR for any degree of unresponsiveness.)
EOSINOPHILIA
EOSINOPHILIA PLUS LUNG INFILTRATE
EPILEPSY
EPISTAXIS
ERYTHEMA
ERYTHREMIA
EYE
-----BLIND/POOR VISION
-----CATARACTS
-----DIPLOPIA BINOCULAR
-----DIPLOPIA MONOCULAR
-----EXOPHTHALMOS
-----LARGE PUPIL
-----PERIORBITAL EDEMA
-----PHOTOPHOBIA

FACE PAIN, SEE PAIN
FAINT/SYNCOPE
FATIGUE
FAT, EXCESS (OBESITY)
FATTY LIVER
FEVER
FEVER, FUO
FERTILITY, SEE INFERTILITY
FINGERNAILS, DISORDERS OF
FLUID RETENTION
-----AROUND HEART, SEE HEART
-----AROUND LUNG, SEE LUNG
-----FLUID RETENTION, FEET/LEGS
-----GENERALIZED
-----INAPPROPRIATE ADH SYNDROME
-----PERIORBITAL
FRICTION RUB

GALACTORRHEA
GI HEMORRHAGE
GENITALIA, AMBIGUOUS
GLUCOSE, BLOOD
-----HYPERGLYCEMIA
-----HYPOGLYCEMIA
GOITER
GROWTH
-----SHORT OR DELAYED
-----TALL OR RAPID
GYNECOMASTIA

HAIR
-----ALOPECIA
-----AXILLARY/PUBIC HAIR LOSS IN FEMALE
-----HIRSUTISM
--------IF SEVERE, SEE VIRILISM
-----SEX HAIR, LOSS IN MALE
HALITOSIS, SEE MOUTH
HALLUCINATIONS, SEE ENCEPHALOPATHY
HEADACHE, SEE PAIN
HEARING IMPAIRED and/or EAR NOISE
HEART
-----ARRHYTHMIA, SEE ARRHYTHMIA
-----CARDIOMYOPATHY
-----CHEST PAIN, SEE PAIN
-----DYSPNEA
-----EFFUSION PERICARDIAL
-----EDEMA, SEE FLUID RETENTION
-----EXTRASYSTOLES
-----HEART BLOCK
-----HEART FAILURE/CARDIOPATHY
-----HYPERTENSION
-----HYPOTENSION
-----MYOCARDITIS (CARDIOPATHY, MYOCARDIOPATHY)
-----ORTHOPNEA
-----PAROXYSMAL NOCTURNAL DYSPNEA
-----PERICARDIAL EFFUSION and/or PERICARDITIS
-----SHOCK
HEIGHT, SEE GROWTH
HEMOLYSIS
HEMOPTOSIS
HEPATOMEGALY, INCLUDED IN LIVER DISEASE
HICCUPS
HIP PAIN, SEE PAIN
HIRSUTISM
-----IF SEVERE, SEE VIRILISM
HOARSNESS/VOICE CHANGE
HUNGER, SEE APPETITE
HYPERANDROGENISM
HYPERCALCEMIA
HYPERCHOLESTEROLEMIA
HYPERGLYCEMIA
HYPERHYDROSIS
HYPERKALEMIA
HYPERMETABOLISM
HYPERPNEA
HYPERTENSION
HYPOCALCEMIA
HYPOGLYCEMIA
HYPOGONADISM IN FEMALE (INCLUDED IN AMENORRHEA)
HYPOGONADISM IN MALE
HYPOKALEMIA
HYPONATREMIA
HYPOPHOSPHATEMIA
HYPOTENSION (CONSIDER SHOCK)

ICTERUS
ILEUS
IMPOTENCY, MALE
INAPPROPRIATE ADH SYNDROME
INFERTILITY
-----FEMALE
-----MALE (STERILITY)
INSOMNIA
INTELLIGENCE IMPAIRED
INTESTINAL BLEEDING, SEE BLOOD
IRRITABILITY, SEE ENCEPHALOPATHY
ITCH

JAUNDICE
JOINT PAIN, SEE PAIN

KIDNEY OR BLADDER STONES
KIDNEY FAILURE (NEPHRITIS/NEPHROPATHY)

LEG PAIN, SEE PAIN
LEUKOPENIA
LIBIDO/POTENTIA DECREASED
LIVER DISEASE
LOWER EXTREMITY PAIN
LUNG
-----COUGH
-----DYSPNEA
-----HEMOPTOSIS
-----INFILTRATE PRESENT
-----ORTHOPNEA
-----PAROXYSMAL NOCTURNAL DYSPNEA
-----PULMONARY INFILTRATE
-----PULMONARY INFILTRATE PLUS EOSINOPHILIA
-----PLEURAL EFFUSION/PLEURITIS
-----SHORT OF BREATH/RAPID BREATHING
-----STRIDOR
-----WHEEZING RESPIRATIONS
LYMPHADENOPATHY, LOCAL OR GENERALIZED
LYMPHOPENIA

MASCULINIZATION
MEMORY POOR, SEE ENCEPHALOPATHY
MENSTRUAL PERIODS
-----ABSENT or DECREASED PERIODS
-----BLEEDING EXCESSIVE or INAPPROPRIATE
MOUTH
-----BAD TASTE/HALITOSIS
-----DENTAL DISORDER (ABNORMAL TEETH)
-----DRY
-----EXCESS SALIVA (PTYALISM)
-----GUM DISORDERS
-----PTYALISM
MUSCLE
-----CRAMP/SPASM
-----IRRITABILITY (INCLUDED IN SEIZURES)
-----MYOPATHY
      (CONSIDER MUSCLE PAIN, WEAKNESS, PARALYSIS, PERIPHERAL
       NEUROPATHY)
-----PAIN
      (CONSIDER LOWER EXTREMITY PAIN, UPPER EXTREMITY PAIN, MUSCLE
       SPASM, MYOPATHY, PERIPHERAL NEUROPATHY)
-----PARALYSIS/INCOMPLETE PARALYSIS,EXTREMITY
      (CONSIDER MYOPATHY, PERIPHERAL NEUROPATHY, WEAKNESS GENERALIZED)
-----TREMOR

NAILS, DISORDERS OF
NAUSEA
NECK PAIN, POSTERIOR
NERVOUSNESS, SEE ENCEPHALOPATHY
NEPHRITIS
NEUROPATHY, PERIPHERAL
NEUTROPENIA
NIGHT SWEATS
NIPPLE DISCHARGE
NOCTURIA, SEE URINE
NOSE BLEEDS
NUMBNESS (PARESTHESIAS)

OBESITY
OSTEOPOROSIS (OSTEOPENIA) INCLUDES OSTEOMALACIA
OVARIAN FAILURE

PAIN
-----ABDOMINAL
-----BACK
-----CHEST
-----FACE PAIN
-----HEAD (HEADACHE)
-----JOINT/ARTHRITIS/ARTHRALGIA
-----LOWER EXTREMITY (INCLUDES HIP AREA)
-----MUSCLE PAIN
-----NECK PAIN, POSTERIOR
-----TESTES PAIN
-----UPPER EXTREMITY (INCLUDES SHOULDER AREA)
PANCYTOPENIA
PARALYSIS/INCOMPLETE PARALYSIS, EXTREMITY (CONSIDER MYOPATHY,
     PERIPHERAL NEUROPATHY, WEAKNESS GENERALIZED)
PARESTHESIAS
PAROTID OR SALIVARY GLAND ENLARGEMENT
PERICARDIAL EFFUSION and/or PERICARDITIS
PERSPIRATION
-----ANHYDROSIS
-----NIGHT SWEATS
-----PERSPIRATION, INCREASED
PERSONALITY CHANGE, SEE ENCEPHALOPATHY
PETECHIAE, SEE SKIN
PHOSPHATASE (ALKALINE)
-----HIGH
-----LOW
PHOSPHATE
-----HYPERPHOSPHATEMIA
-----HYPOPHOSPHATEMIA
PHOTOPHOBIA, SEE EYE
PHOTOSENSITIVITY OF SKIN
PLATELETS, LOW, SEE BLOOD
PLEURAL EFFUSION/PLEURITIS
POLYCYTHEMIA
POLYURIA, SEE URINE
POTASSIUM
-----BLOOD, ELEVATED
-----BLOOD, LOW
PSYCHOSIS, SEE ENCEPHALOPATHY
PRURITUS
PTYALISM
PUPIL, DILATED
PURPURA, SEE BLOOD

SALIVARY GLAND ENLARGEMENT
SEIZURES
SHOCK
SHOULDER PAIN, SEE PAIN
SINGULTUS
SKIN
-----BRUISES EASILY (ECCHYMOSIS, PURPURA,PETECHIAE)
-----DRY
-----ERYTHEMA
-----HIRSUTISM
--------IF SEVERE, SEE VIRILISM
-----ITCH
-----JAUNDICE
-----PARESTHESIAS
-----PERSPIRATION DECREASED
-----PERSPIRATION INCREASED
-----PETECHIAE
-----PHOTOSENSITIVITY
-----PIGMENTATION
--------HYPERPIGMENTATION
--------HYPOPIGMENTATION
-----PURPURA
-----TELANGIECTASIA
-----ULCER GENITALIA
-----ULCER SKIN
-----URTICARIA (WHEALS)
-----YELLOW
SLEEP, POOR
SODIUM, BLOOD, LOW
SPASM, MUSCLE, SEE MUSCLE
SPINE, VERTEBRAL BODY COLLAPSE/DESTRUCTION
SPLEEN, LARGE
SPLENOMEGALY, GIANT
STERILITY
-----FEMALE (INFERTILITY)
-----MALE
STOMACH BLEEDING, SEE BLOOD
STOOL, BLOOD IN, SEE BLOOD
SWALLOWING DIFFICULTY
SWEAT, SEE PERSPIRATION
SWELLING, SEE FLUID
SYNCOPE/FAINT

TASTE, BAD TASTE IN MOUTH, SEE MOUTH
TEETH ABNORMAL, SEE MOUTH
TELANGIECTASIA
TESTES, HYPOGONADISM
TESTES PAIN
TESTOSTERONE ELEVATED
TETANY
THROMBOCYTOPENIA, SEE BLOOD
THYROID ENLARGEMENT
TINNITUS
TIREDNESS, GENERALIZED
TOENAILS, DISORDERS OF
TREMOR

ULCER, SEE SKIN
UREMIA
URIC ACID HIGH
URINE
-----DYSURIA, FREQUENCY***
-----NOCTURIA
-----POLYURIA
-----REDDISH URINE***
URTICARIA

VAGINAL BLEEDING EXCESSIVE/INAPPROPRIATE
VERTEBRAL BODY COLLAPSE/DESTRUCTION
VIRILISM
-----ANDROGENS ELEVATED
--------if younger than puberty age,
--------add TALL OR RAPID
VERTIGO
VISCERAL NEUROPATHY
VISION, SEE EYE
VOICE, CHANGE IN/HOARSNESS
VOMITING

WEAKNESS, GENERALIZED
WEIGHT LOSS
-----ASSOCIATED WITH POOR APPETITE
-----ASSOCIATED WITH NORMAL OR INCREASED APPETITE
WHEEZING RESPIRATIONS
WHITE BLOOD CELL COUNT LOW

XEROSIS
XEROSTOMIA

YELLOW SKIN

Computer-Assisted Diagnosis System.
© Copyright 1983 David E. Wade, M.D. All Rights Reserved.

*** Only one or a few differential diagnoses.