1) The recognition of the anemic syndrome will lead to systematically review the following diseases:
-hemoglobinopathies, hypo- or aplastic anemia, megaloblastic anemia,
-hemolytic and acute hemorrhagic anemia,
-myelodysplastic disorders, myeloproliferative disorders, lymphatic neoplasms,
-anemia related to chronic inflammatory diseases
2) Dyspnea, chest pain, abnormal cardiac rhythm will lead to review the following pathologies:
-heart rhythm disorders and diseases (heart failure, valvular heart disease, diseases of the pericardium, myocardium, heart lung),
-atherosclerosis, ischemic heart disease, diseases of the blood vessels and the aorta,
- pneumonia, bronchial asthma, COPD, pulmonary interstitial diseases, diseses of pleura, mediastinum and diaphragm, primary pulmonary hypertension.
Particular importance will be given to the differential diagnosis of the different causes of chest pain.
3) Oedema will lead to review the following pathologies:
-Kidney diseases: glomerulonephrites, acquired and congenital disorder of the renal tubules, interstitial nephropathy, nephrolithiasis
-Heart diseases: heart failure.
-Intestinal malabsorption: inflammatory intestinal diseases and related differential diagnosis, irritable bowel, mesenterial vasculopathies.
-Liver diseases: cirrhosis; acute and chronic hepatitis; infiltrative, genetic and metabolic liver disorders; diseases of the gallbladder and biliary tract.
4) Jaundice will lead to review the inherent systemic diseases:
liver cirrhosis, acute and chronic hepatitis, infiltrative, genetic and metabolic liver disorders; diseases of the gallbladder and biliary tract.
5) Diarrhea and constipation will lead to review the following systematic diseases: disorders of intestinal absorption, celiac disease, acute and chronic pancreatitis.
6) The osteoarticular and muscle pain, alterations of sensitivity and motility, changes in skin diseases will lead to systematic review regarding:
-systemic lupus erythematosus, rheumatoid arthritis, systemic sclerosis, Sjogren's syndrome, ankylosing spondylitis, reactive arthritis, and infectious, Behcet's syndrome, vasculitis, sarcoidosis, amyloidosis, gout and crystal arthropathies, osteoarthritis, Guillain-Barre syndrome, polymyositis, dermatomyositis, chronic granulomatous disease, autoinflammatory diseases.
-Atopy, allergy to inhalant agents, adverse reactions to foods and drugs. Eosinofilic and hypereosinophilic syndrome. Acquired Immunodeficiency.
- Parathyroid disease, Paget’ disease, porphyria, storage diseases such as Wilson's disease, lysosomal storage diseases, abnormal metabolism of purine and pyrimidine , glycogen storage diseases, inherited metabolic abnormalities of carbohydrates, membrane transport and fatty tissue.
7) Fever will lead to review the differential diagnosis involving:
fever of unknown origin (FUO), factitia fever, sepsis and septic shock, bacterial endocarditis, osteomyelitis, diseases due to gram-positive and gram-negative bacteria, mycobacteria, spirochetes, rickettsia, mycoplasma, chlamidia, DNA or RNA virus, infections by fungi, da protozoa and helminths.
8) Recurrent or frequent infections will lead to consider:
the primary immunodeficiencies with particular attention to CVID and IgA deficiency.
8) The cough will lead to review the following systemic diseases:
bronchial asthma, hypersensitivity pneumonia, pneumonia, bronchiectasiae, COPD, interstitial lung diseases , primary pulmonary hypertension, pulmonary embolism, diseases of the pleura, mediastinum, diaphragm.
9) Abnormal blood pressure will lead to review:
-primary and secondary hypertension, resiatnt and low-renin hypertension;
- cardiovascular risk factors, the atherosclerosis, the abnormalities of lipoproteins metabolism;
-pheochromocitoma, primary aldosteronism, the Cushing syndrome;
- revascular disease (fibrodysplastic and atheromatous stenosis of renal artery), the aortic diseases.
10) Weight and appetite disturbance will lead to review:
- nutritonal status and balance, vitamins and oligoelements deficiency;
-lymphatic neoplasms, skin cancer, lung and breast cancer, gastro-intestinal cancers, liver and biliary tract cancer, pancreas cancer, neoplasms of kidney, prostatic gland, testis, ovary, bone and soft tissues,;
- paraneoplastic syndrome;
- environmental pathologies, poisoning and overdose of drugs.
11) Hemorragic lesions of the skin or abnormal venous drainage will lead to review: coagulative disorders, thrombosis and thrombophilia, platelet and vessel diseases. In such context will be also considered the clinical picture due to thrombosis in unusual sites.