Differential Diagnosis of Common Complaints

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Differential Diagnosis
of Common Complaints
Job Aid
U.S. Coast Guard Training Center Petaluma
TABLE OF CONTENTS
DERM
EENT
CV
RESP
GI
GU
GYN
MUS/SKEL
NEURO
MH
Erythema
Red Eye
Cardiac Chest
Pain
Acute Cough
Abdominal Pain
STD
Menses
Neck Pain
Altered Mental
Status
Mood
Disorders
Anthrax
(cutaneous)
Blepharitis
Cellulitis
Chemical Burn
Drug
Reaction
Furuncle
Urticaria
Viral
Exanthemas
(measles,
mumps,
rubella)
Chalazion
Conjunctivitis,
allergic/infectious
Acute Coronary
Syndrome
Bronchitis,
Mycoplasm
Appendicitis
Chancroid
Angina Pectoris
Bronchitis
Viral
Cholecystitis
Chlamydia
Constipation
Condyloma
Acuminata
Pericarditis
Influenza
Pneumonia,
Bacterial
Corneal Abrasion
Foreign Body
Glaucoma
Hordeolum
Hyphema
Pneumonia,
Viral
GERD
Irritable Bowl
Syndrome
Non-Cardiac
Pain
Chronic
Cough
Barotrauma
Anxiety
COPD
Cerumen
Impaction
Costochondritis
GERD
GERD
Tuberculosis
Mastoiditis
Otitis Externa
Otitis Media
Perforation of
Tympanic
Membrane
HIV
HSV II
Alcohol Abuse
Muscle
Strain,
Cervical
Seizure
CVA
Pleuritis
Female Specific
Abdominal Pain
Ectopic
Pregnancy
Endometriosis
Syphilis
Trichomoniasis
Ovarian Cyst
Hydrocele,
Acute
Inguinal
Hernia
Prostatitis,
Acute
Testicular
Torsion
UTI
Varicocele
Serous Otitis
Media
Temporomandibu
lar Joint (TMJ)
Syndrome
Continued on Next Page
1CONDITIONS
Depression
END
Pediculosis
Epididymitis
Anxiety
END
Lymphogran
-uloma
Venereum
Male
Complaint
Adjustment
Disorder
Suicidal
Ideation
PUD
Uveitis
Eustachian Tube
Dysfunction
Gonorrhea
Dysmenorrhea,
Primary
Cervical Disk
(HNP)
Pancreatitis,
Acute
Subconjunctival
Hemorrhage
Wart,
Common
Hepatitis
Hernia,
Abdominal
Retinal
detachment
Molluscum
Contagiosum
Food Poisoning
Gastroenteritis,
Acute
Pinguecula
Earache
Diverticulitis
Pneumonia,
Mycoplasma
Pterygium
Growths
Diarrhea
Dysfunctional
Uterine
Bleeding
Shoulder Pain
Bicipital
Rupture,
Proximal
Bicipital
Tendonitis
Bursitis,
Subacromial
Impingement
Syndrome
Rotator Cuff
Tear
Headache,
Emergent
Hemorrhage,
Subarachnoid
Hypertension
Emergency
Meningitis
DERM
EENT
CV
RESP
GI
GU
MUS/SKEL
Inflammatory
Stuffy Nose
Syncope
Difficult
Breathing
Rectal
Pain/Bleeding
Female Complaint
Elbow Pain
NEURO
Headache,
Non-emergent
Acne Vulgaris
Allergic Rhinitis
Arrhythmia
Anaphylaxis
Colorectal Cancer
Bacterial Vaginosis
Bursitis, Olecranon
Cluster
Insect Bite/Sting
(non-venomous)
Common Cold
Orthostatic
Hypotension
Asthma
Hemorrhoid
Bartholins Cyst
Epicondylitis
Sinusitis
Miliaria
Pilonidal Cyst
Sinusitis
Pneumothorax,
Spontaneous
Candidiasis,
Volvovaginal
Pseudofolliculitis
Barbae
Epistaxis
Seizure
END
Scabies
Scaly
Sore
Mouth/Throat
Candidiasis
(oral)
Aphthous Ulcer
Pityriasis Rosea
Herpes Simplex
Virus
Psoriasis
Epiglottitis
Seborrheic
Dermatitis
Laryngitis
Tinea Capitis
Peritonsillar
abscess
Tinea Corporis
Tinea Cruris
Tinea Pedis
Tinea Unguium
Tinea Versicolor
Mononucleosis
Ulcerative Colitis
Tension
Vascular
UTI
END
Vascular
Hematuria
Deep Vein
Thrombosis
Glomerulonephritis
Raynauds
Disease
Renal Calculi
Pyelonephritis, Acute
Varicose
Veins
Wrist pain
Carpal Tunnel
Syndrome
Labyrinthitis
Ganglion Cyst
Motion Sickness
Scaphoid Fracture
END
END
Pharyngitis,
Bacterial
Finger pain
Pharyngitis,
Viral
Paronychia
Salivary Stone
END
Continued on Next Page
2CONDITIONS
Vertigo
Menieres Disease
Vertigo, Benign
Positional
DERM
MUS/SKEL
NEURO
Vesicular
Lower Back Pain
Facial Neuropathy
Atopic Dermatitis
Mechanical, Muscular Strain
Bells Palsy
Contact Dermatitis
Neurological, Herniated Disk
Eczematous Dermatitis/
Dyshidrosis
Prostatitis
Cerebrovascular accident
(CVA)
Herpes Simplex Virus
Renal Calculi
Trigeminal Neuralgia
Pyelonephritis
Herpes Zoster
END
Knee Pain
Impetigo
Smallpox
Bursitis, Patellar
Varicella (Chickenpox)
Collateral Ligament Tear

Cruciate Ligament Tear
Meniscal Tear
END
Patellofemoral Syndrome
Popliteal Cyst
Ankle Pain
Achilles Tendon Rupture
Ankle Sprain
Foot Pain
Fifth Metatarsal Fracture
Heel Spur
Plantar Fasciitis
Toe Pain
Ingrown Toenail
Leg Pain
Shin Splints
END
END
3CONDITIONS
GUIDE TO SCOPE OF PRACTICE FOR HS TECHNICIANS

A Health Services Technician (HS) provides supportive services to medical officers and basic primary health care in
their absence. Each HS who provides medical treatment to patients at a Coast Guard clinic shall have an assigned
Designated Supervising Medical Officer (DSMO) from that facility. One of the primary goals of the HS is to eventually
work independently after completion of the Independent Duty Health Services Technician School.
An Independent Duty Health Services Technician (IDHS) works outside of a clinical setting, and is supervised by a
Designated Medical Officer Advisor (DMOA). The IDHS practices independently, though acts as the eyes, ears and
hands in consultation with the DMOA or Duty Flight Surgeon when a situation is beyond the scope of technician health
care.
This job aid captures all of the medical conditions that the HS3 (A for apprentice), HS2 (J for journeyman), and IDHS
(M for master) should be familiar with. This job aid is divided into nine categories by body system plus a tenth for
mental health conditions. The categories are further broken down into patient chief complaints or presenting situation.
The chief complaints have a list of conditions with corresponding potential differential diagnosis. Though the conditions
pathogenesis is not discussed here, each condition is presented with:
A definition
Key features
Differentiating signs and symptoms
Differentiating objective findings
Common diagnostic test considerations
Proposed treatment
Recommended follow-up
As you use the following guide to determine if a condition is within your scope of practice, remember that the A is for
Apprentice and indicates that the HS, in achieving their rank, has included that condition in their scope of practice.
4GUIDE TO SCOPE OF PRACTICE FOR HS TECHNICIANS
DERMATOLOGICAL
CHIEF
COMPLAINT
CONDITION
HS3 Post
A School
HS2
IDHS C
School
Anthrax (cutaneous)
Cellulitis
Growths
Inflammatory
Scaly
HS3 Post
A School
HS2
IDHS C
School
Atopic Dermatitis
Contact Dermatitis
Eczema (dyshidrosis)
Furuncle
A
A
J
J
M
M
Urticaria
Drug Reaction
Erythema
DERMATOLOGICAL, Continued
Vesicular
CONDITION

Herpes Zoster
Impetigo
Viral Exanthemas
(measles, mumps,
rubella)
Molluscum
Contagiosum
Wart (common)
Acne Vulgaris
Insect bite/sting
(nonvenomous)
Miliaria
Pseudofolliculitis,
Barbae
Scabies
Candidiasis(oral)
Pityriasis Rosea
Psoriasis
Seborrheic Dermatitis
Tinea Capitis
Tinea Corporis
Tinea Cruris
Tinea Pedis
Tinea Unguium
Tinea Versicolor
CHIEF
COMPLAINT
Smallpox
Varicella (chickenpox)
EYES, EARS, NOSE, AND THROAT

CHIEF
COMPLAINT
CONDITION
HS3 Post
A School
HS2
IDHS C
School
Chalazion
Chemical Burn
Blepharitis
Epistaxis
Sinusitis
Aphthous Ulcer
Epiglottitis
Laryngitis
Mononucleosis
Peritonsillar Abscess
Corneal Abrasion
J
A
Pinguecula
Pterygium
Retinal Detachment
Uveitis
Barotrauma
A
A
A
Cerumen Impaction
Earache
Eustachian Tube
Dysfunction
Mastoiditis
Subconjunctival
Hemorrhage
IDHS C
School
Common Cold
Conjunctivitis, Infectious
Hyphema
Temporomandibular Joint
Syndrome
HS2
HS3 Post
A School
Hordeolum
Earache,
continued
CONDITION
Glaucoma
CHIEF
COMPLAINT
Allergic Rhinitis
Conjunctivitis, Allergic
Foreign Body
Red Eye
EYES, EARS, NOSE, AND THROAT, Continued
Stuffy Nose
Sore Throat
Pharyngitis, Bacterial
Pharyngitis, Viral
Salivary Stone
Otitis Externa
Otitis Media
Perforation
Serous Otitis Media
CARDIOVASCULAR
CHIEF
COMPLAINT
Cardiac Chest
Pain
CONDITION
HS3 Post
A School
HS2
IDHS C
School
Acute Coronary
Syndrome (ACS)
Bronchitis,
Mycoplasma
Angina Pectoris
Bronchitis, Viral
Pericarditis
Anxiety (see Mental

HealthFeeling Down
or Worried)
Costochondritis
Non-Cardiac
Chest Pain
Syncope
Vascular
RESPIRATORY
Gastroesophageal
Reflux Disease
(GERDsee
RespiratoryChronic
Cough)
Pleuritis
CHIEF
COMPLAINT
Acute Cough
CONDITION
HS3 Post
A School
HS2
IDHS C
School
Influenza
Pneumonia, Bacterial
Pneumonia,
Mycoplasma
Pneumonia, Viral
Chronic Obstructive
Pulmonary Disease
M
Chronic
Cough
Gastroesophageal
Reflux Disease
Arrhythmia
Tuberculosis
Orthostatic
Hypotension
Anaphylaxis
Asthma
Difficult
Breathing
Seizure (see
Neurological Altered
Mental Status)
Deep Vein Thrombosis
Raynauds Disease
Varicose Veins
Pneumothorax,
Spontaneous
GASTROINTESTINAL
CHIEF
COMPLAINT
CONDITION
GENITOURINARY
HS3 Post
A School
Appendicitis
Cholecystitis
M
M
Diarrhea (symptom)
Gastroenteritis, Acute
(viral)
Gastroesophageal
Reflux Disease
A
A
CHIEF
COMPLAINT
CONDITION
HS3 Post
A School
Bacterial Vaginosis
Female
Complaint
Bartholins Cyst
Male
Complaint
IDHS
C
School
Candidiasis, Vulvovaginal
Urinary Tract Infection
Epididymitis
Hydrocele, Acute
HS2
Inguinal Hernia
Prostatitis, Acute
Testicular Torsion
Urinary Tract Infection
(UTI)
Varicocele
Glomerulonephritis
Hepatitis
Hernia, Abdominal
Irritable Bowel
Syndrome
Pancreatitis, Acute
Pyelonephritis
Peptic Ulcer Disease
Renal Calculi
Chancroid
Endometriosis
Chlamydia
Ovarian Cyst
Condyloma Acuminata
Colorectal Cancer
Gonorrhea
Hemorrhoid
Human Immunodeficiency
Virus (HIV)
Ectopic Pregnancy
Rectal
Pain/Bleeding
J
A
Food Poisoning
Abdominal Pain
Female
IDHS C
School
Constipation
(symptom)
Diverticulitis
Abdominal pain
HS2
Pilonidal Cyst
(abscess)
Ulcerative Colitis
Hematuria
Sexually
Transmitted
Disease
Lymphogranuloma
Venereum
Pediculosis
Syphilis
Trichomoniasis
GYNECOLOGICAL
CHIEF
COMPLAINT
Menses
CONDITION
MUSCULOSKELETAL
HS3 Post
A School
Dysfunctional Uterine
Bleeding
Dysmenorrhea
HS2
IDHS C
School
CHIEF
COMPLAINT
CONDITION
HS3 Post
A School
HS2
IDHS C
School
Herniated Cervical Disk

(HNP)
Bicipital Tendon
Rupture, Proximal
Impingement Syndrome
Rotator Cuff Tear
Cervical Muscle Strain

Neck pain
Bicipital Tendonitis
Shoulder pain
Subacromial Bursitis
Bursitis, Olecranon
Epicondylitis
Carpal Tunnel
Syndrome
Elbow pain
Wrist pain
Ganglion Cyst
Scaphoid Wrist Fracture
Finger pain
Paronychia
Continued next page
MUSCULOSKELETAL, Continued
CHIEF
COMPLAINT
Lower Back
Pain
Knee Pain
CONDITION
NEUROLOGICAL
HS3 Post
A School
HS2
IDHS C
School
Mechanical Muscular
Strain
Neurological, Herniated
Disk
CONDITION
HS3 Post
A School
HS2
IDHS C
School
Hemorrhage,
Subarachnoid
Hypertension
Emergency
Alcohol Abuse
Altered Mental
Status
Cerebrovascular
Accident (CVA)
Seizure
Prostatitis (see GU male)

Pyelonephritis (see GU
hematuria)
Renal Calculi (see GU

hematuria)
Bursitis, Patellar
Collateral Ligament Tear
Cruciate Ligament Tear
Meniscal Tear
Patellofemoral Syndrome
Popliteal Cyst
Achilles Tendon Rupture
Ankle Pain
Ankle Sprain
Fifth Metatarsal Fracture
Heel Spur
Plantar Fasciitis
Toe Pain
Ingrown nail
Leg Pain
Shin splints
Foot Pain
CHIEF
COMPLAINT
Emergent
Headache
Meningitis
Cluster Headache
Non-Emergent
Headache
Vertigo
Facial
Neuropathy
Sinusitis
Tension Headache
Vascular Headache
Labyrinthitis
Menieres Disease
Motion Sickness
Vertigo, Benign
Positional
Bells Palsy
Cerebrovascular
Accident
Trigeminal neuralgia
MENTAL HEALTH
CHIEF
COMPLAINT
Feeling Down or
Worried
CONDITION
HS3 Post
A
School
HS2
IDHS C
School
Adjustment Disorder
Anxiety
Depression
Suicidal Ideation
This page is intentionally blank.
CHIEF COMPLAINT: ERYTHEMA

CONDITION &
DEFINITION
KEY FEATURES
DIFFERENTIATING
SIGNS & SYMPTOMS
DIFFERENTIATING
OBJECTIVE
FINDINGS
COMMON
DIAGNOSTIC TEST
TREATMENT
FOLLOW-UP
Anthrax
(cutaneous)
Caused by Bacillus
anthracis and is
transmitted to
humans by infected
animals; has also
been used for
hostile purposes as
a bio- logical
warfare agent.
Begins as a
localized, painless,
pruritic, red papule
1-6 days after
exposure
Progressive
enlargement with
marked erythema,
edema, vesicles,
central ulceration,
and black pustules
Same as s/s
Culture lesion
Assess localized
lymphadenopathy
Chest radiograph
and specific tests
as indicated
Antibiotic:
Ciprofloxacin 500 mg
po bid for 60 days
CONTACT MO
and Flight
Surgeon
Cellulitis
Acute, diffuse
bacterial infection
of dermis and
subcutaneous
tissue
Regional erythema
May have fever,

malaise, myalgia,
headache, nausea,
vomiting
May have fever and

malaise
Exposure Hx
important
Be familiar with
the AVIP
www.anthrax.osd.mil
Indurated patch that is

painful and warm to
touch
Localized red (rubor)
Culture lesion
Antibiotic:
Tender (dolor)
CBC
Warm (calor)
Mark borders of
induration to
follow progression
Mild: Penicillin VK,

or erythromycin (Emycin)
Marked nonpitting
swelling (tumor)
Assess regional
lymphadenopathy
Drug Reaction
Most common
adverse reaction to
drugs is a skin rash
Generalized,
confluent, pruritic
maculopapular rash
Notify Command Disease Alert

Report
Hx medication use
Onset may be
delayed by 1 week;
R/O anaphylaxis and
bacterial pharyngitis
Bright pink/red
confluent
maculopapular
patch(es)
Complete HEENT,
CV & respiratory
exams
Severe: Ceftriaxone
(Rocephin) IM
F/U every 24
hours until
resolved
IF not resolved in
7 days or severe,
contact MO
Augmentin, if a bite
CBC if secondary
infection
suspected
Rapid strep and/or
throat culture if
Streptococcus
suspected
13DERMATOLOGICAL
Antihistamine:
Hydroxyzine (Atarax)
or diphenhydramine
(Benadryl)
Discontinue drug
causing eruption
CONTACT MO if
no improvement in
24 hours
Complete VAERS
Report if vaccine
reaction
CHIEF COMPLAINT: ERYTHEMA (continued)

CONDITION &
DEFINITION
KEY FEATURES
DIFFERENTIATING
SIGNS & SYMPTOMS
DIFFERENTIATING
OBJECTIVE FINDINGS
COMMON
DIAGNOSTIC TEST
TREATMENT
FOLLOW-UP
Furuncle
Pus-filled mass
caused by
staphylococcus
aureus or MRSA
Localized erythema
Papule or nodule, firm

or fluctuant; painful and
warm to touch
Localized red (rubor)
Culture lesion
Tender (dolor)
CBC.
Warm (calor)
Patient contacts
may also be
contaminated with
MRSA
Antibiotic: TMP/SMX
(Septra DS) (covers
both staph. aureus and
MRSA)
F/U Every
24 hours
until
resolved
Incise and drain if

fluctuant lesion
Large wound may
require Iodoform
packing repack
daily or PRN
If NOT
resolved in
7 days or
severe,
contact MO
Antihistamine:
Hydroxyzine (Atarax) or
diphenhydramine
(Benadryl)
F/U PRN.
Chronic
conditions
refer to MO
Fever is rare
Papule or nodule
(tumor)
Assess regional
lymphadenopathy
Urticaria
Hives usually are a
result of an adverse
drug or food
reaction; though
there are other
causes, they usually
are unknown.
Generalized, confluent,
pruritic maculopapular
rash
Recent history of
ingestion of drug or
food associated with
generalized rash
Ask about over-thecounter or herb use
General distribution of
wheals or hives in
patches
Respiratory distress
Aspirin (salicylate) is
most common cause
14DERMATOLOGICAL
Usually none
indicated
Avoid cause
Respiratory distress
will need emergent
treatment (see
anaphylaxis)
CHIEF COMPLAINT: ERYTHEMA (continued)

CONDITION &
DEFINITION
KEY FEATURES
DIFFERENTIATING
SIGNS & SYMPTOMS
DIFFERENTIATING
OBJECTIVE FINDINGS
COMMON
DIAGNOSTIC TEST
TREATMENT
FOLLOW-UP
Viral Exanthemas
Measles, mumps,
and rubella are
contagious viral
diseases
Generalized or
regional erythemic
maculopapular rash
Measles
Skin exam: as
described by history
CBC
Antipyretic:
Acetaminophen
If not improved
in 7 days,
consult with MO
PRN
May have fever,

malaise, myalgia,
headache and
lymphadenopathy
Coryza
Assess regional
lymphadenopathy
Cough
Conjunctivitis
Kopliks Spots (white)
on bucal mucosa
Complete HEENT, CV
and respiratory exams
Rash spreads from

face to trunk and
extremities
Mumps
Parotid gland pain and
swelling, 15% with
meningeal signs
Maculopapular rash
less common
Rubella
Childhood disease
Petechiae of soft
palate
Rosy red oval or round
macules
Rash spreads rapidly
from face to trunk and
extremities; fades in
24 to 48 hours
15DERMATOLOGICAL
R/O
Mononucleosis
Otherwise,
symptomatic Tx
Ensure MMR
vaccination is up-todate
CHIEF COMPLAINT: GROWTHS

CONDITION &
DEFINITION
KEY FEATURES
DIFFERENTIATING
SIGNS & SYMPTOMS
DIFFERENTIATING
OBJECTIVE FINDINGS
COMMON
DIAGNOSTIC TEST
TREATMENT
FOLLOW-UP
Molluscum
Contagiosum
Individual or
grouped papules
Usually an incidental and

asymptomatic finding by
the patient
Dome-shaped, pearly
white to flesh colored
small lesions on trunk,
extremities, or groin
Biopsy may be
indicated if unable to
differentiate from
basal cell carcinoma
(BCC)
Self limiting in
most cases
F/U PRN
Contagious viral
disease
In children it is
transmitted from
fomites
The lesions are firm

and centrally
umbilicated
In adults it is
transmitted from
fomites, but
primarily sexually
or intimate contact
Wart, common
Verruca vulgaris,
verruca plantaris (sole
of foot); caused by
direct contact; human
papilloma virus
Individual papule
(also see genital
warts)
Smooth flesh colored

papules that become
dome-shaped, graybrown growths with
black dots
Cauliflower fleshcolored papules that

become dome- shaped
growths
No skin lines through

lesion as corns do
16DERMATOLOGICAL
BCC usually have

telangiectasia and
usually found on face
Usually nothing
indicated
Cryotherapy or
cantharidin
application may
be indicated
Good hygiene
Condom use if
genital
Self limiting in
most cases
Cryotherapy or
salicylic acid
patch
F/U PRN.
Therapy may
require
repeated
application
every two
weeks
CHIEF COMPLAINT: INFLAMMATORY

CONDITION &
DEFINITION
KEY FEATURES
DIFFERENTIATING
SIGNS & SYMPTOMS
DIFFERENTIATING
OBJECTIVE FINDINGS
COMMON
DIAGNOSTIC TEST
TREATMENT
FOLLOW-UP
Acne Vulgaris
Inflammatory
disorder of the
pilosebaceous
glands.
Few or multiple
papules, pustules or
nodules on face, chest
or back
Closed comedones
and/or open comedones
Non-inflamed
comedones to
inflammatory papules,
pustules, nodules, and
cysts on face, chest
and/or back
Usually none
indicated
Topical: Benzyl peroxide

gel
F/U PRN
Insect Bite/Sting
(non-venomous)
Insect bites/stings
inoculate poisons,
invade tissue, and
transmit disease.
Here we discuss
irritative bites only.
Irritative bites: localized

inflamed papule
Other varied reactions

may be localized,
toxic systemic, or
allergic systemic
Irritative bites: local

erythema, edema,
and pain
Usually none
indicated unless
related conditions
suspected
Symptomatic treatment
F/U PRN
Related conditions like

allergy, Lyme Disease,
West Nile Virus,
Malaria, etc will require
specific treatments
Chronic
conditions
refer to MO
Miliaria
Sweat flow is
obstructed (prickly
heat) by humidity
(or extreme cold).
Regionalized papules
and pruritus
Heat or prickly rash
Multiple discrete, small,

red, inflamed papules
mostly on trunk and
back
Usually none
indicated
Topical: Hydrocortisone
1% lotion to affected
area.
Cool environment
F/U PRN
Pseudofolliculitis
Barbae
Inflammatory
response to an
ingrown hair.
Papules on beard area
Difficulty shaving; razor

bumps
Beard area has multiple

yellow or grayish
inflamed pustules
surrounded by red base
with hair in middle or
ingrown
Usually none
indicated
Topical: Benzyl peroxide

gel
If associated with beard,
massage beard area
gently in a circular motion
with a warm, moist, soapy
soft washcloth or facial
scrub pad; give a limited
(days) no shaving chit.
F/U PRN
Consider related
conditions like allergy,
Lyme Disease, West
Nile Virus, Malaria,
etc.
Complete thorough
skin exam and review
of systems
17DERMATOLOGICAL
Apply after washing

with mild soap and
water twice per day
Chronic
conditions
refer to MO
CHIEF COMPLAINT: INFLAMMATORY (continued)

CONDITION &
DEFINITION
KEY FEATURES
DIFFERENTIATING
SIGNS & SYMPTOMS
DIFFERENTIATING
OBJECTIVE FINDINGS
COMMON
DIAGNOSTIC
TEST
TREATMENT
FOLLOW-UP
Scabies
Mite infestation
from close contact
with infected
individual or
linen/clothing.
Papules and pruritus
Itch/scratch that may

interrupt sleep
Small, inflamed papules

of linear burrows most
common on groin,
genitals, fingers/toes
webbing
Usually none
indicated
Topical:
F/U PRN
Permethrins lotion or
shampoo (Elimite/Nix)
Also treat shipboard or
home contacts and wash
associated clothing and
linen
CHIEF COMPLAINT: SCALY

CONDITION &
DEFINITION
KEY FEATURES
DIFFERENTIATING
SIGNS & SYMPTOMS
DIFFERENTIATING
OBJECTIVE FINDINGS
COMMON
DIAGNOSTIC TEST
TREATMENT
FOLLOW-UP
Candidiasis (oral)
Thrush is a fungal
infection of the oral
epithelium caused
by antibiotics,
steroids, or immunosuppression (AIDS).
White intra-oral plaque

that is easily scraped
off
History of antibiotic or
oral topical steroids
(like asthma
treatment) or HIV
infection
White curd-like patches

that appear like cottage
cheese
Potassium
hydroxide (KOH
preparation)
microscopic eval
Topical antifungal:
Clotrimazole troches
OR
Oral Antifungal:
Fluconazole
F/U if not
improved in 14
days
Pityriasis Rosea
Self-limiting skin
disorder of unknown
cause (may be viral).
Delicate, salmoncolored round or oval

patches of fine white
flakes
Psoriasis
Chronic, recurring
skin disease of the
epidermis; of
unknown cause
(may be genetic).
Marked, silvery, flaking

patches or plaques
Investigate cause
if unknown
Pasty cottage
cheese taste
Onset with heralds
patch 2-10 mm
pink/tan oval patch
frequently
misdiagnosed as
ringworm.
Pruritus
Gradual onset
exacerbated by stress
and sunlight; nail pitting
Heralds patch with

salmon-colored round to
oval patches with
delicate flaking; over
trunk and occasionally
extremities; Christmas
tree rash pattern on
back.
Usually none
indicated
Reassurance selflimiting, resolves in two

weeks to two months
F/U PRN
Silvery pink scaly

patches or plaques,
classically on scalp,
elbows and knees
Usually none
indicated
High-potency topical
steroids have some
effect
Refer to MO
18DERMATOLOGICAL
Refer to MO
CHIEF COMPLAINT: SCALY (continued)

CONDITION &
DEFINITION
KEY FEATURES
DIFFERENTIATING
SIGNS &
SYMPTOMS
DIFFERENTIATING
OBJECTIVE FINDINGS
COMMON
DIAGNOSTIC TEST
TREATMENT
FOLLOW-UP
Seborrheic
Dermatitis
Chronic dandruff
condition affecting
mostly hairy
regions.
Regional greasy
scaling patches or
plaques
Chronic
Superficial, greasy, flaky

patch on scalp, eyebrows,
face, chest, and groin
Usually none indicated

May have fungal
component
Topical:
Selenium sulfide shampoo
(Selsun Blue) every day for
2 weeks
F/U PRN.
Consider lowpotency topical
steroid cream;
hydrocortisone
1% if unimproved
Tinea Capitis
Fungal infection of
scalp.
Scaly patch on
scalp
Alopecia
Round scaly patches with

alopecia
Potassium hydroxide
(KOH) preparation
microscopic evaluation
Oral antifungal:
Refer to MO
Refer to MO
Tinea Corporis
Fungal infection of
face, trunk, or
extremities.
Scaly patch on
body
Ringworm
Annular, erythematous, scaly

patch with central clearing
Potassium hydroxide
(KOH) preparation
Antifungal:
Clotrimazole 1% cream
F/U PRN
Tinea Cruris
Fungal infection of
groin.
Scaly patch on
groin
Jock itch
Sharply demarcated patch or

plaque with elevated, scaly
border (occasionally vesicular
border)
Potassium hydroxide
(KOH) preparation
Antifungal: Clotrimazole
1% cream
Loose-fitting under-clothes
may help
F/U PRN.
Tinea Pedis
Fungal infection of
foot.
Scaly patch on feet
Athletes foot
Diffuse, not well- demarcated

scaly patches on sole or toe
webs
Potassium hydroxide
(KOH) preparation
Antifungal: Clotrimazole
1% cream and/or tolnaftate
1% powder, solution, cream
Keep area dry, wear clean
and dry socks
F/U PRN
Tinea Unguium
Fungal infection of
nail.
Scaly nails
Onychomycosis
Nail exam: subungual scaly

debris with yellowish nail
Potassium hydroxide
(KOH) preparation
Oral antifungal:
Refer to MO
Refer to MO
Tinea Versicolor
Fungal infection of
the skin.
Scaly patch on
body
Fine
hypopigmented
small patches,
usually multiple
on trunk
White, tan or pink patches

with fine flaking border
Potassium hydroxide
(KOH) preparation
Woods Lamp
Topical:
Selenium sulfide shampoo
(Selsun Blue) every day for
2 weeks.
F/U PRN
Waxing and
waning Sx
Fungal
Pruritis of scalp
Pruritis of affected
area
Pruritis of groin
Pruritis of foot/feet
Mild pruritis of
affected area
19DERMATOLOGICAL
Consider
bacterial
erythrasma if
not improving
CHIEF COMPLAINT: VESICULAR

CONDITION &
DEFINITION
KEY FEATURES
DIFFERENTIATING SIGNS &

SYMPTOMS
DIFFERENTIATING
OBJECTIVE FINDINGS
COMMON
DIAGNOSTIC
TEST
TREATMENT
FOLLOW-UP
Atopic Dermatitis
Recurrent eruptions
associated with
history of hay fever,
asthma, dry skin or
eczema.
Papulovesicular
patch
Chronic history of same
Lichenified vesicular
patches with classic
distribution of flexural
area of extremities
Usually none
indicated
Topical:
Hydrocortisone 1%
cream
Antihistamine:
diphenhydramine
(Benadryl) for itch
F/U if not
improved in 7
days
Contact Dermatitis
Cutaneous reaction
to irritant like
chemical, product,
metal, latex,
clothing, soap,
plant, etc.
Papulovesicular
patch
Acute history of contact to

exogenous plant, chemical or
metal; common offending
agents include poison
ivy/oak/sumac
Wet, papulovesicular
patch with geometric
outline and sharp
margins
Usually none
indicated
Oral Steroid:
Prednisone (tapered
dose)
Antihistamine:
diphenhydramine
(Benadryl) for itch
F/U if not
improved in 7
days
Eczematous
Dermatitis or
Dyshidrosis
Recurrent eruptions
affecting the hands
and feet.
Papulovesicular
patch
Acute or chronic associated

with excessive sweating,
related to stress or irritation by
nickel, chromate or cobalt
Papulovesicular patches
on hands or feet soles
(Some shoes have
metal that are causative
agent)
Usually none
indicated
Topical:
Hydrocortisone 1%
cream
F/U PRN; usually

chronic; may
develop
secondary
bacterial infection
Acute or chronic. Primary

infection; fever, malaise,
headache, regional
adenopathy.
Grouped grape-like
cluster of uniform
vesicles that quickly
become papules that
rupture & weep
Tzanck Smear or
HSV antibody titers
Antiviral:
IF not resolved in
14 days, contact
MO for advice
Eczematous
Pruritis is
prominent
symptom
Severe pruritis.
Mild pruritis
Scratching or oozing and

crusting may occur
Infectious
Herpes Simplex
Virus
Recurrent,
incurable,
contagious viral
disease. (see oral
and genital)
Localized, grouped,
uniform lesion
Recurrent lesions with

prodrome of fever or local
warmth, burning, usually just
prior to eruption
May be found on any

body location
Usually recurs in same
location
20DERMATOLOGICAL
Acyclovir (Zovirax) for

best results, take with
first onset of Sx
Good hygiene
Patient education on
transmission. Condom
use if genital
Disease Alert
Report required
IF primary genital
infection
CHIEF COMPLAINT: VESICULAR (continued)

CONDITION &
DEFINITION
KEY FEATURES
DIFFERENTIATING SIGNS
& SYMPTOMS
DIFFERENTIATING
OBJECTIVE FINDINGS
COMMON
DIAGNOSTIC TEST
TREATMENT
FOLLOW-UP
Localized,
unilateral, linear,
dermatomal lesion
Acute prodrome of knife-like

pain, pruritis prior to eruption;
lesion lasting weeks to
months with predominant
complaint of pain
Groups of vesicles on an
erythematous base
situated unilaterally along
a dematomal (nerve)
distribution
Usually none
indicated
Antiviral:
Acyclovir (Zovirax)
Analgesic:
Acetaminophen OR
ibuprofen OR
acetaminophen with
codeine (narcotic)
given short duration
or as advised by MO
Contact MO for
advice
Infectious (cont)
Herpes Zoster
Shingles is a
latent cutaneous
varicella virus
infection involving a
single dermatome It
is not infectious,
though it may
cause primary
varicella if not
immune.
Lesion lasting weeks

to months
Impetigo
Superficial
contagious skin
infection caused by
Staphylococcus
aureus, Group A
beta-hemolytic
streptococci or
Streptoccus
Pyogenes
Localized crusted
lesion
Acute
Smallpox
Highly contagious
and deadly
orthopox virus. It
has been
eradicated through
aggressive
immunization
programs, though
has the potential for
use in bioterrorism.
Prodrome regional
maculopapular
rash
Acute onset with

oropharyngeal, facial, &
arm lesions spreading to
trunk & legs
History of minor trauma to

area may be associated
with disruption leading to
weeping lesion that
becomes crusted
Fever, headache,
abdominal pain, vomiting,
backache, & extreme
malaise
Honey-crusted lesion
with red base, usually on
face, that may have
multiple new lesions
surrounding
Culture wound on
the advice of MO
Antibiotic:
Dicloxacillin or
cephalexin (Keflex)
Good hygiene
F/U if not improved

in 7 days
After 1-2 days, cutaneous

lesions become vesicular,
then pustular; unlike
varicella, all lesions are in
the same stage of
development on a given
body part. After 8-9 days
all lesions become
crusted.
Viral culture notify

laboratory of
smallpox suspicion;
highly contagious
Treatment is
generally supportive,
with antibiotics for
secondary bacterial
infections. Antivirals
have never been
used clinically.
CONTACT MO
and Flight
Surgeon
21DERMATOLOGICAL
Notify Command Disease Alert

Report
Be familiar with
the SVP.
http://www.smallpox.
army.mil/
CHIEF COMPLAINT: VESICULAR (continued)

CONDITION &
DEFINITION
KEY FEATURES
DIFFERENTIATING
SIGNS & SYMPTOMS
DIFFERENTIATING
OBJECTIVE FINDINGS
Generalized macules
that quickly develop to
papules, rupture &
crust
Acute prodrome of
chills, fever, malaise,
headache, sore throat,
anorexia, dry cough
Crops of vesicles
described as dewdrop
on a rose petal in
varying stages of
development from
macules to papules to
vesicles to crusted
lesions; first on trunk,
then head and
extremities
COMMON
DIAGNOSTIC
TEST
TREATMENT
FOLLOW-UP
Symptomatic
treatment; Selflimiting though a
course of acyclovir
my shorten
duration
Antiviral:
Acyclovir (Zovirax)
Bed rest
CONTACT MO
for advice
Infectious (cont)
Varicella
Chickenpox is a
highly contagious
viral disease,
spread by
respiratory droplets
or direct contact.
Lesions first develop on

trunk, then to head and
extremities
Classic crops of
lesions with new
papules develop
simultaneously with
ruptured crusted lesions
Pruritis
22DERMATOLOGICAL
CBC otherwise
usually nothing
indicated
Infectious from
48 hours
before rash to
when all
lesions crusted
over
Disease Alert
Report required
Heals without
scar
CHIEF COMPLAINT: RED EYE OR PAIN

CONDITION &
DEFINITION
KEY FEATURES
DIFFERENTIATING
SIGNS & SYMPTOMS
DIFFERENTIATING
OBJECTIVE FINDINGS
COMMON
DIAGNOSTIC
TEST
TREATMENT
FOLLOW-UP
Blepharitis
Inflammation of the
eyelid by either
seborrhea or
staphylococcal
cause.
Erythema of the
eyelid margin
Seborrheic
Blepharitis: Dry flakes
and oily secretion on
the lid margins
Complete eye exam

Erythema of lid margin
that may be ulcerated if
staphylococcal infection
Usually none
indicated
Clean eyelid
margin with baby
shampoo (also
see seborrhea
dermatitis)
F/U if not resolved

in 14 days
For
staphylococcal:
Topical
ophthalmic:
Gentamycin OR
erythromycin
solution/ointment
No contact lens
use until resolved
Warm compress
to promote
drainage 5-10
minutes tid
No contact lens
use until resolved
No contact lens
use until resolved
Immediate
irrigation with
copious normal
saline for at least
10 minutes. Hold
eyelid open.
Chalazion
Non-infectious
meibomian gland
occlusion causing
swelling.
Chemical Burn to
eye
Self explanatory.
Itchy, watery,
burning sensation
Staphyloccocal
Blepharitis: Ulcerations
at base of eyelashes
and photophobia
Non-tender
erythemic
papule of the
eyelid
Mild foreign body

sensation but usually
painless
Complete eye exam
Swelling behind the lid

margin
Usually none
indicated
Itchy, watery,
burning
sensation
Erythema of the
affected part of
the eye
Itchy, watery,
burning
sensation
Determine causative
agent
Complete eye exam
Generalized erythema of
affected area
Assess for corneal

abrasion with fluorescein
stainepithelial defect
shows brilliant green with
fluorescent staining
Usually none
indicated
Fluorescein
staining to
determine
ulceration or
abrasion
If alkali burn,
irrigate for at least
40 minutes and
during transport if
possible
MEDEVAC
23EENT
F/U if not resolved

in 14 days
CONTACT MO or
Duty Flight
Surgeon
Emergency
transport to
emergency
department or
ophthalmologist
must be considered
CHIEF COMPLAINT: RED EYE OR PAIN (continued)

CONDITION &
DEFINITION
KEY FEATURES
DIFFERENTIATING
SIGNS & SYMPTOMS
DIFFERENTIATING
OBJECTIVE FINDINGS
COMMON
DIAGNOSTIC TEST
TREATMENT
FOLLOW-UP
Conjunctivitis,
Allergic
Inflammation of the
conjunctiva.
Erythema of
the eyelid
Complete eye exam
Bilateral Itchy,
watery,
burning
sensation
Different Palpebral
conjunctiva with
cobblestone-like
swelling
Usually none
indicated
Topical ophthalmic:
liquid tears
Oral Antihistamine:
Diphenhydramine
(Benadryl), loratadine
(Claritin), or
Fexofenadine
(Allegra)
Treat underlying
allergic symptoms
F/U if not
resolved in 14
days
History of allergies,
Rhinorrhea, itchy,
watery eyes
Seasonal
environmental
conditions present
Conjunctivitis,
Infectious
Contagious viral or
bacterial infection of
the conjunctiva.
Erythema of
the eyelid
Itchy, watery,
burning
sensation
Pink eye refers to

bacterial infection.
Corneal Abrasion
Breakdown in the
epithelial barrier due
to an abrasive injury
or contact lenses.
Most common eye
injury.
Foreign body
sensation, tearing
Bacterial - may have

history of inoculation
or family member
with pink eye,
purulent discharge
with morning
crusting of lid
margin
Complete eye exam
Injected conjunctiva
and margin edema
Bacterial crusted
discharge may or may
not be present
Viral may have

associated viral
symptoms with
watery discharge
History of trauma or
contact lens irritation
Severe pain and

photophobia
Usually none
indicated
Viral - may have

preauricular
adenopathy
Complete eye exam
Consider tetracaine
0.5% ophthalmic
solution to help
examine eye
Epithelial defect shows

brilliant green with
fluorescein staining
24EENT
Fluorescein staining
to confirm abrasion
No contact lens
use until resolved
Topical ophthalmic:
Bacterial infection
- Gentamicin OR
erythromycin
solution/ointment
Viral infection
liquid tears
Good hygiene
No contact lens
use until resolved
Irrigation with normal

saline for at least 10
minutes
Topical ophthalmic:
Gentamicin OR
erythromycin
solution/ointment
No contact lens
use until resolved
F/U if not
resolved in 7
days
Usually
resolves in 24
hours
If not resolved
in 24 hours
consult MO

CONDITION &
DEFINITION
KEY FEATURES
DIFFERENTIATING
SIGNS & SYMPTOMS
DIFFERENTIATING
OBJECTIVE FINDINGS
COMMON
DIAGNOSTIC TEST
TREATMENT
FOLLOW-UP
Foreign Body on
eye
Self explanatory
Foreign body
sensation, tearing
History of trauma
Complete eye exam
Mild to severe pain
Photophobia
IF/U if not
resolved in
24 hours
Foreign body
sensation
Consider tetracaine
0.5% ophthalmic
solution to help
examine eye
Fluorescein staining
to determine
abrasion
Reinforce eye
protection
use
Tearing
Glaucoma
Closed-angle
glaucoma is an acute
decreased outflow of
aqueous humor
through pupil due to
an anatomically
narrow anterior
chamber increasing
intraocular pressure.
(open-angle is a slow
progressive disease)
Injected
conjunctiva
and ocular
pain
May have
eyelid edema
Acute blurred
vision
Frontal headache
Lacrimation
Halos around
lights
Possible nausea &

vomiting
Foreign body may be

imbedded and
sometimes difficult to
find & may or may not
cause abrasion
Epithelial defect shows

brilliant green with
fluorescein staining
Complete eye exam
Tonometry
Increased intraocular
pressure (IOP) to 50-65
mmHg. IOP in uveitis is
generally 35-45 mmHg
If no tonometry,
red, painful eye
with visual
halos is
warning sign
25EENT
Attempt to
visualize foreign
body and carefully
remove using
cotton-tip moist
with normal saline
Irrigation with
normal saline for
at least 10
minutes
Topical
ophthalmic:
Entamicin OR
erythromycin
solution/ointment
No contact lens
use until resolved
Emergency treatment
is required as the
optic nerve may
become compressed
by high intraocular
pressure
No contact lens
use until resolved
CONTACT MO
or Duty Flight
Surgeon
MEDEVAC

CONDITION &
DEFINITION
KEY FEATURES
DIFFERENTIATING
SIGNS & SYMPTOMS
DIFFERENTIATING
OBJECTIVE FINDINGS
COMMON
DIAGNOSTIC
TEST
TREATMENT
FOLLOW-UP
Hordeolum
Infection or
inflammation of
eyelid hair follicle
internal or external
(aka sty)
Sudden onset of
localized tenderness on
eyelid margin
Complete eye exam

Erythemic papule on
eyelid margin
Usually none
indicated
F/U if not
resolved in 7
days
Bacterial infection usually

has discharge in area
Warm compress
to promote
drainage 5-10
minutes tid
No contact lens
use
Bacterial infection:
gentamicin or
erythromycin
solution/ointment
No contact lens
use until resolved
Hyphema
Blood in the anterior
chamber
Tender
erythemic
papule on
eyelid margin
Itchy, watery,
burning
sensation
May or may not

have erythema of
the eyelid
Pinguecula
Benign yellowish
colored lesion on
bulbar conjunctiva
caused by irritation
Pterygium
Benign yellowish
colored lesion
encroaching onto
the cornea caused
by irritation
Perceived as
unsightly
Perceived as
unsightly
spontaneous
presentation
Complete eye exam
Blood in anterior
chamber, decreased
visual acuity, intraocular
pressure may rise
Dull ache &

decreased vision
Eye irritation and patient

concern
Complete eye exam
Triangular, fleshy papule

over sclera/bulbar
conjunctiva
Eye irritation, visual

changes, & patient
concern
Complete eye exam
Triangular, fleshy growth

of bulbar conjunctiva onto
the cornea; nasal side
Asymptomatic
Asymptomatic
26EENT
Tonometry
Think: concern for

increased intraocular
pressure
Bed rest for 3-5 days
CONTACT MO
or Duty Flight
Surgeon
No contact lens
use until resolved
Usually none
indicated
Reassurance
F/U PRN
Consult with
MO if in doubt
Usually none
indicated
Reassurance
F/U PRN
Consult with
MO if in
doubt. Refer
to optometrist
if change in
acuity.
No contact lens
use until resolved
No contact lens
use until resolved

CONDITION &
DEFINITION
KEY FEATURES
DIFFERENTIATING
SIGNS & SYMPTOMS
DIFFERENTIATING
OBJECTIVE FINDINGS
COMMON
DIAGNOSTIC TEST
TREATMENT
FOLLOW-UP
Retinal Detachment
Self-explanatory. The
cause can be trauma
or retinal tear
common in highly
myopic [good nearsight (minus lens)]
individuals
Decrease or loss
of vision
History of visual
flashes of lights or
sparks
Complete eye exam
Ophthalmoscope
Patch as directed
Detached retina
appears gray with
white folds during
ophthalmoscope exam
Tonometry
Emergency
treatment is
required
CONTACT MO
or Duty Flight
Surgeon
MEDEVAC
No contact lens
use until resolved
Subconjunctival
Hemorrhage
Blood under the
conjunctiva
May or may not

have erythema of
the eyelid
Tonometry
May be described as
a curtain falling or
cloudy or smoky in
front of their eye
Asymptomatic.
Complete eye exam
History of venous
pressure from
straining
Blood under the

conjunctiva may spill
over into the lower lid
margin
No treatment is
necessary short of
treatment to
associated minor
trauma if any.
Treat underlying
illness if present
Uveitis
Acute inflammation of
the uveal tract (iris,
ciliary body and
choroids), increasing
intraocular pressure
Injected
conjunctiva &
ocular pain
Acute blurred vision,

deep ache & photophobia
May have history of
trauma or inflammatory condition
Complete eye exam
Tonometry
Dilated pupil, injected

flare along limbus
border
Increased intraocular
pressure to 35-45
mmHg
If no tonometry, red,
painful eye with
photophobia is
warning sign.
27EENT
No contact lens
use until resolved
Emergency treatment
is required as the
optic nerve may
become compressed
by high intraocular
pressure
F/U if not
improved in 14
days
No contact lens
use until resolved
CONTACT MO
or Flight
Surgeon
MEDEVAC
CHIEF COMPLAINT: EARACHE

CONDITION &
DEFINITION
KEY FEATURES
DIFFERENTIATING
SIGNS & SYMPTOMS
DIFFERENTIATING
OBJECTIVE FINDINGS
COMMON
DIAGNOSTIC TEST
TREATMENT
FOLLOW-UP
Barotrauma
Ear pain or damage
caused by rapid change
in pressure
Ear pain
rapid pressure
change
Conductive hearing loss
Weber or Rinne
Test
Self-limiting
Whisper test or
Audiogram
Decongestant
or Valsalva
maneuver may
be helpful
F/U if not
improved in 7
days
Cerumen Impaction
Cerumen is a natural
lubricant for the ear
canal; accumulation of
cerumen can cause
obstruction, thus hearing
loss, tinnitus, and
infection.
Ear pain and/or

hearing loss
Eustachian Tube
Dysfunction
ET equalized pressure in
the middle ear. Viral
symptoms and allergies
may block tube with
swelling.
Ear pain and/or

hearing loss
Popping sensation in
ear
Normal TM
Tympanometry.
(normal peak though
may be diminished)
Decongestant:
Pseudoephedrine
F/U if not
improved in 7
days
Mastoiditis
Infective process of the
mastoid air cells
Ear pain
History of recurrent or
inadequate treat-ment
of otitis media
Fever, bulging purulent

& erythemic TM
CBC & mastoid

radiographs
Antibiotics:
Ceftriaxone IV
(Rocephen)
(consult with MO
prior to
administering drug)
CONTACT MO
or Duty Flight
Surgeon
MEDEVAC
R/O TM perforation
Acute hearing loss
May be
asymptomatic
Bilateral or unilateral
itchy sensation in ear
canal
TM not visible with

irritated appearing
external canal
Chronic Q-tip use in

ear canal causes
cerumen production
leading to impaction
Feverish feeling
Emulsifying
Agent:
Debrox
Postauricular edema
and tenderness
Ear irrigation
with warm
sterile water
Emergency
treatment is
required
28EENT
F/U if not
improved in 7
day
CHIEF COMPLAINT: EARACHE (continued)

CONDITION &
DEFINITION
KEY FEATURES
DIFFERENTIATING
SIGNS & SYMPTOMS
DIFFERENTIATING
OBJECTIVE FINDINGS
COMMON
DIAGNOSTIC TEST
TREATMENT
FOLLOW-UP
Otitis Externa
Infection of the
external auditory canal
Ear pain
May have history of

swimming
Tenderness with pinna

tug
Topical:
Corticosporin
Itchy sensation in
ear canal
Edema and erythema of

external canal
May have otorrhea
Normal TM
F/U if not
improved in 7
days;
R/O
Pseudamona
s infection
with
persistent
symptoms
History of viral
symptoms or
Eustachian tube
dysfunction
TM inflamed, non-mobile,
bulging with decreased
light reflex
Tympanometry
F/U if not
improved in 7
days
May have nasal

discharge, otorrhea,
fever or dizziness
Antibiotics:
Amoxicillin
(Amoxil), or
erythromycin
(Emycin)
History of trauma,
barotrauma, or
insertion of object
into ear canal
TM perforated. Blood may

be present in canal
Tympanometry
No specific
treatment
Keep ear dry

with ear plugs
in shower
F/U if not
improved in 7
days
No swimming
Otitis Media
Infection of the middle
ear
Perforation of
Tympanic Membrane
Self-explanatory
Ear pain
Ear pain and

hearing loss
Serous Otitis Media

Effusion of serous
fluid in middle ear
Temporomandibular
Joint (TMJ)
Syndrome
Pain in the TMJ that
may be referred to the
ear; commonly caused
by grinding of teeth
Ear Pain
Ear or TMJ pain
Bleeding from canal,

hearing loss, tinnitus
History of viral or
allergy symptoms or
Eustachian tube
dysfunction
Popping sensation
in ears
Popping sensation
in TMJ or ears
Headache
Audiogram before
and after treatment
TM is relatively normal with

fluid line or fluid bubble
visible
Tympanometry
Decongestant:
Pseudoephedrine
F/U if not
improved in 7
days
Normal ear exam
F/U PR
May have tenderness

and crepitus of TMJ
with range of motion
test or mastication
Stress
reduction may
be helpful
Referral to
dental clinic
29EENT
CHIEF COMPLAINT: STUFFY NOSE

CONDITION &
DEFINITION
KEY FEATURES
DIFFERENTIATING
SIGNS & SYMPTOMS
DIFFERENTIATING
OBJECTIVE FINDINGS
COMMON DIAGNOSTIC
TEST
TREATMENT
FOLLOWUP
Allergic Rhinitis
Allergic response to
airborne allergens
affecting the nose
and eyes
Nasal
congestion
Usually none
indicated
CBC (eosinophilia)
Postnasal drip may

cause cough
May have dark circles

under eyes
CT of sinus if Sx
persist
Antihistamine:
loratadine
(Claritin), or
fexofenadine
(Allegra)
F/U PRN
Seasonal
allergies
common in the
spring where
perennial
allergies may
last all year
Pale, boggy
turbinates, conjunctiva
injection
Watery, itchy eyes

and nose, sneezing,
clear nasal discharge
Common Cold
Viral upper
respiratory infection
occurring anytime
during the year.
(influenza is usually
in winter months)
Nasal congestion.
General malaise and

low-grade fever
Possible fever
Rhinorrhea, sore
throat, and cough
Nasal turbinate edema

and erythema with
clear/white discharge
F/U if not
improved in
7 days
Influenza has high

fever with more acute
& severe Sx
Injected conjunctiva
and throat
Clear lungs
Self limiting.
Analgesic:
Acetaminophen or
ibuprofen
Decongestant:
Pseudoephedrine
or combined with
antihistamine
Bloody nose
May have history of

aspirin or NSAID use
or trauma
Bleeding from the

nostril(s) and/or clot
Anterior
epistaxis:
Pinch nostrils for
several minutes.
Vasoconstrictor
like Afrin may
help.
Posterior
epistaxis: Pack
nostril with
Vaseline-coated
gauze
Refer for
emergency
intervention
if
unsuccessful
immediate
treatment
Epistaxis
(Nosebleed):
Anterior:
Kiesselbachs
plexus
Posterior:
posterior half of
roof of nasal
cavity
May be
idiopathic,
traumatic or
medical cause
Stuffy nose
30EENT
CBC
CT of sinus if Sx
persist
CHIEF COMPLAINT: STUFFY NOSE (continued)

CONDITION &
DEFINITION
KEY FEATURES
DIFFERENTIATING
SIGNS & SYMPTOMS
DIFFERENTIATING
OBJECTIVE FINDINGS
COMMON
DIAGNOSTIC
TEST
TREATMENT
FOLLOW-UP
Sinusitis
Inflammation or
infection of mucous
membranes of
paranasal sinus
Nasal congestion
Sinus pressure,
facial pain or
headache
Turbinates are
erythemic and swollen
Usually none
indicated
Face pain worse when

bending over (tilt test),
sinus tenderness with
percussion
CT of sinus if
Sx persist
Reserve
antibiotics for
patients that fail a
7 day course of
decongestants
and analgesics
F/U if not
improved in 7
days or
increased fever
or headache
Antibiotic:
Amoxicillinclavulanate
(Augmentin) or
Septra DS
May have yellow green nasal

discharge, maxillary
toothache, fever or
malaise
May be unable to
transilluminate sinuses
31EENT
CHIEF COMPLAINT: SORE MOUTH/THROAT

CONDITION &
DEFINITION
KEY
FEATURES
DIFFERENTIATING
SIGNS & SYMPTOMS
DIFFERENTIATING
OBJECTIVE FINDINGS
COMMON
DIAGNOSTIC
TEST
TREATMENT
FOLLOW-UP
Aphthous Ulcer
Mouth ulceration on
buccal mucosa referred
to as canker sore.
Cause is idiopathic
though may be related to
stress or other more
serious condition if
recurrent.
Mouth sore
Painful ulcers
White circular lesions

surrounded by an
erythematous margin
Usually none
indicated
OTC benzocaine
preparations like
Anbesol and
Oragel
F/U PRN
Epiglottitis
Inflammation and
infection of the epiglottis.
More common in
children.
Sore throat

Incurable, contagious,
recurrent viral disease.
HSV1 generally
associated with oral
symptoms and HSV2
genital symptoms though
may be mixed and not
distinguishable clinically.
Referred to as fever
blister. Recurrence may
be associated with sunlight, illness, or emotional
stress.
Refer to MO if
recurrent
Reassurance
Mouth sore
Fever, dysphagia,
drooling, muffled voice,
and may hold tripod
position (head forward
and tongue out)
May have prodrome

of localized pain,
warmth, burning
usually just prior to
irruption
Occasional tender
adenopathy
Headache, myalgia,
or fever
Primary infection may

be worst of Sx
Inspiratory strider,
cervical adenopathy
Blood culture
Throat most likely

appears normal
Throat culture
conducted ONLY
in emergency
room with
tracheostomy kit
available
Do NOT use tongue

blade to visualize
throat
Primary infection:
grouped grape-like
cluster of uniform
vesicles on
erythematous base;
lesions erode and
crust, last 2 to 6
weeks
Recurrent Infection:
same as above
though dome
shaped lesions
rupture and crust
lasting about 8 days
32EENT
Chest radiograph
Tzanck Smear or
HSV antibody titers
Antibiotics:
Ceftriaxone IV
(Rocephen)
(consult with MO
prior to
administering drug)
CONTACT MO or
Duty Flight
Surgeon
MEDEVAC
Emergency
treatment is
required
Antiviral:
Acyclovir (Zovirax)
For best results,
take with first onset
of Sx
Patient
education on
transmission
Condom use if
genital
IF not resolved
in 14 days
contact MO for
advice
Disease Alert
Report required
IF primary
genital infection
only
CHIEF COMPLAINT: SORE MOUTH/THROAT (continued)

CONDITION &
DEFINITION
KEY FEATURES
DIFFERENTIATING
SIGNS & SYMPTOMS
DIFFERENTIATING
OBJECTIVE FINDINGS
COMMON
DIAGNOSTIC
TEST
TREATMENT
FOLLOW-UP
Laryngitis
Inflammation of the
mucosa of the larynx
or vocal cords may
be associated with
excessive voice use
or virus
Sore throat
Voice hoarseness main

feature
Exam may be normal or

have slight pharyngeal
erythema
Usually none
indicated
Supportive care
F/U if not
improved in 7
days
Mononucleosis
Contagious infection
caused by the
Epstein-Barr virus.
Spread by person to
person
oropharyngeal route
Gradual onset of
sore throat, fatigue
and malaise
Headache, fever,
malaise, fatigue
Appears ill and is

febrile
Sx generally lasting
longer than 2 weeks (a
normal course for
common viral
syndromes)
Palatal petechiae is
key feature with
white membrane on
tonsils, posterior
cervical adenopathy,
hepatic or splenic
enlargement
Rapid Strep test

(30% with mono
also have strep
throat)
Mono Spot
CBC
Consider EBV,
LFT and throat
culture
Avoid contact
sports
Good hygiene
If viral, fever, malaise,

difficult swallowing,
regional
lymphadenopathy may
be present
May have generalized

maculopapular rash
Peritonsillar
Abscess
Bacterial cellulites of
peritonsillar area.
Initiates in tonsil and
spreads to
surrounding soft
tissue.
Severe sore throat

and difficulty
swallowing
Fever with marked

trismus (difficulty
opening mouth)
Virtually always
unilateral and hot
potato voice
Appears ill and is

febrile
Pharyngeal
erythema, tonsil
displaced medially
with unilateral neck
swelling
Strict voice rest for
a few days or until

resolving
CT of neck or
ultrasound can
confirm diagnosis
Supportive care.
Recovery may
take weeks.
Maintain healthy
diet and rest
Antibiotic:
Penicillin IV or
ceftriaxone IV
(Rocephen)
(consult with MO prior
to administering drug)
Emergency treatment
is required. (Incision
& drainage of
abscess completed in
emergency room)
33EENT
Consult MO
or Duty Flight
Surgeon
Follow up if
not improved
in 30 days
CONTACT MO
or Duty Flight
Surgeon
MEDEVAC
CHIEF COMPLAINT: SORE MOUTH/THROAT (continued)

CONDITION &
DEFINITION
KEY FEATURES
DIFFERENTIATING
SIGNS & SYMPTOMS
DIFFERENTIATING
OBJECTIVE
FINDINGS
COMMON
DIAGNOSTIC
TEST
TREATMENT
FOLLOW-UP
Pharyngitis,
Bacterial
Infection of throat by
group A betahemolytic
streptococci; other
organisms can cause
bacterial infection,
but they are not
discussed here.
Also referred to as
tonsillopharyngitis
Severe sore throat
Acute onset
May appear ill and

is febrile
Triad: pharyngeal
erythema (beefy
red), tonsillar
exudate, cervical
adenopathy
Rapid Strep
Throat culture if
rapid strep
negative
Antibiotic:
Penicillin VK
F/U if not
improved in 7
days
Tonsillar
hypertrophy
may be present
and concern for
airway
obstruction
Pharyngitis, Viral
Viral infection of the
throat (also see
mono-nucleosis)
Acute onset of
sore throat and
malaise
Fever
Rapid Strep
Rhinorrhea
Viral conjunctivitis
Pharyngeal
erythema
Nonproductive
cough
Describes halitosis,
fever, difficulty
swallowing, chills,
malaise & headache
Usually NO common
cold symptoms or cough
Salivary Stone
Calcium salts
accumulate in
salivary glands
causing parotid,
submandibular or
sublingual duct
obstruction.
Swelling and pain

of the salivary
gland
Feverish, difficulty
swallowing, chills,
malaise, and
headache
Coryza and common
cold symptoms usually
suggest viral, not
bacterial infection
Localized pain is key

feature mostly after eating
The stone may be felt

by palpation of the
duct/gland in the
mouth
34EENT
If stone is not
apparent on exam,
give patient lemon
juice, hard candy
(something to
stimulate saliva).
Reproduction of Sx
is diagnostic.
Saline gargle
New toothbrush
Good hygiene
Family may have

same Sx
consider
testing/treatment
Supportive care
Saline gargle
Good hygiene
Manual
manipulation
(massage) of
duct/gland may
help stone
extraction
Antibiotics
indicated if
associated
bacterial infection
present
F/U if not improved

in 7-14 days
F/U if not
improved in 7
days
Watch for
secondary
infection
CHIEF COMPLAINT: CHEST PAIN

CONDITION &
DEFINITION
KEY FEATURES
DIFFERENTIATING
SIGNS & SYMPTOMS
DIFFERENTIATING
OBJECTIVE FINDINGS
COMMON
DIAGNOSTIC TEST
TREATMENT
FOLLOW-UP
Acute onset of
O acute
P rest may make
better, activity/stress
makes worse
Q dull, tight, pressing,
not usually sharp pain
R substernal ache,
radiating to back or
shoulders
S severe to vague
T angina at rest lasts
longer then 20 minutes.
Shortness of breath,
nausea, diaphoresis, &
weakness may be
associated
Appears anxious,
diaphoretic, pallor,
dyspnea
Assess vitals, jugular

vein distention, thirdfourth heart sound,
adventitious lung
sounds, extremity
edema
ECG may have

non ST-segment
changes. STsegment
elevation and/or
Q-waves is
suggestive of MI
IV Normal
Saline
Morphine
Oxygen
Nitroglycerin
Aspirin
CONTACT MO
or Duty Flight
Surgeon
MEDEVAC
Troponin-I Normally,
troponin levels
are very low;
even slight
elevations can
indicate some
degree of
damage to the
heart
Comfortable
rest
Emergency
treatment is
required
Cardiac
Acute Coronary
Syndrome
Acute obstruction
of coronary artery.
Ranges from
unstable angina
pectoris (cardiac
chest pain at rest)
to myocardial
infarction (necrosis
of heart muscle) to
sudden death.
Known as Acute
Myocardial
Infarction (MI)
Angina Pectoris
Chest pain caused
by diminished
oxygen supply to
heart muscle by
ischemia or
narrowing of the
coronary arteries.
Stable angina is
exercise induced.
Unstable angina
also occurs at rest.
Prinzmetals angina
may occur at rest;
caused by coronary
artery spasms, not
ischemia.
chest pain
Patient may
focus on denial
of cardiac
relation to
cardiac
condition
Acute onset of
chest pain
Denial of cardiac
relation may be
patient focus
O acute
P rest may make
better, activity/stress
makes worse
Q dull, tight, pressing,
not usually sharp pain
R substernal ache,
shoulders
S severe to vague
T see definition
weakness may be
associated
Creatinine kinase
(CK) or CK-MB
Appears anxious,
dyspnea
No test is
diagnostic for
angina
Assess vitals, jugular

vein distention, thirdfourth heart sound,
adventitious lung
sounds, extremity
edema
ECG is indicated
though may be
normal. Unstable
angina may have
ST segment
changes.
35CARDIOVASCULAR
IV Normal
Saline
Morphine
Oxygen
Nitroglycerin
Aspirin
Comfortable
rest
Emergency
treatment is
required
CONTACT MO
or Duty Flight
Surgeon
MEDEVAC
CHIEF COMPLAINT: CHEST PAIN (continued)

CONDITION &
DEFINITION
KEY FEATURES
DIFFERENTIATING
SIGNS & SYMPTOMS
DIFFERENTIATING
OBJECTIVE
FINDINGS
COMMON
DIAGNOSTIC TEST
TREATMENT
FOLLOW-UP
Acute onset of
chest pain
O acute
P relieved by leaning
forward and sitting up
Q dull, tight, pressing
R substernal ache,
shoulders
S severe to vague
T may have recent viral
syndrome
weakness may be
associated
ECG may have

ST-segment
concave
elevation in most
leads creating a
smile face
Analgesics:
CONTACT MO
or Duty Flight
Surgeon.
CBC and Chest

radiograph
Physical complaints
prompt patient to seek
medical attention; worry,
insomnia, muscle tension,
headache, fatigue, GI
upset.
ECG is normal
Objective
Anxiety
Questionnaire.
(Becks)
Acute Tx:
Antianxiety:
hydroxyzine (Atarax)
OR diazepam
(Valium)
Chronic Tx:
Refer to MO
CONTACT MO
or Duty Flight
Surgeon IF
doubt
History of physical
exertion or trauma to
chest or ribs
Direct palpable chest

wall tenderness of
costochondral
ligament/muscle
Analgesics:
Acetaminophen or
ibuprofen
CONTACT MO
or Duty Flight
Surgeon IF
doubt
Cardiac (continued)
Pericarditis
Inflammation of the
pericardium
(fibroserous sac
surrounding the
heart)
Appears anxious,
dyspnea
Assess vitals,
febrile, friction rub
heart sound,
adventitious lung
sounds
Aspirin or
ibuprofen
Oxygen PRN
Comfortable rest.
Emergency
treatment may be
necessary
Consider
MEDEVAC
as MI cannot
be ruled out
Non-Cardiac
Anxiety
Excessive worry,
fear, nervousness,
and hypervigilance.
May be associated
with adjustment
disorder or
generalized.
Chest pain may be

associated with
stress or panic
attack
Costochondritis
Tietzes disease
is an inflammation
of the rib cartilage/
ligament/muscles.
Chest pain is
exacerbated by
cough or deep
breathing
Appears anxious,
dyspnea
Mental health
interview
Assess vitals and

R/O cardiac
involvement
ECG is normal
Reassurance
36CARDIOVASCULAR
CHIEF COMPLAINT: CHEST PAIN (continued)

CONDITION &
DEFINITION
KEY FEATURES
DIFFERENTIATING
SIGNS & SYMPTOMS
DIFFERENTIATING
OBJECTIVE FINDINGS
COMMON
DIAGNOSTIC TEST
TREATMENT
FOLLOW-UP
Epigastric heartburn
May have normal

exam findings
ECG is normal
Acute Tx:
H2 Inhibitor:
Ranitidine (Zantac)
For chronic Tx or
H. pylori refer to
MO
CONTACT MO or
Duty Flight
Surgeon IF doubt
Analgesics:
Aspirin or ibuprofen
F/U if not
improved in 7
days
Consult with
MO PRN
Non-Cardiac (continued)
Gastroesophageal
Reflux Disease
Irritation caused by
reflux of gastric
secretions into the
espophagus (i.e.
GERD). Excessive
use of tobacco,
alcohol, &
caffeinated products
can be contributing
factors
Chest pain and

nausea may be
associated with
meal, exercise, or
patient resting
supine
Pleuritis
Viral infection
causing
inflammation of the
pleurae sac
surrounding the
lungs
Chest pain
Regurgitation causing
bitter taste
Symptoms relieved by
sitting up or antacids
Assess for epigastric

tenderness
Antigen/antibody
for H. pylori
May have nagging

cough
Marked sharp
stabbing pain with
respiration
May have recent viral
syndrome
Febrile
ECG is normal
Friction fremitus with

respiratory sounds
Chest
radiographs
37CARDIOVASCULAR
CHIEF COMPLAINT: SYNCOPE

CONDITION &
DEFINITION
KEY FEATURES
DIFFERENTIATING
SIGNS & SYMPTOMS
DIFFERENTIATING
OBJECTIVE FINDINGS
COMMON
DIAGNOSTIC TEST
TREATMENT
FOLLOW-UP
Arrhythmia
Rhythm is just that;
regular, coordinated
electrical impulses.
Arrhythmia is loss of
heart rhythm, either
a regular or irregular
abnormality.
Transient, sudden
loss of consciousness that resolves
spontaneously
May have history of

arrhythmia and
fainting
Orthostatic blood
pressure
Refer to MO
Complete physical
examination
ECG is indicated
but may be
normal at time of
exam
Evaluate
urgency of case
Palpitations and
lightheadedness
may precede
syncope
CONTACT MO or
Duty Flight
Surgeon IF doubt
or abnormal ECG
Age usually greater

then 50
Orthostatic
Hypotension
Benign failure of
normal
compensation for
blood pressure drop
reducing blood flow
to brain due to
dehydration
Vasovagal syncope
has similar end
result with different
mechanism of action
Transient, sudden
loss of consciousness that resolves
spontaneously
Brought on by
dehydration
secondary to
vomiting, diarrhea,
bleeding, diuretic
medication,
emotional stress,
warm environment
Appears anxious,
dyspnea or normal
Orthostatic blood
pressure
Complete physical
examination
ECG is indicated
but may be
normal at time of
exam
Electrolyte
imbalance can
cause ECG
changes
Appears anxious,
dyspnea or normal
Palpitations and
lightheadedness
may precede
syncope
38CARDIOVASCULAR
IV NS or oral fluid
replenishment
CONTACT MO or
Duty Flight
Surgeon IF doubt
or abnormal ECG
CHIEF COMPLAINT: SYNCOPE (continued)

CONDITION &
DEFINITION
KEY FEATURES
DIFFERENTIATING
SIGNS & SYMPTOMS
DIFFERENTIATING
OBJECTIVE FINDINGS
COMMON
DIAGNOSTIC TEST
TREATMENT
FOLLOW-UP
Seizure
Paroxysmal hyper
excitation of the
neurons in the brain;
epilepsy is chronic
recurrent seizures
Compromised
motor activity
Partial Seizure no
loss of
consciousness,
though simple muscle
contractions,
paresthesias, loss of
bowel & bladder
Between seizures
physical exam is normal
though may have
bruising or trauma to
tongue just after
CBC
During seizure,
maintain airway
and prevent
injury
Consult with MO or
Flight Surgeon
Petit Mal Seizure

sudden stopping of
motor function with
blank stare
Grand Mal Seizure
loss of
consciousness, tonicclonic muscle
contractions, loss of
bowel & bladder;
postictal period
39CARDIOVASCULAR
Chemical Panel
Urinalysis
Drug & alcohol
screening
CT scan or MRI
Refer to MO
Seizure > 10
minutes needs
emergency
intervention!
CHIEF COMPLAINT: VASCULAR SYMPTOMS

CONDITION &
DEFINITION
KEY FEATURES
DIFFERENTIATING
SIGNS & SYMPTOMS
DIFFERENTIATING
OBJECTIVE FINDINGS
COMMON
DIAGNOSTIC TEST
TREATMENT
FOLLOW-UP
Deep Vein
Thrombosis
Blood clot(s) in the
calf or femoral veins
resulting in
inflammation
(e.g., DVT)
Leg pain
Limb pain and swelling
Calf tenderness
swelling with increased
diameter (note
difference between
unaffected calf)
Positive Homans
sign
Support hose
CONTACT MO or
Duty Flight
Surgeon
Raynauds Disease
Vasospasm of the
vessels of the digits
in response to cold
or stress
Hand pain
Normal examination
between attacks
Cold challenge test
Refer to MO
Cold challenge test

will reproduce Sx
Caution patient
about cold
exposure and to
stop tobacco use
Varicose Veins
Superficial veins
with incompetent
valves cause dilation
of veins
Burning sensation
and unsightly
discoloration at site
Usually nothing
indicated
Avoid prolonged
standing, and use
support hose PRN
Refer to MO PRN
Fingertips turn
mottled white and
red then cyanotic
Tobacco use
exacerbates Sx
Patient concern mostly
about appearance
though extensive
varicosities have
constant dull ache
Dilated, tortuous veins

of the medial anterior
ankle, calf or thigh
40CARDIOVASCULAR
Refer to MO
Evaluate
urgency of case
CHIEF COMPLAINT: COUGH

CONDITION &
DEFINITION
KEY FEATURES
DIFFERENTIATING
SIGNS & SYMPTOMS
DIFFERENTIATING
OBJECTIVE FINDINGS
COMMON
DIAGNOSTIC TEST
TREATMENT
FOLLOW-UP
Bronchitis,
Mycoplasma
Inflammatory
condition of the
tracheobronchial
tree caused by
mycoplasm
pneumoniae (nonbacterial)
Non-productive,
recurrent, barking
cough early, then
becomes
productive
Low-grade fever
Chest radiograph
Lung sounds: coarse

rhonchi and possibly
rales
Cough suppression
with expectorant:
Robitussin DM
Antibiotic:
Erythomycin (E-Mycin)
or Bactrim DS
Bed rest
F/U if not
improved in 7
days
Bronchitis, Viral
Inflammatory
condition of the
tracheobronchial
tree caused by virus
Non-productive,
recurrent, barking
cough
Lung sounds: coarse

rhonchi and possibly
rales
Chest radiograph
Cough suppression
with expectorant:
Robitussin DM
F/U if not
improved in 7
days
High fever
Chest radiograph
Nasal turbinate
edema & erythema
with clear/white
discharge
F/U if not
improved in 7
days
Injected conjunctive
and throat. Clear
lungs.
Analgesic:
Acetaminophen or
ibuprophen
Cough suppression
with expectorant:
Robitussin DM
Acute
Influenza
Flu is a viral
infection that affects
the nasopharynx,
conjunctiva, and
respiratory tract,
usually in winter
months.
(common cold
occurs anytime
during the year)
Non-productive
acute cough,
usually worse at
night
Severe cough with

purulent sputum
late
Sx persist for > 2

weeks
Fever, fatigue, and

possible
hemoptysis
Scant white to clear

sputum
May or may not

have fever
Sx usually 7-10
days
Common in
smokers
Abrupt onset of
nonproductive cough
with high fever,
malaise, headache,
Rhinorrhea, sore throat,
& conjunctivitis
(Common cold has lowgrade fever with less
severe Sx and may not
be seasonal)
41RESPIRATORY
Self limiting
Annual influenza
vaccine
CHIEF COMPLAINT: COUGH (continued)

CONDITION &
DEFINITION
KEY FEATURES
DIFFERENTIATING
SIGNS & SYMPTOMS
DIFFERENTIATING
OBJECTIVE FINDINGS
COMMON
DIAGNOSTIC TEST
TREATMENT
FOLLOW-UP
Productive,
severe cough
with copious
purulent sputum
High fever
Appears ill
Dark, thick, rusty

sputum
Febrile >
100F/37.8C
Chest radiograph
with lobar
consolidation
CONTACT MO or
Duty Flight
Surgeon
Tachypnea, shaking
chills, tachycardia,
malaise, confusion
Pulse > 100
Lung sounds: rales

and whispered
pectoriloquy
Assess
bronchophony &
egophony
Antibiotic:
Ceftriaxone (Rocephin)
Plus azithromycin
(Zithromax)
Analgesic:
Acetaminophen or
ibuprofen
Cough suppression
with expectorant:
Robitussin DM or with
codeine
Acute (continued)
Pneumonia,
Bacterial
Community
acquired
(outside
hospital/nursing
home) bacterial
infection of the
lung
Usually worse at
night
Streptococcus
pneumoniae
Pneumonia,
Mycoplasma
Atypical
pneumonia,
walking
pneumonia is an
infection of the
lung more
common in the
summer months
and in young
adults.
Non-productive, dry
cough
Mild symptoms,
sore throat, lowgrade fever, sore
throat & malaise
May appear ill
Headache usually
always present
Erythematous throat,
fluid-line or bubbles
behind TM
Lung sound: pleural

friction rub
Mycoplasma
pneumoniae
42RESPIRATORY
Pulse Ox
CBC
Note: Repeat chest xray in 4-6 weeks
Chest radiograph
with bilateral
pleural effusion
Pulse Ox
Consider Rapid
Strep & Mono
Spot if sore throat
severe
Consider oxygen
and IV NS
Bed rest
Antibiotic:
Azithromycin
(Zithromax) or
erythromycin (E-Mycin)
Analgesic:
Acetaminophen or
ibuprofen
Cough suppression
with expectorant:
Robitussin DM or with
codeine
Bed rest
F/U if not
improved in 7
days

CONDITION &
DEFINITION
KEY FEATURES
DIFFERENTIATING
SIGNS & SYMPTOMS
DIFFERENTIATING
OBJECTIVE FINDINGS
COMMON
DIAGNOSTIC TEST
TREATMENT
FOLLOW-UP
Productive, mild
cough
Fever
Tachycardia
Usually has cervical

adenopathy
Chest radiograph
with peribronchial
thickening and
bilateral spars
infiltrate
Analgesic:
Acetaminophen or
ibuprophen
Cough
suppression with
expectorant:
Robitussin DM.
Bed rest
F/U if not
improved in 7
days
Bronchodilator:
Nebulized albuterol
Oxygen NC
CONTACT MO
or Duty Flight
Surgeon if
doubt
Acute (continued)
Pneumonia, Viral
Viral infection of
the lungs with
recent history of
common cold or
influenza
Severe cough with

white to clear
sputum
Fever & fatigue
Recent history of
upper respiratory
viral illness
Lung sounds: rales or

pleural friction rub
Pulse Ox
Weight loss &

dyspnea
Pulse Ox
History of recurrent
bronchial infections
Respiratory effort and

use of accessory
muscles, barrel
chest, pursed lip
breathing
Peek flow before

and after treatment
Chronic
Chronic
Obstructive
Pulmonary
Disease
Permanent dilation
and destruction of
the alveolar ducts
and bronchi
caused by chronic
lung irritation seen
in ages > 40
(occupational,
cigarette smoking,
or alpha1antirypsin
deficiency)
Chronic coughing
with scant sputum
Clubbing of fingers
Change in weight
43RESPIRATORY

CONDITION &
DEFINITION
KEY FEATURES
DIFFERENTIATING
SIGNS & SYMPTOMS
DIFFERENTIATING
OBJECTIVE FINDINGS
COMMON
DIAGNOSTIC TEST
TREATMENT
FOLLOW-UP
Chronic, mild
nagging cough and
nausea
Epigastric
heartburn
May have normal

exam findings
Antigen/antibody
for H. pylori
Regurgitation
causing bitter taste
ECG is normal
CONTACT MO
or Duty Flight
Surgeon IF
doubt
Symptoms relieved
by sitting up or
antacids
Assess for
epigastric
tenderness
Acute Tx:
H2 Inhibitor:
Ranitidine (Zantac)
Chronic (continued)
Gastroesophageal
Reflux Disease
(GERD)
reflux of gastric
secretions into the
esophagus
Tuberculosis
TB is primarily a
lung infection
caused by inhalation
of tubercle bacilli
from close contact
with actively infected
person
Chronic cough
May have chest pain
Productive yellow/
green sputum that
progresses
Prominent features
are chronic not
feeling well with
drenching night
sweats
For chronic Tx or H.
pylori refer to MO
Complete HEENT,
CV, Respiratory, &
GI Exam
Lung sounds: rales in

upper lobes with
whispered pectoriloquy
Hemoptysis is late
Sx
History of close
contact with infected
person
44RESPIRATORY
PPD (PPD
converter does
not necessarily
mean active
disease (may be
past exposure),
though all with
active disease are
positive)
CBC
Sputum culture
with acid-fast
smear x 3 (culture
takes 3-6 wks)
Chest radiograph:
multi-nodule
infiltrate in apical
lobe and hilar
adenopathy
Multi drug therapy

is required
Direct observation
therapy
recommended
Consult with MO.
CONTACT MO
or Duty Flight
Surgeon
CHIEF COMPLAINT: DIFFICULT BREATHING

CONDITION &
DEFINITION
KEY FEATURES
DIFFERENTIATING
SIGNS & SYMPTOMS
DIFFERENTIATING
OBJECTIVE FINDINGS
COMMON
DIAGNOSTIC TEST
TREATMENT
FOLLOW-UP
Anaphylaxis
Immune hypersensitivity reaction
to an antigen
(insect, food,
medication)
Acute labored
tachypnea, cough,
and wheeze
History of exposure
Pulse Ox
May have Urticaria

and angioedema of
the face with
cyanosis
Peak Flow before

and after Tx
Bronchodilator:
Epinephrine 1:1000
0.3 to 0.5 mg IM and
Nebulized albuterol;
oxygen, IV NS
Antihistamine:
Diphenhydramine
(Benadryl)
Oral steroid:
Prednisone may be
indicated to prevent
recurrence
CONTACT MO or
Duty Flight
Surgeon
Bronchodilator:
Epinephrine 1:1000
0.3 to 0.5 mg IM and
Nebulized albuterol;
oxygen, IV NS
Oral steroid:
Prednisone may be
indicated to prevent
recurrence
CONTACT MO or
Duty Flight
Surgeon
CONTACT MO or
Duty Flight
Surgeon
MEDEVAC
IgE mediated
Asthma
Disorder of the
tracheobronchial
tree with reversible
airway obstruction
(bronchospasm
with inflammatory
process)
Acute labored
tachypnea, cough,
and wheeze
Pneumothorax,
Spontaneous
Sudden collapse
of lung most
common in young,
tall, thin men
(primary) or
persons who
smoke
(secondary)
Acute labored
tachypnea,
cough, and
wheeze
Sx may be
subtle
History of asthma
Prolonged
expiratory wheeze
brought on by
exposure trigger
May have cyanosis
History of smoking,
vigorous exercises
Sharp chest
discomfort that is
worse with
breathing
Obvious distress
requiring immediate
care
ABCs first
Lung sounds:
rhonchi and wheeze
Vitals: hypotension
Complete HEENT,
CV, respiratory, skin
exam
Obvious distress
requiring immediate
care
ABCs first
Pulse Ox
Peak Flow before
and after Tx
Lung sounds:
expiratory wheeze
Asymmetrical chest
movements and
decreased lung
sounds
Just listening to the
lungs makes the Dx
45RESPIRATORY
Pulse Ox
Oxygen
Chest radiograph
Emergency
treatment is
required
IF reaction to
vaccine,
complete
VAERS Report
This page left intentionally blank
46RESPIRATORY
CHIEF COMPLAINT: ABDOMINAL PAIN

CONDITION &
DEFINITION
KEY FEATURES
DIFFERENTIATING
SIGNS & SYMPTOMS
DIFFERENTIATING
OBJECTIVE FINDINGS
COMMON
DIAGNOSTIC TEST
TREATMENT
FOLLOW-UP
Appendicitis
Acute inflammation
of the vermiform
appendix
Nausea, vomiting,
constipation & fever
RLQ involuntary
guarding
CBC
UA
RLQ rebound
tenderness; pain
may be referred
(Rovsings sign)
Prompt referral
to ER or direct
hospital
admission
CONTACT MO or
Duty Flight
Surgeon
Emergency
treatment is
required
MEDEVAC
Cholecystitis
Acute inflammation
of the gallbladder
Constipation
(symptom)
Difficulty passing
stool or diminished
frequency of
defecation. May be
symptom of other
conditions
Nausea, vomiting,
loose stool, and
fever
Nausea
Early, colicky to
constant pain in
epigastrium or
periumbilical; RLQ
later
Vomiting after pain
& pain worse with
movement
Colicky to constant
pain at RUQ to
inferior angle of
right scapula
RUQ tender with deep

palpation during
inspiration (Murphys
Sign)
Brought on by fatty
foods. More
common in
females
May have dark

urine, light stool,
and/or jaundice
Diffuse cramps
Difficulty expelling
feces; less frequent
defecation then
normal for patient
Pain with
psoas/obturator
maneuver (Psoas
Obturator sign)
CBC
UA
LFT
Gallbladder
ultrasound
Abdomen bloated
and tender
Labs directed
towards cause
Hyperactive bowl
sounds
MO may
recommend
rectal exam for
occult blood
detection
47GASTROINTESTINAL
Prompt referral to
ER or direct
hospital admission
CONTACT MO or
Duty Flight
Surgeon
MEDEVAC
Stool softener:
Docusate sodium
(Colase)
Increase water
intake
Increase dietary
fiber AFTER
relief of Sx
F/U if not
improved in 24
hours
Consult with
MO PRN
CHIEF COMPLAINT: ABDOMINAL PAIN (continued)

CONDITION &
DEFINITION
KEY FEATURES
DIFFERENTIATING
SIGNS & SYMPTOMS
DIFFERENTIATING
OBJECTIVE FINDINGS
COMMON
DIAGNOSTIC TEST
TREATMENT
FOLLOW-UP
Diarrhea
(symptom)
Acute diarrhea is
abnormal and
increased
frequency and
liquid stool
consistency.
May be symptom of
other conditions.
Symptoms lasting
> 2 weeks =
chronic diarrhea.
Nausea, vomiting,
fever
Diffuse cramps
CBC
Abnormal and
increased
frequency and
liquid stool
consistency
Diffuse, abdominal
tender
UA
May have poor skin

turgor indicating
dehydration
Stool culture and

ova/parasite may
be indicated
Antidiarrheal:
Loperamide
(Immodium)
Antibiotics may be
indicated
MO may
recommend rectal
exam for occult
blood detection
F/U if not
improved in 72
hours or chronic
symptoms,
CONTACT MO
and or Duty
Flight Surgeon.
Diverticulitis
Inflamed diverticula
(outpouchings of
the mucosa
through the
muscular wall of
the intestine)
Nausea, vomiting,
fever, anorexia, and
constipation or
diarrhea
Intermittent chronic
pain, usually LLQ
Food Poisoning
Bacterial cause
from contaminated
food
Nausea
Vomiting
Fever
Diarrhea
Onset of nausea,
vomiting & diarrhea
within 1224 hours
of eating
Diffuse cramps
LLQ tenderness,
tympanic sound on
percussion
CBC
UA
MO may
recommend rectal
exam for occult
blood detection
CBC
Stool culture may

be indicated
Diffuse abdominal
tender
May have poor skin
turgor indicating
dehydration
48GASTROINTESTINAL
MO may
recommend rectal
exam for occult
blood detection
Increase water
intake; consider
IV normal saline if
dehydrated
NO solids x 24
hours then
BRATS diet x 24
hours
Consider cause
Bowel spasm relief:

Dicyclomine (Bentyl)
Antibiotic:
Metronidazole
(Flagyl) PLUS
ciprofloxacin (Cipro)
CONTACT MO
or Duty Flight
Surgeon
Antibiotic:
Ciprofloxacin (Cipro)
F/U if not
improved in 24
hours
Increase water
intake; consider
IV normal saline if
dehydrated
NO solids x 24
hours then
BRATS diet x 24
hours

CONDITION &
DEFINITION
KEY FEATURES
DIFFERENTIATING
SIGNS & SYMPTOMS
DIFFERENTIATING
OBJECTIVE FINDINGS
COMMON
DIAGNOSTIC TEST
TREATMENT
FOLLOW-UP
Gastroenteritis,
Acute
Viral cause of
vomiting and
diarrhea. Irritants
like medications and
alcohol can cause
nausea and vomiting
referred to as
gastritis.
Nausea
May have normal exam
CBC
Vomiting
Increase water
intake
Malaise
Fever
Diarrhea
NO solids x 24
hours then
BRATS diet x
24 hours
F/U if not
improved in 24
hours
Gastroesophageal
Reflux Disease
(GERD)
reflux of gastric
secretions into the
esophagus
Nausea
Hepatitis
Viral hepatitis is an
inflammatory
disease of the liver
caused by a distinct
group of viruses
(HAV and HBV are
discussed here)
Fever
Jaundice
Anorexia
Nausea
Malaise
Myalgia
Onset of nausea,
vomiting and
diarrhea within 4872 hours of feeling
ill
Diffuse cramps
Nausea, better
after vomiting or
bowel movement
Epigastric
heartburn
Regurgitation
causing bitter taste.
Symptoms relieved
by sitting up or
antacids.
May have nagging

cough
HAV may be
infectious 2 wks
before Sx and 1 wk
after. Caused by
contaminated food
and water
May have normal

exam findings.
Assess for
epigastric
tenderness
Antigen/antibody
for H. pylori
ECG to R/O
cardiac chest
pain
Complete HEENT,
CV, Respiratory, &
GI Exam
Jaundice skin and

sclera
CBC
LFT
RUQ tenderness
with splenic and/or
liver enlargement
Serologic marker
for specific type of
hepatitis
HBV - may be
infectious for 6 wks
before Sx and
unpredictable after.
Caused by sexual
contact or blood
products
49GASTROINTESTINAL
Acute Tx:
H2 Inhibitor:
Ranitidine (Zantac)
CONTACT MO
or Duty Flight
Surgeon IF
doubt
For chronic Tx or
H. pylori refer to
MO
HAV Immune
globulin. Also Tx
intimate contacts
HBV Hepatitis B
immune globulin
and start HB
vaccine in
unvaccinated and
booster in
vaccinated. Also Tx
sexual contacts
CG member should
be vaccinated with
both HA and HB
vaccines
CONTACT MO
or Duty Flight
Surgeon

CONDITION &
DEFINITION
KEY FEATURES
DIFFERENTIATING
SIGNS & SYMPTOMS
DIFFERENTIATING
OBJECTIVE FINDINGS
COMMON
DIAGNOSTIC TEST
TREATMENT
FOLLOW-UP
Hernia, Abdominal
An abnormal
opening or
weakness in the
abdominal muscular
wall allowing
protrusion of
abdominal viscus
(Inguinal hernia
see GU conditions)
May be
asymptomatic or
have mild pain
If reducible or
irreducible: may
complain of a soft
bulge at the site
Visual exam noting

size and suppleness
of the mass
None indicated
If strangulated:
colicky abdominal
pain, nausea and
vomiting,
abdominal
distention
Reducible = able to
push mass in
CONTACT MO
or Duty Flight
Surgeon IF in
doubt
Gently reduce
hernia if possible,
and if not
considered
strangulated
Irreducible = unable
to push mass in
Strangulated =
irreducible,
discolored, painful;
do not reduce
Irritable Bowl
Syndrome
Chronic abdominal
pain, with altered
diarrhea/constipation
and gaseousness in
the absence of
detectable pathology
Nausea
Vomiting
Diarrhea or
constipation
Gas
Pancreatitis, Acute
Inflammation of the
pancreas caused by
trauma, virus, cysts,
drugs (steroids,
sulfa, NSAID), duct
obstruction, alcohol
Nausea
Vomiting
Fever
Jaundice
Dark urine
Predominate
alternating diarrhea
and constipation
without blood in
stool
May have vague

abdominal tenderness >
left
If strangulated
hernia,
MEDEVAC
CBC
ESR
Stool culture,
hemoccult, ova
and parasites
MO may
recommend
rectal exam for
occult blood
detection
Possible stressors
in life
no weight loss
Sudden, severe
epigastric pain
radiating to midback
Bluish flank (Gray

Turners sign)
Complete blood
chemistry test
Bluish periumbilical
(Cullens sign)
CBC
Hypotension
UA
Mild jaundiced
Ultrasound or CT
Crackles in lungs
Epigastric tenderness
Frothy dark urine
50GASTROINTESTINAL
Bowl spasm
relief:
Dicyclomine
(Bentyl)
Treat for
constipation or
diarrhea
CONTACT MO
or Duty Flight
Surgeon IF in
doubt
IV NS
Analgesics
PRN:
Acetaminophen
or ibuprofen
CONTACT MO
or Duty Flight
Surgeon
Otherwise NPO
as directed by
MO.
MEDEVAC

CONDITION &
DEFINITION
KEY FEATURES
DIFFERENTIATING
SIGNS & SYMPTOMS
DIFFERENTIATING
OBJECTIVE FINDINGS
COMMON
DIAGNOSTIC TEST
TREATMENT
FOLLOW-UP
Peptic Ulcer
Disease
Erosion of gastric
mucosa. Duodenal
> gastric
Nausea
CBC
Vomiting
Melena
Epigastric tenderness
though exam may be
unremarkable
Acute Tx:
H2 Inhibitor:
Ranitidine (Zantac)
CONTACT MO
or Duty Flight
Surgeon IF in
doubt
Abdominal
cramping
MO may
recommend rectal
exam for occult
blood detection
Duodenal Ulcer:
nocturnal pain,
heartburn, better
with food/antacids
Gastric Ulcer:
heartburn or back
pain, worse w/ food
51GASTROINTESTINAL
Chronic Tx:
Refer to MO
CHIEF COMPLAINT: ABDOMINAL PAIN Female Specific

CONDITION &
DEFINITION
KEY FEATURES
DIFFERENTIATING
SIGNS & SYMPTOMS
DIFFERENTIATING
OBJECTIVE FINDINGS
COMMON
DIAGNOSTIC TEST
TREATMENT
FOLLOW-UP
Ectopic Pregnancy
Implantation of fertile
egg in fallopian tube,
cervix, or ovary
Nausea
IV NS
Vomiting
(morning
sickness)
Otherwise NPO
as directed by
MO
CONTACT MO
or Duty Flight
Surgeon
Mild or severe
unilateral pelvic
or referred pain
HCG Positive when

patient is pregnant
(R/O pregnancy in
all females with
abdominal pain or
abnormal uterine
bleeding)
Emergency
treatment is
required
Endometriosis
Abnormal growth of
endometrial tissue
outside the uterus
Nausea
Dyspareunia
Vomiting
Dysmenorrheal
Mild or severe
pelvic or referred
pain
Determine last
menses and
menses history;
sexual contact.
Vague to diffuse
abdominal or pelvic
tenderness
HCG Negative (R/O

pregnancy in all
females with
abdominal pain or
abnormal uterine
bleeding)
Analgesics PRN:
Acetaminophen,
ibuprofen or
combination of both
(Tylenol 1000 mg
PLUS Motrin 800
mg)
This is a chronic
condition
requiring referral
to MO for workup and Tx
Ovarian Cyst
Associated with or
without ovulation, a
cyst may cause
dysmenorrhea or
rupture releasing
blood/fluid and
severe pain.
Nausea
Dysmenorrhea
Vomiting
Mild or severe
pelvic or referred
pain
Determine last
menses and
menses history;
sexual contact.
Unilateral lower
quadrant or pelvic
tenderness;
exacerbated by
movement
Abdominal rigidity =
possible surgical case
Goal is to
determine urgency
of case.
If non-emergent
case:
Analgesics PRN:
Acetaminophen,
ibuprofen or
combination of both
(Tylenol 1000 mg
PLUS Motrin 800
mg)
Otherwise:
CONTACT MO
or Duty Flight
Surgeon
HCG Negative (R/O

pregnancy in all
females with
abdominal pain or
abnormal uterine
bleeding)
Amenorrhea or
abnormal uterine
bleeding
Determine last
menses and
menses history;
sexual contact
Unilateral lower
quadrant or pelvic
tenderness
exacerbated by
movement
Shock (cool, clammy,
pallor, hypotension,
tachycardia)
Note: Mittelschmerz
is a self-limiting midcycle pelvic pain
associated with
ovulation.
IV NS
NPO as directed
by MO
Transport
52GASTROINTESTINAL
MEDEVAC
Emergent case =
MEDEVAC
CHIEF COMPLAINT: RECTAL PAIN/BLEEDING

CONDITION &
DEFINITION
KEY FEATURES
DIFFERENTIATING
SIGNS & SYMPTOMS
DIFFERENTIATING
OBJECTIVE FINDINGS
COMMON
DIAGNOSTIC TEST
TREATMENT
FOLLOW-UP
Colorectal Cancer
Malignant tumor of
the colon, rectum, or
anus
Fatigue associated
with anemia and
blood mixed into
stool
Abdominal tenderness or
mass on right or left side
CBC
Stool may be
narrow or ribbon-like
MO may
recommend
rectal exam for
occult blood
detection
Take home point:

persistent rectal
bleeding may be
colorectal cancer
and MUST be
referred to the MO
CONTACT MO
or Duty Flight
Surgeon IF in
doubt
Hemorrhoid
Varicosities
(congested veins) in
the rectum or anus
Bright red blood,

not necessarily in
stool
May be internal or
external
CBC
Anal pain, burning,

itching
MO may
recommend
rectal exam for
occult blood
detection
Stool softener:
Docusate sodium
(Colase)
Topical:
Hydrocortisone
ointment (Anusol
HC)
F/U if not
improved in 72
hours,
CONTACT MO
and or Duty
Flight Surgeon
Pilonidal Cyst
(abscess)
Acute abscess or
chronic draining
sinus tract in the
sacrococcygeal
area. May involve
bacterial infection.
Coccyx pain, not
rectal pain.
Sacrococcygeal
(superior to anus)
drainage or scant
bleeding
The treatment of
choice is incision &
drainage. Large
wound may require
iodiform packing
repack daily
F/U every 24
hours until
resolved. IF not
resolved in 7
days or severe,
CONTACT MO
Ulcerative Colitis
Inflammation of
colon/rectum, similar
to Crohns disease
though UC spreads
in a continuous
fashion, where
Crohns has patchy
inflammation
Bloody diarrhea
Anemia
Fever
Arthralgia
Tenesmus
Alternating diarrhea
and constipation
with blood in stool
Hemorrhoid or blood
may or may not be
visible
Enlarged,
thrombosed
hemorrhoids are
extremely painful,
firm, bluish
Lesion is abscess,
though location is
unique to disease
Mid-line swelling with

or without pit or sinus
tract
Lesion may have or

does contain hair
May have signs of

infections: Localized
red (rubor), tender
(dolor), warm (calor),
swelling (tumor)
Urgent and frequent

bowel movements
Regular lower
abdominal cramps
Weight loss
Complete GI exam
noting abdominal
tenderness on
palpation to lower
abdomen
Orthostatic
hypotension
53GASTROINTESTINAL
None, unless wound

culture is indicated
Antibiotics only
indicated in signs of
infection or positive
culture
CBC
Hemoccult
MO may
recommend
rectal exam for
occult blood
detection
Refer to MO
CONTACT MO
or Duty Flight
Surgeon IF in
doubt
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54GASTROINTESTINAL
CHIEF COMPLAINT: SEXUALLY TRANSMITTED DISEASE

CONDITION &
DEFINITION
KEY FEATURES
DIFFERENTIATING
SIGNS & SYMPTOMS
DIFFERENTIATING
OBJECTIVE FINDINGS
COMMON
DIAGNOSTIC TEST
TREATMENT
FOLLOW-UP
Chancroid
Contagious bacterial
infection of genitals
caused by
Haemophilus ducreyi
Ulceration on
genitals
Sexual history
usually has multiple
partners; travel to
developing country
The HS/IDHS
conducts visual GU
exam with
chaperone
STD Screening PRN:

(test for H. ducreyi
not available in US)
HIV
Painful ulceration on
genitals with
inguinal adenopathy
that may progress to
abscess (bubo)
CONTACT MO
or Duty Flight
Surgeon IF
doubt
Tender ulcerated
genital lesion with
inguinal adenopathy
that may have
abscess
development
RPR (syphilis)
Antibiotic:
Ceftriaxone
(Rocephin) IM or
erythromycin
(E-mycin)
Chlamydia
Disease Alert
Report
Gonorrhea
Tx for partner(s)
also
HSV antibody
Encourage
condom use
Pap smear (HPV)
Chlamydia
Trachomatis
Contagious
intracellular parasite.
Most common STD.
Condyloma
Acuminata
Contagious viral
infection of the
genitals/anus caused
by human papilloma
virus
Scant white to clear

urethral or vaginal
discharge
Wart-like growth on
genitals or anus
Possible history of
sexual contact
Females may be
asymptomatic
Possible history of
sexual contact
Pruritus
Dysuria
Female pelvic exam

by MO may be
indicated
The HS/IDHS
conducts visual GU
exam with
chaperone
STD Screening PRN:
HIV
RPR (syphilis)
Chlamydia
Antibiotic:
Doxycycline or
Azithromycin
Tx for partner(s)
also
Encourage condom
use
CONTACT MO
or Duty Flight
Surgeon IF
doubt
CONTACT MO
or Duty Flight
Surgeon IF
doubt
Discharge may not

be visible
Gonorrhea
Female pelvic exam

by MO may be
indicated
HSV antibody
Pap Smear (HPV)
The HS/IDHS
conducts visual GU
exam with
chaperone
STD Screening PRN:
Refer to MO
HIV
RPR (syphilis)
Encourage
condom use
Chlamydia
Gonorrhea
HSV antibody
Pap Smear (HPV)
Cauliflower-like
clusters of papules
on genitals or anus
Female pelvic exam
by MO may be
indicated
55GENITOURINARY
Disease Alert
Report
Disease Alert
Report
CHIEF COMPLAINT: SEXUALLY TRANSMITTED DISEASE (continued)

CONDITION &
DEFINITION
KEY FEATURES
DIFFERENTIATING
SIGNS & SYMPTOMS
DIFFERENTIATING
OBJECTIVE FINDINGS
COMMON
DIAGNOSTIC TEST
TREATMENT
FOLLOW-UP
Gonorrhea
Contagious bacterial
infection caused by
Neisseria
gonorrhoeae (gramnegative diplococus)
Purulent urethral or
vaginal discharge
STD Screening PRN:
Antibiotic:
Ceftriaxone
(Rocephin) IM
Tx for partner(s)
also
Encourage
condom use
CONTACT MO or
Duty Flight
Surgeon IF doubt
F/U if not
resolved in 14
days, contact
MO for advice
Disease Alert
Report
required IF
primary genital
infection only
Herpes Simplex
Virus
Recurrent, incurable,
contagious viral
disease (see oral and
skin)
Localized,
grouped, uniform
lesion on genitals.
(may be found on
other body parts)
Possible history of
sexual contact
Males with severe
pyuria and dysuria
Female with
moderated vaginal
pruritus and
burning
Possible history of
sexual contact
Acute or chronic
Primary infection;
fever, malaise,
headache, regional
adenopathy
Recurrent lesions
with prodrome of
fever or local
warmth, burning,
usually just prior to
eruption
The HS/IDHS
conducts visual GU
exam with
chaperone
Discharge apparent
on genitals and
underwear or sheets
HIV
RPR (syphilis)
Chlamydia
Gonorrhea
HSV antibody
Female pelvic exam

by MO may be
indicated
Pap Smear
(HPV)
The HS/IDHS
conducts visual GU
exam with
chaperone
STD Screening PRN:
Grouped grape-like
cluster of uniform
vesicles quickly
become papules
that rupture and
weep and may be
found on any body
location
Usually recurs in
same location
Female pelvic exam

by MO may be
indicated
56GENITOURINARY
HIV
RPR (syphilis)
Chlamydia
Antiviral:
Acyclovir (Zovirax)
(for best results,
take with first onset
of Sx)
Gonorrhea
HSV antibody
Pap Smear
(HPV)
Good hygiene;
patient
education on
transmission
Tzanck Smear
Condom use if
genital
Disease Alert
Report

CONDITION &
DEFINITION
KEY FEATURES
DIFFERENTIATING
SIGNS & SYMPTOMS
DIFFERENTIATING
OBJECTIVE FINDINGS
COMMON
DIAGNOSTIC TEST
TREATMENT
FOLLOW-UP
Human Immunodeficiency Virus

(HIV)
Retrovirus that
infects/kills CD4
lymphocytes
resulting in patient
prone to
opportunistic
infections and
malignancies
leading to acquired
Immunodeficiency
syndrome (AIDS)
Flu-like or mononucleosis-like
complaint
CONTACT MO
or Duty Flight
Surgeon IF
doubt
Lymphogranuloma
Venerum
Systemic,
contagious
intracellular parasite
affecting the
inguinal lymph
nodes. (virulent
Chlamydia
trachomatis)
Primary Stage:
Painless papules,
on external
genitalia
Sexual, drug, and

blood transfusion
history helpful
Head to toe physical if

suspected
Note the following:
STD Screening PRN:
Refer to MO
HIV
May be
asymptomatic or
early fever,
myalgia, headache,
malaise, and rash
RPR (syphilis)
Counsel on lifestyle changes
Vitals
Chlamydia
Weight Hx
Gonorrhea
Oral thrush or ulcers
HSV antibody
Lymphadenopathy
Initial Sx may be
mild and selflimiting
Lung crackles
Pap Smear
(HPV)
Cardiac murmur/gallop
CBC
Immunize:
pneumonia,
influenza,
tetanus
booster,
hepatitis A and
B vaccines
Hepatomegaly
Splenomegaly
Skin lesions
If HIV ELISA is
positive, confirm
with Western Blot
Female pelvic exam by

MO may be indicated
The HS/IDHS conducts

visual GU exam with
chaperone
STD Screening PRN:
Possible papules on
external genitalia or
unilateral tender
inguinal node
enlargement may
drain
As disease
progresses, general
lymphadenopathy
chronic diarrhea,
weight loss, and
recurrent night
sweats develop.
Fever
Foreign travel to
Africa, South
America, Haiti,
Jamaica, East Asia,
and Indonesia with
history of sexual
contact
Secondary:
inguinal node
enlargement is
hallmark.
Travel history is key

to diagnosis
Rare in U.S.

MO may be indicated
57GENITOURINARY
HIV
RPR (syphilis)
Chlamydia
Gonorrhea
HSV antibody
Pap Smear
(HPV)
CBC
Antibiotics:
Doxycycline
Encourage condom
use
Disease Alert
Report
Notify Health
Department
for patient
contact
investigation
CONTACT MO
or Duty Flight
Surgeon IF
doubt
Disease Alert
Report

CONDITION &
DEFINITION
KEY FEATURES
DIFFERENTIATING
SIGNS & SYMPTOMS
DIFFERENTIATING
OBJECTIVE FINDINGS
COMMON
DIAGNOSTIC TEST
TREATMENT
FOLLOW-UP
Pediculosis
Infestation of the
scalp (capitis), body
(corporis), or pubic
area (pubis) by
parasite
(lice/crab/louse)
Acute onset of
intense pruritis in
affected hair areas
Possible history of
sexual contact with
infestation exposure
Complete skin exam and

visual GU exam with
chaperonee
None usually
indicated
F/U PRN
Itch/scratch
interrupts sleep
Papules, erythema, in
hair areas of groin or
scalp; nits or egg
capsules that appear as
whitish structures on hair
filaments
Topical:
Permethrin lotion or
shampoo
(Elimite/Nix)
Also treat
shipboard or home
contacts and wash
associated clothing
and linen
Syphilis
Contagious
spirochete disease
caused by
Treponema
pallidum. The
clinical stages of
syphilis, if
untreated, are
primary, secondary,
latent, and tertiary.
Primary painless
ulceration on
genitals may be
subtle
Possible history of
sexual contact
Primary non-tender
ulcerated (button-like)
genital lesion, inguinal
adenopathy; secondary
lesion is generalized
non-tender
STD Screening PRN:
Antibiotic:
HIV
Erythematous macular
rash that also involves
soles and palms
HSV antibody
Penicillin G
benzathine IM 2.4
mil units OR
Doxycycline 100
mg bid x 14 days
(for patients
allergic to
penicillin in
primary and
secondary
infection)
CONTACT MO
or Duty Flight
Surgeon IF
doubt.
Onset 1-2 weeks

after exposure;
primary lesion selflimiting in 7-10 days;
secondary lesion is
generalized rash
Fever, malaise
Tertiary syphilis
involves latent
neurologic symptoms
Tertiary syphilis involves

latent neurologic
symptoms
MO may be indicated
58GENITOURINARY
STD screening
may be indicated
PRN
RPR (syphilis)
Chlamydia
Gonorrhea
Pap Smear (HPV)
If Rapid Plasma
Reagin (RPR) is
positive, confirm
with fluorescent
treponemal
antibody absorption
(FTA-ABS).
Encourage
condom use
Eggs not
destroyed may
hatch with a
second
infestation in 2
weeks
Disease Alert
Report

CONDITION &
DEFINITION
KEY FEATURES
DIFFERENTIATING
SIGNS & SYMPTOMS
DIFFERENTIATING
OBJECTIVE FINDINGS
COMMON
DIAGNOSTIC TEST
TREATMENT
FOLLOW-UP
Trichomoniasis
Contagious
flagellated protozoa
infection caused by
Trichomonas
vaginalis. Though
referred to as
vaginalis, may be
found in males as
well as females.
Mild urethral or
vaginal pruritus
Sexual history
usually reveals
multiple partners
The HS/IDHS conducts

a visual GU exam with
chaperone
Urinalysis:
Wet mount
motile organisms
Females with
vaginal discharge
and rancid odor
Vaginal pH > 6.0

(normal around
4.0)
CONTACT MO
or Duty Flight
Surgeon IF
doubt
Males may have

dysuria and
discharge, but may
be asymptomatic
Females with copious

yellow to green vaginal
frothy discharge with
rancid odor. Males
may have mild urethral
discharge.
Antibiotic:
Metronidazole
(Flagyl)
Encourage condom
use

MO may be indicated
HIV
RPR (syphilis)
Cherry red cervix
Chlamydia
Gonorrhea
HSV antibody
Pap Smear
(HPV)
59GENITOURINARY
STD Screening PRN:
CHIEF COMPLAINT: MALE COMPLAINT

CONDITION &
DEFINITION
COMMON
FEATURES
DIFFERENTIATING
SIGNS & SYMPTOMS
DIFFERENTIATING
OBJECTIVE FINDINGS
COMMON
DIAGNOSTIC TEST
TREATMENT
FOLLOW-UP
Epididymitis
Testicular pain
and/or scrotal
swelling
Possible fever
Consider STD if
patient is under 35
y/o
The HS/IDHS
conducts a visual GU
exam with chaperone
Urinalysis may
have pyuria
Testicular tenderness
more
superior/posterior and
elevation of testicle
may decrease pain
(Prehns sign)
If suspected,
complete STD
screening for
Chlamydia and
Gonorrhea
Antibiotics:
Septra DS if NOT an
STD
CONTACT MO
or Duty Flight
Surgeon IF
doubt
Infection or
inflammation of the
epididymis
Common causes
are coliform
bacteria and ductal
obstruction
For young males
(<35 yo) consider
N. gonorrheae or
Chlamydia
trachomotis
Hydrocele, Acute
Fluid accumulation
in the serous lining
covering the testicle
and epididymis
(tunica vaginalis)
Testicular pain
and/or scrotal
swelling
Inguinal Hernia
An abnormal
opening or
weakness in the
abdominal muscular
wall allowing
protrusion of
abdominal viscus
(hernia, abdominal
see GI conditions)
May be
asymptomatic
or have mild
pain
Scrotum may feel

heavy
May have fluctuation

in the size of the
scrotum
If reducible or
irrreducible: May
complain of a soft
bulge at the site
If strangulated:
colicky abdominal
pain, nausea and
vomiting, abdominal
distention
May have scrotal

edema and erythema
The HS/IDHS
exam with chaperonee
Swelling of the
scrotum
The HS/IDHS
exam with chaperonee
Reducible = able to
push mass in
Irreducible = unable to
push mass in
Strangulated =
Irreducible, discolored,
painful; do not reduce
For gonorrhea:
Ceftriaxone
(Rocephin) IM
For chlamydia:
Doxycycline or
Azithromycin
Disease Alert
Report if STD
Transilluminationlight passes through

the hydrocele causing
a red glow
(IF light does not
pass through solid,
firm mass = tumors =
carcinoma until
proven other-wise)
If mass clearly
transilluminates,
reassure patient, though
may not be self-limiting
& referral to MO is
indicated.
CONTACT MO
or Duty Flight
Surgeon IF
doubt
None indicated
If not considered
strangulated, gently
reduce hernia
CONTACT MO
or Duty Flight
Surgeon IF
doubt
If strangulated
hernia,
MEDEVAC
60GENITOURINARY
CHIEF COMPLAINT: MALE COMPLAINT (continued)

CONDITION &
DEFINITION
COMMON
FEATURES
DIFFERENTIATING
SIGNS & SYMPTOMS
DIFFERENTIATING
OBJECTIVE FINDINGS
COMMON
DIAGNOSTIC TEST
TREATMENT
FOLLOW-UP
Prostatitis, Acute
Infection or
inflammation of
the prostate gland.
Usually caused by
ascending urethral
infection of coli
form bacteria or
non-bacterial
chronic cause.
Lower back and

perineal pain
Urinary frequency,
urgency minor
feature
Urinalysis may
have leukocytes
Nocturia may be
present
Subtle symptoms
with lower back
pain (also see
renal calculi) in
the absence of
STD Sx, provide
direction for Tx
F/U if not
improving in 14
days
Antibiotic:
Ciprofloxacin (Cipro)
or Septra DS
Treat for 30 days
Prostate Specific
Antigen (PSA)
Urinalysis
normal
Do not delay
emergency Tx for
urinalysis if high
suspicion
Emergency
treatment is
required
CONTACT MO
or Duty Flight
Surgeon
Torsion usually
rotates inward.
For de-torsion, the
testis is rotated
outward. More
than one rotation
may be needed.
Pain reduction
guides progress.
The HS/IDHS
conducts a visual
GU exam with
chaperone
Digital rectal exam
by MO is indicated =
tender, boggy
prostate (IF prostate
hard with nodules or
mass = tumor =
carcinoma until
proven otherwise)
Testicular
Torsion
The twisting of the
testis and
spermatic cord
resulting in acute
ischemia of testis
Testicular pain
and/or scrotal
swelling
excessive physical
activity just before
symptoms
Nausea and/or
vomiting
Scrotum enlarged,
red, edematous
Testis may appear

high in scrotum with
tenderness
Elevating scrotum
increases pain
Cremasteric reflex
absent
The HS/IDHS
conducts a visual
GU exam with
chaperone
61GENITOURINARY
MEDEVAC
If de-torsion
fails,
emergency
surgery is
required to
save testis.
Salvage drops
to 20% in 6-8
hrs and near
0% in 12 hrs.
CHIEF COMPLAINT: MALE COMPLAINT (continued)

CONDITION &
DEFINITION
COMMON
FEATURES
DIFFERENTIATING
SIGNS & SYMPTOMS
DIFFERENTIATING
OBJECTIVE FINDINGS
COMMON
DIAGNOSTIC TEST
TREATMENT
FOLLOW-UP
Urinary Tract
Infection (UTI)
Infection of the
urinary tract or
bladder.
Uncommon in
males. Cause may
be ascending
infection of
coliform bacteria
or STD.
Dysuria; urinary
frequency and
urgency.
Consider causes
that introduce coli
form bacteria as
urinary infection
The HS/IDHS
conducts a visual
GU exam with
chaperone.
Urinalysis - may
have leukocyte
and nitrites
F/U if not
improved in 7
days
Suprapubic
discomfort
CVA tenderness
usually not present
Digital rectal exam

by MO is indicated if
need to R/O
prostatitis.
If suspected,
complete STD
screening PRN,
considering
Chlamydia or
Gonorrhea
Antibiotic:
Septra DS or
ciprofloxacin
(Cipro)
Varicocele
A collection of
large veins,
usually on the left
scrotum, caused
by venous valve
dilation.
Testicular pain
and/or scrotal
swelling
The HS/IDHS
conducts a visual
GU exam with
chaperone
Analgesic:
Ibuprofen or
acetaminophen for
discomfort PRN.
May require
referral to MO IF
doubt
Visible swelling or
palpable bag of
worms in scrotum
Feeling of heaviness in
the testicle(s)
62GENITOURINARY
Urinalysis normal
Athletic support for

scrotum
CHIEF COMPLAINT: FEMALE COMPLAINT

CONDITION &
DEFINITION
COMMON
FEATURES
DIFFERENTIATING
SIGNS & SYMPTOMS
DIFFERENTIATING
OBJECTIVE FINDINGS
COMMON
DIAGNOSTIC TEST
TREATMENT
FOLLOW-UP
Bacterial Vaginosis
A bacterial infection
of the vagina and/or
vulva commonly
caused by
Gardnerella
vaginalis.
Not STD.
Mild vaginal
Urinalysis
Pruritis
Dysuria
Antibiotic:
Metronidazole
(Flagyl)
CONTACT MO
or Duty Flight
Surgeon IF
doubt
Dyspareunia
Bartholins Cyst
Mucus-filled
glandular cyst of the
Bartholins gland
occurring on either
side of the vaginal
opening; cause
unknown, though
may be due to
vaginal irritation.
Not STD.
Mild vaginal
pruritis
Dysuria
Dyspareunia
Warm compresses
to area is mainstay
of Tx
Analgesic:
Ibuprofen or
acetaminophen for
discomfort PRN.
CONTACT MO
or Duty Flight
Surgeon IF
doubt
Candidiasis, Volvovaginal
Yeast-like fungal
infection of the vulva
or vagina. Caused
by Candida
albicans. Not STD.
Vulvar-vaginal
pruritis
History of
vaginal/vulva
irritation
A grayish to clear
discharge with
unique fishy
vaginal odor
Usually starts
asymptomatic, as
cyst grows larger it
become very painful
with sitting
If untreated, may
develop into an
abscess
White, malodorous
discharge
Female pelvic exam

by MO may be
indicated
The HS/IDHS
conducts a visual
GU exam with
chaperone
Lump or mass at the

introitus
Note: any drainage or
signs of infection =
abscess.
Patient may relay

that symptoms
similar to past yeast
infections
The HS/IDHS
conducts a visual
GU exam with
chaperone
The HS/IDHS
conducts a visual
GU exam with
chaperonee
Cheesy discharge
with white plaques
on erythematous
base
63GENITOURINARY
Wet mount clue

cell
KOH whiff test

with amine/fishy
odor
Urinalysis
normal
Dx made with
physical
examination
DDX:
Skenes Duct Cyst

duct obstruction
at distal urethra
Vulvar Inclusion
Cyst duct
obstruction at
sebaceous gland
of epidermis
Urinalysis
normal
KOH prep with

pseudohyphae
and budding
spores
If the cyst becomes

abscess consider
antibiotics;
Cephalexin (Keflex)
Antifungal:
Clotrimazole 1%
vaginal cream or
floxurindine
(Diflucan)
F/U if not
improved in 7
days
CHIEF COMPLAINT: FEMALE COMPLAINT (continued)

CONDITION &
DEFINITION
COMMON
FEATURES
DIFFERENTIATING
SIGNS & SYMPTOMS
DIFFERENTIATING
OBJECTIVE FINDINGS
COMMON
DIAGNOSTIC TEST
TREATMENT
FOLLOW-UP
Urinary Tract
Infection (UTI)
Infection of the
urinary tract or
bladder. Cause may
be ascending
infection of coli form
bacteria or STD
Dysuria; urinary
frequency and
urgency
Suprapubic
discomfort
Patient may relay

that symptoms
similar to past
infections
The HS/IDHS
conducts a visual
GU exam with
chaperonee
Urinalysis - may
have leukocyte
and nitrites
F/U if not
improved in 7
days
CVA tenderness
usually not present
If suspected, STD
screening PRN,
considering
Chlamydia or
Gonorrhea
Antibiotic:
Septra DS or
ciprofloxacin
(Cipro)
CHIEF COMPLAINT: HEMATURIA

CONDITION &
DEFINITION
COMMON
FEATURES
DIFFERENTIATING
SIGNS & SYMPTOMS
DIFFERENTIATING
OBJECTIVE FINDINGS
COMMON
DIAGNOSTIC TEST
TREATMENT
FOLLOW-UP
Glomerulonephritis,
Acute
Inflammation of the
glomeruli of the kidney.
More common in
young adults.
Hematuria
Complete physical
exam
May have
hypertension
CONTACT MO or
Duty Flight
Surgeon for
directions.
F/U with MO for

proper work-up
Urinalysis Blood
and protein (no
leukocytes or
nitrites)
CBC
Renal Function
Test
Pyelonephritis, Acute
Bacterial infection of
the kidney; may lead to
bacteremia,
progressing to septic
shock and death if
untreated
Hematuria
Urinalysis Blood
and protein PLUS
leukocytes, &
nitrites
CONTACT MO
or Duty Flight
Surgeon
Urine culture >100,000 CFU/ml.
CBC
Renal ultrasound
or spiral CT
Antibiotic:
Septra DS or
ciprofloxacin
(Cipro)
Analgesic:
Acetaminophen
(NSAIDS
metabolized in
kidney)
History of recent
streptococcal
infection or other
infection
Oliguria, edema,
and weight gain
Fever
Flank pain
Shaking chills
Urinary urgency
Frequency
Dysuria
Malaise,
Myalgia
Anorexia
Nausea
Vomiting
Diarrhea
Headache
Suprapubic pain
Complete physical
examination
Febrile
Tachycardia
CVA tenderness
Increase fluids, SIQ

x 72 hours
64GENITOURINARY
F/U if no
improvement in
24 hrs; consider
hospitalization
and MEDEVAC
CHIEF COMPLAINT: HEMATURIA, (continued)

CONDITION &
DEFINITION
COMMON
FEATURES
DIFFERENTIATING
SIGNS & SYMPTOMS
DIFFERENTIATING
OBJECTIVE FINDINGS
COMMON
DIAGNOSTIC TEST
TREATMENT
FOLLOW-UP
Renal Calculi
Kidney stones are
crystallized minerals,
commonly calcium or
uric acid that forms in
the urinary tract
system.
Hematuria,
though may
just present as
flank pain
May have history of

kidney stones,
family history of
kidney stones
Patient appears
anxious and unable
to sit; paces the
floor.
CONTACT MO
or Duty Flight
Surgeon
Pain originates in
flank though may
radiate to
groin/testicles/supra
-pubic or labia
May have CVA

tenderness though
no fever unless
kidney infection also
present
Analgesic:
Ketorolac (Toradol)
or morphine IM/IV
Oral Analgesic:
Tramadol (Ultram)
Tx nausea PRN.
IV NS
Urinalysis Blood
and acidic (<7pH)
or alkalytic
(>7pH). Normal
urine pH is around
7.0
Spiral CT of
kidneys
Catch urine to find

stone
May have
diaphoresis,
tachycardia,
nausea, vomiting
65GENITOURINARY
MEDEVAC PRN
66GENITOURINARY
CHIEF COMPLAINT: MENSES COMPLAINT

CONDITION &
DEFINITION
KEY FEATURES
DIFFERENTIATING
SIGNS & SYMPTOMS
DIFFERENTIATING
OBJECTIVE FINDINGS
COMMON
DIAGNOSTIC TEST
TREATMENT
FOLLOW-UP
Dysfunctional
Uterine Bleeding
This is abnormal
uterine bleeding
caused by hormone
imbalance.
Other causes of
abnormal uterine
bleeding include
anovulation;
pregnancy-related,
malignancies,
infection, masses,
tumors, or cysts.
Lower abdominal
pain and cramping
with dysfunctional
uterine bleeding.
Dysfunctional uterine
bleeding is more
frequent than typical
menses; > 7 days of
heavy menses OR less
then 21 days apart OR
irregular bleeding
between menses.
Ask about possibility of
pregnancy
The HS/IDHS
conduct an
abdominal exam
History alone may

elicit tentative
diagnosis of
dysfunctional
uterine bleeding
Refer to MO for
pelvic exam
If HCG is
positive, patient
is pregnant.
Consider ectopic
pregnancy or
threatened
abortion which
are emergent
conditions.
CBC
Urinalysis, and
other tests PRN
Oral
Contraceptive
Pill:
Take tid for 3 days,
then once daily for
three months to
prevent recurrence.
Consult with MO
prior to treatment
CONTACT MO
or Duty Flight
Surgeon
HCG Negative
(R/O pregnancy
in all females
with abdominal
pain or uterine
bleeding)
CONTACT MO
or Duty Flight
Surgeon IF
doubt
Dysmenorrhea,
Primary
Primary: cramps,
lower abdominal
pain that occurs
before or during
menses caused by
excess
prostaglandin
release. Secondary
dysmenorrhea has
pathologic cause.
Crampy lower
abdominal pain
Pain is intermittent or
constant and may be
associated with
moodiness, fatigue,
headache, bloating and
nausea.
The HS/IDHS
conduct an
abdominal exam
History alone may
elicit diagnosis
Refer to MO for
pelvic exam
67GYNECOLOGICAL
CBC
Analgesic:
Urinalysis
Dysmenorrhea
workup: wet
mount, pap,
cultures,
ultrasound
Ibuprofen 800
mg tid.
May add
acetaminophen
1000 mg tid for
severe
discomfort
68GYNECOLOGICAL
CHIEF COMPLAINT: NECK PAIN

CONDITION &
DEFINITION
COMMON
FEATURES
DIFFERENTIATING
SIGNS & SYMPTOMS
DIFFERENTIATING
OBJECTIVE FINDINGS
COMMON
DIAGNOSTIC TEST
TREATMENT
FOLLOW-UP
Cervical Muscle
Strain
A strain can refer
to muscle and
ligamentous
injury, though
here, generally,
strain refers to
muscle injury. The
term strain and
sprain are often
interchangeable.
Pain along
trapezius and/or
sternocleidomastoid
muscles
O trauma or
spontaneous
P extreme movement
or spasm makes worse
Q dull ache
R nonradicular
S mild to moderate
T constant
Insp: symmetrical w/o

atrophy/deformity/discolor
Palp: tenderness at
paraspinous and
trapezius muscle
ROM: active - limited;
passive - full
Stability: yes
Motor: 5/5 strengths
Sense: normal
No bony tenderness
Radiograph indicated
if trauma
Analgesic/NSAID:
Ibuprofen
F/U if not
improved in 14
days
Herniated
Cervical Disk
Rupture of the
inter-vertebral disc
with protrusion of
the nucleus
pulposus in the
spinal canal.
Neck pain may be

prominent, though
may present as
deltoid or hand
numbness also.

Palp: tenderness at
cervical disk (C5/6/7)
passive - limited
Stability: stable
(neck and grip)
Sense: distal sensation
in hand may diminish
Distraction Test less pain;
Compression Test more
pain
Radiograph
indicated if
trauma
Analgesic/NSAID:
Ibuprofen
MRI to confirm
HNP
Moist heat
Bed Rest for 12 days
ROM exercises
when acute
pain subsides
Chronic
problem
If not
improving, refer
to MO
HNP = Herniated
Nucleus Pulposus
Tension headache may

be associated
O acute trauma or
past trauma
P worse w/ extension;
better w/ rest
Q dull to sharp ache
R radiculopathy in
deltoid or hand
S mild to moderate
T intermittent
Tension headache may
be associated.
69MUSCULOSKELETAL
Ice initially,
then moist heat
Rest
May last 1-2

weeks
ROM exercises
when acute
pain subsides
F/U if not
improved in 14
days
If in doubt,
CONTACT the
MO
CHIEF COMPLAINT: SHOULDER PAIN

CONDITION &
DEFINITION
COMMON
FEATURES
DIFFERENTIATING
SIGNS & SYMPTOMS
DIFFERENTIATING
OBJECTIVE FINDINGS
COMMON
DIAGNOSTIC TEST
TREATMENT
FOLLOW-UP
Bicepital Tendon
Rupture,
Proximal
The tendon
rupture is more
common in older
adults and often
associated with
chronic shoulder
pathology.
Involves proximal
bicepital tendon,
though may be
generalized pain
O acute trauma or
force on muscle
P worse w/ onset;
better over time
Q sudden sharp ache
R nonradicular
S mild to moderate
T worse w/ onset
Insp: asymmetrical with

bulge deformity distally &
may have ecchymosis
Palp: early tenderness
proximally, then no pain
ROM: active - full;
passive - full
Stability: stable
Sense: normal
The bulge can be
accentuated by
contraction of biceps
if trauma
Analgesic/NSAID:
Ibuprofen
CONTACT MO
or Duty Fight
Surgeon for
advice

Palp: tenderness over
bicipital groove.
ROM: active - full;
passive - full
Stability: pain, weakness
with Yergasons Test
Sense: normal
Usually nothing
indicated
Often a result of a trivial

event
Bicepital
Tendonitis
Inflammation of
the tendon
caused by
repetitive
movement or
trauma
Involves anterior
bicipital groove,
though may be
generalized pain
O overuse
P worse w/ use;
better w/ rest
Q dull ache
R nonradicular
S mild to moderate
T intermittent or
constant
Often concurrent with
subacromial bursitis
70MUSCULOSKELETAL
Progressive
ROM exercises
Nonsurgical
treatment is
effective
Distal rupture
may require
surgical
intervention
Analgesic/NSAID:
Ibuprofen
No overhead reach
for 3-4 days,
consider sling to
prevent reach
F/U if not
improved in 14
days
CHIEF COMPLAINT: SHOULDER PAIN (continued)

CONDITION &
DEFINITION
COMMON
FEATURES
DIFFERENTIATING
SIGNS & SYMPTOMS
DIFFERENTIATING
OBJECTIVE FINDINGS
COMMON
DIAGNOSTIC TEST
TREATMENT
FOLLOW-UP
Impingement
Syndrome
A chronic
inflammation
causing fibrosis of
the tendon or an
anatomical tilting
of the acromion
process
Chronic
generalized
shoulder pain
exacerbated by
overhead reach
O chronic overuse or
past trauma
P worse w/ overhead
lifting or ball throwing;
better w/ rest
Q dull ache
R nonradicular
S mild to moderate
T intermittent or
constant

the glenohumeral joint
passive - limited
w/ abduction > 90 degree
Sense: normal
Failed conservative
treatment requires
referral to orthopedic
surgeon. MRI is
indicated then.
Analgesic/NSAID:
Ibuprofen
F/U if not
improved in 14
days
Past history of rotator

or acromion joint
trauma
Chronic cases may result

in atrophy of rotator cuff
muscles
O chronic w/ past
trauma or night pain
P worse w/ overhead
lifting or ball throwing;
better w/ rest
Q dull ache
R nonradicular
S mild to moderate
T intermittent or
constant

the glenohumeral joint
passive - full
w/ Drop Arm Test
Sense: normal
Past history of rotator

or acromion joint
trauma
Chronic cases may result

in atrophy of rotator cuff
muscles.
Rotator Cuff
Tear
Four muscles
compose the
rotator cuff. The
supraspinatus is
most often
involved in a tear.
Cause of tear may
be acute injury,
though commonly
it is related to old,
degenerative
injury.
Chronic pain
associated with
specific past injury;
acute presentation
is also possible
71MUSCULOSKELETAL
Failed conservative
treatment requires
referral to orthopedic
surgeon. MRI is
indicated then.
Codman
Exercises
Avoid overhead
reaching
If not
improving, refer
to MO; steroid
injections may
be indicated
Analgesic/NSAID:
Ibuprofen
Codman
Exercises
Avoid overhead
reaching
If not
improving, refer
to MO; steroid
injections may
be indicated
F/U if not
improved in 14
days
CHIEF COMPLAINT: SHOULDER PAIN (continued)

CONDITION &
DEFINITION
COMMON
FEATURES
DIFFERENTIATING
SIGNS & SYMPTOMS
DIFFERENTIATING
OBJECTIVE FINDINGS
COMMON
DIAGNOSTIC TEST
TREATMENT
FOLLOW-UP
Subacromial
Bursitis
Inflammation of
the bursae, the
fluid-filled sac of
the acromion
process
Involves anterior
aspect of lateral
shoulder, though
may be generalized
pain
O acute trauma or
overuse
P worse w/ use;
better w/ rest
Q dull ache
R nonradicular
S mild to moderate
T intermittent or
constant

Palp: tenderness at
anterior/inferior acromion
passive - full
Stability: yes
Sense: distal sensation
in hand may diminish.
Arm maximally flexed for
palpation
if trauma
Analgesic/NSAID:
Ibuprofen
F/U if not
improved in 14
days
Often concurrent with

bicipital tendonitis
72MUSCULOSKELETAL
Codman
Exercises
If not improving,
refer to MO;
steroid injections
may be indicated
CHIEF COMPLAINT: ELBOW PAIN

CONDITION &
DEFINITION
COMMON
FEATURES
DIFFERENTIATING
SIGNS & SYMPTOMS
DIFFERENTIATING
OBJECTIVE FINDINGS
COMMON
DIAGNOSTIC TEST
TREATMENT
FOLLOW-UP
Bursitis,
Olecranon
Inflammation of
the bursae, the
fluid-filled sac of
the olecranon
process
Acute pain on
dorsal aspect with
dramatic swelling is
the most common
presentation
O acute swelling
(trauma) is most
common. Infection may
also be acute (cellulitis).
P worse w/ attempt to
put on shirt; better w/
rest
Q dull ache
R nonradicular
S mild to moderate
T intermittent or
constant
Insp: asymmetrical w/o

atrophy/discolor.
Dramatic fluctuant
swelling.
the dorsal olecranon
passive - full
Stability: stable
Sense: normal
Usually nothing
indicated
Analgesic:
Ibuprofen
Radiograph
indicated if
trauma
RICE
F/U if not
improved in 7
days or signs of
infection
Self-limiting
Reassurance
Gradual swelling is due

to chronic inflammation
Epicondylitis,
Medial/Lateral
A chronic irritation
(not inflammation)
causing fibrosis of
the
muscles/tendon
just distal to the
epicondyle
Gradual elbow
pain. Lateral
epicondylitis is
most common.
Aspiration of fluid
may be both
therapeutic and
diagnostic. Fluid
should be
analyzed and
cultured.
See cellulitis -if infection

suspected
O gradual pain with

history of overuse
P worse w/ wrist
extension or rotation;
better w/ rest
Q dull ache
R nonradicular
S mild to moderate
T intermittent or
constant

Palp: tenderness just
distal to epicondyle
ROM: active full;
passive full; Lateral =
pain with wrist extension
Stability: stable
Sense: normal
Lateral more common

than medial symptoms
Medial = pain with wrist

flexion
73MUSCULOSKELETAL
Usually nothing
indicated
Analgesic:
Acetaminophen or
ibuprofen
ROM Exercises
and isometric
squeezing of
rubber ball
If not improving,
refer to MO;
steroid injections
may be indicated
F/U if not
improved in 14
days
CHIEF COMPLAINT: WRIST PAIN

CONDITION &
DEFINITION
COMMON
FEATURES
DIFFERENTIATING
SIGNS & SYMPTOMS
DIFFERENTIATING
OBJECTIVE FINDINGS
COMMON
DIAGNOSTIC TEST
TREATMENT
FOLLOW-UP
Carpal Tunnel
Syndrome
Compression of
the median nerve
due to repetitive
movement of the
wrist (for
example, typing)
Vague, gradual or
acute ache in wrist
or hand
O vague pain with

history of overuse
P worse w/ sleep &
repetitive action; better
w/ rest
Q dull ache
R radicular referral to
thenar, thumb, index
and middle fingers
S mild to moderate
T intermittent
Insp: asymmetrical w/
thenar atrophy w/o
deformity/discolor
Palp: tenderness and
radiation; Positive Tinels
and Phalens Tests
ROM: active full;
passive full
Stability: stable
Sense: decreased
sensation to thenar,
thumb, index, and middle
fingers
if trauma
Analgesic:
Ibuprofen
F/U if not
improved in 30
days or worse,
refer to MO
Ganglion Cyst
Cystic structure
that arises from
the capsule of the
joint synovial
sheath and
contains thick,
clear, mucinous
fluid
Painful, localized
mass on dorsal or
volar surface of
wrist
O gradual with or
without pain, may have
history of overuse
P worse w/ activities
of frequent movement;
better w/ rest
Q dull ache
R non-radicular
unless median nerve
involved
S mild to moderate
T intermittent

atrophy/discolor. Lump
on dorsal or volar aspect
fluctuant mass
ROM: active full;
passive full
Stability: stable
Sense: normal unless
median nerve involved
Usually nothing
indicated
Modify repetitive
movement
activities
Night splint help
prevent full
flexion of wrist
during sleep
74MUSCULOSKELETAL
Reassurance is
usually
adequate
If activities of
daily living
(picking up
paper/glass) are
compromised,
refer to MO for
possible
aspiration of
mass
F/I if not
improved in 30
days or worse,
refer to MO
CHIEF COMPLAINT: WRIST PAIN (continued)

CONDITION &
DEFINITION
COMMON
FEATURES
DIFFERENTIATING
SIGNS & SYMPTOMS
DIFFERENTIATING
OBJECTIVE FINDINGS
COMMON
DIAGNOSTIC TEST
TREATMENT
FOLLOW-UP
Scaphoid Wrist
Fracture
Most common fx
of the wrist
caused by fall on
outstretched
hand. Important
because of
frequency and
Scaphoid only
has proximal
blood supply.
Untreated fracture
can lead to
osteonecrosis.
Acute wrist pain

after trauma
O acute associated
with trauma
P worse w/ gripping;
better w/ rest
Q dull ache
R nonradicular
S mild to moderate
T intermittent

Palp: tenderness at
(snuffbox) dorsal
Scaphoid bone
ROM: active limited;
passive full
Stability: stable
Sense: normal
Radiograph
indicated if trauma
Fracture may not

be visible on initial
radiographs and
must be repeated
if pain persists
beyond 2-3 weeks
Analgesic:
Acetaminophen
with codeine for 7
days (short term).
CONTACT MO
or Duty Flight
Surgeon
75MUSCULOSKELETAL
When in doubt,
treat as fracture.
Short arm splint
and immobilize
thumb (thumb
spica cast).
Contact MO
CHIEF COMPLAINT: FINGER PAIN

CONDITION &
DEFINITION
COMMON
FEATURES
DIFFERENTIATING
SIGNS & SYMPTOMS
DIFFERENTIATING
OBJECTIVE FINDINGS
COMMON
DIAGNOSTIC TEST
TREATMENT
FOLLOW-UP
Paronychia
Infection of the
tissue around
fingernail. (called
a Felon if
fingertip involved).
Staphylococcus
aureus is the
most common
cause.
Acute pain at distal

phalanx along edge
of nail
O acute w/ history of
trauma vague pain.
P worse w/ palpation
to lesion; better w/ rest
Q dull ache
R nonradicular
S moderate to sever
T constant
localized red (rubor),
tender (dolor), warm
(calor), fluctuant swelling
(tumor) along lateral
edge on nail.
Palp: very tender
ROM: active full;
passive full
Stability: stable
Sense: intact
Culture if unsure or
suspect MRSA
Antibiotic:
Cephalexin
(Keflex)
Follow up every
24 hours until
resolved.
I and D as directed
by MO
If not resolved in
7 days;
CONTACT MO
76MUSCULOSKELETAL
CHIEF COMPLAINT: LOWER BACK PAIN

CONDITION &
DEFINITION
COMMON
FEATURES
DIFFERENTIATING
SIGNS & SYMPTOMS
DIFFERENTIATING
OBJECTIVE FINDINGS
COMMON
DIAGNOSTIC TEST
TREATMENT
FOLLOW-UP
Mechanical
Muscular Strain
Lower back pain
secondary to
paravertebral
spinal muscle
strain caused by
physical activity
or poor fitness.
Chronic
symptoms can be
related to
psychosocial
issues.
Acute and focused

lower back pain
O acute w/ history of
physical strain. The
strain and cause may
be as trivial as leaning
forward to tie shoe.
P worse w/ activity;
better w/ rest
Q dull ache
R nonradicular. May
involve buttocks.
S moderate to sever
T constant

Palp: tenderness at
sacroiliac region. May
have muscle spasms.
passive full
Stability: stable
Sense: intact with
negative Straight Leg
Raise
Usually nothing
indicated.
Note: The motor and
sensory function can
help distinguish
muscular strain from
neurological
involvement with
herniated disk. See
lower back pain;
Neurological,
Herniated Disk
Analgesic:
Ibuprofen
Muscle spasms
give:
diazepam, (Valium)
1-2 days
F/U if not
improved in 14
days
Neurological,
Herniated Disk
(L4 L5 S1)
Rupture of the
inter-vertebral
disc with
protrusion of the
nucleus pulposus
in the spinal
canal. HNP =
Herniated
Nucleus
Pulposus.
Acute or insidious
radiation of lower
back pain
O acute physical
strain or insidious
P worse w/ sitting,
standing, cough; better
supine with knees bent
Q dull to sharp ache
R unilateral radiculopathy to anterior thigh
and below knee
S moderate to severe
T intermittent or
constant
Patient may have
incontinence or loss of
rectal tone.

Palp: tenderness at
lumbar disk (L4/5-S1))
passive - limited
Stability: yes
Motor: 3/5 strengths (big
toe dorsiflexion diminished w/ L5 rupture 67%)
Sense: dermatome L4 =
big toe, L5 = plantar/anter,
S1 = little toe sensation
diminished. Positive
Straight Leg Raise
77MUSCULOSKELETAL
MRI to confirm HNP

only if symptoms
persist longer than 4
weeks or if significant
neurological deficit
Note: the toe-walk
and heal-walk will
help localize HNP.
Weak toe walk
indicates S1
involvement 28% and
a weak heal walk is
L4 involvement 5%
Limit activities
that aggravate
Sx with return
to normal
activity plan
and
psychosocial
intervention if
indicated
Home exercise
concentrating
on abdominal
muscle tone
Analgesic:
Acetaminophen
with codeine for no
longer than 7 days.
Limit activities
that aggravate
Sx for 3-4
weeks
Physical
therapy
F/U if not
improved in 7
days;
CONTACT MO
CHIEF COMPLAINT: KNEE PAIN

CONDITION &
DEFINITION
COMMON
FEATURES
DIFFERENTIATING
SIGNS & SYMPTOMS
DIFFERENTIATING
OBJECTIVE FINDINGS
COMMON
DIAGNOSTIC TEST
TREATMENT
FOLLOW-UP
Bursitis, Patellar
Inflammation of
the bursae (fluidfilled sac), caused
by repetitive
kneeling. There
are several bursa
of the knee that
may be involved.
Knee pain with

direct pressure or
after prolonged
sitting or kneeling
O may or may not

present as pain. May
just be swelling.
P worse after sitting or
kneeling; better w/
activity
Q dull ache
R nonradicular
S mild to moderate
T intermittent
Insp: w/o atrophy/

discolor. Swelling may
be evident
bursae
ROM: active full;
passive full
Stability: stable
Sense: normal
Usually nothing
indicated
Analgesic:
Ibuprofen
No kneeling for 710 days
If not improved in
14 days or signs
of infection or
gouty, refer to
MO.
The patient will be

feverish if infected.
An infected bursae will

show signs of infection.
O acute pain without

initial swelling
P worse w/
ambulation; better after
swelling reduces
Q sharp ache
R nonradicular
S severe
T constant;
ambulation limitation
may be 24-48 hrs after
swelling progresses
Insp: slight swelling

with possible
ecchymosis
Palp: tender over
ligament
passive limited
Stability: instable,
positive valgus/varus
stress test
Sense: normal
Analgesic:
Ibuprofen
If not improved in
14 days; consult
with MO
Collateral
Ligament Tear
(Lateral/Medial)
The medial
ligament is most
commonly injured
and related to
valgus force as in
a football clipping
injury.
Acute knee pain

without initial
swelling
Note: infected
(septic) and gouty
knees will present as
a swollen, painful
knee in the absence
of trauma and will
require MO
consultation for
diagnostic approach.
to rule out fracture
Note: Unlike the
lateral, the medial
collateral ligament
attaches to the
meniscus and injury
to either can affect
the other.
78MUSCULOSKELETAL
RICE and
crutches
Immobilize for
2-3 days, then
regular, gentle
ROM exercises
Usually nonsurgical. ROM

exercises and
strengthening
are important to
recovery
CHIEF COMPLAINT: KNEE PAIN (continued)

CONDITION &
DEFINITION
COMMON
FEATURES
DIFFERENTIATING
SIGNS & SYMPTOMS
DIFFERENTIATING
OBJECTIVE FINDINGS
COMMON
DIAGNOSTIC TEST
TREATMENT
FOLLOW-UP
Cruciate
Ligament Tear
(Anter./Posterior)
The anterior
cruciate ligament
is the prime knee
stabilizer and
more likely to be
injured. A tear
results from a
twisting or hyperextension of the
knee joint.
Acute and severe

knee pain and
swelling associated
with trauma
O sudden pain may

be associated with an
audible pop
P worse w/
ambulation; better after
swelling reduces
Q sharp ache
R nonradicular
S severe
T constant
Insp: marked swelling

with possible
ecchymosis
Palp: tender knee
passive limited
Stability: instable;
positive Drawer Sign
Sense: normal
Radiograph
indicated to rule
out fracture
Analgesic:
Ibuprofen
Consult with the

MO
MRI, although
quite sensitive to
detecting tears,
rarely are
necessary unless
diagnosis is
allusive or surgery
is indicated
Pain develops over 24

hrs as swelling worsens
Initially, knee may be

too swollen to examine
Meniscal Tear
(Lateral/Medial)
The menisci are
fibrocartilaginous
pads that act as
shock absorbers.
Significant twisting
can injury the
meniscus, though
in older patients,
minimal or no
trauma can cause
injury.
Acute trauma may

result in a locking
sensation with
flexion
O Insidious, even with

trauma. No initial
swelling
P worse w/ locking
sensation or squatting;
better with rest
Q sharp ache
R nonradicular
S mild
T - intermittent
Insp: may have slight

swelling otherwise
normal
Palp: tender along joint
line
passive limited
Stability: stable,
positive McMurray test
with painful click
Sense: normal
RICE and
crutches
Immobilize for
2-3 days, then
regular, gentle
ROM exercises
If not corrected
by surgery,
ROM exercises
and
strengthening
are important to
recovery
Radiograph
indicated to rule
out fracture
Analgesic:
Ibuprofen
Diagnosis may be
allusive and MRI
is quite sensitive
to detecting tears
RICE and
crutches
Immobilize for
2-3 days, then
regular, gentle
ROM exercises
Surgery may be
indicated
79MUSCULOSKELETAL
If not improved in
14 days; consult
with MO
CHIEF COMPLAINT: KNEE PAIN (continued)

CONDITION &
DEFINITION
COMMON
FEATURES
DIFFERENTIATING
SIGNS & SYMPTOMS
DIFFERENTIATING
OBJECTIVE FINDINGS
COMMON
DIAGNOSTIC TEST
TREATMENT
FOLLOW-UP
Patellofemoral
Syndrome
Vague pain
associated with
running or
climbing stairs,
usually in younger
patients. Cause
can be articular
surface
irregularities or
patellar
malalignment.
Diffuse knee pain

with running and
may have crepitus
with squatting
O insidious
P worse w/ prolonged
sitting or running; better
with rest
Q dull ache
R nonradicular
S mild
T - intermittent

atrophy/deformity/
discolor
Palp: nontender,
though crepitus with
movement
ROM: active full;
passive full
Stability: Stable.
Positive Patellar Grind
test
Sense: normal
Usually nothing
indicated
Q-angle
measurement can
be helpful to
determining
malalignment.
Analgesic:
Ibuprofen
Continue activity
but change to low
impact or
swimming until
resolved
F/U if not
improved in 2-3
months
Popliteal Cyst
A Baker cyst is a
cystic structure
that arises from
the capsule of the
joint synovial
sheath associated
with arthritis or
degeneration of
the meniscus
Cyst may be
painless and
present as swelling
behind the knee
O gradual and may be

painless w/ just patient
complaint of swelling
behind the knee
P worse if cyst
ruptures; better after
swelling reduces
Q dull ache
R nonradicular
S slight to mild
T intermittent
swelling in popliteal
fossa w/o atrophy or
discoloration.
Palp: tender or
nontender popliteal
mass.
ROM: active full;
passive full
Stability: stable though
may have positive
McMurray if meniscus is
cause
Sense: normal
Transillumination, or
shining a light through
the cyst, can
demonstrate that the
mass is filled with
fluid
Observation
unless the cyst
becomes large
and painful
F/U PRN
NSAIDs for
minor
discomfort
Treatment is
directed at the
cause. Refer to
MO PRN
80MUSCULOSKELETAL
CHIEF COMPLAINT: ANKLE PAIN

CONDITION &
DEFINITION
COMMON
FEATURES
DIFFERENTIATING
SIGNS & SYMPTOMS
DIFFERENTIATING
OBJECTIVE FINDINGS
COMMON
DIAGNOSTIC TEST
TREATMENT
FOLLOW-UP
Achilles Tendon
Rupture
Usually the tendon
ruptures just
proximal to
calcaneus, and
more common in
middle-aged men
who play quick,
stop-and-go
sports.
Sudden, severe
calf pain
O sudden w/audible
pop and pain may
resolve quickly
P worse w/
ambulation; better with
rest
Q sudden sharp then
dull ache
R nonradicular
T constant
calf swelling and
ecchymosis
Palp: tender
passive limited
Stability: unstable w/
positive Thompson test
(no plantar flexion w/
calf squeeze)
Sense: normal
Usually nothing
indicated.
Analgesic:
Ibuprofen PRN
CONTACT MO
or Duty Flight
Surgeon
O sudden and
swelling may not be
immediate
P worse w/
rest
Q sudden sharp then
dull ache
R nonradicular
T constant
swelling and
ecchymosis
Palp: tender at ATFL
Tenderness at base
of 5th metatarsal may
indicate fracture.
passive limited
Stability: unstable w/
positive Drawers sign
Sense: normal
to rule out fracture if
patient unable to
weight-bear, or if
there is marked
swelling.
Ankle Sprain
Most common
ankle ligament
sprain is the lateral
anterior talofibular
ligament (ATFL)
caused by an
inversion injury.
The rare aversion
injury involves the
medial deltoid
ligaments.
Acute ankle pain

associated with
trauma
Ability to
ambulate and
weight-bear
helps determine
severity
81MUSCULOSKELETAL
Initially RICE
Immediate
referral to
MO required
There are
surgical and
non-surgical
approaches
requiring an
orthopedic
evaluation
Analgesic:
Ibuprofen
RICE and
crutches
Immobilize for
2-3 days, then
regular, gentle
ROM exercises
Severe sprains
may require a
cast or
orthopedic boot
for 2-3 weeks
MEDEVAC
If not improved in
14 days; consult
with MO
CHIEF COMPLAINT: FOOT PAIN

CONDITION &
DEFINITION
COMMON
FEATURES
DIFFERENTIATING
SIGNS & SYMPTOMS
DIFFERENTIATING
OBJECTIVE FINDINGS
COMMON
DIAGNOSTIC TEST
TREATMENT
FOLLOW-UP
5TH Metatarsal
Fracture
The fifth
metatarsal is at
the base of the
small toe, and the
proximal end,
where the fracture
occurs, is in the
mid-portion of the
foot.
These fractures
occur after forced
inversion with the
foot and ankle in
plantar flexion,
causing the
tendon to pull off a
piece of the bone.
Patients who
sustain a fracture
have pain over this
middle/outside
area of their foot
O trauma (after an
inversion injury)
P walking and
prolonged standing
aggravate the
symptoms
Q sudden sharp then
dull ache
R nonradicular
T constant,
aggravated by
prolonged standing,
walking or activity
Insp: ecchymosis and

swelling at the site
Palp: tenderness at the
base of the fifth
metatarsal. Full
evaluation of the distal
fibula and lateral
ligamentous structures
must be included in the
assessment.
Stability: stable
Sense: normal
Radiographs are
indicated with
initial evaluation
Analgesic:
Ibuprofen
F/U if not
improving in 6
weeks
Weight-bearing
radiographs
indicated if
treatment
unsuccessful
Heel Spur
Soft, bendable
deposits of
calcium that are
the result of
tension and
inflammation in
the plantar fascia
attachment to the
heel.
Dull ache that is

felt most of the
time with episodes
of a sharp pain in
the center of the
heel or on the
inside margin of
the heel.
O first ambulation
P worse w/ fist
time, though returns
over course of day
Q sudden sharp then
dull ache
R nonradicular
T constant,
aggravated by
prolonged standing

Palp: tender at
calcaneal tuberosity
ROM: active full;
passive full
Stability: stable
Sense: normal
Radiographs not
indicated with
initial evaluation
Weight-bearing
radiographs
indicated if
treatment
unsuccessful
82MUSCULOSKELETAL
Options include
elastic wrapping,
ankle splints and
low-profile
walking boots or
casts
Weight bearing is
allowed as
tolerated
Treatment should
be continued until
symptoms abate-usually within six
weeks
Analgesic:
Ibuprofen
Heel cushion or
donut
Avoid high
impact exercise
or work
F/U if not
improving in 3-6
months
CHIEF COMPLAINT: FOOT PAIN (continued)

CONDITION &
DEFINITION
COMMON
FEATURES
DIFFERENTIATING
SIGNS & SYMPTOMS
DIFFERENTIATING
OBJECTIVE FINDINGS
COMMON
DIAGNOSTIC TEST
TREATMENT
FOLLOW-UP
Plantar Fasciitis
Degenerative tear
of fascial origin
from the
calcaneus. This
may be
associated with a
heel spur.
Acute or
Chronic arch
pain
Radiographs not
indicated with
initial evaluation
Weight-bearing
radiographs
indicated if
treatment
unsuccessful
Analgesic:
Ibuprofen
Heel cup (raise
heel slightly to
decrease strain on
plantar fascia) or
OTC orthotic insert
F/U if not
improved in 3-6
months
Usually no
trauma; worse
on first
ambulation an
gradually gets
better
throughout day

Palp: tender at medial
calcaneal tuberosity
and distally along
plantar fascia
ROM: active full;
passive full
Stability: stable
Sense: normal
O first ambulation
P worse w/ fist
time throughout day
Q dull ache
R nonradicular
T constant
83MUSCULOSKELETAL
CHIEF COMPLAINT: TOE PAIN

CONDITION &
DEFINITION
COMMON
FEATURES
DIFFERENTIATING
SIGNS & SYMPTOMS
DIFFERENTIATING
OBJECTIVE FINDINGS
COMMON
DIAGNOSTIC TEST
TREATMENT
FOLLOW-UP
Ingrown Toenail
The toenail
abnormally grows
into nail bed and
may involve
infection of the
tissue around
toenail.
Staphylococcus
aureus is the most
common organism
involved
Acute pain at distal

phalanx along
edge on nail
O Insidious
P - worse w/ palpation
to lesion; better w/ rest
Q dull ache
R nonradicular
S moderate to sever
T constant
localized red (rubor),
tender (dolor), if infected
will also be warm (calor),
and swollen (tumor)
along lateral edge on
nail
Palp: very tender
ROM: active full;
passive full
Stability: stable
Sense: normal
Culture if unsure or
suspect MRSA
Soak the foot in

warm water 4 times
a day, preferably
with Epsom salts.
If infected:
Antibiotic:
Cephalexin
(Keflex)
Follow up every
24 hours until
resolved
84MUSCULOSKELETAL
Pain
management,
no boots
Partial toenail
removal as
directed by MO
IF not resolved in
7 days;
CONTACT MO
CHIEF COMPLAINT: LEG PAIN

CONDITION &
DEFINITION
KEY FEATURES
DIFFERENTIATING
SIGNS & SYMPTOMS
DIFFERENITIATING
OBJECTIVE FINDINGS
COMMON
DIAGNOSTIC TEST
TREATMENT
FOLLOW-UP
Shin Splints
A general name
given to pain at
the front of the
lower leg related
to inflammation of
the periosteum of
the tibia due to
traction forces on
the muscles
attached. Caused
by training too
hard or running in
ill-fitting or wornout footwear.
Lower leg pain over

inside of the shin
O gradual onset
P - worse with running;
better w/o activity
Q dull ache
R nonradicular
S mild to moderate
T intermittent
Insp: w/o atrophy/

discolor, deformity. May
have slight swelling.
anterior tibia (shin)
ROM: active full;
passive full
Stability: stable
Sense: normal
Usually nothing
indicated
Note: If symptoms
appear persistent,
radiographs may
indicate stress
fracture.
Analgesic:
Ibuprofen
Wear proper
footwear and
lessen the impact
of training
F/U if not
improved in 14
days; or refer to
MO
85MUSCULOSKELETAL
This page is intentionally blank.
86MUSCULOSKELETAL
CHIEF COMPLAINT: ALTERED MENTAL STATUS

(though any neurological condition can have AMS, the CC here is categorized by common presenting features)
CONDITION &
DEFINITION
COMMON
FEATURES
DIFFERENTIATING
SIGNS & SYMPTOMS
DIFFERENTIATING
OBJECTIVE FINDINGS
COMMON
DIAGNOSTIC TEST
TREATMENT
FOLLOW-UP
Alcohol Intoxication
Physically and/or
psychologically reliant
on alcohol. Alcohol
abuse may be
situational or chronic.
Alcohol dependency
is a chronic, life-time
diagnosis.
Acute intoxication
Sloppy speech,
alcohol on breath
Appears intoxicated
Reasonable blood
alcohol concentration
(BAC) is <0.06%.
Acute Tx:
Refer to CDAR
(1 drink = 0.03%
BAC: 12 oz of 4%
beer, 1.5 oz of 40%
shot, or 6 oz of 11%
wine)
Monitor
Note: 5 drinks/2.5 hrs

= 0.15 BAC
= intoxication/delirium
Chronic Tx:
Refer to MO
CBC
Acute Tx:
Aspirin 650 mg bid
CONTACT MO
or Duty Flight
Surgeon.
Chronic Tx:
Refer to MO
MEDEVAC
Cerebrovascular
Accident (CVA)
Infarction or
hemorrhage in the
brain caused by
ischemia, trauma or
anticoagulation. Most
common in age > 45.
Cognitive deficit
Nausea and vomiting

Headache
Happy, sad or angry
affect
(Note: diabetic
emergencies may
appear as
intoxication)
Acute cognitive
deficit
Slurred speech
Motor and sensory
deficits
Headache may be
gradual or sudden
The classic chronic

alcoholic may appear
with poor hygiene,
spider angiomas on
skin, red faced, pot
belly, thin extremities.
Ask:
C = cut down need?
A = annoyed by drink?
G = guilty about drink?
E = eye opener need?
Patient able to easily

close both eyes but
unable to completely
smile. Facial
weakness does not
include forehead as it
does in Bells Palsy.
Complete physical
examination including
neurological
87NEUROLOGICAL
Blood chemistries
Time
Avoid stimulants
like caffeine
Severe cases
may require MO
consultation.
Blood glucose
RPR
Urinalysis
ECG
CT of head
Note: MNM-0013
is:
Maturity = Mod.
Zero illegal drink
Zero DUI
1 drink per hour
3 drinks per 24
hours
Never leave drink
unattended
CHIEF COMPLAINT: ALTERED MENTAL STATUS

(though any neurological condition can have AMS, the Chief Complaint is categorized by common presenting features)
CONDITION &
DEFINITION
COMMON
FEATURES
DIFFERENTIATING
SIGNS & SYMPTOMS
DIFFERENTIATING
OBJECTIVE FINDINGS
COMMON
DIAGNOSTIC TEST
TREATMENT
FOLLOW-UP
Seizure
Paroxysmal
hyperexcitation of
the neurons in the
brain. Epilepsy is
chronic recurrent
seizures.
Compromised
motor activity
Partial Seizure no loss

of consciousness,
though simple muscle
contractions,
paresthesias, loss of
bowel & bladder
Between seizures,
physical exam is
normal, though may
have bruising or trauma
to tongue just after.
CBC
During seizure,
maintain airway
and prevent
injury.
Consult with MO
or Flight Surgeon
Petit Mal Seizure

sudden stopping of
motor function with
blank stare
Chemical Panel
Urinalysis
Drug & alcohol
screening
CT scan or MRI
Grand Mal Seizure

loss of consciousness,
tonic-clonic muscle
contractions, loss of
bowel & bladder;.
postictal period
88NEUROLOGICAL
Refer to MO
Seizure > 10
minutes need
emergency
intervention!
CHIEF COMPLAINT: HEADACHE

CONDITION &
DEFINITION
COMMON
FEATURES
DIFFERENTIATING
SIGNS & SYMPTOMS
DIFFERENTIATING
OBJECTIVE
FINDINGS
COMMON
DIAGNOSTIC TEST
TREATMENT
FOLLOW-UP
Acute cognitive
deficit with
sudden, severe
headache
Sudden, severe
headache. Reports
worst headache of
life
Appears with altered

level of
consciousness
CBC
Oxygen
Blood chemistries
IV- NS
Blood glucose
Comfortable rest
CONTACT MO
or Duty Flight
Surgeon
Nausea, vomiting
Tachycardia
Emergent
Hemorrhage,
Subarachnoid
Hemorrhage within
the subarachnoid
space of the brain
caused by trauma or
anticoagulation
Increased BP
Altered consciousness
May have visual and
neurological deficiency
Hypertension
Emergency
Severe hyper-tension
with potential to
cause target organ
damage (brain,
cardio-vascular
system, and kidneys)
Normal mental
status with
headache
Meningitis
Bacterial or viral
infection/inflammation
of the covering of the
brain and spinal cord.
Cause is mainly
bacterial or viral.
Cause must be
identified because
treatments are
different.
Acute severe
headache with
a fever
May be asymptomatic
or have a headache
with blurred vision
Nausea and maybe
vomiting
Complete physical
examination
including
neurological
Marked increased
BP with a diastolic of
>120 (>210/>120)
and bounding pulse
Fundoscopic =
papilledema
Complete physical
examination
including
neurological
May have
cognitive deficit
RPR
Urinalysis
ECG
CT of head
CBC
Blood chemistries
Urinalysis
Emergency
treatment is required
Acute Tx:
Determine cause:
CBC
Gradual or sudden
headache with neck
pain and stiffness
Nuchal rigidity on
flexion only
Lumbar Puncture
Occasional rash
Fundoscopic =
papilledema
Complete physical
examination
including
neurological
89NEUROLOGICAL
CT of head
CONTACT MO
or Duty Flight
Surgeon
MEDEVAC
Spiral CT of
kidneys
Febrile
Photophobia
Antihypertensive:
Nitroprusside IV; BP
must be reduced
within 1 hour
ECG
Fever
Positive Kernigs or
Brudzinskis sign
MEDEVAC
Emergency
If bacterial, IV
antibiotics as
directed
If viral, IV
analgesics as
directed
Emergency
CONTACT MO
or Duty Flight
Surgeon
MEDEVAC
CHIEF COMPLAINT: HEADACHE (continued)

CONDITION &
DEFINITION
COMMON
FEATURES
DIFFERENTIATING
SIGNS & SYMPTOMS
DIFFERENTIATING
OBJECTIVE FINDINGS
COMMON
DIAGNOSTIC
TEST
TREATMENT
FOLLOW-UP
Normal mental
status with sharp,
boring headache
Rhinorrhea
Appears un-rested,
and in pain
Usually nothing
indicated
Unilateral headache
centered around orbit
and lasting 30-120
minutes in clusters
over 4-12 weeks with
1-2 per day.
Complete physical
neurological
If uncertain, CT
or MRI of head
Acute Tx:
Ergotamines (NOT
with sulfa allergy):
Sumatriptan SQ
(Imitrex) or Midrin,
oxygen, IV NS if
dyhydrated
F/U if not
improved in 24
hrs refer to MO
Sinus pressure, facial

pain or headache
Turbinates are
erythematic and
swollen
Non-Emergent
Cluster Headache
Excruciating unilateral
periorbital or temporal
pain typically in men.
Cause unknown, though
suggests hypothalamic
disorder.
Sinusitis
Inflammation or infection
of mucous membranes
of paranasal sinus
Normal mental
status with dull,
functional
headache
Nasal
Congestion
Ipsilateral lacrimation
May have yellow green nasal

discharge, maxillary
toothache, fever or
malaise.
Chronic Tx refer
to MO
Face pain worse when

bending over (tilt test),
sinus tenderness with
percussion
May be unable to
transilluminate sinuses
Usually none
indicated
CT of sinus if Sx
persist
Antibiotic:
Amoxicillinclavulanate
(Augmentin) or
Septra DS
Reserve antibiotics
for patients that fail
a 7 day course of
decongestants and
analgesics
If severe pain, treat
sooner
90NEUROLOGICAL
F/U if not
improved in 7
days or
increased fever
or headache
CHIEF COMPLAINT: HEADACHE (continued)

CONDITION &
DEFINITION
COMMON
FEATURES
DIFFERENTIATING
SIGNS & SYMPTOMS
DIFFERENTIATING
OBJECTIVE FINDINGS
COMMON
DIAGNOSTIC TEST
TREATMENT
FOLLOW-UP
Bilateral occipital or
band-like head pain is
most common, though
may be a generalized
pain.
Normal physical
finding
Usually nothing
indicated
F/U PRN
Complete physical
neurological
If uncertain, CT or
MRI of head
Analgesics:
Acetaminophen
(Tylenol) or
NSAIDS
Unilateral headache,
preceded by aura,
gradually intense and
throbbing
Appears un-rested, in
pain and may have
facial flushing during
attack
Usually nothing
indicated
Associated nausea,
vomiting,
photophobia, blurred
vision are very
common
Complete physical
neurological
Non-Emergent (continued)
Tension Headache
Diffuse bilateral
occipital or band-like
pain usually
associated with stress
(episodic) and may be
chronic in nature
Normal mental
status with dull,
functional
headache
Vascular Headache
Migraine headache is
a diffuse severe
unilateral pain. Exact
cause is unknown
though a disturbance
of cerebral blood flow
precipitated by food,
alcohol, BCP,
menses, fatigue,
excess sleep, hunger,
stress or relief of
stress is involved.
65% with positive
family history of same.
Normal mental
status with severe,
throbbing
headache
91NEUROLOGICAL
If uncertain, CT or
MRI of head
Stress reduction
or evaluate
workplace
ergonomics
Acute TX
Ergotamines
(NOT with sulfa
allergy):
Sumatriptan SQ
(Imitrex) or
Midrin, oxygen, IV
NS if dyhydrated
Chronic TX refer
to MO
F/U if not
improved in 24
hrs refer to MO
CHIEF COMPLAINT: VERTIGO

CONDITION &
DEFINITION
COMMON
FEATURES
DIFFERENTIATING
SIGNS & SYMPTOMS
DIFFERENTIATING
OBJECTIVE FINDINGS
COMMON
DIAGNOSTIC TEST
TREATMENT
FOLLOW-UP
Benign Positional
Vertigo
Vertigo occurs with
certain head
positions. Cause
associated with
otoconial crystals that
stimulate semicircular
canal hair cells
Vertigo with body

position changes
Vertigo associated
with positional
changes. Usually
occurs when supine
or acute change in
body position.
Dix-Hallpike Barany
Maneuver positive
(with + nystagmus)
Usually nothing
indicated
Antiemetics:
Meclozine
F/U if not
improved in 24
hours
Labyrinthitis
Inflammation of the
vestibular labyrinth of
the inner ear
Vertigo with
nausea and
vomiting
Gradual, severe vertigo

with bilateral tinnitus
and associated nausea,
and vomiting
Dix-Hallpike
Maneuver negative
Usually nothing
indicated
Antiemetics:
meclozine
Complete physical
neurological
CT or MRI if tumor
is suspected
Hydration for
vomiting
F/U if not
improved in 24
hours
Menieres Disease
Disease of the inner
ear in which there is
increased endolymph,
which creates
increased pressure in
the inner ear
Vertigo. symptoms
may be vague
Periodic, sudden,
severe attacks of
vertigo with unilateral
tinnitis and hearing
loss
Dix-Hallpike
Maneuver negative
Diagnosis of
exclusion may
require rule out of
other conditions
Antiemetics:
Meclozine
F/U if not
improved in 24
hrs refer to MO
Motion Sickness
Normal response to
abnormal erratic or
rhythmic motions.
Chronic symptoms
without relief of
stimulus can be
debilitating
Vertigo or
lightheadedness
and nausea
Antiemetics:
Meclozine,
preferably prior to
travel
Hydration for
vomiting
F/U if not
improved in 24
hours
May have recent HO

viral infection
Occasional nausea,
vomiting
Motion stimulus.
Symptoms may include
nausea, vomiting,
yawing, salivation, and
hyperventilation.
Complete physical
neurological
Complete physical
neurological
Dix-Hallpike
Maneuver negative
Complete physical
neurological
92NEUROLOGICAL
CT or MRI if tumor
is suspected
CT or MRI if tumor
is suspected
Usually nothing
indicated
CHIEF COMPLAINT: FACIAL NEUROPATHY

CONDITION &
DEFINITION
COMMON
FEATURES
DIFFERENTIATING
SIGNS & SYMPTOMS
DIFFERENTIATING
OBJECTIVE FINDINGS
COMMON
DIAGNOSTIC TEST
TREATMENT
FOLLOW-UP
Bells Palsy
Facial muscle
weakness caused by
inflammation of the
seventh cranial
nerve (facial nerve).
Complete resolution
within 6 weeks.
Cause unknown
though may be
associated with
herpes.
Facial flaccidity
Sudden onset of
flaccidity of one side
of the face
Patient not able to

close affected eyelid
Usually nothing
indicated
Keep affected eye

moist with eye
drops or ophthalmic
ointment
CONTACT MO
or Duty Flight
Surgeon
Cerebrovascular
Accident (CVA)
Infarction or
hemorrhage in the
brain cause by
ischemia, trauma or
anticoagulation.
Most common in age
> 45.
CBC
Acute TX: Aspirin

650 mg bid
CONTACT MO
or Duty Flight
Surgeon
MEDEVAC
May have loss of

hearing
May have history of or
active herpes lesion
on face
Facial
flaccidity
Slurred speech, motor

and sensory deficits
Acute
cognitive
deficit
Headache may be
gradual or sudden.
Unable to completely
smile
Facial weakness
includes forehead
Complete physical
neurological.
Patient able to easily

close both eyes but
unable to completely
smile
Facial weakness does
not include forehead
as it does in Bells
Palsy
Complete physical
neurological
93NEUROLOGICAL
Blood chemistries
Blood glucose
RPR
Urinalysis
ECG
CT of head
Chronic Tx:
Refer to MO
CHIEF COMPLAINT: FACIAL NEUROPATHY (continued)

CONDITION &
DEFINITION
COMMON
FEATURES
DIFFERENTIATING
SIGNS & SYMPTOMS
DIFFERENTIATING
OBJECTIVE FINDINGS
COMMON
DIAGNOSTIC TEST
TREATMENT
FOLLOW-UP
Trigeminal
Neuralgia
Tic douloureux is a
syndrome of
paroxysms of
lancinating facial
pain in the
distribution of one or
more division of the
fifth (trigeminal)
nerve. Caused by
compression to the
trigeminal nerve in
90% of cases.
Rarely an aneurysm.
Facial pain in
clusters
Pain burst for several

seconds then remits
Patient may present

asymptomatic or have
pain on one side of face
with light touch
MRI for all patients

to exclude mass
lesions or central
demyelination
Carbamazepine
(Tegretol) works in
75% of cases.
CONTACT MO
or Duty Flight
Surgeon
Attack brought on by
mild trigger such as
light touch or draft of
air
Dental pathology
may be cause
dental exam will
help rule out
94NEUROLOGICAL
CHIEF COMPLAINT: FEELING DOWN OR WORRIED

CONDITION &
DEFINITION
KEY FEATURES
DIFFERENTIATING
SIGNS & SYMPTOMS
DIFFERENTIATING
OBJECTIVE FINDINGS
COMMON
DIAGNOSTIC TEST
TREATMENT
FOLLOW-UP
Adjustment
Disorder
Transient,
situational
maladjustment
due to special
stress (significant
life stressor)
Patient may present

with somatic
complaints caused by
excessive worry or
low mood
Patient usually presents

with depressed mood
associated with feelings
of being in hopeless
situation. Thoughts are
often dominated by the
problems that
precipitate the episode.
May appear anxious

or depressed:
preoccupied by
problems that
precipitate the
episode; military/sea
life, homesick
R/O anxiety and

depression
Self-limiting
CONTACT MO
and/or Duty
Flight Surgeon
IF doubt
Anxiety
Excessive worry,
fear, nervousness,
& hyper vigilance.
May be associated
with adjustment
disorder or
generalized.
Patient may present

with somatic
excessive worry
Physical complaints
prompt patient to seek
medical attention;
worry, insomnia,
muscle tension,
headache, fatigue, GI
upset.
Appears anxious,
dyspnea
If presenting with
chest pain - ECG is
normal
Depression
Abnormal
emotional state;
sadness, rejection,
worthlessness,
despair, and
discouragement.
May be associated
with adjustment
disorder or major
depression.
Patient may present

with somatic
low mood
Anxiety
Questionnaire and
Depression
Questionnaire
Anxiety
Questionnaire
Chest pain may be

associated with stress
or panic attack.
FIVE of the following
criteria daily for TWO
weeks:
Appears sad,
unkempt, tearful,
minimal eye contact,
slow movements
Depression
Questionnaire
(SIGECAPS)
Improvement
when the stress
is removed or
adaptive coping
mechanism
employed
Acute Tx:
Antianxiety:
Hydroxyzine
(Atarax), or
diazepam (Valium)
Chronic Tx:
Refer to MO
CONTACT MO
and/or Duty
Flight Surgeon
IF doubt
Listen
CONTACT MO
and/or Duty
Flight Surgeon
IF doubt
Psychomotor loss
Encourage
proper diet, daily
exercise,
pursuing
pleasurable
interest, minimal
alcohol
consumption;
exercise is
proven to reduce
depression
Libido down
Refer to MO
Suicidal ideation
IF suicidal: refer
to suicidal
ideation
Sleep more/less
Interest down
Guilt dominant
Energy down
Concentration down
Appetite more/less
95MENTAL HEALTH
CHIEF COMPLAINT: FEELING DOWN OR WORRIED (continued)

CONDITION &
DEFINITION
KEY FEATURES
DIFFERENTIATING
SIGNS & SYMPTOMS
DIFFERENTIATING
OBJECTIVE FINDINGS
COMMON
DIAGNOSTIC
TEST
TREATMENT
FOLLOW-UP
Suicidal Ideation
Self destructive
thoughts or acts;
three types:
Patient may present

with somatic
excessive worry or
low mood.
See anxiety and

depression above
May appear anxious

or depressed. See
anxiety and
depression above
Suicide Risk
Questionnaire
(SADPERSON)
Suicidal thoughts
ALONE require
immediate
healthcare
intervention
CONTACT MO
and/or Duty
Flight Surgeon
successful
(death)
ASK: Do you want to

hurt yourself? or Do
you have a plan to
hurt yourself?
Mental Health
Interview
Obtain assistance
Establish a No
Harm Safety
Plan
attempt
gesture
Thoughts & plans
about suicide are
ideation.
96MENTAL HEALTH
Follow unit
SOP, i.e.,
suicide ideation
policy
Contact
command
ICD CODES, ABBREVIATED VERSION

CONDITION
CODE
Dermatological
Erythema due to Anthrax
692.4
Erythema due to a Drug Reaction (internal)
693.0
Erythema due to a Drug Reaction (contact)
692.3
Erythema/Urticaria
708.9
Wart (common)
078.10
Acne Vulgaris
706.1
Tinea Corporis
110.5
Tinea Cruris
110.3
Tinea Pedis
110.4
Tinea Versicolar
111.0
Atopic Dermatitis
691.8
Contact Dermatitis
692.9
Eczema (dyshidrosis)
705.81
Herpes Zoster
053.9
Smallpox
050.9
Varicella (chickenpox)
052.9
97ICD 9 CODES
HEENT
Blepharitis
373.00
Allergic Conjunctivitis
372.05
Infectious Conjunctivitis
372.30
Corneal Abrasion
918.1
Subconjunctival Hemorrhage
372.72
Cerumen Impaction
380.4
Eustachian Tube Dysfunction
381.81
Otitis Externa
380.10
Otitis Media
382.9
Perforation (ear)
384.20
Serous Otitis Media
381.01
Allergic Rhinitis
477.9
Upper Respiratory Infection
465.9
Common Cold
460.0
Epistaxis
784.7
Sinusitis (Acute)
461.9
Viral Pharyngitis
462
98ICD 9 CODES
Gastrointestinal
Appendicitis
541
Constipation
564.00
Diarrhea
787.91
Food Poisoning
005.9
Acute Gastroenteritis (viral)
008.8
Gastroesophageal Reflux Disease (GERD)
530.81
Peptic Ulcer Disease
533.90
Ectopic Pregnancy
633.90
Genitourinary
Vulvovaginal Candidiasis
112.1
Dysmenorrhea
625.3
Urinary Tract Infection (including cystitis)
599.0
Epididymitis
604.90
Inguinal Hernia
550.90
Acute Prostatitis
601.0
Testicular Torsion
608.20
Pyelonephritis
590.80
Renal Calculii
592.0
99ICD 9 CODES

Genitourinary, continued
Chancroid
009.0
Chlamydia
079.98
Gonorrhea
098.0
Herpes Simplex Virus II (HSV II)
054.9
Human Immunodeficiency Virus (HIV) (symptomatic)
042
Human Immunodeficiency Virus (HIV) asymptomatic)
V08
Pediculosis
132.9
Syphilis
097.9
Cardiovascular
Acute Coronary Syndrome (ACS) (AMI)
411.1
Angina Pectoris
413.9
Costochondritis
733.6
Pleuritis
511.0
Respiratory
Bronchitis, Viral
466.0
Bronchitis, Acute
466.0
Influenza
487.1
Pneumonia, Bacterial
482.9
100ICD 9 CODES

Respiratory, continued
Pneumonia, Mycoplasmal
483.0
Pneumonia, Viral
480.9
Tuberculosis
011.9
Anaphylaxis
995.0
Asthma
493.90
Musculoskeletal
Neck - Cervical Muscle Strain
847.0
Herniated Cervical Disk Neck
722.0
HNP Herniated Nucleus Pulposus
722.2
Shoulder Bicepital Tendon Rupture, Proximal
840.8
Shoulder Biceptial Tendonitis
726.12
Shoulder Subacromial Bursitis
726.19
Elbow Epicondylitis, Media
726.31
Elbow Epicondylitis, Lateral
726.32
Elbow Epicondylitis, Olecranon
726.33
Wrist Carpal Tunnel Syndrome
354.0
Wrist Scaphoid Wrist Fracture
814.01
Lower back Mechanical muscular strain
846.9
101ICD 9 CODES

Musculoskeletal, continued
Knee Bursitis, Patellar
726.64
Ankle Ankle sprain
845.00
Foot Fifth Metatarsal Fracture
825.25
Leg Shin splints
844.9
Neurological
Alcohol Abuse
305.00
Cerebrovascular Accident (CVA)
434.91
Seizure
780.39
Emergent headache - Hemorrhage, Subarachnoid
430
Meningitis
322.9
102ICD 9 CODES
REFERENCES
Barkauskas, Baumann, Darling-Fisher, Health & Physical Assessment (Mosbys current edition)
Skedmore-Roth, L., Nursing Drug Reference (Mosbys current edition)
Beers, M.H., The Merck Manual (Merck Research Laboratories current edition)
Dunn, S.A., Primary Care Consultant (Mosbys current edition)
Snider, R.K., Essentials of Musculoskeletal Care (American Academy of Orthopaedic Surgeons current
edition)
Skinner, H.B., Current Diagnosis and Treatment in Orthopedics (Lange Medical Books current edition)
Listed medications are found on the Standardized Health Services Technician Formulary, Health Services
Allowance List (Afloat), and the CG Nonprescription Medication Program.
103REFERENCES Revised 1/18/08

Differential Diagnosis of Common Complaints

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D

Lower Back Pain

Mechanical, Muscular Strain

Neurological, Herniated Disk

Herpes Simplex Virus

Collateral Ligament Tear

GUIDE TO SCOPE OF PRACTICE FOR HS TECHNICIANS

4GUIDE TO SCOPE OF PRACTICE FOR HS TECHNICIANS

Herpes Simplex Virus

5GUIDE TO SCOPE OF PRACTICE FOR HS TECHNICIANS

EYES, EARS, NOSE, AND THROAT

Herpes Simplex Virus

EYES, EARS, NOSE, AND THROAT, Continued

Serous Otitis Media

6GUIDE TO SCOPE OF PRACTICE FOR HS TECHNICIANS

Anxiety (see Mental

Deep Vein Thrombosis

7GUIDE TO SCOPE OF PRACTICE FOR HS TECHNICIANS

Urinary Tract Infection

Peptic Ulcer Disease

Herpes Simplex Virus

8GUIDE TO SCOPE OF PRACTICE FOR HS TECHNICIANS

Herniated Cervical Disk

Rotator Cuff Tear

Cervical Muscle Strain

9GUIDE TO SCOPE OF PRACTICE FOR HS TECHNICIANS

Prostatitis (see GU male)

Renal Calculi (see GU

Collateral Ligament Tear

Cruciate Ligament Tear

Achilles Tendon Rupture

Fifth Metatarsal Fracture

10GUIDE TO SCOPE OF PRACTICE FOR HS TECHNICIANS

11GUIDE TO SCOPE OF PRACTICE FOR HS TECHNICIANS

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12GUIDE TO SCOPE OF PRACTICE FOR HS TECHNICIANS

CHIEF COMPLAINT: ERYTHEMA

May have fever,

May have fever and

Indurated patch that is

Localized red (rubor)

Mild: Penicillin VK,

Notify Command Disease Alert

CHIEF COMPLAINT: ERYTHEMA (continued)

Papule or nodule, firm

Localized red (rubor)

Incise and drain if

CHIEF COMPLAINT: ERYTHEMA (continued)

May have fever,

Rash spreads from

CHIEF COMPLAINT: GROWTHS

Usually an incidental and

The lesions are firm

Smooth flesh colored

Cauliflower fleshcolored papules that