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Flushing

  • Common ddx

    • menopause
    • EtOH
    • Cushing's
    • Rosacea (facial erythema triggered by EtOH, spicy foods)
    • allergies (urticaria)
    • hyperthyroidism (heat intolerance)
    • diabetes (polyuria, hypoglycemic episodes)
    • panic attack (associated with anxiety, hyperventilation)
  • Serious ddx

    • anaphylaxis (acute dyspnea, urticaria)
    • carcinoid syndrome (diarrhea, flushing)
    • dermatomyositis (heliotrope rash, proximal muscle weakness)
    • polycythemia vera (headache, pruritus esp after showering)
    • lupus (butterfly rash that is scarring, mucosal ulcers)
    • SJS (recent antibiotics, nikolsky sign)
    • occult malignancy (weight loss, nightsweats)
  • Labs

    • FSH, estradiol if menopause
    • cortisol level if Cushing's
    • urine catecholamines if pheochromocytoma
    • secretin stimulation test if gastrinoma
    • urine 5-HIAA if carcinoid
    • skin biopsy if mastocytosis
  • Other ddx

    • ZES (refractory GERD)
    • pheochromocytoma (episodic tachycardia, hypertension)
    • mastocytosis (urticaria)
  • HPI

    • onset
    • triggering event
    • aggravates: EtOH, spicy food, sunlight
    • alleviates
    • associations with: anxiety, tachycardia, hyperventilation
    • menopausal sx: mood swings, hot flashes
  • ROS

    • fever, weight loss, nightsweats
    • rash, hives, pruritus
    • headache, dizziness
    • chest pain, dyspnea
    • nausea, vomiting, diarrhea, abdominal pain
    • polyuria, polydipsia, heat intolerance
    • muscle weakness
  • PMH

    • refractory GERD
  • FH

  • SH

    • EtOH usage
  • Meds

    • recent antibiotics
    • steroids
  • Allergies

  • Px

    • vitals
    • gen impression
    • cushinoid features: obesity, buffalo hump, purple striae
    • skin (flushed area, rash, urticaria, nikolsky sign)
    • ENT: ulcers in nasal and oral cavity
    • cardio, pulm
    • abd: abdominal mass
    • neuro: muscle strength

  • Print | Citations

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