COVID-19 clinical presentation <div class="redbox"> <p style="text-size:12px;">COVID-19 can present with a myriad of symptoms so should probably be on most differential diagnosis lists during the pandemic</p> <li><a href="https://productivemedic.com/covid-remote-assessment/" target="_blank">COVID assessment, DDx and complications</a></li> <li><a href="https://www.google.com/imgres?imgurl=https%3A%2F%2Ff6publishing.blob.core.windows.net%2F2ab0884c-0618-4586-aaf1-41004e6ad656%2FWJCC-8-3956-g002.png&imgrefurl=https%3A%2F%2Fwww.wjgnet.com%2F2307-8960%2Ffull%2Fv8%2Fi18%2F3956.htm&tbnid=I0G0VvXcx_akPM&vet=12ahUKEwj1_43FsrnuAhUH-YUKHSoZAFQQMygYegUIARCwAQ..i&docid=IBDQMbzRItpvKM&w=3307&h=2168&q=covid%2019%20presentation&safe=strict&ved=2ahUKEwj1_43FsrnuAhUH-YUKHSoZAFQQMygYegUIARCwAQ" target="_blank">Clinical presentation summary infographic</a></li> <div>
*Common causes
  • Viral infection
  • Vertigo <a href="https://www.racgp.org.au/afp/2016/april/an-approach-to-vertigo-in-general-practice/" target="_blank" rel="noopener noreferrer">An approach to vertigo in general practice - RACGP</a> <table class="table table-bordered"><caption>Most common differential diagnoses of vertigo</caption> <tbody> <tr></tr> <tr><th>Differential diagnosis</th><th>Onset and duration</th><th>Provoking factors</th><th>Special features</th><th>Physical exam findings</th></tr> <tr> <td>Labyrinthitis</td> <td>Few seconds to minutes</td> <td>Change in&nbsp;the&nbsp;head&nbsp;position</td> <td>Tinnitus</td> <td>Hearing loss present</td> </tr> <tr> <td>Vestibular neuronitis</td> <td>Seconds to minutes</td> <td>Recent upper respiratory tract infection</td> <td>Imbalance, while nystagmus is horizontal or rotational, the direction of the fast component is away from the side of the lesion</td> <td>Absence of hearing loss</td> </tr> <tr> <td>Benign paroxysmal positional vertigo</td> <td>Seconds</td> <td>Change in the head position</td> <td>Positional</td> <td>Positive Dix−Hallpike</td> </tr> <tr> <td>Ménière’s disease</td> <td>Hours</td> <td>Spontaneous</td> <td>Hearing loss and tinnitus</td> <td>Hearing assessment for sensorineural hearing loss</td> </tr> </tbody> </table>
  • Psychogenic (Anxiety)
  • Vasovagal syncope
  • Orthostatic hypotension
  • Vestibular migraine
  • Anaemia
  • Hypothyroidism
Red flags
  • Progressive symptoms
  • Confusion/behavioural changes
  • Associated symptoms
    • Collapse
    • Chest pain
    • Dyspnoea
    • Headache
    • Neurological symptoms
    • Hearing loss
Investigations to consider
  • U+Es, LFTs, Bone profile, Serum glucose
  • Urinalysis
  • CXR
  • CT scan/MRI
  • ECG/24h ECG
  • Echocardiogram
  • Audiometry
  • Carotid Doppler
  • EEG
* DDx list disclaimer: please read
  • These lists could never be comprehensive and remain practical to use during the consultation. We have included conditions that we think will cover the vast majority of primary care presentations for any given symptom. This does not mean other conditions, red flags and investigations should not be considered.
  • Each list is provided as a brief reminder only and is presented in no particular order. The authors have used editorial licence to allow quicker access during the consultation and to prevent duplication.
  • We feel that the "Must not Miss" conditions should always appear at the top of your differential diagnosis list. The consequences of missing a diagnosis from within this category carry significant morbidity and mortality risks to your patient.
  • Many diagnoses are not obvious or apparent at the initial presentation. It may be appropriate to share your diagnostic uncertainty with patient, and also provide specific guidance (safety netting) on when and where patients should seek further advice and follow up.