> These diagnoses “**do not exist**” in adults. Of course they do exist, but in my view, they are diagnoses of exclusion, and should be avoided as much as possible given the risk of missed serious diagnosis or falsely providing a patient reassurance with premature diagnostic closure for a colloquial diagnosis. I have gone my whole career without ever providing an adult a diagnosis of costochondritis or gastroenteritis. There is an [excellent podcast](https://emcrit.org/emcrit/functional-heuristics-in-resuscitation/) on EM-Crit regarding this type of “functional heuristic” in Emergency Medicine | Diagnosis | Reason | | -------------------------------------------------------------- | ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- | | Cannabis hyperemesis | Cyclical vomiting can be dramatic, marijuana use is common, so doesn’t seal diagnosis (see ROME III criteria). exclude other causes eg [[Ectopic pregnancy\|ectopic]]. I have seen ischaemic bowel diagnosed as cannabanoid hyperemesis. | | Constipation | What is the cause of constipation? A tumor? A [[Sigmoid volvulus]]? Constipation is a *symptom*, not a diagnosis. | | Gastroenteritis | Beware “gastro” dx in a vomiting patient without diarrhea. [[Vomiting]] can precede diarrhea, however, especially in adults, need to exclude sinister causes eg appendicitis, and provide strict worsening advice (don’t want the patient to deteriorate at home believing “the doc told me it’s just gastro”) | | Costochondritis | “Imagine a bullet going through the chest wall. Every structure it passes through is a cause of [[Chest pain]].” Exclude all the other structures before settling on MSK structures. | | Renal colic age > 50 | Need to exclude, or at least consider, [[Abdominal Aortic Aneurysm\|AAA]] (this doesn’t mean all need a CT angio, but alternative ddx needs to be assessed). | | Pyelonephritis, period pain, or "function" pain in young women | - None of these exist until [[Ectopic pregnancy]] has been excluded. <br>- Beware [[Cognitive biases\|premature closure]] on pyelonephritis and putting a patient of any age in SSU with this diagnosis *without evidence* (i.e. with a normal urine sample) | | Asymptomatic UTI age > 80 | High rate of bacteruria; if presenting symptoms don’t fit UTI, look for another cause | | "Mild anaphylaxis" | If you diagnosis [[Anaphylaxis]], then *treat* anaphylaxis with adrenaline. If the patient has an allergic reaction that is not anaphylaxis (see [[Anaphylaxis#WHO definition\|WHO or ASCIA]] definition), then do not call it anaphylaxis | | Migraine | Most controversial on this list; of course it exists, but we often incorrectly describe severe headaches as "migraines" without migraine character, or diagnosis migraines in adults with "red flags" and no prior history of the same incorrectly. I'm perfectly happy describing these symptoms as a severe [[Headache]] and avoiding premature diagnostic closure. |