Follow up with patient's history Flashcards
Reasons for a more thorough Physical exam: constitutional symptoms
- fever
- diaphoresis
- nausea/vomiting
- pallor
- fatigue
- weight loss
- malaise
Does yes always mean a referral
Think about:
1. does the complaint represent something new, different or unusual for the patient
2. is there an explanation for it that would minimize concern
3. has the patient mentioned this to the physician
4. if a physician is aware of it has it become worse since you last spoke to the physician
what types of conditions can present with chronic fatigue
- psychological
- endocrine/metabolic
- infections
- neoplasms
- Connective Tissue disease
- Sleep disturbances
- medications
What are some follow up questions with fatigue
- can you describe your fatigue for me
- is it interfering with you daily activities
- when did the fatigue begin
- was the onset slow, gradual or fast
- do you know why you are tired
- have you noticed any other unusual symptoms
Fatigue as a red flag
- when it interferes with ADLs
- duration 2-4 weeks or more
How might a patient report malaise
- something just isn’t right
- im afraid the disease is coming back (especially with conditions that are in remission)
- associated with systemic diseases that generate fever
Fever, Chills and Sweats
- Associated with systemic illness
- elevation in temperature tends to be highest in the evening
- fever: temp >99.5 to 101
- present 2-3 weeks
- physical presentation: temp is elevated = chills and vasoconstriction, epinephrine secretion, shivering
- fever breaks = vasodilation and sweating
Unexplained weight change
- loss of 5-10% of body weight over past 6 months
- rapid weight gain usually fluid retention
- check extremities, abdomen, neck, face for excess fluid and muscle wasting
Nausea and Vomiting follow up questions
- can you describe it to me?
- how long have you been experiencing this
- any other unusual symptoms
- do you know why you are nauseated
- is your physician aware
- has it gotten worse since you talked to your physician
- is nausea associated with vomiting or any other symptoms
- do you have vomitting without nausea
- how are you treating your nausea
Common causes of nausea and vomiting/what neurological signs to look out for
- acute = ketoacidosis pregnancy, MI etc
- recurrent: bulimia, metabolic, pregnancy
- with neurological symptoms: increased intracranial pressure, vestibular disturbances, migraine headaches, midline cerebellar hemorrhage
Paresthesia, Numbeness or weakness potential causes
- primary neurologic disorders
- renal and endocrine disease
- drug reactions
- progressive sensory or strength deficits
- saddle anesthesia, urinary retention, increased urinary frequency and overflow inconteinence
- glove and stocking
- bilateral sensory and motor deficits
- combination of ipsilateral
- UE, LE sensroy and motor deficits
Dizziness and lightheadedness follow questions
- do you feel light-headed or faint
- is there a spinning sensation in your head
- is the room spinning around you
- is it assoicated with nausea, vomiting, diaphoresis, hearing loss, tinnitus, visual disturbances, or hemiparesis
- have you fallen becuase of your dizziness
Potential causes of dizziness
- neurological disorders: MS, vistibular, BPP etc
- cardiac and vascular disorders
- other
three types of dizziness
- vertigo
- presyncope
- disequilibrium
Vertigo
- spinning
- swaying
- tilting
