Lecture 7 - Non-specific Patient Presentations

Question 1

Identify when providers tend to become concerned with fatigue

Answer 1

Persistent
-include many psychological and physical causes
=ex: depression, anxiety, substance abuse
(Chronic fatigue syndrome = Epstein-Barr virus infection => pain and exhaustion)

Question 2

Recall the threshold for a high fever (high grade)

Answer 2

Greater than 103 degrees F (can denature proteins and cause harm = convulsing or having seizures)

Question 3

State the 2 proinflammatory cytokines discussed in class

Answer 3

IL-1 and TNFa (TNF alpha)

Question 4

List the 3 criteria used to define fever of unknown origin (FUO)

Answer 4

• at least 3 weeks duration
• temp > 38.3 (101 degrees F)
• failure to diagnose after THREE outpatient visits or THREE days of hospitalization

Question 5

Identify the top 3 causes of a fever of unknown origin (FUO)

Answer 5

-Infections (30-40%)
-Neoplasms (20-30%)
-Autoimmune disorders (10-20%)
(And then misc diseases at 15-20% and idiopathic at 5-15%)

Question 6

Given a scenario, recognize the headache warning signs that always point to a serious underlying condition

Answer 6

• Visual loss
• Disequilibrium
• Confusion or lethargy
• New onset seizure

Question 7

Headache that afflicts young women in their 20s to 30s the most.
Pain is throbbing or pulsatile, but evolves to more intense; can be unilateral or alternate sides

Answer 7

Migraine headache

Question 8

Headache that afflicts young all ages and both genders.
Generally occurs late in day on weekdays.
May be worse with stress and precede a migraine.

Answer 8

Cluster headache

Question 9

Headaches that afflicts middle-aged men, 30 to 50 years of age, being usually unilateral (orbital or temporal)
Often in smokers or drinkers, and wakes people up

Answer 9

Tension headache

Question 10

Why must giant cell arteritis be treated with steroids immediately?

Answer 10

The patient will go permanently blind if not treated immediately as a medical emergency
-ischemic optic neuropathy may occur

Question 11

What does FAST stand for when dealing with a stroke victim?

Answer 11

• Face (paralyzed?)
• Arms (can they hold them both out and parallel to the ground?)
• Speech (slurred?)
• Time (to get them to hospital)

Question 12

How long do migraines usually last?

Answer 12

4-72 hours and aggravated by physical activity

Question 13

How long do tension headaches usually last?

Answer 13

30 minutes to 1 week

Question 14

What headache presents with band-like distribution with varying intensities?

Answer 14

Tension headaches

Question 15

How long do cluster headaches usually last?

Answer 15

1-2 attaches per day, lasting less than an hour

Question 16

What may cluster headaches cause?

Answer 16

May cause transient or permanent ipsilateral Horner’s syndrome

Question 17

Identify when providers tend to become concerned with weight loss

Answer 17

Unintentional
-marked unexplained weight loss often suggests serious physical/psychological issue
=ex: depression, anorexia nervosa (don’t eat), bulimia (eat and purge), disease of any organ system

Question 18

Fever 1, 2, 3 Rule

Answer 18

Low grade fever = Less than or equal to 101
Moderate grade fever = 102
High grade fever = Greater than 103

Question 19

Which prostaglandin is Fever associated with?

Answer 19

PGE2 (fEver = pgE2)

Question 20

What are the top 2 proinflammatory cytokines of fever?

Answer 20

IL-1 and TNFa (PGE2)

Question 21

What is the anti-inflammatory cytokine with fever?

Answer 21

IL-4

Question 22

What part of the brain regulates temperature?

Answer 22

Hypothalamic nuclei

Question 23

What temperature is classified as a high fever in newborns?

Answer 23

99

Question 24

What is the most common fever of unknown origin?

Answer 24

Infection

Abscess, TB, and endocarditis, Epstein-Barr, HIV

Question 25

What are some examples of neoplasms, which cause Fever of unknown origins (FUO)?

Answer 25

Lymphoma
Leukemia
Solid tumors
Malignant histocytosis

Question 26

What is a miscellaneous cause for FUO (fever of unknown origin)?

Answer 26

Sarcoidosis
Whipple’s veteran
Thyroiditis

Question 27

With idiopathic diseases, what can you conclude?

Answer 27

Not a whole lot; the cause remains elusive, meaning you can investigate the issue, but you’ll never figure out what is actually going on

Question 28

What is the percent of spontaneous resolution in idiopathic patients?

Answer 28

75% of affected patients

Question 29

What are some examples of headache alarms that can cause visual loss?

Answer 29

• GCA = giant cell arteritis = nodules become inflamed, which can actually impede blood flow, impacting the eye, causing a loss of vision
• Acute angle-closure glaucoma

Question 30

What are some examples of headache alarms that can cause disequilibrium?

Answer 30

• Stroke

- Brain tumor

Question 31

What are some examples of headache alarms that can cause confusion or lethargy?

Answer 31

• Meningitis
• Encephalitis
• Brain tumor
• Brain abscess

Question 32

What are some examples of headache alarms that can cause new onset seizures?

Answer 32

• Stroke
• Encephalitis
• Brain tumor

Question 33

What is giant cell arteritis (GCA)

Answer 33

Nodules become inflamed, which can actually impede blood flow, impacting the eye, causing a loss of vision; It can also cause claudication = pain produced by lack of blood flow

Question 34

When do brain tumor headaches occur the most?

Answer 34

In the morning

Question 35

What percent of children that have brain tumor headaches won’t have other symptoms that are either neurologic or physical symptoms?

Answer 35

1%