3_generalsurvey#F648

8/10/2019 3_generalsurvey#F648

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ANAMNEZA

Dr. Sorin Stamate

Octombrie 2006


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GENERAL SYMPTOMS

FEVER

Elevation of body temperature above thenormal circadian range

Based on individual situation, someonekeeps relative low or high body temperature


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GENERAL SYMPTOMS

FEVER

Fever, the balance is shifted to increase the core temperature

HYPERTHERMIA (HYPERPYREXIA)

= an elevation of body temperature above the

hypothalamic set point

= > 41 o C

= due to insufficient heat dissipation


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GENERAL SYMPTOMS

FEVER

Diurnal variation

Rectal temperature > 0.6o C oral temperature

Range: 36.8o

C 0.4o

C to 37.7o

C

Fever: early morning >37.2o C

PM >37.7o C

> 38o C (axillary)


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GENERAL SYMPTOMS

FEVER

3 STAGES:

STADIUM INCREMENTI (Feeling cold, goosebumps, and shivering)

FASTIGIUM

STADIUM DECREMENTIIN CRYSIS

IN LYSIS


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GENERAL SYMPTOMS

FEVER Depending on what's causing your fever, additional fever symptoms may include:

Sweating Shivering, SHACKING CHILL

Headache

Myalgias, arthralgias

Lack of appetite Dehydration

Malaise

Somnolence

Very high fevers, between 103 and 106 F, may cause: Hallucinations

Confusion

Irritability

Convulsions


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Fever Description Clinical conditions

CONTINOUS Fluctuation < 0.5 - 1 C Pneumonia, erysipelasTyphoid fever,

Drug fever

REMITTENT Fluctuations > 1

But no below 37C

TuberculosisLocalized SuppurationSepticemiaBronchopneumonia

IRREGULAR The fever pattern can not be

systematized

Suppurations

Septicemia

INTERMITENT Great fluctuationsReturn to baseline and to normal

Reappears at different intervals

Tertian -Pl. falcipariumQuartian -Pl. malariae

5-day feverTrench fever

Irregularcholangitis ,

Digestive neoplasias

urinary tract infections

FEVER PATTERNS


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Fever Description Clinical conditions

RECURRENT

(RELAPSING)

Febrile episodes are separated by

intervals of normal temperature

Brucellosis

Hodgkin lymphoma

Endocarditis

Relapsing fever (Borelia sp.)

PFAPA syndrome

HECTIC Daily temperature excursion

> 1-3C

Intermittent bacteriemia

EpsteinBarr virus

Crohns disease

Juvenile rheumatoid arthritis

INVERSE Higher in the morning than in the

evening

Miliary tuberculosis

FEVER PATTERNS

Fever pattern cannot be considered pathognomonic for a particular infectionFever pattern can be altered by antipyretics, antibiotics, corticosteroids


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GENERAL SYMPTOMS

HYPOTHERMIA

an abnormally low temperature, below 35C (95F) rectally

may occur in various situations:- Reduced movement

-water immersion and near-drowning

- prolonged unconsciousness in low ambient temperatures,

especially in combination with alcohol intoxication (which causes

peripheral vasodilatation), drug overdosage, stroke or head injury

-severe hypothyroidism


10/26

GENERAL SYMPTOMS

HYPOTHERMIA

36C Increased metabolic rate, vasoconstriction35C (hypothermia) Shivering maximal, impaired judgement

34C Uncooperative

33C Depressed conscious level

28-32C

(severe hypothermia)

Progressive depression of conscious level,

muscle stiffness

Failure of vasoconstrictor response and shivering

Bradycardia, hypotension, J waves present on ECG,

risk of arrhythmias

< 28C Coma, patient may appear dead,

Absent pupillary and tendon reflexes

Spontaneous ventricular fibrillation

20C Asystole/profound bradyarrhythmias


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J or OSBORNE WAVE


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- HEADACHES

- CEPHALAGIA

- MIGRAINE

- HUNGER

- APPETITE

- DIZZINESS

- VERTIGO

- DYSPNEA= shortness of breath SOB

- ASTHENIA = FATIGABILITY

refers to the perception that the

patient or the environment is

rotating or spinning. These

sensations point primarily to a

problem in the labyrinths of the

inner ear, peripheral lesions of

CN VIII or lesions in its central

pathways,or nuclei in the brain.

GENERAL SYMPTOMS

the desire for food. It is stimulated bythe sight, smell or thought of food andaccompanied by the flow of saliva inthe mouth and gastric juice in thestomach. Appetite is psychological,dependent on memory andassociations, as compared tohunger, a sensation that promotesfood consumption


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GENERAL SYMPTOMS

1. Location.Where is it? Does it radiate?

2. Quality.What is it like?3. Quantity or severity.How bad is it? (For pain, ask for a rating

on a scale of 1 to 10.)

4. Timing.When did (does) it start? How long did (does) it last?How often did (does) it come?

5. Setting in which it occurs.Include environmental factors,personal activities, emotional reactions, or other circumstances thatmay have contributed to the illness.

6. Remitting or exacerbating factors.Does anything make it

better or worse?7. Associated manifestations.Have you noticed anything else

that accompanies it?


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GENERAL SYMPTOMS

HEADACHE CEPHALALGIA MIGRAINE

TENSION headaches:

- Usually bilateral; may be generalized or localized to the back

of the head and upper neck or to the frontotemporal area

Mild and aching or a sense of tightness and pressure Gradual onset, duration: variable hours or days, but often weeks

or months, often recurrent or persistent over long periods

Assoc. symptoms: anxiety, tension, and depression

Agg. by sustained muscular tension; emotional

May be relieved by massage, relaxation


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GENERAL SYMPTOMS


MIGRAINE:

Typically frontal or temporal, one or both sides, but also may be occipital or

generalized.

Throbbing or aching, variable in severity

Fairly rapid, reaching a peak in 12 hours; lasts several hours to 12 days

Often begins between childhood and early adulthood. Typically recurrent at

intervals of weeks, months, or years, usually decreasing with pregnancy and

advancing age

Assoc. with: nausea and vomiting, visual disturbances (local flashes of light,blind spots) or neurological symptoms (local weakness, sensory disturbances).

May be provoked by alcohol, certain foods, or tension. More common

premenstrually. Aggravated by noise and bright light

Quiet, dark room; sleep


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GENERAL SYMPTOMS


CLUSTER HEADACHE:

One-sided; high in the nose, and behind and over the eye.

Steady, severe

Abrupt onset, often 23 hours after falling asleep; 1-2 hours in duration;

its course is typically clustered in time, with several each day or week and then

relief for weeks or months

Assoc. with: Unilateral stuffy, runny nose, and reddening and tearing of the eye

May be provoked by alcohol during a cluster

SIMILAR headaches: associated with eye disorders


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GENERAL SYMPTOMS


OTHER HEADACHES

FACE PAINS: Assoc. with acute paranasal sinusitis

Trigeminal Neuralalgia

ACUTE ILLNESSES WITH VERY SEVERE HEADACHE- Meningitis

- Subarachnoid Hemorrhage

FOLLOWING HEAD TRAUMA:- Post-concussion syndrome

- Chronic subdural hematoma

BRAIN TUMOR


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PATIENT

EXAMNINATION

ANAMNESIS

1) PERSONAL AND PRELIMINARY DATA

2) CHIEF COMPLAINT

3) PRESENT ILLNESS

4) PAST HISTORY-PHYSIOLOGICAL DATA

5) PAST HISTORY-PATHOLOGICAL DATA6) FAMILY HISTORY

7) PERSONAL AND SOCIAL HISTORY

PHYSICAL

EXAMINATION

GENERAL CLINICAL

EXAMINATION

DETAILED EXAMINATION OF SYSTEMS

1. GENERAL SURVEY

2. SKIN, MUCOSAE, HAIR AND NAILS

3. SUBCUTANEOUS TISSUES

4. THE MUSCULAR SYSTEM

5. THE SKELETON

6. THE LIMPH NODES

7. THE PERIPHERAL VASCULAR

SYSTEM AND NERVES


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GENERAL

SURVEY

POSTURE (DECUBITUS)

SPEECH AND MENTAL EVALUATION

WEIGHT AND HEIGHT

NUTRITION STATUS

PATIENTS BUILD

FACIES

STANDING AND MARCHING

GENERAL SURVEY


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GENERAL SURVEY

POSTURE

DECUBITUS

INDIFFERENT

PREFFERED

PHYSIOLOGICAL

PATHOLOGICAL

GENERAL SURVEY


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ORTHOPNEA

CALMING PAIN

CALMING DYSPNEA

EXTREME

ORTHOPNEA

PILLOW SIGN

SQUATTING

CALMING COUGH

GENERAL SURVEY

POSTURE


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PILLOW SIGN


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PLEURAL DISEASES:

PLEURITIS: sitting on the AFFECTED SIDE

PLEURAL EFFUSION: sitting on the HEALTHY SIDE

PATHOLOGICAL POSTURE


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OPISTHOTONUS

-MENINGISM

-TETANUS


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OPISTHOTONUS


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ULCER: pressing the epigastrium

BILIARY COLIC: right sided decubitus, slightly curved

ACUTE RENAL COLIC: none

ABDOMINAL COLIC: curling, hips and knees flexed

PERITONEAL IRRITATION:involuntary guarding- pressure of the parietal peritoneum onto theinflamed area results in a reflex contraction of the overlying muscles

board-like rigidityin generalized peritonitis.

The anterior abdominal wall does not move with respirationand breathing becomes increasinglythoracic

3_generalsurvey#F648

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