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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
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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
HEADACHE CEPHALALGIA MIGRAINE
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
HEADACHE CEPHALALGIA MIGRAINE
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
HEADACHE CEPHALALGIA MIGRAINE
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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PATHOLOGICAL POSTURE
OPISTHOTONUS
-MENINGISM
-TETANUS
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OPISTHOTONUS
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PATHOLOGICAL POSTURE
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