General Symptoms:

Weight Loss

n  Causes may be GI, endocrine, chronic infections, malignancies, depression anorexia nervosa

n  Wt loss with high food intake: diabetes, hyperthyroidism, malabsorption or bulimia

Strength

n  Fatigue = sense of weariness or loss of energy

Some causes: depression, anxiety, endocrine, infections (mono), anemia

n  Weakness = loss of muscular power

n  Fever = abnormal increase in body temp

Shaking chills-body shivers, teeth chatter

Menopause = heat and sweating

Head

n  Headache = most important attribute is chronological pattern

Acute/Chronic/Progressive

Most common recurring headache = tension + migraine

Changing/progressively severe– tumor

Extremely severe– arachnoid hemorrhage or meningitis

Nausea and vomiting– migraine, brain tumors, subarachnoid

hemorrhage

Eyes

n  Blurring — high blood sugars

n  Sudden/gradual? Sudden– retinal detachment, vitreous hemorrhage

or occlusion of central retinal artery

n  Difficulty with close/far? Close– hyperopia (farsightedness)

presbyopia (aging vision), or Far — myopia (nearsightedness)

n  Visual field defect: partial/central/periphal/one side?

Slow central loss — nuclear cataract, macular degeneration

Peripheral loss — glaucoma

One-sided loss — hemianopsia and quadrantic defects

n  Moving specks — vitreous floaters

n  Flashing lights — vitreous detachment from retina

n  Pain, redness of eyes, tearing – read up on this topic

n  Diplopia (double vision): horizontal/vertical

Weakness/paralysis of extraocular muscles

Horizontal — CN III, VI

Vertical — CN III, IV

Ears

n  Pattern of hearing loss – central or conductive etioloty

n  Conductive/Sensorial loss?

Conductive-external or middle ear

Sensorial – inner ear ; Patient has trouble understanding speech

n  Tinnitus = perceived sound w/o external stimulus; increase w/ age

n  True vertigo = feels like being pulled

n  Earache (Pain) — external or middle ear; or referred from mouth, throat Nose and Sinuses

n  Rhinorrhea = nasal discharge; occurs with sneezing, watery eyes, itchiness of eyes, nose, throat — viral infections, allergic rhinitis

If with pain and face tenderness, headache, fever — Sinusitis

n  Epistaxis = nose bleed — trauma, inflammation, drying

Mouth, Throat, Neck

n  Bleeding gums — Gingivitis

n  Hoarseness = husky, rough, harsh voice — overuse or infection

Chronic — smoking, allergy

Enlarged lymph nodes — Pharyngitis

n  Enlarged thyroid (Goiter)

Breast

n  Pain/Discomfort/Lumps?

Lumps — cysts, benign tumors, cancers

Differentiation of breast nodules (see focuses lecture notes)

n  Nipple discharge?

Milky, bilateral — pregnancy, imbalance hormone

Non-milky, unilateral — local breast disease

Chest Pain

n  Myocardium — MI, angina pectoris

n  Aorta — Dissecting aneurysm

n  Trachea/large bronchi — Tracheobronchitis

n  Parietal pleura — Pleurisy, pericarditis

n  Esophagus — Reflux esophagitis, spasm

n  Chest wall (musculoskeletal + skin) — Costochondritis, herpes zoster

n  Anxiety most common cause of chest pain in kids

n  Ask patient to show and watch gestures:

Clenched fist over sternum — angina pectoris

Finger pointing to area of heart — noncardiac

Hand up and down epigastrium to neck — heartburn

n  Palpitations = unpleasant awareness of heartbeat

Persistent irregularity — atrial fibrillation

n  Selected heart rates and rhythms

Regular fast rate < 120/min — sinus tachycardia

n  Dyspnea = nonpainful, uncomfortable awareness of breathing inappropriate to circumstances — can only be reported by patient

Patient description: shortness of breath, smothering, can’t take

deep breath, deep sighs

n  Orthopnea = dyspnea when patient lying down, improves when sitting up

Quantified by number of pillows patient sleeps on or patient sleeps

sitting up — left ventricular failure, mitral stenosis, obstructive lung disease

n  Paroxysmal noctural dyspnea = sudden dyspnea + orthopnea that waken patient 1-2 hrs. after going to bed — left ventricular failure, mitral stenosis, asthmatic attack

n  Edema = excessive fluid in interstitial space — swelling from cardiovascular, rheumatologic, ir immunologic causes

Dependent edema = in lowest body part (feet, legs).  Puffy lids and tight rings (if edema elsewhere ) — renal disease or hypoalbuminemia

Enlarged wasteline — ascites = fluid in peritoneal cavity

n  Cough = reflex response to irritation of receptors in larynx, trachea

– left-sided heart failure

Sputum (phlegm) – volume, odor, color, consistency

Mucoid Sputum = translucent, white, gray

Purulent Sputum = yellow, green

Mucopurulent = combination

Helpful diagnostic symptoms: fever, chest pain, dyspnea,

orthopnea, wheezing

Hemoptysis = cough up blood– Cystic fibrosis

Blood in stomach darker than respiratory and mix with food (vomited, not coughed up)

GI Tract

n  Dysphagia = difficulty swallowing

Point to chest — esophageal disorder

Point to throat — problem with food transfer or esophageal disorder

Only with solid food — esophageal narrowing

Solid + Liquid food — esophageal muscle disorder

n  Odynophagia = pain with swallowing

Sharp, burning — mucosal inflammation — reflux esophagitis due to herpesvirus or Candida

Squeezing, cramping — muscular problem

n  Indigestion = distress with eating

Heartburn = burning/warmth retrosternally and may radiate from

epigastrium to neck — reflux gastric acid to esophagus

–Heavy meal, lying down

Severe — heart disease

Chronic — reflux esophagitis

Excessive Gas = frequent belching, abdominal bloating, flatus

– foods, intestinal lactase deficiency, irritable bowel

syndrome

Abdominal Pain

–Visceral Pain = hollow organs distended or contract

forcefully

Poorly localized, near midline

Gnawing, burning, cramping, aching

–Parietal Pain = originate in parietal peritoneum due to

inflammation. Steady, aching pain-more severe

and localized than visceral pain — patient usually

lie still

*Acute Appendicitis = visceral + parietal pain

periumbilical pain — right lower quandrant pain

–Referred Pain = felt in distant sites but at same spinal

level of

innervation — Duodenal or pancreatic origin-> Back

pain from biliary tree -> right shoulder or right

posterior chest

n  Appetite

Anorexia = loss of appetite

Nausea = sick to stomach

Retching = spasmodic movement of chest and diaphragm. Can lead to

Vomiting = forceful expulsion of gastric contents through mouth

*All three suggest GI disorders, diabetic acidosis, liver disease, anorexia nervosa/bulimia

n  Regurgitation = raise esophageal/gastric contents w/o nausea or retch

Hematemesis = red blood + brownish/blackish vomitus with “coffee ground” particles — duodenal/gastric ulcers

n  Stools Black — melena

Red blood — hematochezia

Obstipation = constipation with no fecal passage/gas — intestinal

obstruction

Diarrhea = increase frequency of stool passage-watery

Large diarrheal stools — small bowel or proximal colon

problem

Small stools — left colon or rectum

Steatorrhea= large, yellow/gray, greasy, foul-smelling, frothy

– malabsorption

Tenesmus = intense urge but no result — rectal problem

n  Jaundice (icterus) = yellow skin and eyes due to increased bilirubin

Mechanism: Increased bilirubin production

Decreased uptake of bilirubin by liver

Decreased ability of liver to conjugate bilirubin

Decreased excretion of bilirubin into bile

–Hepatocellular Jaundice = liver cell damage

–Cholestatic Jaundice = damage liver cells or

intrahepatic bile ducts

Impaired bilirubin excretion — bilirubin conjugated.

Causes : Viral hepatitis, cirrhosis, drug-induced cholestasis

Dark urine — impaired bilirubin excretion

Acholic stool — light color, gray — viral hepatitis

Itching Skin — cholestatic/obstructive jaundice

Risk factors for liver disease:

Hepatitis

Cirrhosis

Toxic liver damage

Gallbladder disease

Hereditary

Urinary Tract

n  Kidney Pain: near costovertebral angle — acute pyelonephritis

Can radiate to umbilicus. Visceral pain-dull, aching, steady

n  Ureteral Pain: colicky pain originating in costovertebral angle — lower

quadrant of abdomen — upper thigh — testicle/labium

–Obstruction of ureter by urinary stones

n  Bladder — suprapubic pain, dull, steady

n  Dysuria(?) = pain on urination — inflammation of bladder/urethra

Burning sensation — Cystitis, urethritis, stones, acute prostatitis

Female-internal burning — cystitis/urethritis

–external burning — vulvovaginitis

n  Urinary urgency = intense desire to void — bladder infection

Man with bladder obstruction:

–Hesitancy in starting urination

–Strain to void

–Reduced force of urinary stream

–Dribbling

Urethritis = pain on urination w/o frequency or urgency

n  Polyuria = increase in 24-hour urinary volume (3 L)

n  Urinary frequency = abnormally frequent voiding (no polyuria — bladder

Problem or flow impairment )

n  Nocturia = urinary frequency at night

n  Polydipsia = abnormally high intake of water, assoc w/ polyuria

n  Hematuria = blood in urine — detect by urinalysis

Gross hematuria = detect with eyes

Causes : cystitis, bladder malignancy, kidney stone

n  Urinary incontinence = involuntary loss of urine

–urge incontinence = detrusor contractions too strong

–stress incontinence = intraurethral pressure too low

–overflow incontinence = bladder enlarged due to obstruction

–functional incontinence = environmental

Genital System-Female

n  Girls in US: menarche begins between 9-16 years old

n  Factors determining menarche: nutrition, genetics, socioeconomic status

n  Amenorrhea = absence of periods

Primary amenorrhea = failure to initiate periods

Secondary amenorrhea = period stops after having begun — pregnancy,

Lactation, menopause, malnutrition, anorexia nervosa,

Hypothalamo-pituitary

n  Oligomenorrhea = infrequent periods

n  Polymenorrhea = abnormally frequent periods

n  Menorrhagia= increased amount/duration of flow

n  Postcoital bleeding = bleeding after intercouse — cercival cancer or polyps

n  Menopause = cessationof menses between ages 45-52 years

Postmenopausal bleeding = bleeding after 6 months w/o periods

– endometrial cancer (?)

Hot flashes and sweating

n  Dysmenorrhea = pain w/ menstruation: bearing down, aching, cramping in

Lower abdomen, pelvis.  PMS = 4-10 days before period:tension, mood swings, irritability, depression

n  Amenorrhea + heavy bleeding — threatened abortion or dysfunctional

uterine bleeding

n  Vulvovaginitis

Vaginal Discharge (Amount, color, consistency, odor)

itching

n  Sexual Dysfunction: base on phase of sexual response -desire, arousal, or

orgasm — health, lack of estrogen, medications, attitudes

Dyspareunia = pain on intercourse

Vaginismus = involuntary spasm of muscles around vaginal orifice

Makes intercourse painful

Genital System-Male

n  Penile Discharge: Color, consistency, amount — Penile urethritis

n  Sores/growths on penis, swelling/pain in scrotum — STDs

n  Infections via oral-penile transmission (i.e. oral sex) — Clamydia,

gonorrhea, syphilis, herpes

n  Sexual problem:

Desire Phase — psychogenic, medication, or medical problem

Arousal Phase — erectile disorder due to systemic or psychogenic

problem

Ejaculatory Phase/Orgasm — Premature ejaculation = young men

Reduced/absent ejaculation = middle age men

Ask about medication, surgery, neurological deficit

Peripheral Vascular System

n  Swelling of feet/legs — venous disorder

n  Coldness/numbness — arterial disorder

n  Local inflammation — superficial thrombophlebitis, lymphangitis,

cellulitis, erythema nodosum

n  Pallor of fingers -> Cyanosis -> Redness — Raynaud’s Disease/Phenomenon

n  Intermittent claudication = pattern of pain accompanying impairment of arterial flow — in older people — aching, cramping, numbness, severe fatigue — appears w/ walking and disappears w/ rest

Musculoskeletal System

n  Problems of joints:

Bursitis = inflammation of bursae

Tendonitis = inflammation of tendon

Tenosynovitis = inflammation of tendon sheaths

Sprains = stretching/tearing of ligaments

n  Pain in hip joints usually in groin or buttock — can be felt in anterior thigh or in knee – Hip pain near greater trochanter of femur — trochanteric bursitis

n  Pain in only one joint area — bursitis, tendinitis, monoarticular arthritis, or

Injury

n  Rheumatic fever/gonococcal arthritis — migratory pattern of spread

n  Rhematoid arthritis — progressive and symmetrical

n  Severe pain + swollen joint (no injury) — gouty or septic arthritis

In children — osteomyelitis

n  Associated symptoms:

– Other symptoms in involved joint — swelling, stiffness, limited

motion, tenderness, warmth, redness

Arthralgias = pain in joints without arthritis (redness, warmth)

Myalgias = pain in muscles

Gelling = stiffness after inactivity — degenerative joint disease -

last  few minutes

Stiffness in rheumatoid arthritis — 30 minutes +

Tenderness, warmth, redness in joint — acute gout, septic arthritis, Rheumatic fever

–Generalized symptoms — fever, chills, fatigue, anorexia, weight loss

Common in rheumatic fever; High fever + chills — infection

–Symptoms elsewhere in body giving important clues to nature of

problem

Skin:    butterfly rash on cheek — Systemic Lupus Erythematosus

Scaly rash + pitted nails of psoriasis — Psoriatic arthritis

Papules, pustules, vesicles on reddened bases on distal

extremities — Gonococcal arthritis

Expanding erythematous patch early in illness — Lyme

Disease

Hives — Serum sickness, drug reaction

Erosions or scales on penis + crusted scaling papules on

soles and palms — Reiter’s Syndrome = arthritis + urethritis + conjuctivitis

Maculopapular rash of rubella — arthritis of rubella

Clubbing of fingers — Hypertrophic osteoarthopathy

Preceding sore throat — Acute rheumatic fever or gonococcal arthritis

Diarrhea + abdominal pain — arthritis w/ ulcerative colitis

Low Back Pain

Numbness, weakness, tingling — nerve root involvement

Neck Pain

Nervous System

n  Loss of consciousness — vasodepressor syncope, hyperventilation, tonic-clonic seizure – in young people

n  Cardiac sycope — sudden onset, offset – older people

n  Sycope = sudden, temporary loss of consciousness that occurs

When blood flow to brain insufficent

Near-sycope (pre-sycope) = symptoms of impending faint– muscle

weakness, lightheadedness, without actual loss of consciousness

n  Tonic-clonic seizure (grand mal) = starts faster, lasts longer, can involve injury and incontinence, slower recovery Bilateral, distal weakness — polyneuropathy

Bilateral proximal weakness — myopathy

Weakness w/ repeated effort-improve w/ rest — myasthenia gravis

Involuntary movements (tremors)

n  Paresthesias = sensations w/o obvious stimulus – prickling, tingling,

warmth, coldness, pressure (leg goes to sleep-nerve compression)

n  Dysesthesias = distorted sensations in response to stimulus, can last longer than stimulus (light touch perceive as burning)

Loss of sensation, paresthesias, dysesthesias — involve peripheral

nerves,

sensory roots, spinal cord

Paresthesias in hand and mouth — hyperventilation

n  Restless Legs Syndrome = develops at rest, urge to move about– relieve by walking

Hematologic System

n  Congenital bleeding disorder — spontaneous bleeding, common in males

n  Petechiae in skin + mucous membraine + small bruises — platelet disorders

Large bruises, hematomas = mass of extravasated blood, hemarthroses =       bood in joints — clotting disorders

n  Spontaneous bleeding, bleeding w/ minor trauma — general bleeding

disorder

n  Possible deficiency in Vit C/K — diet, malabsorption

Endocrine System

n  Obesity, weakness, fatigue, ankle edema, decreased/no menstrual periods –

Cushing’s Syndrome (adrenal cortical hyperfunction)

n  Weakness, weight loss, nausea, vomiting, darken skin, postural hypotension — Addison’s Syndrome (adrenal insufficiency)

n  Diabetes mellitus — polyuria, polydipsia, polyphagia, weakness, fatigue, weight loss, blurred vision

n  Cold intolerance, decreased sweating — Hypothyroidism

n  Episodic sweating and heat intolerance — menopause

Tags: anemia, Angina Pectoris, anxiety, brain tumors, bulimia, chronic infections, depression, depression anorexia nervosa, diabetes, endocrine, GI, Hoarseness, hyperthyroidism, infections, malabsorption, malignancies, migraine, Mitral Stenosis, mono, obstructive lung disease, pericarditis, Pharyngitis, Pleurisy, reflux gastric acid, Subarachnoid, Tracheobronchitis, ventricular failure

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