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Thread: Common Symptoms

  1. #1

    Default Common Symptoms

    Dizziness

    Dizziness is a common description that people use to describe a variety of symptoms. These include light-headedness, wooziness, vertigo, feeling unsteady, confusion, and anxiety. Dizziness is rarely life threatening, especially if it is infrequent and short lived, for example, lasting a few seconds only. The true significance of dizziness lies in its underlying cause.

    Causes

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    Dizziness is classically categorized into 4 subtypes: 1)vertigo 2)presyncope or syncope 3)dysequilibrium and 4)light-headeness (undifferentiated dizziness). However, it may be difficult to identify a single category in every patient, particularly in the elderly, who often manifest more than 1 subtype. Medications may also cause more than 1 subtype of dizziness.

    Open-ended questions
    Tell me about your symptoms. Describe the sensation you've been having without using the word dizzy.

    Go over the last time you had this sensation, from start to finish.

    Let's review all your medications, including over-the-counter medications, nutritional supplements, or herbal medicines.

    Alarm symptoms

    Chest discomfort or presyncope/syncope
    Acute-onset vertigo plus neurologic deficits
    Acute-onset vertigo plus neck or occipital pain plus neurologic deficits
    Acute vertigo (lasting >1 day), nausea, vomiting, severe imbalance
    Sudden-onset severe vertigo, facial paralysis, otalgia, external ear vesicular eruption, hearing loss
    History of diabetes mellitus (insulin and/or oral hypoglycemic use)

    Questions to categorize dizziness into 4 subtypes
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    Questions to differentiate vertigo
    Quality and Time Course
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    Associated symptoms

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    Modifying symptoms
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    Differential Diagnosis
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    Diagnostic Algorithms

    Dizziness
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    Vertigo
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    Last edited by admin; Tue 8th November '16 at 11:02am.
    Clinical Pharmacy Specialist - Infectious Diseases

  2. #2

    Default Re: Common Symptoms

    Palpitations

    Palpitations are an awareness of the patient's own heart beating.



    Causes

    Palpitations may be due to sinus tachycardia, ectopic beats, or arrhythmias.

    Palpitations due to sinus tachycardia are a normal response to exercise and may occur in various conditions, particularly infections and stress.

    Ectopic betas are cardiac beats that do not originate from the sinoatrial node. They are often one-off abnormal beats of minimal significance but may sometimes be caused by coronary ischemia.

    Arrhythmias are abnormal heat rhythms lasting for more than a few beats. They are usually caused by electrical problems in the heart.

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    Group palpitations

    1.The patient has noticed occasional "missed beats". This is rarely important and is usually due to ectopic beats.

    2.The palpitations are a minor part of a more serious situations such as when the patient is suffering a myocardial infarction.

    3.The patient is suffering from intermittent bouts of prolonged palpitations, which are their main symptoms.

    ----------
    Palpitations

    Palpitations are defined as the awareness of one's own heartbeats. Palpitations are a frequent reason for visits to both primary care and cardiology practices, reported in up to 16% of medical outpatients. Although many patients with palpitations have a psychiatric disorder or other benign condition, potentially morbid or mortal arrhythmias must also be considered. Investigation may include expensive and sometimes invasive diagnostic testing, underscoring the importance of a thoughtful clinical evaluation. Because many patients have intermittent symptoms that do not occur during the clinician's examination, the history plays a key role.

    Etiology
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    Interview Framework and Getting Started With the History
    • Let patients describe the symptoms in their own words before asking any closed-ended questions.
    • The focus of the interview is to identify patients who require diagnostic testing for serious arrhythmia.
    • Identification of a psychiatric disorder will benefit the patient even if unrelated to the palpitations.


    Alarm Symptoms
    Unfortunately, most studies on the diagnostic accuracy of the history in evaluating palpitations fail to distinguish between benign arrhythmias and arrhythmias requiring further action. Historical features that warrant further investigation for a potential serious arrhythmia include:
    • Palpitations associated with syncope or presyncope.
    • A family history of sudden cardiac death or known arrhythmia.
    • Use of any medications known to prolong the QT interval, such as methadone, antiarrhythmic agents, or antipsychotics, and so on.
    • A personal history of heart disease, including coronary artery disease, congenital or valvular heart disease, hypertrophic cardiomyopathy, or dilated cardiomyopathy.


    Focused Questions
    • Note the patient's age and gender.
    • Elicit a detail description of the palpitations. In addition, ask the patient to tap out the rhythm of the perceived heartbeats to differentiate between regular and irregular rhythms and fast versus slow rhythms.
    • Elicit the circumstances in which the palpitations occur.
    • Ask about associated symptoms.
      • Syncope or presyncope
      • Chest pain
      • Shortness of breath
      • Stroke symptoms
      • Vagal symptoms such as diaphoresis
      • Polyuria

    • Take a detail medication history, concentration on:
      • Recreational or prescription stimulant use
      • Street drugs such as cocaine or methamphetamines
      • Caffeine
      • Alcohol
      • Tobacco
      • ������-Agonists
      • Theophylline


    Common Symptoms-screen-shot-2016-12-13-at-3-52-43-pm-png

    Diagnostic Approach
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    Last edited by admin; Mon 22nd May '17 at 9:36pm.
    Clinical Pharmacy Specialist - Infectious Diseases

  3. #3

    Default Re: Common Symptoms

    Breathlessness/Dyspnea



    Differential diagnosis

    • Heart
      • Endocardium: Valvular heart disease
      • Conduction system
        • Bradycardia
        • Tachycardia
          • Atrial fibrillation and other supra ventricular tachycardias
          • Ventricular tachycardia

      • Myocardium: Heart failure
        • Systolic failure
        • Diastolic failure

      • Coronary arteries
      • Pericardium

    • Lung
      • Alveoli
        • Pulmonary edema
        • Pneumonia

      • Airways
        • Suprathoracic airways
        • Intrathoracic airways
          • Asthma
          • COPD

      • Blood vessels
        • Pulmonary emboli
        • Primary pulmonary hypertension

      • Pleural
        • Pneumothorax
        • Pleural effusions
          • Transudative
            • HF
            • Cirrhosis
            • Nephrotic syndrome
            • Pulmonary embolism (PE)

          • Exudative
            • Tuberculosis
            • Cancer
            • Parapneumonic effusions
            • Connective tissue diseases
            • PE

      • Interstitium
        • Edema
        • Inflammatory
          • Organic exposures
          • Mineral exposures
          • Idiopathic diseases

        • Infectious

    • Anemia


    Also literatures from UpToDate

    Causes of Acute Dyspnea
    Cardiovascular system
    Acute myocardial ischemia
    Heart failure
    Cardiac tamponade
    Respiratory system
    Bronchospasm
    Pulmonary embolism
    Pneumothorax
    Pulmonary infection - bronchitis, pneumonia
    Upper airway obstruction - aspiration, anaphylaxis

    Conditions Associated with Chronic Dyspnea
    Upper airway
    Laryngeal mass
    Vocal fold paralysis
    Paradoxical vocal fold dysfunction
    Goiter
    Neck mass compressing airway
    Chest/abdominal wall
    Diaphragmatic paralysis
    Kyphoscoliosis
    Late pregnancy
    Massive obesity
    Ventral hernia
    Ascites
    Intra-abdominal process
    Pulmonary
    Asthma
    Bronchiectasis
    Brochiolitis
    COPD/emphysema
    Chronic thromboembolic disease
    Interstitial lung disease
    Lung mass compressing or occluding airway
    Pleural effusion
    Pulmonary right-to-left shunt
    Pulmonary hypertension
    Trapped lung
    Cardiac
    Arrhythmia
    Constrictive pericarditis, pericardial effusion
    Coronary heart disease
    Deconditioning
    Heart failure (systolic or diastolic dysfunction)
    Intracardiac shunt
    Restrictive cardiomyopathy
    Valvular dysfunction
    Neuromuscular disease
    Amyotrophic lateral sclerosis
    Brachial plexopathy
    Glycolytic enzyme defects (e.g., McArdle)
    Mitochondrial diseases
    Polymyositis/dermatomyositis
    Toxic/metabolic/systemic
    Anemia
    Metabolic acidosis
    Renal failure
    Thyroid disease
    Miscellaneous
    Anxiety
    Early pregnancy (effect of progesterone)


    Pivotal points
    • Fever
    • Chest pain
      • Acute or chronic/recurrent
      • Pleuritic or nonpleuritic


    • Risk factors
    • Associated symptoms, signs, and tests


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    Like chest pain, breathlessness (dyspnea) is a very common symptom. You should be confident in evaluating patients with breathlessness. Common and important causes are listed in Table 4.2 and this discussion is confined to these.

    Breathlessness is a symptom of many conditions, not just cardiac conditions. It could equally be discussed under a respiratory system heading.

    Common Symptoms-screen-shot-2016-04-28-at-1-31-34-pm-png

    Shortness of breath, or dyspnea is the sensation of uncomfortable breathing. This feeling of discomfort may reflect an increased awareness of breathing or the perception that breathing is difficult or inadequate. Dyspnea usually indicates pulmonary or cardiac disease, but can also be the presenting symptom of metabolic derangements, hematologic disorders, toxic ingestions, psychiatric conditions, or simple reconditioning. Dyspnea is the second most common reason for emergency department visits in the United States.

    Dyspnea can be classified based on the primary physiologic derangement:

    • Pulmonary
    • Cardiac
    • Hematologic (e.g., anemia)
    • Chest wall or neuromuscular disease
    • Metabolic (e.g., acidosis)
    • Functional (e.g., panic disorders)
    • Deconditioning


    Etiology
    The purpose of breathing is to meet the metabolic demands of the body. Thus, any condition that increases the work of breathing or increases respiratory drive may result in dyspnea. In addition, dyspnea may result from or be exacerbated by primary psychological conditions.

    Alarm Symptoms
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    Open-Ended Questions
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    Focused Questions
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    Differential Diagnosis
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    Diagnostic Approach
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    Last edited by admin; Sun 21st May '17 at 9:45pm.
    Clinical Pharmacy Specialist - Infectious Diseases

  4. #4

    Default Re: Common Symptoms

    Acute Respiratory Complaints of Cough and Congestion

    Differential Diagnosis of Acute Cough and Congestion
    • Common cold
    • Sinusitis
    • Bronchitis
    • Influenza
    • Pneumonia
      • CAP
      • Aspiration pneumonia
      • TB
      • Opportunistic (e.g. PCP)


    Pivotal Points
    • Symptoms, signs, or risk factors for pneumonia
      • Symptoms: High fever (with the exception of influenza), dyspnea, altered mental status, hypoxia
      • Signs: Abnormal vital signs (high fever >38 C, HR >100 bpm, RR >24 breaths per minute, hypotension, hypoxia), dullness to percussion, crackles, decreased breath sounds, bronchophony, egophony
      • Risk factors: Elderly patients, known COPD, heart failure, kidney failure, DM

    • Patients at increased risk for poor outcomes
      • Immunocompromised patients
      • Elderly patients
      • Those with HF, CKD, or COPD

    • In patients with pneumonia, is it simply a CAP or another type of pneumonia? - Determine the likely etiologic pathogen(s).


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    Cough

    It is normal for the respiratory mucosa to produce a small amount of secretions. These are removed by mucociliary action. When there is an abnormal amount of secretions or other foreign material, the normal mucociliary action is unable to cope and a cough is used to remove the material. Involuntary coughing always indicates an abnormality but the causes form a wide spectrum from minor, transient problems to serious, life-threatening disease.

    Cough less than 2 months is acute and more than 2 months is chronic. The two categories have different patterns of causation.

    Causes (Acute)

    • Infection affecting any part of the respiratory tree - nasopharyngitis to laryngotracheobronchitis to pneumonia.
    • Allergic reactions
    • Reaction to irritant
    • Any of the causes of chronic cough at their onset


    Causes (Chronic)

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    Last edited by admin; Sun 9th April '17 at 11:06pm.
    Clinical Pharmacy Specialist - Infectious Diseases

  5. #5

    Default Re: Common Symptoms

    Sputum

    causes

    Common Symptoms-screen-shot-2016-04-28-at-7-17-45-pm-png
    Clinical Pharmacy Specialist - Infectious Diseases

  6. #6

    Default Re: Common Symptoms

    Insomnia

    Disorders of sleep are common, especially in shift workers and following long distance air travel. A careful history of the onset and pattern of disrupted sleep with close attention to sleep hygiene will often disclose the sources of sleep disruption.


    • Initial insomnia: the inability to get to sleep at the usual time;
    • Terminal insomnia: the early awakening and specifically produces deficits in rapid eye movement sleep.


    Clinical Occurrence:
    • Poor sleep hygiene
    • Medications
    • Illicit drug use
    • Alcohol use
    • Depression
    • Anxiety disorder
    • Panic disorder
    • Obstructive sleep apnea
    • Hypomania or mania
    Clinical Pharmacy Specialist - Infectious Diseases

  7. #7
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    Default Re: Common Symptoms

    Muscle Weakness

    Open-ended questions
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    Alarm symptoms
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    Focused questions
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    Common Symptoms-screen-shot-2016-06-27-at-9-07-14-pm-png
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    B.S. Pharm, West China School of Pharmacy, Class of 2007, Health System Pharmacist, RPh. Hematology, Infectious Disease. Chengdu, Sichuan, China.

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  8. #8
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    Default Re: Common Symptoms

    Syncope

    Common Symptoms-screen-shot-2016-06-27-at-9-23-11-pm-png

    Alarm symptoms
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    Distinguishing seizures from syncope
    Common Symptoms-screen-shot-2016-06-27-at-9-27-10-pm-png
    B.S. Pharm, West China School of Pharmacy, Class of 2007, Health System Pharmacist, RPh. Hematology, Infectious Disease. Chengdu, Sichuan, China.

    Blog: http://www.tomhsiung.com
    Facebook: http://www.facebook.com/TomHsiung
    Twitter: @TomHsiung
    Sina Microblog (Weibo): http://weibo.com/xiongliang0



  9. #9
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    Default Fever

    The differential diagnosis of fever

    B.S. Pharm, West China School of Pharmacy, Class of 2007, Health System Pharmacist, RPh. Hematology, Infectious Disease. Chengdu, Sichuan, China.

    Blog: http://www.tomhsiung.com
    Facebook: http://www.facebook.com/TomHsiung
    Twitter: @TomHsiung
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