General Health Review of Systems

Question 1

what are constitutional sx

Answer 1

group of sx that can affect many different systems of the body

Question 2

what are some examples of constitutional sx

Answer 2

weight loss
fevers
fatigue
malaise
chills
night sweats
dizzy
numbness and tingling
n/v
changes in mentation

Question 3

what is a general characteristic of constitutional sx and why is this important in med screening

Answer 3

generally they are very nonspecific

vast number of dz/conditions as potential cause
- require further Q and eval for any dx

Question 4

what is the key tactic for effective screening? why?

Answer 4

look for clusters of complaints

use this to identify potential causes

Question 5

when is fatigue a normal response

Answer 5

hard work
sustained stress
grief

Question 6

when is fatigue a concern and possible referral may be indicated

Answer 6

if interfering w function, daily activities

unknown cause for >2-4wks or remarkable change in level of energy

Question 7

what other sx may be clustered w a presentation of fatigue

Answer 7

nausea
fever
weight loss

Question 8

what are 8 possible causes of fatigue

Answer 8

psychological
endocrine/metabolic
infectious
connective tissue dz
sleep disturbances
cardiac disorders
cancer
adverse drug rxns

Question 9

what are possible psychological causes for fatigue? how do you screen for them?

Answer 9

depression
- ask other Qs, screen for depression on intake

anxiety
- look for physical signs - heart racing, palpitations

Question 10

what are possible endocrine/metabolic causes for fatigue

Answer 10

hypothyroidism
DM
chronic renal failure
Addison’s dz
anemia

Question 11

what are some questions to screen for possible endocrine causes to fatigue

Answer 11

excessive urination?
recent blood work?
- look at RBC count for anemia
- can tell you other info

Question 12

what are possible infectious causes of fatigue

Answer 12

HIV
hepatitis
mononucleous (aka mono)
TB

Question 13

what is a possible connective tissue disease that could cause fatigue

Answer 13

rheumatic disease

Question 14

what is a common characteristic of connective tissue diseases that could cause fatigue

Answer 14

typically puts body in an inflammatory state
- esp if disease has active phases

Question 15

what are some possible sleep disturbances that could cause fatigue

Answer 15

sleep apnea
GERD

Question 16

when is a fever a concern for a possible referral

Answer 16

temp =/>100 for >2wks

Question 17

how can fever/chills/sweat manifest that you should ask about

Answer 17

night sweats

Question 18

what is an important precaution when treating an elderly patient in regards to fever/chills/sweat

Answer 18

elderly have reduced thermo reg responses
- fever might not manifest until late in the disorder

Question 19

when is a fever a red flag

Answer 19

fever for >3wks
fever >102 in adult (>104-106 in children) with associated cog changes, tachycardia, lethargy

Question 20

what is lethargy

Answer 20

pt is unresponsive, doesn’t react, doesn’t move, doesn’t eat
- significant fatigue

Question 21

what are possible causes of fever/chills/sweat

Answer 21

menopause
systemic illnesses

Question 22

what systemic illnesses can be possible causes of fever/chills/sweat

Answer 22

infections (ie pneumonia)
cancers
connective tissue disorders (ie RA)

Question 23

what specific characteristic of connective tissue disorders lends to it being a possible cause of fever/chills/sweat

Answer 23

a lot have active inflammatory states
- when in remission might not have the fever`

Question 24

what dictates the urgency in someone presenting w n/v

Answer 24

urgency depends on associated sx

Question 25

when are urgent referrals indicated for a pt presenting w n/v

Answer 25

acute causes
can’t keep fluid down, pt getting dehydrated
MD is unaware of the n/v

Question 26

what are possible acute cause of n/v

Answer 26

ketoacidosis
inferior MI
infection - hep or flu
drug withdrawal
early pregnancy
medication use

Question 27

what main meds can cause n/v

Answer 27

opiates
digitalis
chemo

Question 28

what are possible chronic causes of n/v

Answer 28

psychogenic disorders/EDs
metabolic disorders
gallstone associated w fatty foods
bile reflux after gastric surgery
pregnancy

Question 29

what are possible chronic metabolic disorders that could cause n/v

Answer 29

adrenal insufficiency
uremia

Question 30

what are some neurologic sx that may be in association w n/v

Answer 30

inc intracranial pressure
vestibular disorders
migraine headaches
midline cerebellar hemorrhage
GI disorders

Question 31

what neurologic sx associated w n/v are indicators for an urgent referral

Answer 31

inc intracranial pressure
midline cerebellar hemorrhage

Question 32

when is unexplained weight change a red flag and referral may be indicated

Answer 32

5-10% inc or dec of body weight over a 3 mo period

Question 33

what are the exceptions to 5-10% rule for unexplained weight change

Answer 33

pregnancy >5lb wt gain in 1 wk or >5lb loss within first trimester

CHF >2-3lb in a day

Question 34

what are possible causes for unexplained weight change (16)

its a lot, use this as a reference more than anything else

Answer 34

metastatic cancers
depression
alcoholism
fluid retention
ascites
GI disorders
gallbladder and pancreatic disorders
Crohns dz
infections
anorexia nervosa
chronic pulmonary, cardiac, or renal failure
rheumatic disorders
endocrine disorders
thyroid dysfunction
DM
med side effects

Question 35

sx of paresthesia, numbness or weakness is unusual in what population

Answer 35

orthopedic

Question 36

how can paresthesia, numbness, or weakness sx present

Answer 36

altered sensation in glove and stocking distribution

combo of UE and LE deficits (sensory, motor)

diffuse changes that aren’t fitting that pattern

Question 37

what are possible causes for sx of paresthesia, numbness, or weakness

Answer 37

adverse drug reactions (ex: illegal - whippets)
chronic renal failure
stroke (CVA)
spinal cord disorders
peripheral neuropathy
MS
endocrine diseases

Question 38

what is a possible endocrine disease that could cause sx of paresthesia, numbness, or weakness

Answer 38

hypothyroidism

Question 39

how would a pt describe vertigo (6)

Answer 39

head spinning
room spinning
headache
weaving
seasickness
rocking

Question 40

how would a patient describe lightheadness in other words

Answer 40

dizzy
unsteady

Question 41

how does vertigo differ from lightheadedness in etiology

Answer 41

vertigo is more of a vestibular issue

Question 42

possible peripheral vs central vestibular disorders that could cause vertigo/LOB

Answer 42

PERIPHERAL - inner ear stuff
- Meniere’s dz
- labyrinthitis / vestibulitis

CENTRAL - brain itself
- CVA, TIA, cerebellar mass
- MS
- vertebrobasilar insufficiency

concussion could be a central or peripheral cause

Question 43

what are some possible causes of lightheadness/dizziness

Answer 43

medication side effects
cardiac and vascular insufficiency / arrhythmias
OH
impaired ventricular function
anxiety and emotional distress

Question 44

how can BP and VS be important in medical screening

Answer 44

help you cluster the sx
- esp if trying to determine possible causes of LOB/dizzy/lightheadedness

Question 45

what are components that suggest changes in mentation (5)

Answer 45

1. level of consciousness
2. attention - ability to focus on task/activity
3. memory - short vs long term
4. orientation - identity, place, time
5. though processes - logical, coherent

Question 46

what are 4 possible causes of a change in mentation

Answer 46

1. adverse drug reactions
2. infection
3. neurological disorders
4. trauma

Question 47

what type of neurological disorder is an example of a possible cause for a change in mentation

Answer 47

dementia

Question 48

what population inc the likelihood of infection being a possible cause for a change in mentation

Answer 48

elderly
- ex: UTI

Question 49

what is important consider when identifying a change in mentation

Answer 49

when did this start
how fast did it start