Flashcards in Lecture 7 - Non-specific Patient Presentations Deck (35):
Identify when providers tend to become concerned with fatigue
-include many psychological and physical causes
=ex: depression, anxiety, substance abuse
(Chronic fatigue syndrome = Epstein-Barr virus infection => pain and exhaustion)
Recall the threshold for a high fever (high grade)
Greater than 103 degrees F (can denature proteins and cause harm = convulsing or having seizures)
State the 2 proinflammatory cytokines discussed in class
IL-1 and TNFa (TNF alpha)
List the 3 criteria used to define fever of unknown origin (FUO)
-at least 3 weeks duration
-temp > 38.3 (101 degrees F)
-failure to diagnose after THREE outpatient visits or THREE days of hospitalization
Identify the top 3 causes of a fever of unknown origin (FUO)
-Autoimmune disorders (10-20%)
(And then misc diseases at 15-20% and idiopathic at 5-15%)
Given a scenario, recognize the headache warning signs that always point to a serious underlying condition
-Confusion or lethargy
-New onset seizure
Headache that afflicts young women in their 20s to 30s the most.
Pain is throbbing or pulsatile, but evolves to more intense; can be unilateral or alternate sides
Headache that afflicts young all ages and both genders.
Generally occurs late in day on weekdays.
May be worse with stress and precede a migraine.
Headaches that afflicts middle-aged men, 30 to 50 years of age, being usually unilateral (orbital or temporal)
Often in smokers or drinkers, and wakes people up
Why must giant cell arteritis be treated with steroids immediately?
The patient will go permanently blind if not treated immediately as a medical emergency
-ischemic optic neuropathy may occur
What does FAST stand for when dealing with a stroke victim?
-Arms (can they hold them both out and parallel to the ground?)
-Time (to get them to hospital)
How long do migraines usually last?
4-72 hours and aggravated by physical activity
How long do tension headaches usually last?
30 minutes to 1 week
What headache presents with band-like distribution with varying intensities?
How long do cluster headaches usually last?
1-2 attaches per day, lasting less than an hour
What may cluster headaches cause?
May cause transient or permanent ipsilateral Horner's syndrome
Identify when providers tend to become concerned with weight loss
-marked unexplained weight loss often suggests serious physical/psychological issue
=ex: depression, anorexia nervosa (don't eat), bulimia (eat and purge), disease of any organ system
Fever 1, 2, 3 Rule
Low grade fever = Less than or equal to 101
Moderate grade fever = 102
High grade fever = Greater than 103
Which prostaglandin is Fever associated with?
PGE2 (fEver = pgE2)
What are the top 2 proinflammatory cytokines of fever?
IL-1 and TNFa (PGE2)
What is the anti-inflammatory cytokine with fever?
What part of the brain regulates temperature?
What temperature is classified as a high fever in newborns?
What is the most common fever of unknown origin?
(Abscess, TB, and endocarditis, Epstein-Barr, HIV)
What are some examples of neoplasms, which cause Fever of unknown origins (FUO)?
What is a miscellaneous cause for FUO (fever of unknown origin)?
With idiopathic diseases, what can you conclude?
Not a whole lot; the cause remains elusive, meaning you can investigate the issue, but you'll never figure out what is actually going on
What is the percent of spontaneous resolution in idiopathic patients?
75% of affected patients
What are some examples of headache alarms that can cause visual loss?
-GCA = giant cell arteritis = nodules become inflamed, which can actually impede blood flow, impacting the eye, causing a loss of vision
-Acute angle-closure glaucoma
What are some examples of headache alarms that can cause disequilibrium?
What are some examples of headache alarms that can cause confusion or lethargy?
What are some examples of headache alarms that can cause new onset seizures?
What is giant cell arteritis (GCA)
Nodules become inflamed, which can actually impede blood flow, impacting the eye, causing a loss of vision; It can also cause claudication = pain produced by lack of blood flow
When do brain tumor headaches occur the most?
In the morning