Questions and Answers
What does H&P Exam stand for?
What are common symptoms of fatigue?
Generalized weakness, easy fatigability, and mental fatigue.
Fatigue is often caused by __________ factors.
psychological and physical
Which of the following conditions can cause fatigue? (Select all that apply)
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Fatigue is generally regarded as a psychological issue only.
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What should a clinician inquire about when assessing fatigue?
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Match the following types of diabetes with their characteristics:
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___________ is characterized by chronic fatigue and weakness due to a lack of adrenal hormones.
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What is a common presenting symptom in primary care for older adults?
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Which of the following laboratory tests is typically used to evaluate anemia?
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What is the role of the thyroid hormones in relation to fatigue?
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Congestive heart failure can present with fatigue.
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What are hallmark signs of Type 2 Diabetes Mellitus?
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How many hours does the patient sleep each night?
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What issues might the patient experience regarding sleep? (Select all that apply)
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Does the patient feel rested when he or she awakens?
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What might a sleep diary help determine?
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What chronic conditions might interfere with sleep? (Select all that apply)
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Why might a medication history be relevant to sleep disturbances?
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A family history may help uncover psychosocial links to sleep disturbances.
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Altered sleep can affect daily activities, such as ____.
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What is assessed during a Sleep Physical Exam? (Select all that apply)
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What is Primary Insomnia?
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The sleep disturbance associated with primary insomnia is not due to the direct physiological effects of a substance.
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What common symptoms might a patient complain of with primary insomnia?
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What lifestyle changes can help alleviate symptoms of Restless Leg Syndrome?
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What symptoms might indicate Obstructive Sleep Apnea (OSA)? (Select all that apply)
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What is essential for the diagnosis of Myasthenia Gravis?
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Which symptom is commonly associated with Hyperthyroidism? (Select all that apply)
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Which of the following diseases may contribute to impaired digestion? (Select all that apply)
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What are common symptoms associated with malabsorption syndromes? (Select all that apply)
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What is the most valuable diagnostic measurement for diagnosing malabsorption?
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Which of the following is NOT a classification of pain?
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What is the PQRST mnemonic used for?
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The ______ scale allows patients to rate their pain on a 10-centimeter scale.
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What factors should be identified when assessing pain?
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Match the term related to pain with its correct description:
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What scale is often helpful for pediatric patients in assessing pain?
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What is defined as a temperature of at least 101°F for at least 3 weeks without the discovery of the cause?
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What percentage of fevers in children is due to upper respiratory or viral illness?
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Recent travel can be an important factor to consider when evaluating a fever.
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Which condition is important to consider if there is generalized lymphadenopathy?
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What is a common cause of prolonged fever in pediatric patients?
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What should be observed during the physical exam for fever?
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Infection may present with seemingly unrelated symptoms, such as confusion in an elderly patient with a urinary tract infection, or __________ in a child with strep throat.
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What is considered clinically significant for unintended weight loss?
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What might emotional issues contribute to?
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A complete metabolic profile is recommended for patients experiencing __________.
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Which of the following can cause unintended weight gain?
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Diabetes is not a potential cause for unintended weight loss.
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What cardiovascular condition can potentially lead to dizziness?
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The classic triad of Meniere's disease includes tinnitus, decreased hearing, and __________.
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What are some common causes of dizziness classified as peripheral?
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Older adults are at a higher risk of dizziness due to multifactorial causes.
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Which class of agents is known to potentially contribute to dizziness and falls?
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Study Notes
H&P Exam
- Comprehensive evaluation for general complaints, focusing on neurologic and cardiovascular systems.
- Review of systems (ROS) includes weight loss, appetite changes, fever, and other systemic signs.
- Assessment of general appearance, behavior, personal hygiene, and mood.
Fatigue
- Fatigue has both psychological and physical causes, including thyroid disorders, infections, and chronic diseases.
- Symptoms to assess: weakness, easy fatigability, mental fatigue, and significant medical history such as anemia.
- Evaluate lifestyle factors: living conditions, relationships, and stressors.
- Changes in weight and vital signs can indicate underlying endocrine or infectious issues.
- History of joint pain and increased urination may point to specific conditions like septic arthritis or diabetes.
Fatigue Physical Exam
- Examine general appearance and demeanor, checking for signs of depression and thyroid dysfunction.
- Conduct thorough evaluations of skin, eyes, abdomen, cardiovascular, respiratory systems, and musculoskeletal health.
Fatigue - Labs and Diagnostic Studies
- Common tests include CBC, ferritin, urinalysis, fasting blood glucose, and TSH to check thyroid function.
- Additional tests may involve ESR, serologies for infections, and imaging such as chest x-rays.
Differential Diagnoses of Fatigue
- Consider causes such as sleep disturbances, psychological disorders, and chronic conditions like heart failure and cancer.
- Chronic fatigue may indicate more serious underlying causes or autoimmune conditions.
Fatigue - Gerontological Considerations
- Fatigue as a common symptom in elderly; consider medication side effects and polypharmacy.
- Evaluate for conditions like obesity, sleep disorders, cardiac issues, and cancer that commonly affect older populations.
Stress, Anxiety, Depression, and Dysthymia
- Psychological disorders account for 50% of fatigue cases, presenting with sadness, cognitive difficulties, and sleep disturbances.
- Utilize screening tools like Beck Depression Inventory for assessments.
Type 2 DM
- Risk factors include obesity, inactivity, and family history; hallmark signs are polydipsia, polyphagia, and polyuria.
- Diagnosis through fasting glucose over 110 mg/dL and glucose tolerance testing; monitor with Hemoglobin A1c.
Hypothyroidism
- Symptoms include fatigue, cold intolerance, menstrual irregularities, and cognitive decline.
- Diagnosis confirmed by measuring T3, T4, and TSH levels.
Malignancy
- Fatigue may arise indirectly from anemia, appetite loss, and renal impairment in malignancy cases.
- Diagnostic tools include CBC, liver function tests, and imaging studies like mammograms or colonoscopies.
Anemia
- Can be primary or secondary to other conditions; look for symptoms like pallor, neurological issues, and fatigue.
- Diagnostics emphasize CBC, reticulocyte count, and iron studies.
Chronic Renal Failure
- Major causes include diabetes and hypertension; symptoms progress from asymptomatic to fatigue, cognitive decline, and nausea.
- Confirm with blood chemistry showing elevated BUN and creatinine, and possible anemia.
Arrhythmias
- Various arrhythmias can manifest as fatigue; particularly common in elderly.
- Diagnosis through EKG, observing heart rate and rhythm abnormalities.
Congestive Heart Failure
- Presents with fatigue, poor activity tolerance, and shortness of breath, especially in patients with cardiac history.
COPD
- Associated with chronic respiratory conditions that lead to fatigue; may require pulmonary assessment.
Pregnancy
- Important to ask about the last menstrual period; signs may include missed cycles, fatigue, and breast tenderness.
Mononucleosis
- Caused by Epstein-Barr virus, commonly presenting in adolescence with fatigue and systemic symptoms.
Addison's Disease
- Characterized by adrenal cortex failure leading to fatigue, electrolyte imbalances, and darkened skin.
- Diagnosis involves hormone level evaluation and can be assessed via an ACTH stimulation test.
Sleep Disorders
- Various conditions (OSA, insomnia) can severely impact sleep quality; inquire about sleep history and disturbances.
Sleep Physical Exam
- Essential evaluations include vital signs, mental status checks, and respiratory assessments for sleep disorders.
Primary Insomnia
- Defined by difficulty initiating or maintaining sleep; must persist for over one month and affects daily functioning.### Insomnia
- Sleep disturbances may arise from various disorders but not exclusively during narcolepsy or other mental disorders.
- Common symptoms include daytime sleepiness, irritability, cognitive impairment, and possible weight changes, anxiety, or depression.
- A polysomnogram is utilized to rule out physiological causes, alongside a sleep diary kept for at least one week.
- Sleep history should document time to fall asleep, awakening frequency, total sleep time, naps, substance intake, daily stress, exercise, fatigue, and medication use.
- Treatment is tailored to the underlying cause and may involve behavioral changes or pharmaceutical sleep aids.
Obstructive Sleep Apnea (OSA)
- Linked to obesity, narrowed airways, and lifestyle factors like smoking and alcohol use.
- Symptoms include snoring, periods of breathing cessation at night, and daytime drowsiness.
- Diagnostic overnight polysomnogram records sleep activities, oxygen levels, and heart rhythms, revealing episodes of apnea.
- Treatment often includes CPAP therapy and correcting underlying causes.
Restless Leg Syndrome (RLS)
- Associated with obesity, pregnancy, smoking, iron-deficiency anemia, and certain medications.
- Characterized by an uncontrollable urge to move the limbs, particularly at rest, with sensations like tingling or burning.
- Management involves lifestyle modifications such as eliminating tobacco and alcohol and incorporating exercise.
- Diagnostic tests may include CBC and metabolic panels to check for anemia and other underlying disorders.
Weakness
- Defined as a lack of strength and can indicate various neurological diseases, endocrine issues, or malignancy.
- Distinction between proximal and distal weakness can indicate specific conditions, requiring a thorough history of symptoms.
- Neurological exams focus on muscle mass, strength, tone, and any associated cognitive changes.
- A comprehensive history of symptoms like headache, intolerance to temperature, appetite changes, and balance issues is essential.
Multiple Sclerosis (MS)
- A demyelinating, autoimmune disease often presenting with visual disturbances or intermittent weakness.
- Visual symptoms might include diplopia and blurred vision, alongside potential gait issues and bladder dysfunction.
- Diagnosis includes neurological exams and MRI to reveal demyelinated regions.
- Cerebrospinal fluid analysis may show IgG oligoclonal bands, aiding diagnosis but not confirming it definitively.
Muscular Dystrophies
- Comprises several types characterized by progressive muscle weakness, skeletal deformities, and potential cardiac involvement.
- Genetic testing may be necessary, with increased creatine phosphokinase levels in some forms.
- An electromyogram can help differentiate types of muscular disorders.
- Active lifestyle can improve quality of life despite the lack of definitive treatment.
Myasthenia Gravis
- An autoimmune disorder causing fluctuating muscle weakness, primarily affecting ocular, facial, and pharyngeal muscles.
- Early symptoms often include diplopia and ptosis, with potential progression to respiratory difficulties.
- Diagnosis relies on antibody tests and the Tensilon test to observe symptom changes with edrophonium administration.
- CT scans can identify thymomas which may co-occur with the disease.
Polymyositis and Dermatomyositis
- Systemic diseases characterized by bilateral proximal muscle weakness; dermatomyositis includes a distinctive rash and associated malignancy risks.
- Muscle biopsy confirms diagnosis and assesses disease activity through enzyme levels.
- Symptoms may appear suddenly or gradually and may involve specific skin manifestations like a butterfly rash on the face.
Amyotrophic Lateral Sclerosis (ALS)
- Classified as a motor neuron disease marked by weakness and atrophy that starts in the hands and progresses asymmetrically.
- Common symptoms include muscle cramps, fasciculations, and dysarthria, with cognitive functions typically spared.
- Diagnosis is supported by EMG findings and muscle biopsy indicating denervation changes.
Guillain-Barré Syndrome
- An acute, rapidly progressive polyneuropathy, usually following a viral infection, surgery, or immunization.
- Symptoms start in the legs and may lead to respiratory failure in severe cases.
- Diagnosis includes clinical presentation, cerebrospinal fluid analysis showing increased protein, and EMG findings.
Hyperthyroidism
- Causes muscle weakness and may be mistaken for fatigue, alongside symptoms like weight loss and tachycardia.
- Diagnosis involves measuring T3, free T4, and TSH levels, with elevated T3 and T4 and suppressed TSH being indicative.
Cushing's Disease
- Results from excess cortisol production due to endogenous causes like pituitary adenomas or exogenous steroid use.
- Symptoms include "moon face," central obesity, and skin changes, with possible mental health alterations.
- Diagnosis involves suppression tests with dexamethasone and 24-hour urine cortisol collection.
Fever of Unknown Origin (FUO)
- Defined as a fever lasting more than three weeks without an identifiable cause, necessitating thorough investigation.
- Common causes vary by age group, with infections being prevalent, particularly in children.
- Investigate recent travel, medication history, and potential exposure to infectious agents.
Fever Physical Exam
- Physical examination focuses on skin lesions, lymphadenopathy, and cardiovascular assessment to identify possible infection sources.
- Respiratory evaluation is essential as upper respiratory infections account for many FUOs, and abdominal examination may reveal underlying conditions.
Infection
- Both viral and bacterial infections can lead to prolonged fever, with specific symptoms guiding diagnosis.
- Lab tests such as CBC, urinalysis, and cultures may be required for effective diagnosis.
- In vulnerable populations (children, elderly), infection signs may not align with traditional presentations, warranting broad diagnostic considerations.
Unintended Weight Loss
- Clinically significant when weight loss exceeds 5% of body weight in 6-12 months without clear cause.
- Important to evaluate the patient's appetite, diet, and activity level to identify potential underlying issues.### Unexplained Weight Loss
- Significance when weight loss is greater than 5% of usual body weight over 6-12 months; may indicate serious health issues.
- Common causes for unexplained weight loss include malignancy, diabetes, digestive diseases, thyroid disease, and depression.
- Symptoms to assess: cough, hemoptysis, shortness of breath, nausea, vomiting, diarrhea, fatigue, changing moles, and abnormal bleeding.
- Nutritional issues can arise from financial or transportation problems, inability to shop or prepare meals, and poor fitting dentures.
- Alcohol and smoking history is essential as both can increase risks for weight loss and malignancies.
Unintended Weight Gain
- Assessment includes daily eating habits, physical activity levels, and changes due to aging or menopause, which impact metabolism.
- Aging leads to slower metabolism, and hormonal changes in menopause can affect appetite and fat storage.
- Medication review is critical; steroids, certain antidepressants, and tranquilizers can cause weight gain and fluid retention.
Physical Examination for Weight Issues
- Evaluate general appearance and clothing fit to assess any significant weight change.
- Conduct vital signs check and mental status assessment.
- Physical examination should include skin integrity, lymph nodes, abdominal tenderness, and extremity strength and mobility.
- Document weight changes over the past year to track trends.
Diagnostic Tests for Weight Changes
- Conduct blood tests: CBC with differential, fasting blood sugar, A1C, TSH, total serum protein.
- Utilize imaging evaluations like chest x-ray, abdominal ultrasound, and possibly CT scans or mammography if indicated.
Differential Diagnoses for Weight Change
- Consider conditions like cancers, malabsorption syndromes, diabetes mellitus, anorexia nervosa, anxiety, and psychosocial factors.
- Common endocrine disorders such as hypothyroidism may also lead to significant weight change alongside symptoms like fatigue and cold intolerance.
Dizziness Overview
- Dizziness includes sensations ranging from feeling faint to vertigo (spinning sensation).
- Types of dizziness can be classified as central (related to brainstem or cerebellum) or peripheral (inner ear issues).
- Diagnostic evaluation should include patient history for past injuries, medication use, and symptoms associated with dizziness.
Physical Examination for Dizziness
- Perform vital signs check and assess general appearance.
- Evaluate for nystagmus during visual examinations and ear inspections for infections.
- Application of specific tests such as Dix-Hallpike maneuver to diagnose benign paroxysmal positional vertigo (BPPV).
Labs & Diagnostic Studies for Dizziness
- Audiometry and electronystagmography (ENG) can quantify hearing loss and detect nystagmus.
- Imaging studies like MRI or CT may be warranted to rule out central causes.
Differential Diagnoses for Dizziness
- Address central causes including brainstem dysfunction, multiple sclerosis, and migraines.
- Peripheral causes may include BPPV, Meniere's disease, and vestibular neuronitis.
- Evaluate for cardiovascular issues contributing to dizziness such as orthostatic hypotension.
Gerontological Considerations for Dizziness
- Dizziness is prevalent among older adults, with risk factors including medication use, balance impairments, and past medical history.
- Polypharmacy increases the risk of dizziness due to the cumulative effects of multiple medications.
Connective Tissue Disorders
- Common disorders include rheumatoid arthritis, lupus, and vasculitis, with joint pain often being a prominent symptom.
- Fever may be present but is less common than muscle and joint pain.
Immunodeficiency Disorders
- Can be primary (genetic) or secondary (acquired) with secondary being more prevalent.
- Primary types include B-cell and T-cell deficiencies; secondary causes may involve infections, malignancies, or medication side effects.
Drug Reactions
- Chemotherapy can lead to leukopenia and subsequent drug reactions, including allergic responses manifested as fever and rash.
Functional and Financial Malnutrition
- Common in the elderly and economically disadvantaged, results from an inability to obtain or prepare a proper diet.
- Symptoms may include dry skin, cravings, lethargy, and nutritional deficiencies affecting overall health.
Drugs Causing Weight Loss
- Certain medications, such as thyroid hormones in excessive doses, anti-depressants, and anti-obesity medications, may lead to weight loss as a side effect.
Malabsorption Syndromes
- Impaired absorption leads to multiple nutrient deficiencies and symptoms such as weight loss, abdominal bloating, and muscle weakness.
- Diagnosis through stool tests and imaging studies to identify underlying causes of malabsorption.
Pain Management Standards
- Recognize patients' rights to pain control; establish protocols for screening, assessment, and treatment.
- Necessitate education for providers and involve patient needs in discharge planning.
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Description
Test your knowledge on constitutional symptoms and the H&P exam. This quiz covers key concepts in recognizing general complaints and assessing various bodily systems. It's an essential tool for medical students and healthcare practitioners.