Constitutional Symptoms Quiz

Questions and Answers

What does H&P Exam stand for?

History and Physical Exam (correct)

Heart and Peripheral Exam

Health and Performance Exam

Health Promotion Exam

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)

Hyperthyroidism Signup and view all the answers

Fatigue is generally regarded as a psychological issue only.

False Signup and view all the answers

What should a clinician inquire about when assessing fatigue?

Living arrangements, relationships, daily activity patterns, and stressors. Signup and view all the answers

Match the following types of diabetes with their characteristics:

Type 1 DM = Usually diagnosed in childhood, autoimmune destruction of insulin-secreting cells Type 2 DM = Overweight, sedentary lifestyle, often diagnosed in adults Signup and view all the answers

___________ is characterized by chronic fatigue and weakness due to a lack of adrenal hormones.

Addison's Disease Signup and view all the answers

What is a common presenting symptom in primary care for older adults?

Fatigue Signup and view all the answers

Which of the following laboratory tests is typically used to evaluate anemia?

CBC Signup and view all the answers

What is the role of the thyroid hormones in relation to fatigue?

They regulate metabolism, energy levels, and can impact fatigue. Signup and view all the answers

Congestive heart failure can present with fatigue.

True Signup and view all the answers

What are hallmark signs of Type 2 Diabetes Mellitus?

Polydipsia, polyphagia, and polyuria. Signup and view all the answers

How many hours does the patient sleep each night?

Determined based on patient response. Signup and view all the answers

What issues might the patient experience regarding sleep? (Select all that apply)

Trouble falling asleep Signup and view all the answers

Does the patient feel rested when he or she awakens?

Determined based on patient response. Signup and view all the answers

What might a sleep diary help determine?

The type of disturbance experienced. Signup and view all the answers

What chronic conditions might interfere with sleep? (Select all that apply)

Respiratory conditions Signup and view all the answers

Why might a medication history be relevant to sleep disturbances?

It may reveal self-medicating behaviors or medications that alter sleep. Signup and view all the answers

A family history may help uncover psychosocial links to sleep disturbances.

True Signup and view all the answers

Altered sleep can affect daily activities, such as ____.

productivity Signup and view all the answers

What is assessed during a Sleep Physical Exam? (Select all that apply)

Oxygen saturation Signup and view all the answers

What is Primary Insomnia?

Difficulty initiating or maintaining sleep for at least 1 month. Signup and view all the answers

The sleep disturbance associated with primary insomnia is not due to the direct physiological effects of a substance.

True Signup and view all the answers

What common symptoms might a patient complain of with primary insomnia?

Daytime sleepiness, irritability, and cognitive impairment. Signup and view all the answers

What lifestyle changes can help alleviate symptoms of Restless Leg Syndrome?

Eliminating tobacco and alcohol, and adding exercise. Signup and view all the answers

What symptoms might indicate Obstructive Sleep Apnea (OSA)? (Select all that apply)

Snoring Signup and view all the answers

What is essential for the diagnosis of Myasthenia Gravis?

Measurement of serum levels of circulating acetylcholine receptor antibodies. Signup and view all the answers

Which symptom is commonly associated with Hyperthyroidism? (Select all that apply)

Weight loss Signup and view all the answers

Which of the following diseases may contribute to impaired digestion? (Select all that apply)

Chronic Liver Failure Signup and view all the answers

What are common symptoms associated with malabsorption syndromes? (Select all that apply)

Edema in the Lower Extremities Signup and view all the answers

What is the most valuable diagnostic measurement for diagnosing malabsorption?

Measurement of fat in the stool Signup and view all the answers

Which of the following is NOT a classification of pain?

Chronicled Signup and view all the answers

What is the PQRST mnemonic used for?

Guiding the history for the assessment of pain Signup and view all the answers

The ______ scale allows patients to rate their pain on a 10-centimeter scale.

visual analog Signup and view all the answers

What factors should be identified when assessing pain?

Precipitating, palliative, and provocative factors Signup and view all the answers

Match the term related to pain with its correct description:

NRS = Numerical Rating Scale VAS = Visual Analog Scale VRS = Verbal Rating Scale PQRST = Assessment of Pain Signup and view all the answers

What scale is often helpful for pediatric patients in assessing pain?

Pain Faces Scale Signup and view all the answers

What is defined as a temperature of at least 101°F for at least 3 weeks without the discovery of the cause?

Fever Signup and view all the answers

What percentage of fevers in children is due to upper respiratory or viral illness?

50% Signup and view all the answers

Recent travel can be an important factor to consider when evaluating a fever.

True Signup and view all the answers

Which condition is important to consider if there is generalized lymphadenopathy?

All of the above Signup and view all the answers

What is a common cause of prolonged fever in pediatric patients?

Upper respiratory illness Signup and view all the answers

What should be observed during the physical exam for fever?

Examination of the skin, lymph nodes, and cardiac assessment Signup and view all the answers

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.

nausea Signup and view all the answers

What is considered clinically significant for unintended weight loss?

Exceeds 5% of usual body weight over 6-12 months Signup and view all the answers

What might emotional issues contribute to?

Unexplained weight loss Signup and view all the answers

A complete metabolic profile is recommended for patients experiencing __________.

malnutrition Signup and view all the answers

Which of the following can cause unintended weight gain?

Hypothyroidism Signup and view all the answers

Diabetes is not a potential cause for unintended weight loss.

False Signup and view all the answers

What cardiovascular condition can potentially lead to dizziness?

Orthostatic hypotension Signup and view all the answers

The classic triad of Meniere's disease includes tinnitus, decreased hearing, and __________.

dizziness Signup and view all the answers

What are some common causes of dizziness classified as peripheral?

Both A and B Signup and view all the answers

Older adults are at a higher risk of dizziness due to multifactorial causes.

True Signup and view all the answers

Which class of agents is known to potentially contribute to dizziness and falls?

Sedative hypnotics Signup and view all the answers

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.