ANAMNEZA

Dr. Sorin Stamate

Octombrie 2006

GENERAL SYMPTOMS
FEVER

Elevation of body temperature above the

normal circadian range

Based on individual situation, someone

keeps relative low or high body temperature

GENERAL SYMPTOMS
FEVER

Fever, the balance is shifted to increase the core temperature

HYPERTHERMIA (HYPERPYREXIA)
= an elevation of body temperature above the
hypothalamic set point
= > 41 o C
= due to insufficient heat dissipation

GENERAL SYMPTOMS
FEVER

Diurnal variation

Rectal temperature > 0.6o C oral temperature

Range: 36.8o C 0.4 o C to 37.7o C

Fever: early morning >37.2o C

PM >37.7o C
> 38o C (axillary)

GENERAL SYMPTOMS
FEVER
3 STAGES:
STADIUM INCREMENTI (Feeling cold, goosebumps, and shivering)
FASTIGIUM
STADIUM DECREMENTI

IN CRYSIS
IN LYSIS

GENERAL SYMPTOMS
FEVER

Depending on what's causing your fever, additional fever symptoms may include:

Sweating
Shivering, SHACKING CHILL
Headache
Myalgias, arthralgias
Lack of appetite
Dehydration
Malaise
Somnolence

Very high fevers, between 103 and 106 F, may cause:

Hallucinations
Confusion
Irritability
Convulsions

FEVER PATTERNS
Fever
CONTINOUS

Description

Fluctuation < 0.5 - 1 C

Clinical conditions
Pneumonia, erysipelas
Typhoid fever,
Drug fever

REMITTENT

Fluctuations > 1
But no below 37C

Tuberculosis
Localized Suppuration
Septicemia
Bronchopneumonia

IRREGULAR

The fever pattern can not be

systematized

Suppurations
Septicemia

INTERMITENT Great fluctuations

Return to baseline and to normal
Reappears at different intervals

Tertian - Pl. falciparium

Quartian - Pl. malariae
5-day fever Trench fever
Irregular cholangitis ,
Digestive neoplasias
urinary tract infections

FEVER PATTERNS
Fever

Description

Clinical conditions

RECURRENT
(RELAPSING)

Febrile episodes are separated by

HECTIC

Daily temperature excursion

Intermittent bacteriemia

> 1-3C

Epstein Barr virus

intervals of normal temperature

Brucellosis
Hodgkin lymphoma
Endocarditis
Relapsing fever (Borelia sp.)
PFAPA syndrome

Crohns disease
Juvenile rheumatoid arthritis
INVERSE

Higher in the morning than in the

Miliary tuberculosis

evening

Fever pattern cannot be considered pathognomonic for a particular infection

Fever pattern can be altered by antipyretics, antibiotics, corticosteroids

GENERAL SYMPTOMS
HYPOTHERMIA

an abnormally low temperature, below 35C (95F) rectally

may occur in various situations:

- Reduced movement
- water immersion and near-drowning
- prolonged unconsciousness in low ambient temperatures,
especially in combination with alcohol intoxication (which causes
peripheral vasodilatation), drug overdosage, stroke or head injury
- severe hypothyroidism

GENERAL SYMPTOMS
HYPOTHERMIA
36C

Increased metabolic rate, vasoconstriction

35C (hypothermia)

Shivering maximal, impaired judgement

34C

Uncooperative

33C

Depressed conscious level

28-32C
(severe hypothermia)

Progressive depression of conscious level,

muscle stiffness
Failure of vasoconstrictor response and shivering
Bradycardia, hypotension, J waves present on ECG,
risk of arrhythmias

< 28C

Coma, patient may appear dead,

Absent pupillary and tendon reflexes
Spontaneous ventricular fibrillation

20C

Asystole/profound bradyarrhythmias

J or OSBORNE WAVE

GENERAL SYMPTOMS
- HEADACHES
- CEPHALAGIA

- DIZZINESS

- MIGRAINE

- VERTIGO

refers to the perception that the

patient or the environment is
rotating or spinning. These
sensations point primarily to a
problem in the labyrinths of the
inner ear, peripheral lesions of
CN VIII or lesions in its central
pathways,or nuclei in the brain.

- HUNGER

- DYSPNEA = shortness of breath SOB

- APPETITE

- ASTHENIA = FATIGABILITY

the desire for food. It is stimulated by

the sight, smell or thought of food and
accompanied by the flow of saliva in
the mouth and gastric juice in the
stomach. Appetite is psychological,
dependent on memory and
associations, as compared to
hunger, a sensation that promotes
food consumption

GENERAL SYMPTOMS
1.
2.
3.
4.
5.

6.

7.

Location. Where is it? Does it radiate?

Quality. What is it like?
Quantity or severity. How bad is it? (For pain, ask for a rating
on a scale of 1 to 10.)
Timing. When did (does) it start? How long did (does) it last?
How often did (does) it come?
Setting in which it occurs. Include environmental factors,
personal activities, emotional reactions, or other circumstances that
may have contributed to the illness.
Remitting or exacerbating factors. Does anything make it
better or worse?
Associated manifestations. Have you noticed anything else
that accompanies it?

GENERAL SYMPTOMS
HEADACHE

CEPHALALGIA

MIGRAINE

TENSION headaches:

- Usually bilateral; may be generalized or localized to the back

of the head and upper neck or to the frontotemporal area
Mild and aching or a sense of tightness and pressure

Gradual onset, duration: variable hours or days, but often weeks

or months, often recurrent or persistent over long periods
Assoc. symptoms: anxiety, tension, and depression

Agg. by sustained muscular tension; emotional

May be relieved by massage, relaxation

GENERAL SYMPTOMS
HEADACHE

CEPHALALGIA

MIGRAINE

MIGRAINE:
Typically frontal or temporal, one or both sides, but also may be occipital or
generalized.
Throbbing or aching, variable in severity
Fairly rapid, reaching a peak in 12 hours; lasts several hours to 12 days

Often begins between childhood and early adulthood. Typically recurrent at

intervals of weeks, months, or years, usually decreasing with pregnancy and
advancing age
Assoc. with: nausea and vomiting, visual disturbances (local flashes of light,
blind spots) or neurological symptoms (local weakness, sensory disturbances).
May be provoked by alcohol, certain foods, or tension. More common
premenstrually. Aggravated by noise and bright light
Quiet, dark room; sleep

GENERAL SYMPTOMS
HEADACHE

CEPHALALGIA

MIGRAINE

CLUSTER HEADACHE:
One-sided; high in the nose, and behind and over the eye.
Steady, severe
Abrupt onset, often 23 hours after falling asleep; 1-2 hours in duration;
its course is typically clustered in time, with several each day or week and then
relief for weeks or months
Assoc. with: Unilateral stuffy, runny nose, and reddening and tearing of the eye
May be provoked by alcohol during a cluster
SIMILAR headaches: associated with eye disorders

GENERAL SYMPTOMS
HEADACHE

CEPHALALGIA

MIGRAINE

OTHER HEADACHES
FACE PAINS: Assoc. with acute paranasal sinusitis
Trigeminal Neuralalgia
ACUTE ILLNESSES WITH VERY SEVERE HEADACHE
- Meningitis
- Subarachnoid Hemorrhage

FOLLOWING HEAD TRAUMA:

-

Post-concussion syndrome

Chronic subdural hematoma

BRAIN TUMOR

1)
2)
3)
4)

ANAMNESIS

5)
6)

7)

PATIENT

PERSONAL AND PRELIMINARY DATA

CHIEF COMPLAINT
PRESENT ILLNESS
PAST HISTORY-PHYSIOLOGICAL DATA
PAST HISTORY-PATHOLOGICAL DATA
FAMILY HISTORY
PERSONAL AND SOCIAL HISTORY

1.
EXAMNINATION
2.
3.
GENERAL CLINICAL
4.
EXAMINATION
5.
6.
7.
PHYSICAL
EXAMINATION

GENERAL SURVEY
SKIN, MUCOSAE, HAIR AND NAILS
SUBCUTANEOUS TISSUES
THE MUSCULAR SYSTEM
THE SKELETON
THE LIMPH NODES
THE PERIPHERAL VASCULAR
SYSTEM AND NERVES

DETAILED EXAMINATION OF SYSTEMS

POSTURE (DECUBITUS)
SPEECH AND MENTAL EVALUATION
WEIGHT AND HEIGHT

GENERAL
SURVEY

NUTRITION STATUS
PATIENTS BUILD
FACIES
STANDING AND MARCHING

GENERAL SURVEY
POSTURE
INDIFFERENT

DECUBITUS
PHYSIOLOGICAL

PREFFERED

PATHOLOGICAL

GENERAL SURVEY
POSTURE
CALMING PAIN
ORTHOPNEA

CALMING COUGH

CALMING DYSPNEA
PILLOW SIGN
EXTREME
ORTHOPNEA

SQUATTING

PILLOW SIGN

PATHOLOGICAL POSTURE

PLEURAL DISEASES:
PLEURITIS: sitting on the AFFECTED SIDE
PLEURAL EFFUSION: sitting on the HEALTHY SIDE

PATHOLOGICAL POSTURE

OPISTHOTONUS
- MENINGISM
- TETANUS

OPISTHOTONUS

PATHOLOGICAL POSTURE

ULCER: pressing the epigastrium

BILIARY COLIC: right sided decubitus, slightly curved
ACUTE RENAL COLIC: none
ABDOMINAL COLIC: curling, hips and knees flexed
PERITONEAL IRRITATION:
involuntary guarding - pressure of the parietal peritoneum onto the
inflamed area results in a reflex contraction of the overlying muscles
board-like rigidity in generalized peritonitis.
The anterior abdominal wall does not move with respiration
and breathing becomes increasingly thoracic