Diagnosis of Cerebral hemorrhage
Cerebral hemorrhage Diagnosis: Book Excerpts
Diagnostic Tests for Cerebral hemorrhage: Online Medical Books
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Vaginal bleeding, postmenopausal:
History and physical examination
(Handbook of Signs & Symptoms (Third Edition))
Determine the patient’s age and her age at menopause. Ask when she first noticed the abnormal bleeding. Then obtain a thorough obstetric and gynecologic history. When did she begin menstruating? Were her periods regular? If not, ask her to describe any menstrual irregularities. How old was she when she first had intercourse? How many sexual partners has she had? Has she had any children? Has she had fertility problems? If possible, obtain an obstetric and gynecologic history of the patient’s mother, and ask about a family history of gynecologic cancer. Determine if the patient has any associated symptoms and if she’s taking estrogen.
Observe the external genitalia, noting the character of any vaginal discharge and the appearance of the labia, vaginal rugae, and clitoris. Carefully palpate the patient’s breasts and lymph nodes for nodules or enlargement. The patient will require pelvic and rectal examinations.
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Source: Handbook of Signs & Symptoms (Third Edition), 2006
Postmenopausal bleeding:
Diagnosis
(Professional Guide to Diseases (Eighth Edition))
Diagnostic evaluation of the patient with postmenopausal bleeding should include physical examination (especially pelvic examination), a detailed history, standard laboratory tests (such as complete blood count), and cytologic examination of smears from the cervix and the endocervical canal. An endometrial biopsy or dilatation and curettage (D & C) with hysteroscopy reveals pathologic findings in the endometrium.
Diagnosis must rule out underlying degenerative or systemic disease. For instance, evidence of elevated levels of endogenous estrogen may suggest an ovarian tumor. Before testing for estrogen levels, the patient must stop all sources of exogenous estrogen intake — including face and body creams that contain estrogen — to rule out excessive exogenous estrogen as a cause.
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Source: Professional Guide to Diseases (Eighth Edition), 2005
Vaginal bleeding, postmenopausal:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
Determine the patient’s age and her age at menopause. Ask when she first noticed the abnormal bleeding. Then obtain a thorough obstetric and gynecologic history. When did she begin menstruating? Were her periods regular? If not, ask her to describe any menstrual irregularities. How old was she when she first had intercourse? How many sexual partners has she had? Has she had any children? Has she had fertility problems? If possible, obtain an obstetric and gynecologic history of the patient’s mother, and ask about a family history of gynecologic cancer. Determine if the patient has any associated symptoms and if she’s taking estrogen.
Observe the external genitalia, noting the character of any vaginal discharge and the appearance of the labia, vaginal rugae, and clitoris. Carefully palpate the patient’s breasts and lymph nodes for nodules or enlargement. The patient will require pelvic and rectal examinations.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Postmenopausal Bleeding:
History
(The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter)
A. Pattern of bleeding. Although the amount of bleeding is not helpful in identifying malignancy, it should be assessed to determine the likelihood of significant anemia or hypovolemia that may require intervention. Timing of bleeding may suggest its cause.
1. Specific relationship to medication courses or cycles suggests drug-induced bleeding.
2. Postcoital bleeding suggests an atrophic cause or cervical polyp.
3. Association with bowel movements or urination suggests a nongenital source.
B. Current medications. Any hormonal therapy, including estrogen, progesterone, tamoxifen, thyroid replacement, or corticosteroids, should be quantified and recorded.
1. Acyclic bleeding is common in the first 3 to 4 months on continuous estrogen–progestin therapy, and usually does not indicate pathology. Bleeding that is excessive, persists after months of therapy, or occurs after amenorrhea has been established on these regimens should be evaluated.
2. The rate of endometrial cancer in women on tamoxifen or unopposed estrogen is six to seven times the rate for untreated women. The frequency of endometrial polyps is also increased.
3. Exogenous corticosteroids and incorrect dosage of thyroid replacement can lead to menstrual irregularities and postmenopausal bleeding.
C. Past medical history. Nulliparity, early menarche, late menopause, and history of chronic anovulation are risk factors for endometrial hyperplasia and carcinoma. Obesity, hypertension, diabetes, and liver disease are commonly associated with estrogen excess, and can also increase risk (1). Past use of oral contraceptives is associated with decreased risk.
D. Family history. A strong family history of endometrial or colon cancer is a risk factor for endometrial cancer.
Physical examination
A. Vital signs. Blood pressure and pulse can indicate the degree and acuity of blood loss; orthostatic changes can be evidence of significant volume depletion. Fever suggests infection as a potential cause (Chapter 2.6).
B. Abdomen. Tenderness or guarding suggests an infectious or inflammatory cause. Palpation for suprapubic masses is necessary as part of the evaluation for malignant causes.
C. Pelvis. Examine external genitalia, vagina, and cervix for lesions or lacerations that could be the source of bleeding. The uterus and ovaries must be palpated to assess for enlargement, masses, and tenderness.
D. Rectum. Rectal examination and anoscopy may be warranted to rule out hemorrhoids or other intestinal source of bleeding (Chapter 9.11).
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Source: The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter, 2000
Vaginal bleeding, postmenopausal:
History
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Determine the patient’s age and her age at menopause. Ask when she first noticed the abnormal bleeding. Then obtain a thorough obstetric and gynecologic history. When did she begin menstruating? Were her menses regular? If not, ask her to describe any menstrual irregularities. How old was she when she first had intercourse? How many sexual partners has she had? Has she had any children? Has she had fertility problems? If possible, obtain an obstetric and gynecologic history of the patient’s mother, and ask about a family history of gynecologic cancer. Determine if the patient has any associated symptoms and if she’s taking estrogen.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Vaginal bleeding, postmenopausal:
History and physical examination
(Nursing: Interpreting Signs and Symptoms)
Determine the patient's age and her age at menopause. Ask when she first noticed the abnormal bleeding then obtain a thorough obstetric and gynecologic history. When did she begin menstruating? Were her menses regular? If not, ask her to describe menstrual irregularities. How old was she when she first had intercourse? How many sexual partners has she had? Has she had children? Has she had fertility problems? If possible, obtain an obstetric and gynecologic history of the patient's mother and ask about a family history of gynecologic cancer. Determine whether the patient has associated symptoms and if she's taking estrogen.
Observe the external genitalia, noting the character of vaginal discharge and the appearance of the labia, vaginal rugae, and clitoris. Carefully palpate the patient's breasts and lymph nodes for nodules or enlargement. The patient will require pelvic and rectal examinations.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
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