Diagnostic Tests for Chronic Fatigue Syndrome
Chronic Fatigue Syndrome Tests: Book Excerpts
Home Diagnostic Testing
These home medical tests may be relevant to Chronic Fatigue Syndrome:
- Fatigue: Related Home Tests:
- Thyroid: Home Testing:
- Home Anemia Diagnostic Tests
- Adrenal Gland Health: Home Testing:
- Sleep Disorders: Home Testing
Chronic Fatigue Syndrome Diagnosis: Book Excerpts
Tests and diagnosis discussion for Chronic Fatigue Syndrome:
Chronic Fatigue Syndrome, NIAID Fact Sheet: NIAID (Excerpt)
Doctors find it difficult to diagnose
CFS because it has the same symptoms as many other diseases. When
talking with and examining you, your doctor must first rule out
diseases that look similar, such as multiple sclerosis and systemic
lupus erythematosus in which symptoms can take years to develop. In
follow-up visits, you and your doctor need to be alert to any new
cues or symptoms that might show that the problem is something other
than CFS. (Source: excerpt from Chronic Fatigue Syndrome, NIAID Fact Sheet: NIAID)
Chronic Fatigue Syndrome, NIAID Fact Sheet: NIAID (Excerpt)
In the late
1980s, CDC brought together a group of CFS experts to tackle this
problem. Based on the best information available at the time, this
group published in the March 1988 issue of the scientific journal,
Annals of Internal Medicine, strict symptom and physical
criteria -- the first case definition -- by which scientists could
evaluate CFS study patients.
Not knowing the cause or a
specific sign for the disease, the group agreed to call the illness
"chronic fatigue syndrome" after its primary symptom. "Syndrome"
means a group of symptoms that occur together but can result from
different causes. (Today, CFS also is known as myalgic
encephalomyelitis, postviral fatigue syndrome, and chronic fatigue
and immune dysfunction syndrome.)
After using this
definition for several years, CFS researchers realized some criteria
were unclear or redundant. An international group of CFS experts
reviewed the criteria for CDC, which led to the first changes in the
case definition. This new definition was published in the same
journal in December 1994.
Besides revising the CFS case
criteria -- which reduced the required minimum number of symptoms to
four out of a list of eight possible symptoms -- the newer report
also proposed a conceptual outline for studying the syndrome. This
outline recognizes CFS as part of a range of illnesses that have
fatigue as a major symptom. Although primarily intended for
researchers, these guidelines should help doctors better diagnose
CFS. (Source: excerpt from Chronic Fatigue Syndrome, NIAID Fact Sheet: NIAID)
Diagnosis of Chronic Fatigue Syndrome: medical news summaries:
The following medical news items
are relevant to diagnosis of Chronic Fatigue Syndrome:
Diagnostic Tests for Chronic Fatigue Syndrome: Online Medical Books
16 MEDICAL BOOKS ONLINE!
Review excerpts from medical books online, free, without registration,
for more information about the diagnostic tests for Chronic Fatigue Syndrome.
FATIGUE:
DIAGNOSTIC WORKUP
(Algorithmic Diagnosis of Symptoms and Signs)
All patients should have routine laboratory studies, including CBC, sedimentation rate, chemistry panel, VDRL test, and a urinalysis including analysis for myoglobin. CPK, LDH, AST, and urine creatine and creatinine should be done to rule out muscle disease. A thyroid profile should be done to rule out hyperthyroidism. Further endocrine workup including serum cortisol will help differentiate Addison's disease and hypopituitarism. Because fatigue is associated with aldosteronism, a 24-hr urine aldosterone determination should be done.
Tests for chronic infectious disease, such as febrile agglutinins, brucellin antibody titer, heterophile antibody titer or Monospot test, sputum for AFB, and various skin tests for tuberculosis and fungi, can be done. HIV testing may be appropriate if there is a history of high-risk sexual behavior. Serial blood cultures also would be of value if there is significant fever. Tests for chronic organ failure such as BUN, creatinine, serum electrolytes, and liver function tests should be done. A workup of anemia including a workup of malabsorption syndrome may be necessary. Consequently, stool analysis for fat content as well as
d
-xylose absorption testing may be done.
A search for neoplasm will include chest x-rays, x-rays of the skull and long bones, a bone scan, an upper GI series, and small bowel follow-through as well as a barium enema and intravenous pyelogram. A muscle biopsy will help differentiate certain collagen diseases, muscular dystrophy, and trichinosis. An ANA test and serum complement to screen for collagen disease should be done. A Tensilon test may be necessary to differentiate myasthenia gravis. If a neurologic disease is suspected, referral to a neurologist would be in order. Consider EMG also. If sleep apnea is a possibility, overnight polysomnography is indicated.
If all the tests prove negative, referral to a psychiatrist would be appropriate. On the other hand, it may be appropriate to refer the patient to a psychiatrist earlier in the course of the workup. The diagnosis of chronic fatigue syndrome is sometimes made when all the diagnostic tests are negative, but whether it is truly a disease is questionable.
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Source: Algorithmic Diagnosis of Symptoms and Signs, 2003
HEADACHE:
DIAGNOSTIC WORKUP
(Algorithmic Diagnosis of Symptoms and Signs)
Routine diagnostic tests include a CBC to rule out severe anemia, a sedimentation rate to rule out temporal arteritis, a chemistry panel to rule out liver and kidney disease, a VDRL test to rule out central nervous system syphilis, an x-ray of the sinuses to rule out sinusitis, and an x-ray of the cervical spine to exclude cervical spondylosis. A chest x-ray should also be done to rule out the possibility of metastatic neoplasm. A tonometry study may be done if glaucoma is suspected.
If there are focal neurologic signs, referral should be made to a neurologist or neurosurgeon as soon as possible. If one is not readily available, a CT scan or MRI may be done, the CT scan being the preferred procedure if the expense is a consideration.
If there is nuchal rigidity, a CT scan should be done to rule out a space-occupying lesion before proceeding with a spinal tap. If the CT scan is negative, a spinal tap can be done, and this will ascertain whether there is intracranial bleeding or meningitis. It is usually best to refer the patient to a neurologist or neurosurgeon if there is nuchal rigidity.
If the headaches are chronic and episodic, and there are no focal neurologic signs, papilledema, or nuchal rigidity, an imaging study can be postponed for a while until the response to treatment is evaluated. However, if the response to treatment is poor, one should not hesitate to order a CT scan or MRI.
Difficult cases of headache should also be studied with 24-hr blood pressure monitoring, a 24-hr urine for catecholamines, and lumbar puncture to diagnose central nervous system lues. Histamine phosphate 0.5 cc subcutaneously may help diagnose cluster headaches. Response to beta-blockers may help diagnose migraine. Cerebral angiography may be necessary to diagnose aneurysms and arteriovenous malformations. Patients with chronic headache unresponsive to therapy should be referred to a psychiatrist.
» READ BOOK EXCERPT ONLINE »
Source: Algorithmic Diagnosis of Symptoms and Signs, 2003
Fatigue:
History and physical examination
(Handbook of Signs & Symptoms (Third Edition))
Obtain a careful history to identify the patient’s fatigue pattern. Fatigue that worsens with activity and improves with rest generally indicates a physical disorder; the opposite pattern, a psychological disorder. Fatigue lasting longer than 4 months, constant fatigue that’s unrelieved by rest, and transient exhaustion that quickly gives way to bursts of energy are other findings associated with psychological disorders.
Ask about related symptoms and recent viral or bacterial illness or stressful changes in lifestyle. Explore nutritional habits and appetite or weight changes. Carefully review the patient’s medical and psychiatric history for chronic disorders that commonly produce fatigue. Ask about a family history of such disorders.
Obtain a thorough drug history, noting the use of any drug with fatigue as an adverse effect. Ask about alcohol and drug use patterns. Determine the patient’s risk for carbon monoxide poisoning, and inquire as to whether the patient has a carbon monoxide detector.
Observe the patient’s general appearance for overt signs of depression or organic illness. Is he unkempt or expressionless? Does he appear tired or sickly, or have a slumped posture? If warranted, evaluate his mental status, noting especially mental clouding, attention deficits, agitation, or psychomotor retardation.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Headache:
History and physical examination
(Handbook of Signs & Symptoms (Third Edition))
If the patient reports a headache, ask him to describe its characteristics and location. How often does he get a headache? How long does a typical headache last? Try to identify precipitating factors, such as certain foods or exposure to bright lights. Ask what helps to relieve the headache. Is the patient under stress? Has he had trouble sleeping?
Take a drug and alcohol history, and ask about head trauma within the past 4 weeks. Has the patient recently experienced nausea, vomiting, photophobia, or visual changes? Does he feel drowsy, confused, or dizzy? Has he recently developed seizures or does he have a history of seizures?
Begin the physical examination by evaluating the patient’s level of consciousness (LOC). Then check his vital signs. Be alert for signs of increased ICP — a widened pulse pressure, bradycardia, an altered respiratory pattern, and increased blood pressure. Check pupil size and response to light, and note any neck stiffness.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Fatigue:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
Obtain a careful history to identify the patient’s fatigue pattern. Fatigue that worsens with activity and improves with rest generally indicates a physical disorder; the opposite pattern, a psychological disorder. Fatigue lasting longer than 4 months, constant fatigue that’s unrelieved by rest, and transient exhaustion that quickly gives way to bursts of energy are findings associated with psychological disorders.
Ask about related symptoms and any recent viral or bacterial illness or stressful changes in lifestyle. Explore nutritional habits and any appetite or weight changes. Carefully review the patient’s medical and psychiatric history for any chronic disorders that commonly produce fatigue, and ask about a family history of such disorders.
Obtain a thorough drug history, noting use of any narcotic or drug with fatigue as an adverse effect. Ask about alcohol and drug use patterns. Determine the patient’s risk of carbon monoxide poisoning, and ask whether the patient has a carbon monoxide detector.
Observe the patient’s general appearance for overt signs of depression or organic illness. Is he unkempt or expressionless? Does he appear tired or sickly, or have a slumped posture? If warranted, evaluate his mental status, noting especially mental clouding, attention deficits, agitation, or psychomotor retardation.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Headache:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
If the patient reports a headache, ask him to describe its characteristics and location. How often does he get a headache? How long does a typical headache last? Try to identify precipitating factors, such as eating certain foods or exposure to bright lights. Ask what helps to relieve the headache. Is the patient under stress? Has he had trouble sleeping?
Take a drug and alcohol history, and ask about head trauma within the last 4 weeks. Has the patient recently experienced nausea, vomiting, photophobia, or visual changes? Does he feel drowsy, confused, or dizzy? Has he recently developed seizures, or does he have a history of seizures?
Begin the physical examination by evaluating the patient’s level of consciousness (LOC). Then check his vital signs. Be alert for signs of increased ICP—widened pulse pressure, bradycardia, altered respiratory pattern, and increased blood pressure. Check pupil size and response to light, and note any neck stiffness. (See Differential diagnosis: Headache, pages 392 and 393.)
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Fatigue:
Physical examination
(The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter)
A thorough physical examination should be done to investigate findings of underlying disease. This is also an important prerequisite to satisfy the patient’s concern regarding the possibility of an organic cause if a psychiatric diagnosis is made. Particular attention should be given to the presence of pallor, cardiac arrhythmia, dyspnea, fever or other indication of infection; weight loss; lymphadenopathy; evidence of inflammatory arthritis, occult blood loss, organomegaly, or abdominal masses; neurologic signs of impaired coordination; hypertension; edema; generalized pruritus; obesity; peripheral neuropathy; goiter; dry hair or skin; hemoptysis; or pregnancy. Conduct a mental status examination to identify abnormalities in mood, intellectual function, memory, and personality. Pay special attention to assessment of symptoms of depression or anxiety, suicidal ideation, and psychomotor retardation.
Testing.
If diagnostic or patient concerns remain following the history and physical examination, a minimum battery of laboratory screening tests should be performed in the evaluation of fatigue. This should include a complete blood count with leukocyte differential, serum levels of alanine aminotransferase, total protein, albumin, globulin, alkaline phosphatase, calcium, phosphorus, glucose, blood urea nitrogen, creatinine, electrolytes, thyroid-stimulating hormone, erythrocyte sedimentation rate, and urinalysis. The choice of any further investigations should be guided by clinical assessment of the patient to confirm or exclude other causative possibilities; for example, obtain a chest x-ray study in the case of exposure to tuberculosis or a magnetic resonance imaging study of the brain if multiple sclerosis is suspected. In such cases, further investigation should be conducted according to accepted clinical standards. In particular, the use of other screening tests to diagnose CFS is not recommended in the clinical setting, but should be reserved for investigation in the setting of protocol-based research (4).
Diagnostic assessment
A. Organic and psychogenic causes. If the evaluation through history, physical examination, and laboratory studies reveals an organic or psychogenic cause, the diagnosis of “fatigue” should be replaced with a more precise etiologic diagnosis. The most common biomedical causes of fatigue are psychogenic (57%), usually depression or anxiety, and organic causes (37%) with infection representing the largest subgroup followed by cardiovascular and endocrine abnormalities. Cases of cancer and connective tissue disease first presenting as fatigue are rare at 1% each (5). In the case that environmental factors are identified that contribute to fatigue, a trial of behavior modification may eliminate the complaint. Prolonged fatigue is defined as self-reported, persistent fatigue lasting 1 month or longer.
B. Chronic fatigue syndrome. A diagnosis of CFS is made by two criteria:
(a) severe chronic fatigue of 6 months or longer duration with other known medical conditions excluded by clinical diagnosis; and (b) concurrent presence of four or more of the following symptoms: substantial impairment in short-term memory or concentration; sore throat; tender lymph nodes; muscle pain, multiple joint pain without swelling or redness; headaches of a new type, pattern, or severity; unrefreshing sleep and postexertional malaise lasting more than 24 hours. The conditions must have persisted or recurred during 6 or more consecutive months of illness and must not have predated the fatigue (4). For fatigue of undetermined cause present for 6 or more months that does not meet criteria for CFS, a diagnosis of idiopathic chronic fatigue is made.
References
1. Kroenke K, Wood DR, Mangelsdorff AD, Meier NJ, Powell JB. Chronic fatigue in primary care: prevalence, patient characteristics, and outcome. JAMA 1988;
260(7):929–934.
2. Komaroff AL, Buchwal DS. Chronic fatigue syndrome: an update. Annu Rev Med 1998;49:1–13.
3. Godwin M, Delva D, Miller K, et al. Investigating fatigue of less than six month’s duration. Guidelines for family physicians. Can Fam Physician 1999;45:373–379.
4. Fukuda K, Strauss S, Hickie I, Sharpe MC, Dobbins JG, Komaroff AL, and the International Chronic Fatigue Syndrome Study Group. The chronic fatigue syndrome: a comprehensive approach to its definition and study. Ann Intern Med 1994;
121:953–959.
5. Valdini AF. Fatigue of unknown etiology—a review. Fam Pract 1985;2(1):48–53.
» READ BOOK EXCERPT ONLINE »
Source: The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter, 2000
Headache:
Physical examination
(The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter)
A. Focused physical examination (PE). This should include vital signs (notably blood pressure) and an examination of the scalp; eyes, including funduscopic examination; ears; nose; paranasal sinuses; throat; and neck. A screening neurologic examination, including cranial nerves, coordination (finger-to-nose test), and deep tendon reflexes, is sufficient in most instances. In the migraineur, the examination findings should be all normal in the absence of a current headache; a positive finding warrants further testing (section IV).
B. Additional PE. Other PE maneuvers are appropriate if the medical history suggests specific secondary headache causes: palpation of the superficial temporal arteries (temporal arteritis), audiometry (acoustic neuroma), transillumination of the paranasal sinuses (“sinus headache”), or checking for nuchal rigidity plus Kernig’s and Brudzinski’s signs (meningeal irritation).
Testing
A. Clinical laboratory tests. For most recurrent headache patients, no blood, urine, or other clinical laboratory tests are needed. Laboratory tests that might be suggested by the clinical history and PE include erythrocyte sedimentation rate (temporal arteritis), hematocrit or thyroid studies (fatigue), cerebrospinal fluid examination (meningeal irritation), and white blood count with differential (systemic infection).
B. Diagnostic imaging. In most instances, diagnostic imaging is not needed. In one study, 350 patients with a chief complaint of headache, regardless of the presence or absence of neurologic signs, were referred for computed tomography (CT). Only 2% had clinically significant CT findings, and all patients with significant CT findings had abnormal PE findings or unusual clinical symptoms (3).
1. Diagnostic imaging may be indicated in patients with atypical headache patterns, a history of seizures, or focal neurologic signs or symptoms (4). New onset and “worst ever” headaches are significant complaints (i.e., atypical headache patterns).
2. Despite the greater cost, magnetic resonance imaging (MRI) provides the best imaging for the detection of brain tumors and most other chronic pathologic causes of headache that can be detected by imaging. CT is preferred if acute bleeding is suspected.
V. Diagnostic assessment. The key to the diagnosis of headache is the clinical history. A history of an aching, bitemporal headache that is associated with stress and that waxes and wanes is a typical tension headache. Migraine is characteristically a one-sided headache, throbbing in nature, often associated with nausea and vomiting, frequently accompanied by photophobia and sonophobia, and lasting 4 to 12 hours, perhaps longer. It may be “with aura” (classic) or “without aura” (common migraine), with the latter seen in 70% to 80% of migraineurs. Cluster headache is a strictly one-sided, recurring headache that chiefly affects men, and that occurs in “clusters” of 1 to 2 months of episodes. An increasing number of patients have chronic daily headache, often with virtual constant discomfort; many CDHs are the result of “transformed migraine” following daily analgesic use, especially codeine derivatives (5). Because recurrent headache is caused, at least in part, by life stresses and because it also causes personal and family stress, the diagnostic assessment is incomplete until this complex relationship has been adequately explored over a series of visits.
References
1. Stewart WF, Lipton RB, Celentano DD, Reed ML. Prevalence of migraine headache in the United States. JAMA 1992;267:64–69.
2. Becker L, Iverson DC, Reed FM, et al. Patients with new headache in primary care: a report from ASPN. J Fam Pract 1988;27:41–47.
3. Mitchell CS, Osborn RE, Grosskreutz SR. Computed tomography in the headache patient: is routine evaluation really necessary? Headache 1993;33:83–86.
4. The utility of neuroimaging in the evaluation of headache in patients with normal neurologic examinations: summary statement. Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 1994;44:
1353–1354.
5. Silberstein SD, Lipton RB, Sliwinski M. Classification of daily and near daily headaches: field trials of revised IHS criteria. Neurology 1997;49:638–639.
» READ BOOK EXCERPT ONLINE »
Source: The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter, 2000
Fatigue:
Diagnostic Approach
(Field Guide to Bedside Diagnosis)
Organic fatigue is characterized by physical weakness or exhaustion, which is exacerbated by activity and partially relieved by sleep, short duration (,2 months), unintentional weight loss of greater than 10%, and an ill appearance. Most organic causes have associated signs and symptoms, specific and few in number.
Psychological fatigue is characterized by a primary inertia to initiation of physical activity, which when undertaken, can be performed. The patient is tired all the time, but fatigue is not exacerbated by exertion or relieved by rest. A protracted course, multiple and nonspecific associated symptoms, relation to stressful life events, and an anxious or depressed appearance are other clues. The sick role response to prior minor illness can indicate likely response to the current illness.
A medical or psychiatric diagnosis can be found in over two-thirds of patients with more than one month of fatigue. Psychiatric diagnoses, especially depression, panic disorder, or somatization disorder are the most common.
A diagnostic approach that involves careful history-taking and physical examination, assiduous avoidance of early closure, and a clear orientation to the reality of the patient’s perceptions whatever the cause (i.e., never implying “It’s all in your head”), is most rewarding. The differential is wide, and identification of the unusual organic causes among the many psychophysiological ones takes great skill.
| Sign | Sensitivity | Specificity | Likelihood Ratio |
| Hypothyroidism |
| Coarse skin | 29 | 95 | 5.6 |
| Cool dry skin | 16 | 97 | 4.7 |
| Periorbital puffiness | 53 | 81 | 2.8 |
| Enlarged thyroid | 46 | 84 | 2.8 |
| Lateral eyebrow hair loss | 29 | 85 | 1.9 |
» READ BOOK EXCERPT ONLINE »
Source: Field Guide to Bedside Diagnosis, 2007
Headache:
Diagnostic Approach
(Field Guide to Bedside Diagnosis)
Red flags to serious causes include: Sudden onset of “the worst headache of my life,” especially in a non—headache-prone person; headache different from previous headaches; headache precipitated by position change, cough, or exertion; a history of trauma or fever; abnormal mental status or other neurological findings; a headache that disturbs sleep or is present immediately on awakening; immune deficiency such as HIV.
The time course helps in diagnosing headache. A “thunderclap” headache of a ruptured aneurysm peaks instantly. Cluster headache peaks over 3 to
5 minutes, remains at maximum for 45 minutes, and then gradually recedes. Migraine builds over hours, lasts hours to days, and is improved with sleep.
In evaluating patients with recurrent migraine, it is critical to ascertain whether the present headache differs from prior migraines and whether fever is present or spontaneous retinal venous pulsations are abnormally absent. These should prompt a search for alternative causes. If fever is present with headache, rule out meningitis.
Raised intracranial pressure should be suspected with blurred vision upon bending the head forward, headache upon awakening that improves with sitting up, double vision, loss of coordination and balance, or daily
progressive headache with nausea. Pain originating above the tentorium is referred to the frontal, temporal, or parietal region. Pain from the posterior fossa and below is referred to the occiput. Pain from the posterior sagittal and transverse sinuses may be referred to the eye or forehead.
Lumbar puncture, subdural hematoma, or benign intracranial hypertension can cause orthostatic headache. Occipital headache radiating to the vertex and forehead is usually a result of cervical spondylosis but can also be caused by basal subarachnoid hemorrhage, posterior fossa tumor, or meningitis.
» READ BOOK EXCERPT ONLINE »
Source: Field Guide to Bedside Diagnosis, 2007
Fatigue:
Physical assessment
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Begin your physical assessment by observing the patient’s general appearance for overt signs of depression or organic illness. Is he unkempt or expressionless? Does he appear tired or sickly, or have a slumped posture? If warranted, evaluate his mental status, noting especially mental clouding, attention deficits, agitation, or psychomotor retardation. Then, take your patient’s vital signs and perform a complete physical examination.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Headache:
Physical assessment
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Begin the physical examination by evaluating the patient’s level of consciousness (LOC). Then check his vital signs. Be alert for signs of increased ICP: widened pulse pressure, bradycardia, altered respiratory pattern, and increased blood pressure. Check pupil size and response to light, and note any neck stiffness.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Fatigue:
Diagnostic Approach
(The Diagnostic Approach to Symptoms and Signs in Pediatrics)
When childcomplains of fatigue, history and physical exam are often diagnostic.CBC can screen for anemia.Monospot test can confirm diagnosisof infectious mononucleosis, but if result is negative, Epstein-Barrvirus IgG and IgM antibodies can be performed.Psychosocial history is most importantdiagnostic tool for psychologic problems.If diagnosis remains uncertain, initialscreening investigations for chronic disease include sedimentationrate; stool guaiac; serum electrolytes, glucose, creatinine, aminotransferases;blood urea nitrogen; UA; chest radiography; and intermediate-strengthtuberculin skin test.Other investigations depend on suspecteddiagnosis and results of these tests.
» READ BOOK EXCERPT ONLINE »
Source: The Diagnostic Approach to Symptoms and Signs in Pediatrics, 2006
Headache:
Diagnostic Approach
(The Diagnostic Approach to Symptoms and Signs in Pediatrics)
Most commoncauses of headache in otherwise well children are tension-type andmigraine headaches.In ill children, most common causeis viral or bacterial infection.History and physical exam are diagnosticin most cases.In every child with significant headache,careful neurologic exam including funduscopic exam should be performedand BP should be measured.When history and physical exam arenormal, other tests rarely reveal presence of significant organicdisease.Although less common, headaches sometimesare associated with life-threatening illnesses (e.g., meningitis,encephalitis, brain abscess, and brain tumor). Besides history,physical exam, and lumbar puncture for suspected meningitis or encephalitis,CT and MRI are most important diagnostic tools. If increased intracranialpressure is suspected, CT should be performed before lumbar puncture.Cerebral angiography is useful for demonstrating cerebral aneurysmor arteriovenous malformation.
» READ BOOK EXCERPT ONLINE »
Source: The Diagnostic Approach to Symptoms and Signs in Pediatrics, 2006
Fatigue:
History and physical examination
(Nursing: Interpreting Signs and Symptoms)
Obtain a careful history to identify the patient's fatigue pattern. Fatigue that worsens with activity and improves with rest generally indicates a physical disorder; the opposite pattern, a psychological disorder. Fatigue lasting longer than 4 months, constant fatigue that's unrelieved by rest, and transient exhaustion that quickly gives way to bursts of energy are other findings associated with psychological disorders.
Ask about related symptoms and recent viral or bacterial illness or stressful changes in lifestyle. Explore nutritional habits and appetite or weight changes. Carefully review the patient's medical and psychiatric history for chronic disorders that commonly produce fatigue. Ask about a family history of such disorders.
Obtain a thorough drug history, noting the use of any drug with fatigue as an adverse effect. Ask about alcohol and drug use patterns. Determine the patient's risk of carbon monoxide poisoning, and inquire as to whether the patient has a carbon monoxide detector in the home.
Observe the patient's general appearance for overt signs of depression or organic illness. Is he unkempt or expressionless? Does he appear tired or sickly, or have a slumped posture? If warranted, evaluate his mental status, noting especially mental clouding, attention deficits, agitation, or psychomotor retardation.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Headache:
History and physical examination
(Nursing: Interpreting Signs and Symptoms)
If the patient reports a headache, ask him to describe its characteristics and location. How often does he get a headache? How long does a typical headache last? Does he have a history of high blood pressure? Try to identify precipitating factors, such as certain foods or exposure to bright lights. Ask what helps to relieve the headache. Does he experience stress at work or at home? Has he had trouble sleeping?
Take a drug and alcohol history, and ask about head trauma within the past 4 weeks. Has the patient recently experienced nausea, vomiting, photophobia, or vision changes? Does he feel drowsy, confused, or dizzy? Has he recently developed seizures or does he have a history of seizures?
Begin the physical examination by evaluating the patient's level of consciousness (LOC). Then check his vital signs. Be alert for signs of increased ICP—a widened pulse pressure, bradycardia, an altered respiratory pattern, and increased blood pressure. Check pupil size and response to light, and note any neck stiffness.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
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