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Is there a petechial rash? The presence of a petechial rash suggests either a thrombocytopenic purpura, which may be idiopathic or secondary to leukemia, aplastic anemia, collagen disease, or drugs. In addition, ... DIAGNOSTIC WORKUP
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Is there a history of drug ingestion or injection? This will help diagnose drug reactions and serum sickness, which are common and easily discovered in the history. Patients with glucose-6-phosphate ... DIAGNOSTIC WORKUP
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Is there a history of drug ingestion or injection? Of course, the history should reveal that the patient has been on a certain drug or has received certain antitoxins, serums, or vaccines.
Is there a rash? If there is a rash ... DIAGNOSTIC WORKUP
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Fever is defined as an elevation of normal body temperature (37°C, or 98.6°F). True fever occurs when the body adopts a new thermoregulatory “set point” secondary to the release of pyrogenic cytokines in response to bacteria,... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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Because the differential diagnosis of purpura is very large, begin by determining whether the purpura is palpable or nonpalpable. Subsequent workup is dictated by the history, physical, and review of systems to determine appropriate diagnostic tests. If,... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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The etiologies of rash with fever are vast, but a systematic approach will help the clinician quickly narrow the differential. Patients who appear “toxic” with fever and prostration must be rapidly and thoroughly evaluated to rule out life-threatening... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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Purpura represents leakage of blood from vessels into skin/mucous membranes; thus, it is nonblanching on pressure; petechiae are <3 mm, ecchymosis >3 mm in diameter. Idiopathic thrombocytopenic purpura (ITP) is the most common cause of thrombocytopenic and Henoch-Schönlein purpura (HSP) the>... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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Cyclic or periodic fever is an unexplained fever that recurs after fever-free periods at almost predictably fixed intervals. True cyclic fever is rather uncommon in childhood; it should be differentiated from recurrent fever, which refers to fever... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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Recurrent or relapsing fever is a cluster of febrile episodes that occur over a period of time, with documented fever-free intervals and without an apparent medical cause for each episode. It should be differentiated from cyclic fever, which refers to febrile... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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Fever of unknown origin (FUO) is a term that is often misused to describe febrile illness without an obvious etiology or without other symptoms. The definition in different studies is arbitrary, but basically refers to at least 2 weeks of daily documented fever that is unexplained... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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Fever is an elevation of body temperature over the normal daily range for a specific individual in response to different insults. It occurs when the thermoregulatory center in the hypothalamus is reset to higher temperature because of exogenous and... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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... The differential diagnosis of fever is best developed using physiology first and anatomy second.
FEVER, NONINFECTIOUS CAUSES
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... Many patients are told they have a low blood pressure and are even treated for it when that blood pressure may be entirely normal for them. Asymptomatic hypotension may not be pathologic at all. At any rate, an expensive investigation for the causes of “hypotension” would seem
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...Pyrexia
A fever is a common sign that can arise from many disorders. Because these disorders can affect virtually any body system, a fever in the absence of other signs usually has little diagnostic significance. A persistent high fever, though, represents an emergency... Emergency interventions ... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Pictures
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... Purpura is the extravasation of red blood cells from the blood vessels into the skin, subcutaneous tissue, or mucous membranes. It’s characterized by discoloration that’s easily visible through the epidermis, usually purplish or brownish red. Purpuric lesions include petechiae,... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Pictures
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... Infection
Bacterial
Bacterial endocarditis
Sinusitis
Osteomyelitis
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... Infections
Bacterial
Streptococcus pneumoniae
Salmonella spp.
Haemophilus influenzae
Staphylococcus aureus
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... Platelet Disorders
Thrombocytopenia
Drugs, especially
Cytotoxic agents
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... Hypovolemia
External losses
Hemorrhage
Gastrointestinal loss
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... Allergic purpura, a nonthrombocytopenic purpura, is an acute or chronic vascular inflammation affecting the skin, joints, and GI and genitourinary (GU) tracts, in association with allergy symptoms. When allergic purpura primarily affects the GI tract, with... Causes and incidence ... Signs and symptoms ... Diagnosis ... Treatment ... Special considerations ... Pictures
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... Colorado tick fever is a benign infection caused by the Colorado tick fever arbo-virus and transmitted to humans by a tick. It occurs in the Rocky Mountain region of the United States, mostly in April and May at lower altitudes and in June and July at higher altitudes.... Causes and incidence ... Signs and symptoms ... Diagnosis ... Treatment ... Special considerations
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... Idiopathic thrombocytopenic purpura (ITP), thrombocytopenia that results from immunologic platelet destruction, may be acute (postviral thrombocytopenia) or chronic (Werlhof’s disease, purpura hemorrhagica, essential thrombocytopenia, and... Causes and incidence ... Signs and symptoms ... Diagnosis ... Treatment ... Special considerations
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... Lassa fever is an epidemic hemorrhagic fever caused by the Lassa virus, an extremely virulent arenavirus. This highly fatal disorder kills 10% to 50% of its victims, but those who survive its early stages usually recover and acquire immunity to secondary... Causes and incidence ... Signs and symptoms ... Diagnosis ... Treatment ... Special considerations
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... An acute infectious disease caused by spirochetes of the genus Borrelia, relapsing fever (also called tick, fowl-nest, cabin, or vagabond fever or bilious typhoid) is transmitted to humans by lice or ticks and is characterized... Causes and incidence ... Signs and symptoms ... Diagnosis ... Treatment ... Special considerations
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... Acute rheumatic fever is a systemic inflammatory disease of childhood, in many cases recurrent, that follows a group A beta-hemolytic streptococcal infection. Rheumatic heart disease refers to the cardiac manifestations of rheumatic fever and includes... Causes and incidence ... Signs and symptoms ... Diagnosis ... Treatment ... Special considerations
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... Rocky Mountain spotted fever (RMSF) is a febrile, rash-producing illness caused by Rickettsia rickettsii. The disease is transmitted to humans by a tick bite.
RMSF is fatal in about 5% of patients. Mortality rises when... Causes and incidence ... Signs and symptoms ... Diagnosis ... Treatment ... Special considerations
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... Toxic shock syndrome (TSS) is an acute bacterial infection caused by toxin-producing, penicillin-resistant strains of Staphylococcus aureus, such as TSS toxin-1 and staphylococcal enterotoxins B and C. Initially, the disease was thought to... Causes ... Signs and symptoms ... Diagnosis ... Treatment ... Special considerations
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... In hypovolemic shock, reduced intravascular blood volume causes circulatory dysfunction and inadequate tissue perfusion. Without sufficient blood or fluid replacement, hypovolemic shock syndrome may lead to irreversible cerebral and renal damage, cardiac arrest and, ultimately, death... Causes ... Signs and symptoms ... Diagnosis ... Treatment ... Special considerations ... Pictures
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... Signs and Symptoms Cold, pale, clammy skin; hypotension; tachycardia; rapid, shallow respirations; oliguria; restlessness, confusion; obtundation; narrowing pulse pressure; cyanosis
Treatment (Tx) Medication and... Pictures
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... Signs and Symptoms Muscle contraction, loss of consciousness, loss of reflex control, respiratory paralysis, arrhythmias, myocardial infarction, burns, hearing loss, cataracts
Treatment (Tx) CPR, lactated Ringer’s
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... Signs and Symptoms Onset: fewer, chills. Warm phase: pink, flushed skin; low urine output; blood pressure normal or slightly elevated; rapid, bounding pulse; rapid, shallow respirations; altered level of consciousness (anxiety, irritability,... Treatment (Tx)
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... Signs and Symptoms Bright red blood from rectum or mouth, hypotension, tachycardia, nausea, decreased urine output, decreased level of consciousness, increased respiratory rate, cold, clammy skin
Treatment (Tx) Blood
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... Purpura is the extravasation of red blood cells from the blood vessels into the skin, subcutaneous tissue, or mucous membranes. It’s characterized by discoloration that’s easily visible through the epidermis, usually purplish or brownish red. Purpuric lesions include petechiae... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Pictures
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... Fever is a common sign that can arise from numerous disorders. Because these disorders can affect virtually any body system, fever in the absence of other signs usually has little diagnostic significance. A persistent high fever, though, represents an emergency.... Emergency interventions ... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Patient counseling ... Pictures
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... Lyle J. Fagnan
Fever is a physiologic state in which the body temperature is elevated above the individual’s normal temperature. Patients and clinicians consider fever an important sign of illness.
Approach to the ... History ... Physical examination ... Testing. ... Diagnostic assessment. ... Pictures
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... Michael L. O’Dell
Fever with an accompanying rash represents a diagnostic challenge for even the most experienced of clinicians, as this combination of signs can represent trivial or life-threatening illnesses. ... Approach ... History ... Physical examination ... Testing ... Diagnostic assessment
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... John L. Smith
Purpura are the visible extravasation of blood into the skin or mucous membranes. Petechiae are purpura less than 2 mm in diameter and ecchymoses are greater than 1 cm in diameter.
Approach Purpura are... History ... Physical examination ... Testing ... Diagnostic assessment (4)
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... Differential Overview
Purpura
❑Trauma
❑Senile purpura
❑Drugs
❑Vasculitis
❑Vitamin K deficiency ... Diagnostic Approach ... Clinical Findings ... Pictures
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... Differential Overview
Infection
❑ HIV
❑ Tuberculosis
❑ Endocarditis
❑ Osteomyelitis
❑... Diagnostic Approach ... Clinical Findings ... Pictures
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... Differential Overview
Cardiogenic
❑ Anterior myocardial infarction
❑ Arrhythmia
❑ Dilated cardiomyopathy
❑ Aortic stenosis ... Diagnostic Approach ... Clinical Findings ... Pictures
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... Allergic purpura, or anaphylactoid purpura, is a type of nonthrombocytopenic purpura. It’s characterized by allergy symptoms and acute or chronic vascular inflammation affecting the skin, joints, or GI or genitourinary (GU) tract. When allergic... Causes ... Signs and symptoms ... Diagnosis ... Treatment ... Special considerations
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... Idiopathic thrombocytopenic purpura (ITP), thrombocytopenia that results from immunologic platelet destruction, may be acute (postviral thrombocytopenia) or chronic (Werlhof’s disease, purpura hemorrhagica, essential thrombocytopenia, autoimmune thrombocytopenia). Acute ITP... Causes ... Signs and symptoms ... Diagnosis ... Treatment ... Special considerations
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... Often recurrent, acute rheumatic fever is a systemic inflammatory disease of childhood that follows a group A beta-hemolytic streptococcal infection. Rheumatic heart disease refers to the cardiac manifestations of rheumatic fever, including pancarditis (myocarditis,... Causes ... Signs and symptoms ... Diagnosis ... Treatment ... Special considerations
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... An acute bacterial infection, toxic shock syndrome (TSS) is caused by toxin-producing, penicillin-resistant strains of Staphylococcus aureus, such as TSS toxin-1 and staphylococcal enterotoxins B and C. The disease primarily... Causes ... Signs and symptoms ... Diagnosis ... Treatment ... Special considerations
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... In hypovolemic shock, reduced intravascular blood volume causes circulatory dysfunction and inadequate tissue perfusion. Without sufficient blood or fluid replacement, hypovolemic shock syndrome may lead to irreversible cerebral and renal damage,... Causes ... Signs and symptoms ... Diagnosis ... Treatment ... Special considerations ... Pictures
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... Sometimes called pump failure, cardiogenic shock is a condition of diminished cardiac output that severely impairs tissue perfusion. It reflects severe left-sided heart failure and occurs as a serious complication in nearly 15% of all patients... Causes ... Signs and symptoms ... Diagnosis ... Treatment ... Special considerations
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... When an electric current passes through the body, the damage it does depends on the intensity of the current (amperes, milliamperes, or microamperes), the resistance of the tissues it passes through, the kind of current (alternating current,... Causes ... Signs and symptoms ... Diagnosis ... Treatment ... Special considerations ... Pictures
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... Fever is a common sign that can arise from any one of several disorders. Because these disorders can affect virtually any body system, fever in the absence of other signs usually has little diagnostic significance. A persistent high fever, though, represents an emergency. ... Assessment ... History ... Physical examination ... Pediatric pointers ... Geriatric pointers ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching ... Pictures
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... Fever, or pyrexia, is a common sign that can arise from any one of several disorders. Because these disorders can affect virtually any body system, fever in the absence of other signs usually has little diagnostic significance. A persistent high fever, though, represents... Emergency Actions ... History ... Physical assessment ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Patient counseling ... Pictures
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... Purpura is the extravasation of red blood cells from the blood vessels into the skin, subcutaneous tissue, or mucous membranes. It’s characterized by discoloration that’s easily visible through the epidermis, usually purplish or brownish red. Purpuric... History ... Physical assessment ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Patient counseling ... Pictures
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... Occurs whenpathologic process causes body temperature to exceed normal range. DuBois suggested that usual range ofnormal body temperature is 97–100.4°F (36.2–38.0°C)rectal or 96.8–99.3°F (36.0–37.4°C)oral. Rectal temperature tends to be 0.5–1... Principal Causes of Acute Fever ... Clinical Features and Diagnosis: Acute Fever ... Diagnostic Approach: Acute Fever ... Principal Causes of Fever of Unknown Origin ... Clinical Features and Diagnosis: Fever of Unknown Origin ... Diagnostic Approach: Fever of Unknown Origin ... References
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...Purpura are macular discolorations that donot blanch or disappear with pressure. They include petechiae (<3mm in diameter) and ecchymoses (larger lesions). Principal Causes of Purpura and Bleeding Lossof vascular integrity ... Clinical Features and Diagnosis ... Diagnostic Approach ... References
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... Purpura is the extravasation of red blood cells from the blood vessels into the skin, subcutaneous tissue, or mucous membranes. It's characterized by discoloration that's easily visible through the epidermis, usually purplish or brownish red. Purpuric... History and physical examination ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching ... Pictures
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... A fever is a common sign that can arise from many disorders. Because these disorders can affect virtually any body system, a fever in the absence of other signs usually has little diagnostic significance. A persistent high fever, though, represents an... History and physical examination ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching ... Pictures
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The differential diagnosis of fever is best developed using
physiology first and anatomy second.
Physiology. Increased heat in the body is caused by increased
production or decreased elimination or dysfunction of the... Pictures
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Many patients are told that they have a low blood pressure and are even
treated for it when that blood pressure may be entirely normal for them.
Asymptomatic hypotension may not be pathologic at all. At any rate, an
expensive investigation into... Pictures
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... I. History of Present Illness
An 8-day-old girl presented to the emergency department after an episode of
irregular, rapid breathing followed by stiffening of her body and shaking of
her extremities that lasted several
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... I. History of Present Illness
A 10-day-old boy was well until the day of admission, when he was noted by his
mother to have the sudden onset of left arm and leg shaking while sleeping. The
episode lasted about 1 minute and was ... Pictures
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... Author:
William Giasi, Jr., MD
What to Do - Take Action
There are thousands of emergencies every year that require the resuscitation
of infants and children. These emergencies can occur in almost any setting
and providers need... Suggested Readings
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... Author:
Caroline Rassbach, MD
What to Do - Take Action
Shock occurs when the oxygen and nutrient supply is insufficient to meet the
metabolic demands of the body. Shock can be classified as hypovolemic, septic, distributive, and cardiogenic.... Suggested Readings
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What is an allergy and what is it that causes some people to suffer from them? Why do allergies flare up during certain times of the year? Learn...
For most people, arthritis means simply pain in or around a joint. But there are over 100 different kinds of arthritis, each with its own set of...
Not all kidney stones are alike. Learn about the different types, and how each kind of stone brings its own specific problems.
In recent years, the drug Rituxan has become a well-established option only for certain forms of non-Hodgkin's lymphoma (NHL) There are other...