...
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 dehydrogenase deficiency ... 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 ... DIAGNOSTIC WORKUP
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...
Are the episodes of loss of consciousness really seizures? Real seizures, especially grand mal, present with incontinence and/or tongue biting. Hysterical seizures with actual tonic or clonic movements may occur, but ... 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, viruses, or other exogenous... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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...
Seizures are a symptom of some identifiable underlying cause or are idiopathic. Epilepsy is recurrent unprovoked seizures. Seizures may or may not be associated with convulsive activity. Correct classification of the seizure type helps to suggest etiology and... 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... 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 prone to relapse at unpredictable and... 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 episodes with periodicity, and... 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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...
Febrile seizures occur in 3–4% of all children; they often do not require long-term treatment. Each year, between 25,000 and 40,000 children in the U.S. have a first unprovoked afebrile seizure. Most of these children will not have a second seizure and do... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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Seizures in the newborn are often difficult to diagnose, because there may only be subtle manifestations. Any insult that affects the brain in this age group can present with seizures, thus the differential diagnosis is quite extensive. One also has to rule... 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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... This sign is generally considered pathognomonic for anterior horn cell or root disease. It may occur, however, in certain cases of peripheral neuropathy, in electrolyte disturbances, and in myasthenia gravis, especially under treatment. It is also found in healthy states, most
... READ EXCERPTS »
... The differential diagnosis of fever is best developed using physiology first and anatomy second.
FEVER, NONINFECTIOUS CAUSES
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... The differential diagnosis of this sign is similar to the differential diagnosis of tremors (see page 521), but a few additional possibilities should be kept in mind. Idiopathic myoclonus epilepsy, petit mal epilepsy (with the petit mal triad),
... READ EXCERPTS »
... Anatomy can assist one greatly in formulating a differential diagnosis of tremor of hepatic coma, Wilson disease, and alcoholism. The thyroid brings to mind the tremor of Graves disease. The kidneys signify the tremor of uremia and
... READ EXCERPTS »
... To formulate a differential diagnosis of convulsions, one must use both physiology and anatomy. The anatomic causes are charted in Table 19 .
CONVULSIONS
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... Fasciculations are local muscle contractions representing the spontaneous discharge of a muscle fiber bundle innervated by a single motor nerve filament. These contractions cause visible dimpling or wavelike twitching of the skin, but they aren’t strong enough to cause a joint to... Emergency interventions ... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers
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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,... Emergency interventions ... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Pictures
... READ EXCERPTS »
... A decrease in the level of consciousness (LOC), from lethargy to stupor to coma, usually results from a neurologic disorder and may signal a life-threatening complication, such as hemorrhage, trauma, or cerebral edema. However, this sign can also result from a metabolic,... Emergency interventions ... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Pictures
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... Myoclonus — sudden, shocklike contractions of a single muscle or muscle group — occurs with various neurologic disorders and may herald the onset of a seizure. These contractions may be isolated or repetitive, rhythmic or arrhythmic,... Emergency Interventions ... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers
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... Absence seizures are benign, generalized seizures thought to originate subcortically. These brief episodes of unconsciousness usually last 3 to 20 seconds and can occur 100 or more times per day, causing periods of inattention. Absence seizures usually begin between ages 4... History and physical examination ... Medical causes
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... A complex partial seizure occurs when a focal seizure begins in the temporal lobe and causes a partial alteration of consciousness — usually confusion. Psychomotor seizures can occur at any age, but their incidence usually increases during adolescence and... History ... Medical causes ... Special considerations ... Pediatric pointers
... READ EXCERPTS »
... Like other types of seizures, generalized tonic-clonic seizures are caused by the paroxysmal, uncontrolled discharge of central nervous system neurons, leading to neurologic dysfunction. Unlike most other types of seizures, however, this cerebral hyperactivity isn’t confined to... Emergency interventions ... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Pictures
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... Resulting from an irritable focus in the cerebral cortex, simple partial seizures typically last about 30 seconds and don’t alter the patient’s level of consciousness (LOC). The type and pattern reflect the location of the irritable focus... History and physical examination ... Medical causes ... Special considerations ... Pediatric pointers ... Pictures
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... Central Nervous System and Vascular Causes
Cerebrovascular disease
Thrombosis
Embolism
Hemorrhage (intracerebral
... READ EXCERPTS »
... Infection
Bacterial
Bacterial endocarditis
Sinusitis
Osteomyelitis
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... Infections
Bacterial
Streptococcus pneumoniae
Salmonella spp.
Haemophilus influenzae
Staphylococcus aureus
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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. Because of... 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 attacks. ... 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 pancarditis (myocarditis,... 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 treatment is... Causes and incidence ... Signs and symptoms ... Diagnosis ... Treatment ... Special considerations
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... Fasciculations are local muscle contractions representing the spontaneous discharge of a muscle fiber bundle innervated by a single motor nerve filament. These contractions cause visible dimpling or wavelike twitching of the skin, but they aren’t... Emergency Interventions ... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Patient counseling
... READ EXCERPTS »
... A decrease in level of consciousness (LOC), from lethargy to stupor to coma, usually results from a neurologic disorder and may signal a life-threatening complication, such as hemorrhage, trauma, or cerebral edema. However, this sign can also result from a metabolic, GI,... Emergency Interventions ... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Pictures
... READ EXCERPTS »
... Myoclonus—sudden, shocklike contractions of a single muscle or muscle group—occurs with various neurologic disorders and may herald onset of a seizure. These contractions may be isolated or repetitive, rhythmic or arrhythmic, symmetrical or asymmetrical, synchronous or... Emergency Interventions ... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers
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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,... Emergency interventions ... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Patient counseling ... Pictures
... READ EXCERPTS »
... Absence seizures are benign, generalized seizures thought to originate subcortically. These brief episodes of unconsciousness usually last 3 to 20 seconds and can occur 100 or more times a day, causing periods of inattention. Absence seizures usually begin between ages 4... History and physical examination ... Medical causes ... Patient counseling
... READ EXCERPTS »
... A complex partial seizure occurs when a focal seizure begins in the temporal lobe and causes a partial alteration of consciousness—usually confusion. Psychomotor seizures can occur at any age, but incidence usually increases during adolescence and adulthood. Two-thirds of patients... History and physical examination ... Medical causes ... Special considerations ... Pediatric pointers
... READ EXCERPTS »
... Like other types of seizures, generalized tonic-clonic seizures are caused by the paroxysmal, uncontrolled discharge of central nervous system (CNS) neurons, leading to neurologic dysfunction. Unlike most other types of seizures, however, this cerebral... Emergency interventions ... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Patient counseling ... Pictures
... READ EXCERPTS »
... Resulting from an irritable focus in the cerebral cortex, simple partial seizures typically last about 30 seconds and don’t alter the patient’s level of consciousness (LOC). The type and pattern reflect the location of the irritable focus. Simple partial... History and physical examination ... Medical causes ... Special considerations ... Pediatric 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 febrile patient. ... History ... Physical examination ... Testing. ... Diagnostic assessment. ... Pictures
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... Linda M. Savory
Seizures are a common serious neurologic disorder in the outpatient setting. In the United States, approximately 4 million patients suffer at least one seizure and 2 million have suffered two or more. Approximately 10% of these... Approach. ... History. ... Physical examination (PE) ... Testing ... Diagnostic assessment.
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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.
... History ... Physical examination ... Testing ... Diagnostic assessment
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... Differential Overview
❑ Generalized (grand mal)
❑ Partial (focal)
❑ Complex partial (temporal lobe)
❑ Absence (petit mal) ... Diagnostic Approach ... Clinical Findings ... Pictures
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... Differential Overview
Infection
❑ HIV
❑ Tuberculosis
❑ Endocarditis
❑ Osteomyelitis
❑... Diagnostic Approach ... Clinical Findings ... Pictures
... READ EXCERPTS »
... 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
... READ EXCERPTS »
... Fasciculations are local muscle contractions representing the spontaneous discharge of a muscle fiber bundle innervated by a single motor nerve filament. These contractions cause visible dimpling or wavelike twitching of the skin, but they aren’t strong enough to cause... Assessment ... History ... Physical examination ... Pediatric pointers ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching
... READ EXCERPTS »
... 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... Assessment ... History ... Physical examination ... Pediatric pointers ... Geriatric pointers ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching ... Pictures
... READ EXCERPTS »
... A decrease in level of consciousness (LOC), from lethargy to stupor to coma, usually results from a neurologic disorder and may signal a life-threatening complication, such as hemorrhage, trauma, or cerebral edema. However, this sign can also... Assessment ... History ... Physical examination ... Pediatric pointers ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching ... Pictures
... READ EXCERPTS »
... Myoclonus — sudden, shocklike contractions of a single muscle or muscle group — occurs with various neurologic disorders and may herald onset of a seizure. These contractions may be isolated or repetitive, rhythmic or arrhythmic,... Assessment ... History ... Physical examination ... Pediatric pointers ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching
... READ EXCERPTS »
... Like other types of seizures, generalized tonic-clonic seizures are caused by the paroxysmal, uncontrolled discharge of central nervous system (CNS) neurons, leading to neurologic dysfunction. Unlike most other types of seizures, however, this cerebral... Assessment ... History ... Physical examination ... Pediatric pointers ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching ... Pictures
... READ EXCERPTS »
... 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,... Emergency Actions ... History ... Physical assessment ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Patient counseling ... Pictures
... READ EXCERPTS »
... A decrease in level of consciousness (LOC), which can range from lethargy to stupor to coma, usually results from a neurologic disorder and may signal a life-threatening complication, such as hemorrhage, trauma, or cerebral edema. However, this sign can also result from... Emergency Actions ... History ... Physical assessment ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Patient counseling ... Pictures
... READ EXCERPTS »
... Myoclonus — sudden, shocklike contractions of a single muscle or muscle group — occurs with various neurologic disorders and may herald onset of a seizure. These contractions may be isolated or repetitive, rhythmic or arrhythmic, symmetrical or asymmetrical,... Emergency Actions ... History ... Physical assessment ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Patient counseling ... Pictures
... READ EXCERPTS »
... A complex partial seizure occurs when a focal seizure begins in the temporal lobe and causes a partial alteration of consciousness — usually confusion. Psychomotor seizures can occur at any age, but incidence usually increases during adolescence and adulthood. Two-thirds of... History ... Physical assessment ... Medical causes ... Special considerations ... Pediatric pointers ... Patient counseling ... Pictures
... READ EXCERPTS »
... Like other types of seizures, generalized tonic-clonic seizures are caused by the paroxysmal, uncontrolled discharge of central nervous system (CNS) neurons, leading to neurologic dysfunction. Unlike most other types of seizures, however, this cerebral hyperactivity isn... History ... Physical assessment ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Patient counseling ... Pictures
... READ EXCERPTS »
... Resulting from an irritable focus in the cerebral cortex, simple partial seizures typically last about 30 seconds and don’t alter the patient’s level of consciousness (LOC). The type and pattern reflect the location of the irritable focus. Simple partial seizures may be... History ... Physical assessment ... Medical causes ... Special considerations ... Pediatric pointers ... Patient counseling ... Pictures
... READ EXCERPTS »
... 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... 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
... READ EXCERPTS »
... A seizureis a sudden paroxysmal discharge of neurons that causes a transientalteration in neurologic function. This alteration can include changesin level of alertness, sensation, motor activity, and autonomicfunction. Commission on Classification... Classification of Seizure Types ... Principal Causes of Seizures ... Clinical Features and Diagnosis ... Diagnostic Approach ... References
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... Fasciculations, or muscle twitches, are local muscle contractions caused by the spontaneous discharge of a muscle fiber bundle supplied by a single motor nerve cell. These contractions cause visible dimpling or wavelike twitching of the skin, but... History and physical examination ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching
... READ EXCERPTS »
... A decrease in the level of consciousness (LOC), from lethargy to stupor to coma, usually results from a neurologic disorder and may signal a life-threatening complication, such as hemorrhage, trauma, or cerebral edema. However, this sign can also... History and physical examination ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching ... Pictures
... READ EXCERPTS »
... Myoclonus—sudden, shocklike contractions of a single muscle or muscle group—occurs with various neurologic disorders and may herald the onset of a seizure. These contractions may be isolated or repetitive, rhythmic or arrhythmic,... History and physical examination ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching
... READ EXCERPTS »
... 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... History and physical examination ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching ... Pictures
... READ EXCERPTS »
... Absence seizures are benign, generalized seizures thought to originate subcortically. These brief episodes of unconsciousness usually last 3 to 20 seconds and can occur 100 or more times per day, causing periods of inattention. Absence seizures usually begin between... History and physical examination ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching
... READ EXCERPTS »
... A complex partial seizure occurs when a focal seizure begins in the temporal lobe and causes a partial alteration of consciousness—usually confusion. Psychomotor seizures can occur at any age, but their incidence usually increases during adolescence... History and physical examination ... Medical causes ... Nursing considerations ... Patient teaching
... READ EXCERPTS »
... Like other types of seizures, generalized tonic-clonic seizures are caused by the paroxysmal, uncontrolled discharge of central nervous system neurons, leading to neurologic dysfunction. Unlike most other types of seizures, however, this cerebral hyperactivity isn't confined to the... History and physical examination ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching ... Pictures
... READ EXCERPTS »
... Resulting from an irritable focus in the cerebral cortex, simple partial seizures typically last about 30 seconds and don't alter the patient's level of consciousness (LOC). The type and pattern reflect the location of the irritable focus. Simple... History and physical examination ... Medical causes ... Nursing considerations ... Patient teaching ... Pictures
... READ EXCERPTS »
...
This sign is generally considered pathognomonic for anterior horn cell
or root disease. It may occur, however, in certain cases of peripheral
neuropathy, in electrolyte disturbances, and in myasthenia gravis,
especially under treatment. It is
... READ EXCERPTS »
...
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
... READ EXCERPTS »
...
The differential diagnosis of this sign is similar to that of tremors
, but a few additional
possibilities should be kept in mind. Idiopathic myoclonus epilepsy, petit
mal epilepsy (with the petit mal triad), grand mal epilepsy, and
... READ EXCERPTS »
...
Anatomy can assist one greatly in formulating a differential
diagnosis of tremor of hepatic coma, Wilson disease, and alcoholism. The
thyroid brings to mind the tremor of Graves disease. The
kidneys signify the tremor of uremia and... Pictures
... READ EXCERPTS »
...
To formulate a differential diagnosis of convulsions, one must use both
physiology and anatomy.The anatomic causes are charted in Table
19.
Irritability of the nerve cell is caused by the same physiologic factors
that lead to irritability of a... Pictures
... READ EXCERPTS »
... Samir S. Shah
Approach to the Patient with Seizures
I. Definition of the Complaint
Seizures, a ... Pictures
... READ EXCERPTS »
... Eric Marsh, MDAmy R. Brooks-Kayal, MD Seizures Febrile - BASICS Seizures Febrile - description Simple febrile seizures: Single, brief (<15 minutes), generalized seizures during fever > ... Seizures Febrile - DIAGNOSIS ... Seizures Febrile - TREATMENT ... Seizures Febrile - FOLLOW UP ... Seizures Febrile - bibliography ... Seizures Febrile - CODES ... Seizures Febrile - FAQ
... READ EXCERPTS »
In the past, treating kids with epilepsy might have meant using a combination of drugs that had unwanted side effects. Now it's possible for kids...
Deciding on treatment for the seizure disorder epilepsy involves balancing several factors, including the kinds of seizures being treated and...
Life with epilepsy is hard for anyone but for kids it can be particularly tough. Learn about a new treatment approach that may help minimize some...
New devices may help some epilepsy patients who are not seizure-free after taking medications.