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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 dehydrogenase deficiency may ... 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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Is the jaundice associated with hepatomegaly? There is little or no hepatomegaly associated with hemolytic anemias, pernicious anemia, Gilbert's disease, and Dubin-Johnson syndrome.
Is the hepatomegaly massive? ... 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 sources (e.g.,... 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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Yellow skin pigmentation caused by elevated serum bilirubin level is termed jaundice. Bilirubin is the major breakdown product of hemoglobin that is released from dying or damaged erythrocytes. The normal serum bilirubin is less than 1 mg/dL, less than 5% of which is present in... 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 endogenous... 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... 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... 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... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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Jaundice refers to the presence of a yellow hue of the skin, sclerae, or mucous membranes. Direct, or more specifically, conjugated hyperbilirubinemia represents a pathologic condition of cholestasis. It is defined as a direct bilirubin fraction greater than 2 mg/dL, or greater than 15%... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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Jaundice is the presence of a yellow hue of the skin, sclerae, or mucous membranes due to elevation of serum bilirubin; it usually becomes apparent at a total serum bilirubin level of 5 mg/dL. It is present in approximately 60% of term infants and 80% of premature infants during the... 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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... Jaundice is not to be confused with xanthochromia, in which the skin turns orange from carotene deposits but the sclerae remain normal in appearance. Carotenemia is often seen in hypothyroidism and diabetes mellitus, but jaundice is not usually a complication of these
... READ EXCERPTS »
...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... Emergency interventions ... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Pictures
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...Icterus
A yellow discoloration of the skin, mucous membranes, or sclera of the eyes, jaundice indicates excessive levels of conjugated or unconjugated bilirubin in the blood. In fair-skinned patients, it’s most noticeable on the face, trunk,... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Pictures
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... Infections
Bacterial
Streptococcus pneumoniae
Salmonella spp.
Haemophilus influenzae
Staphylococcus aureus
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... Infection
Bacterial
Bacterial endocarditis
Sinusitis
Osteomyelitis
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... Primarily Unconjugated Hyperbilirubinemia
Increased production
Hemolysis, intravascular or extravascular
Ineffective erythropoiesis
... READ EXCERPTS »
... 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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... 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.
... 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 by relapses and remissions.... 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, pericarditis,... 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 delayed... Causes and incidence ... Signs and symptoms ... Diagnosis ... Treatment ... Special considerations
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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
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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... Emergency interventions ... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Patient counseling ... Pictures
... READ EXCERPTS »
... A yellow discoloration of the skin, mucous membranes, or sclera of the eyes, jaundice indicates excessive levels of conjugated or unconjugated bilirubin in the blood. In fair-skinned patients, it’s most noticeable on the face, trunk, and sclera; in... 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 febrile patient. ... 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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... James M. Brian and Cara K. Fox
The hepatobiliary system removes bilirubin, a byproduct of hemoglobin metabolism, from the blood stream. Jaundice, a yellowing of the skin and sclera, results from tissue build-up of bilirubin when the hepatobiliary system... Approach ... History ... Physical examination ... Testing ... Diagnostic assessment ... Pictures
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... Differential Overview
Infection
❑ HIV
❑ Tuberculosis
❑ Endocarditis
❑ Osteomyelitis
❑... Diagnostic Approach ... Clinical Findings ... Pictures
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... Differential Overview
Conjugated
❑ Viral hepatitis
❑ Gallstone obstruction
❑ Drugs
❑ Carotinemia
... Diagnostic Approach ... Clinical Findings ... Pictures
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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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... 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,... Emergency Actions ... History ... Physical assessment ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Patient counseling ... Pictures
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... A yellow discoloration of the skin, mucous membranes, or sclerae of the eyes, jaundice indicates excessive levels of conjugated or unconjugated bilirubin in the blood. Also known as icterus, jaundice is most apparent in natural sunlight. In fact, it may be undetectable in... 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... 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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... Jaundice,yellow discoloration of skin and sclera, is produced by depositionof bilirubin in these tissues. Increase in unconjugated or conjugatedbilirubin or both produce jaundice, which is visible when totalserum bilirubin is >2 mg/dL. ... Principal Causes of Unconjugated Hyperbilirubinemia ... Clinical Features and Diagnosis: Unconjugated Hyperbilirubinemia(Neonatal Onset) ... Clinical Features and Diagnosis: Unconjugated Hyperbilirubinemia(Postneonatal Onset) ... Diagnostic Approach: Unconjugated Hyperbilirubinemia ... Principal Causes of Conjugated Hyperbilirubinemia (NeonatalOnset) ... Clinical Features and Diagnosis: Conjugated Hyperbilirubinemia(Neonatal Onset) ... Principal Causes of Conjugated Hyperbilirubinemia (PostneonatalOnset) ... Clinical Features and Diagnosis: Conjugated Hyperbilirubinemia(Postneonatal Onset) ... Diagnostic Approach: Conjugated Hyperbilirubinemia ... References
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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 emergency.
... History and physical examination ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching ... Pictures
... READ EXCERPTS »
... A yellow discoloration of the skin, mucous membranes, or sclera of the eyes, jaundice indicates excessive levels of conjugated or unconjugated bilirubin in the blood. In fair-skinned patients, it's most noticeable on the face, trunk, and sclera; in dark-skinned patients, on the hard palate,... History and physical examination ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching ... Pictures
... 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 thermoregulatory ... Pictures
... READ EXCERPTS »
...
Jaundice is not to be confused with xanthochromia, in which the skin
turns orange from carotene deposits but the sclerae remain normal in
appearance. Carotenemia is often seen in hypothyroidism and diabetes
mellitus, but jaundice is not usually... Pictures
... READ EXCERPTS »
... Samir S. Shah
Approach to the Patient with Fever
I. Definition of the Complaint
The complaint of fever accounts for a large portion of ambulatory ... Pictures
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... I. History of Present Illness
An 18-month-old girl presented with a 1-day history of fever to 38.0°C and cough. While in the examination room, she had tonic flexion of her upper
extremities and eye deviation to the ... Pictures
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... I. History of Present Illness
A 7-month-old Japanese girl developed fever to 38.9°C associated with cough, rhinorrhea, and loose stools. Over the next few days,
the respiratory symptoms and diarrhea resolved, but her fever persisted. Six
days ... Pictures
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... Eric J. Frehm
Approach to the Patient with Jaundice
I. Definition of the Complaint
Jaundice is the yellow discoloration of the skin, mucous membranes, ... Pictures
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... I. History of Present Illness
A 14-day-old, full-term male infant was transferred from a local community
hospital for further evaluation and management of sepsis and
hyperbilirubinemia. He had been discharged home from the well
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... I. History of Present Illness
A 2-month-old male infant was admitted for further evaluation of his jaundice
and poor growth.
II. Past Medical History
The baby was born via
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... I. History of Present Illness
A 6-week-old, full-term female infant was brought to the hospital by her mother
because of persistence of scleral icterus. The infant had been seen during the
first week of life after the mother noted
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... I. History of Present Illness
A 5-week-old girl was referred to the hospital for evaluation of her jaundice
and poor weight gain. Her father stated that she had been
“yellow her whole life,” starting before she left the newborn
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... Author:
Cynthia Gibson, MD
What to Do - Interpret the Data
Evaluation and treatment of a neonate for possible bacterial infection and
sepsis is one of the most common pediatric practices. Signs and symptoms of
sepsis in a neonate are... Suggested Readings
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... Evaline A. Alessandrini, MD, MSCE Fever and Petechiae - BASICS Fever and Petechiae - description Petechiae:Small hemorrhages into the superficial layers of the ... Fever and Petechiae - DIAGNOSIS ... Fever and Petechiae - TREATMENT ... Fever and Petechiae - FOLLOW UP ... Fever and Petechiae - bibliography ... Fever and Petechiae - CODES ... Fever and Petechiae - FAQ
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... Kathleen M. Loomes, MDPeter C. Wilmot, DO (4th Edition)J. Fernando del Rosario, MD (4th Edition) Jaundice - BASICS Jaundice - description Jaundice is derived from the French word jaune, which means “yellow.” ... Jaundice - DIAGNOSIS ... Jaundice - TREATMENT ... Jaundice - FOLLOW UP ... Jaundice - bibliography ... Jaundice - CODES ... Jaundice - FAQ
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... Epidemiology
Patients undergoing chemotherapy are at considerable risk for serious infection.
The primary cell line affected by aggressive chemotherapy is the neutrophil.
The absolute neutrophil count (ANC) is calculated by multiplying the total
number of white blood cells by... Gram-negative Bacteria in Fever and Neutropenia
... Fungal Pathogens in Fever and Neutropenia
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Basic Issues in Pediatric Fever
Fever is a common presenting complaint in pediatrics. The pediatrician’s concern about fever in a child can be summarized by the following questions:
1. What is the chance, given this temperature elevation, that... Neonate (0 to 28 days) ... Infant (28 to 59 days) ... Children (3 months to 36 months) ... Future Considerations ... Selected Readings ... Pictures
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