10-Minute Diagnosis Manual

category - Undifferentiated Problems

• Anorexia
  

  Anorexia is prolonged diminished appetite or appetite loss. This common symptom is to be differentiated from the eating disorder anorexia nervosa, which is often simply called anorexia. Anorexia may or may not be associated with weight loss. It is almost always a result of one or more underlying causes. Article is organized according to five major headings: Approach, History, Physical Examination, Testing and Diagnostic Assessment. The guide to commonly encountered symptoms and signs.

• Dizziness
  

  Dizziness is a rather imprecise term often used by patients to describe any of a number of peculiar subjective symptoms. These symptoms may include faintness, giddiness, light-headedness, or unsteadiness. True vertigo, a sensation of irregular or whirling motion, is also included in a patient's complaint of dizziness. Article is organized according to five major headings: Approach, History, Physical Examination, Testing and Diagnostic Assessment. The guide to commonly encountered symptoms and signs.

• Edema
  

  Edema is defined as a clinically apparent increase in the interstitial fluid volume that may expand by several liters before the abnormality is evident.

• Falls
  

  Falls are most common at age extremes. In children older than 1 year of age, injuries are the number one cause of death. Falls account for 25% of these deaths. Bike injuries account for 68% of falls in children from 5 to 14 years of age. In patients older than 65 years of age, the incidence of falls is 30%; in those older than 80 years of age, it is >50%. Accidents are the fifth leading cause of death in patients 65 years of age and older, and falls account for two thirds of these deaths. Of elderly patients hospitalized for falls, only 50% are alive l year later.

• Fatigue
  

  Fatigue is a very common complaint in the primary care office. It may be the primary reason a patient seeks care or a secondary complaint. We are all bothered by fatigue at some point in time. However, for millions of patients each year, it becomes bothersome enough to seek medical attention. True fatigue needs to be distinguished from weakness and from excessive somnolence secondary to sleep disturbances. Fatigue lasting less than a month is considered acute. If symptoms last more than a month, fatigue is considered prolonged.

• Fever
  

  Fever is an elevation in the core body temperature above the individual's normal range that occurs in conjunction with an increase in the hypothalamic temperature set point. Fever is defined as a core body temperature of 38°C (100.4°F). Hyperthermia is an elevated body temperature without a change in the hypothalamic setting. Hyperpyrexia, a medical emergency, is defined as a temperature over 41.1°C (106.0°F).

• Headaches
  

  Headache is one of the 20 most frequent reasons that cause patients to visit primary care providers in the United States. In a study of 20,468 patients, migraine headache, one of the common causes of recurrent headache, occurred one or more times yearly in 17.6% of women and in 5.7% of men.

• Hypersomnia
  

  Hypersomnia, also known as excessive daytime sleepiness (EDS), is defined by a need to sleep during daytime hours and the ability to fall asleep in situations during which alertness is desired. EDS should be differentiated from generalized fatigue and nonspecific tiredness, as patients often use the terms interchangeably. Generalized fatigue is a problem of decreased physical energy, muscle exhaustion, and possibly poor concentration and memory, whereas hypersomnia is the problem of falling asleep at inappropriate or undesired times.

• Insomnia
  

  Insomnia is defined as a persistent difficulty initiating and/or maintaining sleep. Insomnia can be a primary syndrome; however, insomnia is more commonly a secondary symptom to underlying environmental, medical, or psychiatric disorders.

• Syncope
  

  Syncope is defined as a transient loss of consciousness with an inability to maintain a postural tone that is followed by spontaneous recovery. The term syncope excludes seizures, coma, shock, or other states of altered consciousness.

• Weight Loss
  

  Unintentional weight loss is generally considered to be significant when greater than 5% of body weight is lost over a period of 6 months or less. It is often associated with increased morbidity and mortality especially among the elderly. Perceived weight loss should be verified before initiating a workup, because 50% of patients with perceived weight loss do not have true weight loss. Of patients with confirmed weight loss, an explanation is generally found in 75% of cases. In 25% of patients an explanation is never found. If a physical cause is present, it is usually discovered within 6 months.