Face: chubby and swollen
Decrease T3,T4, elevated TSH
Middle ages women with burning hands and feet
Secondary thyroid (anterior pituitary)
Myxedema: weight gain, swollen, hypotension, dry skin, constipation, enophthalmos,
lateral third eyebrow missing
Face: swollen eyes
,swollen inside but dry outside
Anasarca
severe generalized edema
something major is dying
-kidney failure
-heart failure
Best question for head trauma
memory
-can they remember the accident, etc
MS questions for history
heat and humidity - does that make it worse
Swollen, tingling feet w/ DM; what?
vascular claudication
"crud in the blood"
Swollen, tingling feet with LBP; what?
Neurogenic Claudication (central canal stenosis)
Chronic cough for 2 mo. 60 year old smoker
cancer
Chronic cough - episodic 25 years old
asthma or allergy
Increased T3, T4, decreased TSH
Secondary thyroid (anterior pit)
Graves: sweaty, diarrhea, exophthalmos
Clubbing nails dyspnea at night
lung problem
-CHF (left)
,Lymphadenopathy
fever, swollen, history of illnesses (how often sick- immunodef)
Organs needed to be evaluated:
lymph nodes
liver
spleen
tonsils
thymus
bone marrow
fever and chills
viral infection
slow onset, fever at night (night sweats), during day comes back closer to normal
bacterial infection
Cancer that has fever
Hodgkins, Ewings
Apyrexia (no fever) - labeled itis
osteoarthritis
costochondritis
cystitis and urethritis
bursitis
tendonitis
osteitis deformans (may have warm shins)
osteochondritis dissecans
Bacterial infection
inc fever
inc neutrophils
no lymphocyte inc
inc leukocyte
Viral infection
, up and down of fever
dec neutrophils
inc lymphocytes
dec leukocytes
17,000 to 18,000 leukocytes
shilling shift
ER referral
2 week sequelae of strep - glomerulonephritis
have you been to the dentist?
confirmation - UA (RBC casts*)
Carditis from strep
Subacute bacterial endocarditis
confirmation - blood culture
Special studies for heart valves
Echo
Osler's nodes, with what finger nail change?
splinter hemorrhage change (valve infection in heart)
malignant hypetension
typically due to kidneys
Causes of secondary hypertension
drugs (oral contraceptives), hormone therapy, DM, adrenals, obesity
hemoptysis
coughing up blood - lungs
haematemesis
vomiting blood - GI
apoplexy
stroke, cell death, with paralysis
Thyroglobulin
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