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Editors: Wasson, John H.; Walsh, B. Timothy; LaBrecque, Mary C.; Sox, Harold C.

Editors: Wasson, John H.; Walsh, B. Timothy; LaBrecque, Mary C.; Sox, Harold C.; Pantell, Robert Title: Common Symptoms Guide, The: A Guide to the Evaluation of Common Adult and Pediatric Symptoms, 5th Edition Copyright ÂŠ2002 McGraw-Hill > Front of Book > Editors Editors John H. Wasson MD Professor of Community and Family Medicine and Medicine Herman O. West Chair of Geriatrics, Dartmouth-Hitchcock Medical Center, Hanover, New Hampshire B. Timothy Walsh MD William and Joy Ruane Professor of Psychiatry Columbia University, College of Physicians and Surgeons, New York, New York Mary C. LaBrecque ARNP/MSN Instructor in Community and Family Medicine Dartmouth-Hitchcock Medical Center, Hanover, New Hampshire Harold C. Sox Jr. MD Editor Annals of Internal Medicine, Philadelphia, Pennsylvania Robert Pantell MD Professor of Pediatrics Director, Division of General Pediatrics, University of California at San Francisco, San Francisco, California DARTMOUTH PRIMARY CARE COOP Secondary Editors This book was set in Minion by V&M Graphics, Inc. Andrea Seils editor Susan Noujam editor Scott Kurtz editor Karen Davis editor Richard Ruzycka production supervisor The cover designer was Mary Belibasakis. The text designer was Joan O'Connor. R. R. Donnelley & Sons Company, Crawfordsville, was printer and binder. Editors: Wasson, John H.; Walsh, B. Timothy; LaBrecque, Mary C.; Sox, Harold C.; Pantell, Robert Title: Common Symptoms Guide, The: A Guide to the Evaluation of Common Adult and Pediatric Symptoms, 5th Edition Copyright ÂŠ2002 McGraw-Hill > Front of Book > NOTICE NOTICE Medicine is an ever-changing science. As new research and clinical experience broaden our knowledge, changes in treatment and drug therapy are required. The authors and the publisher of this work have checked with sources believed to be reliable in their eﬀorts to provide information that is complete and generally in accord with the standards accepted at the time of publication. However, in view of the possibility of human error or changes in medical sciences, neither the authors nor the publisher nor any other party who has been involved in the preparation or publication of this work warrants that the information contained herein is in every respect accurate or complete, and they disclaim all responsiblity for any errors or omissions or for the results obtained from use of the information contained in this work. Readers are encouraged to conﬁrm the information contained herein with other sources. For example and in particular, readers are advised to check the product information sheet included in the package of each drug they plan to administer to be certain that the information contained in this book is accurate and that changes have not been made in the recommended dose or in the contraindications for administration. This recommendation is of particular importance in connection with new or infrequently used drugs. Editors: Wasson, John H.; Walsh, B. Timothy; LaBrecque, Mary C.; Sox, Harold C.; Pantell, Robert Title: Common Symptoms Guide, The: A Guide to the Evaluation of Common Adult and Pediatric Symptoms, 5th Edition Copyright ÂŠ2002 McGraw-Hill > Front of Book > Dedication Dedication To Thomas P. Almy, MD Editors: Wasson, John H.; Walsh, B. Timothy; LaBrecque, Mary C.; Sox, Harold C.; Pantell, Robert Title: Common Symptoms Guide, The: A Guide to the Evaluation of Common Adult and Pediatric Symptoms, 5th Edition Copyright ©2002 McGraw-Hill > Front of Book > Preface Preface Symptoms are common. During a month, 800 of 1000 persons report symptoms and 300 of these visit a clinician. When patients with symptoms seek a clinician's help, they expect an explanation. The Common Symptom Guide deals in depth with symptom evaluation so that the user can provide an explanation. Since its introduction over 25 years ago, The Common Symptom Guide has given clinicians in training—physicians, nurses, physicians' assistants, and nurse practitioners—a tool for evaluating patients in busy practice settings. It provides a listing of pertinent questions, physical ﬁndings, and diﬀerential diagnoses for over 100 common adult and pediatric symptoms. With increasing experience, students of health care learn that a symptom a patient describes may not be the only reason that medical attention is sought. Clinicians who base their evaluation only on the symptom may take needless diagnostic or therapeutic measures because they have failed to identify how the complaint relates to the patient's function. The Dartmouth COOP Charts were designed to overcome this limitation. The charts are an eﬃcient, valid, and reliable way for identifying important limitations in patient function. The ﬁfth edition of The Common Symptom Guide oﬀers an electronic enhancement. http://www.HowsYourHealth.org automatically links age- speciﬁc symptom and function assessment with explanation. Users of the guide are urged to refer their patients to this site whenever general “check- up” is indicated. Patients receive information tailored to their needs and management forms that summarize the concerns for their clinicians. Editors: Wasson, John H.; Walsh, B. Timothy; LaBrecque, Mary C.; Sox, Harold C.; Pantell, Robert Title: Common Symptoms Guide, The: A Guide to the Evaluation of Common Adult and Pediatric Symptoms, 5th Edition Copyright ÂŠ2002 McGraw-Hill > Front of Book > Acknowledgments Acknowledgments We wish to express our gratitude to the nurses, medical students, nurse practioners, physician's assistants, and physicians whose comments have been so valuable to us. Partial support for the ﬁrst and second edition work was provided by the National Fund for Medical Education and by the Robert Wood Johnson Foundation through the Stanford University Clinical Scholars Program. The Dartmouth COOP Charts were developed and tested in clinical practice with the support of the Henry J. Kaiser Family and W. T. Grant Foundation. This ﬁfth edition includes a suggested link to http://www.HowsYourHealth.org. We are indebted to the John A. Hartford Foundation of New York City and the Commonwealth Fund for research and development of this Internet site. Editors: Wasson, John H.; Walsh, B. Timothy; LaBrecque, Mary C.; Sox, Harold C.; Pantell, Robert Title: Common Symptoms Guide, The: A Guide to the Evaluation of Common Adult and Pediatric Symptoms, 5th Edition Copyright ©2002 McGraw-Hill > Table of Contents > Using the Common Symptom Guide Using the Common Symptom Guide THE GENERAL INDEX The Common Symptom Guide speciﬁes what to ask and what parts of the physical examination to perform for the evaluation of 100 symptoms. Each of these symptoms is CAPITALIZED in the Index and appears in the text in alphabetical order. Many other symptoms are listed in the index. The evaluation of these noncapitalized symptoms is covered under the CAPITALIZED symptom that is listed nearby in the Index. Thus, for the patient complaining of “weakness,” the user will ﬁnd reference to DEPRESSION, LETHARGY, and MUSCLE WEAKNESS listed adjacent to “weakness” in the Index. The user can turn to the Database page with a title that best describes the patient's complaint. Potentially life-threatening symptoms are identiﬁed in the index by asterisks (e.g., CHEST PAIN*). THE MEDICATIONS SECTION Patients often do not remember the names of medications that have been prescribed for them. The user of the Guide may aid a patient in recalling these medications by referring to the Medications Section and naming some of the common drugs prescribed for the patient's problem. New medications are frequently introduced (and occasionally withdrawn). This section may be incomplete. THE DIRECTED DATABASE SECTION A. For every symptom, the user of The Common Symptom Guide must always consider the following descriptors (reproduced on the inside front cover) in order to identify the most likely diagnoses: 1. The patient's age. 2. The mode of onset of a symptom: a. Description of events coincident with onset. b. Whether there have been similar episodes in the past. c. Whether the onset was gradual or sudden. d. The total duration of the symptom. 3. The location of the symptom (if applicable). The location should be anatomically precise. 4. The character of the symptom (e.g., dull, sharp, or burning pain). 5. The radiation of the symptom (if applicable). Radiation of the symptom (the pattern of spread) is most often applicable to a patient's description of pain or an abnormal sensation. 6. Precipitating or aggravating factors. 7. Relieving or ameliorating factors. 8. Past treatment or evaluation of the symptom. a. When, where, and by whom? b. What studies were performed in the past and what were the results (i.e., blood studies, x-rays, etc.) c. Past diagnosis and treatment. d. When inquiring about medications, be sure to include over- thecounter and herbal remedies. 9. Course of the symptom (getting worse, getting better). 10. Eﬀect of the symptom on normal daily activities. B. Speciﬁc information to be obtained for each symptom is presented on the Database page using the following format. HISTORY DESCRIPTORS GENERAL DESCRIPTORS: Speciﬁc descriptors listed here will be those considered particularly important for the evaluation of the symptom. The user will always be expected to ask the general descriptors listed in Section A above and reproduced on the inside front cover. ONSET: LOCATION: CHARACTER: RADIATION: AGGRAVATING FACTORS: RELIEVING FACTORS: PAST TREATMENT OR EVALUATION: ASSOCIATED SYMPTOMS Speciﬁc information will be requested which is considered important for the evaluation of the symptom. MEDICAL HISTORY MEDICATIONS FAMILY HISTORY ENVIRONMENTAL/OCCUPATIONAL HISTORY FALSE POSITIVE CONSIDERATIONS PHYSICAL EXAMINATION This section will specify the parts of the uploads/Litterature/ common-symptoms-guide.pdf