Written by Dr.Md.Redwanul Huq (Masum)

Sunday, 23 December 2012 01:44

History of anasarca–

Questions to the patients for taking history of anasarca:

1) Site of 1^st appearance of edema.

2) Questions for CLD:

a) H/O previous Jaundice

b) Intake of hepatotoxic drugs

c) Alcoholism

d) H/O hematemesis & melaena

e) Pain in right hypochondrium

3) Questions for nephritic syndrome:

a) Oliguria

b) Haematuria

4) Questions for CCF:

a) Chest pain

b) Breathlessness

c) Cough.

Important clues related to edema:

Edema with:

A)Dyspnea- CVS cause ( most likely Lt hear failure)

B)Jaundice- Liver cause (most likely CLD)

C)Puffy face- Kidney cause (most likely nephritic syndrome)

1^st appearance of edema:

1)In leg (i.e.swollen feet ankles): CVS cause (commonly)

2)In abdomen: Liver cause (commonly)

3)In face: Renal cause (commonly).

Points to be noted during taking H/O generalized seizure:

a) A patient with <20 years of age:-

i) Childhood onset- Idiopathic,

ii) Family history-

iii) Cerebral birth injury.

b) A patient of 20-50 years of age-

i) Headache, anorexia with vomiting- ICSOL.

ii) Drugs, e.g. Penicillin, isoniazide, metronidazole etc

iii) Alcohol (withdrawal),

iv) Drug abuse- HIV

c) A patient with > 50 years of age-

i) Hypertension, smoking, irregular intake of anti hypertensive drugs- stroke.

ii) Previous H/O hemiplegia.

History of Fever:

Normal body temperature is 97-99º F (36.6-37.2º C).

Fever: >99ºF,

Hyperpyrexia: > 107ºF,

Hypothermia : < 95ºF.

Types of fever:

There are three types of fever: (Hints-CRI – should be remembered while taking history of fever)

1) Continued fever: Here daily fluctuation of temperature is not more than 1.5ºF (1ºC) and the  temperature never touches the base line. e.g. Typhoid fever, Military TB, Lobar pneumonia. (Hints-TML)

2) Remittent fever: Here daily fluctuation of temperature is more than 3ºF (2ºC) and the  temperature never touches the base line. e.g. Amoebic liver abscess, lung abscess, collection of pus in tissues.

3) Intermittent fever: Here fever is present only for several hours during the day & the temperature  touches the base line. e.g.

a) Quotidian fever: Occurs daily (e.g. Kala-azar – double quotidian fever)

b) Tertian fever: Occurs on alternate day i.e. on every third day ( e.g. Malaria by P. Vivax  and P. Ovale)

c) Quartan fever: Occurs after two days i.e. on every fourth day (e.g. Malaria by P. Malariae)