Review Of Constitutional Symptoms From Quizlet

Here is a link to the flash cards and slides from the Constitutional Symptoms Flash Cards from Quizlet.

And here are the slides:


Constitutional symptoms Symptoms indicating that a disease or disorder is affecting the whole body
Generally non-specific sx:
-Weight loss (unintended)-Malaise
-Night sweats
-Decreased appetite


Fatigue Feeling of overwhelming, sustained exhaustion with a decreased capacity for physical and mental work not relieved by rest (person sleep but fatigue is not going away)
-Constitutional symptoms with MANY etiologies
-Need to to distinguish btw organic causes and functional causes including psychiatric
-Can be confused with excessive daytime sleepiness
–Fatigue = weariness, weakness, depeleted energy
–Daytime sleepiness = drowsiness, decreased alertness, sleep propensity (can fall asleep in waiting room)


Fatigue -Pathophysiology Most common causes:
-Psychogenic – when associated with many the psychiatric conditions (depression, anxiety)
-CB, pulmonary (altered O2 delivery)
-Inflamm (increase inflamm response)
-Metabolic (decreased metabolism or increased metabolism can fatigue the whole system)
-Nutritional deficiencies (anemia, malnutrition)


Fatigue – Etiology – Psychogenic Psychogenic Fatigue – Typically worse in the mornings and gets better as day progressess

-Fatigue >6m that fluctuates in severity
-Try to identify stressors (home, work, school)
-Ask about symptoms of depression and anxiety (lack of motivation/apathy, change in appetite, loss of desire in things that used to interest the individual, decreased libido, sadness, sleep disturbance, early morning waking

-Fatigue is generally worse in the morning and improves with activity


Fatigue – Etiology – Physiologic -Results from situations that would cause most people fatigue
–LAck of sleep/sleep disturbance (shift workers, new parents, students)
–Mental stress
–Excessice exercise without proper nutrition that cause depletion
–Poor nutrition


Fatigue – Etiology – Organic Cause of Fatigue -Due to underlying organic pathology
-Usually presents abruptly with a more progressive course rather than fluctuating
-Generally less in the morning and worsen with activity (relieved by rest)
-Beware of underlying chronic dz can also lead to sleep disturbance and secondary depression , which may suggest psychogenic or physiologic etiology and mask underlying cause


Fatigue – DDx- Psychiatric 1) Psychiatric >50% majority
-Depression, anxiety, situational life stressors, physical. sexual abuse
-Key presentation: fatigue is typically chronic, not improved with rest, can improve with activity
-Physical symptoms: sleep disturbance, headaches, digestive complaints, myalgias, increase/decrease of appetite, palpitations, chest pain, decreased libido, PE unremarkable
-Mental picture: sad, feeling of guild, hopelessness, crying spells, withdrawal, irritability, restless, dissatisfaction


Fatigue – DDx 2) Pharmacologic
-Caused by medications
-Sedatives, antidepressants, antyhypertensives (beta blockers)3) Sleep disturbance/lack of sleep
-Sleepapnea (consider in obese patients and patients who snore), restless leg syndrome, bruxism, esophageal reflux4) Endocrine/metabolic
-hypothyrodism – weight gain, cold intolerance, constipation, alopecia, menstrual changes, decreased cognitive function, depression, enlarged thyroid, achilles reflex with delayed return
-hyperthyroid – weight loss with increase appetite, heat intolerance, tachycardia, palpitations, anxiety, sleep disturbance, tremors, diarrhea, exophthalmos, enlarged thyroid, increase in reflexes
-Adrenal insufficiency – addison’s dz presents with weigh loss, diarrhea, hypotension and hyperpigmentation5) neoplastic
has a lots of signs
-neoplasm, – unexplained weight loss, fever
-Leukemia – pallor, fever, easy bbruising, bleeding gums, epistaxis, petechia,infections
-Lymphoma: diffuse adenopathy6) Hematologic
-Anemia: pallor, lightheadedness, dyspnea with exertion, palpatiations7. Cardio-pulmonary
-Congestive Heart Failure: dyspnea, tachycardia edema, extra heart sounds
-Valvular disease
-COPD: dyspnea, wheezes8. Infections (consider in adolescents and young adults
-Mononucleosis: cervical lymphadenopathy, pharyngitis
-Hepatitis: nausea, GI complains, jaundice
-CMV9 Collagen vascular dz
joint pain (arthralgia) arthritis, rashes10 Fibromyalgia
-90% of FM pts are women presenting with pain and non-restorative sleep
-DX based on 18 tenderpoints and costellation of associated sx (insomnia, depression, endometriosis, headached, IBS, lupus, osteoarthritis, post-traumatic stress disorder, restless leg syndrome, RA)


Constitutional symptoms – Fever Normal oral tempre 98.6F (37FC) +/-one degree
Temp-re >100.2F (37.8) are abnormal
Variations >1-1.F are unusual
Diurnal variation – normally tempre is lowest around 6am and higherst around 6pm


Fever – Temp-re homeostasis -Tempre set by hypothalamic nuclei
-Body attempts to maintain that tem-re by balancing heat generation vs heat dissipation
–Heat generation – cellular metabolism, myocardial contraction, respiration, shivering
–Heat conservation – peripheral vascular constriction – to maintain heat
–Heat loss – vasodilation of cutaneous circulation, increased sweating


Fever Normal physiologic response that increases the hypothalamic heat regulation set point

Hypothalamus increases heat set point


Hyperthermia -Increased tem-re that overrides or bypasses the normal homeostasis mechanism
-Tempre- >105.8F (>41C)
are rare physiologic
its due to heat stroke, malignant hyperthermia, CNS disorder, drug induced, serotonin syndrome (pts medicated for depression and anxiety), endocrine


Fever-pathophysiology Pyrogen
-Fever-inducing substance; sets off a cascade of events that eventually increases the set point
–Exogenous pyrogens – bacteria
–Endogenouspyrogens – leukocytes, MO, arachadonic acid metabolites (prostaglandins)-Higher set point -hypothalamus sends symphathetic signals to cause elevated body tem-re through the following mechanism
–Shievering (mm contraction)-Pyrogenic triggers
Infections, tissue injury (inflamm), malignancies (lymphoma, leukemia, carcinoma), Any disorder associated with inflamm (autoimmune)-Patterns (or how patients present at your office)
Normal diurnal variation, rigors (true shaking chills), wide swings in fever, Relapsing fever (malaria, lyme dz.boreliosis, rock fever/bruceliosis)


Fever-DDx Acute
-URI (otitis media in children can cause fever of unknown origin)
-Virus syndromes (gastroenteritis, influenza)
-Drug reactions (anti-tuberculosis, penicillin, recreational drugs (cocane))
-Genitourinary tract infections
Chronic – low grade
-Infectious mononucleosis
-Occult neoplasms
-Dental abscess


Fever-Clinical encounter

-Other (animal or insect bites, drug allergies)

-sexual hx
-skin rashes
-genitourinary (pain with urination, frequency, urgency)
-musculoskeletal (myalgia, joint pain, flank pain)
-other constitutional sx (weight loss, night sweats, lethargy)


Fever – FUO -Tempre >101F occuring on several occasions during 3 weeks period (ambulatory pt) or 1 week period in hospitalized pt
-Cause should not be apparenteven after a complete work-up
-Often self-limiting w./out everfinding the cause OR is caused by common d/o displaying s/sxPresentation of hepatits C and UTI will be very different
Need to rule out all other underlying problems b4 FUO


Fever – FUO- Etiology -Infectious disease
–TB, bacterial endocarditis,intra-abdominal infections
-Collagen vascular dz
–Vasculitis, polymyalgia, pheumatic, SLE, scleroderma
–Lymphoma, Hodgkin
–Factitious fever, pulmonary emboli
–barbiturates, antibiotics, antihypertensices


Constitutional Symptoms – Unintended Weight Loss Unintended Weight Loss >5% of total body weight over a period of 6 months (make sure to ask if weight loss intentional or unintentional

-Weight loss results when caloric intake is less than caloric expenditure


Unintended Weight Loss – Etiology -Diminished intake
Loss of interest in food (occurs in old ppl, not interested or excited), inability to obtain food, attenuated awareness of hunger pain associated with food, early satiety-Malabsorption syndroms
Hepatic,pancreatitc, intestinal disorder (can intake the food, but there is malabsorption)-Loss of nutrients
Recurrent vomiting, diarrhea, glycosuria, proteinuria

-Increased nutrient deman/metabolic rate
Chronic infection, hyperthyrodism/adrenal tumor (pheochromocytoma), excessive exercise, malignancy (cancer increases nutrient demand on the body)


Unintended Weight Loss – Clinical encounter History
-Determine the amount and period of time of weight loss
-Serial eright measurments
-Ask about loose fitting clothing in last 6 monthsAssociated symptoms/ROS
-Appetite changes, dysphagia, early satiety, bowel changes, vomiting (intentional/unintentional), andominal pain

Other Q to ask
-Daily food intake
-Attitudes toward food and body image
-Previous surgeries
-Medications, alcohol/drug abuse
-Family history
-Risk assessment (sexual history, IB drug use) for HIV
-Social history (including poverty, isolation, or an inability to shop or cook) – do pt like to cook or they rely on eating out to nourish themselves


Unintended Weight Loss-DDx -Organic cause weight loss can be found in >65 of pastients
-Psychiatric causes equal 10% of patients, with depression the most common cause (followed by substance abuse)
-In 25% of patients the cause is not foundMost common cause
-Cancer – typically seen later in the disease (except pancreatic cancer) – most common cause of unexpected weight loss
-Gastrointestinal disorders – gastritis, ulcers, IBD, celiac dz
-Dysphagia – difficulty swallowing
-Chronic disease – CHF, renal dz

Weight Loss with Anorexia
-Usually psychiatric etiology
–Anorexia nervosa

Weight Loss with Normal Appetite
-Usually organic etiology
–Diabetes Mellitus
–Decreased intestinal absorption (Celiac, Parasites, IBD)

Other considerations
–Anorexia and weight loss occur frequently among the elderly d/t:
loose dentures/paintful gums, poverty, medications, dementia, loss of taste and or smell, depression (in many pts, old ppl depressed, parthner recently passed away that changes their life. Not used to cook for themselves b4)

Cancer is always a potential diagnosis
It becomes more likely in presence of certain signs and symptoms, esp in absence of apparent explaination:
weight loss, night sweats, fever, fatigue, pain, lymphadenopathy, hepatosplenomegaly

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