1/12. syncope in the pediatric patient. The cardiologist's perspective.The evaluation of syncopal children or adolescents relies heavily on a thorough, detailed history and physical examination. All syncope associated with exercise or exertion must be considered dangerous. The ECG is mandatory, but other laboratory tests are generally of limited value unless guided by pertinent positives or negatives in the history and physical examination. The ECG allows screening for dysrhythmias, such as wolff-parkinson-white syndrome, heart block, and long qt syndrome, as well as hypertrophic cardiomyopathies and myocarditis. Tilt table testing can be useful in selecting therapy by demonstrating the physiologic response leading to syncope in an individual patient. The most common type of syncope in otherwise healthy children and adolescents is neurocardiogenic or vasodepressor syncope, which is a benign and transient condition. Because syncope can be a predictor of sudden cardiac death, it must be taken seriously, and appropriate screening must be performed.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
2/12. Hormonal and cardiovascular reflex assessment in a female patient with pure autonomic failure.We report the case of a 72-year-old female with pure autonomic failure, a rare entity, whose diagnosis of autonomic dysfunction was determined with a series of complementary tests. For approximately 2 years, the patient has been experiencing dizziness and a tendency to fall, a significant weight loss, generalized weakness, dysphagia, intestinal constipation, blurred vision, dry mouth, and changes in her voice. She underwent clinical assessment and laboratory tests (biochemical tests, chest X-ray, digestive endoscopy, colonoscopy, chest computed tomography, abdomen and pelvis computed tomography, abdominal ultrasound, and ambulatory blood pressure monitoring). Measurements of catecholamine and plasmatic renin activity were performed at rest and after physical exercise. Finally the patient underwent physiological and pharmacological autonomic tests that better diagnosed dysautonomia.- - - - - - - - - - ranking = 0.19085528775622keywords = physical (Clic here for more details about this article) |
3/12. Lessons to be learned: a case study approach insulinoma presenting as a change in personality.A 43-year-old man presented with attacks of altered behaviour over a short period of time; they were associated with episodes of hypoglycaemia. The clinical suspicion of insulinoma prompted investigations that quickly established serum insulin and c-peptide levels to be elevated at the times when blood glucose values were low. A physical lesion was found in the head of the pancreas by means of computerised tomography and endo-duodenal ultrasound scan; an octreotide scan was negative. The patient underwent laparotomy and enucleation of a benign tumour, measuring 2.6 cm in diameter, lying within the head of the pancreas; histological examination confirmed it to be an insulinoma. Postoperatively, the patient's personality gradually became more normal and his fasting blood glucose concentrations returned to within normal limits. The diagnosis and management of insulinoma are discussed in the context of this clinical case; there is also reference to the protean clinical manifestations that may occur in this condition- and its differential diagnosis.- - - - - - - - - - ranking = 0.19085528775622keywords = physical (Clic here for more details about this article) |
4/12. Physical symptoms under forced-phase advance treatment in a patient with delayed sleep phase syndrome: a case report.The physical symptoms that are observed with forced waking in patients with delayed sleep phase syndrome (DSPS) often prevent the successful treatment of patients. Better understanding of these symptoms will assist in providing appropriate treatment in such patients. Herein, a 19-year-old female patient with DSPS is described, in whom headache, fatigue, and dizziness were observed under forced-phase advance treatment. Statistical analysis showed that her headache was dependent on the therapeutic week, and her fatigue was dependent on the period of the day. There was no association between dizziness and either factor. Experience with this patient indicates that the fatigue observed with forced waking is related to the circadian system. This relationship should be explored for other physical symptoms as well.- - - - - - - - - - ranking = 0.38171057551244keywords = physical (Clic here for more details about this article) |
5/12. dizziness and panic in china: associated sensations of zang fu organ disequilibrium.In china, distress is commonly experienced as dizziness that can develop into acute episodes resembling Western panic attacks. These distressing sensations occur in a unique cultural context with a distinctive set of associated symptoms, beliefs and purported etiologies. The experience of illness is informed by traditional Chinese medicine (TCM), an indigenous theory that elaborates a system of organ functioning called zang fi. Depending on the implicated zang fi organ disequilibrium, dizziness and panic present with a specific constellation of associated physical and mental symptoms. This paper presents a clinical survey of psychiatric disorders that demonstrates dizziness to be characteristic of Chinese anxiety states, most particularly panic. Three specific cases of dizziness-focused panic ascribed to different states of zangfu disequilibrium are described. In a typical pattern, initial dizziness and associated symptoms intensify until they generalize into panic attacks. The degree of dizziness and panic corresponds to the state of disequilibrium of the zang fu organ system as well as instability of the social, interpersonal and environmental context of the patient. This paper elucidates the dynamic interpretants of dizziness in the Chinese context to contribute to a medical anthropology of this sensation.- - - - - - - - - - ranking = 0.19085528775622keywords = physical (Clic here for more details about this article) |
6/12. Fits, faints and funny turns. Could it be a mental disorder?BACKGROUND: patients who present to primary care with symptoms of fainting and dizziness, for which there is no adequate physical explanation, are frequently suffering from an undiagnosed psychiatric disorder. OBJECTIVE: This article aims to improve the recognition of common mental disorders presenting as 'fits, faints and funny turns' (FFFTs) and to encourage general practitioners to view these disorders as a positive diagnosis in need of treatment. DISCUSSION: Psychiatric disorders, particularly panic attacks and depression, are common in the setting of FFFTs and should be a positive diagnosis rather than a diagnosis of exclusion. A detailed description of the episode, with corroborating information from a witness if possible, and psychiatric rating scales can assist in this process. Identifying a physical cause for the episode does not exclude a psychiatric diagnosis and vice versa. Specific psychological and pharmacological therapies are effective for anxiety and depression.- - - - - - - - - - ranking = 0.38171057551244keywords = physical (Clic here for more details about this article) |
7/12. dizziness.There are several causes of dizziness, each of which requires a different form of management. Virtually all causes of dizziness can be treated with medication, diet, or physical therapy. This article discusses the most common causes of dizziness and management. Case examples are used extensively.- - - - - - - - - - ranking = 0.19085528775622keywords = physical (Clic here for more details about this article) |
8/12. rehabilitation exercise for treatment of vestibular disorder: a case study.vertigo and dizziness are common symptoms in the general population. While the clinical picture is well known and widely described, there are different interpretations of Benign Paroxysmal Positional vertigo. The purpose of this case report was to describe the treatment of a 56 year old woman with complains of positional vertigo for 35 consecutive years. She suffered from a sudden onset of rotatory, unilateral horizontal canal type benign paroxysmal positional vertigo (BPPV). The symptoms started a day after falling from a bus, where she injured her head. Otherwise her medical history was unremarkable. She was treated with an individualized home exercise program of eye movement exercises, Brandt/Daroff exercises, and general conditioning exercises (i.e., laying on the left side from sitting on the bed, while the head rotated 45 degrees to the right, waiting for about one minute; twice a day on gradual basis, not laying on the side all the way, but to use enough pillows to lay about at 60 degrees). Four weeks from the start of physical therapy, the patient was free of symptoms, even when her neck was in the extended position.- - - - - - - - - - ranking = 0.19085528775622keywords = physical (Clic here for more details about this article) |
9/12. Vascular syndromes.patients with suspected transient ischemic attacks are frequently seen in the Emergency Department. Accurate diagnosis is crucial but often very difficult because signs and symptoms often will have resolved when the patient is seen. This article reviews the details of the history and physical examination that may help to establish a correct diagnosis.- - - - - - - - - - ranking = 0.5keywords = physical examination, physical (Clic here for more details about this article) |
10/12. Positional nystagmus.Positional nystagmus may be persistent or transitory. Of the persistent forms, type I refers to nystagmus changing direction in different head positions and type II to nystagmus beating in a single direction. Both types may denote either peripheral or central abnormality. Transitory, or paroxysmal, positional nystagmus is classified as type III, and the history and physical and electronystagmographic features of its accompanying vertigo and nystagmus permit subdivision into typical and atypical forms. Guidelines are given for the differentiation of typical and atypical forms. In the great majority of cases type III positional nystagmus denotes a harmless inner ear disturbance, but the occasional serious intracranial lesion is also causative. Most instances of the latter, but not all, will fit in the atypical group. A case is reported of vermis metastasis with presenting features of postural vertigo and paroxysmal downbeat positional nystagmus.- - - - - - - - - - ranking = 0.19085528775622keywords = physical (Clic here for more details about this article) |
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