HANDBOOK OF

Signs &

Symptoms

FIFTH EDITION

HANDBOOK OF

Signs & Symptoms

FIFTH EDITION

Clinical Editor

Andrea Ann Borchers, PhD, RN

Associate Professor of Nursing

Division of Nursing

Kettering College

Kettering, OH

Acquisitions Editor: Shannon W. Magee

Product Development Editor: Maria M. McAvey

Editorial Assistant: Zachary Shapiro

Production Project Manager: Marian Bellus

Design Coordinator: Elaine Kasmer

Manufacturing Coordinator: Kathleen Brown

Senior Marketing Manager: Mark Wiragh

Prepress Vendor: SPi Global

5th edition

Copyright © 2015 Wolters Kluwer

Copyright © 2010 Wolters Kluwer Health / Lippincott Williams & Wilkins

All rights reserved. This book is protected by copyright. No part of this book may be reproduced or transmitted in any form or by any means, including as photocopies or scanned-in or other electronic copies, or utilized by any information storage and retrieval system without written permission from the copyright owner, except for brief quotations embodied in critical articles and reviews. Materials appearing in this book prepared by individuals as part of their official duties as U.S. government employees are not covered by the above-mentioned copyright. To request permission, please contact Wolters Kluwer Health at Two Commerce Square, 2001 Market Street, Philadelphia, PA 19103, via email at permissions@lww.com, or via our website at lww.com (products and services).

9 8 7 6 5 4 3 2 1

Printed in China

Library of Congress Cataloging-in-Publication Data

Borchers, Andrea Ann, author.

Handbook of signs & symptoms / Andrea Ann Borchers. — Fifth edition. p. ; cm.

Handbook of signs and symptoms

Preceded by Handbook of signs & symptoms. 4th ed. c2010. Includes bibliographical references and index.

ISBN 978-1-4511-9425-8

I. Handbook of signs & symptoms. Preceded by (work):II. Title.III. Title: Handbook of signs and symptoms. [DNLM: 1. Signs and Symptoms—Handbooks. WB 39]

RC69

616'.047—dc23

2014035784

This work is provided “as is,” and the publisher disclaims any and all warranties, express or implied, including any warranties as to accuracy, comprehensiveness, or currency of the content of this work.

This work is no substitute for individual patient assessment based upon healthcare professionals’ examination of each patient and consideration of, among other things, age, weight, gender, current or prior medical conditions, medication history, laboratory data and other factors unique to the patient. The publisher does not provide medical advice or guidance and this work is merely a reference tool. Healthcare professionals, and not the publisher, are solely responsible for the use of this work including all medical judgments and for any resulting diagnosis and treatments.

Given continuous, rapid advances in medical science and health information, independent professional verification of medical diagnoses, indications, appropriate pharmaceutical selections and dosages, and treatment options should be made and healthcare professionals should consult a variety of sources. When prescribing medication, healthcare professionals are advised to consult the product information sheet (the manufacturer’s package insert) accompanying each drug to verify, among other things, conditions of use, warnings and side effects and to identify any changes in dosage schedule or contradictions, particularly if the medication to be administered is new, infrequently used or has a narrow therapeutic range. To the maximum extent permitted under applicable law, no responsibility is assumed by the publisher for any injury and/or damage to persons or property, as a matter of products liability, negligence law or otherwise, or from any reference to or use by any person of this work.

LWW.com

This work is dedicated to

Sam, Kim, Tim, Emily, Ellen and Kelly. You are and always will be the lights of my life.

CONTRIBUTORS

Samuel A. Borchers, OD

Optometrist

Comprehensive Family Eye Care

Centerville, Ohio

Veterans Administration Medical Center

Dayton, Ohio

Clinical Faculty

Primary Care Optometry and Ocular Disease Management

The Ohio State University

Columbus, Ohio

Allison J. Terry, PhD, MSN, RN

Associate Professor of Nursing

Auburn University Montgomery

Montgomery, Alabama

Laura M. Willis, MSN, APRN,FNP-C

Assistant Professor

Kettering College

President, Connect: RN2ED

Family Nurse Practitioner

PREVIOUS EDITION CONTRIBUTORS

Diane Dixon Abercrombie, PA-C,MA, MMSc

Marsha L. Conroy, RN, BA, BSN,MSN, APN

Ken Ehlers, PA-C, MPAS

Timothy L. Hudson, MS, MEd,CCRN, FACHE

Julia Anne Isen, BSN, MS, FNP-C

Anna L. Jarrett, PhD, ACNP/CNS-BC

Manuel D. Leal, PA-C, MPAS, LCDR

William Pawlyshyn, RN, BSN, MS,MN, APRN, BC

Sundaram V. Ramanan, MD, MS,FRCP, FACP

Richard R. Roach, MD, FACP

Allison J. Terry, RN, PhD, MSN

Pamela Yee, MD

Philip Zazove, MD

FOREWORD

“The CT scan is normal,” the emergency department physician explains to the resident. “I'm thinking of sending the patient home, but I've only done a cursory examination.” Ten minutes later, the resident returns. “The patient had a stroke. She has a positive Homans sign and a positive Babinski's reflex. Arrange a room.”

As this type of drama plays out every day in hospitals and clinics, eliciting a thorough history and performing a careful examination continue to be the cornerstones of clinical practice. Despite marked improvements in technology, the patient assessment is based on both subtle history clues and an observant exam. This still yields the highest diagnostic results, not to mention the cost-benefit ratio and the rapport it establishes with the patient. Those clues should always direct the technology, not the other way around.

Handbook of Signs & Symptoms, Fifth Edition, is a treasure trove of prompts and reminders for the clinician. It provides a comprehensive description of common to unusual patient complaints, coupled with diagnostic testing that is both routine and specific. It describes physical examination findings in detail and clarifies the mechanics of performing even rarely used tests.

Signs and symptoms are formatted alphabetically for quick retrieval, and elicited history is linked to the essentials of the exam. Readers are alerted to urgent situations in the Emergency Interventions section. Differential diagnoses are listed under Medical Causes, following the elaboration of the symptom history and exam findings. Under the heading Other Causes, the clinician is alerted to medications or herbal remedies that are associated with the patient's complaint. Special Considerations address pediatric, gender-specific, and geriatric concerns.

This new edition of the handbook has been updated to include important signs and symptoms related to diseases that have recently taken center stage in clinical medicine, including avian influenza, respiratory syncytial virus, Kawasaki disease, and metabolic syndrome — an epidemic disease that has become essential to diagnose and manage.

Illustrations are scattered throughout the book to augment the reader's understanding of particular tests, and tables point out the often subtle differences in signs and symptoms to help distinguish among the most common complaints. These visual graphics make great teaching tools, too. The index is invaluable to the reader looking for a particular, familiar exam finding as well as for the differential utilizing that finding. The addition of a new appendix that focuses on obtaining a health history answers the need for comprehensive, reliable, and consistent documentation information that is important to formatting electronic medical records.

Handbook of Signs & Symptoms, Fifth Edition, sharpens the novice clinician's ability to listen to the patient with an ear tuned to critical history and offers the seasoned clinician an opportunity to hone examination skills. It is an invaluable tool for maximizing the evaluation of a puzzling patient. Following the handbook's format provides the clinician with an added measure of security that the most careful history and educated examination have been performed.

Richard R. Roach, MD, FACP

Assistant Professor

International Medicine Department

Kalamazoo Center for Medical Studies Michigan State University

East Lansing, Michigan

CONTENTS

CONTRIBUTORS

PREVIOUS EDITION CONTRIBUTORS

FOREWORD

A

B

C

D

E

F

G

H

I

J

K

L

M

O

PQ

R

S

T

U

V

WXYZ

LESS COMMON SIGNS AND SYMPTOMS POTENTIAL AGENTS OF BIOTERRORISM