| | NIGHT SWEATS
Doorway information about patient
The paint is a 22-year-old man who comes to he clinic due to night sweats.
Vital signs
. Temperature : 36.9’C
. Blood pressure : 115/80 mmHg
. Pulse : 68 / min
. Respiration : 12 / min
Approach to the patient
Night sweats can be defined as sweating that requires the patient to change their bed clothes and is not due to elevated ambient temperature or humidity. Night sweats can arise form disorders in virtually any system and form multiple disease modalities within those systems (eg , infection , malignancy , metabolic derangements).
The evaluation should focus n features in the history and physical examination that might identify the primary system. Features that increase the likelihood of significant disease include :
. Additional system symptoms (eg, weight loss , fever)
. Localizing sign and symptoms (eg,, cough , skin rash)
. Smoking history or alcohol or drug abuse
. Disease -specific risk factors (eg, obesity ,unprotected sexual intercourse)
. Immunosuppressive conditions ( eg, recent cancer treatment)
Different diagnosis
Menopause and male or female hypogonadism can cause - hot flashes - ( a sudden sensation of warmth in the upper body), but true night sweats may or may not be present . - Flushing - (vasodilation and redness in the face and upper body ) can also be due to menopause as well as certain medications (eg , niacin ) and carcinoid tumors. Idiopathic - hyperhidrosis - typically affects the axillae , palms , and soles and is generally worse during the day.
Important causes of night sweat include:
. Idiopathic (begin ) night sweats
. Infection (eg , tuberculosis , HIV , osteomyelitis , endocarditis)
. Malignancy (eg, lymphoma)
. Systemic inflammatory / autoimmune disorders
. Thyroid disordes
. Gastroesophageal reflux
. Hypoglycemia
. Medications (eg, antidepressants)
. Alcohol or opioid withdrawal
HISTORY AND PHYSICAL EXAM
As noted previously , the initial goal is to identify the primary system involved. Therefor , in addition to the general questions listed here , the history should include a detailed review of system
History
History of present illness
. What happens when you have hight sweats?
. How long have they been happening ?
. Have you had fevers or chills ?
. Have you lost weight unintentionally ?
. How is your appetite ?
. Do you have weakness or fatigue ?
. Have you noticed lumps in your neck , armpits or groin?
. Do you have pain anywhere?
. Do you have cough or breathing problems ?
. Have you noticed a racing or pounding heart?
. Do you feel warm when those around you feel comfortable?
. Have you traveled anywhere recently?
Past medical history
. have you had a similar problems before ?
. What prior medical conditions & surgeries have you had ?
Family history
. Is there anyone in your family with thyroid problems? cancer ?
Social history
. What kind of work do you do ?
. Do you smoke ? Wen did you start & how much do you smoke .
. Do you drink alcohol ? how much & how often ?
. have you used illicit drugs ?
. Are you sexually active ? Do you have sex with men , women , or both ?
If the patient dose not have localizing symptoms , an extended examination will be required ./ the spleen and lymphatic system , in particular , warrant attention , an all major lymphatic chains should be palpated .
Physical examination
HEENT
. Examine for lip lag / exophthalmos.
. Examine oropharynx for thrush.
Neck
. Examine for thyromegaly & thyroid nodules .
lymphatic
. palpate all major lymphatic chains
lungs
. Auscultate for breath sound & adventitious sounds,
Heart
. Auscultate ofr murmurs, gallops & rubs .
Abdomen
. Palpate ofr hepatosplenomegaly
. Percuss the spleen.
Neurologic
. Evaluate deep tendon reflexes.
. Examine for hand tremor.
Skin
. Examine for rashes
Closing the encounter
Begin by discussing any significant findings form the history and examination, If you have narrowed the cases to a specific organ system , discuss that with the patient as well . Asking the patient for - specific concerns - (eg, ‘ What do you think may be the cause of your symptoms?” “ What are you concerned it might be?”) is often helpful for clarifying the differential diagnosis and ensuring that the patent’s concern are addressed.
Diagnostic studies
When evaluating a patent with nonspecific symptoms such as night sweats , focus on the most likely diagnosis and the mist straightforward tests. you may need to screen multiple organ systems , but avoid taking a “ shotgun” approach of ordering many low-yield tests to rule out unlikely possibilities. Be diplomatic in discussing sensitive subjects (eg, HIV test)
Tests to consider in the evaluation of night sweats include:
. Complete blood count
. Erythrocyte sedimentation rate or C-reactive protein
. Glucose and electrolytes
. TSH
. HIV test
. Chest X-ray
. Purified protein derivative skin test or interferon please assay for tuberculosis
Advanced imagine and testing (eg, CT scan ,echocardiogram , bone marrow analysis ) are not usually ordered in the initial assessment unless specific findings are found on history or examination.
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2018/05/24 09:48pm 
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