Presenting Complaints

Effective pain management begins with a thorough and accurate assessment of the patient. Even though pain is a common presenting complaint, lack of regular assessment and reassessment of pain remains a problem and contributes to the undertreatment of pain.23... 

The presenting complaints of overexposed workers may be toothache and excessive salivation. There may be a dull red appearance of the oral mucosa. One or more teeth may loosen, followed by pain and swelling of the jaw healing may be delayed after dental procedures such as extractions with necrosis of bone, a sequestrum may develop with sinus tract formation. In a series of 10 cases, the shortest period of exposure to phosphorus fume (concentrations not measured) that led to bone necrosis was 10 months (2 cases), and the longest period of exposure was 18 years. ... 

TABLE 6-3. Presenting complaints of depression beyond the typical symptoms... 

A 64-year-old woman had a 2-week history of daily bilateral holocranial headache as the presenting complaint of lithium toxicity (serum concentration 2.5 mmol/1) dosage reduction resolved the headache and the extrapyramidal and cerebellar effects (199). 

This system of questioning will establish the presenting complaint and will also give information about what the patient has already done about the symptoms. However it fails to consider family history, previous symptoms, general appearance or any social or lifestyle factors associated with the presenting symptoms. 

This system establishes the presenting complaint and whether or not the patient has had it before. It can be used to find the necessary information for making a diagnosis. Remember that not all questions will necessarily need to be asked and that the order of questioning is not that critical. Use the mnemonic as a checklist or aide memoir. 

In the emergency room, a BAC should be ordered in any patient in whom alcohol ingestion is suspected, regardless of the presenting complaint. For clinical purposes, most laboratories report BAC in units of milligrams per decihter. In legal cases, results are reported in percent (grams of ethyl alcohol per 100 ruL of whole blood). For example, a whole blood alcohol level of 150 mg/dL reported in the hospital corresponds to 0.15% BAC obtained by law enforcement. 

A presenting complaint of UI mandates a directed physical examination and a brief neurologic assessment. This should ideally include an abdominal examination to exclude a distended bladder, a neurologic assessment of the perineum and lower extremities, a pelvic exam in women (looking especially for evidence of prolapse or hormonal deficiency), and a genital and prostate examination in men. 

The typical presenting complaints of endophthalmitis are pain, decreased vision, and conjunctival hyperemia (1). The earliest findings are periphlebitis accompanied by anterior chamber reaction and vitreous cellular debris (2). In the typical case, the vitreous is too opaque to view retinal detail. Hypopyon is considered the hallmark of an infection although severe sterile inflammation may cause hypopyon in some instances. Wound abnormalities are commonly noted in endophthalmitis cases. Lid edema is a frequent finding. 

Pathological fracture through an osteosarcoma as the presenting complaint or during preoperative treatment is seen in 5%-10% cases (Jaffe et al. 1987). They occur either spontaneously or as a result of minor trauma (Fig. 21.11). There is an increased risk in telangiectatic osteosarcoma as it is predominantly lytic (Huvos et al. 1982). It has been claimed that pathological fracture is associated with a poor outcome because of the dissemination of the tumour within the haematoma so that amputation... 

Cough and dyspnea are common presenting complaints. Auscultation of the lungs reveals inspiratory crackles in about one-half of patients (8,9). Digital clubbing is occasionally seen (8,9,11). 

---