Meningitis HISTORY_LIST onset of fever degree of fever duration of fever chills rigor headache neck stiffness cough sputum lethargy malaise night sweats anorexia irritablity confusion nausea vomiting photophobia skin rashes myalgia dysuria exposure to TB exposure to hepititis foreign travel recent upper respiratory dz. CHRONIC DISEASE SYSTEMIC DISORDERS pneumonia bronchitis otitis media sinusitis endocarditis cellulitis HIV or AIDS immumosupression diabetes alcholism sickle cell dz. malignancy tuberculosis history of syphillis PREVIOUS TESTS tuberculin tests recent WBC count recent differential SOCIAL HISTORY smoking alcohol caffeine illicit drugs - cocaine high fisk AIDS activities transfusions,IV drugs, unsafe sex ALLERGY medications foods seasonal MEDS_LAB_TESTS **** MEDS recent or new antibiotics **** LAB Electrolytes BUN Creatnine CBC blood C &S collect sputum sputum gram stain sputum C &S tuberculin test HIV test **** TESTS lumbar puncture for CSF CXR REVIEW_OF_SYSTEMS_1 GENERAL weight changes appetite changes anorexia difficulty sleeping fever chills polyphagia hypophagia changes in thirst sleeping habit change bowel habit change fatigue hypertension previous physical exams SKIN pigmentation changes texture changes lesions eruptions pruritis easy bruising easy bleeding unusual hair loss changes in hair distribution skin masses finger/toe nail change rashes hives striae skin atrophy uremic frost hirsutism plethora neurofibromatosis lesion HEENT head trauma skull fractures head masses hearing loss vertigo chronic ear infection ear discharge ear pain hearing aid use loss of vision recent change in vision photophobia diplopia (double vision) glaucoma exudates dry eyes eye pain cataracts eye surgery itchy eyes excessive tearing corrective lenses nose bleeds chronic sinusitis nasal fractures nasal drainage polyps changes in sense of smell edentulous (without teeth) partial plate full plate recent dental work oral lesions tonsillitis strep throat tongue problems voice changes chronic hoarseness chronic halitosis NECK neck masses enlarged thyroid gland brachial cleft cysts neck injury REVIEW_OF_SYSTEMS_2 CHEST chronic coughing sputum production hemoptysis wheezing pneumonia bronchitis TB TB exposure SOB (altered by position?) edema chest pains pacemaker HEART MI coronary artery disease heart murmur heart valve disease left ventricular hypertrophy mistral valve stenosis pericarditis palpitations DOE paroxysmal nocturnal dyspnea orthopnea edema hypertension rheumatic fever cardiomyopathy ectopic heart beats arrhythmia exercise intolerance claudication heart medications ABDOMEN abdominal pain nausea vomiting diarrhea constipation hematochezia hematemesis hemorrhoids GI x-rays GI scopings rectal bleeding ulcers bowel polyps bowel incontinence gall bladder disease gall stones hepatitis cirrhosis hepatomegaly splenomegaly GU renal insufficiency renal failure dialysis kidney stones kidney disease kidney cyst flank pain hematuria pyuria dysuria chronic cystitis nocturia anuria hesitancy enuresis change in urine color prostatitis epididymitis scrotal problems TURP pain on intercourse genital lesions genital discharge REVIEW_OF_SYSTEMS_3 OB/GYN metorrhagia menorrhagia irregular menses problems in pregnancy use of contraception breast masses nipple discharge breast skin changes changes in axillary nodes monthly breast exam breast feeding children EXTREMITIES difficulty with gait weakness joint swelling joint stiffness muscle pain muscle swelling muscle injuries sagittal plan scoliosis coronal plane scoliosis fractured bones SLE osteoarthritis rheumatoid arthritis fibromyalgia NEURO seizures head injury LOC loss of coordination difficulty in balance sciatica difficulty : fine motor skills difficulty speaking CVA (stroke) weakness in arms weakness in legs tingling in legs and feet tingling in arms PSYCHIATRIC depression bipolar disorder suicide attempts hospitalization for psychiatric problems personality disorders ENDOCRINE goiter exophthalmos dry skin dry hair intolerance to heat intolerance to cold changes in growth sterility impotence decreased libido LYMPHATIC AND HEMATOLOGICAL lymphadenopathy transfusion anemia PHYSICAL_EVAL_1 VITALS BP Pulse Temp Heart rate GENERAL consciousness level: obtunded lethargic labored respirations SKIN capillary refill rashes nail bed splinter hemorrhages Janeway's lesions petechia purpura HEENT pupil size pupil reactivity extraocullar movements nystagmus papilledema PHYSICAL_EVAL_2 NECK rigid neck Brudinski's sign neck flex -> hip/knee flex Kernig's sign (flexing hip & extending knee elicits resistance) CHEST rhonchi crackles dullness to percussion HEART rhythm murmur NEURO altered mental status cranial nerve palsies motor weakness sensory DTR's Babinski's sign gag reflex DIFF_DIAGNOSIS meningitis (bacterial, viral, or tb) encephalitis brain abscess parameningitis infection (viral or tuberculin) Cause of Bacterial Meningitis > than 15 years S. pneumoniae N. meningitis H. influenzae Gram negative bacilli Staphylococci Listeria