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Symptom: INSOMNIACause: Generalized anxiety disorder
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Description:
Anxiety can cause chronic insomnia as well as symptoms of tension, such as fatigue and restlessness; signs of autonomic hyperactivity, such as diaphoresis, dyspepsia, and high resting pulse and respiratory rates; and signs of apprehension



Symptom: PULSE, ABSENT OR WEAKCause: Cardiac tamponade
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Description:
Life-threatening cardiac tamponade causes a weak, rapid pulse accompanied by these classic findings: paradoxical pulse, jugular vein distention, hypotension, and muffled heart sounds. Narrowed pulse pressure, pericardial friction rub, and hepatomegaly may also occur. The patient may appear anxious, restless, and cyanotic and may have chest pain, clammy skin, dyspnea, and tachypnea


Symptom: PULSE PRESSURE, NARROWEDCause: Cardiac tamponade
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Description:
With cardiac tamponade, a life-threatening disorder, pulse pressure narrows by 10 to 20 mm Hg. Paradoxical pulse, jugular vein distention, hypotension, and muffled heart sounds are classic. The patient may be anxious, restless, and cyanotic, with clammy skin and chest pain. He may exhibit dyspnea, tachypnea, a decreased LOC, and a weak, rapid pulse. A pericardial friction rub and hepatomegaly may also occur


Symptom: TREMORSCause: Drugs
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Description:
Phenothiazines (particularly piperazine derivatives such as fluphenazine) and other antipsychotics may cause resting and pill-rolling tremors. Infrequently, metoclopramide and metyrosine also cause these tremors. Lithium toxicity, sympathomimetics (such as terbutaline and pseudoephedrine), amphetamines, and phenytoin can all cause tremors that disappear with dose reduction


Symptom: PULSE, ABSENT OR WEAKCause: Aortic stenosis
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Description:
With aortic stenosis, the carotid pulse is sustained but weak. Dyspnea (especially on exertion or paroxysmal nocturnal), chest pain, and syncope dominate the clinical picture. The patient commonly has an atrial gallop. Other findings include a harsh systolic ejection murmur, crackles, palpitations, fatigue, and narrowed pulse pressure



Symptom: PULSE, ABSENT OR WEAKCause: Treatments
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Description:
Localized absent pulse may occur distal to arteriovenous shunts for dialysis


Symptom: TREMORSCause: Alcohol withdrawal syndrome
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Description:
Acute alcohol withdrawal after long-term dependence may first be manifested by resting and intention tremors that appear as soon as 7 hours after the last drink and progressively worsen. Other early signs and symptoms include diaphoresis, tachycardia, elevated blood pressure, anxiety, restlessness, irritability, insomnia, headache, nausea, and vomiting. Severe withdrawal may produce profound tremors, agitation, confusion, hallucinations and, possibly, seizures


Symptom: GAIT, PROPULSIVE (Festinating gait)Cause: Manganese poisoning
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Description:
Chronic overexposure to manganese can cause an insidious, usually permanent, propulsive gait. Typical early findings include fatigue, muscle weakness and rigidity, dystonia, resting tremor, choreoathetoid movements, masklike facies, and personality changes. Those at risk for manganese poisoning are welders, railroad workers, miners, steelworkers, and workers who handle pesticides



Symptom: CREPITATION, BONY (Bony crepitus)Cause: Osteoarthritis
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Description:
In its advanced form, joint crepitation may be elicited during ROM testing. Soft fine crepitus on palpation may indicate roughening of the articular cartilage; coarse grating may indicate badly damaged cartilage. The cardinal symptom of osteoarthritis is joint pain, especially during motion and weight bearing. Other findings include joint stiffness that typically occurs after resting and subsides within a few minutes after the patient begins moving


Symptom: PULSE PRESSURE, NARROWEDCause: Shock
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Description:
With anaphylactic shock, narrowed pulse pressure occurs late, preceded by a rapid, weak pulse that soon becomes uniformly absent. Within seconds or minutes after exposure to an allergen, the patient experiences hypotension, anxiety, restlessness, and feelings of doom, along with intense itching, a pounding headache and, possibly, urticaria. Other findings include dyspnea, stridor, and hoarseness; chest or throat tightness; skin flushing; nausea, abdominal cramps, and urinary incontinence; and seizures
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