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Is there chest pain? If there is chest pain along with the hemoptysis, one should suspect a pulmonary embolism.
Is there fever and/or purulent sputum? The presence of fever and purulent sputum suggests ... DIAGNOSTIC WORKUP
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Are there exudates? This is a key question when evaluating a sore throat. Most cases of sore throat with exudates will be found to have streptococcal pharyngitis. Without exudates, one could still have a streptococcal sore throat, but it is less likely. ... DIAGNOSTIC WORKUP
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Is the patient an adult or a child? If the patient is a child, acute epiglottitis, acute laryngotracheitis, foreign body, congenital laryngeal stridor, laryngismus stridulus, and a retropharyngeal abscess should be considered. ... DIAGNOSTIC WORKUP
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... Wheezing is classically due to bronchial asthma, but there is a danger in jumping to that conclusion because it occurs in a few other conditions as well. The wheezing of bronchial asthma is heard primarily on expiration, whereas the wheezing of... DIAGNOSTIC WORKUP
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Is it acute or chronic? Acute onset of a cough would suggest an acute URI, viral pneumonia, or bronchopneumonia. A chronic cough is more suggestive of pneumoconiosis, chronic bronchitis, emphysema, bronchiectasis, tuberculosis, ... DIAGNOSTIC WORKUP
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Hemoptysis is defined as coughing up blood from a source below the vocal cords. Other potential sites of bleeding (nose, mouth, throat, GI system) must be eliminated; it can be particularly difficult to discern hemoptysis from hematemesis.... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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...
Sore throat is a common symptom. Many patients incorrectly believe that antibiotics improve the clinical course in all sore throats. Although the vast majority of sore throats are of viral origin and should be managed conservatively, an appropriate history... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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Initial history of cough should include an assessment of the production of sputum, and the quantity, quality, and circumstances of the sputum production and coughing episodes. Additionally, associated history and physical findings, with particular attention to inciting... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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...
Initial history of cough should include an assessment of the production of sputum. Additionally, associated history and physical findings, with particular attention to the quantity, quality, and circumstances surrounding coughing episodes and social details (such as history... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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...
Stridor is characterized by a high-pitched grating sound on inhalation or exhalation, but it is caused by narrowing or obstruction of the upper airway. Wheezing is a high-pitched musical sound on inhalation or exhalation that is due to oscillations of narrowed lower airway walls. The age of... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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Hemoptysis is defined as coughing or spitting up blood. Blood can originate from any anatomic site that communicates with the mouth (the “aerodigestive” tract): the mouth, sinuses, nasopharynx, oropharynx, esophagus, stomach, airways, or lung parenchyma. History often... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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Most sore throats and coughs are due to infection. Children may have 5–8 upper respiratory infections per year. The primary differential is between viral and bacterial etiologies, especially group A β-hemolytic streptococcus.
Differential Diagnosis ... Workup and Diagnosis ... Treatment
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Priority of stridor evaluation is based on history and clinical presentation. A child with new stridor and respiratory distress requires immediate intervention. The most common cause of chronic stridor in infants is laryngomalacia. Synchronous airway lesions need to be considered and... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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Breath sounds are made by air flow through airways. Normally they are fairly quiet and somewhat louder during inspiration as air flows toward the stethoscope. Wheezing is defined as continuous breath sounds that are more prominent during expiration and often accompanied by expiratory... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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A cough occurs by increased intrathoracic pressure against a closed glottis (Valsalva maneuver), followed by the abrupt opening of the glottis and a sudden expulsion of air. Increased intrathoracic pressure leads to dynamic compression of the airways. The effect... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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In adults, “chronic” is often defined as more than 3 months of coughing in 2 years, but chronic cough is not as well defined in children. In general, for children, cough of more than 3–4 weeks’ duration will be brought to the... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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... True hemoptysis must be distinguished from epistaxis (see page 188) and hematemesis (see page 261). If the blood is bright red and alkaline (use nitrazine paper to test) and the nasal passages and posterior pharynx are clear, then it is
... READ EXCERPTS »
... Breaking down the orophraynx, nasopharynx, and larynx into anatomic components is not very valuable in developing a differential diagnosis of sore throat. What is useful is to use the mnemonic VINDICATE to establish the etiologies. Further analyzing the
... READ EXCERPTS »
... The differential diagnosis of cough is best developed with the use of anatomy. Cough may arise from an irritative focus anywhere along the respiratory tract. The irritation may be intrinsic, in which case it is usually inflammatory, neoplastic,
... READ EXCERPTS »
... Both these symptoms are the result of the same pathophysiologic mechanism: obstruction in the upper air passages. That obstruction may be due to any one of the etiologies recalled by the mnemonic MINT.
M—Malformations
... READ EXCERPTS »
... Frightening to the patient and commonly ominous, hemoptysis is the expectoration of blood or bloody sputum from the lungs or tracheobronchial tree. It’s sometimes confused with bleeding from the mouth, throat, nasopharynx, or GI tract. (See Identifying... Emergency interventions ... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pictures
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... A loud, harsh, musical respiratory sound, stridor results from an obstruction in the trachea or larynx. Usually heard during inspiration, this sign may also occur during expiration in severe upper airway obstruction. It may begin as low-pitched &ldquo... Emergency interventions ... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Pictures
... READ EXCERPTS »
... Productive coughing is the body's mechanism for clearing airway passages of accumulated secretions that normal mucociliary action doesn't remove. It's a sudden, forceful, noisy expulsion of air from the lungs that contains sputum, blood, or both. The sputum's... Emergency interventions ... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pictures
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... Resonant, brassy, and harsh, a barking cough is part of a complex of signs and symptoms that characterize croup syndrome, a group of pediatric disorders marked by varying degrees of respiratory distress. It's most prevalent in the fall and may... Emergency interventions ... History and physical examination ... Medical causes ... Special considerations
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... A nonproductive cough is a noisy, forceful expulsion of air from the lungs that doesn't yield sputum or blood. It's one of the most common complaints of patients with respiratory disorders.
Coughing is a necessary protective mechanism that... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pictures
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... Wheezes are adventitious breath sounds with a high-pitched, musical, squealing, creaking, or groaning quality. They are caused by air flowing at a high velocity through a narrowed airway. When they originate in the large airways, they can be heard by placing an unaided ear over the chest... Emergency interventions ... History and physical examination ... Medical causes ... Special considerations ... Pediatric pointers ... Pictures
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... Asthma
Extrinsic
Intrinsic
Exercise- or cold-induced
Drug-induced
Aspirin
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... Acute
Viral upper respiratory infection
Pharyngitis
Rhinitis
Tracheobronchitis
... READ EXCERPTS »
... Pseudohemoptysis
Blood of upper gastrointestinal origin
Upper airway lesions
Epistaxis
Gingival bleeding
... READ EXCERPTS »
... Whooping cough, also known as pertussis, is a highly contagious respiratory infection usually caused by the nonmotile, gram-negative coccobacillus Bordetella pertussis and, occasionally, by the related similar bacteria B. parapertussis and B. bronchiseptica.... Causes and incidence ... Signs and symptoms ... Diagnosis ... Treatment ... Special considerations
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... Frightening to the patient and often ominous, hemoptysis is the expectoration of blood or bloody sputum from the lungs or tracheobronchial tree. It’s sometimes confused with bleeding from the mouth, throat, nasopharynx, or GI tract. (See Identifying hemoptysis.)... Emergency interventions ... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Patient counseling ... Pictures
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... A loud, harsh, musical respiratory sound, stridor results from an obstruction in the trachea or larynx. Usually heard during inspiration, this sign may also occur during expiration in severe upper airway obstruction. It may begin as low-pitched “croaking” and progress... Emergency interventions ... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Pictures
... READ EXCERPTS »
... Productive coughing is the body’s mechanism for clearing airway passages of accumulated secretions that normal mucociliary action doesn’t remove. It’s a sudden, forceful, noisy expulsion of air (from the lungs) that contains sputum or blood ... Emergency interventions ... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Patient counseling ... Pictures
... READ EXCERPTS »
... Resonant, brassy, and harsh, a barking cough is part of a complex of signs and symptoms that characterize croup syndrome, a group of pediatric disorders marked by varying degrees of respiratory distress. Croup syndrome is most common in boys and most... Emergency interventions ... History and physical examination ... Medical causes ... Special considerations
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... A nonproductive cough is a noisy, forceful expulsion of air from the lungs that doesn’t yield sputum or blood. It’s one of the most common complaints of patients with respiratory disorders.
Coughing is a necessary protective mechanism that clears airway passages.... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Patient counseling ... Pictures
... READ EXCERPTS »
... Wheezes are adventitious breath sounds with a high-pitched, musical, squealing, creaking, or groaning quality. They’re caused by air flowing at a high velocity through a narrowed airway. When they originate in the large airways, they can be heard by placing... Emergency interventions ... History and physical examination ... Medical causes ... Special considerations ... Pediatric pointers ... Patient counseling ... Pictures
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... Kathryn M. Larsen and Mary Knudtson
Hemoptysis is defined as the coughing up or expectoration of blood from the tracheobronchial tree, which can be from the trachea, major airways, or the lung parenchyma. It is an alarming symptom that... Approach ... History ... Physical examination ... Testing ... Diagnostic assessment
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... Alexandra Duke and Tahany Maurice-Habashy
Stridor is a common type of wheezing (Chapter 8.9). It is characterized by a harsh, raspy, medium-pitched sound produced as air flows through a partially blocked airway. It is... Approach ... History ... Physical examination ... Testing ... Diagnostic assessment ... Pictures
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... Thomas C. Bent
Wheezing is one of the most common respiratory complaints to present to primary care physicians. Although most often caused by asthma or chronic obstructive pulmonary disease, there are multiple causes.... Approach ... History ... Physical examination ... Testing ... Diagnostic assessment ... Pictures
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... Désirée A. Lie
Cough is among the top 10 reasons for visits to family physicians in the United States. It accounts for 200 to 400 million episodes of illness per year. Three causal conditions increasing in frequency... Approach ... History ... Physical examination ... Testing ... Diagnostic assessment
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... Differential Overview
❑ Bronchitis
❑ Pneumonia
❑ Pulmonary edema
❑ Pulmonary infarction
❑ Tuberculosis ... Diagnostic Approach ... Differential Diagnosis ... Pictures
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... Differential Overview
❑ Rhinovirus
❑ Group A streptococci
❑ Ebstein-Barr virus
❑ Adenovirus ... Diagnostic Approach ... Clinical Findings ... Pictures
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... Differential Overview
Wheezing
❑ Asthma
❑ Reactive airways disease
❑ Pulmonary edema
❑... Diagnostic Approach ... Clinical Findings ... Pictures
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... Differential Overview
❑ Viral upper respiratory infection
❑ Asthma
❑ Sinusitis
❑ Mycoplasma bronchitis
❑ Pneumonia
... Diagnostic Approach ... Clinical Findings ... Pictures
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... Differential Overview
❑ Upper respiratory infection
❑ Allergy
❑ Asthma
❑ Chronic bronchitis
❑ Chronic sinusitis
... Diagnostic Approach ... Clinical Findings ... Pictures
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... Frightening to the patient and often ominous, hemoptysis is the expectoration of blood or bloody sputum from the lungs or tracheobronchial tree. It’s sometimes confused with bleeding from the mouth, throat, nasopharynx, or GI tract. (See Identifying hemoptysis, page 168.)... Assessment ... History ... Physical examination ... Pediatric pointers ... Geriatric pointers ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching ... Pictures
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... A loud, harsh, musical respiratory sound, stridor results from an obstruction in the trachea or larynx. Other causes include foreign-body aspiration, croup syndrome, laryngeal diphtheria, pertussis, retropharyngeal abscess, and congenital abnormalities of the larynx. ... Assessment ... History ... Physical assessment ... Pediatric pointers ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching ... Pictures
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... Wheezes are adventitious breath sounds with a high-pitched, musical, squealing, creaking, or groaning quality. They’re caused by air flowing at a high velocity through a narrowed airway. When they originate in the large airways, they can be heard by placing an... Assessment ... History ... Physical examination ... Pediatric pointers ... Medical causes ... Nursing considerations ... Patient teaching ... Pictures
... READ EXCERPTS »
... Productive coughing is the body’s mechanism for clearing airway passages of accumulated secretions that normal mucociliary action doesn’t remove. It’s a sudden, forceful, noisy expulsion of air (from the lungs) that contains sputum, blood, or... Assessment ... History ... Physical examination ... Pediatric pointers ... Geriatric pointers ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching ... Pictures
... READ EXCERPTS »
... Resonant, brassy, and harsh, a barking cough is part of a complex of signs and symptoms that characterize croup syndrome, a group of pediatric disorders marked by varying degrees of respiratory distress. Croup syndrome is most common in boys. It’s most... Assessment ... History ... Physical examination ... Pediatric pointers ... Geriatric pointers ... Medical causes ... Nursing considerations ... Patient teaching
... READ EXCERPTS »
... Frightening to the patient, hemoptysis is the expectoration of blood or bloody sputum from the lungs or tracheobronchial tree. It’s sometimes confused with bleeding from the mouth, throat, nasopharynx, or GI tract. (See Identifying... Emergency Actions ... History ... Physical assessment ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Patient counseling ... Pictures
... READ EXCERPTS »
... A loud, harsh, musical respiratory sound, stridor results from an obstruction in the trachea or larynx. Usually heard during inspiration, this sign may also occur during expiration in severe upper airway obstruction. It may begin as low-pitched “croaking” and progress... Emergency Actions ... History ... Physical assessment ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Patient counseling ... Pictures
... READ EXCERPTS »
... Wheezes are adventitious breath sounds with a high-pitched, musical, squealing, creaking, or groaning quality. Also known as sibilant rhonchi, they’re caused by air flowing at a high velocity through a narrowed airway. When they originate in the large airways,... Emergency Actions ... History ... Physical assessment ... Medical causes ... Special considerations ... Pediatric pointers ... Patient counseling ... Pictures
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... Productive coughing is the body’s mechanism for clearing airway passages of accumulated secretions that normal mucociliary action doesn’t remove. It’s a sudden, forceful, noisy expulsion of air (from the lungs) that contains sputum or blood (or... Emergency Actions ... History ... Physical assessment ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Patient counseling ... Pictures
... READ EXCERPTS »
... Resonant, brassy, and harsh, a barking cough is part of a complex of signs and symptoms that characterize croup syndrome, a group of pediatric disorders marked by varying degrees of respiratory distress. Croup syndrome is most common in boys and most prevalent... History ... Physical assessment ... Medical causes ... Special considerations ... Patient counseling ... Pictures
... READ EXCERPTS »
... A nonproductive cough is a noisy, forceful expulsion of air from the lungs that doesn’t yield sputum. It’s one of the most common complaints of patients with respiratory disorders.
Coughing is a necessary protective mechanism that clears... History ... Physical assessment ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Patient counseling ... Pictures
... READ EXCERPTS »
... Hemoptysisis the coughing up of blood or blood-stained sputum. It is a manifestation of bleeding intothe lungs or conducting airways, and as a consequence, blood alsomay be found in tracheal secretions or aspirate. Principal Causes ... Clinical Features and Diagnosis ... Diagnostic Approach ... References
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...Sore throat refers to any painful sensationof the pharynx or surrounding tissues and is a common complaintin childhood and adolescence. Principal Causes of Sore Throat Infection Pharyngitis/tonsillitis Viral Bacterial Group A ... Clinical Features and Diagnosis ... Diagnostic Approach ... References
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...Wheezing is a high-pitched musical soundthat is usually produced by narrowing of the segmental bronchi andbronchioles. May be heard during inspiration, expiration, or both. Principal Causes of Wheezing Asthma Bronchiolitis Pneumonia Foreign ... Clinical Features and Diagnosis ... Diagnostic Approach ... References
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... Definedas sound that occurs on sudden release of air under high pressure,which is generated by forceful contraction of expiratory musclesagainst a closed glottis. Clinical dilemma is to determine whethercoughing is associated with... Principal Causes of Cough ... Clinical Features and Diagnosis ... Diagnostic Approach ... References
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... Stertoris noisy, snoring-type breathing that results from airway obstructionin the nose, nasopharynx, or oropharynx. The sounds are heard onlyduring inspiration. Stridor is a low- to medium-pitchedsound that signifies airway obstruction in... Principal Causes of Airway Obstruction ... Clinical Features and Diagnosis ... Diagnostic Approach ... References
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... Frightening to the patient and commonly ominous, hemoptysis is the expectoration of blood or bloody sputum from the lungs or tracheobronchial tree. It's sometimes confused with bleeding from the mouth, throat, nasopharynx, or GI tract. (See Identifying hemoptysis.)... History and physical examination ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching ... Pictures
... READ EXCERPTS »
... A loud, harsh, musical respiratory sound, stridor results from a partial to near complete obstruction of the trachea or larynx. Usually heard during inspiration, this sign may also occur during expiration in severe upper airway obstruction. It may begin as low-pitched “croaking... History and physical examination ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching ... Pictures
... READ EXCERPTS »
... Productive coughing is the body's mechanism for clearing airway passages of accumulated secretions that normal mucociliary action doesn't remove. It's a sudden, forceful, noisy expulsion of air from the lungs that contains sputum, blood, or both. The sputum's color,... History and physical examination ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching
... READ EXCERPTS »
... Resonant, brassy, and harsh, a barking cough is part of a complex of signs and symptoms that characterize croup syndrome, a group of pediatric disorders marked by varying degrees of respiratory distress. It's most prevalent in the fall and may recur in the... History and physical examination ... Medical causes ... Nursing considerations ... Patient teaching ... Pictures
... READ EXCERPTS »
... A nonproductive cough is a noisy, forceful expulsion of air from the lungs that doesn't yield sputum or blood. It's one of the most common complaints of patients with respiratory disorders.
Coughing is a necessary protective mechanism that clears airway passages.... History and physical examination ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching ... Pictures
... READ EXCERPTS »
... Wheezes are adventitious breath sounds with a high-pitched, musical, squealing, creaking, or groaning quality. They're caused by air flowing at a high velocity through a narrowed airway. When they originate in the large airways, they can be heard by placing an unaided ear over the chest wall... History and physical examination ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching ... Pictures
... READ EXCERPTS »
...
True hemoptysis must be distinguished from epistaxis and hematemesis . If the blood is bright red and
alkaline (use nitrazine paper to test) and the nasal passages and posterior
pharynx are clear, then it is probably... Pictures
... READ EXCERPTS »
...
Breaking down the oropharynx, nasopharynx, and larynx into anatomic
components is not very valuable in developing a differential diagnosis of
sore throat. What is useful is to use the mnemonic VINDICATE to
establish the... Pictures
... READ EXCERPTS »
...
Both these symptoms are the result of the same pathophysiologic
mechanism: obstruction in the upper air passages. That obstruction may be
due to any one of the etiologies recalled by the mnemonic MINT.
M—Malformations that... Pictures
... READ EXCERPTS »
...
The differential diagnosis of cough is best developed with the use of
anatomy. Cough may arise from an irritative focus anywhere along the
respiratory tract. The irritation may be intrinsic, in which case it
is usually inflammatory, neoplastic,... Pictures
... READ EXCERPTS »
... Debra Boyer
Approach to the Patient with Cough
I. Definition of the Complaint
Cough is one of the most common presenting complaints to pediatricians. ... Pictures
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... I. History of Present Illness
A 7-week-old boy presented to his pediatrician with a 3-week history of
rhinorrhea, congestion, and cough; previously he was in good health. He had no
history of fever. A chest roentgenogram ... Pictures
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... I. History of Present Illness
A 7-month-old girl was well until 4 days before presentation, when she developed
a cough with fevers to 40.5
°C. On the day of presentation, she developed wheezing and a rash on her trunk
and face. This ... Pictures
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... I. History of Present Illness
A 4-month-old boy, who was born prematurely at 28 weeks' gestation, presented with a 1-week history of a cough. Over the next 4 days,
his mother reported an increasing cough with no ... Pictures
... READ EXCERPTS »
... Margaret McNamara, MD Cough - BASICS Cough - description The result of a high-velocity expiration, which removes airway secretions, is generally reflexive, but may sometimes be voluntarily initiated or... Cough - DIAGNOSIS ... Cough - TREATMENT ... Cough - FOLLOW UP ... Cough - bibliography ... Cough - CODES ... Cough - FAQ
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Adults may already know the new ways to avoid catching and spreading the flu. But you may need to teach these behaviors to kids. Listen to an...