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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, ... DIAGNOSTIC WORKUP
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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 pneumonia, lung abscess, ... 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 ... 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 ... 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. Interestingly, bleeding... 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... 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 factors... 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... 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... 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... 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... 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.... 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 attention of caregivers as &... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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... 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, or toxic, or
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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
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... 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 differential (because so many
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... 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 may cause snoring or stridor
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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 recur in... Emergency interventions ... History and physical examination ... Medical causes ... Special considerations
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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, blood, or... Emergency interventions ... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pictures
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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... Emergency interventions ... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pictures
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... Characterized by a harsh, rattling, or snoring sound, stertorous respirations usually result from the vibration of relaxed oropharyngeal structures during sleep or coma, causing partial airway obstruction. Less commonly, these respirations result from retained mucus in the upper airway. ... Emergency interventions ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers
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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
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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... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pictures
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... Acute
Viral upper respiratory infection
Pharyngitis
Rhinitis
Tracheobronchitis
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... Pseudohemoptysis
Blood of upper gastrointestinal origin
Upper airway lesions
Epistaxis
Gingival bleeding
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... Croup is a severe inflammation and obstruction of the upper airway, occurring as acute laryngotracheobronchitis (most common), laryngitis, and acute spasmodic laryngitis; it must always be distinguished from epiglottiditis. It’s derived from an... Causes and incidence ... Signs and symptoms ... Diagnosis ... Treatment ... Special considerations ... Pictures
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... 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.... Causes and incidence ... Signs and symptoms ... Diagnosis ... Treatment ... Special considerations
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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. Croup syndrome is most common in boys and most prevalent in the fall; it may... Emergency interventions ... History and physical examination ... Medical causes ... Special considerations
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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 both). The sputum&rsquo... Emergency interventions ... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Patient counseling ... 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.)... Emergency interventions ... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Patient counseling ... Pictures
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... Characterized by a harsh, rattling, or snoring sound, stertorous respirations usually result from the vibration of relaxed oropharyngeal structures during sleep or coma, causing partial airway obstruction. Less often, these respirations result from retained mucus in the... Emergency interventions ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers
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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... Emergency interventions ... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Pictures
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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
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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 over the past two decades are asthma,... Approach ... History ... Physical examination ... Testing ... Diagnostic assessment
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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 usually... 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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... 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
❑ 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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... A severe inflammation and obstruction of the upper airway, croup can occur as acute laryngotracheobronchitis (most common), laryngitis, and acute spasmodic laryngitis. It must always be distinguished from epiglottitis.
Croup is a childhood disease affecting... Causes ... Signs and symptoms ... Diagnosis ... Treatment ... Special considerations
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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. Croup syndrome is most common in boys. It&rsquo... Assessment ... History ... Physical examination ... Pediatric pointers ... Geriatric pointers ... Medical causes ... Nursing considerations ... Patient teaching
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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, blood, or both. The... Assessment ... History ... Physical examination ... Pediatric pointers ... Geriatric pointers ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching ... 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,... Assessment ... History ... Physical examination ... Pediatric pointers ... Geriatric pointers ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching ... Pictures
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... Characterized by a harsh, rattling, or snoring sound, stertorous respirations usually result from the vibration of relaxed oropharyngeal structures during sleep or coma, causing partial airway obstruction. Less commonly, these respirations result... Assessment ... History ... Physical examination ... Pediatric pointers ... Geriatric pointers ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching
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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... Assessment ... History ... Physical assessment ... Pediatric pointers ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching ... 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. Croup syndrome is most common in boys... History ... Physical assessment ... Medical causes ... Special considerations ... Patient counseling ... 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 Actions ... History ... Physical assessment ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Patient counseling ... Pictures
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... 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 hemoptysis, page 350.) Expectoration of 200 ml... Emergency Actions ... History ... Physical assessment ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Patient counseling ... Pictures
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... Characterized by a harsh, rattling, or snoring sound, stertorous respirations usually result from the vibration of relaxed oropharyngeal structures during sleep or coma, causing partial airway obstruction. Less commonly, these respirations result from retained mucus in... Emergency Actions ... History ... Physical assessment ... 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”... Emergency Actions ... History ... Physical assessment ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Patient counseling ... Pictures
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... 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 airway... History ... Physical assessment ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Patient counseling ... Pictures
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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 mild illness or... Principal Causes of Cough ... Clinical Features and Diagnosis ... Diagnostic Approach ... References
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... 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 of ... 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 Streptococcus ... 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 the supraglottic,... Principal Causes of Airway Obstruction ... Clinical Features and Diagnosis ... Diagnostic Approach ... References
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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 recur in the same child.
A... History and physical examination ... Medical causes ... Nursing considerations ... Patient teaching ... 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, blood, or... History and physical examination ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching
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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... History and physical examination ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching ... Pictures
... READ EXCERPTS »
... Characterized by a harsh, rattling, or snoring sound, stertorous respirations usually result from the vibration of relaxed oropharyngeal structures during sleep or coma, causing partial airway obstruction. Less commonly, these respirations result... History and physical examination ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching
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... 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... History and physical examination ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching ... Pictures
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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... History and physical examination ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching ... 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... 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 etiologies. Further analyzing 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—... Pictures
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... Author:
Caroline Rassbach, MD
What to Do - Make a Decision
Viral croup is the most common form of airway obstruction in children
6 months to 6 years of age. When symptoms are severe enough to seek medical attention, oral... Suggested Readings
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... Shannon Connor Phillips, MD Croup - BASICS Croup - description Croup (laryngotracheobronchitis) is an acute viral infection classically characterized by a triad of symptoms: A barking cough, inspiratory stridor, and ... Croup - DIAGNOSIS ... Croup - TREATMENT ... Croup - FOLLOW UP ... Croup - bibliography ... Croup - CODES ... Croup - FAQ
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When you have watery eyes, a runny nose, congestion and sneezing, how can you tell if it's a cold or an allergy? Find out the difference and the...
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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...