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A history of recurrent bronchial infections, pneumonia, and hemoptysis in a patient whose chest X-rays show peribronchial thickening, areas of atelectasis, and scattered cystic changes suggest bronchiectasis.
In recent years, computed tomography scanning has supplanted bronchography as the most useful diagnostic test for bronchiectasis. It’s sometimes used with high-resolution techniques to better determine anatomic changes. Bronchoscopy doesn’t establish the diagnosis of bronchiectasis, but it does help to identify the source of secretions. Bronchoscopy can also be instrumental in pinpointing the site of bleeding in hemoptysis.
Other helpful laboratory tests include:
❑ sputum culture and Gram stain to identify predominant organisms
❑ complete blood count to detect anemia and leukocytosis
❑ pulmonary function tests to detect decreased vital capacity, expiratory flow rate, and hypoxemia. These tests also help determine the physiologic severity of the disease and the effects of therapy and help evaluate patients for surgery.
When cystic fibrosis is suspected as the underlying cause of bronchiectasis, a sweat electrolyte test is useful.
Source: Professional Guide to Diseases (Eighth Edition), 2005
If the patient abruptly displays orofacial dyskinesia, review his medication regimen. If he’s taking a phenothiazine or other antipsychotic, withhold the drug if possible, and prepare to give 50 mg of diphenhydramine to reverse the drug’s effects. If he has difficulty swallowing, take precautions necessary to prevent aspiration and choking and have suction equipment on hand.
If the patient’s dyskinesia is chronic, ask when it began. Then obtain a complete drug history. Also, note a history of seizures. Next, closely examine the patient’s dyskinesia. Is it unilateral or bilateral? Does it involve the entire face or only part of it? Are neck muscles involved? Does the patient have any voluntary control over the movements? Characterize the abnormal movements. Are they constant, or repetitive and intermittent? Listen to his speech—does it sound abnormal? Can he swallow?
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
A history of recurrent bronchial infections, pneumonia, and hemoptysis in a patient whose chest X-rays show peribronchial thickening, areas of atelectasis, and scattered cystic changes suggests bronchiectasis.
In recent years, computed tomography scanning has supplanted bronchography as the most useful diagnostic test for bronchiectasis. It’s sometimes used with high-resolution techniques to better determine anatomic changes. Bronchoscopy doesn’t establish the diagnosis of bronchiectasis, but it does help to identify the source of secretions. Bronchoscopy can also be instrumental in pinpointing the site of bleeding in hemoptysis.
Other helpful laboratory tests include:
❑ sputum culture and Gram stain to identify predominant organisms
❑ complete blood count to detect anemia and leukocytosis
❑ pulmonary function studies to detect decreased vital capacity, expiratory flow, and hypoxemia; these tests also help determine the physiologic severity of the disease and the effects of therapy, as well as help evaluate patients for surgery.
Evaluation may also include urinalysis and an electrocardiogram. (The latter is normal unless cor pulmonale develops.) When cystic fibrosis is suspected as the underlying cause of bronchiectasis, a sweat electrolyte test is useful.
Source: Handbook of Diseases, 2003
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