...
Is the chest pain acute or chronic? If it is acute, one must consider acute myocardial infarction, pulmonary embolism, pneumothorax, pericarditis, ... DIAGNOSTIC WORKUP
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COUGH
(Algorithmic Diagnosis of Symptoms and Signs)
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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 ... 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 ... 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 ... 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 ... 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... DIAGNOSTIC WORKUP
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...
Although most cases of chest pain are due to benign etiologies, such as gastroesophageal reflux or a muscle strain, life-threatening etiologies must be assessed and treated immediately if present. There are five... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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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... 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... 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... 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... 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... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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Chest pain is a frequent complaint in pediatrics, especially in the adolescent age group. Although rarely cardiac in etiology, this often represents the patient's/family's greatest fear... 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,... 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... 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... 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... 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... 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&... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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... Hardly a day goes by in a busy practitioner’s office that he or she is not confronted with a patient complaining of chest pain. The main concern, of course, is to exclude an acute myocardial infarction, which is not an easy
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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
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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
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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
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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.
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... Chest pain usually results from disorders that affect thoracic or abdominal organs — the heart, pleurae, lungs, esophagus, rib cage, gallbladder, pancreas, or stomach. An important... 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... 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... History and physical examination ... Medical causes ... Other causes ... Special considerations ... 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... 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... 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... Emergency interventions ... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... 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... Emergency interventions ... History and physical examination ... Medical causes ... Special considerations ... Pediatric pointers ... Pictures
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... Skin and subcutaneous lesions [including adiposis dolorosa, thrombophlebitis of thoracoepigastric vein (Mondor's disease)]
Breast lesions
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... Acute
Viral upper respiratory infection
Pharyngitis
Rhinitis
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... Asthma
Extrinsic
Intrinsic
Exercise- or cold-induced
Drug-induced
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... Pseudohemoptysis
Blood of upper gastrointestinal origin
Upper airway lesions
Epistaxis
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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... Causes and incidence ... Signs and symptoms ... Diagnosis ... Treatment ... Special considerations
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Chest pain
(Professional Guide to Signs & Symptoms (Fifth Edition))
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... Chest pain usually results from disorders that affect thoracic or abdominal organs—the heart, pleurae, lungs, esophagus, rib cage, gallbladder, pancreas, or stomach. An important indicator... Emergency interventions ... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Patient counseling ... 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... 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.
... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric 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... Emergency interventions ... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Patient counseling ... Pictures
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Hemoptysis
(Professional Guide to Signs & Symptoms (Fifth Edition))
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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... Emergency interventions ... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Patient counseling ... Pictures
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Stridor
(Professional Guide to Signs & Symptoms (Fifth Edition))
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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... Emergency interventions ... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... 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... Emergency interventions ... History and physical examination ... Medical causes ... Special considerations ... Pediatric pointers ... Patient counseling ... Pictures
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Cough
(The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter)
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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... Approach ... History ... Physical examination ... Testing ... Diagnostic assessment
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Hemoptysis
(The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter)
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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... Approach ... History ... Physical examination ... Testing ... Diagnostic assessment
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Stridor
(The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter)
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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... Approach ... History ... Physical examination ... Testing ... Diagnostic assessment ... Pictures
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Wheezing
(The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter)
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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,... Approach ... History ... Physical examination ... Testing ... Diagnostic assessment ... Pictures
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Chest Pain, Atypical
(The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter)
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... Jim Nuovo
Atypical chest pain is defined as pain that does not have a characteristic anginal quality (heaviness or squeezing sensation), precipitating factors (e.g., exertion), or location (substernal and... Approach ... History ... Physical examination ... Testing ... Diagnostic assessment
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Chest Pain, Substernal
(The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter)
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... Marie K. Yamamotoya
Substernal chest pain requires a rapid and accurate assessment to identify potentially life-threatening events. Substernal chest pain of cardiac origin encompasses the entire clinical spectrum... Approach ... History ... Physical examination ... Testing ... Diagnostic assessment
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... Differential Overview
❑ Bronchitis
❑ Pneumonia
❑ Pulmonary edema
❑ Pulmonary infarction ... Diagnostic Approach ... Differential Diagnosis ... Pictures
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... Differential Overview
❑ Rhinovirus
❑ Group A streptococci
❑ Ebstein-Barr... 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 ... Diagnostic Approach ... Clinical Findings ... Pictures
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... Differential Overview
❑ Upper respiratory infection
❑ Allergy
❑ Asthma
❑ Chronic... Diagnostic Approach ... Clinical Findings ... Pictures
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... Differential Overview
❑ Chest wall pain
❑ Angina
❑ Unstable angina
❑ Myocardial infarction ... Diagnostic Approach ... Clinical Findings ... Pictures
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... Differential Overview
❑ Costochondritis
❑ Pneumonia
❑ Rib fracture
❑ Pulmonary embolism ... Diagnostic Approach ... Clinical Findings ... Pictures
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Chest pain
(Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)
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... Disorders that affect thoracic or abdominal organs — the heart, pleurae, lungs, esophagus, rib cage, gallbladder, pancreas, or stomach — are typical causes of chest pain. It can also... Assessment ... History ... Physical examination ... Pediatric pointers ... Geriatric pointers ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching ... Pictures
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Cough, barking
(Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)
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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... Assessment ... History ... Physical examination ... Pediatric pointers ... Geriatric pointers ... Medical causes ... Nursing considerations ... Patient teaching
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Cough, productive
(Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)
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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... Assessment ... History ... Physical examination ... Pediatric pointers ... Geriatric pointers ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching ... Pictures
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Hemoptysis
(Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)
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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. ... Assessment ... History ... Physical examination ... Pediatric pointers ... Geriatric pointers ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching ... Pictures
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Stridor
(Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)
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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,... Assessment ... History ... Physical assessment ... Pediatric pointers ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching ... Pictures
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Wheezing
(Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)
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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,... Assessment ... History ... Physical examination ... Pediatric pointers ... Medical causes ... Nursing considerations ... Patient teaching ... Pictures
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... Chest pain usually results from disorders that affect thoracic or abdominal organs — the heart, pleurae, lungs, esophagus, rib cage, gallbladder, pancreas, or... History ... Physical assessment ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Patient counseling ... 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... History ... Physical assessment ... Medical causes ... Special considerations ... 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.
... History ... Physical assessment ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric 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,... 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,... Emergency Actions ... History ... Physical assessment ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Patient counseling ... Pictures
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Stridor
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
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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... Emergency Actions ... History ... Physical assessment ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Patient counseling ... Pictures
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... 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... Emergency Actions ... History ... Physical assessment ... Medical causes ... Special considerations ... Pediatric pointers ... Patient counseling ... Pictures
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Chest Pain
(The Diagnostic Approach to Symptoms and Signs in Pediatrics)
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...Although chest pain is common complaint inchildren and adolescents, serious underlying disease presentingas chest pain is uncommon in this population. Principal Causes ... Clinical Features and Diagnosis ... Diagnostic Approach ... References
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Cough
(The Diagnostic Approach to Symptoms and Signs in Pediatrics)
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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... Principal Causes of Cough ... Clinical Features and Diagnosis ... Diagnostic Approach ... References
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Hemoptysis
(The Diagnostic Approach to Symptoms and Signs in Pediatrics)
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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... Principal Causes of Hemoptysis ... Clinical Features and Diagnosis ... Diagnostic Approach ... References
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Sore Throat
(The Diagnostic Approach to Symptoms and Signs in Pediatrics)
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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 ... Clinical Features and Diagnosis ... Diagnostic Approach ... References
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Wheezing
(The Diagnostic Approach to Symptoms and Signs in Pediatrics)
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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 ... 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... Principal Causes of Airway Obstruction ... Clinical Features and Diagnosis ... Diagnostic Approach ... References
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... Chest pain usually results from disorders that affect thoracic or abdominal organs—the heart, pleurae, lungs, esophagus, rib cage, gallbladder, pancreas, or stomach. An important indicator of several acute and life... History and physical examination ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching ... Pictures
... READ MEDICAL BOOK EXCERPTS ONLINE » (free access, no registration)
... 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... History and physical examination ... Medical causes ... Nursing considerations ... Patient teaching ... Pictures
... READ MEDICAL BOOK EXCERPTS ONLINE » (free access, no registration)
... 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. ... History and physical examination ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching ... Pictures
... READ MEDICAL BOOK EXCERPTS ONLINE » (free access, no registration)
... 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... History and physical examination ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching
... READ MEDICAL BOOK EXCERPTS ONLINE » (free access, no registration)
... 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... History and physical examination ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching ... Pictures
... READ MEDICAL BOOK EXCERPTS ONLINE » (free access, no registration)
... 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... History and physical examination ... 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... History and physical examination ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching ... Pictures
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...
Hardly a day goes by in a busy practitioner’s office that he or she is
not confronted with a patient complaining of chest pain. The main concern,
of course, is to exclude an acute myocardial... Pictures
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...
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... Pictures
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...
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 ... Pictures
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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 ... Pictures
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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 ... Pictures
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Cough
(Pediatric Complaints and Diagnostic Dilemmas)
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... Debra Boyer
Approach to the Patient with Cough
I. Definition of the Complaint
Cough is ... 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 ... Pictures
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... Margaret McNamara, MD Cough - BASICS Cough - description The result of a high-velocity expiration, which removes airway secretions, is... Cough - DIAGNOSIS ... Cough - TREATMENT ... Cough - FOLLOW UP ... Cough - bibliography ... Cough - CODES ... Cough - FAQ
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