Diagnosis of Thoracic outlet syndrome
Thoracic outlet syndrome Diagnosis: Book Excerpts
Diagnostic Tests for Thoracic outlet syndrome: Online Medical Books
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FAILURE TO THRIVE:
Ask the Following Questions:
(Algorithmic Diagnosis of Symptoms and Signs)
- Is there a history of an abnormal gestation? There may be a history that the mother was a chronic alcoholic or ingested such drugs as phenytoin, trimethadione, or narcotics. The mother may have had toxoplasmosis, rubella, herpes simplex, or other diseases during her gestation.
- Is the child's environment abnormal? Careful investigation may disclose that the child has been neglected or that there are economic circumstances to indicate that the child is not getting enough food. Investigation may also indicate that the child is not getting adequate love or practicing good hygiene.
- Are there abnormalities found on the neurologic examination? Neurologic examination may reveal findings to suggest microcephaly, muscular atrophy, hydrocephalus, spastic diplegia, and other neurologic causes of mental retardation.
- Are there endocrine abnormalities? Cretinism, pituitary tumors, and genital abnormalities may be suggested from the endocrine examination.
- Are there findings to suggest a GI disorder? Wasting and a distended abdomen may suggest a malabsorption syndrome. The history of frequent pneumonia may indicate fibrocystic disease. Cataracts may suggest galactosemia.
DIAGNOSTIC WORKUP
The routine diagnostic workup should include a CBC, sedimentation rate, urinalysis, urine culture, chemistry panel, thyroid profile, sweat test, stool for quantitative fat, chest x-ray, and an EKG. Bone age x-rays are often helpful in indicating a growth delay.
If there are focal neurologic signs or a pituitary tumor is suspected, a CT scan of the brain may be necessary. Additional endocrinologic tests include serum growth hormone level before and after exercise, somatomedin-C level, and overnight dexamethasone suppression test. However, an endocrinologist, pediatrician, or orthopedic surgeon should be consulted before ordering expensive diagnostic tests.
» READ BOOK EXCERPT ONLINE »
Source: Algorithmic Diagnosis of Symptoms and Signs, 2003
Failure to Thrive:
Differential Diagnosis
(In A Page: Pediatric Signs and Symptoms)
-
Psychosocial (non-organic)
–Insufficient caloric intake
–Most common etiology
–Cause accounts for 1/3–1/2 of cases investigated in tertiary settings
-
Gastrointestinal disorders
–Gastroesophageal reflux
–Celiac disease
–Milk protein allergy
–Pancreatic insufficiency
–Inflammatory bowel disease
-
Endocrine disorders
–Hypothyroidism
–Hyperthyroidism
–Diabetes mellitus
–Diabetes insipidus
–Growth hormone deficiency
-
Cardiac disorders
–Congestive heart failure
–Congenital anomalies
-
Pulmonary disorders
–Brochopulmonary dysplasia
–Asthma
–Cystic fibrosis
-
Infectious
–HIV
–Parasites
–Tuberculosis
-
Neurologic
–Hypotonia
–Cerebral hemorrhage
–Diencephalic syndrome
-
Metabolic
–Galactosemia
–Methylmalonic acidemia
–Tyrosinemia
-
Renal
–Renal tubular acidosis
–Chronic urinary tract infections
–Chronic renal insufficiency
-
Syndromes
–Down syndrome
–Turner syndrome
–Russell-Silver dwarfism
–Fetal alcohol syndrome
-
Anatomic
–Cleft lip/palate
–Malrotation
–Pyloric stenosis
-
Lead poisoning
Workup and Diagnosis
- History
–Emesis, number and quality of stools, excessive energy, diaphoresis, breathing difficulties, urinary frequency
–Diet history: Duration and quantity of feeding, food preferences, juice intake, food allergies
–Medical history: Chronic medical problems, surgeries
–Observation: Eye contact, absence of smile, lack of interest in environment, parental interaction
–Psychosocial history: Caretakers, financial status, employment, family stress, poverty indicators, support systems, parental age, substance abuse - Birth history
–Growth retardation, low birth weight, intrauterine stress, prematurity, parental substance abuse
- Physical exam
–Accurate height, weight, and head circumference, multiple points on growth curve
–Neuro/developmental age (milestones)
–Murmurs, wheezes/crackles, abdominal masses
–Exam of hard/soft palate, dysmorphic features
–Signs of neglect/abuse including poor hygiene
persistent diaper rash, bruising, unexplained scars
-
Initial lab screen to include CBC, electrolytes, urinalysis
–Consider thyroid function tests, HIV testing, TB skin testing, celiac testing (anti-tissue transglutaminase)
-
Radiographs/imaging only if history dictates
-
Diet journal, 3-day calorie counts
» READ BOOK EXCERPT ONLINE »
Source: In A Page: Pediatric Signs and Symptoms, 2007
FAILURE TO THRIVE:
Approach to the Diagnosis
(Differential Diagnosis in Primary Care)
Routine diagnostic workup should include a CBC, sedimentation rate, urinalysis, urine culture, chemistry panel, sweat test, stool for quantitative fat, chest x-ray, and electrocardiogram ECG. Bone age x-rays are helpful in determining growth retardation. At this point, it is helpful to consult a pediatrician before ordering expensive diagnostic tests.
» READ BOOK EXCERPT ONLINE »
Source: Differential Diagnosis in Primary Care, 2007
FAILURE TO THRIVE:
Approach to the Diagnosis
(Differential Diagnosis in Primary Care)
Routine diagnostic workup should include a CBC, sedimentation rate,
urinalysis, urine culture, chemistry panel, sweat test, stool for
quantitative fat, chest x-ray, and electrocardiogram (ECG). Bone age x-rays
are helpful in determining growth retardation. At this point, it is helpful
to consult a pediatrician before ordering expensive diagnostic tests.
» READ BOOK EXCERPT ONLINE »
Source: Differential Diagnosis in Primary Care, 2007
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