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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, ... 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 ... DIAGNOSTIC WORKUP
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Is there a history of drug ingestion or injection? This will help diagnose drug reactions and serum sickness, which are common and easily discovered in the history. Patients with glucose-6-phosphate ... DIAGNOSTIC WORKUP
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Is there a history of drug ingestion or injection? Of course, the history should reveal that the patient has been on a certain drug or has received certain antitoxins, serums, or vaccines.
Is there a rash? ... DIAGNOSTIC WORKUP
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Fever is defined as an elevation of normal body temperature (37°C, or 98.6°F). True fever occurs when the body adopts a new thermoregulatory “set point” secondary to the release of pyrogenic cytokines in response to bacteria, viruses, or other exogenous sources (e.g.,... 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... 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... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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The etiologies of rash with fever are vast, but a systematic approach will help the clinician quickly narrow the differential. Patients who appear “toxic” with fever and prostration must be rapidly and thoroughly evaluated to rule out life-threatening... 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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Cyclic or periodic fever is an unexplained fever that recurs after fever-free periods at almost predictably fixed intervals. True cyclic fever is rather uncommon in childhood; it should be differentiated from recurrent fever, which refers to fever prone to relapse at unpredictable and... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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Recurrent or relapsing fever is a cluster of febrile episodes that occur over a period of time, with documented fever-free intervals and without an apparent medical cause for each episode. It should be differentiated from cyclic fever, which refers to febrile episodes with... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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Fever of unknown origin (FUO) is a term that is often misused to describe febrile illness without an obvious etiology or without other symptoms. The definition in different studies is arbitrary, but basically refers to at least 2 weeks of daily documented fever that is... 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 of air... 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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Fever is an elevation of body temperature over the normal daily range for a specific individual in response to different insults. It occurs when the thermoregulatory center in the hypothalamus is reset to higher temperature because of exogenous and... 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 it may
... READ EXCERPTS »
... The differential diagnosis of fever is best developed using physiology first and anatomy second.
FEVER, NONINFECTIOUS CAUSES
FEVER,
... 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 »
... 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.
... 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 both. The sputum's... Emergency interventions ... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pictures
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...Pyrexia
A fever is a common sign that can arise from many disorders. Because these disorders can affect virtually any body system, a fever in the absence of other signs usually has little diagnostic significance. A persistent high fever,... Emergency interventions ... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... 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... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pictures
... READ EXCERPTS »
... Acute
Viral upper respiratory infection
Pharyngitis
Rhinitis
Tracheobronchitis
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... Infection
Bacterial
Bacterial endocarditis
Sinusitis
Osteomyelitis
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... Infections
Bacterial
Streptococcus pneumoniae
Salmonella spp.
Haemophilus influenzae
Staphylococcus aureus
... READ EXCERPTS »
... Colorado tick fever is a benign infection caused by the Colorado tick fever arbo-virus and transmitted to humans by a tick. It occurs in the Rocky Mountain region of the United States, mostly in April and May at lower altitudes and in June and July at higher altitudes. Because of... Causes and incidence ... Signs and symptoms ... Diagnosis ... Treatment ... Special considerations
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... Lassa fever is an epidemic hemorrhagic fever caused by the Lassa virus, an extremely virulent arenavirus. This highly fatal disorder kills 10% to 50% of its victims, but those who survive its early stages usually recover and acquire immunity to secondary attacks. ... Causes and incidence ... Signs and symptoms ... Diagnosis ... Treatment ... Special considerations
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... An acute infectious disease caused by spirochetes of the genus Borrelia, relapsing fever (also called tick, fowl-nest, cabin, or vagabond fever or bilious typhoid) is transmitted to humans by lice or ticks and is characterized by relapses and remissions. Rodents... Causes and incidence ... Signs and symptoms ... Diagnosis ... Treatment ... Special considerations
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... Acute rheumatic fever is a systemic inflammatory disease of childhood, in many cases recurrent, that follows a group A beta-hemolytic streptococcal infection. Rheumatic heart disease refers to the cardiac manifestations of rheumatic fever and includes pancarditis (myocarditis, pericarditis,... Causes and incidence ... Signs and symptoms ... Diagnosis ... Treatment ... Special considerations
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... Rocky Mountain spotted fever (RMSF) is a febrile, rash-producing illness caused by Rickettsia rickettsii. The disease is transmitted to humans by a tick bite.
RMSF is fatal in about 5% of patients. Mortality rises... Causes and incidence ... Signs and symptoms ... Diagnosis ... Treatment ... Special considerations
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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. parapertussis and ... 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... Emergency interventions ... History and physical examination ... Medical causes ... Special considerations
... 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 (or both). The sputum... Emergency interventions ... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Patient counseling ... 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... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Patient counseling ... Pictures
... READ EXCERPTS »
... Fever is a common sign that can arise from numerous disorders. Because these disorders can affect virtually any body system, fever in the absence of other signs usually has little diagnostic significance. A persistent high fever, though, represents an... Emergency interventions ... 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... Approach ... History ... Physical examination ... Testing ... Diagnostic assessment
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... Lyle J. Fagnan
Fever is a physiologic state in which the body temperature is elevated above the individual’s normal temperature. Patients and clinicians consider fever an important sign of illness.
Approach to ... History ... Physical examination ... Testing. ... Diagnostic assessment. ... Pictures
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... Michael L. O’Dell
Fever with an accompanying rash represents a diagnostic challenge for even the most experienced of clinicians, as this combination of signs can represent trivial or life-threatening illnesses.
Approach A useful way of... History ... Physical examination ... Testing ... Diagnostic assessment
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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
Infection
❑ HIV
❑ Tuberculosis
❑ Endocarditis
❑ Osteomyelitis
❑ Malaria ... 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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... Often recurrent, acute rheumatic fever is a systemic inflammatory disease of childhood that follows a group A beta-hemolytic streptococcal infection. Rheumatic heart disease refers to the cardiac manifestations of rheumatic... Causes ... Signs and symptoms ... Diagnosis ... Treatment ... Special considerations
... 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 »
... 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.... Assessment ... History ... Physical examination ... Pediatric pointers ... Geriatric pointers ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching ... Pictures
... READ EXCERPTS »
... Fever is a common sign that can arise from any one of several disorders. Because these disorders can affect virtually any body system, fever in the absence of other signs usually has little diagnostic significance. A persistent high fever, though, represents... 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 and most prevalent in the... 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 (or both). The sputum... Emergency Actions ... History ... Physical assessment ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Patient counseling ... Pictures
... READ EXCERPTS »
... Fever, or pyrexia, is a common sign that can arise from any one of several disorders. Because these disorders can affect virtually any body system, fever in the absence of other signs usually has little diagnostic significance. A persistent high... Emergency Actions ... History ... Physical assessment ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... 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... History ... Physical assessment ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Patient counseling ... Pictures
... READ EXCERPTS »
... 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... Principal Causes of Cough ... Clinical Features and Diagnosis ... Diagnostic Approach ... References
... READ EXCERPTS »
... Occurs whenpathologic process causes body temperature to exceed normal range. DuBois suggested that usual range ofnormal body temperature is 97–100.4°F (36.2–38.0°C)rectal or 96.8–99.3°F (36.0–37.4°C)oral. Rectal... Principal Causes of Acute Fever ... Clinical Features and Diagnosis: Acute Fever ... Diagnostic Approach: Acute Fever ... Principal Causes of Fever of Unknown Origin ... Clinical Features and Diagnosis: Fever of Unknown Origin ... Diagnostic Approach: Fever of Unknown Origin ... References
... READ EXCERPTS »
...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 ... 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... History and physical examination ... 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 both. The sputum's color, consistency,... History and physical examination ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching
... 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. However, a... History and physical examination ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching ... Pictures
... READ EXCERPTS »
... A fever is a common sign that can arise from many disorders. Because these disorders can affect virtually any body system, a fever in the absence of other signs usually has little diagnostic significance. A persistent high fever, though,... 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 usually inflammatory, neoplastic... Pictures
... READ EXCERPTS »
...
The differential diagnosis of fever is best developed using
physiology first and anatomy second.
Physiology. Increased heat in the body is caused by increased
production or decreased elimination or dysfunction of the... 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... Pictures
... READ EXCERPTS »
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