Question

Please Write Succinct:  Cough

• Review of Systems: Associated symptoms and Risk Factors
• Findings on Focused Physical Exa
• Five Differential Diagnosis

See example below for question #1:

1. Sore Throat

ROS:

Associated symptoms: fever, redness or eye discomfort, sneezing, wheezing, cough, runny nose, postnasal drip, GERD like symptoms, fatigue, muscle ache, n/v, and diarrhea.

Risk Factors:

Smoking, new sexual partners, irritant exposure, medications, and chronic health problems.

Red flags:

drooling, unable to swallow, unable to lie down, restless, unable to stay still, and unable to talk.

PE findings:

Epiglottis- severe illness with signs of upper airway obstruction such as restlessness, stridor, difficulty breathing, drooling, inability to swallow and high fever signals epiglottis and requires immediate referral. Further examination with a tongue blade could trigger laryngospasms and lead to airway obstruction.

Peritonsillar retropharyngeal abscess- orthopnea, dyspnea, symmetrical swelling, abscess, trismus.

Viral pharyngitis: Erythema, edema of throat, tender posterior cervical nodes.

GAS: temp more than 101.5, exudate anterior cervical lymphadenopathy.

Mononucleosis: presence or absence of pharyngeal exudate, posterior cervical lymphadenopathy, splenomegaly.

Gonococcal pharyngitis: pharyngeal exudate bilateral cervical lymphadenopathy

Inflammation: sinus tenderness, pale or swollen pharynx, postnasal drainage visible, no fever or lymphadenopathy.

Aphthous Stomatitis: shallow ulcers, no vesicles; indurated papules that progress to 1 cm ulcers; ulcer has yellow membrane and red halo; no fever or nodes.

Herpes simplex Lesions: perioral lesions; lymph adenitis; vesicles on palate, pharynx gingiva.

Herpetic pharyngitis: vesicles, ulcers, or exudate of the oral and pharyngeal mucosa.

Candidiasis: curd like white plaques that bleed when scraped off.

Differential diagnosis:

Viral Pharyngitis, Streptococcal Pharyngitis, peritonsillar or retropharyngeal abscess, Mononucleosis, Epiglottis, gonococcal pharyngitis, Herpangina, Vincent angina, Aphthous stomatitis, HSV type 1, Candidiasis, GERD.

Answer 1

COUGH

Associated symptoms:

• Shortness. of breath.
• Decrease in.the ability to tolerate exercise.
• Wheezing
• whistling breathing.
• Runny nose/. rhinitis
• Sore throat.
• Heartburn.
• Weight loss.
• Fever and chills.

the four major risk factors for chronic cough:

- Current smoking
- Gastroesophageal reflux disease (GERD)
- asthma
- COPD

RED fLAGS : severe systemic disease, respiratory distress, hemoptysis, and altered level of consciousness. Red flag symptoms:

• Systemic symptoms: persistent fever (pneumonia, TB); night sweats, weight loss (TB, lung cancer)
• Dyspnea (asthma, congestive heart failure, COPD, interstitial lung disease)
• Hemoptysis (TB, lung cancer); copious sputum production (bronchiectasis)
• Severe thoracic pain/pleurisy (pneumonia, TB, pulmonary embolism)
• Change in character of a chronic cough (esp. in a smoker's cough)
• History of contact with TB and/or HIV

Patients with underlying chronic diseases such as chronic obstructive pulmonary disease, asthma, cough and heart are found, by the lack of it, can be done so that in the present and the exacerbation of their disease, and this is considered derived , if it is of a bad reputation.

PE fINDINGS :

Breathing pattern

The normal respiratory rate is 12-20 / min for adults and up to 44 / min in children
- Bradypnea, respiratory rate <12 / min
- TACHINOEA, respiratory rate> 20 / min, shallow breathing
- Hyperpnea, respiratory rate> 20 / min, deep breathing
- the inspiratory ratio: expiratory, the ratio between the longest inspiratory and expiratory time period of the breath, which is normally 1: 2.
- The WEB spirit of other reasons includes:
- cheyne stoke breathingf Stoke, deep breathing followed by alternate periods of apnea
- It is the result of a delay in the detection of changes in ventilation and blood pressure of carbon dioxide.
- common causes include: advanced heart failure, damage to respiratory centers (eg, stroke, traumatic brain injury, metabolic encephalopathies), and central sleep apnea.
- Ataxic breath, irregular breathing in number and depth.
- Genetic breath, prolonged exhalation.
- Greater effort to breathe
- TAQUYPNOEA
-

use of the accessory nerve in the spirit of breath

* Sternocleidomastoid muscle
* Scalene muscles
* M. pectoralis major muscle
* Tracheal out of the midline

- Tripod in patients with respiratory distress, emphysema and it will be a while before sitting down to rest on the knee-bearing hands.
- Peripheral sign of respiratory dysfunction
- Cyanosis: bluish coloration of the skin and mucous membranes (due to deoxygenated hemoglobin)
- clubbed nails

etiology

- Commonly chronic circumscribed (including congenital heart disease, cardiac shunts, interstitial lung disease, lung cancer and cystic fibrosis).
- COPD is a cause of clubbing and excellent nail in the patient with COPD and the underlying malignancy.
- A syndrome (either hereditary or paraneoplastic) can also be observed in hypertrophic osteoarthropathy when the pain manifests itself with a nail full of synovial effusions and PERIOSTITIS.

clinical features

- Painless inflammation of the connective tissue in the distal phalanges
Lovibond angle ≥ 180 °, the angles of the nail bed and the surrounding skin
- The nail bed feels spongy, when pressed and released and lifted back.
- Schamroth test
- The phalanges distal to each other to touch each claw
- Where the nail is, the normal diamond-shaped "window" between the nail beds was not seen.

Abnormalities in the shape of the breast.

- The maximum anteroposterior diameter increases in the arch of your opponents like COPD, giving rise to a "tummy" appearance.
- revocation in the intercostal space
- Asymmetric movement of the sides may be associated with disease, nerve damage, or pleural effusion.
- Kyphosis such as scoliosis or forced vital to decreased capacity, forced expiratory volume and general respiratory function
- Sputum producing secretions, or if
- White and translucent viral infection (for example, bronchitis, those present in the territory of the cough in the morning)
- foamy white lung edema
- Yellow green; bacterial infection
- Oh, a sign of pseudomonal infection
- a bacterial infection or a decreased stakes Pneumoconiosis
- Blackish brown, if it is by chance or by blood; If it is still to be investigated (and it cannot be an accident that the body has found)
- soluble, tuberculosis, actinomycosis
- hemoptysis, see next section

The newborns

- jugular, sternal back and ribs
- nose, nasal flaring or burning from a stinger
- The neck extension

DIffERENTIAL DIAGNOSIS:

asthma, gastroesophageal reflux disease (GERD), nonasthmatic eosinophilic bronchitis (NAEB), and upper airway cough syndrome, otherwise known as postnasal drip syndrome, CHF—congestive heart failure; COPD—chronic obstructive pulmonary disease; GERD—gastroesophageal reflux disease; NYD—not yet diagnosed; URI—upper respiratory infection; URTI—upper respiratory tract infection.