1/28. Understanding airway disease in infants.Large airway diseases manifest in ways distinct from those of small airway diseases. Noisy breathing that begins early in life suggests a congenital lesion of the large airways. The findings of elevated respiratory rate, in conjunction with subcostal retractions, hyperinflation to percussion, and musical wheezes, are diagnostic of small airway obstruction. Differentiating large from small airway disease is crucial, because each disease has a distinct diagnosis, and treatment of the 2 disease types can be quite different. When these principles are applied to a patient with wheezing or other signs of airway compromise, it becomes fairly easy to differentiate large from small airway disease. The treatment of patients with large airway disease can be substantially different from that of patients with small airway disease. Being able to differentiate the two is critically important. With the use of the history, physical examination, and radiographic evaluations described earlier, nearly every patient can be given an accurate diagnosis and treated appropriately.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
2/28. Goitre presenting as an oropharyngeal mass: an unusual finding in the elderly.Thyroid goitre presentation in the neck with extension inferiorly to the mediastinum is well-known. Extension superiorly into the retropharyngeal space is very rare and may be accompanied by change in voice and/or airway compromise. A case is described of a patient with change in voice and mild airway compromise secondary to a goitre presenting in the oropharynx. Computed tomography (CT) and physical findings are discussed with the need to recognize this rare entity.- - - - - - - - - - ranking = 0.081275988342238keywords = physical (Clic here for more details about this article) |
3/28. Cockatiel-induced hypersensitivity pneumonitis.Diagnosing an environmental or occupationally related pulmonary disorder often involves a process of elimination. Unlike commonly diagnosed conditions in other specialties, a cause-and-effect relationship may be implied, yet other factors such as temporality and biologic plausibility are lacking. Our patient was referred with a suspected work-related pulmonary disorder. For several years, she had suffered with dyspnea on exertion and repeated flulike illnesses. She worked at an automobile repair garage that performed a large number of emission tests, and there was concern that her workplace exposures were the cause of her symptoms. After a careful review of her history, physical examination, and laboratory testing, we came to the conclusion that she had hypersensitivity pneumonitis related to pet cockatiels in her home. Clinical points of emphasis include the importance of a complete environmental history and careful auscultation of the chest when performing the physical examination. In addition, we encountered an interesting physical diagnostic clue, a respiratory sound that assisted with the eventual diagnosis.- - - - - - - - - - ranking = 2.0812759883422keywords = physical examination, physical (Clic here for more details about this article) |
4/28. Bilateral vocal fold paresis and multiple system atrophy.OBJECTIVE: To review a case series of patients with systemic neurodegenerative disease presenting to a laryngologist for workup of dysphonia and found to have bilateral vocal fold paresis. DESIGN: Case series. SETTING: Tertiary care voice center. patients: Series of patients with neurodegenerative disorders examined for dysphonia. MAIN OUTCOME MEASURES: history and physical examination including fiberoptic laryngoscopy were performed on all patients. Some patients underwent polysomnography. RESULTS: Seven patients during a 2-year period were noted to have bilateral abductor vocal fold paresis. Five of 7 (71%) had the diagnosis of multiple system atrophy proposed by the laryngologist. All 7 patients described sleep-disordered breathing with stridor. CONCLUSIONS: patients with systemic neurodegenerative disorders such as parkinson disease should be examined for multiple system atrophy and for evidence of bilateral vocal fold paresis. Workup for stridor should include polysomnography. Treatment of glottic obstruction in these patients includes constant positive airway pressure at night or tracheotomy. The finding of bilateral vocal fold paresis can be life threatening.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
5/28. Stridor and dysphagia in diffuse idiopathic skeletal hyperostosis (DISH).As otolaryngologists, we are the first consulted for stridor and dysphagia. One must consider both extrinsic and intrinsic etiologies in the differential diagnosis of these symptoms. We report a series of patients with diffuse idiopathic skeletal hyperostosis (DISH) who presented with stridor or dysphagia. We describe the initial presenting symptoms, physical examination/radiographic findings, and discuss the management options. Traditional teaching is that surgery is rarely indicated for DISH of the cervical spine. Recommendations regarding the role of surgery as well as a review of our surgical experience are discussed.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
6/28. Evaluation and management of stridor in the newborn.Stridor in a newborn should necessitate an immediate work-up to rule out a life-threatening airway obstruction. Three cases of newborns with stridor are presented. These cases emphasize the need for an immediate and thorough physical examination of any stridorous newborn, followed by radiologic studies and direct laryngoscopy. While other invasive procedures are frequently required for a precise diagnosis, a careful examination with special attention to the quality of the stridor often permits a more effective diagnostic approach in an atmosphere of appropriate urgency.- - - - - - - - - - ranking = 0.081275988342238keywords = physical (Clic here for more details about this article) |
7/28. Childhood sexual abuse in patients with paradoxical vocal cord dysfunction.We present three prototypical cases of paradoxical vocal cord dysfunction. The symptoms of this functional disorder mimic those of bronchial asthma attacks. These patients typically have experienced extensive medical intervention including intubation and corticosteroid use. We identify a history of childhood sexual abuse as an important factor contributing to the development of this psychosomatic disorder. We discuss the severity of psychopathology in patients with paradoxical vocal cord dysfunction and how this physical symptom may have developed to express psychological difficulties.- - - - - - - - - - ranking = 0.081275988342238keywords = physical (Clic here for more details about this article) |
8/28. hemothorax in a patient with asthma.Treatment of chronic illnesses such as asthma can often become routine. This is a case report that emphasizes the importance of a thorough history and physical examination for each exacerbation of asthma. An 11-year-old girl with a history of asthma presented to the emergency room with wheezing and dyspnea that was assumed to be an exacerbation of her chronic illness. After careful history taking and physical examination, a chest radiograph was recommended. The x-ray revealed a hemothorax and a new diagnosis was made, thoracic Ewing's sarcoma.- - - - - - - - - - ranking = 2keywords = physical examination, physical (Clic here for more details about this article) |
9/28. All that wheezes.New onset wheezing in the young child can present an interesting differential diagnostic challenge, especially when there is an atypical presentation of a foreign body lodged in the airway. A thorough history and physical examination helps, but one must remember that a foreign body in the trachea or esophagus can masquerade as a respiratory illness. The chest x-ray is a useful part of the evaluation process. A high degree of suspicion is necessary on the part of the physician to remember that "all that wheezes is not asthma," even in the absence of a history of aspiration of a foreign body.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
10/28. Cervical lung herniation associated with upper airway obstruction.We present the case of a 6-year-old boy with reactive airway disease who developed cervical lung herniation resulting in compression of the trachea and audible stridor. This association has never been reported in the pediatric age group, and a review of the literature revealed that lung herniation is a rare condition in the pediatric population. Most patients are asymptomatic. Herniation occurs in the cervical area in approximately one fourth of patients. The diagnosis is usually made by physical examination and confirmed by radiographic studies. Treatment is seldom necessary; most patients require only education and reassurance. Surgical intervention is indicated when respiratory distress, cosmetic concerns, or progressive increase in size occur.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
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