1/10. death in Antarctica.Antarctic tourism is flourishing, but Antarctic cruises are often more physically demanding than typical "tropical" cruises. An 82-year-old Antarctic tourist died of probable septic shock secondary to lower respiratory tract infection six days after sustaining a suspected vertebral fracture in a minor fall from an inflatable boat. This case highlights the need for Antarctic cruise ships to be equipped to provide life support and for better screening and education of prospective Antarctic tourists.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/10. situs inversus totalis.The etiology of situs inversus totalis remains uncertain. However, the literature establishes that isolated situs inversus totalis is usually asymptomatic in the neonate. This case study illustrates the importance of physical assessment skills in identifying situs inversus totalis in the neonate. Current research may reveal the etiology of this rare but fascinating abnormality.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
3/10. A coughing child: could it be asthma?BACKGROUND: A child presenting with cough is common in general practice. Usually the cough is due to an upper respiratory tract infection, however, parents are often concerned that the cough may be asthma. OBJECTIVE: This article focusses on identifying various causes of persistent cough, especially asthma. DISCUSSION: Significant causes of an acute cough need to be considered such as inhaled foreign bodies, aspiration, infections such as pertussis and pneumonia, and asthma. Clinical history, followed by physical examination and consideration of special investigations will guide the diagnosis. cough as the sole symptom of asthma is unusual. There is usually associated wheeze and shortness of breath. A family or personal history of atopic symptoms lend weight to the possibility of asthma. In children with asthma, physical examination and even spirometry may be normal between episodes. In some cases where asthma is suspected, a trial of bronchodilation with formal assessment of response may be appropriate.- - - - - - - - - - ranking = 12.098277417625keywords = physical examination, physical (Clic here for more details about this article) |
4/10. Recurrent infections and joint pain.A seven-year-old white male presented with recurrent bouts of paranasal sinusitis, streptococcal pharyngotonsillitis, lower respiratory tract infections, continuous low-grade fever, and conjunctivitis, which required frequent use of antibiotics over a period of two years. A careful review of systems also revealed a six-month history of arthralgia affecting his knees, elbows, and hands, which limited his daily activities. Prominent in the history were recurrent bouts of a generalized salmon-red, nonpruritic rash, which was most pronounced on the face and trunk and which was exacerbated by fever. His past medical history revealed severe bouts of gastroesophageal reflux disease, chronic intermittent bloody mucous diarrhea, and atopic dermatitis. A detailed review of the patient's family pedigree over five generations revealed a strong genetic predisposition for autoimmune diseases of several types. His physical examination revealed a thin, pale, chronically ill-appearing male, bilateral conjunctivitis, and pale nasal mucosae with no lymphadenopathy, organomegaly, arthritis, or rash. All laboratory results were unremarkable except for a positive rheumatoid factor and a suboptimal antibody response to immunization with pneumococcal vaccine. A diagnosis of juvenile rheumatoid arthritis of the systemic onset type was established, and, based upon his humoral immune deficiency, treatment with intravenous immunoglobulin was initiated with remarkable improvement in his symptomatology.- - - - - - - - - - ranking = 6.0491387088127keywords = physical examination, physical (Clic here for more details about this article) |
5/10. Successful diaphragmatic pacing for idiopathic alveolar hypoventilation.We describe the case of a 17-year-old woman noted to have idiopathic alveolar hypoventilation, with multiple intensive care Unit (ICU) admissions because of acute respiratory failure (ARF) due to respiratory infections. After two years of diaphragmatic pacing arterial blood gases have substantially improved, without obstructive apnoea. Signs of right ventricular enlargement and pulmonary hypertension have decreased. Morning headache and diurnal somnolence have disappeared, and she is also able to perform more physical and mental activity, allowing her to enjoy a better quality of life.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
6/10. Diagnostic value of lung uptake of indium-111 oxine-labeled white blood cells.One hundred sixty-two white-blood-cell scans were retrospectively reviewed to determine the sensitivity and specificity of the test for pulmonary and pleural infection. All scans were performed 18-24 hr after injection of indium-111 oxine-labeled autologous or donor cells. Pulmonary activity was graded on a scale of 0-4: 0 = equal to soft tissue; 1 = greater than soft tissue but less than rib; 2 = equal or greater than rib but less than liver; 3 = equal or greater than liver but less than spleen; 4 = equal to spleen. Activity was also characterized as being focal or diffuse. The white-blood-cell scan findings were correlated with the clinical diagnosis on the basis of physical examination, laboratory results, chest radiographs, clinical course, and pathologic studies when available. As pulmonary activity increased from grade 1 to 4, sensitivity declined from 93% to 14% and specificity increased from 64% to 100%. The sensitivity and specificity of focal uptake were 31% and 89% vs 62% and 74% for diffuse pulmonary activity. Making a distinction between focal and diffuse activity did not improve the specificity of low grades of pulmonary activity. The white-blood-cell scan can be very sensitive or very specific for pulmonary or pleural infection, depending on the criteria selected for a positive scan.- - - - - - - - - - ranking = 6.0491387088127keywords = physical examination, physical (Clic here for more details about this article) |
7/10. The cough and the bedsheet.Of 33 patients with psychogenic cough tic, 31 were successfully treated using an unusual reinforced suggestion technique. The cough usually follows an incidental upper respiratory tract infection and persists as a loud paroxysmal barking or honking sound for weeks to months. Paroxysms occur all day but cease with sleep. The diagnosis is often delayed for weeks to months while the patient is exposed to an increasing intensity of diagnostic procedures and therapy. Thirty percent of some 20 patients previously reported in the literature had been hospitalized. The reinforced suggestion technique depends upon the physician's convincing the patient that the persistent cough has weakened the chest muscles, which are now unable to contain the cough, and that a bedsheet tightly wrapped around the chest will provide the necessary support to stop the cough within 24 to 48 hours. The typical patient can produce the cough on command, has an ambivalent response to the prospect of care, is unconcerned about his symptoms, submits willingly to the examination and procedures, and is kept out of school for the duration of the cough. Findings on physical examination are normal except for abnormal gag and corneal reflexes. The gag reflex was depressed in six and absent in 20 of the 31 patients. The corneal reflex was depressed in 16 and absent in 5 of the 31 patients. These abnormal responses help to corroborate the psychogenic etiology. Early recognition of the nonorganic nature of this syndrome will reduce parental anxiety, loss of school time, risk of iatrogenic complications, and unnecessary medical and hospital expense.- - - - - - - - - - ranking = 6.0491387088127keywords = physical examination, physical (Clic here for more details about this article) |
8/10. The effect of social adversity on the fatigue syndrome, psychiatric disorders and physical recovery, following glandular fever.Two hundred and fifty patients attending primary care with glandular fever or an upper respiratory tract infection were studied prospectively up to 6 months after onset. Of these patients 228 were interviewed with the Life Events and Difficulties Schedule and the Schedule for Affective Disorders and Schzophrenia, giving research Diagnostic Criteria for psychiatric disorders. The experience of severe social adversity (provoking agents) had a significant association with psychiatric disorder at 2 months (odds ratio = 5.3) and 6 months (odds ratio = 5.8) after onset of infection. This association was especially significant for depressive illness (odds ratio = 9.1 at 2 months and 11.9 at 6 months). In contrast, social adversity had little association with the development of the post-infectious fatigue syndrome, or delayed physical recovery. Social adversity may be an important maintaining factor for psychiatric disorders, especially depressive illness, following acute infections.- - - - - - - - - - ranking = 5keywords = physical (Clic here for more details about this article) |
9/10. Recurrent respiratory papillomatosis.Recurrent respiratory papillomatosis lesions of the respiratory tract affect both children and adults. The etiology currently accepted by researchers is the human papillomavirus. Though relatively rare in children, these lesions can be serious and potentially fatal if the airway should become compromised or obstructed. Of the numerous treatments tested since recurrent respiratory papillomatosis was first described, the surgical laser is the most effective tool for controlling these lesions. A 5-year-old female patient who suffered from recurrent respiratory papillomatosis since the age of 2 and had over 80 laser treatments in a 3-year period is discussed. Laser and interferon administered concurrently lessened the frequency of laser therapy in this patient. Variations in number and size of recurrent respiratory papillomatosis lesions present a challenge to the anesthetist. Delivery of anesthesia requires precise preanesthetic planning and coordination. Since these lesions are most prevalent in the laryngeal airway, the surgical field must be shared by the anesthetist and the surgeon. The etiology, medical and physical therapeutic management, anesthetic management, and complications of patients with RRP are presented.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
10/10. Acute respiratory failure due to gentamicin aerosolization.We report a paradoxical episode of near-fatal bronchoconstriction which occurred in an adult bronchiectatic subject, with chronic pseudomonas aeruginosa airways colonization, immediately after his first inhalation of a gentamicin solution. This adverse reaction may be due to the gentamicin itself, the physical properties of the solution, or preservatives in the (commercially available) gentamicin solution.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
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