INDEX OF SUSPICION

1996 ◽  
Vol 17 (2) ◽  
pp. 65-68
Author(s):  
Martha Toledo-Valido ◽  
M. Joyce Neal ◽  
John T. Duelge ◽  
Meena Kalyanaraman ◽  
Maria Patterson
Keyword(s):  
Blood Pressure ◽  
Emergency Department ◽  
Early Diagnosis ◽  
Physical Examination ◽  
Respiratory Distress ◽  
Shortness Of Breath ◽  
Breath Sounds ◽  
History Of ◽  
Case Presentations ◽  
The Right

This section of Pediatrics in Review reminds clinicians of those conditions that can present in a misleading fashion and require suspicion for early diagnosis. Emphasis has been placed on conditions in which early diagnosis is important and that the general pediatrician might be expected to encounter, at least once in a while. The reader is encouraged to write possible diagnoses for each case before turning to the discussion, which is on the following page. We invite readers to contribute case presentations and discussions. Case 1 Presentation A 3-year-old girl is brought to the emergency department because of 24 hours of fever, nonproductive cough, and shortness of breath that has worsened progressively. She has no history of significant illness. She has been taking amoxicillin for 1 week to treat otitis media and pharyngitis. On physical examination, the child appears in obvious respiratory distress. She has a temperature of 101°F (38.3°C), pulse of 150 beats/min, respiratory rate of 46 breaths/min, and blood pressure of 137/72 mm Hg. She is breathing with subcostal and intercostal retractions and nasal flaring. Her breath sounds are diminished in the area of the right upper lobe, and generalized inspiratory and expiratory wheezing is heard. Both tympanic membranes are red and distorted.

INDEX OF SUSPICION

1994 ◽  
Vol 15 (5) ◽  
pp. 201-203
Author(s):  
Mary D. Dvorak ◽  
Britta Mazur ◽  
A. George Pascual
Keyword(s):  
Early Diagnosis ◽  
Physical Examination ◽  
General Pediatrician ◽  
History Of ◽  
Night Awakening ◽  
Case Presentations

This section of Pediatrics in Review reminds clinicians of those conditions that can present in a misleading fashion and require suspicion for early diagnosis. Emphasis has been placed on conditions in which early diagnosis is important and that the general pediatrician might be expected to encounter, at least once in a while. The reader is encouraged to write possible diagnoses for each case before turning to the discussion, which is on the following page. We invite readers to contribute case presentations and discussions. Case 1 Presentation A 6-day-old girl is brought into the clinic having a 12-hour history of fever to 101°F(38.3°C), irritability, and refusal to breastfeed. The child's mother is a bright, articulate woman who is very concerned about providing the best for this baby, her first, and is dedicated to breastfeeding. She notes that the child previously had been "a very good baby" - quiet, pleasant, and nondisruptive. Since birth, the child has slept for much of the day and night, awakening every 5 to 7 hours to feed. The baby usually wets her diapers after each feeding. However, her mother says that the last wet diaper was noted 6 hours ago, and it was barely wet. Upon physical examination, the child appears quiet but awake.

INDEX OF SUSPICION

1993 ◽  
Vol 14 (9) ◽  
pp. 361-363
Author(s):  
Elizabeth R. Marino ◽  
Robert B. Baker ◽  
Jeffrey M. Devries ◽  
Sanjiv B. Amin
Keyword(s):  
Blood Pressure ◽  
Early Diagnosis ◽  
Physical Examination ◽  
Sleep Disturbance ◽  
Nasal Congestion ◽  
Family Members ◽  
Respiratory Difficulty ◽  
General Pediatrician ◽  
Mucous Membranes ◽  
Case Presentations

This section of Pediatrics in Review reminds clinicians of those conditions that can present in a misleading fashion and require suspicion for early diagnosis. Emphasis has been placed on conditions in which early diagnosis is important and that the general pediatrician might be expected to encounter, at least once in a while. The reader is encouraged to write possible diagnoses for each case before turning to the discussion, which is on the following page. We invite readers to contribute case presentations and discussions. Case 1 Presentation You are seeing a 16-year-old male who has had nasal congestion that began a few months ago. The congestion was intermittent at first but has become constant. He denies sneezing, itchy eyes, or other respiratory difficulty. His mother is concerned because he often is awakened by his congestion. He frequently is irritable in the mornings, and she believes the sleep disturbance is responsible for the decline in his grades, which had been very good. Except for one uncle, no family members have complained of allergies. He is a slim boy whose pulse is 90 beats/min, blood pressure is 136/80 mm Hg, and temperature is 98.8°F (37.1°C). Physical examination otherwise is normal except for mildly reddened, edematous nasal mucous membranes that have a small amount of thin white mucoid discharge.

Consultation with the Specialist

1993 ◽  
Vol 14 (6) ◽  
pp. 237-238
Author(s):  
James Seidel
Keyword(s):  
Blood Pressure ◽  
Emergency Department ◽  
Physical Examination ◽  
Local Community ◽  
Community Hospital ◽  
Vital Signs ◽  
Neurologic Examination ◽  
The Right ◽  
Spine Radiographs ◽  
Large Hematoma

Case Report Bobbi, a 5-year-old, was playing "catch" on the lawn of his surburban home. When he went to fetch the ball that had rolled into the street, he was struck by an automobile traveling about 25 miles per hour. Witnesses reported that Bobbi's body was lifted up by the car and thrown about 12 feet onto the pavement. A neighbor responded immediately and noted that Bobbi was responsive to verbal commands and had a large bump on the front of his head and a swollen right thigh. The Emergency Medical Services System was activated, and within 10 minutes he was transported to the emergency department at the local community hospital. Bobbi was in obvious pain but was awake and responded to questions. He knew his sister's and teachers' names, but did not remember being struck by the car. His vital signs were: respirations 35/min; pulse, 100/min; blood pressure, 98/68 mm Hg; and temperature, 36.5°C. Physical examination was remarkable for a large hematoma on the right frontal and parietal areas of the skull and a swollen tender right thigh. Bobbi's spine was normal upon physical examination, and the neurologic examination was normal except for some retrograde amnesia. There was no spinal swelling or tenderness, and cervical spine radiographs were normal

INDEX OF SUSPICION

1996 ◽  
Vol 17 (8) ◽  
pp. 291-294
Author(s):  
J. Peter Harris ◽  
Carol J. Buzzard ◽  
Liliana D. Gutierrez ◽  
Franz E. Babl ◽  
Susan K Ratzan
Keyword(s):  
Early Diagnosis ◽  
Good Health ◽  
Left Shoulder ◽  
High School Senior ◽  
Left Chest ◽  
School Senior ◽  
History Of ◽  
Female High School ◽  
Case Presentations ◽  
The Right

This section of Pediatrics in Review reminds clinicians of those conditions that can present in a misleading fashion and require suspicion for early diagnosis. Emphasis has been placed on conditions in which early diagnosis is important and that the general pediatrician might be expected to encounter, at least once in a while. The reader is encouraged to write possible diagnoses for each case before turning to the discussion, which is on the following page. We invite readers to contribute case presentations and discussions. Case 1 Presentation While driving to work, a 17-year-old female high school senior who has been in good health has an abrupt syncopal episode resulting in a headon collision at 40 miles per hour. She is alert and oriented right after the accident, but complains of sternal pain as well as pain in her left chest, left shoulder, and the right side of her jaw. Evaluation in the emergency department reveals slight tachypnea of 26 breaths/min, blood pressure of 90/60 mm Hg, a midsternal abrasion, a left pneumothorax, and nondisplaced fractures of the left clavicle and right mandible. Results of her neurologic examination, including mental status, are normal. She denies the use of any medication, street drugs, or alcohol, but she does report a 9-month history of brief spells of lightheadedness, diaphoresis, nausea, and visual blackouts, with one previous episode proceeding to complete syncope.

scholarly journals Tension hydrothorax in a patient with SARS-CoV-2 pneumonitis and pleural Mycobacterium tuberculosis

2021 ◽  
Vol 14 (7) ◽  
pp. e243760
Author(s):  
Mohsin F Butt ◽  
Maggie Symonds ◽  
Ruhaid Khurram
Keyword(s):  
Emergency Department ◽  
Mycobacterium Tuberculosis ◽  
Pleural Effusion ◽  
Respiratory Distress ◽  
Chest Radiograph ◽  
Left Lung ◽  
Pleural Effusions ◽  
Mediastinal Shift ◽  
History Of ◽  
The Right

Unilateral pleural effusions are uncommonly reported in patients with SARS-CoV-2 pneumonitis. Herein, we report a case of a 42-year-old woman who presented to hospital with worsening dyspnoea on a background of a 2-week history of typical SARS-CoV-2 symptoms. On admission to the emergency department, the patient was severely hypoxic and hypotensive. A chest radiograph demonstrated a large left-sided pleural effusion with associated contralateral mediastinal shift (tension hydrothorax) and typical SARS-CoV-2 changes within the right lung. She was treated with thoracocentesis in which 2 L of serosanguinous, lymphocyte-rich fluid was drained from the left lung pleura. Following incubation, the pleural aspirate sample tested positive for Mycobacterium tuberculosis. This case demonstrates the need to exclude non-SARS-CoV-2-related causes of pleural effusions, particularly when patients present in an atypical manner, that is, with tension hydrothorax. Given the non-specific symptomatology of SARS-CoV-2 pneumonitis, this case illustrates the importance of excluding other causes of respiratory distress.

INDEX OF SUSPICION

1995 ◽  
Vol 16 (9) ◽  
pp. 349-351
Author(s):  
Sanjiv B. Amin ◽  
Jeffrey M. Devries ◽  
Patricia McQuilkin ◽  
Nathalie Quion ◽  
Thomas G. DeWitt
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Chest Pain ◽  
Early Diagnosis ◽  
Physical Examination ◽  
Respiratory Rate ◽  
General Pediatrician ◽  
Difficulty Breathing ◽  
Case Presentations

This section of Pediatrics in Review reminds clinicians of those conditions that can present in a misleading fashion and require suspicion for early diagnosis. Emphasis has been placed on conditions in which early diagnosis is important and that the general pediatrician might be expected to encounter, at least once in a while. The reader is encouraged to write possible diagnoses for each case before turning to the discussion, which is on the following page. We invite readers to contribute case presentations and discussions. Case 1 Presentation A 15-year-old girl comes to your office complaining that she has experienced intermittent, sudden episodes of chest pain, fatigue, palpitations, and sensations of difficulty breathing and lightheadedness for 2 months. These episodes occur several times daily and are unaccompanied by other symptoms such as syncope, wheezing, swelling of the extremities, or fever. She denies being worried, but reports that her parents are very frightened because a 16-year-old male cousin died recently while playing soccer, and two other relatives, a 27-year-old cousin and a 29-year-old uncle, died suddenly during exercise. The physical examination reveals a somewhat anxious girl complaining of mild precordial chest pain. Her temperature is 36.9°C(98.4°F) orally, respiratory rate is 16 breaths/min, heart rate is 110 beats/min, and blood pressure is 100/60 mm Hg; weight and height are at the 75th percentile.

INDEX OF SUSPICION

1996 ◽  
Vol 17 (5) ◽  
pp. 181-183
Author(s):  
Janice L. Block ◽  
Selina Daisy ◽  
A K Mostaque ◽  
James A. Waler
Keyword(s):  
Emergency Department ◽  
Early Diagnosis ◽  
Physical Examination ◽  
General Pediatrician ◽  
Amoxicillin Clavulanate ◽  
Drug Regimens ◽  
Case Presentations

This section of Pediatrics in Review reminds clinicians of those conditions that can present in a misleading fashion and require suspicion for early diagnosis. Emphasis has been placed on conditions in which early diagnosis is important and that the general pediatrician might be expected to encounter, at least once in a while. The reader is encouraged to write possible diagnoses for each case before turning to the discussion, which is on the following page. We invite readers to contribute case presentations and discussions. Case 1 Presentation An 11-month-old boy is brought to the emergency department because of 3 days of fever, "crossed eyes," and a discharge of bloody pus from his left ear. His mother also has noticed that he is less steady on his feet. His left ear has been infected for 6 months despite therapy with amoxicillin/clavulanate, cefpodoxime, clarithromycin, ceftriaxone, cefaclor, and antibiotic drops with hydrocortisone. The mother states that she has been fully compliant with the drug regimens. On physical examination, the child's height and weight are in the 50th percentile. He tugs frequently at both ears but is afebrile and does not look ill. He is unable to move his left eye laterally past midline, giving him a cross-eyed appearance on left lateral gaze.

INDEX OF SUSPICION

1994 ◽  
Vol 15 (7) ◽  
pp. 289-291
Author(s):  
John C. Leopold ◽  
Andrew P. Sirotnak ◽  
Joseph Ryan ◽  
Vincent J. Menna
Keyword(s):  
Emergency Department ◽  
Early Diagnosis ◽  
Good Health ◽  
Burning Sensation ◽  
Periorbital Edema ◽  
Pediatric Clinic ◽  
General Pediatrician ◽  
The Family ◽  
History Of ◽  
Case Presentations

This section of Pediatrics in Review reminds clinicians of those conditions that can present in a misleading fashion and require suspicion for early diagnosis. Emphasis has been placed on conditions in which early diagnosis is important and that the general pediatrician might be expected to encounter, at least once in a while. The reader is encouraged to write possible diagnoses for each case before turning to the discussion, which is on the following page. We invite readers to contribute case presentations and discussions. Case 1 Presentation A 13-year-old boy who has been in good health previously comes to the pediatric clinic with a history of a pruritic red rash that comes and goes for several hours after he has been swimming. This rash has been a problem for the last 5 days. Two days ago, after swimming, he developed a diffuse rash together with periorbital edema and a burning sensation on his back. He suddenly became lightheaded and collapsed into his mother's arms, losing consciousness briefly. By the time he arrived at the emergency department, the rash was gone and his examination was normal. No treatment was prescribed. Yesterday, while washing the family car with cold soapy water, his right arm and hand swelled and turned solidly red in a "glove" distribution.

Abnormal cardiac conduction in a septic patient: incidental finding or cause for concern?

2018 ◽  
Vol 17 (2) ◽  
pp. 98-98
Author(s):  
M Jackson ◽  
◽  
K Balasubramaniam ◽  
Keyword(s):  
Emergency Department ◽  
Chest Pain ◽  
Respiratory Distress ◽  
Septic Patient ◽  
Incidental Finding ◽  
Cardiac Conduction ◽  
Shortness Of Breath ◽  
History Of ◽  
Unexplained Syncope

A 64-year-old male presents to the emergency department in acute respiratory distress. He gives a limited history of progressive shortness of breath of one week’s duration and several episodes of sudden unexplained syncope. There was no history of chest pain, palpitations or localising symptoms of infection. He takes no regular medications.

INDEX OF SUSPICION

1995 ◽  
Vol 16 (3) ◽  
pp. 117-119
Author(s):  
Randy Cron ◽  
Laurette Ho ◽  
Bradley Bradford
Keyword(s):  
Early Diagnosis ◽  
External Genitalia ◽  
Low Grade ◽  
Palpable Mass ◽  
Pelvic Ultrasonography ◽  
Distended Bladder ◽  
Focus Of Infection ◽  
History Of ◽  
Case Presentations ◽  
Free Area

This section of Pediatrics in Review reminds clinicians of those conditions that can present in a misleading fashion and require suspicion for early diagnosis. Emphasis has been placed on conditions in which early diagnosis is important and that the general pediatrician might be expected to encounter, at least once in a while. The reader is encouraged to write possible diagnoses for each case before turning to the discussion, which is on the following page. We invite readers to contribute case presentations and discussions. Case 1 Presentation A previously healthy 6-month-old girl is seen at the office for evaluation of fussiness and infrequent urination. The child has not voided in the past 9 hours despite her usual fluid intake. She is afebrile, with no focus of infection found on careful physical examination. A palpable mass is felt in the suprapubic area. Her external genitalia are normal. Renal and pelvic ultrasonography reveal an echo-free area superior to a normal lower renal ureteral segment on the left side, with a circular echo free area at the lower end of the ureter extending into and taking up about one quarter of the space within a distended bladder. Case 2 Presentation A 4-year-old boy is seen in your office with a 4-day history of sore throat and low-grade fever.

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