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Extra resources for Current Medical Diagnosis & Treatment 2006
In addition, antibiotic treatment of adults with purulent sputum production shows no benefit. Wheezing and rhonchi are frequent findings in 31 32 adults with acute bronchitis, and do not represent adult-onset asthma in most cases. Physical examination of adults with persistent cough may also reveal evidence of chronic sinusitis, contributing to postnasal drip syndrome or asthma. Chest and cardiac signs may distinguish chronic obstructive pulmonary disease (COPD) from congestive heart failure. In patients with cough and dyspnea, a normal match test (ability to blow out a match from 25 cm away) and maximum laryngeal height > 4 cm (measured from the sternal notch to the cricoid cartilage at end expiration) substantially decrease the likelihood of COPD.
Constitutional symptoms. • Tobacco use history. • Vital signs (heart rate, respiratory rate, body temperature). • Chest examination. • Chest radiography when unexplained cough lasts more than 3–6 weeks. General Considerations Cough adversely affects personal and work-related interactions, disrupts sleep, and often causes discomfort of the throat and chest wall. Most people seeking medical attention for acute cough desire symptom relief; few are worried about serious illness. Cough results from stimulation of mechanical or chemical afferent nerve receptors in the bronchial tree.
End-expiratory chest radiography enhances detection of a small pneumothorax. Table 2-3. Clinical findings suggesting increased left ventricular end-diastolic pressure (LVEDP). Tachycardia Systolic hypotension Jugular venous distension (> 5–7 cm H2O)1 Hepatojugular reflux (> 1 cm)2 Crackles, especially bibasilar Third heart sound3 Lower extremity edema Radiographic pulmonary vascular redistribution or cardiomegaly1 Modified with permission from Badgett RG et al: Can the clinical examination diagnose left-sided heart failure in adults?