Dyspnea is the subjective sensation of uncomfortable or difficult breathing. Most patients report dyspnea as
"shortness of breath." Patients report dyspnea when their breathing is excessive for the activity that they are
doing. The sensation of dyspnea is produced by stimulation of both central and peripheral receptors that
monitor respiratory muscle activity, hypoxia, hypercapnia, acid-base status, airway irritation, and changes in
the pressure volume characteristics of the lung (i.e., j receptors in lung fibrosis or emphysema).
Approach to the Patient: Dyspnea (Fig. 33-3) In obtaining a history, the patient should be asked to describe in his/her own words what the discomfort feels like, as well as the effect of position, infections, and environmental stimuli on the dyspnea. Orthopnea is a common indicator of congestive heart failure, mechanical impairment of the diaphragm associated with obesity, or asthma triggered by esophageal reflux. Nocturnal dyspnea suggests congestive heart failure or asthma.
Distinguishing Cardiogenic from Noncardiogenic Pulmonary Edema
The history is essential for assessing the likelihood of underlying cardiac disease as well as for identification of one of the conditions associated with noncardiogenic pulmonary edema.
The physical examination in cardiogenic pulmonary edema is notable for evidence of increased intracardiac pressures (S3 gallop, elevated jugular venous pulse, peripheral edema), and rales and/or wheezes on auscultation of the chest.
The first edition of Harrison’s Principles of Internal Medicine was
published more than half a century ago. Over the decades, this textbook
has evolved to reflect the continuing advances in the field of
internal medicine and to meet the growing information base required
of medical students and clinical practitioners. The users of this sixteenth
edition of Harrison’s will not even have to open the volume to
see that it marks a transition point in the book’s history. The new cover
is only the most obvious indication of a new direction for Harrison’s.
Lewis Thomas, in his semi-autobiographical book The Youngest Science:
Notes of a Medicine-Watcher, reminisced about his father, an internist in the
early twentieth century who would sit by his patient, holding his hand while
nature affected the cure. There was little else he could offer. Now, after
almost 100 years, we have crossed vast frontiers in medicine, from hormones
to the immune system to unlocking the promise of genomics. We have
relegated diseases such as erythroblastosis to the history books and transformed
AIDS from a death sentence to a chronic illness.
Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Wertheim cung cấp cho các bạn kiến thức về ngành y đề tài: Cavernostomy x Resection for Pulmonary Aspergilloma: A 32-Year History...
We evaluated the effects of previous pulmonary tuberculosis (TB) on the risk of obstructive
lung disease. We analyzed population-based, the Second Korea National Health and
Nutrition Examination Survey 2001. Participants underwent chest X-rays (CXR) and
spirometry, and qualified radiologists interpreted the presence of TB lesion independently.
A total of 3,687 underwent acceptable spirometry and CXR. Two hundreds and ninty four
subjects had evidence of previous TB on CXR with no subjects having evidence of active
This first chapter lays the groundwork for the rest of the discussions in this book. Of
all the chapters, it covers the broadest range of topics; most of these are discussed
further later in the book, but some of the basics—for example, the brief history of
Oracle and the contents of the different “flavors” of the Oracle database products—
are unique to this chapter.
Oracle has grown from its humble beginnings as one of a number of databases avail-
able in the 1970s to the market leader of today.
(BQ) Part 1 book "Pocket guide to diagnostic cardiac catheterization" presents the following contents: A brief history of cardiac catheterization, the cardiac catheterization laboratory, the tools, precatheterization care, vascular access, the multipurpose catheter, angiography of coronary bypass grafts,...
A pre-tested questionnaire was used by a trained
counselor to obtain information on demographic
characteristics, social and medical history from the
subjects. Other important information about PTB such
as previous BCG vaccination, contact with an index
case and exposure to tuberculin skin test were also
Laboratory investigations: Three early morning sputum
were collected from each consenting asymptomatic
subject. The samples were transported to TB laboratory
of the department of Medical Microbiology and
Parasitology, UCH, for immediate processing.
The majority, 160 (59.0%) of the subjects had been
working in their units for more than two years while 64
(23.6%) had not spent up to one year in their various
units. Most 254 (93.7%) reported negative history of
chronic cough while a higher percentage 257 (94.8%)
denied any history of smoking. In relation to alcohol
consumption, 44 (16.2%) gave history of alcohol intake,
the majority 208 (76.8%) gave a negative history while
19 (7.0%) did not give any definite answer.
Eleven (4.1%) subjects agreed to recently have
contact with patients with chronic cough, 178 (65.
Inclusion and exclusion criteria: Patients were eligible for enrollment in the study if they were aged 18 yr or more, had newly diagnosed pulmonary TB, had no history of previous treatment for TB, had knowledge of their HIV status, resided within 20 km of study site, assessed to be cooperative and willing for DOTS therapy as judged by counselor, had no major complications of HIV disease like encephalopathy, renal or hepatic disease, malignancy or any end stage disease and did not have any medical condition that might interfere with the management of the pulmonary tuberculosis like diabetes,...
People concentrated in congregated systems, such as prisons, are important but often neglected
reservoirs for TB transmission, and threaten those in the outside community. Therefore, this study was conducted to
determine the prevalence of tuberculosis in a prison system of North Gondar Zone.
Methods: An active case-finding survey in North Gondar Prison was carried out from March to May 2011. All prison
inmates who had history of cough for at least a week were included in the study.
The objective of this study was to determine the prevalence of presumed ocular tuberculosis among
diagnosed pulmonary tuberculosis patients in a tertiary government hospital in the Philippines and determine its
common presentation in the population. This was a cross-sectional study in which 103 patients who were labeled
to have active pulmonary tuberculosis underwent history and ocular examination prior to anti-tubercular therapy.
The diagnosis of presumed ocular tuberculosis was made when clinical signs of tuberculosis (TB) uveitis were found
in the participants.
They observed that the use of well defined symptoms
as diagnostic tool, even in resource limited settings,
may improve the chances of diagnosing childhood
pulmonary tuberculosis. Fourie et al observed some
clinical criteria thought to be most relevant as
predictors of tuberculosis in children . These criteria
include history of contact with a case of tuberculosis,
positive skin test, persistent cough, low weight for
age, and unexplained/ prolonged fever.
In our study, we aimed to determine the validity of diagnostic methods for tuberculosis. Eighty-one
people suspected to have tuberculosis were included in the study. The validity of the applied methods
for the diagnosis of tuberculosis tuberculin skin test (TST), sputum smear, and used in diagnostic chest
X-ray findings (CXR), clinical features and history were evaluated as culture was considered the
reference test. Included in the study of 81 people (54 males 27 females) mean age was determined as
45.04 ± 18.69.
All the necessary
information and data were collected from both medical records of the patients and special questionnaires that were designed by our staff in
1996 for this purpose. Statistical analysis was carried out descriptively by using frequency and percentage. Presence of TB in the patients
was confirmed by identifying the microorganism in the tissues detecting pathological changes in favour of TB and/or having past history of
pulmonary TB associated with its anatomical complications such as cavitation, bronchiectasis, and bronchial stenosis.
This revision of the Global Strategy for Asthma
Management and Prevention again provides a unified text
as a source document. Each chapter contains separate
sections containing details and management advice for
specific age categories where these are considered
relevant. These age groups include children 5 years and
younger (sometimes called preschool age), children older
than 5 years, adolescents, adults, and the elderly.
Approach to the Patient: Hemoptysis The history is extremely valuable. Hemoptysis that is described as bloodstreaking of mucopurulent or purulent sputum often suggests bronchitis. Chronic production of sputum with a recent change in quantity or appearance favors an acute exacerbation of chronic bronchitis. Fever or chills accompanying bloodstreaked purulent sputum suggests pneumonia, whereas a putrid smell to the sputum raises the possibility of lung abscess. When sputum production has been chronic and copious, the diagnosis of bronchiectasis should be considered.