Pearls

A thorough medical history is the best way to make a diagnosis and to guide the selection of diagnostic studies.
All patients with presumed infectious pneumonia must have follow-up chest x-rays to verify that the infiltration has resolved. If not, further work-up is required.
In nonsmokers with normal chest x-rays the most common cause of cough is post-nasal drip. Remember, too, that chronic cough occurs in 10% to 20% of all patients taking angiotensin converting enzyme inhibitor drugs.
Cough, not wheezing, may be the predominant symptom in patients with asthma. In those who present with wheezing, beware of asthma mimics.
One half of patients with chronic cough due to gastroesophageal reflux disease have none of the classical symptoms of reflux.
Chest pain of cardiac origin, with the exception of pericarditis, is seldom worsened by breathing; in contrast, chest pain of respiratory origin, especially pleurisy, characteristically is worsened.
The major diagnostic goal in massive hemoptysis is localization of the bleeding site so that surgical removal or embolization can be performed.
Tuberculin skin testing should be regarded as a diagnostic aid but is not to be relied on for ruling in or out active tuberculosis.
Immediately following thoracentesis, patients may experience relief of dyspnea and chest pressure, but hypoxemia may persist for several hours.
Pleural effusions of moderate size or larger in a symptomatic patient with presumed pneumonia require a thoracentesis.
Solitary pulmonary nodules due to tuberculosis and histoplasmosis commonly calcify, whereas those due to coccidioidomycosis do not.
Review of old x-rays is extremely useful in establishing chronology of disease, thereby avoiding expensive invasive procedures.

Preface < back | next > A. Approach to the Patient
3 of 23 HTML pages