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The following signs may be seen:

  1. Sunsetting signs
    1. Associated with tumor
    2. Associated with disease
    3. Associated with tumor
  2. ABC
  3. DEF

Abbreviations: ABG (arterial blood gas); ACE (angiotensin converting enzyme); BMI (body mass index); CBC (complete blood count); CSF (cerebrospinal fluid); CXR (chest X-ray); DOE (dyspnea on exercise); ECG (electrocardiogram); FEF (forced expiratory flow rate); FEV1 (forced expiratory volume); FVC (forced vital capacity); JVD (jugular vein distention); MCV (mean corpuscular volume); Plt (platelet); RV (residual volume); SIADH (syndrome of inappropriate antidiuretic hormone); TSH (thyroid stimulating hormone); Vt (tidal volume); WBC (white blood cell);


Organ system Diseases Clinical manifestations Diagnosis Other features
Symptoms Physical exam
Loss of consciousness Agitation Weight loss Fever Chest pain Cough Orthopnea DOE Cyanosis Clubbing JVD Peripheral edema Auscultation CBC ABG Imaging Spirometry Gold standard
Acute Dyspnea Respiratory system Head and Neck,

Upper airway

Angioedema[1] - - - - - +/- + - - +/- - + Normal Normal ↓O2, ↑CO2 Normal N/A Physical exam Generalized edema
Anaphylaxis[2] +/- + - +/- - - - - +/- - - - Scattered wheezing Normal Normal Normal N/A Vital sign Type 1 hypersensitivity
Aspiration[3] - + - - +/- + - - + - - - Diminished breath sounds Normal Normal Atelectasis ↓Vt, ↑RV Bronchoscopy Choking
Croup[4] - + - +/- - + - - + - - - Stridor ↑WBC Normal Steeple sign Normal Physical exam Barking cough
Epiglottitis[5] - + - + - + - - - - - - Stridor ↑WBC Normal Thumb sign Normal Laryngoscopy Drooling
Rhinosinusitis[6] - - - + - +/- - - - - - - Normal ↑WBC Normal Air fluid level Normal Physical exam Headache
Vocal cord dysfunction[7] - - - - - +/- - - - - - - Stridor Normal Normal Normal ↓ FVC Laryngoscopy Choking sensation
Chest and Pleura,

Lower airway

Asthma attack[8] - + - - +/- + - - + - - - Wheeze ↑ Eosinophil Respiratory alkalosis Normal ↓ FEV1, PEF Physical exam and

Spirometry

Chest pain
Atelectasis - - - +/- +/- +/- - - +/- - - - Diminished breath sounds, Wheeze Normal ↓O2, Normal/↓CO2 Collapsed lung lobe, fissuresdisplacement ↓ FVC Chest CT scan Surgical procedure, Aspiration,

Mechanical ventilation

Bronchitis[9] - - - + + + - - - - - - Rhonchi  ↑WBC Normal Normal Normal Physical exam Rhonchi relieved by cough
Bronchospasm[10] +/- + - - + +/- - - + - - - Wheeze Normal ↓O2, ↑CO2 Normal ↓Vt, ↑RV Physical exam Allergic reaction
Bronchiolitis[11] - - - + +/- + - - - - - - Wheeze and Crackles ↑WBC Normal Bronchovascular markings ↓Vt Clinical assessment Respiratory syncytial virus (RSV)
COPD exacerbation[12] - + - + + + + - + +/- +/- +/- Wheeze, Rhonchi, and Crackles ↑WBC, ↑RBC Respiratory alkalosis Hyperexpansion ↓ FEV1/FVC Clinical assessment Acute exacerbations of chronic bronchitis (AECB)
Lung carcinoma[13] - - + - - + - - + + - - Wheeze and Crackles Normal Normal Mass lesion, hilar lymphadenopathy ↓Vt, ↑RV Bronchoscopy  Paraneoplastic syndromes, such as SIADH and lambert-Eaton
Pneumonia[14] - - - + + + - - - - - - Wheeze, Rhonchi, and Crackles ↑WBC, neutrophilia Normal Lobar consolidation Normal Chest X-ray and CT Scan productive cough
Pneumothorax[15] - - - - + - - - - - +/- - Diminished breath sounds Normal ↓O2, ↑CO2 Radiolucency without lung marking ↓Vt CXR and Chest CT scan Tracheal deviation
Pulmonary embolism[16] - - - - + - - +/- - - - - Normal Normal Respiratory alkalosis Normal Normal Pulmonary CT angiography Pleuritic chest pain
Rib fractures (flail chest)[17] - + - - + - - - - - - - Normal Normal Respiratory acidosis Fracture marks Normal Chest X-ray Pneumothorax
Cardiovascular system Acute myocardial ischemia[18] +/- + - +/- + - + + - - - - Normal Normal Normal Normal Normal Cardiac troponin I Nausea and vomiting, Positive pertinent risk factors, such as hypertension, diabetes, and smoking
Acute heart failure[19] +/- + - - +/- + +/- + + - + + S3 Normal Respiratory alkalosis ↑ Cardiothoracic ratio ↓Vt B-type natriuretic peptide (BNP) and N-terminal proBNP (NT-proBNP) Excessive sweating, high blood pressure
Pericardial tamponade[20] +/- - - - + - +/- +/- - - + - Muffled heart sounds Normal Normal Water bottle appearance enlarged heart Normal Echocardiography Fluid accumulation in pericardium
Tachyarrhythmia[18] +/- + - - +/- - - - - - - - High pulse rate Normal Normal Normal Normal ECG Palpitation
Pulmonary edema[21] +/- + - + + + + + + + + + Basal crackle Normal Respiratory alkalosis Bat wing pattern, air bronchograms ↓Vt, ↑RV Cardiac Catheterization Tachypnea
Central nervous system Stroke + - - +/- - - - - - - - - Normal Normal Normal Intracranial infarct or hemorrhage Normal Brain MRI Paralysis or paresthesia
Encephalitis[22] + + - + - - - - - - - - Normal ↑WBC, neutrophilia Normal Normal Normal CSF PCR Confusion
Traumatic brain injury[23] + +/- - - - - - - - - - - Normal Normal Respiratory acidosis Intracerebral hemorrhage Normal Brain CT scan Lucid interval
Toxic/Metabolic Organophosphate poisoning[24] + - - + - - - - - - - - Wheeze Normal ↓O2, ↑CO2 Normal Normal Blood test Salivation, Lacrimation, Emesis, Miosis
Salicylate poisoning[25] + - - - - - - - + - - - Normal Normal Metabolic acidosis, Respiratory alkalosis Normal Normal Blood test Vomiting, Tinnitus, Confusion, Hyperthermia
Carbon monoxide poisoning[26] + - - - + + - - + - - - Wheeze Carboxyhemoglobin ↓O2, ↑CO2 Normal N/A Carboxyhemoglobin (HbCO) level Headache, Dizziness, Weakness, Vomiting, Confusion
Diabetic ketoacidosis[27] + +/- - - - - - - - - - - Scattered wheeze, Kussmaul's respiration ↑WBC Metabolic acidosis Normal Normal Blood test (acidosis, hyperglycemia, ketonemia) Vomiting, Abdominal pain, Weakness, Confusion
Systemic Panic attack[28] +/- + - - - - - - - - - - Normal Normal Normal Normal Normal Clinical assessment Severe anxiety
Pregnancy[29] - - - - +/- - - - - - - + Normal ↑WBC, RBC ↓O2, ↑CO2 Normal ↓Vt, ↑RV βhCG Missed period, Hyperemesis
Sepsis[30] +/- - - + - - - - - - - - Normal ↑WBC, neutrophilia ↓O2, ↑CO2 Normal Normal SIRS criteria Chills, Confusion
Organ system Diseases Clinical manifestations Diagnosis Other features
Symptoms Physical exam
Loss of consciousness Agitation Weight loss Fever Chest pain Cough Orthopnea DOE Cyanosis Clubbing JVD Peripheral edema Auscultation CBC ABG Imaging Spirometry Gold standard
Chronic Dyspnea Respiratory system Head and Neck,

Upper airway

Goiter[31] - - - - - - - - - - - + Normal Normal Normal Normal Normal Blood test (TSH, T4) Weight gain
Laryngeal adenocarcinoma[32] - - + - - +/- - - - - - - Stridor Normal ↓O2, ↑CO2 Retropharyngeal tissue thickness Normal Laryngoscopy Choking sensation
Vocal cord paralysis[7] - - - - - +/- - - - - - - Stridor Normal Normal Pharyngeal constrictor muscles thinning, uvular deviation Normal Laryngoscopy Choking sensation
Tracheal stenosis[33] - - - - +/- +/- - - + + - - Stridor, Stertorous Normal ↓O2, ↑CO2 Soft tissue thickening internal to normal-appearing tracheal cartilage Normal Bronchoscopy Respiratory distress
Chest and Pleura,

Lower airway

Bronchial asthma[8] - + +/- - +/- + - - + + - - Wheeze ↑ Eosinophil Respiratory alkalosis, Metabolic acidosis Pulmonary hyperinflation,

Bronchial wall thickening

↓ FEV1/FVC Spirometry before and after bronchodilator Paroxysmal respiratory distress
Bronchiectasis[9] - - - + + + - - + + - - Rhonchi, Wheezing, Crackles ↑WBC, neutrophilia ↓O2, ↑CO2 Tram-track opacities ↑ FEV1/FVC High resolution computed tomography (HRCT) Chronic productive cough
COPD[12] - - +/- - - + + + + + + +/- Expiratory wheeze ↑ RBC Respiratory alkalosis, Metabolic acidosis ↑ Bronchovascular markings, Cardiomegaly ↓ FEV1/FVC Physical exam and

Spirometry

Heavy smoking history
Emphysema[34] - - - - - +/- - - + + - - Expiratory wheeze, Hyperinflation Normal Respiratory alkalosis, Metabolic acidosis Flattening of diaphragm, vertical heart ↓ FEV1/FVC Physical exam and

Spirometry

Barrel chest
Pulmonary hypertension[35] - - - - +/- +/- - - +/- +/- + + Accentuated S2 Normal Hypoxia and acidosis Enlarged pulmonary arteries ↑Physiologic RV Cardiac catheterization Syncope,

Ascites, Pleural effusion

Interstitial lung disease[36] - - - - + + - - + + - - Rhonchi, Wheezing, Crackles Normal ↓O2, ↑CO2 Peripheral pulmonary infiltrative opacification ↑ FEV1/FVC High resolution computed tomography (HRCT) Pneumoconiosis
Sarcoidosis[37] - - +/- - +/- + - - + - - - Crackles Normal ↓O2, ↑CO2 Hilar adenopathy ↑ FEV1/FVC High resolution computed tomography (HRCT) Hypercalcemia, high ACE
Alveolitis[38] - - - + + + - - - - - - Basal crackle ↑WBC, neutrophilia Normal  Basal reticulonodular opacification   ↑ FEV1/FVC High resolution computed tomography (HRCT) Dry cough
Bronchiolitis obliterans[11] - - - + + + - - + + - - Expiratory wheeze ↑WBC ↓O2, ↑CO2 Hyperinflation, Reticulonodular opacities ↓ FEV1/FVC Lung biopsy Complication of allogeneic hematopoietic stem cell transplantation
Cystic fibrosis[39] - - + + - +/- - - + + - - Rhonchi, Wheezing, Crackles Normal Metabolic alkalosis Thick-walled bronchiectasis ↓ FEF75%/FVC Sweat test Absent vas deferens
Pleural effusion[40] - +/- + - + - +/- - - - +/- +/- Egophony ("E-to-A" change) Normal Normal Blunting of the costophrenic and cardiophrenic angle ↓Vt, ↑RV Light's criteria ↓Tactile fremitus, Asymmetrical chest expansion
Pulmonary right-to-left shunt[41] - - - - +/- + - - + + - - Diminished breath sounds Normal ↓O2, ↑CO2, Respiratory acidosis Normal ↓Vt, ↑RV

(physiological)

Pulmonary CT angiography Chronic hypoxemia
Diaphragmatic paralysis[42] - - - +/- +/- +/- - - - - - - Normal Normal Normal Unilateral or bilateral diaphragmatic flattening ↓Vt, ↑RV

(anatomical)

CXR confirmed by fluoroscopic sniff test Respiratory insufficiency
Tuberculosis[43] - - + + + + - - +/- - - - Rhonchi, Wheezing, Crackles ↑WBC ↓O2, ↑CO2 Patchy consolidation or poorly defined linear and nodular opacities Restrictive, obstructive, or mixed IFN-γ release assay (IGRA)

Acid-fast staining

Night sweat
Cardiovascular system Constrictive pericarditis[20] - - - - + - + + - - + - Muffled heart sounds Normal Normal Calcifications  Normal Chest CT scan Syncope
Restrictive cardiomyopathy[44] - - - - + - + + - - - +/- Normal Normal Normal Dilatation of the inferior vena cava and right atrium Normal Right ventricular biopsy Weight gain,

Nausea

Valvular heart disease[18] - - - - + - +/- + - - - - Cardiac murmur Normal Normal Dilatation of heart chambers Normal Echocardiography Syncope, Palpitation
Bradyarrhythmia[45] - - - - - - - - - - - - Normal Normal Normal Normal Normal ECG Syncope, Palpitation
Pericardial effusion[46] - - - +/- + + +/- +/- - - + - Muffled heart sounds Normal Normal Fluid density around the heart Normal M-mode and 2-dimensional Doppler echocardiography Hoarseness, Palpitation
Coronary heart disease[18] - +/- - - + - + + - - - - Normal Normal ↓O2 Normal Normal Cardiac troponin I Nausea, Lightheadedness, Sweating
Intracardiac shunt[47] - - - - +/- - +/- + + + - - Cardiac continuous murmur Normal ↓O2 Dilatation of heart chambers Normal Echocardiography Syncope, Palpitation
Neuromuscular disease Amyotrophic lateral sclerosis[48] +/- - +/- - - - - - - - - - Normal ↑WBC Normal Normal ↓Vt, ↑RV Revised El Escorial criteria (clinical) Muscle weakness, Dysphagia
Polymyositis/dermatomyositis[49] - - +/- - + - - - - - - +/- Normal ↑WBC Normal Normal ↓Vt, ↑RV Muscle biopsy Muscle weakness, Heliotrope
Mitochondrial diseases[50] - - +/- - - - - - - - - - Wheeze ↓WBC, Plt Normal Normal ↓Vt, ↑RV Muscle biopsy Muscle pain
Glycolytic enzyme defects (e.g., McArdle)[51] +/- - - - - - - - - - - +/- Normal Normal Normal Normal ↓Vt, ↑RV Muscle biopsy (ragged red fibers) Myoglobinuria,

Muscle weakness

Toxic/Metabolic Metabolic acidosis[52] - - + - - - - - - - - - Normal Normal Metabolic acidosis, Respiratory alkalosis Normal Normal ABG Confusion, Vomiting
Renal failure[53] - - + - - - + + - - - + Normal ↓ RBC Metabolic acidosis Normal Normal Cr Nausea, Vomiting, Oliguria
Systemic Anemia[54] - - + - - - - +/- - - - - Normal ↓ RBC ↓O2 Normal Normal HGB, MCV Weakness, Fatigue
Anxiety[55] + + + - +/- +/- - - - - - - Normal Normal Normal Normal Normal Psychological interview Sweating, Palpitation
Ascites[56] - - - - - - - - - - - - Normal Normal Normal Peritoneal fluid accumulation ↓Vt, ↑RV Abdominal ultrasound Abdominal distention
Depression[57] - + + - - - - - - - - - Normal Normal Normal Normal Normal Psychological interview Depressed mood, Fatigue
Kyphoscoliosis[58] - - - - - - - - - - - - Wheeze Normal Normal Deviated vertebral column ↓Vt, ↑RV

(anatomical)

Standing lateral spine radiograph Low back pain
Obesity[59] - - - - - - - - - - - - Normal Normal ↓O2 Normal ↓Vt, ↑RV

(anatomical)

BMI Low stamina,

Sweating

Autoimmune Churg-Strauss syndrome[60] - - - - - + - - - - - - Scattered wheezing Normal Normal Areas of parenchymal opacification ↓Vt, ↑RV Biopsy  Fatigue,Numbness
Microscopic polyangiitis[61] - - +/- + + - - - - - - +/- Scattered wheezing ↑WBC ↓O2, ↑CO2 Normal ↓Vt, ↑RV Histological confirmation Skin lesions, Nerve damage
Wegener's granulomatosis[62] - - +/- - - + - - - - - - Wheezing, Crackles ↓ RBC ↓O2, ↑CO2 Cavitate nodules, ground-glass opacity ↓ FEV1/FVC Biopsy demonstrating a granulomatous vasculitis Chronic rhinosinusitis
Goodpasture's disease[63] - - - - - + - - - - - -  Bilateral coarse crepitations ↓ RBC, HGB, HCT Normal  Like pulmonary edema Normal Kidney biopsy Hematuria,

Hemoptysis


 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Stage 1
 
Prepubertal external genitalia
Prepubertal pubic hair
Growth 5-6 cm/year
 
by:By Tanner_scale-male.svg: M•Komorniczak -talk-, polish wikipedist.derivative work: J.McHardy (talk) - Tanner_scale-male.svg, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=9871642
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Stage 2
 
Enlargement of scrotum and testes; scrotum skin become hyperpigmented and harder
Sparse growth of long, slightly pigmented hair, straight or curled, at base of penis
Growth 5-6 cm/year
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Boys
 
 
 
 
 
Stage 3
 
Enlargement of penis (length at first); further testes growth
Darker, coarser, and more curled hair, spreading over pubes
Growth 7-8 cm/year
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Stage 4
 
Increased penis size with growth and development of glans; testes and scrotum larger, scrotum skin darker
Adult type hair, but smaller area; no spread to medial surface of thighs
Growth 10 cm/year
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Stage 5
 
Adult external genitalia
Adult type hair with same horizontal distribution ("feminine")
No further height increase after 17 years
 
 
 
 
 
 
 
Tanner staging
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Stage 1
 
Prepubertal external genitalia
Prepubertal pubic hair
Growth 5-6 cm/year
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Stage 2
 
Breast bud with elevation of breast and papilla; enlargement of areola
Sparse growth of long, slightly pigmented hair, straight or curled, along labia
Growth 7-8 cm/year
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Girls
 
 
 
 
 
Stage 3
 
Further enlargement of breast and areola; no separation of their contour
Darker, coarser and more curled hair, spreading sparsely over junction of pubes
Growth 8 cm/year
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Stage 4
 
Areola and papilla form a secondary mound above level of breast
Adult type hair, but smaller area than in adult; no spread to medial surface of thighs
Growth 7 cm/year
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Stage 5
 
Mature breast: projection of papilla only, related to recession of areola
Adult type hair with horizontal distribution ("feminine")
No further growth after 16 years
 
 
 
 
 
 


 
 
 
 
Exercise
 
Calcium Supplementation
 
Vitamin D supplementation
 
Smoking cessation
 
Reduced alcohol consumption
 
Hip protectors
 
Fall protection
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
• Balance, strength and functional training exercises
 
Women
• 9-18 yrs: 1,300 mg
• 19-50 yrs: 1,000 mg
• 51-70 yrs: 1,200 mg
• 71 and more yrs: 1,200 mg
Men
• 50-70 yrs: 1,000 mg
• 71 and more yrs: 1,200 mg
 
Women
• 9-18 yrs: 600 IU
• 19-50 yrs: 600 IU
• 51-70 yrs: 600 IU
• 71 and more yrs: 800 IU
Men
• More than 50 yrs: 800-1,000 IU

• Serum vitamin D level of 20 ng per mL (50 nmol per L) is recommended for good bone health
 
• Stop-smoking program and nicotine patch
 
Limit to:
• One drink/day for women
• Two drinks/day for men

• Moderate alcohol may associated with slightly higher BMD and lower fracture risk in postmenopausal women
 
• Hard and soft hip protectors, upon preference
 
Multifactorial interventions:
• Individual risk assessment
• Tai Chi and other exercise programs
• Home safety assessment and modification by an occupational therapist
• Gradual withdrawal of psychotropic medication
• Visual impairment correction
• Improve mobility
 


 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Lifestyle modifications
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Exercise
 
Calcium Supplementation
 
Vitamin D supplementation
 
Smoking cessation
 
Reduced alcohol consumption
 
Hip protectors
 
 
 
 
 
 
Fall protection
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Balance, strength and functional training exercises
 
Women
• 9-18 yrs: 1,300 mg
• 19-50 yrs: 1,000 mg
• 51-70 yrs: 1,200 mg
• 71 and more yrs: 1,200 mg
Men
• 50-70 yrs: 1,000 mg
• 71 and more yrs: 1,200 mg
 
Women
• 9-18 yrs: 600 IU
• 19-50 yrs: 600 IU
• 51-70 yrs: 600 IU
• 71 and more yrs: 800 IU
Men
• More than 50 yrs: 800-1,000 IU

• Serum vitamin D level of 20 ng per mL (50 nmol per L) is recommended for good bone health
 
• Stop-smoking program • Nicotine patch
 
Limit to:
• One drink/day for women
• Two drinks/day for men
• Moderate alcohol may associated with slightly higher BMD and lower fracture risk in postmenopausal women
 
Hard and soft hip protectors, upon preference
 
 
 
 
 
 
 
 
 
Multifactorial interventions:
• Individual risk assessment
• Tai Chi and other exercise programs
• Home safety assessment and modification by an occupational therapist

• Gradual withdrawal of psychotropic medication
• Visual impairment correction
• Improve mobility
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Chronic corticosteroid use
 
 
 
Children and adolescent
 
 
 
 
 
 
 
 
 
 
 
Adults
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Men
 
 
 
 
 
 
 
 
 
Women
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
• Young hypogonadal
• More than 70 yrs
• Less than 70 yrs with:
••Low body weight
••Prior fracture
••High risk medication use
••Disease or condition associated with bone loss
 
 
 
 
 
 
 
 
 
• More than 65 yrs
• Postmenopausal women younger than 65 yrs with:
••History of fragility fracture
•• Weigh less than 127 lb (58 kg)
••Medications or diseases that cause bone loss
•• Parental history of hip fracture
•• smoking
•• Alcoholism
•• Rheumatoid arthritis.
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  1. ↑ Bernstein JA, Cremonesi P, Hoffmann TK, Hollingsworth J (2017). "Angioedema in the emergency department: a practical guide to differential diagnosis and management". Int J Emerg Med. 10 (1): 15. doi:10.1186/s12245-017-0141-z. PMC 5389952. PMID 28405953.
  2. ↑ Bjornsson HM, Graffeo CS (2010). "Improving diagnostic accuracy of anaphylaxis in the acute care setting". West J Emerg Med. 11 (5): 456–61. PMC 3027438. PMID 21293765.
  3. ↑ O'Horo JC, Rogus-Pulia N, Garcia-Arguello L, Robbins J, Safdar N (2015). "Bedside diagnosis of dysphagia: a systematic review". J Hosp Med. 10 (4): 256–65. doi:10.1002/jhm.2313. PMC 4607509. PMID 25581840.
  4. ↑ Bjornson CL, Johnson DW (2013). "Croup in children". CMAJ. 185 (15): 1317–23. doi:10.1503/cmaj.121645. PMC 3796596. PMID 23939212.
  5. ↑ Negus VE (1927). "The Function of the Epiglottis". J Anat. 62 (Pt 1): 1–8. PMC 1250045. PMID 17104162.
  6. ↑ Meltzer EO, Hamilos DL (2011). "Rhinosinusitis diagnosis and management for the clinician: a synopsis of recent consensus guidelines". Mayo Clin Proc. 86 (5): 427–43. doi:10.4065/mcp.2010.0392. PMC 3084646. PMID 21490181.
  7. ↑ 7.0 7.1 Wood RP, Milgrom H (September 1996). "Vocal cord dysfunction". J. Allergy Clin. Immunol. 98 (3): 481–5. PMID 8828523.
  8. ↑ 8.0 8.1 Hodder R, Lougheed MD, Rowe BH, FitzGerald JM, Kaplan AG, McIvor RA (2010). "Management of acute asthma in adults in the emergency department: nonventilatory management". CMAJ. 182 (2): E55–67. doi:10.1503/cmaj.080072. PMC 2817338. PMID 19858243.
  9. ↑ 9.0 9.1 Cantin, Luce; Bankier, Alexander A.; Eisenberg, Ronald L. (2009). "Bronchiectasis". American Journal of Roentgenology. 193 (3): W158–W171. doi:10.2214/AJR.09.3053. ISSN 0361-803X.
  10. ↑ Molis MA, Molis WE (2010). "Exercise-induced bronchospasm". Sports Health. 2 (4): 311–7. doi:10.1177/1941738110373735. PMC 3445098. PMID 23015953.
  11. ↑ 11.0 11.1 Holbro A, Lehmann T, Girsberger S, Stern M, Gambazzi F, Lardinois D, Heim D, Passweg JR, Tichelli A, Bubendorf L, Savic S, Hostettler K, Grendelmeier P, Halter JP, Tamm M (2013). "Lung histology predicts outcome of bronchiolitis obliterans syndrome after hematopoietic stem cell transplantation". Biol. Blood Marrow Transplant. 19 (6): 973–80. doi:10.1016/j.bbmt.2013.03.017. PMID 23562737.
  12. ↑ 12.0 12.1 Qureshi H, Sharafkhaneh A, Hanania NA (2014). "Chronic obstructive pulmonary disease exacerbations: latest evidence and clinical implications". Ther Adv Chronic Dis. 5 (5): 212–27. doi:10.1177/2040622314532862. PMC 4131503. PMID 25177479.
  13. ↑ Dela Cruz CS, Tanoue LT, Matthay RA (2011). "Lung cancer: epidemiology, etiology, and prevention". Clin Chest Med. 32 (4): 605–44. doi:10.1016/j.ccm.2011.09.001. PMC 3864624. PMID 22054876.
  14. ↑ Simonetti AF, Viasus D, Garcia-Vidal C, Carratalà J (2014). "Management of community-acquired pneumonia in older adults". Ther Adv Infect Dis. 2 (1): 3–16. doi:10.1177/2049936113518041. PMC 4072047. PMID 25165554.
  15. ↑ Currie GP, Alluri R, Christie GL, Legge JS (2007). "Pneumothorax: an update". Postgrad Med J. 83 (981): 461–5. doi:10.1136/pgmj.2007.056978. PMC 2600088. PMID 17621614.
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