Academic literature on the topic 'Medical examination couch'
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Journal articles on the topic "Medical examination couch"
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Cattra, Chiara, and Laur Evans. "Edu-couch-ing the masses: an online, multi-disciplinary psychiatry teaching programme." BJPsych Open 7, S1 (June 2021): S128. http://dx.doi.org/10.1192/bjo.2021.369.
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AimsIn response to medical students expressing concer at limited access to psychiatric placements, particularly on-the-ground teaching or witnessed patient cases, we established “Psych From The Couch” – an open-access, free, Zoom-based, interactive teaching programme. We sought to:Explore new means of psychiatric education, assess needs of multiple “categories” of student – medical, nursing, or PA students, junior doctors, wider MDT – and meet those needs in a creative, yet virtually-limited format.Assess disparities between students' self-declared learning deficits and objective knowledge gaps.To explore the use and value of virtual programmes as a structured means for inclusive multi-disciplinary education of psychiatric practice.MethodWe gathered information on students' self-declared learning needs and deficits, location, role, training level, and confidence at the outset of the programme, with data from ~180 “students”.We experiemtned with learning styles and methods of online interaction, running a series of 10 sessions - recorded for those unable to attend - incorporating the bredth of psychiatric curricula:Diagnostic Principles“Organic” PsychiatrySubstance MisusePsychotic DisordersAffective DisordersOld Age PsychiatryCAMHSEmergencies & LegalitiesExaminations in PsychiatryReal World PsychiatryWe utilised initial sign-up forms and repeated feedback requests to assess wider student needs, establish overarching structure to our programme, and ensure learning objectives were appropriate and met.We collated final feedback and scores at the close, assessing via examination questions and self-defined Likert scale, and incentivising feedback with a final portfolio certificate.ResultDemographics of open-access teaching varied broadly, from senior medical staff to access to medicine students; 92.9% were medical students. Students were diversely sourced from all years', with ~50% collectively in their penultimate or final years' of study.Most common self-defined decficits reported were understandably anxiety regarding practical examinations or assessment given recent placement restrictions, however many reflected on anxieties regarding psychiatric emergencies, substance misuse, legal frameworks, personality disorders as a diagnostic category, and pharmacological management.Our cohort responded warmly to our teaching style and techniques, with feedback and consequent improvements to teaching technique weekly. We were able to evidence improvements to global confidence, and confidence in key areas of prior learning anxiety.ConclusionCategorising self-defined deficits yielded fasctinating information on students' perception of their learning needs and deficits; these data may offer insight into potential deficits in the scope of nationwide psychiatric teaching.We were able to separately identify international students' or professionals' self-defined needs as distinct from UK students and graduates, with further rich data on the potential needs of those entering the NHS workforce.We also evidenced – with data regarding increased confidence, fewer self-defined learning deficits, significant Twitter social interaction, and in practical application of a virtual teaching methodology – proof of the concept of “Psych From The Couch”.
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Pfeiffer, Bock, Hohenberger, and Kröger. "The arteriomobil project for peripheral arterial disease." Vasa 37, no. 4 (November 1, 2008): 345–52. http://dx.doi.org/10.1024/0301-1526.37.4.345.
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Background: Peripheral Arterial Disease in Germany is underestimated with regard to incidence and the consequences. In 1997 the Federal Association of the Peripheral Arterial Disease Self Help Groups started the Arteriomobil Project to increase the awareness for venous and arterial diseases in the general population. We report peripheral arterial disease (PAD) prevalence rates and discuss the unique concept of this project. Patients and methods: The Arteriomobil is a mobile home modified to a simple investigation room with an examination couch, a Doppler equipment and a computer for data acquisition. From April 1997 to April 2007, a total of 14.785 volunteers aged 18 to 102 years (mean age ± SD: 64 ± 11 years, 63% females) were investigated. Patients were recruited as a result of their active visit to the Arteriomobil and their active participation in the investigation. In all participants the medical history was documented according to a standardized computer-assisted interview and a standardized Ankle Brachial Index (ABI) determined. Results: PAD prevalence in females (ABI < 0.9) increased from 2% in the 5th decade of life to 33% in 10th decade and in males from 4.8% to 41% accordingly. Age- and gender-adjusted odds ratios for PAD were highest in smoker: Odds ratio 2.85 (95% Confidence interval 2.5–3.2) and Diabetes mellitus 1.91 (95%CI 1.7–2.2). Hypertension and hypercholesterolemia had a lower impact. Family history of known PAD, CHD or CVD had no impact. Although 49.5% of all participants complained of "leg disorders during exercise" intermittent claudication turned out to be the most discriminating symptom for PAD 5.87 (95%IC 5.18–6.66). Previous myocardial infarction (MI) was the most frequently reported vascular co-morbidity in those with PAD (OR 2.23, 95%IC 1.9–2.7) followed by stroke (2.12, 1.7–2.7), angina pectoris (1.50, 1.3–1.8) and paresis (2.01, 1.6–2.6). The incidence of anti-platelet treatment was significantly higher in participants with coronary heart disease than in those with PAD or cerebrovascular disease. Conclusions: The Arteriomobil Project is the largest database regarding the prevalence of PAD in the German population. and the data underlines the high prevalence of PAD in Germany.
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Anaev, E. Kh. "Modern approaches to the management of patients with bronchoectasia." Russian Pulmonology 30, no. 1 (April 21, 2020): 81–91. http://dx.doi.org/10.18093/0869-0189-2020-30-1-81-91.
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The bronchoectasia (BE) is a chronic heterogeneous lung disease characterized by recurrent infection, inflammation, persistent cough and sputum discharge. The early BE diagnosis is one of the main recommendations of the European Respiratory Society (ERS) guidelines, which requires medical history collection and multispiral computed tomography (MSCT) of thoracic organs. Despite the complex examination, in most patients BE is classified as idiopathic. The minimum set of tests, including serum immunoglobulins, allergic bronchopulmonary aspergillosis tests and hematology is proposed in ERS guideline for detection of BE causes. Other examinations are recommended to perform based on disease history and radiological characteristics, indicating the importance of BE clinical phenotype identification by different healthcare specialists, for which special examinations are required. Initial examination algorithms and management of patients with BE, in particular, MSCT-semiotics and clinical features, which could help to identify specific reasons are presented in the article.
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Enache, Raluca, and Dorin Sarafoleanu. "The chronic cough syndrome." Romanian Journal of Rhinology 6, no. 22 (June 1, 2016): 69–73. http://dx.doi.org/10.1515/rjr-2016-0008.
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Abstract Cough is a common symptom encountered in medical practice and can occur throughout the life of a person. From a physiological point of view, it represents a mechanism responsible for the elimination of secretions from the airways. At the same time, cough may be the first symptom of an illness. There are many causes that may lead to the emergence of a chronic cough syndrome, the most frequent being pulmonary diseases. Besides the bronchopulmonary pathology, there are a number of extrapulmonary disorders that may manifest with coughing. The first step in evaluating the patient with chronic cough is performing a correct and complete anamnesis, followed by the physical examination of the patient. The treatment of the chronic cough syndrome must address mainly the underlying disease but, in case of failure of the established treatment, the antitussive therapy is used.
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Lindsley, William G., William P. King, Robert E. Thewlis, Jeffrey S. Reynolds, Kedar Panday, Gang Cao, and Jonathan V. Szalajda. "Dispersion and Exposure to a Cough-Generated Aerosol in a Simulated Medical Examination Room." Journal of Occupational and Environmental Hygiene 9, no. 12 (December 2012): 681–90. http://dx.doi.org/10.1080/15459624.2012.725986.
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Bhattacharjee, Swapna, Shekhar Bhattacharjee, and Rukhsana Parvin. "Cough Variant Asthma in Medical Outpatient Department of a Tertiary Care Hospital in Bangladesh." Journal of Enam Medical College 3, no. 1 (February 20, 2013): 29–31. http://dx.doi.org/10.3329/jemc.v3i1.13871.
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Background: Cough variant asthma (CVA) is a subset of asthma where the only symptom is chronic persistent cough. Many cases go unrecognized due to lack of proper evaluation. Response to asthma medication with features supportive of airway hypersensitivity helps in management of this disease. Objective: To find out the proportion of cough variant asthma among the patients attending medicine outpatient department of Enam Medical College, Savar, Dhaka. Materials and Methods: This cross sectional study was conducted in Enam Medical College Hospital, Savar, Dhaka over a period of two years from July 2009 to July 2011. Cough variant asthma was diagnosed mainly on clinical ground as chronic cough without wheezing, fever, weight loss, shortness of breath or sputum or any other apparent cause that persisted for more than eight weeks with absolutely normal physical examination of chest, normal chest radiography and blood count except raised eosinophil count and IgE level. Patients who met these criteria were given 2 weeks course of inhaler beclomethasone propionate and were assessed for improvement. Those who improved after steroid inhalation were categorised as having cough variant asthma. Results: Out of purposively selected 148 patients complaining only of chronic dry cough for more than eight weeks, 92 patients met the primary selection criteria for cough variant asthma. These 92 patients were given 2 weeks trial of 250 ìgm beclomethasone inhalation twice daily. Seventy nine patients reported almost complete recovery from chronic cough after 2 weeks and were categorized as having CVA. Thirteen patients did not improve and were not categorized as CVA. Conclusion: These findings suggest that cough variant asthma is the most common among the patients with chronic cough not due to any apparent cause. The efficacy of inhaled corticosteroid suggests that early intervention is effective in the treatment of this disease. DOI: http://dx.doi.org/10.3329/jemc.v3i1.13871 J Enam Med Col 2013; 3(1): 29-31
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Koch, Andrea, and Jürgen Behr. "Husten – Differenzialdiagnosen." DMW - Deutsche Medizinische Wochenschrift 143, no. 17 (August 2018): 1258–71. http://dx.doi.org/10.1055/s-0043-109521.
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AbstractA thorough anamnesis and the physical examination of a patient with cough mostly lead the way to the further diagnostic and therapeutic procedure. As far as there are no obvious reasons for the cough symptoms, any case of persisting chronic cough needs a diagnostic clarification – including computed tomography of the thorax and bronchoscopy as the final step. If clinical findings make them necessary, also invasive diagnostic procedures – such as bronchoscopy, thoracoscopy and surgical biopsy of the lung – must not be avoided. According to the clinical presentation appropriate medical disciplines have to be consulted for the diagnostic clarification of chronic cough. Besides pulmonology und allergology these are ENT medicine, gastroenterology, cardiology, infectiology, neurology and possibly psychiatry. The therapy of chronic and acute cough should be aimed at a causal treatment approach.
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Islam, Md Safiqul, and Md Mahmudur Rahman Siddiqui. "Sarcoidosis - A Case Report." Anwer Khan Modern Medical College Journal 10, no. 1 (October 20, 2019): 92–95. http://dx.doi.org/10.3329/akmmcj.v10i1.43668.
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Sarcoidosis is a chronic granulomatous disorder of unknown etiology, commonly affecting the lungs, skin and eyes. Although lungs and lymph nodes are involved in more than 90% of patients, virtually any organ can be involved. We describe a 36 years old lady presented with fever, skin rashes, cough, polyarthralgia, bodyache, wt. loss for 3 months. Examination revealed Fever, Erythema Nodosum, Cervical Lymphadenopathy. Investigations revealed high ESR (80 mm in 1st hour), high CRP, Hilar Lymphadenopathy on Chest X ray, Non-caseous Granuloma, Giant cell and Asteroid body on Lymph node Biopsy. All of her history, clinical examinations and Investigations are suggestive of Sarcoidosis. With symptomatic treatment and watchful observation, now she is completely symptoms free and leaving a healthy life.
Anwer Khan Modern Medical College Journal Vol. 10, No. 1: Jan 2019, P 92-95
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Widiasmaran, Wulan, Ayu Anggraini Kusumaningrum, Fitri Amalia, and Dimas Tri Anantyo. "BRONKHOPNEUMONIA AS COMORBIDITIES OF CMV INFECTION : STUDY CASE ON 1 YEAR 9 MONTHS OLD BOY." DIPONEGORO MEDICAL JOURNAL (JURNAL KEDOKTERAN DIPONEGORO) 10, no. 1 (January 31, 2021): 55–59. http://dx.doi.org/10.14710/dmj.v10i1.28187.
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Background. Pneumonia is an acute lung parenchyma inflammation, which includes the alveoli and tissues. According to RISKESDAS 2018, pneumonia prevalence of children under five years old in Indonesia has increased from 1.6% in 2013 to 2% in 2018. Cytomegalovirus infection (CMV) is the most common congenital infection and causes high morbidity in newborns. The purpose of this case is to report a case in Semarang and conduct a discussion of pneumonia cases and a history of CMV infection so that proper treatment can immediately start.Method. Anamnesis carried out on February 1, 2020, at Government Hospital in Semarang. Data obtained from allonamnesis with the patient's mother, physical examination, supporting examinations, and medical records of patients. Case. Patient of a boy aged one year nine months that come to the ER with a chief complaint of fever and cough.Discussion. A boy aged one year nine months with fever and cough complaints about five days before entering the hospital. Sputum culture examination revealed the presence of Klebsiella pneumonia, then treated with cefoperazone sulbactam. The patient had a history of cytomegalovirus infection but not optimally treated because of the high avidity value.Conclusion. Patient has diagnosed with bronchopneumonia et causa Klebsiella pneumonia.
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Pimenova, A. S., O. Yu Borisova, M. S. Petrova, N. T. Gadua, A. B. Borisova, L. I. Kafarskaya, and S. S. Afanasiev. "COMPARISON OF RAYON AND FLOCKED SWABS FOR COLLECTION AND TRANSPORT OF DEEP THROAT SWABS FOR DETECTION OF BACTERIA CAUSING WHOOPING COUGH BY MULTIPLEX REAL-TIME PCR ASSAY." Russian Clinical Laboratory Diagnostics 64, no. 8 (October 7, 2019): 493–96. http://dx.doi.org/10.18821/0869-2084-2019-64-8-493-496.
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The aim of the work was to comparison of rayon and flocked swabs for collection and transport of deep throat swabs for detection of bacteria causing whooping cough by multiplex real-time PCR assay. The study included 87 patients aged from 1 month to 37 years, hospitalized in Infectious Diseases Clinical Hospital No. 1 of the Moscow Department of Healthcare. 68 (78,2 %) people had a diagnosis of whooping cough, the main group of which consisted of children aged 1 to 12 months (median 4 months); 17 (19,5 %) - other diseases of the respiratory tract; 2 (2,3 %) - contact with sick whooping cough. The initial examination of patients was carried out on the 1 - 8th week of the onset of the disease. The material from the patients was taken at one-day interval with commercial rayon swabs and flocked swabs. Identification and differentiation of specific genome fragments of the causative agents of whooping cough in biological material was carried out by real-time PCR using the «AmpliSens® Bordetella multi-FL» reagent kit. The efficiency of PCR-based diagnostics of whooping cough using flocked swabs at the preanalytical stage was 83,8 %, and rayon swabs - 82,3 %. The use of a flocked swabs at the preanalytical stage increased the research efficiency by 1,5 %. Thus, when collecting biological material for PCR-based diagnostics of whooping cough it is possible to use flocked swabs.
Dissertations / Theses on the topic "Medical examination couch"
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Sjukriana, Juke, and n/a. "Ergonomics and user inclusivity : developing design critieria and specifications for a medical examination couch." University of Canberra. Industrial Design, 1999. http://erl.canberra.edu.au./public/adt-AUC20061113.160732.
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A medical examination couch is a primary piece of equipment in the health care
delivery system. Unfortunately, the current design of examination couches used
by Australian general and nursing practitioners is inadequate. Incompatibility of
the couches with physical (anthropometric) dimensions and a majority of
medical procedures contribute to risks of Cumulative Trauma Disorders (CTDs)
or musculoskeletal problems among practitioner-users. The inappropriate
height, width and gynaecological attachments of the existing couches also
cause patient discomfort.
This research aimed to develop a new examination couch design in order to
improve practitioners' effectiveness, efficiency, health and safety while
enhancing patient comfort. Ergonomics and user inclusivity were implemented
in the vital stages of the couch development process. Practitioner and patient
surveys, reviews of patient positions, medical procedures and equipment,
Hierarchical Task Analysis (HTA) and an ergonomic analysis of couches in the
Australian market were conducted to develop design criteria. The design
criteria development demonstrated that adjustable height, head, body and foot
sections were the major features, and adjustable gynaecological footpads and
instrument placement (drawers) were the most important attachments. A wide
variety of anthropometric data was applied to the development of design
specifications and adjustments.
To produce a prototype for a new examination couch design developed from
the ergonomic research and initial user surveys, the researcher collaborated
with a medical couch manufacturer, Metron Medical Australia Pty Ltd. Through
this collaboration, the developed criteria and specifications were applied to
actual production processes.
User trials (a focus group, practitioner and patient surveys and personal
communication) were conducted to investigate the effectiveness and efficiency
of the couch prototype in a real clinical environment.
From the trials, modifications to
particular couch features were
identified if they were considered
difficult to operate, unnecessary or
uncomfortable for patients. For
example, the mechanism of the
gynaecological footpads, which
comprised three different adjustment controls, had to be simplified in order to
avoid confusion and time consumption. The footpads had also to be equipped
with straps or half a shoe to increase patient comfort and security.
The collaborating manufacturer will need to adapt the design modifications from
the user trials and conduct more extensive engineering research and value
analysis for a final production couch model. Nevertheless, this research
succesfully demonstrated the significance of ergonomics and user-centred
design in developing design criteria more effectively, detecting usability
problems before the couch is brought to the market, and in saving the
manufacturer's overall product development costs.
Book chapters on the topic "Medical examination couch"
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Zengeya, Stanley Tamuka, and Tiroumourougane V. Serane. "Examination of the respiratory system." In The MRCPCH Clinical Exam Made Simple. Oxford University Press, 2011. http://dx.doi.org/10.1093/oso/9780199587933.003.0012.
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The examination of the respiratory system causes much anxiety among candidates, as many feel the findings are difficult to elicit, particularly in a small child. Just like other systems, having a structured approach makes identification and interpretation of the findings easy. It is important to practise the proper examination technique repeatedly, as this is the best way to improve the skills that are essential to obtain accurate findings. However, the examination itself can be performed in a different sequence depending on the age and the degree cooperation of the child. The examination of the respiratory system is best done in correlation with the available medical history. First, assimilate the available history, which will give an idea of the expected findings and subsequent diagnosis. At the end of the examination, it is important to describe significant findings (table 6.1) with reference to specific surface locations, as shown in figure 6.1. Key competence skills required in examination of the respiratory system are given in table 6.2. These steps are repeated in every system to reiterate their importance and to help you recollect the initial approach of any clinical exam. Also refer to chapter 4. • On entering the examination room, demonstrate your strict adherence to infection control measures by washing your hands or by using alcohol rub. • Introduce yourself both to the parents and the child. • Talk slowly and clearly with a smile on your face. • Establish rapport with the child and parents. • Expose the chest adequately while ensuring their privacy. • Positioning the patient: the child should be undressed appropriately to the waist to allow proper examination. It may be easier to examine an older child when they sit on the edge of the bed, or on a chair. It is preferable to examine younger children on their parent’s lap rather than on a couch separated from the parents, as this can cause much anxiety. Removing a toddler or an infant from his or her parent will most probably yield a screaming child in whom eliciting any physical findings will be virtually impossible.
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Zengeya, Stanley Tamuka, and Tiroumourougane V. Serane. "Examination of the musculoskeletal system." In The MRCPCH Clinical Exam Made Simple. Oxford University Press, 2011. http://dx.doi.org/10.1093/oso/9780199587933.003.0018.
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The musculoskeletal examination, as for other systems, is best done in correlation with the medical history. You may be asked to examine the whole system, the spine, or a single joint. A structured approach is required, both for a screening examination and individual joint examination. Practise a systematic approach for presenting your findings, even if the examination is carried out in a different sequence from the one outlined here. Key competence skills required in the musculoskeletal examination are given in table 12.1. Musculoskeletal cases commonly encountered in the MRCPCH Clinical Exam are listed in table 12.2. Stepwise examination of the musculoskeletal examination is performed as follows: • visual survey (head to toe inspection) • screening examination of the musculoskeletal system: gait, arms, legs, spine (pGALS) • Examination of individual joints (hands and wrists, elbows, shoulders, head and neck, hips, knee, foot and ankle, spine):… • look • feel • move • measurements • assessment of function • joint-specific tests…. These steps are repeated in every system to reiterate their importance and to help you recollect the initial approach of any clinical exam. Also refer to chapter 4. • On entering the examination room, demonstrate strict adherence to infection control measures by washing your hands or by using alcohol rub. • Introduce yourself both to the parents and the child. • Talk slowly and clearly with a smile on your face. • Establish rapport with the child and parents. • Expose adequately while ensuring their privacy. Ideally, the child should be undressed to their underwear. If possible, watch the child undress. • Ask three important questions:… • Do you have pain anywhere? • Can you dress completely without difficulty? • Can you walk up and down the stairs without difficulty?... • Positioning: early in the examination, it is preferable to examine a younger child on their parent’s lap rather than on a couch. Useful information can be obtained by watching the child walk and play. Depending on the joint, examine an older child either in the sitting or lying position.
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Bellsham-Revell, Hannah, Aaron Bell, and Catherine Head. "Late presentation of the Fontan circulation." In Challenging Concepts in Congenital and Acquired Heart Disease in the Young, 29–40. Oxford University Press, 2020. http://dx.doi.org/10.1093/med/9780198759447.003.0003.
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A 16-year-old boy presented to the congenital heart disease department with oedema and chronic cough productive of casts. He had previously undergone Fontan completion for complex congenital heart disease overseas. Examination and basic investigations showed relapsed protein-losing enteropathy and plastic bronchitis, two significant complications of the Fontan circulation. He was extensively investigated, and his medical therapy optimized. Although initially referred for heart transplant assessment, he has been taken off the transplant list after good response to medical therapy alone. This case shows the complex multidisciplinary management of the adolescent Fontan patient with life-threatening complications.
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Sinharay, Rudy. "Chest Medicine." In Oxford Assess and Progress: Clinical Medicine. Oxford University Press, 2019. http://dx.doi.org/10.1093/oso/9780198812968.003.0009.
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Respiratory conditions are common, and the burden of morbidity on the general population is high. You only have to take part in a few general medical takes as a junior doctor to realize this. As the on- call bleep goes off again, you are referred another exacerbation of chronic obstructive pulmonary disease (COPD) or asthma, a breathless patient (is it a pulmonary embolism, pneumothorax, or something less common?), or a patient with haemoptysis and weight loss [is it lung cancer or tuberculosis (TB)?] or productive cough (pneumonia or bronchiectasis?). The number of different respiratory conditions can be bewildering, and it is essential for the developing physician to be able to manage ‘common presentations’, as well as potentially life- threatening situations such as an asthma attack or an acute pulmonary embolism. The nuances of history taking is often key to successfully clinching a diagnosis: ● What chronic conditions, respiratory or otherwise, do your patients have? ● What is the onset of symptoms? Sudden breathlessness may indicate a pneumothorax or pulmonary embolus. A chronic productive cough may indicate COPD or bronchiectasis. ● Social history— do they smoke, what are their living conditions, what is their occupation? Luckily, we have other tools to help us. The age- old art of inspection, palpation, percussion, and auscultation during an examination is essential when assessing the patient. Combined with imaging techniques, including chest radiography, CT scanning, and bedside thoracic ultrasound, the answer is often easily obtained. Keeping an open mind to the less common causes of breathlessness, cough, and haemoptysis is important. Combined with lung function testing, autoimmune blood tests, and bronchoscopy, subtler diagnoses such as interstitial lung disease, fungal lung disease, and autoantibody- induced haemoptysis may be revealed. And a word to the wise— not all breathlessness originates from the lungs! For instance, an increased body mass index will cause a physical restriction on the mechanics of breathing and a compensated metabolic acidosis may cause tachypnoea. As with all chronic diseases, the management of chronic respiratory disease is becoming increasingly complicated with the advent of biologics, immunotherapy, antifibrotic therapy, and a genuinely confusing array of inhalers.
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Colbert, Dom. "The Returned Traveller." In MCQs in Travel Medicine. Oxford University Press, 2012. http://dx.doi.org/10.1093/oso/9780199664528.003.0020.
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Respiratory illness, fever, diarrhoea, and dermatitis are the four most frequent medical problems in the returned traveller. Unexplained fever is the most urgent of these because febrile conditions such as malaria, meningitis, and typhoid can all deteriorate rapidly and become life-threatening. Respiratory infections are also very common and are often viral in origin. A persistent cough or a doubtful CXR warrants further investigation. Diarrhoea that persists may well be helminthic in origin with giardiasis high on the list. In cases already treated with antibiotics one must consider C. difficile infection while the unmasking of inflammatory bowel disease or irritable bowel syndrome is probably more common than supposed. Dermatitis is often due to exacerbation of an existing condition, e.g. psoriasis or eczema. Tropical-related dermatitis is most frequently due to infected arthropod bites. CLM is the main parasitic cause. Exanthems and enanthems occur in a variety of systemic conditions ranging from acute HIV to dengue fever to coxsackie infection. Rashes are seldom diagnostic unless the cause is obvious, e.g. scabies or typhoid (rose spots). In all cases the practitioner should adhere to a strict protocol that involves a good history, careful physical examination, and routine screening and microscopy of blood, urine, and stool. Simple X-rays and ultrasound examination may also be considered. In no case should the practitioner hesitate to refer the patient to a specialist physician. Nowadays computer-assisted diagnosis is becoming more popular and more reliable. The Kabisa Travel System, developed in Antwerp, has been shown to perform equally well with travel physicians in diagnosing the cause of fever in those returned from a tropical environment. Kabisa is the Swaili word for ‘hand in the fire, I am absolutely certain’!
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Tiber, Simon. "Upper and Lower Respiratory Tract Infections." In Tutorial Topics in Infection for the Combined Infection Training Programme. Oxford University Press, 2019. http://dx.doi.org/10.1093/oso/9780198801740.003.0040.
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Pharyngitis is common with incidence peaking from autumn to spring. Respiratory viruses are most commonly implicated, and are generally self-limiting conditions not requiring diagnostic workup or treatment. Bacterial pharyngitis is less common, is spread by droplets or direct transmission, and Streptococcus pyogenes (Group A strep, or GAS) is the most frequent cause. Haemophilus influenzae, Mycoplasma pneumoniae, and Neisseria gonorrhoeae are less frequent causes. Rapid antigen detection tests make the point-of-care assessment of GAS pharyngitis possible, although a negative test does not exclude infection. No method can distinguish oropharyngeal colonization from actual infection, but culture can obtain antibiotic susceptibility testing. Suspicion of infection with Neisseria gonorrhoeae, Bordetella pertussis, Haemophilus influenzae, Mycoplasma pneumoniae, Chlamydophila pneumoniae, or Corynebacterium diptheriae should be communicated to the laboratory so that the appropriate culture media is utilized. The Centor criteria provide a clinical predictive score that can give the likelihood a sore throat is due to a bacterial infection with the following: the presence of tonsillar exudate, tender anterior cervical adenopathy, fever over 38°C, and absence of cough. If three or four of these criteria are met, the positive predictive value is 40% to 60%. The absence of three or four of the Centor criteria has a relatively high negative predictive value of 80%, and may be use to evaluate whether antibiotics can be withheld or deferred. Oral penicillin or macrolide are used to treat streptococcal pharyngitis. Treatment may reduce severity, duration, transmission, and risk of post-infectious sequelae like rheumatic heart disease and post-streptococcal glomerulonephritis. Other complications include scarlet fever, streptococcal toxic shock syndrome, and quinsy. Otitis media, is frequent in the young children, possibly due to a short and horizontal Eustachian tube. Purulent material buils up leading to a bulging, red tympanic membrane which may rupture and discharge. Intense local pain and fevers may occur. Streptococcus pneumoniae, Moraxella catarrhalis, and Haemophilus influenzae are frequently implicated. Frequently there are no sequelae, although complications include hearing impairment, and less common are mastoiditis, bacteraemia, and meningitis. Diagnosis is clinical based on presentation and otoscopic examination. Microbiological diagnosis is possible through culture of exuate on swab or following tympanocentesis.