Postgraduate medicine
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Based on the current literature, the following steps seem reasonable in evaluating a pleural effusion: document the presence, location, and approximate volume of pleural fluid; decide clinically on the likelihood of an exudative effusion; if clinical evaluation suggests an exudative effusion, perform a thoracentesis and obtain fluid for diagnostic evaluation; perform the necessary tests to characterize the effusion as a transudate or an exudate; if a transudate exists, normally do not perform further tests on the effusion; if an exudate exists, perform selected tests to narrow the differential diagnosis; if this evaluation is undiagnostic, consider closed pleural biopsy; if the diagnosis remains unclear after two closed biopsies, consider pleuroscopy with biopsy or open pleural biopsy at the time of a thoracotomy.
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Migraine headaches may be confused with other types of headache, namely, those caused by tension and by organic disorders, but several features often set them apart. For one, migraines are often accompanied by other symptoms, such as nausea and vomiting. ⋯ Treatment can involve such methods as biofeedback, diet, and limitation of exercise, and a number of medications are available for both treatment and prophylaxis. Studies of drug treatment of childhood migraine are few, so clinicians must tailor treatment to the individual case, watching for side effects and limiting the duration of treatment as much as possible.
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Postgraduate medicine · Apr 1986
Acute exanthems in children. Clues to differential diagnosis of viral disease.
The numerous viral skin diseases that affect children present a diagnostic challenge to the clinician. Most of these diseases may be conveniently grouped according to the clinical appearance of the exanthem as maculopapular, petechial, papular, or vesicular. ⋯ Nonviral disease should be considered in the differential diagnosis of a patient with skin eruptions, especially of the maculopapular type. Common nonviral causes include Kawasaki disease, toxic shock syndrome, and drug reactions.