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Examination can direct subsequent diagnostic testing for acute and persistent cough Pneumonia is suspected when acute cough is accompanied by vital sign abnormalities (tachycardia, tachypnea, fever) or findings suggestive of airspace consolidation (rales, decreased breath sounds, fremitus, egophony) Although purulent sputum is associated with bacterial infections in patients with structural lung disease (eg, chronic obstructive pulmonary disease [COPD]; cystic fibrosis), it is a poor predictor of pneumonia in the otherwise healthy adult In addition, antibiotic treatment of adults with purulent sputum production shows no benefit Wheezing and rhonchi are frequent findings in adults with acute bronchitis and do not represent adult-onset asthma in most cases Physical examination of adults with persistent cough may also reveal evidence of chronic sinusitis, contributing to postnasal drip syndrome or asthma Chest and cardiac signs may distinguish COPD from CHF In patients with cough and dyspnea, a normal match test (ability to blow out a match from 25 cm away) and maximum laryngeal height > 4 cm (measured from the sternal notch to the cricoid cartilage at end expiration) substantially decrease the likelihood of COPD Similarly, normal jugular venous pressure and negative hepatojugular reflux decrease the likelihood of biventricular CHF

Figure 2 1 Revised pneumonia probabilities based on history and physical examination findings (Reproduced, with permission, from Metlay JP et al Testing strategies in the initial management of patients with community-acquired pneumonia Ann Intern Med 2003 Jan 21;138(2):109 18)

Either a sensation of motion when there is no motion or an exaggerated sense of motion in response to a given bodily movement Duration of discrete vertiginous events is key to diagnosis Must differentiate peripheral from central etiologies of vestibular dysfunction Peripheral: Onset is sudden; often associated with tinnitus and hearing loss; horizontal nystagmus may be present Central: Onset is gradual; no associated auditory symptoms Evaluation includes audiogram and electronystagmography (ENG) or videonystagmography (VNG)

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accessed items such as applications, documents, and other information. It also aids in maneuvering between running applications.1 You add items by dragging their icons to the Dock; you remove items by dragging them off the Dock. Clicking an icon will bring it to the foreground, launching it first if it is not already running. A triangle next to an application icon indicates that the application is running. The Dock also holds the familiar Macintosh Trash icon, which collects files waiting to be deleted from the system. You can customize the Dock s appearance and behavior through the System Preference program, located in /Application.

The Stack is the natural partner of the Queue. A stack is a last-in, first-out (LIFO) collection, so the items are removed in the opposite of the order in which they were added. Think of a stack as a stack of dishes at a buffet table, or a stack of coins on your desk. You add a dish on top, and that s the first dish you take off the stack. You ve already seen a form of stack in 9, when we described the call stack. Each time you call a method, it s added to the top of the call stack. When a method returns, it s removed from the top of the stack. The principal methods for adding to and removing from a stack are Push( ) and Pop( ); these method names are nonintuitive, but they re traditional with stacks. Push( ) adds an item to the stack, and Pop( ) removes it. Stack also offers a Peek( ) method, very much like Queue. The significant methods and properties for Stack are shown in Table 14-4.

Vertigo is the cardinal symptom of vestibular disease It is either a sensation of motion when there is no motion or an

Laboratory investigations such as audiologic evaluation, caloric stimulation, ENG or VNG, and MRI are indicated in patients with persistent vertigo or when central nervous system disease is suspected These studies will help distinguish between central and peripheral lesions and to identify causes requiring specific therapy ENG consists of objective recording of the nystagmus induced by head and body movements, gaze, and caloric stimulation It is helpful in quantifying the degree of vestibular hypofunction and may help with the differentiation between peripheral and central lesions Computer-driven rotatory chairs and posturography platforms offer additional diagnostic modalities from specialized centers

Brandt T et al General vestibular testing Clin Neurophysiol 2005 Feb;116(2):406 26 [PMID: 15661119] Guilemany JM et al Clinical and epidemiological study of vertigo at an outpatient clinic Acta Otolaryngol 2004 Jan;124(1):49 52 [PMID: 14977078] Lempert T et al Episodic vertigo Curr Opin Neurol 2005 Feb;18(1):5 9 [PMID: 15655395]

Count Clear( ) Contains( ) CopyTo( ) GetEnumerator( ) Peek( ) Pop( ) Push( ) ToArray( )

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