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[DOCX File]Review of Systems
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Other triggers include colds, strong odors or fumes, tobacco smoke, post-nasal drip and acid reflux (GERD). Separating the symptoms from asthma Vocal cord dysfunction is often mistaken for asthma.
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[DOC File]SYMPTOMS - Nusrum
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( ) Hoarseness ( ) Post Nasal Drip ( ) Wheezing ( ) Nasal Blockage ( ) Chronic Cough ( ) Sinus Problems ( ) Bloody Sputum Cardiovascular: ( ) Shortness of breath with activity ( ) Shortness of breath while sleeping ( ) Shortness of breath while laying down ( ) Chest Pain ( ) Fast heat beat ( ) Slow heart beat ( ) Leg swelling
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[DOCX File]VOCAL CORD DYSFUNCTION
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Name: _____Date:_____ Date of Birth:_____ MR# _____ Reason for Visit: _____
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[DOC File]PATIENT INFORMATION - Hudson-Essex Allergy
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Post nasal drip. Chronic bronchitis. Bronchial Asthma. Emphysema. Pneumonia. Pulmonary tuberculosis. Laryngitis. Lung abscess. Medications (ACE inhibitors) Gastroesophageal reflux disease. Left ventricular failure and mitral stenosis. Pulmonary emboli. Irritating particles, chemicals, or gases. Shortness of Breath Dyspnea
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[DOC File]Family Medicine of North Texas
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NONE / hearing loss / ringing / ear pain / change in sense of smell / runny nose / post nasal drip / ... NONE / shortness of breath / cough / coughing up blood / coughing up phlegm / wheezing. Gastrointestinal: NONE / abdominal pain / nausea / vomiting / diarrhea / constipation / heartburn.
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[DOC File]Name__________________________________________________Age ...
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Review of Systems. Check all that apply . Constitutional: Fever. Chills. Night Sweats. Weight loss. Weight Gain. Eyes: Double Vision. Blurry Vision. Cataracts . Glasses
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[DOC File]ALLERGIC RHINITIS
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☐frequent nosebleeds ☐nasal congestion ☐nose/sinus problems ☐rhinorrhea (nasal mucus) ... ☐teeth abnormalities ☐difficulty swallowing ☐post nasal drip ☐hoarseness ☐mouth breathing. ... ☐wheezing ☐shortness of breath ☐hemoptysis ☐sputum production ☐sleep apnea ☐cough.
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[DOCX File]PatientPop
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Nasal and Eye Symptoms: Check the following if they apply to you: ( NONE ( Nasal blockage ( Sneezing ( Post nasal drip ( Itchy nose ( Itchy eyes ( Headache ( Ear problems ( Other: When are you symptomatic: ( Winter ( Spring ( Summer ( Fall. Medications taken and their effects: Suspected or known causes of these symptoms:
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[DOCX File]PatientPop
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NASAL ALLERGY: Yes No Not Sure. ... ⁯Itchy ears ⁯Dizziness ⁯Popping ears ⁯Stuffy nose ⁯Nasal discharge⁯Post nasal drip ... Lungs: ⁯Cough⁯ Shortness of breath ⁯Wheezing ⁯Mucus production ⁯Cough up blood ⁯N/A. Gastrointestinal: ⁯Nausea/vomiting Diarrhea Constipation Heartburn/indigestion Cramps ...
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All That Wheezes is not Asthma
Allergic symptoms include: nasal stuffiness; clear, watery nasal discharge; itchy, watery eyes; post-nasal drip, often with morning sore throats; hoarse voice; sinus headaches; cough; fatigue; and wheezing. Allergy patients may have any or all of these symptoms. Not all patients with allergy-like symptoms have true allergic rhinitis.
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Wheezing and post nasal drip