i. Generalized polyphonic. Asthma, generalized mono-phonic-tracheobronchomalacia.

ii. Localized. Foreign body, lymph node, tuberculosis, Hodgkin or non-Hodgkin lymphoma, sarcoidosis, histo-plasmosis, or coccidioidomycosis.

7. Heart. Check rate and rhythm. Is there increased jugular venous pressure, third heart sound, or gallop, as in congestive heart failure?

8. Extremities. Is there clubbing (bronchiectasis, cystic fibrosis, or hypogammaglobulinemia) or cyanosis (congestive heart failure)?

B. Laboratory Data. Obtain CBC with differential. Check WBCs for leukocytosis with left shift (infectious diseases), lymphocytosis (pertussis), or lymphopenia (immunodeficiency diseases). Low hemoglobin and hematocrit may indicate pulmonary hemosiderosis or chronic infection.

C. Radiographic and Other Studies. Obtain as directed by history and physical exam.

1. Chest x-ray. To study airway, parenchyma, lung volume, diaphragm, and cardiovascular structure. Use lateral film to assess retrocardiac region behind diaphragm.

2. Inspiratory, expiratory, or decubitus films. To rule out foreign body and air trapping.

3. Barium swallow study. To detect swallowing dysfunction, gastroesophageal reflux, congenital anomalies or masses (slings).

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