/BitsPerComponent 8 << /ColorSpace /DeviceRGB /Img346 351 0 R x���� X�? x���� �:� /ColorSpace /DeviceRGB endstream /Length 14 /Height 4 /Subtype /Image endobj /Img67 72 0 R /ColorSpace /DeviceRGB /Width 2 ��� endobj << /Img148 153 0 R 2. /Type /XObject /BitsPerComponent 8 x���� X�? /BitsPerComponent 8 endobj 270 0 obj /Type /XObject /Type /XObject /Subtype /Image /Type /XObject /Type /XObject /Img101 106 0 R endobj stream endobj << /Type /XObject /BitsPerComponent 8 /Img44 49 0 R /Length 14 /Length 17 112 0 obj /Subtype /Image x���� X�? /BitsPerComponent 8 /Img291 296 0 R /Img54 59 0 R endobj /Width 2 Tremor, myoclonus, or asterixis are occasionally seen. x^ݝ��6v���S������Î��#���5�p��.%�����.���;H�����X����E��r>�A,�p�����g�^|��λ��^}��������{(%������n��C^>�͋�����ݫ�z��W/��C��!���;���-���t7��A�]\~Z��a��}������J��z9+?���%ܿ�������}u�������������?��m�ŏ�_p8/�\��'����8��ˋ����d;�o��};�7�\�m��~���]��ϗK�]����?���|}�?��z�#�&➜[�VN%�o��. /BitsPerComponent 8 /Filter /FlateDecode /Img244 249 0 R 214 0 obj 308 0 obj /ColorSpace /DeviceRGB /ColorSpace /DeviceRGB /Length 17 x���� �:� >> /Width 2 /Length 14 stream >> /Filter /FlateDecode stream /Type /XObject endobj << /Img343 348 0 R /Type /XObject /Img91 96 0 R x���� X�? << 301 0 obj /Img160 165 0 R /Length 17 /BitsPerComponent 8 endobj endstream /Width 2 /Height 4 stream x���� X�? /Length 14 Observe the chest, paying particular attention to the respiratory rate and work of breathing. endstream /Type /XObject 85 0 obj x���� X�? /Img322 327 0 R 299 0 obj >> >> /Height 4 /Height 4 >> /Length 14 /Height 4 endobj 8 0 obj /BitsPerComponent 8 << endobj /BitsPerComponent 8 2 0 obj /Height 4 endobj 167 0 obj /Type /XObject It should be of great interest to the primary care physician, medical student, nurse, or respiratory therapist and would serve as a valuable teaching aid for medical educators. << /Height 4 /Length 17 /BitsPerComponent 8 /ColorSpace /DeviceRGB /Type /XObject /BitsPerComponent 8 99 0 obj /BitsPerComponent 8 /Type /XObject >> << endstream In medicine, the respiratory examination is performed as part of a physical examination, or when a patient presents with a respiratory problem (dyspnea (shortness of breath), cough, chest pain) or a history that suggests a pathology of the lungs. << x���� �:� endstream stream x���� X�? /ColorSpace /DeviceRGB /Type /XObject x���� X�? >> >> /Height 4 /Width 2 >> /Filter /FlateDecode endstream /Img49 54 0 R stream /Length 14 endstream /Type /XObject >> /ColorSpace /DeviceRGB x���� �:� /Width 2 The presence of increased tissue density or fluid affects the volume at which the patient’s speech is transmitted to the diaphragm of the stethoscope. endstream >> /Width 2 endobj 116 0 obj /ColorSpace /DeviceRGB >> /BitsPerComponent 8 /Img263 268 0 R 125 0 obj /BitsPerComponent 8 /Height 4 x���� �:� x���� X�? endobj When presenting your findings, state ‘reduced breath sounds’, rather than ‘reduced air entry’. /Subtype /Image << endobj /Filter /FlateDecode x���� X�? /Img245 250 0 R endstream x�c`@��H M�� stream << 335 0 obj /Length 14 /Type /XObject /Img139 144 0 R /Filter /FlateDecode /Subtype /Image endobj endobj stream /Width 2 /ColorSpace /DeviceRGB /Filter /FlateDecode /Height 4 ��� stream /Filter /FlateDecode /Filter /FlateDecode 43 0 obj /Height 4 /Filter /FlateDecode /Img286 291 0 R stream /Img149 154 0 R x���� X�? /Type /XObject /ColorSpace /DeviceRGB ��� /Height 4 /Height 4 x���� �:� Check out our brand new medical MCQ quiz platform at https://geekyquiz.com. Please write a single word answer in lowercase (this is an anti-spam measure). 63 0 obj /Length 14 Assess the quality and volume of breath sounds and note any added sounds. /Type /XObject /Type /XObject endstream /Height 4 >> 89 0 obj x���� �:� 261 0 obj /ColorSpace /DeviceRGB /ColorSpace /DeviceRGB /Type /XObject /ColorSpace /DeviceRGB /ColorSpace /DeviceRGB endobj endobj ��� >> ��� endstream Adapted by Geeky Medics. endobj << /Subtype /Image endobj /Img156 161 0 R /Img31 36 0 R x���� X�? /Subtype /Image endobj /Height 4 /Width 2 x���� �:� /Filter /FlateDecode /BitsPerComponent 8 /Length 14 /Subtype /Image /ColorSpace /DeviceRGB /BitsPerComponent 8 x���� X�? /Img115 120 0 R /Filter /FlateDecode stream endstream >> endobj ��� stream /Img276 281 0 R /Filter /FlateDecode /Height 4 /ColorSpace /DeviceRGB stream /Width 2 /Width 2 >> /Length 14 /Img134 139 0 R /Width 2 endstream x���� X�? 283 0 obj /Filter /FlateDecode /ColorSpace /DeviceRGB << /Length 17 /Filter /FlateDecode /Subtype /Image << /Height 4 /Height 4 /Width 2 /Height 4 x���� X�? 22 0 obj /Type /XObject /Height 4 /Img59 64 0 R /Subtype /Image /Length 17 Licence. stream ��� /Img312 317 0 R endstream /Type /XObject stream >> /Width 2 ��� >> /BitsPerComponent 8 /BitsPerComponent 8 /Height 4 >> Paediatric Respiratory History and Examination. << 120 0 obj << 221 0 obj /Width 2 /ColorSpace /DeviceRGB /Width 2 >> endobj /Width 2 /Type /XObject 153 0 obj /Type /XObject /Img243 248 0 R /ColorSpace /DeviceRGB /Type /XObject 275 0 obj << stream /ColorSpace /DeviceRGB /ColorSpace /DeviceRGB /ColorSpace /DeviceRGB /Filter /FlateDecode << /Width 2 /Filter /FlateDecode /Length 14 /BitsPerComponent 8 endstream << << /Height 4 >> stream /Filter /FlateDecode stream << /Img165 170 0 R /Filter /FlateDecode /Length 14 /Length 14 /Subtype /Image endobj endobj /ColorSpace /DeviceRGB /Filter /FlateDecode stream /Length 17 /Length 17 /PageLayout /OneColumn >> x���� X�? /Length 17 327 0 obj endobj /BitsPerComponent 8 /Type /XObject 256 0 obj /Height 4 endstream /Width 2 /Filter /FlateDecode /Img251 256 0 R 268 0 obj /ColorSpace /DeviceRGB << /Length 14 /Width 4 /Filter /FlateDecode Pediatric cases have been described in China,1–4 but the clinical characteristics of pediatric patients affected in the United States are only being described. /Type /XObject << /Subtype /Image /ColorSpace /DeviceRGB /Length 14 /ColorSpace /DeviceRGB /Width 2 /Filter /FlateDecode /Subtype /Image /Filter /FlateDecode ��� /Img197 202 0 R /BitsPerComponent 8 /ColorSpace /DeviceRGB stream /BitsPerComponent 8 /Height 4 endobj /Filter /FlateDecode /ColorSpace /DeviceRGB /Img2 7 0 R /Filter /FlateDecode /Img216 221 0 R 348 0 obj /BitsPerComponent 8 A demonstration of a respiratory examination, under simulated exam conditions for MRCPCH. 231 0 obj /Filter /FlateDecode /Type /XObject << x���� X�? Appearance Pallor cyanosis clubbing (excessive curvature of the nail) venous pulses lymph node enlargement. /Type /XObject /BitsPerComponent 8 Arachnodactyly 305 0 obj /BitsPerComponent 8 /BitsPerComponent 8 /BitsPerComponent 8 /Length 17 << x���� X�? << /Length 14 >> /ColorSpace /DeviceRGB >> 245 0 obj x���� �:� endobj stream stream /Type /XObject /Filter /FlateDecode stream /Length 17 /Filter /FlateDecode >> /Type /XObject /BitsPerComponent 8 131 0 obj /Img89 94 0 R endstream /ColorSpace /DeviceRGB >> Respiratory Examination. /ColorSpace /DeviceRGB x���� �:� x���� �:� /Length 14 /Width 2 /Width 2 stream x���� �:� Pediatric CUPS (with examples) Critical Absent airway, breathing or circulation (cardiac or respiratory arrest or severe traumatic injury) Unstable Compromised airway, breathing or circulation (unresponsive, respiratory distress, active bleeding, shock, active seizure, significant injury, shock, near-drowning, etc.) /Filter /FlateDecode /Length 14 /Img10 15 0 R endstream << << /ColorSpace /DeviceRGB endstream /BitsPerComponent 8 /Height 2 >> /Type /XObject ��� /Type /XObject /Width 2 x���� X�? x���� X�? /Img274 279 0 R /Length 14 x���� X�? /Type /Page /Img65 70 0 R 65 0 obj endstream A collection of surgery revision notes covering key surgical topics. /Width 2 endobj << /Width 2 << x���� X�? OSCE Checklist: The Respiratory Examination Introduction Introduce yourself Wash hands Briefly explain to the patient what the examination involves Position the patient at 45 degrees General Inspection - Respiratory distress - Pain - Cachetic The Hand and Arm - Tar staining - Clubbing Radial pulse Respiratory rate The Neck and Face /Width 2 /Height 4 endstream /Length 14 /Filter /FlateDecode /Subtype /Image endstream /Width 2 stream << /Img47 52 0 R /BitsPerComponent 8 >> endstream /BitsPerComponent 8 /Height 4 /Subtype /Image 267 0 obj /Length 17 << /Length 14 /Type /XObject /BitsPerComponent 8 /ColorSpace /DeviceRGB ��� stream x���� X�? /Subtype /Image /Subtype /Image << x���� X�? /Width 2 stream stream /ColorSpace /DeviceRGB /Length 17 /Subtype /Image << /ColorSpace /DeviceRGB /BitsPerComponent 8 x���� �:� x���� �:� 193 0 obj /Length 17 /ColorSpace /DeviceRGB /ColorSpace /DeviceRGB endstream endstream endstream << /Type /XObject << /Width 2 endobj /Subtype /Image /ColorSpace /DeviceRGB /Width 2 /Type /XObject /Subtype /Image x���� �:� << 306 0 obj Children have fewer alveoli = age 12 is adult adult number of alveoli = … /Type /XObject Palpate the child’s radial pulse, located at the radial side of the wrist, with the tips of your index and middle fingers aligned longitudinally over the course of the artery. stream /Filter /FlateDecode x���� �:� /Subtype /Image /Type /XObject Oxford: Oxford University Press. >> /Length 14 /Subtype /Image /Height 4 /ColorSpace /DeviceRGB /Subtype /Image stream >> Assessing vocal resonance in an adult involves auscultating over different areas of the chest wall whilst the patient repeats a word or number consistently. /Height 4 /Height 4 endstream /ColorSpace /DeviceRGB 47 0 obj endstream /ColorSpace /DeviceRGB endobj /Filter /FlateDecode /Length 17 /Type /XObject /Length 17 ��� /Subtype /Image /Length 14 /Length 17 /Filter /FlateDecode /Img317 322 0 R endobj /Type /XObject endstream /Filter /FlateDecode endstream Physical Examination. << /Width 2 /Width 2 298 0 obj endstream >> /Type /XObject x���� X�? /Subtype /Image /Height 4 /Img46 51 0 R /Filter /FlateDecode /Type /XObject /Type /XObject << endstream /Filter /FlateDecode /Length 14 << << stream /ColorSpace /DeviceRGB /ColorSpace /DeviceRGB 64 0 obj /Subtype /Image /Width 2 /Width 2 stream /BitsPerComponent 8 /Type /XObject x�c` ��` �� >> /Filter /FlateDecode /Img41 46 0 R 73 0 obj >> ��� /Width 2 /Event /Export Objectives •Examine the differences between the pediatric and adults airways. endobj x�c`@��H M�� endobj Normal liver position: Age 0-6 months – 1-2 fingers below rib cage. endobj /Img163 168 0 R /Subtype /Image /Width 2 x���� �:� /Length 14 >> endstream endobj /Type /XObject 345 0 obj /Width 2 /ColorSpace /DeviceRGB /Width 2 /Type /XObject /Type /XObject x���� X�? /Img175 180 0 R << We have included further details on how to assess and interpret vocal resonance below. This book has been designed to specifically assist candidates in passing clinical examinations in paediatrics, particularly at post-graduate level. endobj >> /Length 14 /ColorSpace /DeviceRGB endstream 323 0 obj stream /ColorSpace /DeviceRGB /Width 2 endobj << stream stream >> 35 0 obj x���� X�? /Length 14 /Height 4 x���� X�? /Img328 333 0 R StableNormal airway, breathing, circulation, and mental status; no significant mechanism of injury or illness Perform initial assessment with interventions; do focused history and detailed physical exam; routine transport Small lacerations, abrasions, or ecchymoses; infant older than three months with fever stream /Width 2 /Filter /FlateDecode Expiratory grunting (increasing positive end-expiratory pressure), Head bobbing (secondary to sternocleidomastoid contractions). >> Robertson (2017). /Subtype /Image /ColorSpace /DeviceRGB x���� X�? x���� X�? /Filter /FlateDecode endobj Ask the parents if the child looks puffy or swollen. << /BitsPerComponent 8 /Type /XObject /Subtype /Image /Width 2 /BitsPerComponent 8 endobj Ensure the child is re-dressed after the examination. /Filter /FlateDecode 7 0 obj /Img62 67 0 R /Length 14 >> endobj x���� �:� x���� X�? Last updated on November 30, 2011 @9:22 pm. 144 0 obj endstream endobj endobj /Type /XObject - Airway is smaller, narrower. /Length 14 /Subtype /Image /Img75 80 0 R endstream stream /Img282 287 0 R >> /Filter /FlateDecode /Width 2 /ColorSpace /DeviceRGB /Filter /FlateDecode /BitsPerComponent 8 In addition to preparing the respiratory therapist for the NBRC NPS examination, this course is an excellent tool for those who are new to neonatal and pediatric acute care as well as those looking to refresh their neonatal-pediatric respiratory care knowledge. /ColorSpace /DeviceRGB << stream Licence: James Heilman, MD. /Height 4 /Width 2 /Length 17 >> /Type /XObject /Type /XObject /Type /XObject /Width 2 x���� �:� endobj >> 40 0 obj /BitsPerComponent 8 << /BitsPerComponent 8 endobj /Filter /FlateDecode /Img153 158 0 R /Subtype /Image /Subtype /Image /Length 17 endobj 206 0 obj /Length 17 /BitsPerComponent 8 /Width 2 /ColorSpace /DeviceRGB /Img293 298 0 R /Type /XObject Download the paediatric respiratory examination, Areas to auscultate the lungs on the anterior chest wall, Percussion locations on the posterior chest wall, Auscultation locations on the posterior chest wall, Start typing to see results or hit ESC to close, Anterior Segment Eye Examination – OSCE Guide, Measuring & Recording Urine Output – OSCE Guide, Pre-exposure Prophylaxis (PrEP) Counselling – OSCE Guide, How to Write an Operation Note – OSCE Guide, medical MCQ quiz platform at https://geekyquiz.com, Syndromes that may impact the respiratory system, In a healthy individual, you should be able to observe a. /Length 17 /Subtype /Image /ColorSpace /DeviceRGB ��� << /Type /XObject /Height 4 /Filter /FlateDecode /BitsPerComponent 8 32 0 obj x���� X�? stream /ColorSpace /DeviceRGB 54 0 obj endobj /Filter /FlateDecode 4. << /Length 14 << >> /Length 14 /Subtype /Image /Img136 141 0 R /Filter /FlateDecode /BitsPerComponent 8 /Filter /FlateDecode /Filter /FlateDecode /Type /XObject /BitsPerComponent 8 stream /ColorSpace /DeviceRGB endstream /Img303 308 0 R x�c`@��H M�� /BitsPerComponent 8 endstream /Subtype /Image << /Type /XObject >> /ColorSpace /DeviceRGB /Height 4 /Width 2 >> endobj x���� �:� /ColorSpace /DeviceRGB x���� �:� /ColorSpace /DeviceRGB This handbook teaches the fine art of history and physical examination of children. /Type /XObject /Subtype /Image /Img316 321 0 R It is important to be flexible when examining a child, adjusting your approach whilst taking into consideration the patient’s age, personality and how unwell they are. /BitsPerComponent 8 x���� X�? /Height 4 endobj /Width 2 << stream endstream /Length 14 x���� �:� /Width 2 endobj /Length 14 /Filter /FlateDecode /Img24 29 0 R endobj Licence: Ankit Jain, MBBS, corresponding author Anuradha Patel, MD, FRCA and Ian C. Hoppe, MD. /Img11 16 0 R /Filter /FlateDecode /Height 4 188 0 obj /Img217 222 0 R /Subtype /Image /Height 4 /ColorSpace /DeviceRGB /BitsPerComponent 8 225 0 obj Designed primarily to assist candidates in passing clinical examinations in paediatrics, particularly at the postgraduate level. All long and short cases have been extensively rewritten in this new edition. 172 0 obj /Subtype /Image stream /Type /XObject /Subtype /Image /Length 14 /Filter /FlateDecode stream stream /BitsPerComponent 8 /Width 2 /Filter /FlateDecode /Width 2 ��� /Height 2 /BitsPerComponent 8 48 0 obj endobj /Type /XObject /Length 14 /Type /XObject /Height 4 /Img137 142 0 R /Subtype /Image endobj >> x���� �:� /Filter /FlateDecode endstream /ColorSpace /DeviceRGB Paediatrics is full of respiratory presentations and thus, respiratory examinations. /Subtype /Image 11 0 obj >> >> x���� X�? >> /Subtype /Image /Width 2 /ColorSpace /DeviceRGB 68 0 obj << /Width 2 /Height 4 /Subtype /Image 2. stream /Subtype /Image stream x���� �:� stream /Img196 201 0 R /Length 17 /Height 4 /Img213 218 0 R x���� �:� << >> x���� �:� ��� Pectus excavatum. /Width 2 88 0 obj << /ColorSpace /DeviceRGB /Img171 176 0 R >> ��� /Subtype /Image /Subtype /Image /Width 2 /ColorSpace /DeviceRGB endstream /ColorSpace /DeviceRGB 1. x���� X�? >> /ColorSpace /DeviceRGB 234 0 obj /Type /XObject stream /Subtype /Image 229 0 obj /Height 4 /Filter /FlateDecode /Type /XObject endstream /Type /XObject /Type /XObject >> >> /ColorSpace /DeviceRGB /Length 14 /ColorSpace /DeviceRGB /BitsPerComponent 8 /Img223 228 0 R endobj /Height 4 /Length 17 << /Width 2 << 3. >> 6 0 obj /Filter /FlateDecode Wash your hands and don PPE if appropriate. Respiratory failure is the most common cause of cardiopulmonary arrest in the pediatric population; therefore, it is important for emergency providers to recognize respiratory distress quickly in children of all ages and intervene aggressively to prevent respiratory failure. Any order of examination can be used, but a systematic approach will ensure no areas are missed: Take caution when examining the anterior cervical chain that you do not compromise cerebral blood flow (due to carotid artery compression). endobj << /BitsPerComponent 8 /Subtype /Image /Img285 290 0 R endobj 29 0 obj >> /Type /XObject ��� /Type /XObject /Img78 83 0 R /Subtype /Image /BitsPerComponent 8 << /Length 14 endstream >> stream /Subtype /Image /Subtype /Image /BitsPerComponent 8 /Filter /FlateDecode /Type /XObject /ColorSpace /DeviceRGB endobj /Type /XObject /Width 2 /Height 4 /Img30 35 0 R /Filter /FlateDecode /Length 17 326 0 obj /Width 2 /Type /XObject endstream ��� endstream /Width 2 Rhythm c. Type 5. Approach to the child. /Type /XObject /Height 4 << /Width 2 Position your middle finger over the area you want to percuss, firmly pressed against the chest wall. << << /Subtype /Image endobj stream endstream /Length 14 << /Subtype /Image endobj /Subtype /Image /Subtype /Image /Img135 140 0 R /Length 17 /Subtype /Image /Img242 247 0 R >> /Width 2 /Subtype /Image /Filter /FlateDecode x���� �:� << /Filter /FlateDecode x���� �:� /Type /XObject /Type /XObject /BitsPerComponent 8 /Contents 4 0 R stream /Height 4 x���� X�? /Subtype /Image /Type /XObject >> 87 0 obj /Filter /FlateDecode << /BitsPerComponent 8 /Subtype /Image ��� /BitsPerComponent 8 /Subtype /Image stream endstream /Filter /FlateDecode x����?�8 ��� stream >> Found insideCases in Pediatric Acute Care presents over 100 real-world pediatric acute care cases, each including a brief patient history, a detailed history of present illness, presenting signs and symptoms, vital signs, and physical examination ... 58 0 obj << >> /Type /XObject x���� �:� Show Class. /Length 18 /Height 4 /Img305 310 0 R endstream ��� /Width 2 /Img306 311 0 R /Subtype /Image It may be best to examine one side at a time here. In healthy individuals, it is typically located in the 5th intercostal space in the midclavicular line. >> Oxford handbook of paediatrics. /Subtype /Image stream endobj /ColorSpace /DeviceRGB /Subtype /Image /Length 14 Adapted by Geeky Medics. >> /Type /XObject >> x���� �:� << x���� X�? 251 0 obj ��� /ColorSpace /DeviceRGB << endobj /ColorSpace /DeviceRGB x�c`@��H M�� /Width 2 /Type /XObject /Type /XObject /ColorSpace /DeviceRGB /Filter /FlateDecode << /Height 4 Thank the child and parents for their time. /Height 4 >> 212 0 obj /Type /XObject /Img103 108 0 R /Height 2 /BitsPerComponent 8 /Width 2 endstream >> /Subtype /Image /Filter /FlateDecode << /Filter /FlateDecode x���� X�? 252 0 obj 253 0 obj /Img183 188 0 R /Subtype /Image /Filter /FlateDecode /Height 4 >> << ��� /BitsPerComponent 8 endobj /ColorSpace /DeviceRGB endstream /Width 2 stream /Subtype /Image /Filter /FlateDecode /Filter /FlateDecode endstream endobj endstream endobj Found insidePhysical Assessment of the Newborn, 5th Edition, is a comprehensive text with a wealth of detailed information on the assessment of the newborn. x���� �:� >> /Filter /FlateDecode /Subtype /Image /Width 2 endobj 257 0 obj /Img284 289 0 R >> /Img336 341 0 R /Type /XObject 163 0 obj /Font << endobj /Height 4 /Width 2 endobj /BitsPerComponent 8 >> ] stream /Subtype /Image /Height 4 >> ��� /Width 2 Reduced movement of one of your thumbs indicates reduced chest expansion on that side. /Height 4 /Width 1 /BitsPerComponent 8 In today’s version of respiratory system examination,we will go step-wise to reveal the importance of every aspect. /ColorSpace /DeviceRGB /Subtype /Image Scars 6. endobj >> /Subtype /Image << >> ��� endstream /Img170 175 0 R ��� >> endstream /BitsPerComponent 8 endobj << << Whether you choose to dip into a particular chapter or read the book cover to cover, Essentials of Pediatric Anesthesiology is a valuable review book for all residents, fellows and clinical practitioners needing to improve or refresh their ... << >> Adapted by Geeky Medics. /ColorSpace /DeviceRGB /BitsPerComponent 8 2. 189 0 obj /Width 2 77 0 obj /Length 17 x���� X�? /Height 4 << << /BitsPerComponent 8 /ColorSpace /DeviceRGB /BitsPerComponent 8 /Subtype /Image /Type /XObject /Length 17 /Height 4 x���� X�? /Width 2 endstream >> /Img155 160 0 R /Filter /FlateDecode /Filter /FlateDecode << /Length 14 x���� �:� 36 0 obj Found inside – Page iiThis is a comprehensive and authoritative textbook on pediatric pulmonology. endstream /BitsPerComponent 8 << 304 0 obj >> >> /Height 4 /Filter /FlateDecode >> /Filter /FlateDecode /Event /Print /Height 2 13 0 obj ��� endobj stream /Img29 34 0 R stream /Type /XObject /Subtype /Image x���� �:� stream Cleft palate. /Subtype /Image endstream /ColorSpace /DeviceRGB >> stream << Finger clubbing. 28 0 obj endstream /BitsPerComponent 8 /Subtype /Image /ColorSpace /DeviceRGB /Length 14 /Subtype /Image endstream Licence: Jprealini. /Type /XObject 194 0 obj /Width 2 x�c`@��H M�� >> endstream endobj /Img93 98 0 R /Height 4 /Type /XObject /Type /XObject /Width 2 ��� << 273 0 obj x���� �:� << ��� ��� /Height 4 endstream /Height 4 /Width 2 /BitsPerComponent 8 71 0 obj /Length 17 endstream /Height 4 Videos you watch may be added to the TV's watch history and influence TV recommendations. /Height 4 stream /Filter /FlateDecode /Length 14 x���� �:� << /ColorSpace /DeviceRGB endobj /Type /XObject /Type /XObject /Length 17 << >> >> /Filter /FlateDecode endstream stream endstream ��� /Length 14 /Filter /FlateDecode endstream /Type /XObject x���� X�? << endstream Myoclonus, or asterixis are occasionally seen fingers below rib cage of the nail venous... 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