Kawasaki disease physical examination: Difference between revisions

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{{Kawasaki disease}}
{{Kawasaki disease}}


{{CMG}}; {{AE}}
{{CMG}}; {{AE}} {{SH}}


==Overview==
==Overview==
Patients with [disease name] usually appear [general appearance]. Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].
Physical examination of patients with Kawasaki disease is usually remarkable for erythematous [[rash]], irritability, and [[desquamation]] of skin and mucous membranes.
 
OR
 
Common physical examination findings of [disease name] include [finding 1], [finding 2], and [finding 3].
 
OR
 
The presence of [finding(s)] on physical examination is diagnostic of [disease name].
 
OR
 
The presence of [finding(s)] on physical examination is highly suggestive of [disease name].


==Physical Examination==
==Physical Examination==
* Physical examination of patients with [disease name] is usually normal.
Physical examination of patients with Kawasaki disease is usually remarkable for erythematous [[rash]], irritability, and [[desquamation]] of skin and mucous membranes.<ref name="pmid25822554">{{cite journal |vauthors=Saguil A, Fargo M, Grogan S |title=Diagnosis and management of kawasaki disease |journal=Am Fam Physician |volume=91 |issue=6 |pages=365–71 |date=March 2015 |pmid=25822554 |doi= |url=}}</ref>
OR
*Physical examination of patients with [disease name] is usually remarkable for:[finding 1], [finding 2], and [finding 3].
*The presence of [finding(s)] on physical examination is diagnostic of [disease name].
*The presence of [finding(s)] on physical examination is highly suggestive of [disease name].


===Appearance of the Patient===
===Appearance of the Patient===
*Patients with [disease name] usually appear [general appearance].
* Patients with Kawasaki usually appear [[Fatigue|lethargic]]


===Vital Signs===
===Vital Signs===
 
* High-grade [[fever]]
*High-grade / low-grade fever
{| align="right"
*[[Hypothermia]] / hyperthermia may be present
|[[Image:Kawasaki symptoms F.jpg|thumb|center|500px|Image showing desquamation of the fingers.<ref>Source:commons.wikimedia. org, demonstrates digital desquamation by Kawasaki_symptoms.jpg: Dong Soo Kimderivative work: Natr (talk) - Kawasaki_symptoms.jpg, CC BY 2.0, https://commons.wikimedia.org/w/index.php?curid=12776192</ref>]]
*[[Tachycardia]] with regular pulse or (ir)regularly irregular pulse
|}
*[[Bradycardia]] with regular pulse or (ir)regularly irregular pulse
*Tachypnea / bradypnea
*Kussmal respirations may be present in _____ (advanced disease state)
*Weak/bounding pulse / pulsus alternans / paradoxical pulse / asymmetric pulse
*High/low blood pressure with normal pulse pressure / [[wide pulse pressure]] / [[narrow pulse pressure]]
 
===Skin===
===Skin===
* Skin examination of patients with [disease name] is usually normal.
* [[Erythema]]
OR
* [[Edema]]
*[[Cyanosis]]  
* [[Jaundice]] may or may not be present
*[[Jaundice]]
* [[Desquamation]]
* [[Pallor]]
** May occur on the palms of the hand and soles of the feet, as well as perianally.
* Bruises
* [[Rash]]
 
** Limited to groin and lower limbs
<gallery widths="150px">
** [[Pustules]], [[Macule|macules]], and [[Abscess|pustules]] may be rarely seen
 
* Beau's lines are seen as transverse grooves along finger and toe nails
UploadedImage-01.jpg | Description {{dermref}}
UploadedImage-02.jpg | Description {{dermref}}
 
</gallery>
 
===HEENT===
===HEENT===
* HEENT examination of patients with [disease name] is usually normal.
* [[Strawberry tongue]]
OR
* Fissuring of lips
* Abnormalities of the head/hair may include ___
* Erythematous oropharynx without tonsillar swelling
* Evidence of trauma
* [[Conjunctival injection]]
* Icteric sclera
* High frequency [[sensorineural hearing loss]] may or may not be present
* [[Nystagmus]]  
* Extra-ocular movements may be abnormal
*Pupils non-reactive to light / non-reactive to accommodation / non-reactive to neither light nor accommodation
*Ophthalmoscopic exam may be abnormal with findings of ___
* Hearing acuity may be reduced
*[[Weber test]] may be abnormal (Note: A positive Weber test is considered a normal finding / A negative Weber test is considered an abnormal finding. To avoid confusion, you may write "abnormal Weber test".)
*[[Rinne test]] may be positive (Note: A positive Rinne test is considered a normal finding / A negative Rinne test is considered an abnormal finding. To avoid confusion, you may write "abnormal Rinne test".)
* [[Exudate]] from the ear canal
* Tenderness upon palpation of the ear pinnae/tragus (anterior to ear canal)
*Inflamed nares / congested nares
* [[Purulent]] exudate from the nares
* Facial tenderness
* Erythematous throat with/without tonsillar swelling, exudates, and/or petechiae
 
===Neck===
===Neck===
* Neck examination of patients with [disease name] is usually normal.
*Cervical [[lymphadenopathy]]
OR
**Lymph nodes are greater than 15 mm in diameter
*[[Jugular venous distension]]
*Neck stiffness
*[[Carotid bruits]] may be auscultated unilaterally/bilaterally using the bell/diaphragm of the otoscope
**May indicate [[Meningitis|aseptic meningitis]]
*[[Lymphadenopathy]] (describe location, size, tenderness, mobility, and symmetry)
*[[Thyromegaly]] / thyroid nodules
*[[Hepatojugular reflux]]


===Lungs===
===Lung===
* Pulmonary examination of patients with [disease name] is usually normal.
* [[Pneumonitis]] may be present and is demonstrated by:
OR
**Fine [[crackles]] upon auscultation of the lung apices bilaterally
* Asymmetric chest expansion / Decreased chest expansion
**[[Rhonchi]]
*Lungs are hypo/hyperresonant
**Vesicular breath sounds
*Fine/coarse [[crackles]] upon auscultation of the lung bases/apices unilaterally/bilaterally
**Expiratory/inspiratory [[wheezing]]  
*Rhonchi
*Vesicular breath sounds / Distant breath sounds
*Expiratory/inspiratory wheezing with normal / delayed expiratory phase
*[[Wheezing]] may be present
*[[Egophony]] present/absent
*[[Bronchophony]] present/absent
*Normal/reduced [[tactile fremitus]]


===Heart===
===Heart===
* Cardiovascular examination of patients with [disease name] is usually normal.
* [[Arrhythmias|Arrhythmia]] may or may not be present
OR
* [[Tachycardia]] with regular or irregular [[pulse]]  
*Chest tenderness upon palpation
*PMI within 2 cm of the sternum  (PMI) / Displaced point of maximal impulse (PMI) suggestive of ____
*[[Heave]] / [[thrill]]
*[[Friction rub]]
*[[Heart sounds#First heart tone S1, the "lub"(components M1 and T1)|S1]]
*[[Heart sounds#Second heart tone S2 the "dub"(components A2 and P2)|S2]]
*[[Heart sounds#Third heart sound S3|S3]]
*[[Heart sounds#Fourth heart sound S4|S4]]
*[[Heart sounds#Summation Gallop|Gallops]]
*A high/low grade early/late [[systolic murmur]] / [[diastolic murmur]] best heard at the base/apex/(specific valve region) may be heard using the bell/diaphgram of the otoscope
 
===Abdomen===
===Abdomen===
Abdominal examination of patients with [disease name] is usually normal.
* [[Diarrhea]]
 
* [[Nausea and vomiting|Vomiting]]
OR
* [[Abdominal pain]]  
*[[Abdominal distention]]  
*[[Abdominal tenderness]] in the right/left upper/lower abdominal quadrant
*[[Rebound tenderness]] (positive Blumberg sign)
*A palpable abdominal mass in the right/left upper/lower abdominal quadrant
*Guarding may be present
*[[Hepatomegaly]] / [[splenomegaly]] / [[hepatosplenomegaly]]
*[[Hepatomegaly]] / [[splenomegaly]] / [[hepatosplenomegaly]]
*Additional findings, such as obturator test, psoas test, McBurney point test, Murphy test
===Back===
* Back examination of patients with [disease name] is usually normal.
OR
*Point tenderness over __ vertebrae (e.g. L3-L4)
*Sacral edema
*Costovertebral angle tenderness bilaterally/unilaterally
*Buffalo hump


===Genitourinary===
===Genitourinary===
* Genitourinary examination of patients with [disease name] is usually normal.
* [[Epididymoorchitis|Orchitis]] may be present
OR
*A pelvic/adnexal mass may be palpated
*Inflamed mucosa
*Clear/(color), foul-smelling/odorless penile/vaginal discharge
 
===Neuromuscular===
===Neuromuscular===
* Neuromuscular examination of patients with [disease name] is usually normal.
* [[Facial palsy]] may be present
OR
*Patient is usually oriented to persons, place, and time
* Altered mental status
* Glasgow coma scale is ___ / 15
* Clonus may be present
* Hyperreflexia / hyporeflexia / areflexia
* Positive (abnormal) Babinski / plantar reflex unilaterally/bilaterally
* Muscle rigidity
* Proximal/distal muscle weakness unilaterally/bilaterally
* ____ (finding) suggestive of cranial nerve ___ (roman numerical) deficit (e.g. Dilated pupils suggestive of CN III deficit)
*Unilateral/bilateral upper/lower extremity weakness
*Unilateral/bilateral sensory loss in the upper/lower extremity
*Positive straight leg raise test
*Abnormal gait (describe gait: e.g. ataxic (cerebellar) gait / steppage gait / waddling gait / choeiform gait / Parkinsonian gait / sensory gait)
*Positive/negative Trendelenburg sign
*Unilateral/bilateral tremor (describe tremor, e.g. at rest, pill-rolling)
*Normal finger-to-nose test / Dysmetria
*Absent/present dysdiadochokinesia (palm tapping test)
 
===Extremities===
* Extremities examination of patients with [disease name] is usually normal.
OR
*[[Clubbing]]
*[[Cyanosis]]
*Pitting/non-pitting [[edema]] of the upper/lower extremities
*Muscle atrophy
*Fasciculations in the upper/lower extremity


==References==
==References==
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{{WH}}
{{WH}}
{{WS}}
{{WS}}
[[Category: (name of the system)]]
[[Category:Pediatrics]]
[[Category:Cardiovascular diseases]]
[[Category:Angiology]]
[[Category:Cardiology]]
[[Category:Rheumatology]]
[[Category:Dermatology]]
[[Category:Emergency medicine]]
[[Category:Up-To-Date]]

Latest revision as of 15:55, 18 February 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Dildar Hussain, MBBS [2]

Overview

Physical examination of patients with Kawasaki disease is usually remarkable for erythematous rash, irritability, and desquamation of skin and mucous membranes.

Physical Examination

Physical examination of patients with Kawasaki disease is usually remarkable for erythematous rash, irritability, and desquamation of skin and mucous membranes.[1]

Appearance of the Patient

  • Patients with Kawasaki usually appear lethargic

Vital Signs

Image showing desquamation of the fingers.[2]

Skin

  • Erythema
  • Edema
  • Jaundice may or may not be present
  • Desquamation
    • May occur on the palms of the hand and soles of the feet, as well as perianally.
  • Rash
  • Beau's lines are seen as transverse grooves along finger and toe nails

HEENT

Neck

Lung

  • Pneumonitis may be present and is demonstrated by:
    • Fine crackles upon auscultation of the lung apices bilaterally
    • Rhonchi
    • Vesicular breath sounds
    • Expiratory/inspiratory wheezing

Heart

Abdomen

Genitourinary

Neuromuscular

References

  1. ↑ Saguil A, Fargo M, Grogan S (March 2015). "Diagnosis and management of kawasaki disease". Am Fam Physician. 91 (6): 365–71. PMID 25822554.
  2. ↑ Source:commons.wikimedia. org, demonstrates digital desquamation by Kawasaki_symptoms.jpg: Dong Soo Kimderivative work: Natr (talk) - Kawasaki_symptoms.jpg, CC BY 2.0, https://commons.wikimedia.org/w/index.php?curid=12776192

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