Dextrocardia physical examination: Difference between revisions

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===Appearance of the Patient===
===Appearance of the Patient===
*Patients with dextrocardia usually appear normal but when it is associated with other congenital abnormalities, they may present with cyanosis.
*Patients with dextrocardia usually appear normal but when associated with other congenital abnormalities, they may present with cyanosis.


===Vital Signs===
===Vital Signs===
 
* Vital signs of patients with fibroadenoma are usually normal.
*High-grade / low-grade fever
*[[Hypothermia]] / hyperthermia may be present
*[[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===
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===HEENT===
===HEENT===
* HEENT examination of patients with [disease name] is usually normal.
* HEENT examination of patients with dextrocardia is usually normal.
OR
* Abnormalities of the head/hair may include ___
* Evidence of trauma
* Icteric sclera
* [[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.
* Neck examination of patients with dextrocardia is usually normal.
OR
*[[Jugular venous distension]]
*[[Carotid bruits]] may be auscultated unilaterally/bilaterally using the bell/diaphragm of the otoscope
*[[Lymphadenopathy]] (describe location, size, tenderness, mobility, and symmetry)
*[[Thyromegaly]] / thyroid nodules
*[[Hepatojugular reflux]]


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


===Heart===
===Heart===
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===Abdomen===
===Abdomen===
* Abdominal examination of patients with [disease name] is usually normal.
* Abdominal examination of patients with dextrocardia is usually normal. In dextrocardia with situs inversus, the positions of the abdominal organs are reversed, for example, the stomach positioned on the right side instead of the left.
OR
*[[Abdominal distension]]
*[[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]]
*Additional findings, such as obturator test, psoas test, McBurney point test, Murphy test


===Back===
===Back===
* Back examination of patients with [disease name] is usually normal.
* Back examination of patients with dextrocardia 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.
* Genitourinary examination of patients with dextrocardia is usually normal.
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.
* Neuromuscular examination of patients with dextrocardia is usually normal.
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===

Latest revision as of 17:52, 11 May 2020

Dextrocardia Microchapters

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

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].

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 findings that may be seen in patients with dextrocardia include:[1][2][3]

Appearance of the Patient

  • Patients with dextrocardia usually appear normal but when associated with other congenital abnormalities, they may present with cyanosis.

Vital Signs

  • Vital signs of patients with fibroadenoma are usually normal.

Skin

HEENT

  • HEENT examination of patients with dextrocardia is usually normal.

Neck

  • Neck examination of patients with dextrocardia is usually normal.

Lungs

  • Pulmonary examination of patients with dextrocardia is usually normal.

Heart

  • Prominent apical impulse on the right side of the chest
  • Heart sounds easily audible on the right side of the chest

Abdomen

  • Abdominal examination of patients with dextrocardia is usually normal. In dextrocardia with situs inversus, the positions of the abdominal organs are reversed, for example, the stomach positioned on the right side instead of the left.

Back

  • Back examination of patients with dextrocardia is usually normal.

Genitourinary

  • Genitourinary examination of patients with dextrocardia is usually normal.

Neuromuscular

  • Neuromuscular examination of patients with dextrocardia is usually normal.

Extremities

References

  1. ↑ Arunabha DC, Sumit RT, Sourin B, Sabyasachi C, Subhasis M (2014). "Kartagener's syndrome: a classical case". Ethiop J Health Sci. 24 (4): 363–8. doi:10.4314/ejhs.v24i4.13. PMC 4248037. PMID 25489202.
  2. ↑ Maldjian PD, Saric M (2007). "Approach to dextrocardia in adults: review". AJR Am J Roentgenol. 188 (6 Suppl): S39–49, quiz S35-8. doi:10.2214/AJR.06.1179. PMID 17515336.
  3. ↑ Dilorenzo M, Weinstein S, Shenoy R (2013). "Tetralogy of fallot with dextrocardia and situs inversus in a 7-year-old boy". Tex Heart Inst J. 40 (4): 481–3. PMC 3783122. PMID 24082385.

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