Polycystic kidney disease physical examination: Difference between revisions

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{{Polycystic kidney disease}}
{{Polycystic kidney disease}}
{{CMG}} {{AE}} [[User:Sergekorjian|Serge Korjian]],[[User:YazanDaaboul|Yazan Daaboul]]
{{CMG}}; {{AE}}{{MKA}}, [[User:Sergekorjian|Serge Korjian]],[[User:YazanDaaboul|Yazan Daaboul]]


==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].
Patients with polycystic kidney disease usually are in discomfort. Physical examination of patients with polycystic kidney disease is usually remarkable for [[hypertension]], [[jaundice]], [[pallor]], icteric [[sclera]], [[palpable]] [[nodular]] [[hepatomegaly]], [[palpable]] [[flank]] [[mass]].  
 
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 polycystic kidney disease is usually remarkable for [[hypertension]], [[jaundice]], [[pallor]], icteric [[sclera]], [[palpable]] [[nodular]] [[hepatomegaly]], [[palpable]] [[flank]] [[mass]].<ref name="pmid8321262">{{cite journal| author=Gabow PA| title=Autosomal dominant polycystic kidney disease. | journal=N Engl J Med | year= 1993 | volume= 329 | issue= 5 | pages= 332-42 | pmid=8321262 | doi=10.1056/NEJM199307293290508 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8321262 }} </ref><ref name="pmid17434405">{{cite journal| author=Torres VE, Harris PC, Pirson Y| title=Autosomal dominant polycystic kidney disease. | journal=Lancet | year= 2007 | volume= 369 | issue= 9569 | pages= 1287-301 | pmid=17434405 | doi=10.1016/S0140-6736(07)60601-1 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17434405 }} </ref><ref name="pmid26413277">{{cite journal |vauthors=Baker A, King D, Marsh J, Makin A, Carr A, Davis C, Kirby C |title=Understanding the physical and emotional impact of early-stage ADPKD: experiences and perspectives of patients and physicians |journal=Clin Kidney J |volume=8 |issue=5 |pages=531–7 |date=October 2015 |pmid=26413277 |pmc=4581379 |doi=10.1093/ckj/sfv060 |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 polycystic kidney disease usually are in discomfort


===Vital Signs===
===Vital Signs===
 
*[[Hypertension]]
*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===
* Skin examination of patients with [disease name] is usually normal.
OR
*[[Cyanosis]]
*[[Jaundice]]
*[[Jaundice]]
* [[Pallor]]
*[[Pallor]]
* Bruises
 
<gallery widths="150px">
 
UploadedImage-01.jpg | Description {{dermref}}
UploadedImage-02.jpg | Description {{dermref}}
 
</gallery>


===HEENT===
===HEENT===
* HEENT examination of patients with [disease name] is usually normal.
*Icteric [[sclera]]  
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 polycystic kidney disease 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 polycystic kidney disease is usually normal
OR
* Asymmetric chest expansion / Decreased chest expansion
*Lungs are hypo/hyperresonant
*Fine/coarse [[crackles]] upon auscultation of the lung bases/apices unilaterally/bilaterally
*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.
*[[Cardiovascular]] examination of patients with polycystic kidney disease is usually normal
OR
*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.
*A [[palpable]] [[abdominal]] [[mass]] in the [[lumbar]] quadrant
OR
*[[Palpable]] [[nodular]] [[hepatomegaly]]
*[[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]]
*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.
*[[Palpable]] [[mass]] in the [[flank]]
OR
*[[Costovertebral]] [[angle]] [[tenderness]]
*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 polycystic kidney disease 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 polycystic kidney disease 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===
* Extremities examination of patients with [disease name] is usually normal.
*[[Pitting edema]] of the upper/lower [[extremities]]
OR
 
*[[Clubbing]]
*[[Cyanosis]]
*Pitting/non-pitting [[edema]] of the upper/lower extremities
*Muscle atrophy
*Fasciculations in the upper/lower extremity
==References==
==References==
{{reflist|1}}
{{reflist|1}}
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[[Category:Up-To-Date]]
[[Category:Medicine]]
[[Category:Nephrology]]

Latest revision as of 23:46, 29 July 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: M. Khurram Afzal, MD [2], Serge Korjian,Yazan Daaboul

Overview

Patients with polycystic kidney disease usually are in discomfort. Physical examination of patients with polycystic kidney disease is usually remarkable for hypertension, jaundice, pallor, icteric sclera, palpable nodular hepatomegaly, palpable flank mass.

Physical Examination

Physical examination of patients with polycystic kidney disease is usually remarkable for hypertension, jaundice, pallor, icteric sclera, palpable nodular hepatomegaly, palpable flank mass.[1][2][3]

Appearance of the Patient

  • Patients with polycystic kidney disease usually are in discomfort

Vital Signs

Skin

HEENT

Neck

  • Neck examination of patients with polycystic kidney disease is usually normal

Lungs

  • Pulmonary examination of patients with polycystic kidney disease is usually normal

Heart

  • Cardiovascular examination of patients with polycystic kidney disease is usually normal

Abdomen

Back

Genitourinary

  • Genitourinary examination of patients with polycystic kidney disease is usually normal

Neuromuscular

  • Neuromuscular examination of patients with polycystic kidney disease is usually normal

Extremities

References

  1. ↑ Gabow PA (1993). "Autosomal dominant polycystic kidney disease". N Engl J Med. 329 (5): 332–42. doi:10.1056/NEJM199307293290508. PMID 8321262.
  2. ↑ Torres VE, Harris PC, Pirson Y (2007). "Autosomal dominant polycystic kidney disease". Lancet. 369 (9569): 1287–301. doi:10.1016/S0140-6736(07)60601-1. PMID 17434405.
  3. ↑ Baker A, King D, Marsh J, Makin A, Carr A, Davis C, Kirby C (October 2015). "Understanding the physical and emotional impact of early-stage ADPKD: experiences and perspectives of patients and physicians". Clin Kidney J. 8 (5): 531–7. doi:10.1093/ckj/sfv060. PMC 4581379. PMID 26413277.

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