Familial hypocalciuric hypercalcemia physical examination: Difference between revisions

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{{Familial hypocalciuric hypercalcemia}}
{{Familial hypocalciuric hypercalcemia}}


{{CMG}}; {{AE}}  
{{CMG}}; {{AE}} {{Ajay}}


==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 [[familial hypocalciuric hypercalcemia]] (FHH) is usually unremarkable. Very rarely patients may have [[Physical examination|examination]] findings due to [[hypercalcemia]].


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 remarkable for:[finding 1], [finding 2], and [finding 3].
*[[Physical examination]] of patients with FHH is usually unremarkable.<ref name="pmid21321169">{{cite journal |vauthors=Pallan S, Khan A |title=Primary hyperparathyroidism: Update on presentation, diagnosis, and management in primary care |journal=Can Fam Physician |volume=57 |issue=2 |pages=184–9 |year=2011 |pmid=21321169 |pmc=3038812 |doi= |url=}}</ref>
*The presence of [finding(s)] on physical examination is diagnostic of [disease name].
*Patients may have physical examination findings due to [[hypercalcemia]].<ref name="pmid11350446">{{cite journal |vauthors=Mishra SK, Agarwal G, Kar DK, Gupta SK, Mithal A, Rastad J |title=Unique clinical characteristics of primary hyperparathyroidism in India |journal=Br J Surg |volume=88 |issue=5 |pages=708–14 |year=2001 |pmid=11350446 |doi=10.1046/j.0007-1323.2001.01775.x |url=}}</ref>
*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 [[FHH]] usually have a normal appearance.  


===Vital Signs===
===Vital Signs===
 
*Patients with [[hypercalcemia]] may have:
*High-grade / low-grade fever
**[[High blood pressure]] due to [[hypercalcemia]]
*[[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===
*[[Cyanosis]]  
*[[Jaundice]]
* [[Pallor]]
* Bruises
 
<gallery widths=150px>
 
UploadedImage-01.jpg | Description {{dermref}}
UploadedImage-02.jpg | Description {{dermref}}
 
</gallery>


===HEENT===
===HEENT===
* Abnormalities of the head/hair may include ___
*Patients with [[hypercalcemia]] may have:
* Evidence of trauma
** [[Band keratopathy]] ([[calcium]] precipitation in a horizontal band across the [[cornea]] in the [[Palpebral fissure|palpebral aperture]]); may lead to [[Visual impairment|vision impairment]]
* Icteric sclera
* [[Nystagmus]]
* Extra-ocular movements may be abnormal
*Pupils non-reactive to light / non-reactive to accomodation / non-reactive to neither light nor accomodation
*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===
*[[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===
===Cardiovascular===
* Asymmetric chest expansion / Decreased chest expansion
*Patients with [[hypercalcemia]] may have cardiovascular symptoms such as:
*Lungs are hypo/hyperresonant
**[[Palpitation|Palpitations]] due to [[arrhythmias]]
*Fine/coarse [[crackles]] upon auscultation of the lung bases/apices unilaterally/bilaterally
**Shortened [[QT interval]]
*Rhonchi
**[[Chest pain]] due to [[fluid overload]] form [[renal failure]]
*Vesicular breath sounds / Distant breath sounds
**[[Rales]] and [[S3]] due to [[fluid overload]] form [[renal failure]]
*Expiratory/inspiratory wheezing with normal / delayed expiratory phase
*[[Wheezing]] may be present
*[[Egophony]] present/absent
*[[Bronchophony]] present/absent
*Normal/reduced [[tactile fremitus]]
 
===Heart===
*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 distention]]  
*Patients with [[hypercalcemia]] may have:
*[[Abdominal tenderness]] in the right/left upper/lower abdominal quadrant
**[[Nausea and vomiting]]
*[[Rebound tenderness]] (positive Blumberg sign)
**[[Anorexia]]  
*A palpable abdominal mass in the right/left upper/lower abdominal quadrant
**[[constipation]]
*Guarding may be present
**[[Epigastric pain]] and [[tenderness]] due to development of [[pancreatitis]]
*[[Hepatomegaly]] / [[splenomegaly]] / [[hepatosplenomegaly]]
**[[Flank pain]] and [[tenderness]] due to [[nephrolithiasis]]
*Additional findings, such as obturator test, psoas test, McBurney point test, Murphy test
 
===Back===
*Point tenderness over __ vertebrae (e.g. L3-L4)
*Sacral edema
*Costovertebral angle tenderness bilaterally/unilaterally
*Buffalo hump


===Genitourinary===
===Genitourinary===
*A pelvic/adnexal mass may be palpated
*Patients with severe [[hypercalcemia]] may have:
*Inflamed mucosa
**Alteration in [[urinary]] habits
*Clear/(color), foul-smelling/odorless penile/vaginal discharge
**[[Volume depletion]]
**Signs of [[renal failure]]


===Neuromuscular===
===Neuromuscular===
*Patient is usually oriented to persons, place, and time
*The patient is usually oriented to person, place, and time.
* Altered mental status
*Patients with severe [[hypercalcemia]] may have:
* Glasgow coma scale is ___ / 15
**[[Anxiety]]
* Clonus may be present
**[[Fatigue]] and [[weakness]]
* Hyperreflexia / hyporeflexia / areflexia
**[[Lethargy]]
* Positive (abnormal) Babinski / plantar reflex unilaterally/bilaterally
**[[Sleep disturbances]]
* Muscle rigidity
**[[Muscle twitch]] and [[cramps]]
* Proximal/distal muscle weakness unilaterally/bilaterally
**Signs of [[depression]]
* ____ (finding) suggestive of cranial nerve ___ (roman numerical) deficit (e.g. Dilated pupils suggestive of CN III deficit)
**[[Confusion]]
*Unilateral/bilateral upper/lower extremity weakness
**[[Memory]] disturbances
*Unilateral/bilateral sensory loss in the upper/lower extremity
**[[Hypotonia]]
*Positive straight leg raise test
**[[Hyporeflexia]]
*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===
*[[Clubbing]]
*Normal
*[[Cyanosis]]
*Pitting/non-pitting [[edema]] of the upper/lower extremities
*Muscle atrophy
*Fasciculations in the upper/lower extremity


==References==
==References==

Latest revision as of 17:56, 7 December 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ajay Gade MD[2]]

Overview

Physical examination of patients with familial hypocalciuric hypercalcemia (FHH) is usually unremarkable. Very rarely patients may have examination findings due to hypercalcemia.

Physical Examination

Appearance of the Patient

  • Patients with FHH usually have a normal appearance.

Vital Signs

HEENT

Cardiovascular

Abdomen

Genitourinary

Neuromuscular

Extremities

  • Normal

References

  1. ↑ Pallan S, Khan A (2011). "Primary hyperparathyroidism: Update on presentation, diagnosis, and management in primary care". Can Fam Physician. 57 (2): 184–9. PMC 3038812. PMID 21321169.
  2. ↑ Mishra SK, Agarwal G, Kar DK, Gupta SK, Mithal A, Rastad J (2001). "Unique clinical characteristics of primary hyperparathyroidism in India". Br J Surg. 88 (5): 708–14. doi:10.1046/j.0007-1323.2001.01775.x. PMID 11350446.

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