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__NOTOC__
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{{Plummer-Vinson syndrome}}
{{Plummer-Vinson syndrome}}
{{CMG}}
{{CMG}} {{shyam}}; {{AE}}{{Akshun}}
 
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==Overview==
==Physical Examination==
The condition is associated with [[koilonychia]], [[glossitis]], [[cheilitis]], and [[splenomegaly]].
 
*Stomatitis
*Glossitis
*Atrophy of lingual papillae
*Achlorhydria
*Brittle fingernails
*Splenomegaly (33%)
*Anemia


==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 Plummer-Vinson syndrome is usually remarkable for [[glossitis]], [[esophageal webs]] or [[Esophageal stricture|strictures]], and [[dysphagia]]. Other findings on physical examination include [[pallor]], [[stomatitis]], [[atrophy]] of [[Lingual|lingual papillae,]] [[splenomegaly]] (33%), [[achlorhydria]] and [[koilonychia]].
 
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 Plummer-Vinson syndrome is usually remarkable for [[glossitis]], [[esophageal webs]] or [[Esophageal stricture|strictures]], and [[dysphagia]]. Other findings on physical examination include:<ref name="pmid7575056">{{cite journal |vauthors=Hoffman RM, Jaffe PE |title=Plummer-Vinson syndrome. A case report and literature review |journal=Arch. Intern. Med. |volume=155 |issue=18 |pages=2008–11 |year=1995 |pmid=7575056 |doi= |url=}}</ref><ref name="pmid10505167">{{cite journal |vauthors=Mansell NJ, Jani P, Bailey CM |title=Plummer-Vinson syndrome--a rare presentation in a child |journal=J Laryngol Otol |volume=113 |issue=5 |pages=475–6 |year=1999 |pmid=10505167 |doi= |url=}}</ref><ref name="pmid10549778">{{cite journal |vauthors=Anthony R, Sood S, Strachan DR, Fenwick JD |title=A case of Plummer-Vinson syndrome in childhood |journal=J. Pediatr. Surg. |volume=34 |issue=10 |pages=1570–2 |year=1999 |pmid=10549778 |doi= |url=}}</ref><ref name="pmid11753173">{{cite journal |vauthors=López Rodríguez MJ, Robledo Andrés P, Amarilla Jiménez A, Roncero Maíllo M, López Lafuente A, Arroyo Carrera I |title=Sideropenic dysphagia in an adolescent |journal=J. Pediatr. Gastroenterol. Nutr. |volume=34 |issue=1 |pages=87–90 |year=2002 |pmid=11753173 |doi= |url=}}</ref><ref name="pmid4449772">{{cite journal |vauthors=Chisholm M |title=The association between webs, iron and post-cricoid carcinoma |journal=Postgrad Med J |volume=50 |issue=582 |pages=215–9 |year=1974 |pmid=4449772 |pmc=2495558 |doi= |url=}}</ref><ref name="pmid1192404">{{cite journal |vauthors=Larsson LG, Sandström A, Westling P |title=Relationship of Plummer-Vinson disease to cancer of the upper alimentary tract in Sweden |journal=Cancer Res. |volume=35 |issue=11 Pt. 2 |pages=3308–16 |year=1975 |pmid=1192404 |doi= |url=}}</ref><ref name="pmid22843759">{{cite journal |vauthors=Phatak S, Redkar N, Patil MA, Kuwar A |title=Plummer-Vinson syndrome |journal=BMJ Case Rep |volume=2012 |issue= |pages= |year=2012 |pmid=22843759 |pmc=4543800 |doi=10.1136/bcr-2012-006403 |url=}}</ref>
*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 Plummer-Vinson syndrome usually appear [[Fatigue|fatigued]]


===Vital Signs===
===Vital Signs===
 
*[[Hypothermia]] may be present
*High-grade / low-grade fever
*[[Tachycardia]]  
*[[Hypothermia]] / hyperthermia may be present
*Normal to [[low blood pressure]] with normal [[pulse pressure]]  
*[[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===
*[[Cyanosis]]
*Pale skin color ([[Pallor]])
*[[Jaundice]]
*Blue-tinged or very pale whites of eyes
* [[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 ___
*[[Stomatitis]]
* Evidence of trauma
*[[Glossitis]]
* Icteric sclera
*[[Cheilitis]]
* [[Nystagmus]]  
*Atrophy of [[lingual]] papillae
* Extra-ocular movements may be abnormal
*Upper [[esophageal web]] or [[Esophageal stricture|strictures]] on [[laryngoscopy]]
*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===
===Neck===
*[[Jugular venous distension]]
[[Odynophagia]]
*[[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===
* 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===
*Chest tenderness upon palpation
*[[S1]]/[[S2]] normal. Additional heart sound such as [[S3]] may be heard in patients with high output [[heart failure]]
*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]]
*[[Splenomegaly]] (33%)
*[[Abdominal tenderness]] in the right/left upper/lower abdominal quadrant
*[[Achlorhydria]]
*[[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===
*Point tenderness over __ vertebrae (e.g. L3-L4)
*Sacral edema
*Costovertebral angle tenderness bilaterally/unilaterally
*Buffalo hump
 
===Genitourinary===
*A pelvic/adnexal mass may be palpated
*Inflamed mucosa
*Clear/(color), foul-smelling/odorless penile/vaginal discharge


===Neuromuscular===
===Neuromuscular===
*Patient is usually oriented to persons, place, and time
*Patient is usually oriented to time, place and person
* 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===
*[[Clubbing]]  
*[[Koilonychia]]  
*[[Cyanosis]]  
*[[Brittle nails]]
*Pitting/non-pitting [[edema]] of the upper/lower extremities
*Muscle atrophy
*Fasciculations in the upper/lower extremity
 
 
 
 


==References==
==References==

Latest revision as of 07:03, 2 February 2019

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Shyam Patel [2]; Associate Editor(s)-in-Chief: Akshun Kalia M.B.B.S.[3]

Overview

Physical examination of patients with Plummer-Vinson syndrome is usually remarkable for glossitis, esophageal webs or strictures, and dysphagia. Other findings on physical examination include pallor, stomatitis, atrophy of lingual papillae, splenomegaly (33%), achlorhydria and koilonychia.

Physical Examination

Physical examination of patients with Plummer-Vinson syndrome is usually remarkable for glossitis, esophageal webs or strictures, and dysphagia. Other findings on physical examination include:[1][2][3][4][5][6][7]

Appearance of the Patient

  • Patients with Plummer-Vinson syndrome usually appear fatigued

Vital Signs

Skin

  • Pale skin color (Pallor)
  • Blue-tinged or very pale whites of eyes

HEENT

Neck

Odynophagia

Heart

  • S1/S2 normal. Additional heart sound such as S3 may be heard in patients with high output heart failure

Abdomen

Neuromuscular

  • Patient is usually oriented to time, place and person

Extremities

References

  1. ↑ Hoffman RM, Jaffe PE (1995). "Plummer-Vinson syndrome. A case report and literature review". Arch. Intern. Med. 155 (18): 2008–11. PMID 7575056.
  2. ↑ Mansell NJ, Jani P, Bailey CM (1999). "Plummer-Vinson syndrome--a rare presentation in a child". J Laryngol Otol. 113 (5): 475–6. PMID 10505167.
  3. ↑ Anthony R, Sood S, Strachan DR, Fenwick JD (1999). "A case of Plummer-Vinson syndrome in childhood". J. Pediatr. Surg. 34 (10): 1570–2. PMID 10549778.
  4. ↑ López Rodríguez MJ, Robledo Andrés P, Amarilla Jiménez A, Roncero Maíllo M, López Lafuente A, Arroyo Carrera I (2002). "Sideropenic dysphagia in an adolescent". J. Pediatr. Gastroenterol. Nutr. 34 (1): 87–90. PMID 11753173.
  5. ↑ Chisholm M (1974). "The association between webs, iron and post-cricoid carcinoma". Postgrad Med J. 50 (582): 215–9. PMC 2495558. PMID 4449772.
  6. ↑ Larsson LG, Sandström A, Westling P (1975). "Relationship of Plummer-Vinson disease to cancer of the upper alimentary tract in Sweden". Cancer Res. 35 (11 Pt. 2): 3308–16. PMID 1192404.
  7. ↑ Phatak S, Redkar N, Patil MA, Kuwar A (2012). "Plummer-Vinson syndrome". BMJ Case Rep. 2012. doi:10.1136/bcr-2012-006403. PMC 4543800. PMID 22843759.
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