Diffuse esophageal spasm physical examination: Difference between revisions

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==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 primary diffuse esophageal spasm usually appear normal. Physical examination of patients with DES is usually remarkable for findings related to secondary diseases.
 
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 DES is usually remarkable for presence of features related to secondary [[diseases]].
*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 primary DES usually appear normal.  


===Vital Signs===
===Vital Signs===


*High-grade / low-grade fever
*High-grade / low-grade fever in [[infectious]] cause of DES
*[[Hypothermia]] / hyperthermia may be present
*[[Hypothermia]] / [[hyperthermia]] may be present
*[[Tachycardia]] with regular pulse or (ir)regularly irregular pulse
*[[Tachycardia]] with regular pulse or (ir)regularly irregular pulse
*[[Bradycardia]] with regular pulse or (ir)regularly irregular pulse
*[[Bradycardia]] with regular pulse or (ir)regularly irregular pulse
*Tachypnea / bradypnea
*[[Tachypnea]] / [[bradypnea]]
*Kussmal respirations may be present in _____ (advanced disease state)
*[[Kussmaul respirations]]
*Weak/bounding pulse / pulsus alternans / paradoxical pulse / asymmetric pulse
*Weak / bounding pulse
*High/low blood pressure with normal pulse pressure / [[wide pulse pressure]] / [[narrow pulse pressure]]
*[[High blood pressure|High]] / [[low blood pressure]] with normal [[pulse pressure]]


===Skin===
===Skin===
*[[Cyanosis]]  
*Tight, hardened skin in limited [[scleroderma]]  
*[[Jaundice]]
*Red spots or lines in skin of face and hand due to [[telangiectasia]] in [[scleroderma]]  
* [[Pallor]]
*Bumps under the skin due to deposition of [[calcium]] in [[scleroderma]].
* Bruises
*[[Ulcers]] of [[finger]] and [[toes]] may be present in [[scleroderma]]
 
* Insect bite wound may be seen in [[Chagas disease|Chaga's disease]] with excoriation at the bite site.
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UploadedImage-02.jpg | Description {{dermref}}
 
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===HEENT===
===HEENT===
* Abnormalities of the head/hair may include ___
* [[Romana's sign]] is seen in [[Chagas disease|Chaga's disease]] (swelling of eyelid at the site of parasite entry)
* Evidence of trauma
*[[Ophthalmoscopy|Ophthalmoscopic]] exam may be abnormal with findings of [[diabetic retinopathy]] in [[diabetics]] as well as [[cataract]] changes.
* Icteric sclera
* Lower extremities [[edema]] in [[Chagas disease|Chaga's disease]].
* [[Nystagmus]]  
* Dry mouth and dry eye in [[scleroderma]].
* 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===
===Neck===
*[[Jugular venous distension]]
*[[Lymphadenopathy]] (Chaga's disease)
*[[Carotid bruits]] may be auscultated unilaterally/bilaterally using the bell/diaphragm of the otoscope
*[[Thyromegaly]] / [[Thyroid nodule|thyroid nodules]]
*[[Lymphadenopathy]] (describe location, size, tenderness, mobility, and symmetry)
*[[Thyromegaly]] / thyroid nodules
*[[Hepatojugular reflux]]


===Lungs===
===Lungs===
* Asymmetric chest expansion / Decreased chest expansion
* Asymmetric chest expansion / Decreased chest expansion
*Lungs are hypo/hyperresonant
*Lungs are hyperresonant in [[scleroderma]].
*Fine/coarse [[crackles]] upon auscultation of the lung bases/apices unilaterally/bilaterally
*Fine/coarse [[crackles]] upon auscultation of the lung bases/apices bilaterally seen in [[scleroderma]].
*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
Heart involvement in [[Chagas disease|Chagas's cardiomyopathy]] are:
*PMI within 2 cm of the sternum  (PMI) / Displaced point of maximal impulse (PMI) suggestive of ____
 
*[[Heave]] / [[thrill]]
*Displaced [[point of maximal impulse]] (PMI).
*[[Friction rub]]
*[[Heart sounds#Third heart sound S3|S3]], [[S4]]
*[[Heart sounds#First heart tone S1, the "lub"(components M1 and T1)|S1]]
*Disturbances of rhythm ([[arrhythmias]]) may be noted in [[scleroderma]].
*[[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]]  
*[[Abdominal distention]] or bloating is noted in [[Scleroderma]], [[Diabetes]].
*[[Abdominal tenderness]] in the right/left upper/lower abdominal quadrant
*[[Hepatosplenomegaly]] is feature of [[Chagas disease|Chaga's disease]].
*[[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===
*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===
*[[Clubbing]]  
*[[Clubbing]] , [[Cyanosis]] are features of chronic involvement and fibrosis of lungs in [[Scleroderma]].
*[[Cyanosis]]  
*Pitting [[edema]] of the lower extremities may be noted in [[Chagas disease|Chaga's cardiomyopathy]].
*Pitting/non-pitting [[edema]] of the upper/lower extremities
*Muscle atrophy
*Fasciculations in the upper/lower extremity


==References==
==References==
{{Reflist|2}}
{{WH}}
{{WS}}
[[Category: (name of the system)]]
[[Category: (name of the system)]]

Latest revision as of 14:30, 4 December 2017

Diffuse esophageal spasm Microchapters

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Madhu Sigdel M.B.B.S.[2]

Overview

Patients with primary diffuse esophageal spasm usually appear normal. Physical examination of patients with DES is usually remarkable for findings related to secondary diseases.

Physical Examination

  • Physical examination of patients with DES is usually remarkable for presence of features related to secondary diseases.

Appearance of the Patient

  • Patients with primary DES usually appear normal.

Vital Signs

Skin

HEENT

Neck

Lungs

  • Asymmetric chest expansion / Decreased chest expansion
  • Lungs are hyperresonant in scleroderma.
  • Fine/coarse crackles upon auscultation of the lung bases/apices bilaterally seen in scleroderma.

Heart

Heart involvement in Chagas's cardiomyopathy are:

Abdomen

Extremities

References