Cystic fibrosis physical examination: Difference between revisions

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==Overview==
==Overview==
In cystic fibrosis [[abdominal distension]] and [[Clubbing|digital clubbing]] may be detected. In HEENT [[Physical examination|examination]] there are [[Nasal polyp|nasal polyps]] and [[Medical sign|signs]] of [[rhinosinusitis]] ([[Pus|purulent]] nasal discharge, [[Mucous membrane|mucosal]] [[edema]], [[turbinate]] [[Hypertrophy (medical)|hypertrophy]] and [[tenderness]] on [[palpitation]] of the [[Paranasal sinus|sinuses]]). [[Respiratory examination|Lung examination]] may present hyperresonant [[Lung|lungs]], [[wheeze]] or [[crackles]] and [[productive cough]] with mucoid or [[Pus|purulent]] [[sputum]].


==Physical Examination==
==Physical Examination==
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===Vital Signs===
===Vital Signs===


*Tachypnea<ref name="pmid2347215">{{cite journal |vauthors=Browning IB, D'Alonzo GE, Tobin MJ |title=Importance of respiratory rate as an indicator of respiratory dysfunction in patients with cystic fibrosis |journal=Chest |volume=97 |issue=6 |pages=1317–21 |date=June 1990 |pmid=2347215 |doi= |url=}}</ref>
*[[Tachypnea]]<ref name="pmid2347215">{{cite journal |vauthors=Browning IB, D'Alonzo GE, Tobin MJ |title=Importance of respiratory rate as an indicator of respiratory dysfunction in patients with cystic fibrosis |journal=Chest |volume=97 |issue=6 |pages=1317–21 |date=June 1990 |pmid=2347215 |doi= |url=}}</ref>
*High blood pressure <ref name="pmid28811770">{{cite journal |vauthors=Aziz DA, Billoo AG, Qureshi A, Khalid M, Kirmani S |title=Clinical and laboratory profile of children with Cystic Fibrosis: Experience of a tertiary care center in Pakistan |journal=Pak J Med Sci |volume=33 |issue=3 |pages=554–559 |date=2017 |pmid=28811770 |pmc=5510102 |doi=10.12669/pjms.333.12188 |url=}}</ref>
*[[Hypertension|High blood pressure]] <ref name="pmid28811770">{{cite journal |vauthors=Aziz DA, Billoo AG, Qureshi A, Khalid M, Kirmani S |title=Clinical and laboratory profile of children with Cystic Fibrosis: Experience of a tertiary care center in Pakistan |journal=Pak J Med Sci |volume=33 |issue=3 |pages=554–559 |date=2017 |pmid=28811770 |pmc=5510102 |doi=10.12669/pjms.333.12188 |url=}}</ref>


===Skin===
===Skin===
* Skin examination of patients with cystic fibrosis is usually normal.
* Skin [[Physical examination|examination]] of patients with cystic fibrosis is usually normal.
* Skin rashes (due to zinc defficiency) and skin dryness (due to vitamin A defficiency) may present.<ref name="pmid190924372">{{cite journal |vauthors=Moskowitz SM, Chmiel JF, Sternen DL, Cheng E, Gibson RL, Marshall SG, Cutting GR |title=Clinical practice and genetic counseling for cystic fibrosis and CFTR-related disorders |journal=Genet. Med. |volume=10 |issue=12 |pages=851–68 |date=December 2008 |pmid=19092437 |pmc=2810953 |doi=10.1097/GIM.0b013e31818e55a2 |url=}}</ref><ref name="urlCystic Fibrosis - National Library of Medicine - PubMed Health">{{cite web |url=https://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0022782/ |title=Cystic Fibrosis - National Library of Medicine - PubMed Health |format= |work= |accessdate=}}</ref>
* Skin [[Rash|rashes]] (due to [[zinc deficiency]]) and [[Xeroderma|skin dryness]] (due to [[vitamin A deficiency]]) may present.<ref name="pmid190924372">{{cite journal |vauthors=Moskowitz SM, Chmiel JF, Sternen DL, Cheng E, Gibson RL, Marshall SG, Cutting GR |title=Clinical practice and genetic counseling for cystic fibrosis and CFTR-related disorders |journal=Genet. Med. |volume=10 |issue=12 |pages=851–68 |date=December 2008 |pmid=19092437 |pmc=2810953 |doi=10.1097/GIM.0b013e31818e55a2 |url=}}</ref><ref name="urlCystic Fibrosis - National Library of Medicine - PubMed Health">{{cite web |url=https://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0022782/ |title=Cystic Fibrosis - National Library of Medicine - PubMed Health |format= |work= |accessdate=}}</ref>


===HEENT===
===HEENT===
* Nasal polyps<ref name="pmid27329094">{{cite journal |vauthors=Mohd Slim MA, Dick D, Trimble K, McKee G |title=Paediatric nasal polyps in cystic fibrosis |journal=BMJ Case Rep |volume=2016 |issue= |pages= |date=June 2016 |pmid=27329094 |doi=10.1136/bcr-2016-214467 |url=}}</ref>
* [[Nasal polyp|Nasal polyps]]<ref name="pmid27329094">{{cite journal |vauthors=Mohd Slim MA, Dick D, Trimble K, McKee G |title=Paediatric nasal polyps in cystic fibrosis |journal=BMJ Case Rep |volume=2016 |issue= |pages= |date=June 2016 |pmid=27329094 |doi=10.1136/bcr-2016-214467 |url=}}</ref>
*Signs of rhinosinusitis may include:<ref name="pmid25750676">{{cite journal |vauthors=Kang SH, Dalcin Pde T, Piltcher OB, Migliavacca Rde O |title=Chronic rhinosinusitis and nasal polyposis in cystic fibrosis: update on diagnosis and treatment |journal=J Bras Pneumol |volume=41 |issue=1 |pages=65–76 |date=2015 |pmid=25750676 |pmc=4350827 |doi=10.1590/S1806-37132015000100009 |url=}}</ref><ref name="pmid27466844">{{cite journal |vauthors=Le C, McCrary HC, Chang E |title=Cystic Fibrosis Sinusitis |journal=Adv. Otorhinolaryngol. |volume=79 |issue= |pages=29–37 |date=2016 |pmid=27466844 |doi=10.1159/000444959 |url=}}</ref>
*Signs of [[rhinosinusitis]] may include:<ref name="pmid25750676">{{cite journal |vauthors=Kang SH, Dalcin Pde T, Piltcher OB, Migliavacca Rde O |title=Chronic rhinosinusitis and nasal polyposis in cystic fibrosis: update on diagnosis and treatment |journal=J Bras Pneumol |volume=41 |issue=1 |pages=65–76 |date=2015 |pmid=25750676 |pmc=4350827 |doi=10.1590/S1806-37132015000100009 |url=}}</ref><ref name="pmid27466844">{{cite journal |vauthors=Le C, McCrary HC, Chang E |title=Cystic Fibrosis Sinusitis |journal=Adv. Otorhinolaryngol. |volume=79 |issue= |pages=29–37 |date=2016 |pmid=27466844 |doi=10.1159/000444959 |url=}}</ref>
** Purulent [[nasal discharge]]
** Purulent [[nasal discharge]]
** [[Mucosal]] [[edema]]
** [[Mucosal]] [[edema]]
** Inferior turbinate hypertrophy
** Inferior [[turbinate]] [[Hypertrophy (medical)|hypertrophy]]
** [[Pain]] and [[tenderness]] on [[palpation]] of the involved [[sinus]]
** [[Pain]] and [[tenderness]] on [[palpation]] of the involved [[sinus]]
===Neck===
===Neck===
* Neck examination of patients with cystic fibrosis is usually normal.
* Neck [[Physical examination|examination]] of patients with cystic fibrosis is usually normal.
===Lungs===
===Lungs===
Findings of lungs examination may include:<ref name="pmid288117702">{{cite journal |vauthors=Aziz DA, Billoo AG, Qureshi A, Khalid M, Kirmani S |title=Clinical and laboratory profile of children with Cystic Fibrosis: Experience of a tertiary care center in Pakistan |journal=Pak J Med Sci |volume=33 |issue=3 |pages=554–559 |date=2017 |pmid=28811770 |pmc=5510102 |doi=10.12669/pjms.333.12188 |url=}}</ref><ref name="pmid28096997">{{cite journal |vauthors=Salamone I, Mondello B, Lucanto MC, Cristadoro S, Lombardo M, Barone M |title=Bronchial tree-shaped mucous plug in cystic fibrosis: imaging-guided management |journal=Respirol Case Rep |volume=5 |issue=2 |pages=e00214 |date=March 2017 |pmid=28096997 |doi=10.1002/rcr2.214 |url=}}</ref>
Findings of [[Respiratory examination|lungs examination]] may include:<ref name="pmid288117702">{{cite journal |vauthors=Aziz DA, Billoo AG, Qureshi A, Khalid M, Kirmani S |title=Clinical and laboratory profile of children with Cystic Fibrosis: Experience of a tertiary care center in Pakistan |journal=Pak J Med Sci |volume=33 |issue=3 |pages=554–559 |date=2017 |pmid=28811770 |pmc=5510102 |doi=10.12669/pjms.333.12188 |url=}}</ref><ref name="pmid28096997">{{cite journal |vauthors=Salamone I, Mondello B, Lucanto MC, Cristadoro S, Lombardo M, Barone M |title=Bronchial tree-shaped mucous plug in cystic fibrosis: imaging-guided management |journal=Respirol Case Rep |volume=5 |issue=2 |pages=e00214 |date=March 2017 |pmid=28096997 |doi=10.1002/rcr2.214 |url=}}</ref>
* Asymmetric chest expansion / Decreased chest expansion
*[[Lung|Lungs]] are hyperresonant
*Lungs are hyperresonant
*[[Wheeze]] or [[crackles]]  
*Wheeze or [[crackles]]  
*Productive [[cough]] with mucoid or [[Pus|purulent]] [[sputum]]
*Productive cough with mucoid or purulent sputum)


===Heart===
===Heart===
* Cardiovascular examination of patients with cystic fibrosis is usually normal.
* [[Circulatory system|Cardiovascular]] [[Physical examination|examination]] of patients with cystic fibrosis is usually normal.
===Abdomen===
===Abdomen===
*[[Abdominal distention]]<ref name="pmid28472055">{{cite journal |vauthors=Tabori H, Arnold C, Jaudszus A, Mentzel HJ, Renz DM, Reinsch S, Lorenz M, Michl R, Gerber A, Lehmann T, Mainz JG |title=Abdominal symptoms in cystic fibrosis and their relation to genotype, history, clinical and laboratory findings |journal=PLoS ONE |volume=12 |issue=5 |pages=e0174463 |date=2017 |pmid=28472055 |pmc=5417419 |doi=10.1371/journal.pone.0174463 |url=}}</ref>  
*[[Abdominal distention]]<ref name="pmid28472055">{{cite journal |vauthors=Tabori H, Arnold C, Jaudszus A, Mentzel HJ, Renz DM, Reinsch S, Lorenz M, Michl R, Gerber A, Lehmann T, Mainz JG |title=Abdominal symptoms in cystic fibrosis and their relation to genotype, history, clinical and laboratory findings |journal=PLoS ONE |volume=12 |issue=5 |pages=e0174463 |date=2017 |pmid=28472055 |pmc=5417419 |doi=10.1371/journal.pone.0174463 |url=}}</ref>  
*[[Abdominal tenderness]] in the right/left upper/lower abdominal quadrant
*[[Rebound tenderness]] (positive Blumberg sign)
*Guarding may be present


===Genitourinary===
===Genitourinary===
* Genitourinary examination of patients with cystic fibrosis is usually normal.
* [[Genitourinary system|Genitourinary]] [[Physical examination|examination]] of patients with cystic fibrosis is usually normal.
===Neuromuscular===
===Neuromuscular===
* Neuromuscular examination of patients with cystic fibrosis is usually normal.
* [[Neuromuscular]] [[Physical examination|examination]] of patients with cystic fibrosis is usually normal.
===Extremities===
===Extremities===
* Digital clubbing <ref name="pmid190924372">{{cite journal |vauthors=Moskowitz SM, Chmiel JF, Sternen DL, Cheng E, Gibson RL, Marshall SG, Cutting GR |title=Clinical practice and genetic counseling for cystic fibrosis and CFTR-related disorders |journal=Genet. Med. |volume=10 |issue=12 |pages=851–68 |date=December 2008 |pmid=19092437 |pmc=2810953 |doi=10.1097/GIM.0b013e31818e55a2 |url=}}</ref>
* [[Clubbing|Digital clubbing]]<ref name="pmid190924372">{{cite journal |vauthors=Moskowitz SM, Chmiel JF, Sternen DL, Cheng E, Gibson RL, Marshall SG, Cutting GR |title=Clinical practice and genetic counseling for cystic fibrosis and CFTR-related disorders |journal=Genet. Med. |volume=10 |issue=12 |pages=851–68 |date=December 2008 |pmid=19092437 |pmc=2810953 |doi=10.1097/GIM.0b013e31818e55a2 |url=}}</ref>


==References==
==References==
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Latest revision as of 20:11, 27 March 2018

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

Overview

In cystic fibrosis abdominal distension and digital clubbing may be detected. In HEENT examination there are nasal polyps and signs of rhinosinusitis (purulent nasal discharge, mucosal edema, turbinate hypertrophy and tenderness on palpitation of the sinuses). Lung examination may present hyperresonant lungs, wheeze or crackles and productive cough with mucoid or purulent sputum.

Physical Examination

Appearance of the Patient

  • Patients with cystic fibrosis are usually well-appearing.

Vital Signs

Skin

HEENT

Neck

  • Neck examination of patients with cystic fibrosis is usually normal.

Lungs

Findings of lungs examination may include:[8][9]

Heart

Abdomen

Genitourinary

Neuromuscular

Extremities

References

  1. ↑ Browning IB, D'Alonzo GE, Tobin MJ (June 1990). "Importance of respiratory rate as an indicator of respiratory dysfunction in patients with cystic fibrosis". Chest. 97 (6): 1317–21. PMID 2347215.
  2. ↑ Aziz DA, Billoo AG, Qureshi A, Khalid M, Kirmani S (2017). "Clinical and laboratory profile of children with Cystic Fibrosis: Experience of a tertiary care center in Pakistan". Pak J Med Sci. 33 (3): 554–559. doi:10.12669/pjms.333.12188. PMC 5510102. PMID 28811770.
  3. ↑ 3.0 3.1 Moskowitz SM, Chmiel JF, Sternen DL, Cheng E, Gibson RL, Marshall SG, Cutting GR (December 2008). "Clinical practice and genetic counseling for cystic fibrosis and CFTR-related disorders". Genet. Med. 10 (12): 851–68. doi:10.1097/GIM.0b013e31818e55a2. PMC 2810953. PMID 19092437.
  4. ↑ "Cystic Fibrosis - National Library of Medicine - PubMed Health".
  5. ↑ Mohd Slim MA, Dick D, Trimble K, McKee G (June 2016). "Paediatric nasal polyps in cystic fibrosis". BMJ Case Rep. 2016. doi:10.1136/bcr-2016-214467. PMID 27329094.
  6. ↑ Kang SH, Dalcin Pde T, Piltcher OB, Migliavacca Rde O (2015). "Chronic rhinosinusitis and nasal polyposis in cystic fibrosis: update on diagnosis and treatment". J Bras Pneumol. 41 (1): 65–76. doi:10.1590/S1806-37132015000100009. PMC 4350827. PMID 25750676.
  7. ↑ Le C, McCrary HC, Chang E (2016). "Cystic Fibrosis Sinusitis". Adv. Otorhinolaryngol. 79: 29–37. doi:10.1159/000444959. PMID 27466844.
  8. ↑ Aziz DA, Billoo AG, Qureshi A, Khalid M, Kirmani S (2017). "Clinical and laboratory profile of children with Cystic Fibrosis: Experience of a tertiary care center in Pakistan". Pak J Med Sci. 33 (3): 554–559. doi:10.12669/pjms.333.12188. PMC 5510102. PMID 28811770.
  9. ↑ Salamone I, Mondello B, Lucanto MC, Cristadoro S, Lombardo M, Barone M (March 2017). "Bronchial tree-shaped mucous plug in cystic fibrosis: imaging-guided management". Respirol Case Rep. 5 (2): e00214. doi:10.1002/rcr2.214. PMID 28096997.
  10. ↑ Tabori H, Arnold C, Jaudszus A, Mentzel HJ, Renz DM, Reinsch S, Lorenz M, Michl R, Gerber A, Lehmann T, Mainz JG (2017). "Abdominal symptoms in cystic fibrosis and their relation to genotype, history, clinical and laboratory findings". PLoS ONE. 12 (5): e0174463. doi:10.1371/journal.pone.0174463. PMC 5417419. PMID 28472055.

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