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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 [[Hamman-Rich syndrome|acute interstitial pneumonitis]] usually appear ill. Physical examination shows [[tachypnea]], [[tachycardia]], [[Rales|crackles]], [[Wheeze|wheezing]] and signs of [[hypoxemia]]. |
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| Common physical examination findings of [disease name] include [finding 1], [finding 2], and [finding 3].
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| The presence of [finding(s)] on physical examination is diagnostic of [disease name].
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| The presence of [finding(s)] on physical examination is highly suggestive of [disease name].
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| ==Physical Examination== | | ==Physical Examination== |
| * Physical examination of patients with [disease name] is usually normal. | | * Physical examination of patients with acute interstitial pneumonitis will show tachypnea, tachycardia, cyanosis, crackles, and wheezes on auscultation. |
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| *Physical examination of patients with [disease name] is usually remarkable for:[finding 1], [finding 2], and [finding 3].
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| *The presence of [finding(s)] on physical examination is diagnostic of [disease name].
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| *The presence of [finding(s)] on physical examination is highly suggestive of [disease name].
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| ===Appearance of the Patient=== | | ===Appearance of the Patient=== |
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| ===Vital Signs=== | | ===Vital Signs=== |
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| *High-grade / low-grade fever | | *Fever |
| *[[Hypothermia]] / hyperthermia may be present
| | *[[Tachycardia]] |
| *[[Tachycardia]] with regular pulse or (ir)regularly irregular pulse | | *[[Tachypnea]] |
| *[[Bradycardia]] with regular pulse or (ir)regularly irregular pulse | |
| *Tachypnea / bradypnea
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| *Kussmal respirations may be present in _____ (advanced disease state)
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| *Weak/bounding pulse / pulsus alternans / paradoxical pulse / asymmetric pulse
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| *High/low blood pressure with normal pulse pressure / [[wide pulse pressure]] / [[narrow pulse pressure]]
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| ===Skin=== | | ===Skin=== |
| * Skin examination of patients with [disease name] is usually normal.
| | *[[Cyanosis]] because of hypoxemia. |
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| *[[Cyanosis]] | |
| *[[Jaundice]]
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| * [[Pallor]]
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| * Bruises
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| <gallery widths="150px">
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| UploadedImage-01.jpg | Description {{dermref}}
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| UploadedImage-02.jpg | Description {{dermref}}
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| </gallery>
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| ===HEENT=== | | ===HEENT=== |
| * HEENT examination of patients with [disease name] is usually normal. | | *Flared nares |
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| * Abnormalities of the head/hair may include ___
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| * Evidence of trauma
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| * Icteric sclera
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| * [[Nystagmus]]
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| * Extra-ocular movements may be abnormal
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| *Pupils non-reactive to light / non-reactive to accommodation / non-reactive to neither light nor accommodation
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| *Ophthalmoscopic exam may be abnormal with findings of ___
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| * Hearing acuity may be reduced
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| *[[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".)
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| *[[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".)
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| * [[Exudate]] from the ear canal
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| * Tenderness upon palpation of the ear pinnae/tragus (anterior to ear canal)
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| *Inflamed nares / congested nares
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| * [[Purulent]] exudate from the nares
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| * Facial tenderness
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| * Erythematous throat with/without tonsillar swelling, exudates, and/or petechiae
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| ===Neck=== | | ===Neck=== |
| * Neck examination of patients with [disease name] is usually normal. | | * Neck examination of patients with [[Hamman-Rich syndrome|acute interstitial pneumonitis]] is usually normal. |
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| *[[Jugular venous distension]] | | ===Heart=== |
| *[[Carotid bruits]] may be auscultated unilaterally/bilaterally using the bell/diaphragm of the otoscope | | *Tachycardia |
| *[[Lymphadenopathy]] (describe location, size, tenderness, mobility, and symmetry)
| | *Examine heart for findings of congestive heart failure to exclude the diagnosis. |
| *[[Thyromegaly]] / thyroid nodules
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| *[[Hepatojugular reflux]]
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| ===Lungs=== | | ===Lungs=== |
| * Pulmonary examination of patients with [disease name] is usually normal. | | * Diffuse [[crackles]] upon auscultation of the lungs bilaterally<ref name="pmid11144035">{{cite journal |vauthors=Vourlekis JS, Brown KK, Cool CD, Young DA, Cherniack RM, King TE, Schwarz MI |title=Acute interstitial pneumonitis. Case series and review of the literature |journal=Medicine (Baltimore) |volume=79 |issue=6 |pages=369–78 |date=November 2000 |pmid=11144035 |doi= |url=}}</ref> |
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| * Asymmetric chest expansion / Decreased chest expansion
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| *Lungs are hypo/hyperresonant
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| *Fine/coarse [[crackles]] upon auscultation of the lung bases/apices unilaterally/bilaterally
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| *Rhonchi
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| *Vesicular breath sounds / Distant breath sounds
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| *Expiratory/inspiratory wheezing with normal / delayed expiratory phase
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| *[[Wheezing]] may be present | | *[[Wheezing]] may be present |
| *[[Egophony]] present/absent | | *Prolonged expiration |
| *[[Bronchophony]] present/absent | | *Persistent scattered rhonchi |
| *Normal/reduced [[tactile fremitus]]
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| ===Heart===
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| * Cardiovascular examination of patients with [disease name] is usually normal.
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| *Chest tenderness upon palpation
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| *PMI within 2 cm of the sternum (PMI) / Displaced point of maximal impulse (PMI) suggestive of ____
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| *[[Heave]] / [[thrill]]
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| *[[Friction rub]]
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| *[[Heart sounds#First heart tone S1, the "lub"(components M1 and T1)|S1]]
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| *[[Heart sounds#Second heart tone S2 the "dub"(components A2 and P2)|S2]]
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| *[[Heart sounds#Third heart sound S3|S3]]
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| *[[Heart sounds#Fourth heart sound S4|S4]]
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| *[[Heart sounds#Summation Gallop|Gallops]]
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| *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
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| ===Abdomen===
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| Abdominal examination of patients with [disease name] is usually normal.
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| *[[Abdominal distention]]
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| *[[Abdominal tenderness]] in the right/left upper/lower abdominal quadrant
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| *[[Rebound tenderness]] (positive Blumberg sign)
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| *A palpable abdominal mass in the right/left upper/lower abdominal quadrant
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| *Guarding may be present
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| *[[Hepatomegaly]] / [[splenomegaly]] / [[hepatosplenomegaly]]
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| *Additional findings, such as obturator test, psoas test, McBurney point test, Murphy test
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| ===Back===
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| * Back examination of patients with [disease name] is usually normal.
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| OR
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| *Point tenderness over __ vertebrae (e.g. L3-L4)
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| *Sacral edema
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| *Costovertebral angle tenderness bilaterally/unilaterally
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| *Buffalo hump
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| ===Genitourinary===
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| * Genitourinary examination of patients with [disease name] is usually normal.
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| OR
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| *A pelvic/adnexal mass may be palpated
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| *Inflamed mucosa
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| *Clear/(color), foul-smelling/odorless penile/vaginal discharge
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| ===Neuromuscular===
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| * Neuromuscular examination of patients with [disease name] is usually normal.
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| OR
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| *Patient is usually oriented to persons, place, and time
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| * Altered mental status
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| * Glasgow coma scale is ___ / 15
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| * Clonus may be present
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| * Hyperreflexia / hyporeflexia / areflexia
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| * Positive (abnormal) Babinski / plantar reflex unilaterally/bilaterally
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| * Muscle rigidity
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| * Proximal/distal muscle weakness unilaterally/bilaterally
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| * ____ (finding) suggestive of cranial nerve ___ (roman numerical) deficit (e.g. Dilated pupils suggestive of CN III deficit)
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| *Unilateral/bilateral upper/lower extremity weakness
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| *Unilateral/bilateral sensory loss in the upper/lower extremity
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| *Positive straight leg raise test
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| *Abnormal gait (describe gait: e.g. ataxic (cerebellar) gait / steppage gait / waddling gait / choeiform gait / Parkinsonian gait / sensory gait)
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| *Positive/negative Trendelenburg sign
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| *Unilateral/bilateral tremor (describe tremor, e.g. at rest, pill-rolling)
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| *Normal finger-to-nose test / Dysmetria
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| *Absent/present dysdiadochokinesia (palm tapping test)
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| ===Extremities=== | | ===Extremities=== |
| * Extremities examination of patients with [disease name] is usually normal. | | *[[Clubbing]] is not usually present in [[Hamman-Rich syndrome|acute interstitial pneumonitis]]. Presence of [[clubbing]] indicates exacerbation of preexisting fibrotic lung disease. |
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| | *[[Cyanosis]] due to hypoxemia |
| *[[Clubbing]]
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| *[[Cyanosis]]
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| *Pitting/non-pitting [[edema]] of the upper/lower extremities | |
| *Muscle atrophy
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| *Fasciculations in the upper/lower extremity
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| ==References== | | ==References== |