Hamman-Rich syndrome 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 [[Hamman-Rich syndrome|acute interstitial pneumonitis]] usually appear ill. Physical examination shows [[tachypnea]], [[tachycardia]], [[Rales|crackles]], [[Wheeze|wheezing]] and signs of [[hypoxemia]].  
 
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 normal.
* Physical examination of patients with acute interstitial pneumonitis will show tachypnea, tachycardia, cyanosis, crackles, and wheezes on auscultation.  
OR
*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===
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*[[Tachypnea]]  
*[[Tachypnea]]  


===Ski===
===Skin===
*[[Cyanosis]] because of hypoxemia.  
*[[Cyanosis]] because of hypoxemia.
 


===HEENT===
===HEENT===
* HEENT examination of patients with [disease name] is usually normal.
*Flared nares  
OR
* Abnormalities of the head/hair may include ___
* Evidence of trauma
* Icteric sclera
* [[Nystagmus]]
* Extra-ocular movements may be abnormal
*Pupils non-reactive to light / non-reactive to accommodation / non-reactive to neither light nor accommodation
*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===
* Neck examination of patients with [disease name] is usually normal.
* Neck examination of patients with [[Hamman-Rich syndrome|acute interstitial pneumonitis]] is usually normal.
OR
 
*[[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
*[[Hepatojugular reflux]]


===Lungs===
===Lungs===
* Diffuse  [[crackles]] upon auscultation of the lungs  bilaterally
* 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>
*Expiratory/inspiratory wheezing with normal / delayed expiratory phase
*[[Wheezing]] may be present
*[[Wheezing]] may be present
*[[Egophony]] present/absent
*Prolonged expiration
*[[Bronchophony]] present/absent
*Persistent scattered rhonchi
*Normal/reduced [[tactile fremitus]]
 
===Heart===
* Cardiovascular examination of patients with [disease name] is usually normal.
OR
*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


===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.
OR
*[[Cyanosis]] due to hypoxemia
*[[Clubbing]]  
*[[Cyanosis]]  
*Pitting/non-pitting [[edema]] of the upper/lower extremities
*Muscle atrophy
*Fasciculations in the upper/lower extremity


==References==
==References==

Latest revision as of 20:50, 23 March 2018

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

Overview

Patients with acute interstitial pneumonitis usually appear ill. Physical examination shows tachypnea, tachycardia, crackles, wheezing and signs of hypoxemia.

Physical Examination

  • Physical examination of patients with acute interstitial pneumonitis will show tachypnea, tachycardia, cyanosis, crackles, and wheezes on auscultation.

Appearance of the Patient

Vital Signs

Skin

HEENT

  • Flared nares

Neck

Heart

  • Tachycardia
  • Examine heart for findings of congestive heart failure to exclude the diagnosis.

Lungs

  • Diffuse  crackles upon auscultation of the lungs bilaterally[1]
  • Wheezing may be present
  • Prolonged expiration
  • Persistent scattered rhonchi

Extremities

References

  1. ↑ Vourlekis JS, Brown KK, Cool CD, Young DA, Cherniack RM, King TE, Schwarz MI (November 2000). "Acute interstitial pneumonitis. Case series and review of the literature". Medicine (Baltimore). 79 (6): 369–78. PMID 11144035.

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