Post-streptococcal glomerulonephritis physical examination: Difference between revisions

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==Overview==
==Overview==
Patients with post-streptococcal glomerulonephritis usually appear [[lethargic]]. On physical examination, patients usually have high [[blood pressure]], [[periorbital edema]] and [[edema]] of extremities.


==Physical Examination==
==Physical Examination==
* Physical examination of patients with [disease name] is usually normal.
*Physical examination of patients with post-streptococcal glomerulonephritis is usually remarkable for:<ref name="pmid16395114">{{cite journal |vauthors=Fux CA, Bianchetti MG, Jakob SM, Remonda L |title=Reversible encephalopathy complicating post-streptococcal glomerulonephritis |journal=Pediatr. Infect. Dis. J. |volume=25 |issue=1 |pages=85–7 |date=January 2006 |pmid=16395114 |doi= |url=}}</ref><ref name="pmid4795879">{{cite journal |vauthors=Sagel I, Treser G, Ty A, Yoshizawa N, Kleinberger H, Yuceoglu AM, Wasserman E, Lange K |title=Occurrence and nature of glomerular lesions after group A streptococci infections in children |journal=Ann. Intern. Med. |volume=79 |issue=4 |pages=492–9 |date=October 1973 |pmid=4795879 |doi= |url=}}</ref>
OR
**[[Hypertension]]
*Physical examination of patients with [disease name] is usually remarkable for:[finding 1], [finding 2], and [finding 3].
**[[Edema]]
*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 post-streptococcal glomerulonephritis usually appear fatigued.
*Patients with post-streptococcal glomerulonephritis usually appear [[lethargic]].


===Vital Signs===
===Vital Signs===
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===Skin===
===Skin===
* Skin examination of patients with post-streptococcal glomerulonephritis  is usually normal.
*Skin examination of patients with post-streptococcal glomerulonephritis  is usually normal.


===HEENT===
===HEENT===
* HEENT examination of patients with [disease name] is usually normal.
*[[Periorbital edema]]
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 post-streptococcal glomerulonephritis is usually normal.
OR
*[[Jugular venous distension]]
*[[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===
===Lungs===
* Pulmonary examination of patients with [disease name] is usually normal.
* Pulmonary examination of patients with post-streptococcal glomerulonephritis is usually normal.
OR
* 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===
* Cardiovascular examination of patients with [disease name] is usually normal.
*Cardiovascular examination of patients with post-streptococcal glomerulonephritis 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


===Abdomen===
===Abdomen===
Abdominal examination of patients with [disease name] is usually normal.
*Abdominal examination of patients with post-streptococcal glomerulonephritis is usually normal.
 
OR
*[[Abdominal distention]]
*[[Abdominal tenderness]] in the right/left upper/lower abdominal quadrant
*[[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===
===Back===
* Back examination of patients with [disease name] is usually normal.
*Back examination of patients with post-streptococcal glomerulonephritis is usually normal.
OR
*Point tenderness over __ vertebrae (e.g. L3-L4)
*Sacral edema
*Costovertebral angle tenderness bilaterally/unilaterally
*Buffalo hump


===Genitourinary===
===Genitourinary===
* Genitourinary examination of patients with [disease name] is usually normal.
*Genitourinary examination of patients with post-streptococcal glomerulonephritis is usually normal.
OR
*A pelvic/adnexal mass may be palpated
*Inflamed mucosa
*Clear/(color), foul-smelling/odorless penile/vaginal discharge


===Neuromuscular===
===Neuromuscular===
* Neuromuscular examination of patients with [disease name] is usually normal.
*Neuromuscular examination of patients with Post-streptococcal glomerulonephritis is usually normal.
OR
*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===  
* Extremities examination of patients with [disease name] is usually normal.
*[[Pitting edema]] of the upper and lower extremities
OR
*[[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 16:37, 14 June 2018

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

Overview

Patients with post-streptococcal glomerulonephritis usually appear lethargic. On physical examination, patients usually have high blood pressure, periorbital edema and edema of extremities.

Physical Examination

  • Physical examination of patients with post-streptococcal glomerulonephritis is usually remarkable for:[1][2]

Appearance of the Patient

  • Patients with post-streptococcal glomerulonephritis usually appear lethargic.

Vital Signs

  • Afebrile
  • Normal pulse
  • High blood pressure with normal pulse pressure

Skin

  • Skin examination of patients with post-streptococcal glomerulonephritis is usually normal.

HEENT

Neck

  • Neck examination of patients with post-streptococcal glomerulonephritis is usually normal.

Lungs

  • Pulmonary examination of patients with post-streptococcal glomerulonephritis is usually normal.

Heart

  • Cardiovascular examination of patients with post-streptococcal glomerulonephritis is usually normal.

Abdomen

  • Abdominal examination of patients with post-streptococcal glomerulonephritis is usually normal.

Back

  • Back examination of patients with post-streptococcal glomerulonephritis is usually normal.

Genitourinary

  • Genitourinary examination of patients with post-streptococcal glomerulonephritis is usually normal.

Neuromuscular

  • Neuromuscular examination of patients with Post-streptococcal glomerulonephritis is usually normal.

Extremities

References

  1. ↑ Fux CA, Bianchetti MG, Jakob SM, Remonda L (January 2006). "Reversible encephalopathy complicating post-streptococcal glomerulonephritis". Pediatr. Infect. Dis. J. 25 (1): 85–7. PMID 16395114.
  2. ↑ Sagel I, Treser G, Ty A, Yoshizawa N, Kleinberger H, Yuceoglu AM, Wasserman E, Lange K (October 1973). "Occurrence and nature of glomerular lesions after group A streptococci infections in children". Ann. Intern. Med. 79 (4): 492–9. PMID 4795879.

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