Kidney stone physical examination: Difference between revisions

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{{Kidney stone}}
{{Kidney stone}}


{{CMG}}; {{AE}}  
{{CMG}}; {{AE}}{{ADS}}  


==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 nephrolithiasis usually appear in pain and trying to achieve a comfortable position. Common physical examination findings of nephrolithiasis  include [[costovertebral angle]] tenderness, may accompany fever with increased heart rate and respiratory rate. They can have hypoactive bowel sounds due to ileus caused by severe pain. They can have hematuria in microscopic exmaination.
 
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 nephrolithiasis is usually remarkable for:<ref name="pmid18486720">{{cite journal |vauthors=Worcester EM, Coe FL |title=Nephrolithiasis |journal=Prim. Care |volume=35 |issue=2 |pages=369–91, vii |date=June 2008 |pmid=18486720 |pmc=2518455 |doi=10.1016/j.pop.2008.01.005 |url=}}</ref>
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===
*Patients with nephrolithiaisis usually appear in pain.  
*Patients with nephrolithiasis usually appear in pain.  
*Patients tend to move constantly in order to achieve a a comfortable position.  
*Patients tend to move constantly in order to achieve a comfortable position.


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


*High-grade / low-grade fever
*High-grade / low-grade fever.
*[[Tachycardia]] with regular pulse can be seen secondary to pain
*[[Tachycardia]] with regular pulse can be seen secondary to pain.
*[[Tachypnea]]  can be seen
*[[Tachypnea]]  can be seen.


===Skin===
===Skin===
* Skin examination of patients with [disease name] is usually normal.
* Skin examination of patients with nephrolithiasis is usually normal.
OR
*[[Cyanosis]]
*[[Jaundice]]
* [[Pallor]]
* Bruises
 
===HEENT===
===HEENT===
* HEENT examination of patients with nephrolithiasis is usually normal.
* HEENT examination of patients with nephrolithiasis is usually normal.
===Neck===
===Neck===
* Neck examination of patients with [disease name] is usually normal.
* Neck examination of patients with nephrolithiasis 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 nephrolithiasis is usually normal.
* Pulmonary examination of patients with nephrolithiasis is usually normal.
===Heart===
===Heart===
{| align="right"
|[[File:CVangle.png|thumb|200px|Costovertebral angle -By Brainmachine, Source:Wikimedia commons<ref>https://commons.wikimedia.org/w/index.php?curid=19887470</ref>]]
|}
* Cardiovascular examination of patients with nephrolithiasis is usually normal.
* Cardiovascular examination of patients with nephrolithiasis is usually normal.
===Abdomen===
===Abdomen===
*Hypoactive bowel sounds as seen in ileus due to severe pain  
*Hypoactive bowel sounds as seen in ileus due to severe pain  
*[[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===
* Costovertebral angle tenderness bilaterally/unilaterally depending upon sides involved.
* [[Costovertebral angle|Costovertebral angle tenderness]](Murphy's punch sign, Pasternacki's sign, or Goldflam's sign) bilaterally/unilaterally depending upon sides involved.
===Genitourinary===
===Genitourinary===
* Genitourinary examination of patients with [disease name] is usually normal.
* [[Hematuria]]
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 nephrolithiasis 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.
* Extremities examination of patients with nephrolithiasis is usually normal.
OR
*[[Clubbing]]
*[[Cyanosis]]
*Pitting/non-pitting [[edema]] of the upper/lower extremities
*Muscle atrophy
*Fasciculations in the upper/lower extremity
 
==References==
==References==
{{Reflist|2}}
{{Reflist|2}}

Latest revision as of 19:59, 7 June 2018

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

Overview

Patients with nephrolithiasis usually appear in pain and trying to achieve a comfortable position. Common physical examination findings of nephrolithiasis include costovertebral angle tenderness, may accompany fever with increased heart rate and respiratory rate. They can have hypoactive bowel sounds due to ileus caused by severe pain. They can have hematuria in microscopic exmaination.

Physical Examination

  • Physical examination of patients with nephrolithiasis is usually remarkable for:[1]

Appearance of the Patient

  • Patients with nephrolithiasis usually appear in pain.
  • Patients tend to move constantly in order to achieve a comfortable position.

Vital Signs

  • High-grade / low-grade fever.
  • Tachycardia with regular pulse can be seen secondary to pain.
  • Tachypnea can be seen.

Skin

  • Skin examination of patients with nephrolithiasis is usually normal.

HEENT

  • HEENT examination of patients with nephrolithiasis is usually normal.

Neck

  • Neck examination of patients with nephrolithiasis is usually normal.

Lungs

  • Pulmonary examination of patients with nephrolithiasis is usually normal.

Heart

Costovertebral angle -By Brainmachine, Source:Wikimedia commons[2]
  • Cardiovascular examination of patients with nephrolithiasis is usually normal.

Abdomen

  • Hypoactive bowel sounds as seen in ileus due to severe pain

Back

Genitourinary

Neuromuscular

  • Neuromuscular examination of patients with nephrolithiasis is usually normal.

Extremities

  • Extremities examination of patients with nephrolithiasis is usually normal.

References

  1. ↑ Worcester EM, Coe FL (June 2008). "Nephrolithiasis". Prim. Care. 35 (2): 369–91, vii. doi:10.1016/j.pop.2008.01.005. PMC 2518455. PMID 18486720.
  2. ↑ https://commons.wikimedia.org/w/index.php?curid=19887470

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