Spina bifida physical examination: Difference between revisions

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__NOTOC__
__NOTOC__
{{Xyz}}
{{Spina bifida}}


{{CMG}}; {{AE}}
{{CMG}}; {{AE}} {{MMJ}}


==Overview==
==Overview==
Most patients with spina bifida have normal vital signs. Skin examination of patients with spina bifida is usually remarkable for: Spinal area discoloration or [[birthmarks]], protrusions in the [[lumbar spine]], dimples  in the [[lumbar spine]] and patch along the spine. HEENT examination of patients with spina bifida is usually remarkable for: Enlarging head, bulging [[fontanelle]], enlarged [[scalp veins]], [[Cranial bones]] [[suture]] [[diastasis]] and positive [[Macewen's sign|Macewen sign]]. Cardiovascular examination of patients with spina bifida is usually normal but congenital anomalies of the spine have been associated with malformations of the cardiovascular systems.  Congenital anomalies of the spine also may be associated with malformations of the genitourinary system. [[Neuromuscular]] examination of patients with spina bifida may be remarkable for: [[Paralysis]], sensation problems, [[Scoliosis]], pressure [[Ulcer|ulcers]], learning disabilities, [[Clonus]], [[Hyperreflexia]] or [[hyporeflexia]], positive (abnormal) [[Plantar reflex|Babinski]] unilaterally, [[Hypertonia|muscle rigidity]], muscle weakness unilaterally or bilaterally, abnormal gait and [[Dysmetria]].
==Physical Examination==
*Physical examination of patients with spina bifida may be remarkable for:<ref name="pmid4898641">{{cite journal |vauthors=Bannur BB, Purandare GM |title=Microbial production of L-lysine |journal=Hindustan Antibiot Bull |volume=11 |issue=3 |pages=191–205 |date=February 1969 |pmid=4898641 |doi= |url=}}</ref><ref name="pmid5327787">{{cite journal |vauthors=Kenworthy ME |title=Introducing the American Orthopsychiatric Association's president for 1966-67: Norman V. Lourie |journal=Am J Orthopsychiatry |volume=36 |issue=4 |pages=587–9 |date=July 1966 |pmid=5327787 |doi= |url=}}</ref>
*Physical examination of patients with spina bifida may be remarkable for:<ref name="pmid4898641">{{cite journal |vauthors=Bannur BB, Purandare GM |title=Microbial production of L-lysine |journal=Hindustan Antibiot Bull |volume=11 |issue=3 |pages=191–205 |date=February 1969 |pmid=4898641 |doi= |url=}}</ref><ref name="pmid5327787">{{cite journal |vauthors=Kenworthy ME |title=Introducing the American Orthopsychiatric Association's president for 1966-67: Norman V. Lourie |journal=Am J Orthopsychiatry |volume=36 |issue=4 |pages=587–9 |date=July 1966 |pmid=5327787 |doi= |url=}}</ref>
:* Spinal area discoloration or [[birthmarks]] may be the only sign in the newborns with spina bifida occulta  
:* Spinal area discoloration or [[birthmarks]] may be the only sign in the newborns with spina bifida occulta  
Line 22: Line 25:
:*Pressure [[Ulcer|ulcers]]
:*Pressure [[Ulcer|ulcers]]
:*Learning disabilities
:*Learning disabilities
==Physical Examination==
Physical examination of patients with [disease name] is usually normal.
OR
Physical examination of patients with [disease name] is usually remarkable for [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].
===Appearance of the Patient===
*Patients with [disease name] usually appear [general appearance].


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


*High-grade / low-grade fever
*Most patients with spina bifida have normal vital signs.
*[[Hypothermia]] / hyperthermia may be present
*[[Tachycardia]] with regular pulse or (ir)regularly irregular pulse
*[[Bradycardia]] with regular pulse or (ir)regularly irregular pulse
*Tachypnea / bradypnea
*Kussmal respirations may be present in _____ (advanced disease state)
*Weak/bounding pulse / pulsus alternans / paradoxical pulse / asymmetric pulse
*High/low blood pressure with normal pulse pressure / [[wide pulse pressure]] / [[narrow pulse pressure]]


===Skin===
===Skin===
* Skin examination of patients with [disease name] is usually normal.
* Skin examination of patients with spina bifida is usually remarkable for:<ref name="pmid4898641" /><ref name="pmid5327787" />
OR
** Spinal area discoloration or [[birthmarks]] may be the only sign in the newborns with spina bifida occulta
*[[Cyanosis]]  
** Protrusions in the [[lumbar spine]]
*[[Jaundice]]
** Dimples  in the [[lumbar spine]]
* [[Pallor]]
** Hair patch along the spine
* Bruises
 
<gallery widths="150px">
 
UploadedImage-01.jpg | Description {{dermref}}
UploadedImage-02.jpg | Description {{dermref}}
 
</gallery>
 
===HEENT===
===HEENT===
* HEENT examination of patients with [disease name] is usually normal.
* HEENT examination of patients with spina bifida is usually remarkable for:<ref name="pmid4898641" /><ref name="pmid5327787" />
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===
* Enlarging head
* Neck examination of patients with [disease name] is usually normal.
*Bulging [[fontanelle]]
OR
*Enlarged [[scalp veins]]
*[[Jugular venous distension]]
*[[Cranial bones]] [[suture]] [[diastasis]]
*[[Carotid bruits]] may be auscultated unilaterally/bilaterally using the bell/diaphragm of the otoscope
*Positive [[Macewen's sign|Macewen sign]]
*[[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 spina bifida is usually normal.
OR
* Asymmetric chest expansion OR decreased chest expansion
*Lungs are hyporesonant OR hyperresonant
*Fine/coarse [[crackles]] upon auscultation of the lung bases/apices unilaterally/bilaterally
*Rhonchi
*Vesicular breath sounds OR distant breath sounds
*Expiratory wheezing OR inspiratory wheezing with normal OR 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 spina bifida is usually normal but congenital anomalies of the spine have been associated with malformations of the cardiovascular systems.
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 stethoscope
 
===Abdomen===
===Abdomen===
* Abdominal examination of patients with [disease name] is usually normal.
* Abdominal examination of patients with spina bifida is usually normal.
OR
*[[Abdominal distension]]
*[[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 examination of patients with [disease name] 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.
* Congenital anomalies of the spine may be associated with malformations of the genitourinary system,.
OR
===Neuromuscular and extremities===
*A pelvic/adnexal mass may be palpated
[[Neuromuscular]] examination of patients with spina bifida may be remarkable for:<ref name="pmid3046545">{{cite journal |vauthors=Berman P |title=Austin Flint--America's Laennec revisited |journal=Arch. Intern. Med. |volume=148 |issue=9 |pages=2053–6 |date=September 1988 |pmid=3046545 |doi= |url=}}</ref><ref name="pmid2259256">{{cite journal |vauthors=Goya RG, Lu JK, Meites J |title=Gonadal function in aging rats and its relation to pituitary and mammary pathology |journal=Mech. Ageing Dev. |volume=56 |issue=1 |pages=77–88 |date=October 1990 |pmid=2259256 |doi= |url=}}</ref><ref name="pmid4362105">{{cite journal |vauthors=Weiden PL, Schuffler MD |title=Herpes esophagitis complicating Hodgkin's disease |journal=Cancer |volume=33 |issue=4 |pages=1100–2 |date=April 1974 |pmid=4362105 |doi= |url=}}</ref><ref name="pmid3047453">{{cite journal |vauthors=Thier SO |title=Commentary by the current president of the Institute of Medicine |journal=JAMA |volume=260 |issue=14 |pages=2104 |date=October 1988 |pmid=3047453 |doi= |url=}}</ref><ref name="pmid16120229">{{cite journal |vauthors=Vermaes IP, Janssens JM, Bosman AM, Gerris JR |title=Parents' psychological adjustment in families of children with spina bifida: a meta-analysis |journal=BMC Pediatr |volume=5 |issue= |pages=32 |date=August 2005 |pmid=16120229 |pmc=1215488 |doi=10.1186/1471-2431-5-32 |url=}}</ref>
*Inflamed mucosa
* [[Paralysis]]
*Clear/(color), foul-smelling/odorless penile/vaginal discharge
*Sensation problems
 
*[[Scoliosis]]
===Neuromuscular===
*Pressure [[Ulcer|ulcers]]
* Neuromuscular examination of patients with [disease name] is usually normal.
*Learning disabilities
OR
* [[Clonus]]
*Patient is usually oriented to persons, place, and time
* [[Hyperreflexia]] or [[hyporeflexia]]
* Altered mental status
* Positive (abnormal) [[Plantar reflex|Babinski]] unilaterally
* Glasgow coma scale is ___ / 15
* [[Hypertonia|Muscle rigidity]]
* Clonus may be present
* Muscle weakness unilaterally or bilaterally
* Hyperreflexia / hyporeflexia / areflexia
*Abnormal gait
* Positive (abnormal) Babinski / plantar reflex unilaterally/bilaterally
*[[Dysmetria]]
* 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 examination of patients with [disease name] 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==

Latest revision as of 18:56, 31 January 2019

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

Overview

Most patients with spina bifida have normal vital signs. Skin examination of patients with spina bifida is usually remarkable for: Spinal area discoloration or birthmarks, protrusions in the lumbar spine, dimples in the lumbar spine and patch along the spine. HEENT examination of patients with spina bifida is usually remarkable for: Enlarging head, bulging fontanelle, enlarged scalp veins, Cranial bones suture diastasis and positive Macewen sign. Cardiovascular examination of patients with spina bifida is usually normal but congenital anomalies of the spine have been associated with malformations of the cardiovascular systems. Congenital anomalies of the spine also may be associated with malformations of the genitourinary system. Neuromuscular examination of patients with spina bifida may be remarkable for: Paralysis, sensation problems, Scoliosis, pressure ulcers, learning disabilities, Clonus, Hyperreflexia or hyporeflexia, positive (abnormal) Babinski unilaterally, muscle rigidity, muscle weakness unilaterally or bilaterally, abnormal gait and Dysmetria.

Physical Examination

  • Physical examination of patients with spina bifida may be remarkable for:[1][2]
  • Spinal area discoloration or birthmarks may be the only sign in the newborns with spina bifida occulta
  • Protrusions in the lumbar spine
  • Dimples in the lumbar spine
  • Hair patch along the spine

Vital Signs

  • Most patients with spina bifida have normal vital signs.

Skin

  • Skin examination of patients with spina bifida is usually remarkable for:[1][2]
    • Spinal area discoloration or birthmarks may be the only sign in the newborns with spina bifida occulta
    • Protrusions in the lumbar spine
    • Dimples in the lumbar spine
    • Hair patch along the spine

HEENT

  • HEENT examination of patients with spina bifida is usually remarkable for:[1][2]

Lungs

  • Pulmonary examination of patients with spina bifida is usually normal.

Heart

  • Cardiovascular examination of patients with spina bifida is usually normal but congenital anomalies of the spine have been associated with malformations of the cardiovascular systems.

Abdomen

  • Abdominal examination of patients with spina bifida is usually normal.

Genitourinary

  • Congenital anomalies of the spine may be associated with malformations of the genitourinary system,.

Neuromuscular and extremities

Neuromuscular examination of patients with spina bifida may be remarkable for:[3][4][5][6][7]

References

  1. ↑ 1.0 1.1 1.2 Bannur BB, Purandare GM (February 1969). "Microbial production of L-lysine". Hindustan Antibiot Bull. 11 (3): 191–205. PMID 4898641.
  2. ↑ 2.0 2.1 2.2 Kenworthy ME (July 1966). "Introducing the American Orthopsychiatric Association's president for 1966-67: Norman V. Lourie". Am J Orthopsychiatry. 36 (4): 587–9. PMID 5327787.
  3. ↑ Berman P (September 1988). "Austin Flint--America's Laennec revisited". Arch. Intern. Med. 148 (9): 2053–6. PMID 3046545.
  4. ↑ Goya RG, Lu JK, Meites J (October 1990). "Gonadal function in aging rats and its relation to pituitary and mammary pathology". Mech. Ageing Dev. 56 (1): 77–88. PMID 2259256.
  5. ↑ Weiden PL, Schuffler MD (April 1974). "Herpes esophagitis complicating Hodgkin's disease". Cancer. 33 (4): 1100–2. PMID 4362105.
  6. ↑ Thier SO (October 1988). "Commentary by the current president of the Institute of Medicine". JAMA. 260 (14): 2104. PMID 3047453.
  7. ↑ Vermaes IP, Janssens JM, Bosman AM, Gerris JR (August 2005). "Parents' psychological adjustment in families of children with spina bifida: a meta-analysis". BMC Pediatr. 5: 32. doi:10.1186/1471-2431-5-32. PMC 1215488. PMID 16120229.

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