Monkeypox physical examination: Difference between revisions

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VisualWikitext

Latest revision as of 20:20, 20 October 2022

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

Overview

Depending on the stage of the disease, physical findings may include low-grade fever, enlarged lymph nodes (submental, submandibular, cervical, inguinal), and skin rash with typical progression: Macular (1-2 days), papular (1-2 days), vesicular (1-2 days), pustular (5-7 days), scabs (7-14 days)^[1].

Physical Examination

Vital Signs

Low-grade fever (temperature, 100.8°F, 38.2°C)^[2]
- Fever before rash is a key characteristics to identifying monkeypox^[1]

Skin

Skin lesions develop after the prodrome (early set of symptoms). The United States Centers for Disease Control and Prevention described following characteristics of lesions to identify monkeypox^[1]:

Relatively the same size and same stage of development on a single site of the body
Well-circumscribed, deep seated, and often develop umbilication (resembles a dot on the top of the lesion)
Disseminated rash is centrifugal (more lesions on extremities, face)
Includes palms and soles
often painful until the healing phase when they become itchy (crusts)

The skin lesions usually develop simultaneously as macular (1-2 days), then evolve to papular (1-2 days), vesicular (1-2 days), pustular (5-7 days), and finally scabs (7-14 days).

Neck

Lymphadenopathy (submental, submandibular, cervical)

Genitourinary

Inguinal lymphadenopathy
- Lymph nodes may increase in size in seldom cases after sexual intercourse^[3]
Signs of proctitis, or inflammation of the rectum^[4]^[5]
- Anal and rectal pain
- Rectal bleeding
- Malodorous, mucopurulent discharge

References

↑ ^1.0 ^1.1 ^1.2 "Clinical Recognition | Monkeypox | Poxvirus | CDC". Retrieved 2022-06-15.
↑ Fleischauer AT, Kile JC, Davidson M, Fischer M, Karem KL, Teclaw R; et al. (2005). "Evaluation of human-to-human transmission of monkeypox from infected patients to health care workers". Clin Infect Dis. 40 (5): 689–94. doi:10.1086/427805. PMID 15714414.
↑ Adler H, Gould S, Hine P, Snell LB, Wong W, Houlihan CF, Osborne JC, Rampling T, Beadsworth MB, Duncan CJ, Dunning J, Fletcher TE, Hunter ER, Jacobs M, Khoo SH, Newsholme W, Porter D, Porter RJ, Ratcliffe L, Schmid ML, Semple MG, Tunbridge AJ, Wingfield T, Price NM (May 2022). "Clinical features and management of human monkeypox: a retrospective observational study in the UK". [[]]. doi:10.1016/S1473-3099(22)00228-6. |access-date= requires |url= (help)
↑ Basgoz N, Brown CM, Smole SC, Madoff LC, Biddinger PD, Baugh JJ; et al. (2022). "Case 24-2022: A 31-Year-Old Man with Perianal and Penile Ulcers, Rectal Pain, and Rash". N Engl J Med. doi:10.1056/NEJMcpc2201244. PMID 35704401 Check |pmid= value (help).
↑ Harris E (2022). "What to Know About Monkeypox". JAMA. doi:10.1001/jama.2022.9499. PMID 35622356 Check |pmid= value (help).

[urlClinical_Recognition_|_Monkeypox_|_Poxvirus_|_CDC-1] 1.0 ^1.1 ^1.2 "Clinical Recognition | Monkeypox | Poxvirus | CDC". Retrieved 2022-06-15.

[pmid15714414-2] Fleischauer AT, Kile JC, Davidson M, Fischer M, Karem KL, Teclaw R; et al. (2005). "Evaluation of human-to-human transmission of monkeypox from infected patients to health care workers". Clin Infect Dis. 40 (5): 689–94. doi:10.1086/427805. PMID 15714414.

[pmid-3] Adler H, Gould S, Hine P, Snell LB, Wong W, Houlihan CF, Osborne JC, Rampling T, Beadsworth MB, Duncan CJ, Dunning J, Fletcher TE, Hunter ER, Jacobs M, Khoo SH, Newsholme W, Porter D, Porter RJ, Ratcliffe L, Schmid ML, Semple MG, Tunbridge AJ, Wingfield T, Price NM (May 2022). "Clinical features and management of human monkeypox: a retrospective observational study in the UK". [[]]. doi:10.1016/S1473-3099(22)00228-6. |access-date= requires |url= (help)

[pmid35704401-4] Basgoz N, Brown CM, Smole SC, Madoff LC, Biddinger PD, Baugh JJ; et al. (2022). "Case 24-2022: A 31-Year-Old Man with Perianal and Penile Ulcers, Rectal Pain, and Rash". N Engl J Med. doi:10.1056/NEJMcpc2201244. PMID 35704401 Check |pmid= value (help).

[pmid35622356-5] Harris E (2022). "What to Know About Monkeypox". JAMA. doi:10.1001/jama.2022.9499. PMID 35622356 Check |pmid= value (help).

[1]

[2]

[3]

[4]

[5]

@@ Line 1: / Line 1: @@
 __NOTOC__
 {{Monkeypox}}
-{{CMG}}{{AE}} {{Jose}}
+{{CMG}};{{AE}} {{Bassel}}
 ==Overview==
+Depending on the stage of the disease, physical findings may include low-grade fever, enlarged lymph nodes (submental, submandibular, cervical, inguinal), and skin rash with typical progression: Macular (1-2 days), papular (1-2 days), vesicular (1-2 days), pustular (5-7 days), scabs (7-14 days)<ref name="urlClinical Recognition | Monkeypox | Poxvirus | CDC">{{cite web |url=https://www.cdc.gov/poxvirus/monkeypox/clinicians/clinical-recognition.html |title=Clinical Recognition &#124; Monkeypox &#124; Poxvirus &#124; CDC |format= |work= |accessdate=2022-06-15}}</ref>.
 ==Physical Examination==
 ===Vital Signs===
-<sup>Note: Vital signs traditionally include the temperature, blood pressure, heart rate, respiratory rate. The vital signs may also include oxygen saturation (at room air) and blood glycemia.</sup>
-*High-grade / low-grade fever
+*Low-grade fever (temperature, 100.8°F, 38.2°C)<ref name="pmid15714414">{{cite journal| author=Fleischauer AT, Kile JC, Davidson M, Fischer M, Karem KL, Teclaw R | display-authors=etal| title=Evaluation of human-to-human transmission of monkeypox from infected patients to health care workers. | journal=Clin Infect Dis | year= 2005 | volume= 40 | issue= 5 | pages= 689-94 | pmid=15714414 | doi=10.1086/427805 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15714414  }} </ref>
-*[[Hypothermia]] / hyperthermia may be present
+** Fever before rash is a key characteristics to identifying monkeypox<ref name="urlClinical Recognition | Monkeypox | Poxvirus | CDC">{{cite web |url=https://www.cdc.gov/poxvirus/monkeypox/clinicians/clinical-recognition.html |title=Clinical Recognition &#124; Monkeypox &#124; Poxvirus &#124; CDC |format= |work= |accessdate=2022-06-15}}</ref>
-*[[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===
-*[[Cyanosis]]
+Skin lesions develop after the prodrome (early set of symptoms). The United States Centers for Disease Control and Prevention described following characteristics of lesions to identify monkeypox<ref name="urlClinical Recognition | Monkeypox | Poxvirus | CDC">{{cite web |url=https://www.cdc.gov/poxvirus/monkeypox/clinicians/clinical-recognition.html |title=Clinical Recognition &#124; Monkeypox &#124; Poxvirus &#124; CDC |format= |work= |accessdate=2022-06-15}}</ref>:
-*[[Jaundice]]
+*Relatively the same size and same stage of development on a single site of the body
-* [[Pallor]]
+*Well-circumscribed, deep seated, and often develop umbilication (resembles a dot on the top of the lesion)
-* Bruises
+*Disseminated rash is centrifugal (more lesions on extremities, face)
-Note: To describe a rash, always report additional details that include the color (e.g. erythematous), shape (e.g. flat / bullous), dermarcation (e.g. well-circumscribed / diffuse), location (e.g. truncal / on the face / on the extremities), enclosing fluid (e.g. vesicular / filled with pus, clear), and if possible smell (e.g. foul-smelling / odorless)
+*Includes palms and soles
+*often painful until the healing phase when they become itchy (crusts)
-<gallery widths=150px>
+The skin lesions usually develop simultaneously as macular (1-2 days), then evolve to papular (1-2 days), vesicular (1-2 days), pustular (5-7 days), and finally scabs (7-14 days).
-UploadedImage-01.jpg | Description {{dermref}}
-UploadedImage-02.jpg | Description {{dermref}}
-</gallery>
-===HEENT===
-* 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 accomodation / non-reactive to neither light nor accomodation
-*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===
-*[[Jugular venous distension]]
+*[[Lymphadenopathy]] (submental, submandibular, cervical)
-*[[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===
-* 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===
-*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===
-*[[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===
-*Point tenderness over __ vertebrae (e.g. L3-L4)
-*Sacral edema
-*Costovertebral angle tenderness bilaterally/unilaterally (may also be referred to as Murphy's punch sign, which is different from Murphy's sign that suggests cholecystitis. To avoid confusion, write "costovertebral angle tenderness")
-*Buffalo hump
 ===Genitourinary===
-*A pelvic/adnexal mass may be palpated
+*Inguinal lymphadenopathy
-*Inflamed mucosa
+**Lymph nodes may increase in size in seldom cases after sexual intercourse<ref name="pmid">{{cite journal |vauthors=Adler H, Gould S, Hine P, Snell LB, Wong W, Houlihan CF, Osborne JC, Rampling T, Beadsworth MB, Duncan CJ, Dunning J, Fletcher TE, Hunter ER, Jacobs M, Khoo SH, Newsholme W, Porter D, Porter RJ, Ratcliffe L, Schmid ML, Semple MG, Tunbridge AJ, Wingfield T, Price NM |title=Clinical features and management of human monkeypox: a retrospective observational study in the UK |journal=[[]] |volume= |issue= |pages= |date=May 2022 |pmid= |doi=10.1016/S1473-3099(22)00228-6 |url= |accessdate=2022-06-15}}</ref>
-*Clear/(color), foul-smelling/odorless penile/vaginal discharge
+*Signs of proctitis, or inflammation of the rectum<ref name="pmid35704401">{{cite journal| author=Basgoz N, Brown CM, Smole SC, Madoff LC, Biddinger PD, Baugh JJ | display-authors=etal| title=Case 24-2022: A 31-Year-Old Man with Perianal and Penile Ulcers, Rectal Pain, and Rash. | journal=N Engl J Med | year= 2022 | volume=  | issue=  | pages=  | pmid=35704401 | doi=10.1056/NEJMcpc2201244 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=35704401  }} </ref><ref name="pmid35622356">{{cite journal| author=Harris E| title=What to Know About Monkeypox. | journal=JAMA | year= 2022 | volume=  | issue=  | pages=  | pmid=35622356 | doi=10.1001/jama.2022.9499 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=35622356  }} </ref>
-<sup>Write additional pathognomonic findings, such as discharge that resembles cottage cheese for ''C. albicans'' vulvovaginitis / fish-odor for ''T. vaginalis'' ifnection</sup>
+**Anal and rectal pain
+**Rectal bleeding
-===Extremities===
+**Malodorous, mucopurulent discharge
-*[[Clubbing]]
-*[[Cyanosis]]
-*Pitting/non-pitting [[edema]] of the upper/lower extremities
-*Muscle atrophy
-*Fasciculations in the upper/lower extremity
-===Neuromuscular===
-*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)
-==References==
-* References should be cited for the material that you have put on your page. Type in <nowiki>{{reflist|2}}</nowiki>.This will generate your references in small font, in two columns, with links to the original article and abstract.
-* For information on how to add references into your page, click [[References|here]].
-{{reflist|2}}
 ==References==
+{{Reflist|2}}
+[[category:Up to Date]]