Rabies physical examination: Difference between revisions

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Latest revision as of 23:56, 29 July 2020

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

Overview

Common physical examination findings of rabies include hyperpyrexia alternating with hypothermia, tachycardia, respiratory collapse, hypersalivation, lacrimation, sweating, dilatation of the pupils and bradycardia. Skin findings may include percussion myoedema, bite marks and bruises.

Physical Examination

Vital Signs

Hyperpyrexia alternating with hypothermia
Tachycardia
Respiratory and vascular collapse
Bradycardia

Skin

Percussion myoedema (mounding of the muscle at the percussion site)^[1]
Bite marks
Bruises

HEENT

Neck

No abnormal findings

Lungs

Fine/coarse crackles upon auscultation of the lung bases/apices unilaterally/bilaterally, if aspirated.
Wheezing may be present due to aspiration or chest infection
Normal/reduced tactile fremitus

Heart

S1 normal, soft
S2 normal

Abdomen

Guarding may be present

Genitourinary

No abnormal findings

Neuromuscular

Opisthotonos
Altered mental status
Increased tendon reflexes with extensor plantar responses
Flaccid paralysis with generalized areflexia when patient develops coma
Nuchal rigidity
Increased muscle tone
Fasciculations

Extremities

Bite marks
Muscle atrophy
Fasciculations in the upper/lower extremity

References

↑ Hemachudha T, Phanthumchinda K, Phanuphak P, Manutsathit S (1987). "Myoedema as a clinical sign in paralytic rabies". Lancet. 1 (8543): 1210. PMID 2883526.

Template:WikiDoc Sources

[pmid2883526-1] Hemachudha T, Phanthumchinda K, Phanuphak P, Manutsathit S (1987). "Myoedema as a clinical sign in paralytic rabies". Lancet. 1 (8543): 1210. PMID 2883526.

[1]

@@ Line 1: / Line 1: @@
+__NOTOC__
 {{Rabies}}
-{{CMG}}
-{{MJM}}
-==Overview==
+{{CMG}} {{AE}} {{IQ}}
-When a person contracts rabies, they do not show symptoms immediately. The disease take a period of time to manifest in the body which is know as its period of [[incubation]]. Once symptoms arise, the patients condition deteriorates rapidly. There is not a great deal of time available to perform a routine physical examination. A patient will most likely present with some severe symptoms that may be misdiagnosed as diseases such as [[Guillan-Barre syndrome]].
-==Physical Exam==
+== Overview ==
-A patient may present with any of the following conditions:
+Common physical examination findings of rabies include [[hyperpyrexia]] alternating with [[hypothermia]], [[tachycardia]], [[respiratory]] collapse, [[hypersalivation]], [[lacrimation]], [[sweating]], [[Pupillary dilation|dilatation of the pupils]] and [[bradycardia]]. Skin findings may include percussion myoedema, bite marks and [[bruises]].
-*[[Psychosis]]
+== Physical Examination ==
-*[[Thrashing]]
-*[[Seizures]]
-*[[Aphasia]]
-*Muscular twitching
-*Restlessness
-*[[Delirium]]
-A patient with rabies may present with difficulty drinking. This is because attempting to drink may cause [[spasms]] of the [[larynx]] and [[diaphragm]].
+=== Vital Signs ===
+* [[Hyperpyrexia]] alternating with [[hypothermia]]
+* [[Tachycardia]]
+* [[Respiratory]] and [[vascular]] collapse
+* [[Bradycardia]]
+=== Skin ===
+* Percussion myoedema (mounding of the muscle at the percussion site)<ref name="pmid2883526">{{cite journal |vauthors=Hemachudha T, Phanthumchinda K, Phanuphak P, Manutsathit S |title=Myoedema as a clinical sign in paralytic rabies |journal=Lancet |volume=1 |issue=8543 |pages=1210 |year=1987 |pmid=2883526 |doi= |url=}}</ref>
+* Bite marks
+* [[Bruises]]
+=== HEENT ===
+* [[Hypersalivation]]
+*[[Lacrimation]]
+*[[Sweating]]
+*[[Pupillary dilation|Dilatation of the pupils]]
+=== Neck ===
+* No abnormal findings
+=== Lungs ===
+* Fine/coarse [[crackles]] upon [[auscultation]] of the [[lung]] bases/apices unilaterally/bilaterally, if [[Aspirate|aspirated]].
+* [[Wheezing]] may be present due to [[aspiration]] or  [[chest]] [[infection]]
+* Normal/reduced [[tactile fremitus]]
+=== Heart ===
+* [[Heart sounds#First heart tone S1.2C the .22lub.22.28components M1 and T1.29|S1]] normal, soft
+* [[Heart sounds#Second heart tone S2 the .22dub.22.28components A2 and P2.29|S2]] normal
+=== Abdomen ===
+* [[Guarding]] may be present
+=== Genitourinary ===
+* No abnormal findings
+=== Neuromuscular ===
+* [[Opisthotonos]]
+* [[Altered mental status]]
+* Increased [[Tendon reflex|tendon reflexes]] with [[Extensor plantar reflexes|extensor plantar responses]]
+*[[Flaccid paralysis]] with generalized [[areflexia]] when patient develops [[coma]]
+* [[Nuchal rigidity]]
+* Increased [[muscle tone]]
+* [[Fasciculations]]
+=== Extremities ===
+* Bite marks
+* Muscle [[atrophy]]
+* [[Fasciculations]] in the upper/lower extremity
 ==References==
 {{Reflist|2}}
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+{{WikiDoc Sources}}
+[[Category:Disease]]
+[[Category:Viral diseases]]
+[[Category:Mononegavirales]]
+[[Category:Neurology]]
+[[Category:Zoonoses]]
+[[Category:Emergency medicine]]
+[[Category:Intensive care medicine]]
+[[Category:Infectious disease]]
+[[Category:Medicine]]