Cryptococcosis physical examination: Difference between revisions
Jump to navigation
Jump to search
| Line 5: | Line 5: | ||
==Physical Examination== | ==Physical Examination== | ||
====General appearance of patient==== | |||
*Patient may look distressed | |||
*[[Altered mental status]] | |||
====Vitals==== | |||
'''[[Temperature]]''' | |||
*A [[fever|low grade fever]] is often present | |||
====HEENT==== | |||
*[[Nystagmus]] may be present. | |||
*Extra-ocular movements may be abnormal | |||
*[[Eye examination|Ophthalmoscopic exam]] may be abnormal with signs consistent with [[papilledema]] and may indicate [[increased intracranial pressure]]. | |||
*[[Inflamed]] sinuses with [[facial]] [[tenderness]] in some cases. | |||
*Signs of infection indicating [[sinusitis]], [[mastoiditis]], and [[otitis media]] may help identify the source of infection and give a clue about diagnosis. | |||
====[[Neck]]==== | |||
*[[Neck stiffness]] is strongly suggestive of meningitis. | |||
====[[Neuromuscular]]==== | |||
*The [[mental status]] is usually intact | |||
*[[Muscular strength]] is usually intact, but focal deficits might be present | |||
*[[Sensation]] is usually intact, but focal deficits might be present | |||
*[[Reflexes|Hyperactive reflexes]] may be present | |||
*Deficits in [[cranial nerves]] might be present: decreased [[Visual acuity|vision acuity]], [[Muscles of facial expression|facial muscle]] [[Muscle weakness|weakness]], decreased hearing ([[CN VIII]]), and [[diplopia]] | |||
*[[Gait]] might be altered | |||
=====Special tests===== | =====Special tests===== | ||
Following are the special tests for meningitis. Positive tests provide a strong suspicion for meningeal irritation:<ref name="pmid12060874">{{cite journal| author=Thomas KE, Hasbun R, Jekel J, Quagliarello VJ| title=The diagnostic accuracy of Kernig's sign, Brudzinski's sign, and nuchal rigidity in adults with suspected meningitis. | journal=Clin Infect Dis | year= 2002 | volume= 35 | issue= 1 | pages= 46-52 | pmid=12060874 | doi=10.1086/340979 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12060874 }} </ref> | Following are the special tests for meningitis. Positive tests provide a strong suspicion for meningeal irritation:<ref name="pmid12060874">{{cite journal| author=Thomas KE, Hasbun R, Jekel J, Quagliarello VJ| title=The diagnostic accuracy of Kernig's sign, Brudzinski's sign, and nuchal rigidity in adults with suspected meningitis. | journal=Clin Infect Dis | year= 2002 | volume= 35 | issue= 1 | pages= 46-52 | pmid=12060874 | doi=10.1086/340979 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12060874 }} </ref> | ||
Revision as of 15:37, 5 June 2017
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
|
Cryptococcosis Microchapters |
|
Diagnosis |
|---|
|
Treatment |
|
Case Studies |
|
Cryptococcosis physical examination On the Web |
|
American Roentgen Ray Society Images of Cryptococcosis physical examination |
|
Risk calculators and risk factors for Cryptococcosis physical examination |
Overview
Physical Examination
General appearance of patient
- Patient may look distressed
- Altered mental status
Vitals
- A low grade fever is often present
HEENT
- Nystagmus may be present.
- Extra-ocular movements may be abnormal
- Ophthalmoscopic exam may be abnormal with signs consistent with papilledema and may indicate increased intracranial pressure.
- Inflamed sinuses with facial tenderness in some cases.
- Signs of infection indicating sinusitis, mastoiditis, and otitis media may help identify the source of infection and give a clue about diagnosis.
Neck
- Neck stiffness is strongly suggestive of meningitis.
Neuromuscular
- The mental status is usually intact
- Muscular strength is usually intact, but focal deficits might be present
- Sensation is usually intact, but focal deficits might be present
- Hyperactive reflexes may be present
- Deficits in cranial nerves might be present: decreased vision acuity, facial muscle weakness, decreased hearing (CN VIII), and diplopia
- Gait might be altered
Special tests
Following are the special tests for meningitis. Positive tests provide a strong suspicion for meningeal irritation:[1]
- Postive kernig's sign indicate meningitis.
- Positive brudzinski's sign may suggest meningitis
- It should be noted that Kernig's sign and brudzinski's sign are not typically present in fungal meningitis.
- Jolt accentuation:[2]
- Exacerbation of headache by moving head in horizontal direction two to three times indicate positive test.
Gallery
-
![Skin lesion in a case of a disseminated fungal infection, cryptococcosis, caused by a member of the fungal genus, Cryptococcus. From Public Health Image Library (PHIL). [3]](/images/f/f3/Cryptococcosis05.jpeg)
Skin lesion in a case of a disseminated fungal infection, cryptococcosis, caused by a member of the fungal genus, Cryptococcus. From Public Health Image Library (PHIL). [3]
![Skin lesion in a case of a disseminated fungal infection, cryptococcosis, caused by a member of the fungal genus, Cryptococcus. From Public Health Image Library (PHIL). [3]](/index.php/File:Cryptococcosis05.jpeg)
References
- ↑ Thomas KE, Hasbun R, Jekel J, Quagliarello VJ (2002). "The diagnostic accuracy of Kernig's sign, Brudzinski's sign, and nuchal rigidity in adults with suspected meningitis". Clin Infect Dis. 35 (1): 46–52. doi:10.1086/340979. PMID 12060874.
- ↑ Uchihara T, Tsukagoshi H (1991). "Jolt accentuation of headache: the most sensitive sign of CSF pleocytosis". Headache. 31 (3): 167–71. PMID 2071396.
- ↑ "Public Health Image Library (PHIL)".