Secondary adrenal insufficiency physical examination: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Adrenal insufficiency}} | {{Adrenal insufficiency}} | ||
{{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 [disease name] usually appear [general appearance]. Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3]. | ||
==Physical Examination== | ==Physical Examination== | ||
===Appearance of the Patient=== | ===Appearance of the Patient=== | ||
*Patients with | *Patients with secondary adrenal insufficiency usually appear weak and dehydrate. | ||
===Vital Signs=== | ===Vital Signs=== | ||
* | *Low-grade fever may be present | ||
Hyperthermia may be present | |||
*[[Tachycardia]] | *[[Tachycardia]] may be present | ||
* Normal to low blood pressure may be present | |||
* | |||
===Skin=== | ===Skin=== | ||
* [[Pallor]] may be present | |||
* Bruises may be present | |||
* [[Pallor]] | * Unlike Addison's , there is no hyperpigmentation. Its one of the hallmark for differentiating them. | ||
* Bruises | |||
===HEENT=== | ===HEENT=== | ||
* Extra-ocular movements may be abnormal | * Extra-ocular movements may be abnormal | ||
* | * Visual field defects can be seen such as [[bitemporal hemianopsia]] | ||
===Neck=== | ===Neck=== | ||
*[[Jugular venous distension | *No [[Jugular venous distension]] | ||
===Lungs=== | ===Lungs=== | ||
* | * Symmetric chest expansion | ||
* Normal [[tactile fremitus]] | |||
*Normal | |||
===Heart=== | ===Heart=== | ||
*Chest tenderness upon palpation | *Chest tenderness upon palpation | ||
*PMI within 2 cm of the sternum (PMI) | *PMI within 2 cm of the sternum (PMI) | ||
*[[Friction rub]] | *[[Friction rub]] | ||
*[[Heart sounds#First heart tone S1, the "lub"(components M1 and T1)|S1]] | *[[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#Second heart tone S2 the "dub"(components A2 and P2)|S2]] | ||
===Abdomen=== | ===Abdomen=== | ||
*[[Abdominal tenderness]] in the right/left upper/lower abdominal quadrant | *[[Abdominal tenderness]] in the right/left upper/lower abdominal quadrant | ||
*[[Rebound tenderness]] (positive Blumberg sign) | *[[Rebound tenderness]] (positive Blumberg sign) | ||
Revision as of 18:26, 5 October 2017
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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 [disease name] usually appear [general appearance]. Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].
Physical Examination
Appearance of the Patient
- Patients with secondary adrenal insufficiency usually appear weak and dehydrate.
Vital Signs
- Low-grade fever may be present
Hyperthermia may be present
- Tachycardia may be present
- Normal to low blood pressure may be present
Skin
- Pallor may be present
- Bruises may be present
- Unlike Addison's , there is no hyperpigmentation. Its one of the hallmark for differentiating them.
HEENT
- Extra-ocular movements may be abnormal
- Visual field defects can be seen such as bitemporal hemianopsia
Neck
Lungs
- Symmetric chest expansion
- Normal tactile fremitus
Heart
- Chest tenderness upon palpation
- PMI within 2 cm of the sternum (PMI)
- Friction rub
- S1
- S2
Abdomen
- 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
- Buffalo hump
Genitourinary
- A pelvic/adnexal mass may be palpated
- Inflamed mucosa
- Clear/(color), foul-smelling/odorless penile/vaginal discharge
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)
Extremities
- Clubbing
- Cyanosis
- Pitting/non-pitting edema of the upper/lower extremities
- Muscle atrophy
- Fasciculations in the upper/lower extremity