Diffuse esophageal spasm physical examination: Difference between revisions

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Heart involvement in Chagas's cardiomyopathy are:
Heart involvement in Chagas's cardiomyopathy are:


Displaced point of maximal impulse (PMI) suggestive of ____
*Displaced point of maximal impulse (PMI) suggestive of ____
*[[Heart sounds#Third heart sound S3|S3]], [[S4]]
*[[Heart sounds#Third heart sound S3|S3]], [[S4]]
*Disturbances of rhythm (arrhythmias) may be noted in scleroderma.
*Disturbances of rhythm (arrhythmias) may be noted in scleroderma.


===Abdomen===
===Abdomen===
*[[Abdominal distention]]  
*[[Abdominal distention]] or bloating is noted in Scleroderma, Diabetes.
*[[Abdominal tenderness]] in the right/left upper/lower abdominal quadrant
*[[Hepatosplenomegaly]] is feature of Chaga's disease.
*[[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===
===Extremities===
*[[Clubbing]]  
*[[Clubbing]] , [[Cyanosis]] are features of chronic involvement and fibrosis of lungs in scleroderma.
*[[Cyanosis]]  
*Pitting [[edema]] of the lower extremities may be noted in Chaga's cardiomyopathy.
*Pitting/non-pitting [[edema]] of the upper/lower extremities
*Muscle atrophy
*Fasciculations in the upper/lower extremity


==References==
==References==

Revision as of 16:40, 22 November 2017

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

Overview

Patients with primary diffuse esophageal spasm usually appear normal. Physical examination of patients with DES is usually remarkable for findings related to secondary diseases.

Physical Examination

  • Physical examination of patients with DES is usually remarkable for presence of features related to secondary diseases.

Appearance of the Patient

  • Patients with primary DES usually appear normal.

Vital Signs

  • High-grade / low-grade fever in infectious cause of DES
  • 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
  • Weak/bounding pulse
  • High/low blood pressure with normal pulse pressure

Skin

  • Tight, hardened skin in limited scleroderma
  • Red spots or lines in skin of face and hand due to telengectasia in scleroderma
  • Bumps under the skin due to deposition of calcium in scleroderma.
  • Ulcers of finger and toes may be present in scleroderma
  • Insect bite wound may be seen in Chaga's disease with excoriation at the bite site.

HEENT

  • Romana's sign is seen in Chaga's disease (swelling of eyelid at the site of parasite entry)
  • Ophthalmoscopic exam may be abnormal with findings of diabetic retinopathy in diabetics as well as cataract changes.
  • Lower extremities edema in Chaga's disease.
  • Dry mouth and dry eye in scleroderma.

Neck

Lungs

  • Asymmetric chest expansion / Decreased chest expansion
  • Lungs are hyperresonant in scleroderma.
  • Fine/coarse crackles upon auscultation of the lung bases/apices bilaterally seen in scleroderma.

Heart

Heart involvement in Chagas's cardiomyopathy are:

  • Displaced point of maximal impulse (PMI) suggestive of ____
  • S3, S4
  • Disturbances of rhythm (arrhythmias) may be noted in scleroderma.

Abdomen


Extremities

  • Clubbing , Cyanosis are features of chronic involvement and fibrosis of lungs in scleroderma.
  • Pitting edema of the lower extremities may be noted in Chaga's cardiomyopathy.

References

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