Tabes Dorsalis physical examination: Difference between revisions

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===Skin===
===Skin===
* In patients with tabes dorsalis some granulomatous skin lesions may be seen called gumma. Gummas, are granulomatous reactions to long-term smoldering infection with Treponema pallidum and its residual antigens.
* In patients with tabes dorsalis some [[granulomatous]] [[Skin lesion|skin lesions]] which are one of the late manifestations of tertiary syphilis called [[gumma]] may be present. [[Gumma]]<nowiki/>s, are [[granulomatous]] reactions to long-term smoldering infection with [[Treponema pallidum]] and its residual [[Antigen|antigens]].
*[[Jaundice]] may be seen.
*[[Jaundice]] may be seen.


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OR
OR
* Abnormalities of the head/hair may include ___
* Abnormalities of the head/hair may include ___
* Evidence of trauma
* Icteric sclera  
* Icteric sclera  
* [[Nystagmus]]  
* [[Nystagmus]] may be seen
* Extra-ocular movements may be abnormal
* Extra-ocular movements may be abnormal
*Pupils non-reactive to light / non-reactive to accommodation / non-reactive to neither light nor accommodation
*[[Argyll Robertson pupil|Argyll Robertson pupils]] may be present
*Ophthalmoscopic exam may be abnormal with findings of ___
* Hearing acuity may be reduced
* 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===
===Neck===
* Neck examination of patients with [disease name] is usually normal.
*[[Jugular venous distension]] may be seen
OR
*Nontender, mobile, small, cervical [[lymphadenopathy]] may be present
*[[Jugular venous distension]]
*[[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===
===Lungs===
* Pulmonary examination of patients with [disease name] is usually normal.
* In patients with tabes dorsalis some [[granulomatous]] lung lesions which are one of the late manifestations of tertiary syphilis called [[gumma]] may be present. [[Gumma]]<nowiki/>s, are [[granulomatous]] reactions to long-term smoldering infection with [[Treponema pallidum]] and its residual [[Antigen|antigens]].
OR
* 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===
* Cardiovascular examination of patients with [disease name] is usually normal.
OR
*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===
* Asymmetric chest expansion may be seen
Abdominal examination of patients with [disease name] is usually normal.
*Bilaterally coarse [[crackles]] upon auscultation of the lung may be present
 
OR
*[[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===
* Back examination of patients with [disease name] is usually normal.
OR
*Point tenderness over __ vertebrae (e.g. L3-L4)
*Sacral edema
*Costovertebral angle tenderness bilaterally/unilaterally
*Buffalo hump
 
===Genitourinary===
* Genitourinary examination of patients with [disease name] is usually normal.
OR
*A pelvic/adnexal mass may be palpated
*Inflamed mucosa
*Clear/(color), foul-smelling/odorless penile/vaginal discharge


===Neuromuscular===
===Neuromuscular===
* Neuromuscular examination of patients with [disease name] is usually normal.
OR
*Patient is usually oriented to persons, place, and time
*Patient is usually oriented to persons, place, and time
* Altered mental status
* Altered mental status may be present
* Glasgow coma scale is ___ / 15
* Clonus may be present
* Clonus may be present
* Hyperreflexia / hyporeflexia / areflexia
* Hhyporeflexia or areflexia may be seen
* Positive (abnormal) Babinski / plantar reflex unilaterally/bilaterally
* Impaired balance bilateral ''Babinski's'' Reflex may be present
* Muscle rigidity
* Bilateral muscle weakness mostly in lower limbs may be seen
* Proximal/distal muscle weakness unilaterally/bilaterally
* [[Argyll Robertson pupil|Argyll Robertson pupils]] may be present
* ____ (finding) suggestive of cranial nerve ___ (roman numerical) deficit (e.g. Dilated pupils suggestive of CN III deficit)
*Bilateral sensory loss in the extremity mostly in lower limbs may be seen
*Unilateral/bilateral upper/lower extremity weakness
*[[Sensory ataxia|Sensory ataxic gait]] is usually seen in patients with tabes dorsalis
*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)
*Unilateral/bilateral tremor (describe tremor, e.g. at rest, pill-rolling)
*Normal finger-to-nose test / Dysmetria
*Normal finger-to-nose test / Dysmetria

Revision as of 19:57, 30 January 2018

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Physical Examination

Physical examination may show:

References

Template:WH Template:WS

s s s s

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

OR

Common physical examination findings of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

The presence of [finding(s)] on physical examination is diagnostic of [disease name].

OR

The presence of [finding(s)] on physical examination is highly suggestive of [disease name].

Physical Examination

  • Physical examination of patients with [disease name] is usually normal.

OR

  • Physical examination of patients with [disease name] is usually remarkable for:[finding 1], [finding 2], and [finding 3].
  • The presence of [finding(s)] on physical examination is diagnostic of [disease name].
  • The presence of [finding(s)] on physical examination is highly suggestive of [disease name].

Appearance of the Patient

  • Patients with [disease name] usually appear [general appearance].

Vital Signs

  • Usually vital ital signs are normal in tabes dorsal.

Skin


Tertiary syphilis gumma
Source:By NearEMPTiness (Wie Schönes Wissen schafft im MUT) [CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0)], via Wikimedia Commons, rID: 51340


HEENT

  • HEENT examination of patients with [disease name] is usually normal.

OR

  • Abnormalities of the head/hair may include ___
  • Icteric sclera
  • Nystagmus may be seen
  • Extra-ocular movements may be abnormal
  • Argyll Robertson pupils may be present
  • Hearing acuity may be reduced

Neck

Lungs

  • Asymmetric chest expansion may be seen
  • Bilaterally coarse crackles upon auscultation of the lung may be present

Neuromuscular

  • Patient is usually oriented to persons, place, and time
  • Altered mental status may be present
  • Clonus may be present
  • Hhyporeflexia or areflexia may be seen
  • Impaired balance bilateral Babinski's Reflex may be present
  • Bilateral muscle weakness mostly in lower limbs may be seen
  • Argyll Robertson pupils may be present
  • Bilateral sensory loss in the extremity mostly in lower limbs may be seen
  • Sensory ataxic gait is usually seen in patients with tabes dorsalis
  • 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 examination of patients with [disease name] is usually normal.

OR

  • Clubbing
  • Cyanosis
  • Pitting/non-pitting edema of the upper/lower extremities
  • Muscle atrophy
  • Fasciculations in the upper/lower extremity

References

Template:WH Template:WS

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