Spina bifida physical examination: Difference between revisions

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===Vital Signs===
===Vital Signs===


*High-grade / low-grade fever
*Most patients with spina bifida have normal vital signs.
*[[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 may be present in _____ (advanced disease state)
*Weak/bounding pulse / pulsus alternans / paradoxical pulse / asymmetric pulse
*High/low blood pressure with normal pulse pressure / [[wide pulse pressure]] / [[narrow pulse pressure]]


===Skin===
===Skin===
* Skin examination of patients with [disease name] is usually normal.
* Skin examination of patients with spina bifida is usually remarkable for:<ref name="pmid4898641" /><ref name="pmid5327787" />
OR
** Spinal area discoloration or [[birthmarks]] may be the only sign in the newborns with spina bifida occulta
*[[Cyanosis]]  
** Protrusions in the [[lumbar spine]]
*[[Jaundice]]
** Dimples  in the [[lumbar spine]]
* [[Pallor]]
** Hair patch along the spine
* Bruises
 
<gallery widths="150px">
 
UploadedImage-01.jpg | Description {{dermref}}
UploadedImage-02.jpg | Description {{dermref}}
 
</gallery>
 
===HEENT===
===HEENT===
* HEENT examination of patients with [disease name] is usually normal.
* HEENT examination of patients with spina bifida is usually remarkable for:<ref name="pmid4898641" /><ref name="pmid5327787" />
OR
* Abnormalities of the head/hair may include ___
* Evidence of trauma
* Icteric sclera
* [[Nystagmus]]
* Extra-ocular movements may be abnormal
*Pupils non-reactive to light / non-reactive to accommodation / non-reactive to neither light nor accommodation
*Ophthalmoscopic exam may be abnormal with findings of ___
* 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===
* Enlarging head
* Neck examination of patients with [disease name] is usually normal.
*Bulging [[fontanelle]]
OR
*Enlarged [[scalp veins]]
*[[Jugular venous distension]]
*[[Cranial bones]] [[suture]] [[diastasis]]
*[[Carotid bruits]] may be auscultated unilaterally/bilaterally using the bell/diaphragm of the otoscope
*Positive [[Macewen's sign|Macewen sign]]
*[[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.
* Pulmonary examination of patients with spina bifida is usually normal.
OR
* Asymmetric chest expansion OR decreased chest expansion
*Lungs are hyporesonant OR hyperresonant
*Fine/coarse [[crackles]] upon auscultation of the lung bases/apices unilaterally/bilaterally
*Rhonchi
*Vesicular breath sounds OR distant breath sounds
*Expiratory wheezing OR inspiratory wheezing with normal OR delayed expiratory phase
*[[Wheezing]] may be present
*[[Egophony]] present/absent
*[[Bronchophony]] present/absent
*Normal/reduced [[tactile fremitus]]
 
===Heart===
===Heart===
* Cardiovascular examination of patients with [disease name] is usually normal.
* Cardiovascular examination of patients with spina bifida is usually normal but congenital anomalies of the spine have been associated with malformations of the cardiovascular systems.
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 stethoscope
 
===Abdomen===
===Abdomen===
* Abdominal examination of patients with [disease name] is usually normal.
* Abdominal examination of patients with spina bifida is usually normal.
OR
*[[Abdominal distension]]
*[[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===
* Genitourinary examination of patients with [disease name] is usually normal.
* Congenital anomalies of the spine may be associated with malformations of the genitourinary system,.
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.
[[Neuromuscular]] examination of patients with spina bifida may be remarkable for:
OR
* [[Paralysis]]
*Patient is usually oriented to persons, place, and time
*Sensation problems
* Altered mental status
*[[Scoliosis]]
* Glasgow coma scale is ___ / 15
*Pressure [[Ulcer|ulcers]]
* Clonus may be present
*Learning disabilities
* Hyperreflexia / hyporeflexia / areflexia
* [[Clonus]]
* Positive (abnormal) Babinski / plantar reflex unilaterally/bilaterally
* [[Hyperreflexia]] or [[hyporeflexia]]
* Muscle rigidity
* Positive (abnormal) [[Plantar reflex|Babinski]] unilaterally
* Proximal/distal muscle weakness unilaterally/bilaterally
* [[Hypertonia|Muscle rigidity]]
* ____ (finding) suggestive of cranial nerve ___ (roman numerical) deficit (e.g. Dilated pupils suggestive of CN III deficit)
* Muscle weakness unilaterally or bilaterally
*Unilateral/bilateral upper/lower extremity weakness
*Abnormal gait
*Unilateral/bilateral sensory loss in the upper/lower extremity
*[[Dysmetria]]
*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===
* Extremities examination of patients with [disease name] is usually normal.
* Extremities examination of patients with [disease name] is usually normal.

Revision as of 18:46, 31 January 2019

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

Overview

Physical Examination

  • Physical examination of patients with spina bifida may be remarkable for:[1][2]
  • Spinal area discoloration or birthmarks may be the only sign in the newborns with spina bifida occulta
  • Protrusions in the lumbar spine
  • Dimples in the lumbar spine
  • Hair patch along the spine

Vital Signs

  • Most patients with spina bifida have normal vital signs.

Skin

  • Skin examination of patients with spina bifida is usually remarkable for:[1][2]
    • Spinal area discoloration or birthmarks may be the only sign in the newborns with spina bifida occulta
    • Protrusions in the lumbar spine
    • Dimples in the lumbar spine
    • Hair patch along the spine

HEENT

  • HEENT examination of patients with spina bifida is usually remarkable for:[1][2]

Lungs

  • Pulmonary examination of patients with spina bifida is usually normal.

Heart

  • Cardiovascular examination of patients with spina bifida is usually normal but congenital anomalies of the spine have been associated with malformations of the cardiovascular systems.

Abdomen

  • Abdominal examination of patients with spina bifida is usually normal.

Genitourinary

  • Congenital anomalies of the spine may be associated with malformations of the genitourinary system,.

Neuromuscular

Neuromuscular examination of patients with spina bifida may be remarkable for:

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

  1. ↑ 1.0 1.1 1.2 Bannur BB, Purandare GM (February 1969). "Microbial production of L-lysine". Hindustan Antibiot Bull. 11 (3): 191–205. PMID 4898641.
  2. ↑ 2.0 2.1 2.2 Kenworthy ME (July 1966). "Introducing the American Orthopsychiatric Association's president for 1966-67: Norman V. Lourie". Am J Orthopsychiatry. 36 (4): 587–9. PMID 5327787.

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