Duchenne muscular dystrophy physical examination: Difference between revisions

	Duchenne muscular dystrophy Microchapters
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Revision as of 14:53, 26 April 2019

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

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 remarkable for [finding 1], [finding 2], and [finding 3].

Appearance of the Patient

Patients with Duchenne muscular dystrophy usually have waddling or Trendelenburg gait

Vital Signs

Hyperthermia may be present mostly due to respiratory infections
Irregularly pulse may be present
Tachypnea at first due to hypercapnea and bradypnea after respiratory muscle exhaustion

Skin

Skin examination of patients with Duchenne muscular dystrophy is usually normal

HEENT

HEENT examination of patients with Duchenne muscular dystrophy is usually normal

Neck

Neck deviation may be present

Lungs

Decreased chest expansion
Use of accessory breath muscles
Decreased breath sounds may be seen in case of pneumonia
Fine/coarse crackles upon auscultation of the lung may be present in case of pneumonia

Heart

Arrythmia may be present.

Abdomen

Abdomen sticks out because of the lordosis

Back

Scoliosis
Abnormal spinal curves (specially lordosis)

Genitourinary

Urinary dysfunction may be present

Neuromuscular

Patient is usually oriented to persons, place, and time
Hyporeflexia / areflexia may be present
Muscle weakness specially in the lower limbs
Waddling gait

Extremities

Calf muscle hypertrophy
Foot drop
Tight heel cord
Backward bending of the knee
Muscle atrophy in thighs and buttock

References

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@@ Line 23: / Line 23: @@
 ===Appearance of the Patient===
-*Patients with Duchenne muscular dystrophy usually have abnormal gait.
+*Patients with Duchenne muscular dystrophy usually have waddling or Trendelenburg gait
 ===Vital Signs===
-*[[Hypothermia]] / hyperthermia may be present
+*Hyperthermia may be present mostly due to respiratory infections
-*[[Tachycardia]] with regular pulse or (ir)regularly irregular pulse
+*Irregularly pulse may be present
-*[[Bradycardia]] with regular pulse or (ir)regularly irregular pulse
+*Tachypnea at first due to hypercapnea and bradypnea after respiratory muscle exhaustion
-*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 examination of patients with Duchenne muscular dystrophy is usually normal.
+* Skin examination of patients with Duchenne muscular dystrophy is usually normal
 ===HEENT===
-* HEENT examination of patients with [disease name] is usually normal.
+* HEENT examination of patients with Duchenne muscular dystrophy is usually normal
-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===
-* Neck examination of patients with [disease name] is usually normal.
+* Neck deviation may be present
-OR
-*[[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===
-* Pulmonary examination of patients with [disease name] is usually normal.
+* Decreased chest expansion
-OR
+* Use of accessory breath muscles
-* Asymmetric chest expansion OR decreased chest expansion
+* Decreased breath sounds may be seen in case of pneumonia
-*Lungs are hyporesonant OR hyperresonant
+*Fine/coarse [[crackles]] upon auscultation of the lung may be present in case of pneumonia
-*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===
-* Cardiovascular examination of patients with [disease name] is usually normal.
+* [[Arrythmia]] may be present.
-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===
-* Abdominal examination of patients with [disease name] is usually normal.
+*Abdomen sticks out because of the lordosis
-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.
+* Scoliosis
-OR
+* Abnormal spinal curves (specially lordosis)
-*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.
+* Urinary dysfunction may be present
-OR
-*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
-* Hyperreflexia / hyporeflexia / areflexia
+* Hyporeflexia / areflexia may be present
-* Positive (abnormal) Babinski / plantar reflex unilaterally/bilaterally
+* Muscle weakness specially in the lower limbs
-* Muscle rigidity
+*Waddling gait
-* 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===