Tuberculosis physical examination: Difference between revisions
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==Overview== | ==Overview== | ||
Physical examination can provide important information about the patient’s overall condition and other factors that may affect how tuberculosis is treated, such as [[HIV]] infection or other illnesses. Physical findings depend on the location of the tuberculosis infection and most common physical findings include [[fever]], [[decreased breath sounds]], [[tachypnea]] and [[tachycardia]]. | |||
==Physical Examination== | ==Physical Examination== | ||
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=====Appearance of the Patient===== | =====Appearance of the Patient===== | ||
* [[Cachexia]] | |||
* [[Pallor]] | *[[Cachexia]] | ||
*[[Pallor]] | |||
=====Vitals===== | =====Vitals===== | ||
* [[Tachypnea]] | |||
* [[Tachycardia]] | *[[Tachypnea]] | ||
* [[Fever]] | *[[Tachycardia]] | ||
*[[Fever]] | |||
=====Lungs===== | =====Lungs===== | ||
* [[Decreased breath sounds]] | |||
* [[Rales]] | *[[Decreased breath sounds]] | ||
* [[Rhonchi]] | *[[Rales]] | ||
* Bronchial breath sounds | *[[Rhonchi]] | ||
*Bronchial breath sounds | |||
Some patients with active tuberculosis might have a normal physical examination and further test need to be done to confirm the diagnosis. | Some patients with active tuberculosis might have a normal physical examination and further test need to be done to confirm the diagnosis. | ||
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All forms of extra-pulmonary tuberculosis can include findings of pulmonary tuberculosis such as [[cachexia]], [[fever]], [[tachypnea]], [[tachycardia]], and can be associated with an active pulmonary infection. | All forms of extra-pulmonary tuberculosis can include findings of pulmonary tuberculosis such as [[cachexia]], [[fever]], [[tachypnea]], [[tachycardia]], and can be associated with an active pulmonary infection. | ||
{| style="border: 0px; font-size: 90%; margin: 3px; width: 600px" align=center | {| style="border: 0px; font-size: 90%; margin: 3px; width: 600px" align="center" | ||
|valign=top| | | valign="top" | | ||
|+ | |+ | ||
! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Extra-Pulmonary Location}} | ! style="background: #4479BA; width: 200px;" |{{fontcolor|#FFF|Extra-Pulmonary Location}} | ||
! style="background: #4479BA; width: 400px;" | {{fontcolor|#FFF|Additional Physical Examination Findings}} | ! style="background: #4479BA; width: 400px;" |{{fontcolor|#FFF|Additional Physical Examination Findings}} | ||
|- | |- | ||
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Tuberculous Lymphadenitis | | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Tuberculous Lymphadenitis | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | style="padding: 5px 5px; background: #F5F5F5;" |Cervical [[lymph node]] enlargement | ||
|- | |- | ||
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |Skeletal Tuberculosis | | style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |Skeletal Tuberculosis | ||
| style="padding: 5px 5px; background: #F5F5F5;" |[[Low back pain]], [[stiffness]], tenderness, [[joint swelling]] and [[erythema]], limited range of motion. | | style="padding: 5px 5px; background: #F5F5F5;" |[[Low back pain]], [[stiffness]], tenderness, [[joint swelling]] and [[erythema]], limited range of motion. | ||
|- | |- | ||
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |Central Nervous System Tuberculosis | | style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |Central Nervous System Tuberculosis | ||
| style="padding: 5px 5px; background: #F5F5F5;" | [[Altered mental status]], CN palsy (specially CN VI), [[papilledema]], [[hemiparesis]], [[hemiplegia]], and [[nuchal rigidity]]. | | style="padding: 5px 5px; background: #F5F5F5;" |[[Altered mental status]], CN palsy (specially CN VI), [[papilledema]], [[hemiparesis]], [[hemiplegia]], and [[nuchal rigidity]]. | ||
|- | |- | ||
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |Tuberculosis Peritonitis | | style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |Tuberculosis Peritonitis | ||
| style="padding: 5px 5px; background: #F5F5F5;" | Diffuse abdominal tenderness, [[ascites]], [[fever]]. | | style="padding: 5px 5px; background: #F5F5F5;" |Diffuse abdominal tenderness, [[ascites]], [[fever]]. | ||
|- | |- | ||
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |Tuberculous Pericarditis | | style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |Tuberculous Pericarditis | ||
| style="padding: 5px 5px; background: #F5F5F5;" | [[Tachycardia]], [[pulsus paradoxus]] and hypotension (in [[cardiac tamponade]]), [[jugular venous distension]] with a prominent Y descent, [[Kussmaul's sign]], pleural dullness, pericardial knock, [[pericardial rub]],distant [[heart sounds]], [[hepatomegaly]], [[ascites]], and [[ankle edema]]. | | style="padding: 5px 5px; background: #F5F5F5;" |[[Tachycardia]], [[pulsus paradoxus]] and hypotension (in [[cardiac tamponade]]), [[jugular venous distension]] with a prominent Y descent, [[Kussmaul's sign]], pleural dullness, pericardial knock, [[pericardial rub]],distant [[heart sounds]], [[hepatomegaly]], [[ascites]], and [[ankle edema]]. | ||
|- | |- | ||
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |Renal Tuberculosis | | style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |Renal Tuberculosis | ||
| style="padding: 5px 5px; background: #F5F5F5;" | Costo-vertebral angle tenderness (in [[UTI]]), lower abdominal tenderness (in [[obstructive uropathy]]), findings of [[renal insufficiency]]. | | style="padding: 5px 5px; background: #F5F5F5;" |Costo-vertebral angle tenderness (in [[UTI]]), lower abdominal tenderness (in [[obstructive uropathy]]), findings of [[renal insufficiency]]. | ||
|- | |- | ||
| style="padding: 5px 5px; background: #F5F5F5; | | colspan="2" style="padding: 5px 5px; background: #F5F5F5;" |<small>Adapted from Asian Spine J. Feb 2014; 8(1): 97–111<ref name="Moon2014">{{cite journal|last1=Moon|first1=Myung-Sang|title=Tuberculosis of Spine: Current Views in Diagnosis and Management|journal=Asian Spine Journal|volume=8|issue=1|year=2014|pages=97|issn=1976-1902|doi=10.4184/asj.2014.8.1.97}}</ref>; Handbook of Clinical Neurology<ref name="Garcia-Monco2014">{{cite journal|last1=Garcia-Monco|first1=Juan Carlos|title=Tuberculosis|volume=121|year=2014|pages=1485–1499|issn=00729752|doi=10.1016/B978-0-7020-4088-7.00100-0}}</ref>; Circulation Dec 2005 vol.112 no.23 3608-3616<ref name="Mayosi2005">{{cite journal|last1=Mayosi|first1=B. M.|title=Tuberculous Pericarditis|journal=Circulation|volume=112|issue=23|year=2005|pages=3608–3616|issn=0009-7322|doi=10.1161/CIRCULATIONAHA.105.543066}}</ref>; Am J Trop Med Hyg 2013 vol. 88 no. 1 54-64<ref name="Daherda Silva Junior2013">{{cite journal|last1=Daher|first1=E. D. F.|last2=da Silva Junior|first2=G. B.|last3=Barros|first3=E. J. G.|title=Renal Tuberculosis in the Modern Era|journal=American Journal of Tropical Medicine and Hygiene|volume=88|issue=1|year=2013|pages=54–64|issn=0002-9637|doi=10.4269/ajtmh.2013.12-0413}}</ref> Clin Infect Dis.(2011)53(6):555-562.<ref name="FontanillaBarnes2011">{{cite journal|last1=Fontanilla|first1=J.-M.|last2=Barnes|first2=A.|last3=von Reyn|first3=C. F.|title=Current Diagnosis and Management of Peripheral Tuberculous Lymphadenitis|journal=Clinical Infectious Diseases|volume=53|issue=6|year=2011|pages=555–562|issn=1058-4838|doi=10.1093/cid/cir454}}</ref> </small> | ||
|} | |} | ||
Revision as of 20:33, 23 January 2021
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]: Associate Editor(s)-in-Chief: Mashal Awais, M.D.[2]; Alejandro Lemor, M.D. [3]
Overview
Physical examination can provide important information about the patient’s overall condition and other factors that may affect how tuberculosis is treated, such as HIV infection or other illnesses. Physical findings depend on the location of the tuberculosis infection and most common physical findings include fever, decreased breath sounds, tachypnea and tachycardia.
Physical Examination
Pulmonary Tuberculosis
Physical findings for pulmonary tuberculosis include the following:[1]
Appearance of the Patient
Vitals
Lungs
- Decreased breath sounds
- Rales
- Rhonchi
- Bronchial breath sounds
Some patients with active tuberculosis might have a normal physical examination and further test need to be done to confirm the diagnosis.
Extra-Pulmonary Tuberculosis
All forms of extra-pulmonary tuberculosis can include findings of pulmonary tuberculosis such as cachexia, fever, tachypnea, tachycardia, and can be associated with an active pulmonary infection.
| Extra-Pulmonary Location | Additional Physical Examination Findings |
|---|---|
| Tuberculous Lymphadenitis | Cervical lymph node enlargement |
| Skeletal Tuberculosis | Low back pain, stiffness, tenderness, joint swelling and erythema, limited range of motion. |
| Central Nervous System Tuberculosis | Altered mental status, CN palsy (specially CN VI), papilledema, hemiparesis, hemiplegia, and nuchal rigidity. |
| Tuberculosis Peritonitis | Diffuse abdominal tenderness, ascites, fever. |
| Tuberculous Pericarditis | Tachycardia, pulsus paradoxus and hypotension (in cardiac tamponade), jugular venous distension with a prominent Y descent, Kussmaul's sign, pleural dullness, pericardial knock, pericardial rub,distant heart sounds, hepatomegaly, ascites, and ankle edema. |
| Renal Tuberculosis | Costo-vertebral angle tenderness (in UTI), lower abdominal tenderness (in obstructive uropathy), findings of renal insufficiency. |
| Adapted from Asian Spine J. Feb 2014; 8(1): 97–111[2]; Handbook of Clinical Neurology[3]; Circulation Dec 2005 vol.112 no.23 3608-3616[4]; Am J Trop Med Hyg 2013 vol. 88 no. 1 54-64[5] Clin Infect Dis.(2011)53(6):555-562.[6] | |
References
- ↑ Mandell, Gerald (2010). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Churchill Livingstone/Elsevier. ISBN 0443068399.
- ↑ Moon, Myung-Sang (2014). "Tuberculosis of Spine: Current Views in Diagnosis and Management". Asian Spine Journal. 8 (1): 97. doi:10.4184/asj.2014.8.1.97. ISSN 1976-1902.
- ↑ Garcia-Monco, Juan Carlos (2014). "Tuberculosis". 121: 1485–1499. doi:10.1016/B978-0-7020-4088-7.00100-0. ISSN 0072-9752.
- ↑ Mayosi, B. M. (2005). "Tuberculous Pericarditis". Circulation. 112 (23): 3608–3616. doi:10.1161/CIRCULATIONAHA.105.543066. ISSN 0009-7322.
- ↑ Daher, E. D. F.; da Silva Junior, G. B.; Barros, E. J. G. (2013). "Renal Tuberculosis in the Modern Era". American Journal of Tropical Medicine and Hygiene. 88 (1): 54–64. doi:10.4269/ajtmh.2013.12-0413. ISSN 0002-9637.
- ↑ Fontanilla, J.-M.; Barnes, A.; von Reyn, C. F. (2011). "Current Diagnosis and Management of Peripheral Tuberculous Lymphadenitis". Clinical Infectious Diseases. 53 (6): 555–562. doi:10.1093/cid/cir454. ISSN 1058-4838.