Anthrax physical examination

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: João André Alves Silva, M.D. [2]

Physical Examination

Appearance of the Patient

The appearance of the patients and physical exam will depend on the type of anthrax present in that patient.

Vitals

Temperature

• A fever is often present
• Hypothermia may be present

Pulse

Cutaneous Anthrax

• Tachycardia is often present

Gastrointestinal Anthrax

• Tachycardia is often present

Inhalation or Pulmonary Anthrax

• Tachycardia is often present

Injection Anthrax

• Tachycardia is often present

Rhythm

• The pulse is regular
• The pules is irregularly irregular

Strength

• The pulse may be weak
• The pulse may be bounding
• The pulse may be alternating in strength (pulsus alternans)
• A paradoxical pulse may be present

Symmetry

• The pulses may be asymmetric

Blood Pressure

• Hypotension may be present
• Hypertension may be present
• A wide pulse pressure may be present
• A narrow pulse pressure may be present

Respiratory Rate

• Tachypnea may be present
• Bradypnea may be present
• Kussmaul respirations may be present

Skin

• Cyanosis may be present
• Jaundice may be present
• A rash may be present
• Pallor may be present
• Lesions may be present

Head

• Abnormalities of the head/hair may include ___
• There may be evidence of trauma

Eyes

• Icteric sclera may be present
• Nystagmus may be present.
• Extra-ocular movements may be abnormal
• Pupils may not react to light
• Ophthalmoscopic exam may be abnormal with findings of ___

Ears

• Hearing acuity may be reduced
• Weber test may be positive
• Rinne test may be positive
• There may be exudate from the ear canal
• There may be tenderness on movement of the pinnae

Nose

• Nares may be inflamed
• There may be epistaxis
• There may be purulent exudate from the nares
• There may be tenderness to percussion of the sinuses
• The nares may be congested

Throat

• The throat may be erythematous
• There may be exudate in the throat
• There may be petechiae seen in the throat
• There may be tonsillar inflammation

Neck

• Jugular venous pressure may be elevated
• Carotid bruits may be present
• Lymph nodes may be present
• Thyromegaly may be present
• Hepatojugular reflux may be present

Lungs

• Pulmonary edema and rales may be present
• Wheezing may be present
• Consolidation may be present with reduced breath sounds auscultated
• Rales may be present
• Egophony may be present
• Chest movement may be assymetric

Heart

• A heave may be present
• A thrill may be present
• A friction rub may be pressent

Auscultation

• S1
• S2
• S3
• S4
• Gallops
• A systolic murmur best heard at the base may be present
• A systolic murmur best heard at the apex may be present
• A diastolic murmur may be present

Abdomen

• Abdominal distention may be present
• Abdominal tenderness may be present
• Rebound tenderness may be present
• An acute abdomen may be present
• An abdominal mass may be present
• Guarding may be present
• Hepatomegaly may be present
• Splenomegaly may be present
• Genitourinary exam if relevant

Extremities

• Clubbing may be present
• Cyanosis may be present
• Edema may be present

Neurologic

• Mental status may be altered
• Glasgow coma scale is ___
• Clonus may be present
• Hyperactive reflexes may be present
• There are deficits in cranial nerves ___