Insulinoma physical examination: Difference between revisions

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==Overview==
==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].
Physical examination of patients with insulinoma is usually unremarkable. Common findings may include sweating and tachycardia/bradycardia.


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==


*Physical examination of patients with [disease name] is usually remarkable for:[finding 1], [finding 2], and [finding 3].
*Physical examination of patients with insulinoma is usually unremarkable.
*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===
===Appearance of the Patient===
*Patients with [disease name] usually appear [general appearance].  
*Patients with insulinoma usually appear [general appearance].  


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


*High-grade / low-grade fever
*High-grade / low-grade fever- None
*[[Hypothermia]] / hyperthermia may be present
*[[Tachycardia]] with regular pulse- can be tachycardic/bradycardic
*[[Tachycardia]] with regular pulse or (ir)regularly irregular pulse
*[[Bradycardia]] with regular pulse  
*[[Bradycardia]] with regular pulse or (ir)regularly irregular pulse
*Tachypnea / bradypnea
*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===
*[[Cyanosis]]
* can have sweating
*[[Jaundice]]
* [[Pallor]]
* Bruises
 
<gallery widths=150px>
 
UploadedImage-01.jpg | Description {{dermref}}
UploadedImage-02.jpg | Description {{dermref}}
 
</gallery>


===HEENT===
===HEENT===
* Abnormalities of the head/hair may include ___
Unremarkable
* Evidence of trauma
* No abnormalities of the head/hair  
* Icteric sclera  
* No evidence of trauma
* [[Nystagmus]]  
* Normal sclera  
* Extra-ocular movements may be abnormal
* No [[Nystagmus]]  
*Pupils non-reactive to light / non-reactive to accomodation / non-reactive to neither light nor accomodation
* Extra-ocular movements are normal
*Ophthalmoscopic exam may be abnormal with findings of ___
* Pupils -reactive to light and to accommodation
* Hearing acuity may be reduced
* Ophthalmoscopic exam may be normal
*[[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".)
* Hearing acuity is fine
*[[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".)
*[[Weber test]] is normal.  
* [[Exudate]] from the ear canal
* No tenderness upon palpation of the ear pinnae/tragus  
* Tenderness upon palpation of the ear pinnae / tragus (anterior to ear canal)
* No facial tenderness
*Inflamed nares / congested nares
* No erythematous throat with/without tonsillar swelling, exudates, and/or petechiae
* [[Purulent]] exudate from the nares
* Facial tenderness
* Erythematous throat with/without tonsillar swelling, exudates, and/or petechiae


===Neck===
===Neck===
*[[Jugular venous distension]]
*Unremarkable
*[[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===
* Asymmetric chest expansion / Decreased chest expansion
Unremarkable
* Symmetric chest expansion
*Lungs are hypo/hyperresonant
*Lungs are hypo/hyperresonant
*Fine/coarse [[crackles]] upon auscultation of the lung bases/apices unilaterally/bilaterally
*No [[crackles]] upon auscultation of the lung bases/apices unilaterally/bilaterally
*Rhonchi
*No Rhonchi
*Vesicular breath sounds / Distant breath sounds
*Normal Vesicular breath sounds  
*Expiratory/inspiratory wheezing with normal / delayed expiratory phase
*No Expiratory/inspiratory wheezing with normal / delayed expiratory phase
*[[Wheezing]] may be present
*Normal[[tactile fremitus]]
*[[Egophony]] present/absent
*[[Bronchophony]] present/absent
*Normal/reduced [[tactile fremitus]]


===Heart===
===Heart===
*Chest tenderness upon palpation
Unremarkable
*PMI within 2 cm of the sternum  (PMI) / Displaced point of maximal impulse (PMI) suggestive of ____
*PMI within 2 cm of the sternum  (PMI)  
*[[Heave]] / [[thrill]]
*[[Heave]] / [[thrill]] can be due to palpitations
*[[Friction rub]]
*No [[Friction rub]]
*[[Heart sounds#First heart tone S1, the "lub"(components M1 and T1)|S1]]
*Normal [[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]]
*Normal [[Heart sounds#Second heart tone S2 the "dub"(components A2 and P2)|S2]]
*[[Heart sounds#Third heart sound S3|S3]]
*No [[Heart sounds#Third heart sound S3|S3]]
*[[Heart sounds#Fourth heart sound S4|S4]]
*No [[Heart sounds#Fourth heart sound S4|S4]]
*[[Heart sounds#Summation Gallop|Gallops]]
*No [[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
*No 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===
===Abdomen===
*[[Abdominal distention]]  
*No [[Abdominal distention]]  
*[[Abdominal tenderness]] in the right/left upper/lower abdominal quadrant
*No [[Rebound tenderness]] (positive Blumberg sign)
*[[Rebound tenderness]] (positive Blumberg sign)
*No palpable abdominal mass in the right/left upper/lower abdominal quadrant
*A palpable abdominal mass in the right/left upper/lower abdominal quadrant
*No guarding
*Guarding may be present
*No signs of[[Hepatomegaly]] / [[splenomegaly]] / [[hepatosplenomegaly]]
*[[Hepatomegaly]] / [[splenomegaly]] / [[hepatosplenomegaly]]
*Additional findings, such as obturator test, psoas test, McBurney point test, Murphy test


===Back===
===Back===
*Point tenderness over __ vertebrae (e.g. L3-L4)
Unremarkable
*Sacral edema
*No tendernes
*Costovertebral angle tenderness bilaterally/unilaterally
*No sacral edema
*Buffalo hump
*No costovertebral angle tenderness bilaterally/unilaterally
*No hump


===Genitourinary===
===Genitourinary===
*A pelvic/adnexal mass may be palpated
Unremarkable
*Inflamed mucosa
*No pelvic/adnexal mass.
*Clear/(color), foul-smelling/odorless penile/vaginal discharge
*Normal mucosa
*No discharge


===Neuromuscular===
===Neuromuscular===
Unremarkable
*Patient is usually oriented to persons, place, and time
*Patient is usually oriented to persons, place, and time
* Altered mental status
* Altered mental status- can have altered mental status/confusion
* Glasgow coma scale is ___ / 15
* Glasgow coma scale is x / 15. Can be comatose
* Clonus may be present
* Unilateral/bilateral fine tremors can be present
* Hyperreflexia / hyporeflexia / areflexia
* Normal finger-to-nose test
* Positive (abnormal) Babinski / plantar reflex unilaterally/bilaterally
* Muscle rigidity
* 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===
===Extremities===
*[[Clubbing]]  
Unremarkable
*[[Cyanosis]]  
*No [[Clubbing]]  
*Pitting/non-pitting [[edema]] of the upper/lower extremities
*No [[Cyanosis]]  
*Muscle atrophy
*No pitting/non-pitting [[edema]] of the upper/lower extremities
*Fasciculations in the upper/lower extremity
*No muscle atrophy
*No fasciculations in the upper/lower extremity


==References==
==References==

Revision as of 18:16, 17 August 2017

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

Overview

Physical examination of patients with insulinoma is usually unremarkable. Common findings may include sweating and tachycardia/bradycardia.

Physical Examination

  • Physical examination of patients with insulinoma is usually unremarkable.

Appearance of the Patient

  • Patients with insulinoma usually appear [general appearance].

Vital Signs

  • High-grade / low-grade fever- None
  • Tachycardia with regular pulse- can be tachycardic/bradycardic
  • Bradycardia with regular pulse
  • Tachypnea / bradypnea

Skin

  • can have sweating

HEENT

Unremarkable

  • No abnormalities of the head/hair
  • No evidence of trauma
  • Normal sclera
  • No Nystagmus
  • Extra-ocular movements are normal
  • Pupils -reactive to light and to accommodation
  • Ophthalmoscopic exam may be normal
  • Hearing acuity is fine
  • Weber test is normal.
  • No tenderness upon palpation of the ear pinnae/tragus
  • No facial tenderness
  • No erythematous throat with/without tonsillar swelling, exudates, and/or petechiae

Neck

  • Unremarkable

Lungs

Unremarkable

  • Symmetric chest expansion
  • Lungs are hypo/hyperresonant
  • No crackles upon auscultation of the lung bases/apices unilaterally/bilaterally
  • No Rhonchi
  • Normal Vesicular breath sounds
  • No Expiratory/inspiratory wheezing with normal / delayed expiratory phase
  • Normaltactile fremitus

Heart

Unremarkable

Abdomen

Back

Unremarkable

  • No tendernes
  • No sacral edema
  • No costovertebral angle tenderness bilaterally/unilaterally
  • No hump

Genitourinary

Unremarkable

  • No pelvic/adnexal mass.
  • Normal mucosa
  • No discharge

Neuromuscular

Unremarkable

  • Patient is usually oriented to persons, place, and time
  • Altered mental status- can have altered mental status/confusion
  • Glasgow coma scale is x / 15. Can be comatose
  • Unilateral/bilateral fine tremors can be present
  • Normal finger-to-nose test

Extremities

Unremarkable

  • No Clubbing
  • No Cyanosis
  • No pitting/non-pitting edema of the upper/lower extremities
  • No muscle atrophy
  • No fasciculations in the upper/lower extremity

References

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