Insulinoma physical examination

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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

• No high-grade / low-grade fever
• Tachycardia with regular pulse
• 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

• PMI within 2 cm of the sternum (PMI)
• No heave / thrill
• No friction rub
• Normal S1
• Normal S2
• No S3
• No S4
• No Gallops
• 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

• No Abdominal distention
• No Rebound tenderness (positive Blumberg sign)
• No palpable abdominal mass in the right/left upper/lower abdominal quadrant
• No guarding
• No signs ofHepatomegaly / splenomegaly / hepatosplenomegaly

Back

Unremarkable

• No tenderness
• 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