Incidentaloma physical examination: Difference between revisions

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The presence of [finding(s)] on physical examination is highly suggestive of [disease name].
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].
*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 usually appear [general appearance].  
* Patients may appear tired, weak, [[diaphoretic]] and [[anxious]].<sup>[[Pheochromocytoma physical examination#cite note-pmid8325290-1|[1]]]</sup>
* Patients may appear quite well if the [[disease]] is [[asymptomatic]].
* Patients may appear [[Flushing|flushed]] due to associated increase in [[erythropoietin]] secretion.<sup>[[Pheochromocytoma physical examination#cite note-pmid7567437-2|[2]]]</sup>
* Patients may appear [[obese]] due to associated type2 [[diabetes mellitus]] and [[Cushing's syndrome]].<sup>[[Pheochromocytoma physical examination#cite note-pmid12923403-3|[3]]]</sup>
* Patients with Cushing's syndrome usually appears [[overweight]].


===Vital Signs===
===Vital Signs===
 
* [[Tachycardia]] with a regular pulse. Irregular pulse may occurr in [[supraventricular tachycardia]].
*High-grade / low-grade fever
* [[Tachypnea]] if [[malignant]] secondaries are found in the [[lung]]. [[Dyspnea]] occurs in patients with complicated [[heart failure]] and [[Cardiomyopathy|cardiomyopathy.]]
*[[Hypothermia]] / hyperthermia may be present
* Rapid strong equal [[pulse]]
*[[Tachycardia]] with regular pulse or (ir)regularly irregular pulse
* High [[blood pressure]] with normal [[pulse pressure]]
*[[Bradycardia]] with regular pulse or (ir)regularly irregular pulse
* [[Hypotension]] occurs due to fluid contraction
*Tachypnea / bradypnea
* [[Hypertension]], due to [[Cortisol|cortisol's]] enhancement of [[epinephrine]]'s [[vasoconstrictive]] effect
*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]]  
* [[Jaundice]] secondary to deranged [[liver]] function in case of [[metastasis]] to the [[liver]].
*[[Jaundice]]
* [[Hyperpigmentation]] - this is due to Melanocyte-Stimulating Hormone production as a byproduct of ACTH synthesis from [[Proopiomelanocortin|Proopiomelanocortin (POMC)]]
* [[Pallor]]
* [[Telangiectasia]] (dilation of capillaries)
* Bruises
* Thinning of the skin (which causes [[easy bruising]])
 
* Purple or red [[striae]] (the weight gain in Cushing's stretches the skin, which is thin and weakened, causing it to hemorrhage) on the trunk, buttocks, arms, legs or breasts, proximal muscle weakness (hips, shoulders)
<gallery widths="150px">
* [[Hirsutism]] (facial male-pattern hair growth)
 
UploadedImage-01.jpg | Description {{dermref}}
UploadedImage-02.jpg | Description {{dermref}}
 
</gallery>


===HEENT===
===HEENT===
* Abnormalities of the head/hair may include ___
* [[Facial flushing]]
* Evidence of trauma
* [[Icterus|Scleral icterus]] in case of [[metastasis]] to the [[liver]]
* Icteric sclera
* [[MEN2]] patients associated with [[mucosal]] [[Neuroma|neuromas]] show multiple lips and tongue [[Neuroma|neuromas]].
* [[Nystagmus]]  
* [[Moon face|Moon-face]] is a medical sign where the face swells up into a rounded shape. It is often associated with [[Cushing's syndrome]], which has led to it being known as Cushingoid facies ("Cushings-like face"), or [[steroid]] treatment, which has led to the name steroid facies.
* Extra-ocular movements may be abnormal
*Pupils non-reactive to light / non-reactive to accomodation / non-reactive to neither light nor accomodation
*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===
*[[Jugular venous distension]]
* Congested [[neck veins]] in patients with [[cardiomyopathy]]<sup>[[Pheochromocytoma physical examination#cite note-pmid19158054-4|[4]]]</sup>
*[[Carotid bruits]] may be auscultated unilaterally/bilaterally using the bell/diaphragm of the otoscope
* Painless [[lymphadenopathy]] if [[malignant]] secondaries found in the neck (rapid increase in the size of the [[Lymph node|node]]. [[Prevalence]] of [[malignancy]] in [[Lymph node biopsy|lymph node biopsies]] performed is 60%<sup>[[Pheochromocytoma physical examination#cite note-pmid18888946-5|[5]]]</sup>
*[[Lymphadenopathy]] (describe location, size, tenderness, mobility, and symmetry)
* [[Thyromegaly]]/[[thyroid]] [[nodules]] if [[Multiple endocrine neoplasia|MEN]] patients due to [[medullary thyroid cancer]].<sup>[[Pheochromocytoma physical examination#cite note-pmid258100472-6|[6]]]</sup>
*[[Thyromegaly]] / thyroid nodules
* Growth of fat pads along the collar bone and on the back of the neck.
*[[Hepatojugular reflux]]


===Lungs===
===Lungs===
* Asymmetric chest expansion / Decreased chest expansion
* Asymmetric [[chest]] expansion / decreased [[chest]] expansion if [[malignant]] secondaries are found in the [[lung]].
*Lungs are hypo/hyperresonant
*Fine/coarse [[crackles]] upon auscultation of the lung bases/apices unilaterally/bilaterally
*Rhonchi
*Vesicular breath sounds / Distant breath sounds
*Expiratory/inspiratory wheezing with normal / delayed expiratory phase
*[[Wheezing]] may be present
*[[Egophony]] present/absent
*[[Bronchophony]] present/absent
*Normal/reduced [[tactile fremitus]]


===Heart===
===Heart===
*Chest tenderness upon palpation
* Chest [[tenderness]] upon [[palpation]] in [[MEN1]] patients due to [[hyperparathyroidism]].
*PMI within 2 cm of the sternum  (PMI) / Displaced point of maximal impulse (PMI) suggestive of ____
* [[Palpation]]: [[Precordium|Precordial]] [[heave]] especially at apex due to [[left ventricular hypertrophy]] in long standing patients.
*[[Heave]] / [[thrill]]
* Auscultation: normal [[Heart sounds|S1]] and accentuated [[Heart sounds|S2]] due to high systemic resistance.
*[[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 otoscope


===Abdomen===
===Abdomen===
*[[Abdominal distention]]  
* [[Abdominal distention]] in patients with [[primary hyperparathyroidism]] associated [[constipation]] or [[Hirschsprung's disease|Hirschsprung disease]].
*[[Abdominal tenderness]] in the right/left upper/lower abdominal quadrant
* [[Abdominal tenderness]] in the lower [[abdominal]] quadrants in [[Multiple endocrine neoplasia type 2|MEN2]] patients with [[Hirschsprung disease|Hirschsprung disease.]]<sup>[[Pheochromocytoma physical examination#cite note-pmid7491537-7|[7]]]</sup>
*[[Rebound tenderness]] (positive Blumberg sign)
* A palpable [[abdominal mass]] in the lower [[abdominal]] quadrant.
*A palpable abdominal mass in the right/left upper/lower abdominal quadrant
* [[Abdominal guarding|Guarding]] may be present.
*Guarding may be present
* [[Hepatomegaly]] if [[malignant]] secondaries found in [[liver]].
*[[Hepatomegaly]] / [[splenomegaly]] / [[hepatosplenomegaly]]
* [[Diarrhea]] caused by [[gastrointestinal]] secretion of fluid and [[Electrolyte|electrolytes]], and [[flushing]] in [[medullary thyroid cancer]] patients.<sup>[[Pheochromocytoma physical examination#cite note-pmid25810047-8|[8]]]</sup>
*Additional findings, such as obturator test, psoas test, McBurney point test, Murphy test
 
===Back===
*Point tenderness over __ vertebrae (e.g. L3-L4)
*Sacral edema
*Costovertebral angle tenderness bilaterally/unilaterally
*Buffalo hump


===Genitourinary===
===Back ===
*A pelvic/adnexal mass may be palpated
* Point [[tenderness]] in [[MEN1]] patients with [[hyperparathyroidism]]
*Inflamed mucosa
*Clear/(color), foul-smelling/odorless penile/vaginal discharge


===Neuromuscular===
===Neuromuscular===
*Patient is usually oriented to persons, place, and time
* [[Hyporeflexia]] due to low [[potassium]] level in [[Hyperaldosteronism|aldosternonma]]
* Altered mental status
* [[Proximal]] [[muscle weakness]] bilaterally
* Glasgow coma scale is ___ / 15
*Bilateral [[tremors]]
* Clonus may be present
* Hyperreflexia / hyporeflexia / areflexia
* 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===
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*[[Cyanosis]]  
*[[Cyanosis]]  
*Pitting/non-pitting [[edema]] of the upper/lower extremities
*Pitting/non-pitting [[edema]] of the upper/lower extremities
*Muscle atrophy
*[[Muscle atrophy]]
*Fasciculations in the upper/lower extremity
*[[Fasciculations]] in the upper/lower extremity


==References==
==References==

Revision as of 15:17, 31 August 2017

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

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

Appearance of the Patient

Vital Signs

Skin

  • Jaundice secondary to deranged liver function in case of metastasis to the liver.
  • Hyperpigmentation - this is due to Melanocyte-Stimulating Hormone production as a byproduct of ACTH synthesis from Proopiomelanocortin (POMC)
  • Telangiectasia (dilation of capillaries)
  • Thinning of the skin (which causes easy bruising)
  • Purple or red striae (the weight gain in Cushing's stretches the skin, which is thin and weakened, causing it to hemorrhage) on the trunk, buttocks, arms, legs or breasts, proximal muscle weakness (hips, shoulders)
  • Hirsutism (facial male-pattern hair growth)

HEENT

Neck

Lungs

Heart

Abdomen

Back

Neuromuscular

Extremities

References

Template:WH Template:WS

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