Diffuse esophageal spasm physical examination: Difference between revisions

Jump to navigation Jump to search
VisualWikitext
No edit summary
No edit summary
Line 5: Line 5:


==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].
Patients with primary diffuse esophageal spasm usually appear normal. Physical examination of patients with DES is usually remarkable for findings related to secondary diseases.
 
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 DES is usually remarkable for presence of features related to secondary diseases.
*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 primary DES usually appear normal.  


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


*High-grade / low-grade fever
*High-grade / low-grade fever in infectious cause of DES
*[[Hypothermia]] / hyperthermia may be present
*[[Hypothermia]] / hyperthermia may be present
*[[Tachycardia]] with regular pulse or (ir)regularly irregular pulse
*[[Tachycardia]] with regular pulse or (ir)regularly irregular pulse
*[[Bradycardia]] with regular pulse or (ir)regularly irregular pulse
*[[Bradycardia]] with regular pulse or (ir)regularly irregular pulse
*Tachypnea / bradypnea
*Tachypnea / bradypnea
*Kussmal respirations may be present in _____ (advanced disease state)
*Kussmal respirations
*Weak/bounding pulse / pulsus alternans / paradoxical pulse / asymmetric pulse
*Weak/bounding pulse
*High/low blood pressure with normal pulse pressure / [[wide pulse pressure]] / [[narrow pulse pressure]]
*High/low blood pressure with normal pulse pressure


===Skin===
===Skin===
*[[Cyanosis]]
*Tight, hardened skin in limited scleroderma
*[[Jaundice]]
*Red spots or lines in skin of face and hand due to telengectasia in scleroderma
* [[Pallor]]
*Bumps under the skin due to deposition of calcium in scleroderma.
* Bruises
*Ulcers of finger and toes may be present in scleroderma
* Insect bite wound may be seen in Chaga's disease with excoriation at the bite site.


<gallery widths=150px>
<gallery widths="150px">


UploadedImage-01.jpg | Description {{dermref}}
UploadedImage-01.jpg | Description {{dermref}}
Line 52: Line 39:


===HEENT===
===HEENT===
* Abnormalities of the head/hair may include ___
* Romana's sign is seen in Chaga's disease (swelling of eyelid at the site of parasite entry)
* Evidence of trauma
*Ophthalmoscopic exam may be abnormal with findings of diabetic retinopathy in diabetics as well as cataract changes.
* Icteric sclera
* Lower extremities edema in Chaga's disease.
* [[Nystagmus]]
* Dry mouth and dry eye in scleroderma.
* 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]]
*[[Lymphadenopathy]] (Chaga's disease)
*[[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
*[[Thyromegaly]] / thyroid nodules
*[[Hepatojugular reflux]]


===Lungs===
===Lungs===
* Asymmetric chest expansion / Decreased chest expansion
* Asymmetric chest expansion / Decreased chest expansion
*Lungs are hypo/hyperresonant
*Lungs are hyperresonant in scleroderma.
*Fine/coarse [[crackles]] upon auscultation of the lung bases/apices unilaterally/bilaterally
*Fine/coarse [[crackles]] upon auscultation of the lung bases/apices bilaterally seen in scleroderma.
*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
Heart involvement in Chagas's cardiomyopathy are:
*PMI within 2 cm of the sternum  (PMI) / Displaced point of maximal impulse (PMI) suggestive of ____
 
*[[Heave]] / [[thrill]]
Displaced point of maximal impulse (PMI) suggestive of ____
*[[Friction rub]]
*[[Heart sounds#Third heart sound S3|S3]], [[S4]]
*[[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
*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


Revision as of 16:28, 22 November 2017

Diffuse esophageal spasm Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Diffuse esophageal spasm from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic study of choice

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

X-ray

Echocardiography and Ultrasound

CT scan

MRI

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Guidelines for Management

Case Studies

Case #1

Diffuse esophageal spasm physical examination On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Diffuse esophageal spasm physical examination

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Diffuse esophageal spasm physical examination

CDC on Diffuse esophageal spasm physical examination

Diffuse esophageal spasm physical examination in the news

Blogs on Diffuse esophageal spasm physical examination

Directions to Hospitals Treating Psoriasis

Risk calculators and risk factors for Diffuse esophageal spasm physical examination

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

Overview

Patients with primary diffuse esophageal spasm usually appear normal. Physical examination of patients with DES is usually remarkable for findings related to secondary diseases.

Physical Examination

  • Physical examination of patients with DES is usually remarkable for presence of features related to secondary diseases.

Appearance of the Patient

  • Patients with primary DES usually appear normal.

Vital Signs

  • High-grade / low-grade fever in infectious cause of DES
  • Hypothermia / hyperthermia may be present
  • Tachycardia with regular pulse or (ir)regularly irregular pulse
  • Bradycardia with regular pulse or (ir)regularly irregular pulse
  • Tachypnea / bradypnea
  • Kussmal respirations
  • Weak/bounding pulse
  • High/low blood pressure with normal pulse pressure

Skin

  • Tight, hardened skin in limited scleroderma
  • Red spots or lines in skin of face and hand due to telengectasia in scleroderma
  • Bumps under the skin due to deposition of calcium in scleroderma.
  • Ulcers of finger and toes may be present in scleroderma
  • Insect bite wound may be seen in Chaga's disease with excoriation at the bite site.

HEENT

  • Romana's sign is seen in Chaga's disease (swelling of eyelid at the site of parasite entry)
  • Ophthalmoscopic exam may be abnormal with findings of diabetic retinopathy in diabetics as well as cataract changes.
  • Lower extremities edema in Chaga's disease.
  • Dry mouth and dry eye in scleroderma.

Neck

Lungs

  • Asymmetric chest expansion / Decreased chest expansion
  • Lungs are hyperresonant in scleroderma.
  • Fine/coarse crackles upon auscultation of the lung bases/apices bilaterally seen in scleroderma.

Heart

Heart involvement in Chagas's cardiomyopathy are:

Displaced point of maximal impulse (PMI) suggestive of ____

  • S3, S4
  • 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

Back

  • Point tenderness over __ vertebrae (e.g. L3-L4)
  • Sacral edema
  • Costovertebral angle tenderness bilaterally/unilaterally
  • Buffalo hump

Genitourinary

  • A pelvic/adnexal mass may be palpated
  • Inflamed mucosa
  • Clear/(color), foul-smelling/odorless penile/vaginal discharge

Neuromuscular

  • Patient is usually oriented to persons, place, and time
  • Altered mental status
  • Glasgow coma scale is ___ / 15
  • 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

  • Clubbing
  • Cyanosis
  • Pitting/non-pitting edema of the upper/lower extremities
  • Muscle atrophy
  • Fasciculations in the upper/lower extremity

References

Template:WH Template:WS

Retrieved from "https://www.wikidoc.org/index.php?title=Diffuse_esophageal_spasm_physical_examination&oldid=1392456"