Parathyroid adenoma 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 parathyroid adenoma is usually unremarkable. Patients may have physical findings due to severe [[hypercalcemia]] and other [[parathyroid adenoma natural history, complications and prognosis#Natural History, Complications, and Prognosis|complications of parathyroid adenoma]].
 
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 normal.
OR
Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].


OR
*Physical examination of patients with parathyroid adenoma is usually unremarkable.<ref name="pmid21321169">{{cite journal |vauthors=Pallan S, Khan A |title=Primary hyperparathyroidism: Update on presentation, diagnosis, and management in primary care |journal=Can Fam Physician |volume=57 |issue=2 |pages=184–9 |year=2011 |pmid=21321169 |pmc=3038812 |doi= |url=}}</ref>
 
*Patients may have physical findings due to severe [[hypercalcemia]] and other [[parathyroid adenoma natural history, complications and prognosis#Natural History, Complications, and Prognosis|complications of parathyroid adenoma]].<ref name="pmid11350446">{{cite journal |vauthors=Mishra SK, Agarwal G, Kar DK, Gupta SK, Mithal A, Rastad J |title=Unique clinical characteristics of primary hyperparathyroidism in India |journal=Br J Surg |volume=88 |issue=5 |pages=708–14 |year=2001 |pmid=11350446 |doi=10.1046/j.0007-1323.2001.01775.x |url=}}</ref>
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].


===Appearance of the Patient===
===Appearance of the Patient===
*Patients with [disease name] usually appear [general appearance].  
*Patients with parathyroid adenoma usually appear well.  


===Vital Signs===
===Vital Signs===
 
*Patients with [[hypercalcemia]] and other complications may have:
*High-grade / low-grade fever
**[[High blood pressure]] due to [[hypercalcemia]] and [[renal failure]]
*[[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 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===
* Skin examination of patients with [disease name] is usually normal.
*Persistent [[itching]] may be present due to [[renal failure]]
OR
*[[Cyanosis]]
*[[Jaundice]]
* [[Pallor]]
* Bruises
 
<gallery widths="150px">
 
UploadedImage-01.jpg | Description {{dermref}}
UploadedImage-02.jpg | Description {{dermref}}
 
</gallery>


===HEENT===
===HEENT===
* HEENT examination of patients with [disease name] is usually normal.
*Patients with severe [[hypercalcemia]] may have:
OR
** [[Band keratopathy]] ([[calcium]] precipitation in a horizontal band across the [[cornea]] in the palpebral aperture); may lead to [[Visual impairment|vision impairment]]
* Abnormalities of the head/hair may include ___
* Evidence of trauma
* Icteric sclera
* [[Nystagmus]]  
* Extra-ocular movements may be abnormal
*Pupils non-reactive to light / non-reactive to accommodation / non-reactive to neither light nor accommodation
*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 examination of patients with [disease name] is usually normal.
OR
*[[Jugular venous distension]]
*[[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===
* Pulmonary examination of patients with [disease name] is usually normal.
*Patients with [[hypercalcemia]] and other complications may have:
OR
**[[Dyspnea]] due to [[fluid overload]] form [[renal failure]]
* Asymmetric chest expansion OR decreased chest expansion
*Lungs are hyporesonant OR hyperresonant
*Fine/coarse [[crackles]] upon auscultation of the lung bases/apices unilaterally/bilaterally
*Rhonchi
*Vesicular breath sounds OR distant breath sounds
*Expiratory wheezing OR inspiratory wheezing with normal OR delayed expiratory phase
*[[Wheezing]] may be present
*[[Egophony]] present/absent
*[[Bronchophony]] present/absent
*Normal/reduced [[tactile fremitus]]


===Heart===
===Cardiovasvular===
* Cardiovascular examination of patients with [disease name] is usually normal.
*Patients with [[hypercalcemia]] and other complications may have:
OR
**[[Palpitation|Palpitations]] due to [[arrhythmias]]
*Chest tenderness upon palpation
**Shortened [[QT interval]]
*PMI within 2 cm of the sternum  (PMI) / Displaced point of maximal impulse (PMI) suggestive of ____
**[[Chest pain]] due to [[fluid overload]] form [[renal failure]]
*[[Heave]] / [[thrill]]
**[[Rales]] and [[S3]] due to [[fluid overload]] form [[renal failure]]
*[[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 stethoscope


===Abdomen===
===Abdomen===
* Abdominal examination of patients with [disease name] is usually normal.
*Patients with [[hypercalcemia]] and other complications may have:
OR
**[[Nausea and vomiting]]
*[[Abdominal distension]]  
**[[Anorexia]]  
*[[Abdominal tenderness]] in the right/left upper/lower abdominal quadrant
**[[Fecal impaction]] (from [[constipation]])
*[[Rebound tenderness]] (positive Blumberg sign)
**[[Epigastric pain]] and [[tenderness]] due to development of [[pancreatitis]]
*A palpable abdominal mass in the right/left upper/lower abdominal quadrant
**[[Flank pain]] and [[tenderness]] due to [[nephrolithiasis]]
*Guarding may be present
*[[Hepatomegaly]] / [[splenomegaly]] / [[hepatosplenomegaly]]
*Additional findings, such as obturator test, psoas test, McBurney point test, Murphy test
 
===Back===
* Back examination of patients with [disease name] is usually normal.
OR
*Point tenderness over __ vertebrae (e.g. L3-L4)
*Sacral edema
*Costovertebral angle tenderness bilaterally/unilaterally
*Buffalo hump


===Genitourinary===
===Genitourinary===
* Genitourinary examination of patients with [disease name] is usually normal.
*Patients with severe [[hypercalcemia]] and other complications may have:
OR
**Alteration in [[urinary]] habits
*A pelvic/adnexal mass may be palpated
**[[Volume depletion]]
*Inflamed mucosa
**Signs of [[renal failure]]
*Clear/(color), foul-smelling/odorless penile/vaginal discharge


===Neuromuscular===
===Neuromuscular===
* Neuromuscular examination of patients with [disease name] is usually normal.
*Patient is usually oriented to persons, place, and time.
OR
*Patients with severe [[hypercalcemia]] and other complications may have:
*Patient is usually oriented to persons, place, and time
**[[Anxiety]]
* Altered mental status
**[[Fatigue]] and [[weakness]] due to [[renal failure]]
* Glasgow coma scale is ___ / 15
**[[Lethargy]]
* Clonus may be present
**[[Sleep disturbances]]
* Hyperreflexia / hyporeflexia / areflexia
**[[Muscle twitch]] and [[cramps]]
* Positive (abnormal) Babinski / plantar reflex unilaterally/bilaterally
**Signs of [[depression]]
* Muscle rigidity
**[[Confusion]]
* Proximal/distal muscle weakness unilaterally/bilaterally
**[[Memory]] disturbances
* ____ (finding) suggestive of cranial nerve ___ (roman numerical) deficit (e.g. Dilated pupils suggestive of CN III deficit)
**[[Hypotonia]]
*Unilateral/bilateral upper/lower extremity weakness
**[[Hyporeflexia]]
*Unilateral/bilateral sensory loss in the upper/lower extremity
**[[Paresis]]
*Positive straight leg raise test
**[[Coma]]
*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===
* Extremities examination of patients with [disease name] is usually normal.
*Swelling of feet and [[Ankle|ankles]] due to [[renal failure]]
OR
*[[Arthralgia]] due to bone [[resorption]]
*[[Clubbing]]  
*[[Cyanosis]]  
*Pitting/non-pitting [[edema]] of the upper/lower extremities
*Muscle atrophy
*Fasciculations in the upper/lower extremity


==References==
==References==
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[[Category: (name of the system)]]
[[Category:Disease]]
[[Category:Medicine]]
[[Category:Endocrinology]]
[[Category:Parathyroid disorders]]
[[Category:Up-To-Date]]​
[[Category:Primary care]]

Revision as of 12:47, 6 June 2019

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

Overview

Physical examination of patients with parathyroid adenoma is usually unremarkable. Patients may have physical findings due to severe hypercalcemia and other complications of parathyroid adenoma.

Physical Examination

Appearance of the Patient

  • Patients with parathyroid adenoma usually appear well.

Vital Signs

Skin

HEENT

Lungs

Cardiovasvular

Abdomen

Genitourinary

Neuromuscular

Extremities

References

  1. ↑ Pallan S, Khan A (2011). "Primary hyperparathyroidism: Update on presentation, diagnosis, and management in primary care". Can Fam Physician. 57 (2): 184–9. PMC 3038812. PMID 21321169.
  2. ↑ Mishra SK, Agarwal G, Kar DK, Gupta SK, Mithal A, Rastad J (2001). "Unique clinical characteristics of primary hyperparathyroidism in India". Br J Surg. 88 (5): 708–14. doi:10.1046/j.0007-1323.2001.01775.x. PMID 11350446.

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