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==Physical Examination==
==Physical Examination==
=== Appearance of the Patient ===
* Patients with [disease name] usually appear [general appearance].
=== Vital Signs ===
* [[Tachycardia]] with regular pulse or (ir)regularly irregular pulse
* [[Bradycardia]] with regular pulse or (ir)regularly irregular pulse
* Tachypnea / bradypnea
* High/low blood pressure with normal pulse pressure / [[wide pulse pressure]] / [[narrow pulse pressure]]
=== Skin ===
* [[Cyanosis]]
=== HEENT ===
* HEENT examination of patients with [disease name] is usually normal.
=== Neck ===
* [[Jugular venous distension]]
*
=== Lungs ===
* Lungs are hyporesonant OR hyperresonant
* Fine/coarse [[crackles]] upon auscultation of the lung bases/apices unilaterally/bilaterally
* Rhonchi
* [[Wheezing]] may be present
=== Heart ===
* [[Heart sounds#Summation%20Gallop|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 ===
* [[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
=== Genitourinary ===
* Genitourinary examination of patients with [disease name] is usually normal
=== Neuromuscular ===
* Altered mental status
* Hyperreflexia / hyporeflexia / areflexia
* Distal muscle weakness bilaterally
* ____ (finding) suggestive of cranial nerve ___ (roman numerical) deficit (e.g. Dilated pupils suggestive of CN III deficit)
* Bilateral upper/lower extremity weakness
* Unilateral/bilateral sensory loss in the upper/lower extremity
=== Extremities ===
* [[Cyanosis]]
* Pitting/non-pitting [[edema]] of the upper/lower extremities
* Muscle atrophy
Beriberi itself has no specific examination signs. In advanced stages, the signs of related complications as cardiac dysfunction or peripheral neuritis are present. Therefore, for earlier diagnosis of Beriberi, clinical sense in light of the clinical setting and patient symptoms is required.<ref name="pmid23849362">{{cite journal| author=Chisolm-Straker M, Cherkas D| title=Altered and unstable: wet beriberi, a clinical review. | journal=J Emerg Med | year= 2013 | volume= 45 | issue= 3 | pages= 341-4 | pmid=23849362 | doi=10.1016/j.jemermed.2013.04.022 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23849362  }}</ref><ref name="pmid30862772">{{cite journal| author=Shible AA, Ramadurai D, Gergen D, Reynolds PM| title=Dry Beriberi Due to Thiamine Deficiency Associated with Peripheral Neuropathy and Wernicke's Encephalopathy Mimicking Guillain-Barré syndrome: A Case Report and Review of the Literature. | journal=Am J Case Rep | year= 2019 | volume= 20 | issue=  | pages= 330-334 | pmid=30862772 | doi=10.12659/AJCR.914051 | pmc=6429982 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30862772  }}</ref> The examination signs in advanced stages of beriberi may include:  
Beriberi itself has no specific examination signs. In advanced stages, the signs of related complications as cardiac dysfunction or peripheral neuritis are present. Therefore, for earlier diagnosis of Beriberi, clinical sense in light of the clinical setting and patient symptoms is required.<ref name="pmid23849362">{{cite journal| author=Chisolm-Straker M, Cherkas D| title=Altered and unstable: wet beriberi, a clinical review. | journal=J Emerg Med | year= 2013 | volume= 45 | issue= 3 | pages= 341-4 | pmid=23849362 | doi=10.1016/j.jemermed.2013.04.022 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23849362  }}</ref><ref name="pmid30862772">{{cite journal| author=Shible AA, Ramadurai D, Gergen D, Reynolds PM| title=Dry Beriberi Due to Thiamine Deficiency Associated with Peripheral Neuropathy and Wernicke's Encephalopathy Mimicking Guillain-Barré syndrome: A Case Report and Review of the Literature. | journal=Am J Case Rep | year= 2019 | volume= 20 | issue=  | pages= 330-334 | pmid=30862772 | doi=10.12659/AJCR.914051 | pmc=6429982 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30862772  }}</ref> The examination signs in advanced stages of beriberi may include:  


Revision as of 14:45, 13 November 2019

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Abdelrahman Ibrahim Abushouk, MD[2]

Overview

There are no specific signs for Beriberi. Therefore, it should be suspected in light of the patient's symptoms and clinical setting. However, in advanced stages, the signs of cardiac dysfunction (wet beriberi) or peripheral neuropathy (dry beriberi) may be present.

Physical Examination

Appearance of the Patient

  • Patients with [disease name] usually appear [general appearance].

Vital Signs

Skin

HEENT

  • HEENT examination of patients with [disease name] is usually normal.

Neck

Lungs

  • Lungs are hyporesonant OR hyperresonant
  • Fine/coarse crackles upon auscultation of the lung bases/apices unilaterally/bilaterally
  • Rhonchi
  • Wheezing may be present

Heart

Abdomen

Back

  • Back examination of patients with [disease name] is usually normal

Genitourinary

  • Genitourinary examination of patients with [disease name] is usually normal

Neuromuscular

  • Altered mental status
  • Hyperreflexia / hyporeflexia / areflexia
  • Distal muscle weakness bilaterally
  • ____ (finding) suggestive of cranial nerve ___ (roman numerical) deficit (e.g. Dilated pupils suggestive of CN III deficit)
  • Bilateral upper/lower extremity weakness
  • Unilateral/bilateral sensory loss in the upper/lower extremity

Extremities

  • Cyanosis
  • Pitting/non-pitting edema of the upper/lower extremities
  • Muscle atrophy

Beriberi itself has no specific examination signs. In advanced stages, the signs of related complications as cardiac dysfunction or peripheral neuritis are present. Therefore, for earlier diagnosis of Beriberi, clinical sense in light of the clinical setting and patient symptoms is required.[1][2] The examination signs in advanced stages of beriberi may include:

Wet beriberi

The signs of heart failure may be present. These most commonly include:

  • Lower limb edema
  • Shift in the heart apex (enlarged cardiac chambers)
  • Crepitations on pulmonary auscultation
  • Hepatomegaly on abdominal examination

Dry beriberi

The signs of peripheral neuropathy may be present. These most commonly include:

  • Exaggerated, then lost deep tendon reflexes
  • Reduced muscle power and even paralysis in advanced stages
  • Hyposthesia
  • Wrist and ankle drop in advanced stages.

Wernicke-Korsakoff Syndrome

References

  1. ↑ Chisolm-Straker M, Cherkas D (2013). "Altered and unstable: wet beriberi, a clinical review". J Emerg Med. 45 (3): 341–4. doi:10.1016/j.jemermed.2013.04.022. PMID 23849362.
  2. ↑ Shible AA, Ramadurai D, Gergen D, Reynolds PM (2019). "Dry Beriberi Due to Thiamine Deficiency Associated with Peripheral Neuropathy and Wernicke's Encephalopathy Mimicking Guillain-Barré syndrome: A Case Report and Review of the Literature". Am J Case Rep. 20: 330–334. doi:10.12659/AJCR.914051. PMC 6429982. PMID 30862772.


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