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| ==Physical Examination== | | ==Physical Examination== |
| ===Vitals=== | | ===Vitals=== |
| * Temperature ([[pericarditis]], [[pleuritis]], [[fever]] can precipitate ischemic attacks) | | |
| * Absent or decreased pulses in limbs ([[aortic dissection]] all four limbs), [[tachycardia]] ([[pulmonary embolism]]) | | *Temperature ([[pericarditis]], [[pleuritis]], [[fever]] can precipitate ischemic attacks) |
| * Blood pressure in both the arms ([[aortic dissection]]) | | *Absent or decreased pulses in limbs ([[aortic dissection]] all four limbs), [[tachycardia]] ([[pulmonary embolism]]) |
| | *Blood pressure in both the arms ([[aortic dissection]]) |
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| ===Neck=== | | ===Neck=== |
| * Elevated [[jugular venous pulse]] | | |
| | *Elevated [[jugular venous pulse]] |
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| ===Heart=== | | ===Heart=== |
| * Auscultation | | |
| ** Third and fourth heart sound | | *Auscultation |
| ** [[Carotid bruit]] | | **Third and fourth heart sound |
| ** [[Pericardial rub]] ([[pericarditis]]) | | **[[Carotid bruit]] |
| ** Murmur (systolic murmur in [[hypertrophic cardiomyopathy]], [[aortic stenosis]]) | | **[[Pericardial rub]] ([[pericarditis]]) |
| | **Murmur (systolic murmur in [[hypertrophic cardiomyopathy]], [[aortic stenosis]]) |
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| ===Lung=== | | ===Lung=== |
| * [[Palpation]] - shift in trachea from midline ([[tension pneumothorax]]) | | |
| * [[Auscultation]] - decreased breath sound ([[pulmonary edema]]), pleural rub ([[pleuritis]], [[pneumonia]]) | | *[[Palpation]] - shift in trachea from midline ([[tension pneumothorax]]) |
| | *[[Auscultation]] - decreased breath sound ([[pulmonary edema]]), pleural rub ([[pleuritis]], [[pneumonia]]) |
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| ===Abdomen=== | | ===Abdomen=== |
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| *Inspection, palpation and auscultation to evaluate for gastrointestinal etiologies of chest pain | | *Inspection, palpation and auscultation to evaluate for gastrointestinal etiologies of chest pain |
| * May show distension, RUQ tenderness. | | *May show distension, RUQ tenderness. |
| * [[Rectal examination]] - occult bleeding ([[peptic ulcers]]) | | *[[Rectal examination]] - occult bleeding ([[peptic ulcers]]) |
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| ===Neurologic=== | | ===Neurologic=== |
| * [[Cerebrovascular accident]]s ([[aortic dissection]]) | | |
| * [[Paraplegia]] | | *[[Cerebrovascular accident]]s ([[aortic dissection]]) |
| | *[[Paraplegia]] |
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| ===Musculoskeletal/Extremities=== | | ===Musculoskeletal/Extremities=== |
| * Palpation with pain reproducibility
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| * Unilateral extremity enlargement, pain, and erythema (deep vein thrombosis)
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| ===Skin===
| | *[[Palpation]] with pain reproducibility |
| * Hyperesthesia and rash (zoster)
| | *Unilateral extremity enlargement, pain, and [[erythema]] (deep vein thrombosis) |
| * Subcutaneous emphysema (Boerhaave syndrome, pneumothorax) | |
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| ==Overview==
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| 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].
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| OR
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| Common physical examination findings of [disease name] include [finding 1], [finding 2], and [finding 3].
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| OR
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| The presence of [finding(s)] on physical examination is diagnostic of [disease name].
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| OR
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| The presence of [finding(s)] on physical examination is highly suggestive of [disease name].
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| ==Physical Examination==
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| Physical examination of patients with [disease name] is usually normal.
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| OR
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| Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].
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| OR
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| The presence of [finding(s)] on physical examination is diagnostic of [disease name].
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| OR
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| The presence of [finding(s)] on physical examination is highly suggestive of [disease name].
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| ===Appearance of the Patient===
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| *Patients with [disease name] usually appear [general appearance].
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| ===Vital Signs===
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| *High-grade / low-grade fever
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| *[[Hypothermia]] / hyperthermia may be present
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| *[[Tachycardia]] with regular pulse or (ir)regularly irregular pulse
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| *[[Bradycardia]] with regular pulse or (ir)regularly irregular pulse
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| *Tachypnea / bradypnea
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| *Kussmal respirations may be present in _____ (advanced disease state)
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| *Weak/bounding pulse / pulsus alternans / paradoxical pulse / asymmetric pulse
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| *High/low blood pressure with normal pulse pressure / [[wide pulse pressure]] / [[narrow pulse pressure]]
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| ===Skin=== | | ===Skin=== |
| * Skin examination of patients with [disease name] is usually normal.
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| OR
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| *[[Cyanosis]]
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| *[[Jaundice]]
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| * [[Pallor]]
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| * Bruises
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| <gallery widths="150px">
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| UploadedImage-01.jpg | Description {{dermref}}
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| UploadedImage-02.jpg | Description {{dermref}}
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| </gallery>
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| ===HEENT===
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| * HEENT examination of patients with [disease name] is usually normal.
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| OR
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| * Abnormalities of the head/hair may include ___
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| * Evidence of trauma
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| * Icteric sclera
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| * [[Nystagmus]]
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| * Extra-ocular movements may be abnormal
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| *Pupils non-reactive to light / non-reactive to accommodation / non-reactive to neither light nor accommodation
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| *Ophthalmoscopic exam may be abnormal with findings of ___
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| * Hearing acuity may be reduced
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| *[[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".)
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| *[[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".)
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| * [[Exudate]] from the ear canal
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| * Tenderness upon palpation of the ear pinnae/tragus (anterior to ear canal)
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| *Inflamed nares / congested nares
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| * [[Purulent]] exudate from the nares
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| * Facial tenderness
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| * Erythematous throat with/without tonsillar swelling, exudates, and/or petechiae
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| ===Neck===
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| * Neck examination of patients with [disease name] is usually normal.
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| OR
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| *[[Jugular venous distension]]
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| *[[Carotid bruits]] may be auscultated unilaterally/bilaterally using the bell/diaphragm of the otoscope
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| *[[Lymphadenopathy]] (describe location, size, tenderness, mobility, and symmetry)
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| *[[Thyromegaly]] / thyroid nodules
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| *[[Hepatojugular reflux]]
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| ===Lungs===
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| * Pulmonary examination of patients with [disease name] is usually normal.
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| OR
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| * Asymmetric chest expansion OR decreased chest expansion
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| *Lungs are hyporesonant OR hyperresonant
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| *Fine/coarse [[crackles]] upon auscultation of the lung bases/apices unilaterally/bilaterally
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| *Rhonchi
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| *Vesicular breath sounds OR distant breath sounds
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| *Expiratory wheezing OR inspiratory wheezing with normal OR delayed expiratory phase
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| *[[Wheezing]] may be present
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| *[[Egophony]] present/absent
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| *[[Bronchophony]] present/absent
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| *Normal/reduced [[tactile fremitus]]
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| ===Heart===
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| * Cardiovascular examination of patients with [disease name] is usually normal.
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| OR
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| *Chest tenderness upon palpation
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| *PMI within 2 cm of the sternum (PMI) / Displaced point of maximal impulse (PMI) suggestive of ____
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| *[[Heave]] / [[thrill]]
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| *[[Friction rub]]
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| *[[Heart sounds#First heart tone S1, the "lub"(components M1 and T1)|S1]]
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| *[[Heart sounds#Second heart tone S2 the "dub"(components A2 and P2)|S2]]
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| *[[Heart sounds#Third heart sound S3|S3]]
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| *[[Heart sounds#Fourth heart sound S4|S4]]
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| *[[Heart sounds#Summation Gallop|Gallops]]
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| *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
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| ===Abdomen===
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| * Abdominal examination of patients with [disease name] is usually normal.
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| OR
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| *[[Abdominal distension]]
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| *[[Abdominal tenderness]] in the right/left upper/lower abdominal quadrant
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| *[[Rebound tenderness]] (positive Blumberg sign)
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| *A palpable abdominal mass in the right/left upper/lower abdominal quadrant
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| *Guarding may be present
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| *[[Hepatomegaly]] / [[splenomegaly]] / [[hepatosplenomegaly]]
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| *Additional findings, such as obturator test, psoas test, McBurney point test, Murphy test
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| ===Back===
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| * Back examination of patients with [disease name] is usually normal.
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| OR
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| *Point tenderness over __ vertebrae (e.g. L3-L4)
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| *Sacral edema
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| *Costovertebral angle tenderness bilaterally/unilaterally
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| *Buffalo hump
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| ===Genitourinary===
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| * Genitourinary examination of patients with [disease name] is usually normal.
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| OR
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| *A pelvic/adnexal mass may be palpated
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| *Inflamed mucosa
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| *Clear/(color), foul-smelling/odorless penile/vaginal discharge
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| ===Neuromuscular===
| | *[[Hyperesthesia]] and [[rash]] [[Herpes zoster|(zoster)]] |
| * Neuromuscular examination of patients with [disease name] is usually normal. | | *[[Subcutaneous emphysema]] ([[Boerhaave syndrome]], [[pneumothorax]]) |
| OR
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| *Patient is usually oriented to persons, place, and time
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| * Altered mental status
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| * Glasgow coma scale is ___ / 15
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| * Clonus may be present
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| * Hyperreflexia / hyporeflexia / areflexia
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| * Positive (abnormal) Babinski / plantar reflex unilaterally/bilaterally
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| * Muscle rigidity | |
| * Proximal/distal muscle weakness unilaterally/bilaterally
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| * ____ (finding) suggestive of cranial nerve ___ (roman numerical) deficit (e.g. Dilated pupils suggestive of CN III deficit)
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| *Unilateral/bilateral upper/lower extremity weakness
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| *Unilateral/bilateral sensory loss in the upper/lower extremity
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| *Positive straight leg raise test
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| *Abnormal gait (describe gait: e.g. ataxic (cerebellar) gait / steppage gait / waddling gait / choeiform gait / Parkinsonian gait / sensory gait)
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| *Positive/negative Trendelenburg sign
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| *Unilateral/bilateral tremor (describe tremor, e.g. at rest, pill-rolling)
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| *Normal finger-to-nose test / Dysmetria
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| *Absent/present dysdiadochokinesia (palm tapping test)
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| ===Extremities===
| | * |
| * Extremities examination of patients with [disease name] is usually normal. | |
| OR
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| *[[Clubbing]]
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| *[[Cyanosis]]
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| *Pitting/non-pitting [[edema]] of the upper/lower extremities
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| *Muscle atrophy
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| *Fasciculations in the upper/lower extremity
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