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{{familytree/start |summary=PE diagnosis Algorithm.}}
__NOTOC__
{{familytree | | | | | | | | | | A01 | | | | |A01=To determine if the cause is central or peripheral}}
{{Vertigo}}
{{familytree | | | |,|-|-|-|-|-|-|^|-|-|-|-|-|-|-|.| | | | | | }}
{{familytree | | | B01 | | | | | | | | | | | | | B02 | | |B01=Peripheral|B02=Central}}
{{familytree | | | |!| | | | | | | | | | | | | | |!| | | | }}
{{familytree | | | C01 | | | | | | | | | | | | | C02 | | |C01=Intermittent<br>Positional<br> Associated factors (tinnitus, hearing loss, unsteadiness)<br>Nystagmus (delayed, rotatory/horizontal, adaptive)<br>Stops with visual fixation |C02=Non-positional<br>Assosiated factors (other cranial nerves involvement - facial droop/dysarthria)<br>Nystagmus (immediate/delayed, rotatory/horizontal/vertical, not adaptive<br> Does not stop with visual fixation}}
{{familytree/end}}


{{CMG}}; {{AE}} {{ZMalik}}


:*
==Overview==
{| class="wikitable"
Common physical examination findings associated with vertigo include [[nystagus]] [[hearing]] impairment , [[vision]] changes, and [[imbalance]].
|+
! colspan="2" |Peripheral Vertigo Causes<ref> name="Karatas2008">{{cite journal|last1=Karatas|first1=Mehmet|title=Central Vertigo and Dizziness|journal=The Neurologist|volume=14|issue=6|year=2008|pages=355–364|issn=1074-7931|doi=10.1097/NRL.0b013e31817533a3}}</ref>
|-
![[Ménière’s disease]]
|
*Increased [[endolymph]] volume in [[semicircular canals]]. Recurrent vertigo, aural fullness, hearing loss and [[tinnitus]]
|-
![[Acoustic neuroma]]
|
*[[tinnitus]], ear pain, [[aural fullness]], [[headache]], facial weakness.
|-
![[Benign paroxysmal positional vertigo]]
|
*Dislodged [[otoliths]] stimulate vestibular sense organ. Recurrent vertigo, nausea, vomiting, [[torsional]] [[nystagmus]]
|-
![[Acute]] [[labyrinthitis]]
|
*Inflammation of [[labyrinth]]/ [[viral]] or [[bacterial]]. Temporary hearing loss, vertigo, off balance, [[tinnitus]]  
|-
![[Acute vestibular neuritis]]
|
* Inflammation of [[vestibular]] nerve caused by [[viral]] [[infection]]. Vertigo, hearing intact
|-
![[Herpes Zoster Oticus]]
|
* Ear pain, [[facial palsy]], hearing loss, [[tinnitus]] vertigo herpetic eruptions of the [[auricle]] and/or [[external auditory canal]].
|-
![[Cholesteatoma]]
|
*[[Cyst]]/sac of [[keratin]] debris in middle ear. Fullness/pressure in the ear, vertigo, hearing loss, pain
|-
![[Otosclerosis]]
|
*Abnormal bone growth in the middle ear. Vertigo, [[tinnitus]] and, sensorineural hearing loss
|+
! colspan="2" |Central Vertigo Causes<ref name="Kerber2009">{{cite journal|last1=Kerber|first1=Kevin A.|title=Vertigo and Dizziness in the Emergency Department|journal=Emergency Medicine Clinics of North America|volume=27|issue=1|year=2009|pages=39–50|issn=07338627|doi=10.1016/j.emc.2008.09.002}}</ref>
|-
![[Brainstem]] [[Stroke]]
|
*Vertigo, imbalance, double vision, slurred speech, and altered [[consciousness]].
|-
![[Vestibular]] [[Migraine]]
|
*Mostly unilateral severe throbbing [[headache]], vertigo lasting minutes to hours, sensitivity to motion/light/smell/noise, [[nausea]], [[vomiting]], imbalance.
|-
![[Multiple Sclerosis]]
|
*Vertigo may accompany other symptoms like vision problem, fatigue, [[numbness]]/[[tingling]], limited mobility, bladder/bowel/speech/swallowing impairment.
|-
![[Cerebellopontine angle]] [[tumors]]
|
* [[meningioma]] or [[schwannoma]] in [[cerebellopontine]] angle can cause vertigo due to pressure on [[vestibular]] [[nerve]].
|-
![[Lateral medullary syndrome]]
|
*Results from ischemia in the lateral part of the [[brainstem]]([[medulla oblongata]]). Associated with [[ataxia]], [[nystagmus]], vertigo, [[dysphagia]], [[dysarthria]].
|-
![[Chiari malformation]]
|
*Extension of [[brainstem]] into [[spinal canal]]. Associated with [[numbness]]/[[tingling]] of hands and feet, [[dysphagia]], vertigo, unsteady [[gait]], hoarseness.
|+
! colspan="2" |Other Causes
|-
!Medication induced
|
*[[Aminoglycosides]], [[anticonvulsants]]([[phenytoin]]), [[anti-depressants]]([[tricyclic antidepressants]], [[monoamine oxidase]]), [[antihypertensives]], [[diuretics]] ([[furosemide]]), [[barbiturates]], [[cocaine]], [[nitroglycerin]], [[salicylates]]
|-
!Psychogenic
|
*Mood, [[anxiety]], or [[alcohol]] abuse disorders
|}


==Physical Examination==
Physical examination of patients with vertigo is usually remarkable for [[nystagmus]], [[hearing]] impairment, [[nausea]], [[imbalance]], [[vision]] changes.


===Appearance of the Patient===
*Patients with vertigo usually appear [general appearance].


:*
===Vital Signs===
{| class="wikitable"
|+
! colspan="2" | Pathophysiology of Common Causes of Vertigo<ref name="Karatas2008">{{cite journal|last1=Karatas|first1=Mehmet|title=Central Vertigo and Dizziness|journal=The Neurologist|volume=14|issue=6|year=2008|pages=355–364|issn=1074-7931|doi=10.1097/NRL.0b013e31817533a3}}</ref>
|-
![[Ménière’s disease]]
|
*Increased [[endolymph]] volume in [[semicircular canals]].
|-
![[Benign paroxysmal positional vertigo]]
|
*Dislodged [[otoliths]] stimulate vestibular sense organ.
|-
![[Acute]] [[labyrinthitis]]
|
*Inflammation of [[labyrinth]]/ [[viral]] or [[bacterial]].
|-
![[Acute vestibular neuritis]]
|
* Inflammation of [[vestibular]] nerve caused by [[viral]] [[infection]].
|-
![[Cholesteatoma]]
|
*Cyst/sac of [[keratin]] debris in middle ear.
|-
![[Otosclerosis]]
|
*Abnormal bone growth in the middle ear.
|-
![[Perilymphatic fistula]]
|
*Abnormal connection between the middle ear and inner ear.
|}


*Vertigo is derived from the [[Latin]] word vertō which means "a whirling or spinning movement"<ref>"Definition of vertigo". Merriam-Webster Online Dictionary.</ref>.
*High-grade / low-grade fever
*[[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]]


==Classification==
===Skin===
{{familytree/start}}{{familytree | | | | | | | A01 | | | |A01= Classification of Vertigo<ref name="Dieterich2007">{{cite journal|last1=Dieterich|first1=Marianne|title=Central vestibular disorders|journal=Journal of Neurology|volume=254|issue=5|year=2007|pages=559–568|issn=0340-5354|doi=10.1007/s00415-006-0340-7}}</ref><ref name="Karatas2008">{{cite journal|last1=Karatas|first1=Mehmet|title=Central Vertigo and Dizziness|journal=The Neurologist|volume=14|issue=6|year=2008|pages=355–364|issn=1074-7931|doi=10.1097/NRL.0b013e31817533a3}}</ref><ref name="Guerraz2001">{{cite journal|last1=Guerraz|first1=M.|title=Visual vertigo: symptom assessment, spatial orientation and postural control|journal=Brain|volume=124|issue=8|year=2001|pages=1646–1656|issn=14602156|doi=10.1093/brain/124.8.1646}}</ref>}}
* Skin examination of patients with [disease name] is usually normal.
{{familytree | | | | | | | |!| | | | | | | | }}
OR
{{familytree | | | | | | | B01 | | | |B01=Based on Location of Dysfunction}}
*[[Cyanosis]]
{{familytree | | |,|-|-|-|-|^|-|-|-|-|.| }}
*[[Jaundice]]
{{familytree | | C01 | | | | | | | |C02|C01=Peripheral<br>Accounts for over 90% of all causes of vertigo|C02=Central}}
* [[Pallor]]
{{familytree | | |!| | | | | | | | | |!| }}
* Bruises
{{familytree | | D01 | | | | | | | |D02|D01=Lesion in inner ear or vestibulocochlear nerve|D02=Lesion in brainstem or cerebellum}}
{{familytree | | |!| | | | | | | | | |!| }}
{{familytree | | E01 | | | | | | | |E02|E01=Meniere’s disease<br>Benign positional paroxysmal vertigo''<br>Acute labyrinthitis''<br>Acute vestibular neuronitis''<br>Cholesteatoma''<br>Otosclerosis''<br>Perilymphatic fistula''<br>Acoustic Neuroma''|E02=Brainstem Stroke<br>Vestibular Migraine''<br>Multiple Sclerosis''<br>Cerebellar ischemia or hemorrhage''<br>Cerebellar tumors''<br>lateral medullary syndrome''<br>Chiari malformation''}}
{{Family tree/end}}


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


==Causes==
UploadedImage-01.jpg | Description {{dermref}}
* '''Peripheral''' causes of vertigo includes<ref name="Karatas2008">{{cite journal|last1=Karatas|first1=Mehmet|title=Central Vertigo and Dizziness|journal=The Neurologist|volume=14|issue=6|year=2008|pages=355–364|issn=1074-7931|doi=10.1097/NRL.0b013e31817533a3}}</ref>:
UploadedImage-02.jpg | Description {{dermref}}
{| class="wikitable"
|'''Disease''' ||  '''Main Feature'''
|-
| [[Ménière’s disease]] || Increased [[endolymph]] volume in [[semicircular canals]]. Recurrent vertigo, aural fullness, hearing loss and [[tinnitus]]
|-
| [[Benign positional paroxysmal vertigo]] || Dislodged [[otoliths]] stimulate vestibular sense organ. Recurrent vertigo, nausea, vomiting, [[torsional]] [[nystagmus]]
|-
| Acute [[labyrinthitis]] || Inflammation of [[labyrinth]]/ [[viral]] or [[bacterial]]. Temporary hearing loss, vertigo, off balance, [[tinnitus]]
|-
| Acute [[vestibular]] [[neuritis]] || Inflammation of [[vestibular]] nerve caused by [[viral]] [[infection]]. Vertigo, hearing intact
|-
| [[Cholesteatoma]] || Cyst/sac of [[keratin]] debris in middle ear. Fullness/pressure in the ear, vertigo, hearing loss, pain
|-
| [[Otosclerosis]] || Abnormal bone growth in middle ear. Vertigo, [[tinnitus]] and, sensorineural hearing loss
|-
| [[Perilymphatic fistula]] || Abnormal connection between the middle ear and inner ear. Fullness/pressure in the ear,  vertigo, hearing loss/sensitive hearing
|}


* '''Central''' causes of vertigo includes<ref name="Kerber2009">{{cite journal|last1=Kerber|first1=Kevin A.|title=Vertigo and Dizziness in the Emergency Department|journal=Emergency Medicine Clinics of North America|volume=27|issue=1|year=2009|pages=39–50|issn=07338627|doi=10.1016/j.emc.2008.09.002}}</ref>:
</gallery>
{| class="wikitable"
|'''Disease''' || '''Main Feature'''
|-
| [[Brainstem Stroke]] || Vertigo, imbalance, double vision, slurred speech, and altered [[consciousness]].
|-
| [[Vestibular Migraine]] || Mostly unilateral severe throbbing [[headache]], vertigo lasting minutes to hours, sensitivity to motion/light/smell/noise, [[nausea]], [[vomiting]], imbalance.
|-
| [[Multiple Sclerosis]] || Vertigo may accompany other symptoms like vision problem, fatigue, [[numbness]]/[[tingling]], limited mobility, bladder/bowel/speech/swallowing impairment.
|-
| [[Cerebellar]] [[tumors]] || [[meningioma]] or [[schwannoma]] in [[cerebellopontine]] angle can cause vertigo due to pressure on [[vestibular]] [[nerve]].
|-
| [[Lateral medullary syndrome]] || Results from ischemia in the lateral part of the [[brainstem]]([[medulla oblongata]]). Associated with [[ataxia]], [[nystagmus]], vertigo, [[dysphagia]], [[dysarthria]].
|-
| [[Chiari malformation]] || Extension of brainstem into spinal canal. Associated with [[numbness]]/[[tingling]] of hands and feet, [[dysphagia]], vertigo, unsteady gait, hoarseness.
|}


==Differentiating Vertigo from other Diseases==
===HEENT===
*Vertigo is a type of dizziness therefore it must be differentiated from other diseases that causes imbalance, [[dizziness]], and [[lightheadedness]].<ref name="pmid16445269">{{cite journal| author=Labuguen RH| title=Initial evaluation of vertigo. | journal=Am Fam Physician | year= 2006 | volume= 73 | issue= 2 | pages= 244-51 | pmid=16445269 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16445269  }} </ref>
* HEENT examination of patients with [disease name] is usually normal.
OR
* 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


==Epidemiology and Demographics==
===Neck===
*Among the patient who presents with [[dizziness]] in the primary care setting, fifty-four percent have vertigo upon investigation.<ref name="Kroenke1992">{{cite journal|last1=Kroenke|first1=Kurt|title=Causes of Persistent Dizziness|journal=Annals of Internal Medicine|volume=117|issue=11|year=1992|pages=898|issn=0003-4819|doi=10.7326/0003-4819-117-11-898}}</ref>
* 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]]


==Screening==
===Lungs===
*There is insufficient evidence to recommend routine [[screening]] for vertigo.
* Pulmonary examination of patients with [disease name] is usually normal.
OR
* 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]]


==Risk Factors==
===Heart===
*There are no established risk factors for vertigo, as it is a symptom of an underlying disease.
* Cardiovascular examination of patients with [disease name] is usually normal.
*However, vertigo can be prevented in some cases by controlling the underlying cause:
OR
**In [[vestibular]] [[migraine]] recognized triggers including altered sleep patterns, menstrual cycle, chocolate, red wine, ripened/aged cheese, should be avoided.
*Chest tenderness upon palpation
**Avoid drugs or toxins that may cause vertigo.
*PMI within 2 cm of the sternum  (PMI) / Displaced point of maximal impulse (PMI) suggestive of ____
*[[Heave]] / [[thrill]]
*[[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


==Natural History, Complications and Prognosis==
===Abdomen===
*Complications include:
* Abdominal examination of patients with [disease name] is usually normal.
**[[Anxiety]]
OR
**[[Depression]]
*[[Abdominal distension]]  
**Difficulty performing daily tasks
*[[Abdominal tenderness]] in the right/left upper/lower abdominal quadrant
**Diminished quality of life
*[[Rebound tenderness]] (positive Blumberg sign)
**Impaired balance and coordination
*A palpable abdominal mass in the right/left upper/lower abdominal quadrant
*[[Prognosis]] of vertigo depends upon treating the underlying cause. However, vertigo due to a tumor has a poor prognosis compared to other causes of vertigo.
*Guarding may be present
*[[Hepatomegaly]] / [[splenomegaly]] / [[hepatosplenomegaly]]
*Additional findings, such as obturator test, psoas test, McBurney point test, Murphy test


==Diagnosis==
===Back===
'''Diagnostic Study of Choice'''
* Back examination of patients with [disease name] is usually normal.
*There are no established criteria for the diagnosis of vertigo. Associated signs and symptoms should be identified to reach the underlying cause of vertigo.  
OR
*Point tenderness over __ vertebrae (e.g. L3-L4)
*Sacral edema
*Costovertebral angle tenderness bilaterally/unilaterally
*Buffalo hump


'''History and Symptoms'''
===Genitourinary===
*It is important to differentiate between other causes of dizziness before evaluating for the cause of vertigo. True vertigo is described as the room spinning around the patient.  
* Genitourinary examination of patients with [disease name] is usually normal.
*Once true vertigo is established next step is to identify if the origin of dysfunction is central or peripheral.
OR
*
*A pelvic/adnexal mass may be palpated
*Inflamed mucosa
*Clear/(color), foul-smelling/odorless penile/vaginal discharge


'''Physical Examination'''
===Neuromuscular===
* Neuromuscular examination of patients with [disease name] is usually normal.
OR
*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)


'''Laboratory Findings'''
===Extremities===
*There are no diagnostic laboratory findings associated with vertigo.
* Extremities examination of patients with [disease name] is usually normal.
*
OR
 
*[[Clubbing]]
'''Electrocardiogram'''
*[[Cyanosis]]
*There are no ECG findings associated with vertigo.
*Pitting/non-pitting [[edema]] of the upper/lower extremities
*ECG monitoring may be indicated if the cause of dizziness is uncertain.
*Muscle atrophy
 
*Fasciculations in the upper/lower extremity
'''X-ray'''
 
'''Echocardiography or Ultrasound'''
 
'''CT scan'''
 
'''MRI'''
*An MRI is indicated if the cause of vertigo is central in origin.
*An MRI can identify if the underlying cause is a brain tumor like a  [[acoustic neuroma]](vestibular schwannoma) or other pathology in the cerebellopontine angle.
 
'''Other Imaging Findings'''
 
'''Other Diagnostic Studies'''
 
==Treatment==
'''Medical Therapy'''
 
'''Surgery'''
 
'''Primary Prevention'''
 
'''Secondary Prevention'''


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
{{WH}}
{{WS}}
[[Category: (name of the system)]]

Revision as of 17:58, 21 January 2021

Vertigo Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Vertigo 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

MRI

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

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

Overview

Common physical examination findings associated with vertigo include nystagus hearing impairment , vision changes, and imbalance.

Physical Examination

Physical examination of patients with vertigo is usually remarkable for nystagmus, hearing impairment, nausea, imbalance, vision changes.

Appearance of the Patient

  • Patients with vertigo usually appear [general appearance].

Vital Signs

  • High-grade / low-grade fever
  • 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 examination of patients with [disease name] is usually normal.

OR

HEENT

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

OR

  • 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

Lungs

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

OR

  • 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

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

OR

  • Chest tenderness upon palpation
  • PMI within 2 cm of the sternum (PMI) / Displaced point of maximal impulse (PMI) suggestive of ____
  • Heave / thrill
  • Friction rub
  • S1
  • S2
  • S3
  • S4
  • 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

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

OR

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

OR

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

Neuromuscular

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

OR

  • 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

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

OR

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

References

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