Hypoparathyroidism physical examination
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Omodamola Aje B.Sc, M.D. [2]
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].
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 of patients with [disease name] is usually remarkable for:[finding 1], [finding 2], and [finding 3].
- 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
- Patients with hypoparathyroidism usually have neuromuscular irritability and may appear dysphoretic.
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
Common signs are:
- Dry skin
- Coarse hair
- Brittle nails
- Alopecia (patchy)
Some patient may have:
- Atopic eczema
- Exfoliative dermatitis
- Psoriasis
- Impetigo herpetiformis
HEENT
Some patients may have:
- Subcapsular cataracts
- Papilledema
Dental signs
- Enamel hypoplasia
- Shortened premolar roots
- Thickened lamina dura
- Delayed tooth eruption
- Increased dental caries
Neck
- 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
Dyspnea Wheezing
Heart
Prolonged QT interval on EKG Congestive heart failure Cardiomyopathy
Abdomen
Dysphagia
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
Most common presentation is due to neuromuscular irritability. It present as:
- Tetany
- Chvostek's sign - Facial twitching, especially around the mouth. It is elicited by gently tapping the ipsilateral facial nerve as it courses just anterior to the ear.
- Trousseau's sign - Carpal spasm. It is elicited by inflating a blood pressure cuff around the arm to a pressure 20 mm Hg above obliteration of the radial pulse for 3-5 minutes.
- Tingling, burning, or numbness in the fingertips, toes and lips.
- Muscle weakness
- Extrapyramidal signs (due to calcification of basal ganglia)
- Anxiety
- Depression
- Irritability
- Impaired intellectual ability
- Nonspecific EEG changes
- Signs of increased intracrania pressure
Confusion Disorientation Psychosis Anxiety Poor memory Reduced concentration Dystonic spasms Some patients may have: Parkinsonism Choreoathetosis
Extremities
- Clubbing
- Cyanosis
- Pitting/non-pitting edema of the upper/lower extremities
- Muscle atrophy
- Fasciculations in the upper/lower extremity