Hypoparathyroidism physical examination: Difference between revisions

Jump to navigation Jump to search
VisualWikitext
m (Bot: Removing from Primary care)
 
(21 intermediate revisions by 2 users not shown)
Line 2: Line 2:
{{Hypoparathyroidism}}
{{Hypoparathyroidism}}


{{CMG}}; {{AE}} {{DAMI}}
{{CMG}}; {{AE}} {{Anmol}}


==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 hypoparathyroidism is usually due to [[hypocalcemia]]. The presence of [[tetany]] on physical examination is diagnostic of [[hypocalcemia]] which is commonly caused by hypoparathyroidism. The presence of [[Chvostek's sign]] and [[Trousseau's sign|Trousseau's sign]] on physical examination is highly suggestive of [[hypocalcemia]] which is commonly caused by hypoparathyroidism.


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 hypoparathyroidism is usually due to [[hypocalcemia]].<ref name="pmid28138323">{{cite journal |vauthors=Abate EG, Clarke BL |title=Review of Hypoparathyroidism |journal=Front Endocrinol (Lausanne) |volume=7 |issue= |pages=172 |year=2016 |pmid=28138323 |pmc=5237638 |doi=10.3389/fendo.2016.00172 |url=}}</ref><ref name="pmid18535072">{{cite journal |vauthors=Cooper MS, Gittoes NJ |title=Diagnosis and management of hypocalcaemia |journal=BMJ |volume=336 |issue=7656 |pages=1298–302 |year=2008 |pmid=18535072 |pmc=2413335 |doi=10.1136/bmj.39582.589433.BE |url=}}</ref>
*Physical examination of patients with [disease name] is usually remarkable for:[finding 1], [finding 2], and [finding 3].
*The presence of [[tetany]] on physical examination is diagnostic of [[hypocalcemia]] which is commonly caused by hypoparathyroidism.<ref>{{cite book |last1=Schafer |first1=AL |last2=Shoback |first2=DM |editor-last1=De Groot |editor-first1=LJ |editor-last2=Chrousos |editor-first2=G |editor-last3=Dungan |editor-first3=K  |display-editors=etal |date= |title=Hypocalcemia: Diagnosis and Treatment. [Updated 2016 Jan 3]. |url=https://www.ncbi.nlm.nih.gov/books/NBK279022/ |location= Endotext [Internet]. |publisher=South Dartmouth (MA): MDText.com, Inc.; 2000-. |page= |isbn= |author-link= }}</ref>
*The presence of [finding(s)] on physical examination is diagnostic of [disease name].
*The presence of [[Chvostek's sign]] and [[Trousseau's sign|Trousseau's sign]] on physical examination is highly suggestive of [[hypocalcemia]] which is commonly caused by hypoparathyroidism.<ref name="pmid18650515">{{cite journal |vauthors=Shoback D |title=Clinical practice. Hypoparathyroidism |journal=N. Engl. J. Med. |volume=359 |issue=4 |pages=391–403 |year=2008 |pmid=18650515 |doi=10.1056/NEJMcp0803050 |url=}}</ref>
*The presence of [finding(s)] on physical examination is highly suggestive of [disease name].


===Appearance of the Patient===
===Appearance of the Patient===
*Patients with hypoparathyroidism usually have neuromuscular irritability and may appear dysphoretic.
*Patients with hypoparathyroidism usually have [[neuromuscular]] [[irritability]] and may appear [[dysphoric]].


===Vital Signs===
===Vital Signs===
Some patient may have:
*[[Bradycardia]]


*High-grade / low-grade fever
===Skin===
*[[Hypothermia]] / hyperthermia may be present
Careful examination of [[skin]] around [[neck]] should be done for [[surgical]] scar.
*[[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 present are:
Common signs are:
*[[Dry skin]]
*Dry skin
*Coarse [[hair]]
*Coarse hair
*[[Brittle nails]]
*Brittle nails
*[[Alopecia]] (patchy)
*Alopecia (patchy)
Some patient may have:
Some patient may have:
*Atopic eczema
*[[Vitiligo]]
*Exfoliative dermatitis
*Psoriasis
*Impetigo herpetiformis


===HEENT===
===HEENT===
Some patients may have:
Some patients may have:
*Subcapsular cataracts
*Subcapsular [[cataracts]]
*Papilledema
*[[Papilledema]]<ref name="pmid3690435">{{cite journal |vauthors=Sheldon RS, Becker WJ, Hanley DA, Culver RL |title=Hypoparathyroidism and pseudotumor cerebri: an infrequent clinical association |journal=Can J Neurol Sci |volume=14 |issue=4 |pages=622–5 |year=1987 |pmid=3690435 |doi= |url=}}</ref>


===Neck===
===Dental signs===
*[[Jugular venous distension]]
Some pediatric patients may have:
*[[Carotid bruits]] may be auscultated unilaterally/bilaterally using the bell/diaphragm of the otoscope
*[[Enamel]] [[hypoplasia]]
*[[Lymphadenopathy]] (describe location, size, tenderness, mobility, and symmetry)
*Shortened [[premolar]] roots
*[[Thyromegaly]] / thyroid nodules
*Thickened lamina dura
*[[Hepatojugular reflux]]
*Delayed tooth eruption
*[[Dental caries]]


===Lungs===
===Lungs===
* Asymmetric chest expansion / Decreased chest expansion
Some patients may have:
*Lungs are hypo/hyperresonant
*[[Dyspnea]]
*Fine/coarse [[crackles]] upon auscultation of the lung bases/apices unilaterally/bilaterally
*[[Wheeze|Wheezing]]
*Rhonchi
*Vesicular breath sounds / Distant breath sounds
*Expiratory/inspiratory wheezing with normal / delayed expiratory phase
*[[Wheezing]] may be present
*[[Egophony]] present/absent
*[[Bronchophony]] present/absent
*Normal/reduced [[tactile fremitus]]


===Heart===
===Heart===
*Chest tenderness upon palpation
Some patients may have:
*PMI within 2 cm of the sternum  (PMI) / Displaced point of maximal impulse (PMI) suggestive of ____
*[[Palpitation]]
*[[Heave]] / [[thrill]]
*Signs of [[congestive heart failure]] such as [[fluid overload]] ([[S3 gallop]])<ref name="pmid4014262">{{cite journal |vauthors=Levine SN, Rheams CN |title=Hypocalcemic heart failure |journal=Am. J. Med. |volume=78 |issue=6 Pt 1 |pages=1033–5 |year=1985 |pmid=4014262 |doi= |url=}}</ref>
*[[Friction rub]]
 
*[[Heart sounds#First heart tone S1, the "lub"(components M1 and T1)|S1]]
* Signs of [[cardiomyopathy]]<ref name="pmid1633370">{{cite journal |vauthors=Kudoh C, Tanaka S, Marusaki S, Takahashi N, Miyazaki Y, Yoshioka N, Hayashi M, Shimamoto K, Kikuchi K, Iimura O |title=Hypocalcemic cardiomyopathy in a patient with idiopathic hypoparathyroidism |journal=Intern. Med. |volume=31 |issue=4 |pages=561–8 |year=1992 |pmid=1633370 |doi= |url=}}</ref>
*[[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 otoscope


===Abdomen===
===Abdomen===
*[[Abdominal distention]]
Some patients may have:
*[[Abdominal tenderness]] in the right/left upper/lower abdominal quadrant
* [[Dysphagia]]
*[[Rebound tenderness]] (positive Blumberg sign)
*A palpable abdominal mass in the right/left upper/lower abdominal quadrant
*Guarding may be present
*[[Hepatomegaly]] / [[splenomegaly]] / [[hepatosplenomegaly]]
*Additional findings, such as obturator test, psoas test, McBurney point test, Murphy test


===Back===
===Neuromuscular===
*Point tenderness over __ vertebrae (e.g. L3-L4)
Most common presentation is due to neuromuscular irritability. It present as:
*Sacral edema
*[[Tetany|'''Tetany''']]
*Costovertebral angle tenderness bilaterally/unilaterally
*'''[[Chvostek's sign]]:''' [[Facial twitching]], especially around the [[mouth]]. It is elicited by tapping the [[cheek]] (2 cm anterior to the earlobe below the [[zygomatic process]]) over the path of the [[facial nerve]]. Ipsilateral [[twitching]] of the upper [[lip]] is considered as positive sign.
*Buffalo hump
*'''[[Trousseau's sign]]:''' Painful 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, and/or [[numbness]] in the [[Fingertip|fingertips]], [[Toe|toes]] and [[lips]]
*[[Muscle weakness]]
*Signs of [[increased intracranial pressure]]
*[[Dystonic]] [[spasms]]
Some patients may have:
*[[Intellectual disability]]
*[[Confusion]]
*[[Disorientation]]
Some patients may have [[extrapyramidal]] signs (due to [[calcification]] of [[basal ganglia]]):<ref name="pmid22224190">{{cite journal |vauthors=Basak RC |title=A case report of Basal Ganglia calcification - a rare finding of hypoparathyroidism |journal=Oman Med J |volume=24 |issue=3 |pages=220–2 |year=2009 |pmid=22224190 |pmc=3251182 |doi=10.5001/omj.2009.44 |url=}}</ref>
*[[Parkinsonism]]
*[[Choreoathetosis]]
*[[Dystonia]]
*[[Oculogyric crisis]]
*[[Hemiballismus]]


===Genitourinary===
===Psychiatric===
*A pelvic/adnexal mass may be palpated
Some patients may have psychiatric manifestations:<ref name="pmid11834431">{{cite journal |vauthors=Arlt W, Fremerey C, Callies F, Reincke M, Schneider P, Timmermann W, Allolio B |title=Well-being, mood and calcium homeostasis in patients with hypoparathyroidism receiving standard treatment with calcium and vitamin D |journal=Eur. J. Endocrinol. |volume=146 |issue=2 |pages=215–22 |year=2002 |pmid=11834431 |doi= |url=}}</ref><ref name="pmid25772947">{{cite journal |vauthors=Lin KF, Chen KH, Huang WL |title=Organic anxiety in a woman with breast cancer receiving denosumab |journal=Gen Hosp Psychiatry |volume=37 |issue=2 |pages=192.e7–8 |year=2015 |pmid=25772947 |doi=10.1016/j.genhosppsych.2015.01.007 |url=}}</ref>
*Inflamed mucosa
*[[Anxiety]]
*Clear/(color), foul-smelling/odorless penile/vaginal discharge
*[[Depression]]
 
*[[Irritability]]
===Neuromuscular===
*[[Psychosis]]
*Patient is usually oriented to persons, place, and time
*[[Anxiety]]
* Altered mental status
*Memory disturbances
* Glasgow coma scale is ___ / 15
*Reduced concentration
* 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===
*[[Clubbing]]
Some patients may have:
*[[Cyanosis]]  
*[[Edema]] due to [[cardiac dysfunction]]
*Pitting/non-pitting [[edema]] of the upper/lower extremities
*Muscle atrophy
*Fasciculations in the upper/lower extremity


==References==
==References==
Line 137: Line 98:
{{WH}}
{{WH}}
{{WS}}
{{WS}}
[[Category:Disease]]
[[Category:Medicine]]
[[Category:Endocrinology]]
[[Category:Parathyroid disorders]]
[[Category:Up-To-Date]]

Latest revision as of 22:18, 29 July 2020

Hypoparathyroidism Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Hypoparathyroidism from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Criteria

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

X Ray

CT

MRI

Echocardiography or Ultrasound

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Hypoparathyroidism physical examination On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Hypoparathyroidism physical examination

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Hypoparathyroidism physical examination

CDC on Hypoparathyroidism physical examination

Hypoparathyroidism physical examination in the news

Blogs on Hypoparathyroidism physical examination

Directions to Hospitals Treating Hypoparathyroidism

Risk calculators and risk factors for Hypoparathyroidism physical examination

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

Overview

Physical examination of patients with hypoparathyroidism is usually due to hypocalcemia. The presence of tetany on physical examination is diagnostic of hypocalcemia which is commonly caused by hypoparathyroidism. The presence of Chvostek's sign and Trousseau's sign on physical examination is highly suggestive of hypocalcemia which is commonly caused by hypoparathyroidism.

Physical Examination

Appearance of the Patient

Vital Signs

Some patient may have:

Skin

Careful examination of skin around neck should be done for surgical scar.

Common signs present are:

Some patient may have:

HEENT

Some patients may have:

Dental signs

Some pediatric patients may have:

Lungs

Some patients may have:

Heart

Some patients may have:

Abdomen

Some patients may have:

Neuromuscular

Most common presentation is due to neuromuscular irritability. It present as:

Some patients may have:

Some patients may have extrapyramidal signs (due to calcification of basal ganglia):[8]

Psychiatric

Some patients may have psychiatric manifestations:[9][10]

Extremities

Some patients may have:

References

  1. ↑ Abate EG, Clarke BL (2016). "Review of Hypoparathyroidism". Front Endocrinol (Lausanne). 7: 172. doi:10.3389/fendo.2016.00172. PMC 5237638. PMID 28138323.
  2. ↑ Cooper MS, Gittoes NJ (2008). "Diagnosis and management of hypocalcaemia". BMJ. 336 (7656): 1298–302. doi:10.1136/bmj.39582.589433.BE. PMC 2413335. PMID 18535072.
  3. ↑ Schafer, AL; Shoback, DM. De Groot, LJ; Chrousos, G; Dungan, K; et al., eds. Hypocalcemia: Diagnosis and Treatment. [Updated 2016 Jan 3]. Endotext [Internet].: South Dartmouth (MA): MDText.com, Inc.; 2000-.
  4. ↑ Shoback D (2008). "Clinical practice. Hypoparathyroidism". N. Engl. J. Med. 359 (4): 391–403. doi:10.1056/NEJMcp0803050. PMID 18650515.
  5. ↑ Sheldon RS, Becker WJ, Hanley DA, Culver RL (1987). "Hypoparathyroidism and pseudotumor cerebri: an infrequent clinical association". Can J Neurol Sci. 14 (4): 622–5. PMID 3690435.
  6. ↑ Levine SN, Rheams CN (1985). "Hypocalcemic heart failure". Am. J. Med. 78 (6 Pt 1): 1033–5. PMID 4014262.
  7. ↑ Kudoh C, Tanaka S, Marusaki S, Takahashi N, Miyazaki Y, Yoshioka N, Hayashi M, Shimamoto K, Kikuchi K, Iimura O (1992). "Hypocalcemic cardiomyopathy in a patient with idiopathic hypoparathyroidism". Intern. Med. 31 (4): 561–8. PMID 1633370.
  8. ↑ Basak RC (2009). "A case report of Basal Ganglia calcification - a rare finding of hypoparathyroidism". Oman Med J. 24 (3): 220–2. doi:10.5001/omj.2009.44. PMC 3251182. PMID 22224190.
  9. ↑ Arlt W, Fremerey C, Callies F, Reincke M, Schneider P, Timmermann W, Allolio B (2002). "Well-being, mood and calcium homeostasis in patients with hypoparathyroidism receiving standard treatment with calcium and vitamin D". Eur. J. Endocrinol. 146 (2): 215–22. PMID 11834431.
  10. ↑ Lin KF, Chen KH, Huang WL (2015). "Organic anxiety in a woman with breast cancer receiving denosumab". Gen Hosp Psychiatry. 37 (2): 192.e7–8. doi:10.1016/j.genhosppsych.2015.01.007. PMID 25772947.

Template:WH Template:WS

Retrieved from "https://www.wikidoc.org/index.php?title=Hypoparathyroidism_physical_examination&oldid=1639678"