Cryptogenic organizing pneumonia physical examination

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Physical Examination

• Physical examination of a patient with cryptogenic organizing pneumonia demonstrates signs of bronchospasm, consolidation, and fluid accumulation.
• The prevalence and severity of these findings depends on the extent of parenchymal involvement and the subtype of organizing pneumonia.

Sign	Cryptogenic Organizing Pneumonia	Secondary Organizing Pneumonia	Focal Organizing Pneumonia
Tachypnea	65%	70%	-
Crackles	85%	95%	10%
Wheezing	10%	10%	10%
Clubbing	-	5%	-
Cyanosis	5%	5%	-

Physical Examination

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

OR

• 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 cryptogenic organizing pneumonia usually appear in mild distress.

Vital Signs

• Low-grade fever
• Tachycardia with regular pulse
• Tachypnea
• Normal blood pressure with normal pulse pressure

Skin

• Skin examination of patients with cryptogenic organizing pneumonia is usually normal.

HEENT

• HEENT examination of patients with cryptogenic organizing pneumonia is usually normal.

Neck

• Neck examination of patients with cryptogenic organizing pneumonia is usually normal.

Lungs

• On examination patient is in mild dyspnea
• Lungs are hyperresonant
• Fine/coarse crackles upon auscultation of the lung bases/apices bilaterally depending upon the consolidation.
• Vesicular breath sounds
• Wheezing may be present

Heart

• Cardiovascular examination of patients with cryptogenic organizing pneumonia is usually normal.

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