Pneumoconiosis physical examination: Difference between revisions

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==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].
Patients with [[pneumoconiosis]] usually appear breathless. Physical examination of patients with [[pneumoconiosis]] is usually remarkable for [[cough]], [[Wheeze|wheezing]] and [[shortness of breath]] with remote history of occupational exposure to some [[Pathogen|pathogenic]] material. <ref name="pmid23708110">{{cite journal| author=Cullinan P, Reid P| title=Pneumoconiosis. | journal=Prim Care Respir J | year= 2013 | volume= 22 | issue= 2 | pages= 249-52 | pmid=23708110 | doi=10.4104/pcrj.2013.00055 | pmc=6442808 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23708110  }} </ref>
 
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 [disease name] is usually normal.
[[Physical examination]] of patients is usually positive for [[Wheeze|wheezing]] on [[auscultation]] and [[tachypnea]].  


OR
===Appearance of the Patient===
 
Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].
 
OR
 
The presence of [finding(s)] on physical examination is diagnostic of [disease name].


OR
*Patients with [[pneumoconiosis]] usually appear with [[shortness of breath]] and [[digital clubbing]].
 
The presence of [finding(s)] on physical examination is highly suggestive of [disease name].
 
===Appearance of the Patient===
*Patients with [disease name] usually appear [general appearance].  


===Vital Signs===
===Vital Signs===


*High-grade / low-grade fever
*[[Fever]]
*[[Hypothermia]] / hyperthermia may be present
*[[Tachypnea]]
*[[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===
===Lungs===
* Skin examination of patients with [disease name] is usually normal.
OR
*[[Cyanosis]]
*[[Jaundice]]
* [[Pallor]]
* Bruises
 
<gallery widths="150px">
 
UploadedImage-01.jpg | Description {{dermref}}
UploadedImage-02.jpg | Description {{dermref}}


</gallery>
*[[Decreased breath sounds]].
 
*[[Wheezing]] with [[Crackles|end-inspiratory crackles]].
===HEENT===
*[[PFTs|PFT]] with [[Restrictive lung disease|restrictive]] pattern and [[FVC|decreased FVC]].
* HEENT examination of patients with [disease name] is usually normal.
*[[Rhonchi]] can be observed.
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
*[[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===
* 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===
===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]]
*[[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
===Abdomen===
* Abdominal examination of patients with [disease name] is usually normal.
OR
*[[Abdominal distension]]
*[[Abdominal tenderness]] in the right/left upper/lower abdominal quadrant
*[[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===
* 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===
*Accentuation of [[P2]] at the left upper sternal border.
* Neuromuscular examination of patients with [disease name] is usually normal.
*If [[cor pulmonale]] develops, the patient will show [[JVD]], [[hepatojugular reflux]] and [[peripheral edema]]. <ref name="pmid21195893">{{cite journal| author=Yang HY, Wang JD, Chen PC, Lee JJ| title=Pleural plaque related to asbestos mining in Taiwan. | journal=J Formos Med Assoc | year= 2010 | volume= 109 | issue= 12 | pages= 928-33 | pmid=21195893 | doi=10.1016/S0929-6646(10)60142-8 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21195893  }} </ref> <ref name="pmid28370783">{{cite journal| author=Perret JL, Plush B, Lachapelle P, Hinks TS, Walter C, Clarke P | display-authors=etal| title=Coal mine dust lung disease in the modern era. | journal=Respirology | year= 2017 | volume= 22 | issue= 4 | pages= 662-670 | pmid=28370783 | doi=10.1111/resp.13034 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28370783  }} </ref> <ref name="pmid4059668">{{cite journal| author=Munakata M, Homma Y, Matsuzaki M, Ogasawara H, Sasaki Y, Kawakami Y| title=Rales in silicosis. A correlative study with physiological and radiological abnormalities. | journal=Respiration | year= 1985 | volume= 48 | issue= 2 | pages= 140-4 | pmid=4059668 | doi=10.1159/000194814 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4059668  }} </ref> <ref name="pmid6367573">{{cite journal| author=Murphy RL, Gaensler EA, Holford SK, Del Bono EA, Epler G| title=Crackles in the early detection of asbestosis. | journal=Am Rev Respir Dis | year= 1984 | volume= 129 | issue= 3 | pages= 375-9 | pmid=6367573 | doi=10.1164/arrd.1984.129.3.375 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6367573  }} </ref>
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==
==References==


Latest revision as of 20:43, 26 April 2021

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Dushka Riaz, MD

Overview

Patients with pneumoconiosis usually appear breathless. Physical examination of patients with pneumoconiosis is usually remarkable for cough, wheezing and shortness of breath with remote history of occupational exposure to some pathogenic material. [1]

Physical Examination

Physical examination of patients is usually positive for wheezing on auscultation and tachypnea.

Appearance of the Patient

Vital Signs

Lungs

Heart

References

  1. ↑ Cullinan P, Reid P (2013). "Pneumoconiosis". Prim Care Respir J. 22 (2): 249–52. doi:10.4104/pcrj.2013.00055. PMC 6442808. PMID 23708110.
  2. ↑ Yang HY, Wang JD, Chen PC, Lee JJ (2010). "Pleural plaque related to asbestos mining in Taiwan". J Formos Med Assoc. 109 (12): 928–33. doi:10.1016/S0929-6646(10)60142-8. PMID 21195893.
  3. ↑ Perret JL, Plush B, Lachapelle P, Hinks TS, Walter C, Clarke P; et al. (2017). "Coal mine dust lung disease in the modern era". Respirology. 22 (4): 662–670. doi:10.1111/resp.13034. PMID 28370783.
  4. ↑ Munakata M, Homma Y, Matsuzaki M, Ogasawara H, Sasaki Y, Kawakami Y (1985). "Rales in silicosis. A correlative study with physiological and radiological abnormalities". Respiration. 48 (2): 140–4. doi:10.1159/000194814. PMID 4059668.
  5. ↑ Murphy RL, Gaensler EA, Holford SK, Del Bono EA, Epler G (1984). "Crackles in the early detection of asbestosis". Am Rev Respir Dis. 129 (3): 375–9. doi:10.1164/arrd.1984.129.3.375. PMID 6367573.

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