Toxic shock syndrome physical examination: Difference between revisions
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{{Toxic shock syndrome}} | {{Toxic shock syndrome}} | ||
{{CMG}}{{AE}}{{MIR}} | |||
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]. | |||
Common physical examination findings of [disease name] include [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]. | |||
==Physical Examination== | ==Physical Examination== | ||
===Appearance of the Patient=== | |||
*Toxic shock syndrome(TSS) is presented by its shock symptoms, means the patient is always as they . | |||
*If patients typically appear normal, you may write: Patients are usually well-appearing. | |||
*You may include a physical description such as obese, thin, cachectic, ill appearing, diaphoretic etc. Mention in which cases these findings are present (e.g. well-appearing in early stages of cancer, cachectic in late stage cancer) | |||
*For an example of the appearance of a patient section in the physical examination page, click [[Stomach cancer physical examination|here]]. | |||
===Vital Signs=== | ===Vital Signs=== | ||
* High grade [[Fever]] | |||
* [[Hypotension]]: [[systolic blood pressure]] of ≤90 mmHg for adults or less than fifth percentile by age for children <16 years of age, which may be unresponsive to fluid infusion even large amounts of [[isotonic]] [[intravenous fluids]] | * [[Hypotension]]: [[systolic blood pressure]] of ≤90 mmHg for adults or less than fifth percentile by age for children <16 years of age, which may be unresponsive to fluid infusion even large amounts of [[isotonic]] [[intravenous fluids]] | ||
* [[Tachycardia]] (as a result of shock and hypotension) | * [[Tachycardia]] (as a result of shock and hypotension) | ||
* [[Tachypnea]]: may be pressent as a result of pulmonary edema secondary to shock | * [[Tachypnea]]: may be pressent as a result of pulmonary edema secondary to shock | ||
*[[Tachycardia]] | |||
*Tachypnea | |||
===Skin=== | |||
* Diffuse [[Pruritic disorders|pruritic]] [[maculopapular]] [[rash]] with palm and soles [[desquamation]] | |||
* [[Erythroderma]] | |||
* Superficial [[Ulcer|ulcerations]] | |||
* [[petechiae]], [[vesicles]], and bullae | |||
* [[Skin]] [[desquamation]] (apears weeks after the disease onset) | |||
* [[Edema|Non-pitting edema]] | |||
* Hair and nail loss<ref name="urlTintinallis Emergency Medicine: A Comprehensive Study Guide, 8th edition - Judith Tintinalli, J. Stapczynski, O. John Ma, David M. Cline, Garth Meckler - Google Books">{{cite web |url=https://books.google.com/books?id=FNKLCgAAQBAJ&q=It%27s+main+characteristics+involve+diffuse,+red,+macular+rash+resembling+sunburn+that+can+also+involve+the+palms+and+soles.&dq=It%27s+main+characteristics+involve+diffuse,+red,+macular+rash+resembling+sunburn+that+can+also+involve+the+palms+and+soles.&hl=en&sa=X&ved=0ahUKEwjlq-LXoODTAhVF7CYKHQ3aDkoQ6AEIJzAA |title=Tintinalli's Emergency Medicine: A Comprehensive Study Guide, 8th edition - Judith Tintinalli, J. Stapczynski, O. John Ma, David M. Cline, Garth Meckler - Google Books |format= |work= |accessdate=}}</ref><ref name="pmid7282746">{{cite journal |vauthors=Chesney RW, Chesney PJ, Davis JP, Segar WE |title=Renal manifestations of the staphylococcal toxic-shock syndrome |journal=Am. J. Med. |volume=71 |issue=4 |pages=583–8 |year=1981 |pmid=7282746 |doi= |url=}}</ref><ref name="pmid2928649">{{cite journal |vauthors=Olson RD, Stevens DL, Melish ME |title=Direct effects of purified staphylococcal toxic shock syndrome toxin 1 on myocardial function of isolated rabbit atria |journal=Rev. Infect. Dis. |volume=11 Suppl 1 |issue= |pages=S313–5 |year=1989 |pmid=2928649 |doi= |url=}}</ref>. | |||
*[[Cyanosis]] | |||
===HEENT=== | |||
*Ophthalmoscopic exam may be abnormal with findings of [[Conjunctiva|Conjunctival]]-[[Sclera|scleral hemorrhage]] | |||
*[[hyperemia]] of the [[vaginal]] and [[oropharyngeal]] [[mucosa]] | |||
* | |||
* | |||
*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 accomodation / non-reactive to neither light nor accomodation | |||
* | |||
*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=== | |||
*[[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=== | |||
*Asymmetric chest expansion / Decreased chest expansion | |||
*Lungs are hypo/hyperresonant | |||
*Fine/coarse [[crackles]] upon auscultation of the lung bases/apices unilaterally/bilaterally | |||
*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=== | |||
*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 otoscope | |||
===Abdomen=== | |||
*[[Abdominal distention]] | |||
*[[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=== | |||
*Point tenderness over __ vertebrae (e.g. L3-L4) | |||
*Sacral edema | |||
*Costovertebral angle tenderness bilaterally/unilaterally (may also be referred to as Murphy's punch sign, which is different from Murphy's sign that suggests cholecystitis. To avoid confusion, write "costovertebral angle tenderness") | |||
*Buffalo hump | |||
===Genitourinary=== | |||
*A pelvic/adnexal mass may be palpated | |||
*Inflamed mucosa | |||
*Clear/(color), foul-smelling/odorless penile/vaginal discharge | |||
<sup>Write additional pathognomonic findings, such as discharge that resembles cottage cheese for ''C. albicans'' vulvovaginitis / fish-odor for ''T. vaginalis'' ifnection</sup> | |||
===Extremities=== | |||
*[[Edema|Non-pitting edema]] (can develop as a result of increases in [[interstitial fluid]]) | |||
*[[Muscle cramps|Muscle cramps (complication)]] | |||
* | |||
*[[Clubbing]] | |||
*[[Cyanosis]] | |||
*Pitting/non-pitting [[edema]] of the upper/lower extremities | |||
*Muscle atrophy | |||
*Fasciculations in the upper/lower extremity | |||
===Neuromuscular=== | |||
<span> </span> | |||
*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) | |||
* | |||
===Neuropsychologic=== | ===Neuropsychologic=== | ||
| Line 34: | Line 154: | ||
===Skin and [[moucosa]]=== | ===Skin and [[moucosa]]=== | ||
* | * | ||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
Revision as of 21:00, 12 May 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Mahshid Mir, M.D. [2]
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].
Common physical examination findings of [disease name] include [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].
Physical Examination
Appearance of the Patient
- Toxic shock syndrome(TSS) is presented by its shock symptoms, means the patient is always as they .
- If patients typically appear normal, you may write: Patients are usually well-appearing.
- You may include a physical description such as obese, thin, cachectic, ill appearing, diaphoretic etc. Mention in which cases these findings are present (e.g. well-appearing in early stages of cancer, cachectic in late stage cancer)
- For an example of the appearance of a patient section in the physical examination page, click here.
Vital Signs
- High grade Fever
- Hypotension: systolic blood pressure of ≤90 mmHg for adults or less than fifth percentile by age for children <16 years of age, which may be unresponsive to fluid infusion even large amounts of isotonic intravenous fluids
- Tachycardia (as a result of shock and hypotension)
- Tachypnea: may be pressent as a result of pulmonary edema secondary to shock
- Tachycardia
- Tachypnea
Skin
- Diffuse pruritic maculopapular rash with palm and soles desquamation
- Erythroderma
- Superficial ulcerations
- petechiae, vesicles, and bullae
- Skin desquamation (apears weeks after the disease onset)
- Non-pitting edema
- Hair and nail loss[1][2][3].
HEENT
- Ophthalmoscopic exam may be abnormal with findings of Conjunctival-scleral hemorrhage
- hyperemia of the vaginal and oropharyngeal mucosa
- 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 accomodation / non-reactive to neither light nor accomodation
- 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
- 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
- Asymmetric chest expansion / Decreased chest expansion
- Lungs are hypo/hyperresonant
- Fine/coarse crackles upon auscultation of the lung bases/apices unilaterally/bilaterally
- 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
- 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 otoscope
Abdomen
- Abdominal distention
- 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
- Point tenderness over __ vertebrae (e.g. L3-L4)
- Sacral edema
- Costovertebral angle tenderness bilaterally/unilaterally (may also be referred to as Murphy's punch sign, which is different from Murphy's sign that suggests cholecystitis. To avoid confusion, write "costovertebral angle tenderness")
- Buffalo hump
Genitourinary
- A pelvic/adnexal mass may be palpated
- Inflamed mucosa
- Clear/(color), foul-smelling/odorless penile/vaginal discharge
Write additional pathognomonic findings, such as discharge that resembles cottage cheese for C. albicans vulvovaginitis / fish-odor for T. vaginalis ifnection
Extremities
- Non-pitting edema (can develop as a result of increases in interstitial fluid)
- Muscle cramps (complication)
- Clubbing
- Cyanosis
- Pitting/non-pitting edema of the upper/lower extremities
- Muscle atrophy
- Fasciculations in the upper/lower extremity
Neuromuscular
- 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)
Neuropsychologic
- Cerebral edema
- Seizure activity
- Headaches, memory loss,disorientation and poor concentration ,
- Somnolence, irritability, agitation, and hallucinations
- Confusion without any focal neurological findings
Gastrointestinal
- Vomiting
- Watery Diarrhea
- Hepatic Failure: Which may present with hepatomegaly, hypoalbuminemia, non-pitting edema
Renal
- Prerenal failure: Decrease in urinary output, due to dehydration and shock
- Metabolic abnormalities related to RF such as hypocalcemia, hyponatremia, and hypophosphatemia and their related signs and symptoms
Cardiopulmonary
Skin and moucosa
References
- ↑ "Tintinalli's Emergency Medicine: A Comprehensive Study Guide, 8th edition - Judith Tintinalli, J. Stapczynski, O. John Ma, David M. Cline, Garth Meckler - Google Books".
- ↑ Chesney RW, Chesney PJ, Davis JP, Segar WE (1981). "Renal manifestations of the staphylococcal toxic-shock syndrome". Am. J. Med. 71 (4): 583–8. PMID 7282746.
- ↑ Olson RD, Stevens DL, Melish ME (1989). "Direct effects of purified staphylococcal toxic shock syndrome toxin 1 on myocardial function of isolated rabbit atria". Rev. Infect. Dis. 11 Suppl 1: S313–5. PMID 2928649.