Creutzfeldt-Jakob disease 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].
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.
OR
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
The presence of [finding(s)] on physical examination is highly suggestive of [disease name].
===Appearance of the Patient===
===Appearance of the Patient===
*Patients with [disease name] usually appear [general appearance].  
*Patients with Creutzfeldt-Jakob disease usually appear confused.  


===Vital Signs===
===Vital Signs===
 
* Vital Signs of patients with Creutzfeldt-Jakob disease are usually normal.
*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===
===Skin===
* Skin examination of patients with [disease name] is usually normal.
* Skin examination of patients with Creutzfeldt-Jakob disease is usually normal.
OR
*[[Cyanosis]]
*[[Jaundice]]
* [[Pallor]]
* Bruises
 
<gallery widths="150px">
 
UploadedImage-01.jpg | Description {{dermref}}
UploadedImage-02.jpg | Description {{dermref}}
 
</gallery>
 
===HEENT===
===HEENT===
* HEENT examination of patients with [disease name] is usually normal.
* HEENT examination of patients with Creutzfeldt-Jakob disease is usually normal.
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===
* Neck examination of patients with [disease name] is usually normal.
* Neck examination of patients with Creutzfeldt-Jakob disease 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===
===Lungs===
* Pulmonary examination of patients with [disease name] is usually normal.
* Pulmonary examination of patients with Creutzfeldt-Jakob disease 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.
* Cardiovascular examination of patients with Creutzfeldt-Jakob disease 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===
===Abdomen===
* Abdominal examination of patients with [disease name] is usually normal.
* Abdominal examination of patients with Creutzfeldt-Jakob disease is usually normal.
OR
*[[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===
===Back===
* Back examination of patients with [disease name] is usually normal.
* Back examination of patients with Creutzfeldt-Jakob disease is usually normal.
OR
*Point tenderness over __ vertebrae (e.g. L3-L4)
*Sacral edema
*Costovertebral angle tenderness bilaterally/unilaterally
*Buffalo hump
 
===Genitourinary===
===Genitourinary===
* Genitourinary examination of patients with [disease name] is usually normal.
* Genitourinary examination of patients with Creutzfeldt-Jakob disease is usually normal.
OR
*A pelvic/adnexal mass may be palpated
*Inflamed mucosa
*Clear/(color), foul-smelling/odorless penile/vaginal discharge
 
===Neuromuscular===
===Neuromuscular===
* Neuromuscular examination of patients with [disease name] is usually normal.
Physical examination of patients with Creutzfeldt-Jakob disease is usually remarkable for:<ref name="pmid22394291">{{cite journal |vauthors=Head MW, Ironside JW |title=Review: Creutzfeldt-Jakob disease: prion protein type, disease phenotype and agent strain |journal=Neuropathol. Appl. Neurobiol. |volume=38 |issue=4 |pages=296–310 |date=June 2012 |pmid=22394291 |doi=10.1111/j.1365-2990.2012.01265.x |url=}}</ref><ref name="pmid5710312">{{cite journal |vauthors=Argelander H |title=[The psychoanalytic dialogue] |language=German |journal=Psyche (Stuttg) |volume=22 |issue=5 |pages=325–39 |date=May 1968 |pmid=5710312 |doi= |url=}}</ref><ref name="pmid22411235">{{cite journal |vauthors=Sikorska B, Knight R, Ironside JW, Liberski PP |title=Creutzfeldt-Jakob disease |journal=Adv. Exp. Med. Biol. |volume=724 |issue= |pages=76–90 |date=2012 |pmid=22411235 |doi=10.1007/978-1-4614-0653-2_6 |url=}}</ref><ref name="pmid29939637">{{cite journal |vauthors=Sitammagari KK, Masood W |title= |journal= |volume= |issue= |pages= |date= |pmid=29939637 |doi= |url=}}</ref><ref name="pmid3689509">{{cite journal |vauthors=Helton AS, Snodgrass FG |title=Battering during pregnancy: intervention strategies |journal=Birth |volume=14 |issue=3 |pages=142–7 |date=September 1987 |pmid=3689509 |doi= |url=}}</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
 
 
==Overview==
Physical examination is required for the diagnosis of ‪Creutzfeldt-Jakob disease‬. Physical examination findings of ‪Creutzfeldt-Jakob disease‬findings include [[myoclonus]], [[Neurological examination|extrapyramidal signs]], akinetic mutism, and [[Neurological examination|visual or cerebellar signs]]<ref name="Rabinovici-2006">{{Cite journal | last1 = Rabinovici | first1 = GD. | last2 = Wang | first2 = PN. | last3 = Levin | first3 = J. | last4 = Cook | first4 = L. | last5 = Pravdin | first5 = M. | last6 = Davis | first6 = J. | last7 = DeArmond | first7 = SJ. | last8 = Barbaro | first8 = NM. | last9 = Martindale | first9 = J. | title = First symptom in sporadic Creutzfeldt-Jakob disease. | journal = Neurology | volume = 66 | issue = 2 | pages = 286-7 | month = Jan | year = 2006 | doi = 10.1212/01.wnl.0000196440.00297.67 | PMID = 16434680 }}</ref>
 
==Physical Examination==
===General Appearance===
*Patients with Creutzfeldt-Jakob disease‬ often appear confused.
 
===Neurologic Examination===
* [[Speech communication|Speech]] impairment
* [[Speech communication|Speech]] impairment
* [[Myoclonus]]
* [[Myoclonus]]
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* [[posture|Rigid posture]]
* [[posture|Rigid posture]]
* [[Dysarthria]]
* [[Dysarthria]]
* [[Myoclonus]]
* Visual changes leading to [[cortical blindness]]
* [[Akinetic mutism]] in the last stages of the disease
* [[Chorea]]
* [[Peripheral neuropathy]]
* [[Altered mental status]]
[[Myoclonus]] is the most common sign in patients Creutzfeldt-Jakob disease.


Patient is usually disoriented to persons, place, and time.


===Extremities===
* Extremities examination of patients with Creutzfeldt-Jakob disease is usually normal.
==References==
==References==
{{Reflist|2}}
{{Reflist|2}}

Latest revision as of 16:21, 24 October 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Mohamadmostafa Jahansouz M.D.[2]

Overview

Physical Examination

Appearance of the Patient

  • Patients with Creutzfeldt-Jakob disease usually appear confused.

Vital Signs

  • Vital Signs of patients with Creutzfeldt-Jakob disease are usually normal.

Skin

  • Skin examination of patients with Creutzfeldt-Jakob disease is usually normal.

HEENT

  • HEENT examination of patients with Creutzfeldt-Jakob disease is usually normal.

Neck

  • Neck examination of patients with Creutzfeldt-Jakob disease is usually normal.

Lungs

  • Pulmonary examination of patients with Creutzfeldt-Jakob disease is usually normal.

Heart

  • Cardiovascular examination of patients with Creutzfeldt-Jakob disease is usually normal.

Abdomen

  • Abdominal examination of patients with Creutzfeldt-Jakob disease is usually normal.

Back

  • Back examination of patients with Creutzfeldt-Jakob disease is usually normal.

Genitourinary

  • Genitourinary examination of patients with Creutzfeldt-Jakob disease is usually normal.

Neuromuscular

Physical examination of patients with Creutzfeldt-Jakob disease is usually remarkable for:[1][2][3][4][5]

Myoclonus is the most common sign in patients Creutzfeldt-Jakob disease.

Patient is usually disoriented to persons, place, and time.

Extremities

  • Extremities examination of patients with Creutzfeldt-Jakob disease is usually normal.

References

  1. ↑ Head MW, Ironside JW (June 2012). "Review: Creutzfeldt-Jakob disease: prion protein type, disease phenotype and agent strain". Neuropathol. Appl. Neurobiol. 38 (4): 296–310. doi:10.1111/j.1365-2990.2012.01265.x. PMID 22394291.
  2. ↑ Argelander H (May 1968). "[The psychoanalytic dialogue]". Psyche (Stuttg) (in German). 22 (5): 325–39. PMID 5710312.
  3. ↑ Sikorska B, Knight R, Ironside JW, Liberski PP (2012). "Creutzfeldt-Jakob disease". Adv. Exp. Med. Biol. 724: 76–90. doi:10.1007/978-1-4614-0653-2_6. PMID 22411235.
  4. ↑ Sitammagari KK, Masood W. PMID 29939637. Missing or empty |title= (help)
  5. ↑ Helton AS, Snodgrass FG (September 1987). "Battering during pregnancy: intervention strategies". Birth. 14 (3): 142–7. PMID 3689509.

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