Diaphragmatic paralysis physical examination: Difference between revisions

Jump to navigation Jump to search
VisualWikitext
No edit summary
m (Bot: Removing from Primary care)
 
(11 intermediate revisions by 2 users not shown)
Line 5: Line 5:


==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 unilateral diphragmatic paralysis usually appear normal. Patients with bilateral diaphragmatic paralysis usually are in [[respiratory distress]]. The severe forms of bilateral diaphragmatic paralysis would lead to [[pulmonary hypertension]].
 
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 with unilateral diphragmatic paralysis is usually normal.Patients with bilateral diaphragmatic paralysis usually are in [[respiratory distress]]. The severe forms of bilateral diaphragmatic paralysis would lead to [[pulmonary hypertension]].  
OR
*The severe forms of bilateral diaphragmatic paralysis would lead to [[pulmonary hypertension]]. For more information about physical examination in pulmonary hypertension '''[[Pulmonary hypertension physical examination|click here]]'''.
*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===
===Appearance of the Patient===
*Patients with unilateral diaphragmatic paralysis usually appear normal.<ref name="pmid6292583">{{cite journal |vauthors=Piehler JM, Pairolero PC, Gracey DR, Bernatz PE |title=Unexplained diaphragmatic paralysis: a harbinger of malignant disease? |journal=J. Thorac. Cardiovasc. Surg. |volume=84 |issue=6 |pages=861–4 |year=1982 |pmid=6292583 |doi= |url=}}</ref>  
*Patients with unilateral diaphragmatic paralysis usually appear normal.<ref name="pmid6292583">{{cite journal |vauthors=Piehler JM, Pairolero PC, Gracey DR, Bernatz PE |title=Unexplained diaphragmatic paralysis: a harbinger of malignant disease? |journal=J. Thorac. Cardiovasc. Surg. |volume=84 |issue=6 |pages=861–4 |year=1982 |pmid=6292583 |doi= |url=}}</ref>  
*Patients with bilateral diaphragmatic paralysis usually are in respiratory distress.<ref name="pmid155953432">{{cite journal |vauthors=Kumar N, Folger WN, Bolton CF |title=Dyspnea as the predominant manifestation of bilateral phrenic neuropathy |journal=Mayo Clin. Proc. |volume=79 |issue=12 |pages=1563–5 |year=2004 |pmid=15595343 |doi=10.4065/79.12.1563 |url=}}</ref>  
*Patients with bilateral diaphragmatic paralysis usually are in [[respiratory distress]].<ref name="pmid155953432">{{cite journal |vauthors=Kumar N, Folger WN, Bolton CF |title=Dyspnea as the predominant manifestation of bilateral phrenic neuropathy |journal=Mayo Clin. Proc. |volume=79 |issue=12 |pages=1563–5 |year=2004 |pmid=15595343 |doi=10.4065/79.12.1563 |url=}}</ref>  


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


*Tachypnea with exercise may be seen in unilateral diaphragmatic paralysis. <ref name="pmid6292583" />
*[[Tachypnea]] with exercise may be seen in unilateral diaphragmatic paralysis. <ref name="pmid6292583" />
*Tachypnea at rest may be seen in unilateral diaphragmatic paralysis with underlying lung disease. <ref name="pmid155953432" />
*[[Tachypnea]] at rest may be seen in unilateral diaphragmatic paralysis with underlying lung disease. <ref name="pmid15595343">{{cite journal |vauthors=Kumar N, Folger WN, Bolton CF |title=Dyspnea as the predominant manifestation of bilateral phrenic neuropathy |journal=Mayo Clin. Proc. |volume=79 |issue=12 |pages=1563–5 |year=2004 |pmid=15595343 |doi=10.4065/79.12.1563 |url=}}</ref>
*Patients with bilateral diphragmatic paralysis have tachypnea that worsens in supine position.
*Patients with bilateral diphragmatic paralysis have [[tachypnea]] that worsens in [[supine position]].
*Kussmal respirt ations 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 diaphragmatic paralysis 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 diphragmatic paralysis 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 diaphragmatic paralysis is usually normal.
OR
* [[Jugular venous distension]] in severe bilateral diphragmatic paralysis.<ref name="pmid155953433">{{cite journal |vauthors=Kumar N, Folger WN, Bolton CF |title=Dyspnea as the predominant manifestation of bilateral phrenic neuropathy |journal=Mayo Clin. Proc. |volume=79 |issue=12 |pages=1563–5 |year=2004 |pmid=15595343 |doi=10.4065/79.12.1563 |url=}}</ref>
*[[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 unilateral diphragmatic paralysis  is usually normal.
OR
* Bilateral diaphragmatic paralysis can lead to [[pulmonary hypertension]]
* 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===
===Heart===
* Cardiovascular examination of patients with [disease name] is usually normal.
* Cardiovascular examination of patients with diaphragmatic paralysis 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 otoscope
 
===Abdomen===
===Abdomen===
Abdominal examination of patients with [disease name] is usually normal.
* Abdominal examination of patients with diaphragmatic paralysis  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 diaphragmatic paralysis 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 diaphragmatic paralysis 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.
* Neuromuscular examination of patients with diphragmatic paralysis 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===
* Extremities examination of patients with [disease name] is usually normal.
* Extremities examination of patients with diaphragmatic paralysis 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==
Line 173: Line 55:
{{WH}}
{{WH}}
{{WS}}
{{WS}}
[[Category: (name of the system)]]
 
[[Category:Medicine]]
[[Category:Pulmonology]]
[[Category:Up-To-Date]]

Latest revision as of 21:22, 29 July 2020

Diaphragmatic Paralysis Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Diaphragmatic Paralysis from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Study of Choice

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

X-ray

Echocardiography and Ultrasound

CT scan

MRI

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Guidelines for Management

Case Studies

Case #1

Diaphragmatic paralysis physical examination On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Diaphragmatic paralysis 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 Diaphragmatic paralysis physical examination

CDC on Diaphragmatic paralysis physical examination

Diaphragmatic paralysis physical examination in the news

Blogs on Diaphragmatic paralysis physical examination

Directions to Hospitals Treating Psoriasis

Risk calculators and risk factors for Diaphragmatic paralysis physical examination

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

Overview

Patients with unilateral diphragmatic paralysis usually appear normal. Patients with bilateral diaphragmatic paralysis usually are in respiratory distress. The severe forms of bilateral diaphragmatic paralysis would lead to pulmonary hypertension.

Physical Examination

  • Physical examination of patients with unilateral diphragmatic paralysis is usually normal.Patients with bilateral diaphragmatic paralysis usually are in respiratory distress. The severe forms of bilateral diaphragmatic paralysis would lead to pulmonary hypertension.
  • The severe forms of bilateral diaphragmatic paralysis would lead to pulmonary hypertension. For more information about physical examination in pulmonary hypertension click here.

Appearance of the Patient

  • Patients with unilateral diaphragmatic paralysis usually appear normal.[1]
  • Patients with bilateral diaphragmatic paralysis usually are in respiratory distress.[2]

Vital Signs

  • Tachypnea with exercise may be seen in unilateral diaphragmatic paralysis. [1]
  • Tachypnea at rest may be seen in unilateral diaphragmatic paralysis with underlying lung disease. [3]
  • Patients with bilateral diphragmatic paralysis have tachypnea that worsens in supine position.

Skin

  • Skin examination of patients with diaphragmatic paralysis is usually normal.

HEENT

  • HEENT examination of patients with diphragmatic paralysis is usually normal.

Neck

  • Neck examination of patients with diaphragmatic paralysis is usually normal.
  • Jugular venous distension in severe bilateral diphragmatic paralysis.[4]

Lungs

  • Pulmonary examination of patients with unilateral diphragmatic paralysis is usually normal.
  • Bilateral diaphragmatic paralysis can lead to pulmonary hypertension

Heart

  • Cardiovascular examination of patients with diaphragmatic paralysis is usually normal.

Abdomen

  • Abdominal examination of patients with diaphragmatic paralysis is usually normal.

Back

  • Back examination of patients with diaphragmatic paralysis is usually normal.

Genitourinary

  • Genitourinary examination of patients with diaphragmatic paralysis is usually normal.

Neuromuscular

  • Neuromuscular examination of patients with diphragmatic paralysis is usually normal.

Extremities

  • Extremities examination of patients with diaphragmatic paralysis is usually normal.

References

  1. ↑ 1.0 1.1 Piehler JM, Pairolero PC, Gracey DR, Bernatz PE (1982). "Unexplained diaphragmatic paralysis: a harbinger of malignant disease?". J. Thorac. Cardiovasc. Surg. 84 (6): 861–4. PMID 6292583.
  2. ↑ Kumar N, Folger WN, Bolton CF (2004). "Dyspnea as the predominant manifestation of bilateral phrenic neuropathy". Mayo Clin. Proc. 79 (12): 1563–5. doi:10.4065/79.12.1563. PMID 15595343.
  3. ↑ Kumar N, Folger WN, Bolton CF (2004). "Dyspnea as the predominant manifestation of bilateral phrenic neuropathy". Mayo Clin. Proc. 79 (12): 1563–5. doi:10.4065/79.12.1563. PMID 15595343.
  4. ↑ Kumar N, Folger WN, Bolton CF (2004). "Dyspnea as the predominant manifestation of bilateral phrenic neuropathy". Mayo Clin. Proc. 79 (12): 1563–5. doi:10.4065/79.12.1563. PMID 15595343.

Template:WH Template:WS

Retrieved from "https://www.wikidoc.org/index.php?title=Diaphragmatic_paralysis_physical_examination&oldid=1637190"