Tracheitis 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 [[tracheitis]] usually appear [[toxic]], [[lethargic]] and in respiratory distress. They may be aggressive due to [[hypoxia]] and [[hypercarbia]]. Physical examination of patients with [[tracheitis]] is usually remarkable for [[tachycardia]], [[tachypnea]], and [[stridor]]. <ref name="pmid29262085">{{cite journal| author=| title=StatPearls | journal= | year= 2021 | volume=  | issue=  | pages=  | pmid=29262085 | doi= | pmc= | url= }} </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.


OR
Physical examination of patients with [[tracheitis]] is usually remarkable for [[stridor]], [[tracheal]] [[tenderness]], and [[intercostal]] retractions. <ref name="StroudFriedman2001">{{cite journal|last1=Stroud|first1=Robert H.|last2=Friedman|first2=Norman R.|title=An update on inflammatory disorders of the pediatric airway: Epiglottitis, croup, and tracheitis|journal=American Journal of Otolaryngology|volume=22|issue=4|year=2001|pages=268–275|issn=01960709|doi=10.1053/ajot.2001.24825}}</ref> <ref name="CasazzaGraham2018">{{cite journal|last1=Casazza|first1=Geoffrey|last2=Graham|first2=M. Elise|last3=Nelson|first3=Douglas|last4=Chaulk|first4=David|last5=Sandweiss|first5=David|last6=Meier|first6=Jeremy|title=Pediatric Bacterial Tracheitis—A Variable Entity: Case Series with Literature Review|journal=Otolaryngology–Head and Neck Surgery|volume=160|issue=3|year=2018|pages=546–549|issn=0194-5998|doi=10.1177/0194599818808774}}</ref> <ref name="pmid28757125">{{cite journal| author=Blot M, Bonniaud-Blot P, Favrolt N, Bonniaud P, Chavanet P, Piroth L| title=Update on childhood and adult infectious tracheitis. | journal=Med Mal Infect | year= 2017 | volume= 47 | issue= 7 | pages= 443-452 | pmid=28757125 | doi=10.1016/j.medmal.2017.06.006 | pmc=7125831 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28757125  }} </ref> <ref name="pmid379379">{{cite journal| author=Jones R, Santos JI, Overall JC| title=Bacterial tracheitis. | journal=JAMA | year= 1979 | volume= 242 | issue= 8 | pages= 721-6 | pmid=379379 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=379379  }} </ref>


Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].
===Physical Examination===
Coarse [[crackles]] can be heard on auscultation of the [[chest]], signifying underlying [[pneumonia]].  


OR
===Appearance of the Patient===


The presence of [finding(s)] on physical examination is diagnostic of [disease name].
*Patients with bacterial tracheitis may appear toxic, [[lethargic]] and in [[respiratory distress]].


OR
===Vital Signs===


The presence of [finding(s)] on physical examination is highly suggestive of [disease name].
*[[Fever]]


===Appearance of the Patient===
*[[Tachycardia]]
*Patients with [disease name] usually appear [general appearance].


===Vital Signs===
*[[Tachypnea]]


*High-grade / low-grade fever
*[[Hypotension]]
*[[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.
OR
*[[Cyanosis]]
*[[Jaundice]]
* [[Pallor]]
* Bruises


<gallery widths="150px">
*[[Cyanosis]] in impending [[respiratory distress]]


UploadedImage-01.jpg | Description {{dermref}}
===HEENT===
UploadedImage-02.jpg | Description {{dermref}}


</gallery>
===HEENT===
* HEENT examination of patients with [disease name] 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
*Inflamed nares / congested nares
* [[Purulent]] exudate from the nares
*[[Purulent]] exudate from the nares
* Facial tenderness
*Erythematous throat
* Erythematous throat with/without tonsillar swelling, exudates, and/or petechiae
*Mild [[drooling]]


===Neck===
===Neck===
* Neck examination of patients with [disease name] is usually normal.
 
OR
*[[Lymphadenopathy]] may be present
*[[Jugular venous distension]]
*Tracheal tenderness on palpation
*[[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.
 
OR
*[[Stridor]] (Inspiratory or Biphasic)
* Asymmetric chest expansion OR decreased chest expansion
*Decreased chest expansion
*Lungs are hyporesonant OR hyperresonant
*Coarse [[crackles]] upon auscultation of the lungs bilaterally
*Fine/coarse [[crackles]] upon auscultation of the lung bases/apices unilaterally/bilaterally
*[[Egophony]] present when [[pneumonia]] develops as a complication
*Rhonchi
*[[Bronchophony]] present when [[pneumonia]] develops as a complication
*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
*Rapid heart rate can be heard on auscultation
*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.
 
OR
*Abdominal examination of patients with [[tracheitis]] is usually normal.
*[[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===
* Back examination of patients with [disease name] is usually normal.
 
OR
*Back examination of patients with [[tracheitis]] is usually normal.
*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.
 
OR
*[[Genitourinary system|Genitourinary]] examination of patients with [[tracheitis]] is usually normal.
*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.
 
OR
*Neuromuscular examination of patients with [[tracheitis]] is usually normal
*Patient is usually oriented to persons, place, and time
*Altered mental status/ acute confusion may be present in [[Hypoxemia|hypoxemic]] individuals
* 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.
OR
*[[Clubbing]]
*[[Cyanosis]]
*Pitting/non-pitting [[edema]] of the upper/lower extremities
*Muscle atrophy
*Fasciculations in the upper/lower extremity


*[[Cyanosis]] can be seen in [[hypoxemia]].


==References==
==Reference==
{{reflist|2}}
{{reflist|2}}
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[[Category:Intensive care medicine]]
[[Category:Emergency medicine]]
[[Category:Emergency medicine]]
[[Category:Pediatrics]]
[[Category:Pediatrics]]
[[Category:Thorax]]
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Latest revision as of 07:00, 3 May 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 tracheitis usually appear toxic, lethargic and in respiratory distress. They may be aggressive due to hypoxia and hypercarbia. Physical examination of patients with tracheitis is usually remarkable for tachycardia, tachypnea, and stridor. [1]

Physical Examination

Physical examination of patients with tracheitis is usually remarkable for stridor, tracheal tenderness, and intercostal retractions. [2] [3] [4] [5]

Physical Examination

Coarse crackles can be heard on auscultation of the chest, signifying underlying pneumonia.

Appearance of the Patient

Vital Signs

Skin

HEENT

  • Inflamed nares / congested nares
  • Purulent exudate from the nares
  • Erythematous throat
  • Mild drooling

Neck

Lungs

Heart

  • Rapid heart rate can be heard on auscultation

Abdomen

  • Abdominal examination of patients with tracheitis is usually normal.

Back

  • Back examination of patients with tracheitis is usually normal.

Genitourinary

Neuromuscular

  • Neuromuscular examination of patients with tracheitis is usually normal
  • Altered mental status/ acute confusion may be present in hypoxemic individuals

Extremities

Reference

  1. ↑ "StatPearls". 2021. PMID 29262085.
  2. ↑ Stroud, Robert H.; Friedman, Norman R. (2001). "An update on inflammatory disorders of the pediatric airway: Epiglottitis, croup, and tracheitis". American Journal of Otolaryngology. 22 (4): 268–275. doi:10.1053/ajot.2001.24825. ISSN 0196-0709.
  3. ↑ Casazza, Geoffrey; Graham, M. Elise; Nelson, Douglas; Chaulk, David; Sandweiss, David; Meier, Jeremy (2018). "Pediatric Bacterial Tracheitis—A Variable Entity: Case Series with Literature Review". Otolaryngology–Head and Neck Surgery. 160 (3): 546–549. doi:10.1177/0194599818808774. ISSN 0194-5998.
  4. ↑ Blot M, Bonniaud-Blot P, Favrolt N, Bonniaud P, Chavanet P, Piroth L (2017). "Update on childhood and adult infectious tracheitis". Med Mal Infect. 47 (7): 443–452. doi:10.1016/j.medmal.2017.06.006. PMC 7125831 Check |pmc= value (help). PMID 28757125.
  5. ↑ Jones R, Santos JI, Overall JC (1979). "Bacterial tracheitis". JAMA. 242 (8): 721–6. PMID 379379.

Template:WH Template:WS

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