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==Physical Examination==
==Physical Examination==


*Physical examination of patients with [disease name] is usually remarkable for:[finding 1], [finding 2], and [finding 3].
*Physical examination of patients with hyperparathyroidism is usually unremarkable.
*The presence of [finding(s)] on physical examination is diagnostic of [disease name].
*Patients may have physical findings due to severe hypercalcemia and other complications of hyperparathyroidism.
*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 hyperparathyroidism usually appear well.  


===Vital Signs===
===Vital Signs===
 
*Patients with hypercalcemia and other complications may have:
*High-grade / low-grade fever
**High blood pressure may be present due to hypercalcemia and renal failure
*[[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===
*[[Cyanosis]]
*Perisitent itching may be present due to renal failure
*[[Jaundice]]
* [[Pallor]]
* Bruises
 
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UploadedImage-02.jpg | Description {{dermref}}
 
</gallery>


===HEENT===
===HEENT===
* Abnormalities of the head/hair may include ___
*Patients with severe hypercalcemia may have:
* Evidence of trauma
** Band keratopathy (calcium precipitation in a horizontal band across the cornea in the palpebral aperture)  
* 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
*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===
*[[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===
* Asymmetric chest expansion / Decreased chest expansion
*Patients with hypercalcemia and other complications may have:
*Lungs are hypo/hyperresonant
*Dyspnea due to fluid overload form renal failure
*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===
===Cardiovasvular===
*Chest tenderness upon palpation
*Patients with hypercalcemia and other complications may have:
*PMI within 2 cm of the sternum  (PMI) / Displaced point of maximal impulse (PMI) suggestive of ____
**Arrhythmias
*[[Heave]] / [[thrill]]
**Hypotension
*[[Friction rub]]
**Shortened QT interval
*[[Heart sounds#First heart tone S1, the "lub"(components M1 and T1)|S1]]
**Chest pain due to fluid overload form renal failure
*[[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 distention]]
*Nausea and vomiting
*[[Abdominal tenderness]] in the right/left upper/lower abdominal quadrant
*Patients with hypercalcemia and other complications may have:
*[[Rebound tenderness]] (positive Blumberg sign)
**Loss of appetite
*A palpable abdominal mass in the right/left upper/lower abdominal quadrant
**Fecal impaction (from constipation)
*Guarding may be present
**Abdominal tenderness may be present due to development of pancreatitis
*[[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
*Buffalo hump


===Genitourinary===
===Genitourinary===
*A pelvic/adnexal mass may be palpated
*Patients with severe hypercalcemia and other complications may have:
*Inflamed mucosa
**Alteration in urinary habits
*Clear/(color), foul-smelling/odorless penile/vaginal discharge
**Volume depletion
**Signs of renal failure


===Neuromuscular===
===Neurologic===
*Patient is usually oriented to persons, place, and time
*Patient is usually oriented to persons, place, and time.
* Altered mental status
*Patients with severe hypercalcemia and other complications may have:
* Glasgow coma scale is ___ / 15
**Fatigue and weakness due to renal failure
* Clonus may be present
**Sleep disturbances
* Hyperreflexia / hyporeflexia / areflexia
**Muscle twitch and cramps
* Positive (abnormal) Babinski / plantar reflex unilaterally/bilaterally
**Confusion
* Muscle rigidity
**Hypotonia
* Proximal/distal muscle weakness unilaterally/bilaterally
**Hyporeflexia
* ____ (finding) suggestive of cranial nerve ___ (roman numerical) deficit (e.g. Dilated pupils suggestive of CN III deficit)
**Paresis
*Unilateral/bilateral upper/lower extremity weakness
**Coma
*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===
*[[Clubbing]]
*Swelling of feet and ankles due to renal failure
*[[Cyanosis]]
*Pitting/non-pitting [[edema]] of the upper/lower extremities
*Muscle atrophy
*Fasciculations in the upper/lower extremity


==References==
==References==

Revision as of 15:13, 6 September 2017

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

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].
  • 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 of patients with hyperparathyroidism is usually unremarkable.
  • Patients may have physical findings due to severe hypercalcemia and other complications of hyperparathyroidism.


Appearance of the Patient

  • Patients with hyperparathyroidism usually appear well.

Vital Signs

  • Patients with hypercalcemia and other complications may have:
    • High blood pressure may be present due to hypercalcemia and renal failure

Skin

  • Perisitent itching may be present due to renal failure

HEENT

  • Patients with severe hypercalcemia may have:
    • Band keratopathy (calcium precipitation in a horizontal band across the cornea in the palpebral aperture)

Lungs

  • Patients with hypercalcemia and other complications may have:
  • Dyspnea due to fluid overload form renal failure

Cardiovasvular

  • Patients with hypercalcemia and other complications may have:
    • Arrhythmias
    • Hypotension
    • Shortened QT interval
    • Chest pain due to fluid overload form renal failure

Abdomen

  • Nausea and vomiting
  • Patients with hypercalcemia and other complications may have:
    • Loss of appetite
    • Fecal impaction (from constipation)
    • Abdominal tenderness may be present due to development of pancreatitis

Genitourinary

  • Patients with severe hypercalcemia and other complications may have:
    • Alteration in urinary habits
    • Volume depletion
    • Signs of renal failure

Neurologic

  • Patient is usually oriented to persons, place, and time.
  • Patients with severe hypercalcemia and other complications may have:
    • Fatigue and weakness due to renal failure
    • Sleep disturbances
    • Muscle twitch and cramps
    • Confusion
    • Hypotonia
    • Hyporeflexia
    • Paresis
    • Coma

Extremities

  • Swelling of feet and ankles due to renal failure

References

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