Creutzfeldt-Jakob disease physical examination: Difference between revisions

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==Physical Examination==
==Physical Examination==
===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
 
 
===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===
Physical examination of patients with Creutzfeldt-Jakob disease is usually remarkable for:
* [[Speech communication|Speech]] impairment
* [[Speech communication|Speech]] impairment
* [[Myoclonus]]
* [[Myoclonus]]
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* [[posture|Rigid posture]]
* [[posture|Rigid posture]]
* [[Dysarthria]]
* [[Dysarthria]]
* [[Myoclonus]],
* [[Myoclonus]]


* Visual changes leading to cortical blindness
* Visual changes leading to [[cortical blindness]]
* [[Akinetic mutism]] in the last stages of the disease
* [[Akinetic mutism]] in the last stages of the disease
Myoclonus is the most common sign, but there are
* [[Chorea]]
 
* [[Peripheral neuropathy]]
atypical findings such as sleep disturbances, chorea, psychiatric
* [[Altered mental status]]
 
[[Myoclonus]] is the most common sign in patients Creutzfeldt-Jakob disease.
symptoms, and peripheral neuropathy.19 The clinical
 
examination can highlight the heterogeneity of CJD
 
phenotypes, but the common factor is progressive decline
 
in neurological status. The most common physical examination
 
findings stratified by phenotypic strain are listed in


OR
Patient is usually disoriented to persons, place, and time.
*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 Creutzfeldt-Jakob disease 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==
{{Reflist|2}}
{{Reflist|2}}

Revision as of 15:20, 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:

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

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