Goiter physical examination: Difference between revisions

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{{Goiter}}
{{Goiter}}


{{CMG}}; {{AE}}  
{{CMG}}; {{AE}} {{ARK}}


==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].
[[Physical examination]] of patients with goiter is usually remarkable for [[swelling]] at the base of the [[neck]].


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 goiter is usually remarkable for [[swelling]] at the base of the [[neck]].<ref name="pmid18664541">{{cite journal| author=Bonnema SJ, Nielsen VE, Boel-Jørgensen H, Grupe P, Andersen PB, Bastholt L et al.| title=Recombinant human thyrotropin-stimulated radioiodine therapy of large nodular goiters facilitates tracheal decompression and improves inspiration. | journal=J Clin Endocrinol Metab | year= 2008 | volume= 93 | issue= 10 | pages= 3981-4 | pmid=18664541 | doi=10.1210/jc.2008-0485 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18664541  }} </ref><ref name="pmid20823469">{{cite journal| author=Jukić T, Kusić Z| title=Image in endocrinology. Pemberton's sign in patient with substernal goiter. | journal=J Clin Endocrinol Metab | year= 2010 | volume= 95 | issue= 9 | pages= 4175 | pmid=20823469 | doi=10.1210/jc.2010-0944 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20823469  }} </ref>


*Physical examination of patients with [disease name] is usually remarkable for:[finding 1], [finding 2], and [finding 3].
===Appearance of the patient===
*The presence of [finding(s)] on physical examination is diagnostic of [disease name].
*Patients with goiter usually appear with a cosmetic distortion of the [[neck]] along with a [[lump]] at the base of the [[neck]] and are [[asymptomatic]] in general.
*The presence of [finding(s)] on physical examination is highly suggestive of [disease name].


===Appearance of the Patient===
===Vital signs===
*Patients with [disease name] usually appear [general appearance].
*[[Tachycardia]]
 
===Vital Signs===
 
*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===
*[[Cyanosis]]  
*[[Moist skin]]
*[[Jaundice]]
* [[Pallor]]
* Bruises
 
<gallery widths=150px>
 
UploadedImage-01.jpg | Description {{dermref}}
UploadedImage-02.jpg | Description {{dermref}}
 
</gallery>


===HEENT===
===HEENT===
* Abnormalities of the head/hair may include ___
*[[Exophthalmos]]
* Evidence of trauma
* 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===
===Neck===
*[[Jugular venous distension]]
*[[Jugular vein]] compression or [[thrombosis]] (rare) <ref name="pmid4913941">{{cite journal |vauthors=Siderys H, Rowe GA |title=Superior vena caval syndrome caused by intrathoracic goiter |journal=Am Surg |volume=36 |issue=7 |pages=446–50 |year=1970 |pmid=4913941 |doi= |url=}}</ref>
*[[Carotid bruits]] may be auscultated unilaterally/bilaterally using the bell/diaphragm of the otoscope
*[[Superior vena cava syndrome]] (rare) <ref name="pmid4913941">{{cite journal |vauthors=Siderys H, Rowe GA |title=Superior vena caval syndrome caused by intrathoracic goiter |journal=Am Surg |volume=36 |issue=7 |pages=446–50 |year=1970 |pmid=4913941 |doi= |url=}}</ref>
*[[Lymphadenopathy]] (describe location, size, tenderness, mobility, and symmetry)
*[[Thyromegaly]] / thyroid nodules
*[[Hepatojugular reflux]]


===Lungs===
===Lungs===
* Asymmetric chest expansion / Decreased chest expansion
*Normal [[Vesicular breathing|vesicular]] [[breath sounds]]
*Lungs are hypo/hyperresonant
*[[Wheeze]] may be present as a result of compression of the [[thyroid gland]] over the [[trachea]]
*Fine/coarse [[crackles]] upon auscultation of the lung bases/apices unilaterally/bilaterally
*[[Tracheal deviation]] or compression may be seen in some cases
*Rhonchi
*[[Stridor]] may be seen in some cases
*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===
*Chest tenderness upon palpation
*Normal [[S1]] and [[S2]]
*PMI within 2 cm of the sternum  (PMI) / Displaced point of maximal impulse (PMI) suggestive of ____
*No rubs or gallop
*[[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 distention]]
*Normal [[abdominal]] findings
*[[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===
*Point tenderness over __ vertebrae (e.g. L3-L4)
*Normal findings observed
*Sacral edema
*Costovertebral angle tenderness bilaterally/unilaterally
*Buffalo hump


===Genitourinary===
===Genitourinary===
*A pelvic/adnexal mass may be palpated
*Normal findings observed
*Inflamed mucosa
*Clear/(color), foul-smelling/odorless penile/vaginal discharge


===Neuromuscular===
===Neuromuscular===
*Patient is usually oriented to persons, place, and time
*[[Tremors]]
* 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===
*[[Clubbing]]  
*Normal findings observed
*[[Cyanosis]]  
 
*Pitting/non-pitting [[edema]] of the upper/lower extremities
====Pemberton's sign====
*Muscle atrophy
*While clinically evaluating an [[enlarged thyroid gland]], [[Pemberton's sign]] is observed.<ref name="pmid24646105">{{cite journal| author=De Filippis EA, Sabet A, Sun MR, Garber JR| title=Pemberton's sign: explained nearly 70 years later. | journal=J Clin Endocrinol Metab | year= 2014 | volume= 99 | issue= 6 | pages= 1949-54 | pmid=24646105 | doi=10.1210/jc.2013-4240 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24646105  }} </ref><ref name="pmid15044645">{{cite journal| author=Basaria S, Salvatori R| title=Images in clinical medicine. Pemberton's sign. | journal=N Engl J Med | year= 2004 | volume= 350 | issue= 13 | pages= 1338 | pmid=15044645 | doi=10.1056/NEJMicm990287 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15044645  }} </ref><ref name="pmid9385120">{{cite journal| author=Anders H, Keller C| title=Pemberton's maneuver - a clinical test for latent superior vena cava syndrome caused by a substernal mass. | journal=Eur J Med Res | year= 1997 | volume= 2 | issue= 11 | pages= 488-90 | pmid=9385120 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9385120  }} </ref>
*Fasciculations in the upper/lower extremity
*[[Pemberton's sign]] is observed when both arms are elevated until the arms align with the side of the head. Usually in a minute of doing so, this elicits:
**Congestion of [[face]]
**[[Cyanosis]]
**[[Distress]]
*[[Vascular]] engorgement and facial [[congestion]] imply the impaired [[venous]] outflow from the [[head]] and [[neck]]
*[[Trachea|Tracheal]] compression may also be observed
*[[Venous thrombosis]] has also been seen in few cases


==References==
==References==

Latest revision as of 18:44, 17 November 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aravind Reddy Kothagadi M.B.B.S[2]

Overview

Physical examination of patients with goiter is usually remarkable for swelling at the base of the neck.

Physical Examination

Physical examination of patients with goiter is usually remarkable for swelling at the base of the neck.[1][2]

Appearance of the patient

  • Patients with goiter usually appear with a cosmetic distortion of the neck along with a lump at the base of the neck and are asymptomatic in general.

Vital signs

Skin

HEENT

Neck

Lungs

Heart

  • Normal S1 and S2
  • No rubs or gallop

Abdomen

Back

  • Normal findings observed

Genitourinary

  • Normal findings observed

Neuromuscular

Extremities

  • Normal findings observed

Pemberton's sign

References

  1. ↑ Bonnema SJ, Nielsen VE, Boel-Jørgensen H, Grupe P, Andersen PB, Bastholt L; et al. (2008). "Recombinant human thyrotropin-stimulated radioiodine therapy of large nodular goiters facilitates tracheal decompression and improves inspiration". J Clin Endocrinol Metab. 93 (10): 3981–4. doi:10.1210/jc.2008-0485. PMID 18664541.
  2. ↑ Jukić T, Kusić Z (2010). "Image in endocrinology. Pemberton's sign in patient with substernal goiter". J Clin Endocrinol Metab. 95 (9): 4175. doi:10.1210/jc.2010-0944. PMID 20823469.
  3. ↑ 3.0 3.1 Siderys H, Rowe GA (1970). "Superior vena caval syndrome caused by intrathoracic goiter". Am Surg. 36 (7): 446–50. PMID 4913941.
  4. ↑ De Filippis EA, Sabet A, Sun MR, Garber JR (2014). "Pemberton's sign: explained nearly 70 years later". J Clin Endocrinol Metab. 99 (6): 1949–54. doi:10.1210/jc.2013-4240. PMID 24646105.
  5. ↑ Basaria S, Salvatori R (2004). "Images in clinical medicine. Pemberton's sign". N Engl J Med. 350 (13): 1338. doi:10.1056/NEJMicm990287. PMID 15044645.
  6. ↑ Anders H, Keller C (1997). "Pemberton's maneuver - a clinical test for latent superior vena cava syndrome caused by a substernal mass". Eur J Med Res. 2 (11): 488–90. PMID 9385120.

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