Lead poisoning physical examination: Difference between revisions

Jump to navigation Jump to search
 
(21 intermediate revisions by the same user not shown)
Line 2: Line 2:
{{Lead poisoning}}
{{Lead poisoning}}


{{CMG}}; {{AE}} Aksiniya K. Stevasarova, MD
{{CMG}}; {{AE}}{{AKS}}


==Overview==
==Overview==
Patients with chronic [[lead poisoning]] usually appear very sick. Physical examination of patients with [[lead poisoning]] is usually remarkable for [[neurological]], [[gastrointestinal]], and [[hematological] problems.
Patients with chronic [[lead poisoning]] usually appear very sick. Physical examination of patients with [[lead poisoning]] is usually remarkable for [[neurological]]<ref name="pmid22269775">{{cite journal| author=Strayhorn JC, Strayhorn JM| title=Lead exposure and the 2010 achievement test scores of children in New York counties. | journal=Child Adolesc Psychiatry Ment Health | year= 2012 | volume= 6 | issue= 1 | pages= 4 | pmid=22269775 | doi=10.1186/1753-2000-6-4 | pmc=3292821 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22269775  }} </ref>, [[gastrointestinal]]<ref name="pmid28318192">{{cite journal| author=Mottier DM, Cargnel E| title=[Abdominal pain as a presentation by lead poisoning. Case report]. | journal=Arch Argent Pediatr | year= 2017 | volume= 115 | issue= 2 | pages= e96-e98 | pmid=28318192 | doi=10.5546/aap.2017.e96 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28318192  }} </ref>, and [[hematological]] problems.<ref name="pmid29651203">{{cite journal| author=Sachdeva C, Thakur K, Sharma A, Sharma KK| title=Lead: Tiny but Mighty Poison. | journal=Indian J Clin Biochem | year= 2018 | volume= 33 | issue= 2 | pages= 132-146 | pmid=29651203 | doi=10.1007/s12291-017-0680-3 | pmc=5891462 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29651203  }} </ref>


==Physical Examination==
==Physical Examination==
Line 17: Line 17:


* [[Learning disability]]
* [[Learning disability]]


===Appearance of the Patient===
===Appearance of the Patient===
Line 29: Line 28:


===HEENT===
===HEENT===
* Abnormalities of the head may include  
* Abnormalities of the head may include: <ref name="pmid29651203">{{cite journal| author=Sachdeva C, Thakur K, Sharma A, Sharma KK| title=Lead: Tiny but Mighty Poison. | journal=Indian J Clin Biochem | year= 2018 | volume= 33 | issue= 2 | pages= 132-146 | pmid=29651203 | doi=10.1007/s12291-017-0680-3 | pmc=5891462 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29651203  }} </ref><ref name="pmid29523605">{{cite journal| author=Talbot A, Lippiatt C, Tantry A| title=Lead in a case of encephalopathy. | journal=BMJ Case Rep | year= 2018 | volume= 2018 | issue=  | pages=  | pmid=29523605 | doi=10.1136/bcr-2017-222388 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29523605  }} </ref>
* [[Icteric sclera]]  
*[[Burton's lines]]<ref name="pmid16707743">{{cite journal| author=Nogué S, Culla A| title=Images in clinical medicine. Burton's line. | journal=N Engl J Med | year= 2006 | volume= 354 | issue= 20 | pages= e21 | pmid=16707743 | doi=10.1056/NEJMicm050064 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16707743  }} </ref>
*[[Icteric sclera]]  
*[[Headache]]
*[[Headache]]
*[[Metalic taste]]
*[[Metallic taste]]
*[[Irritability]]
*[[Insomnia]]
*[[excess lethargy]]
*[[hyperactivity]]
*[[seizure]]
*[[coma]]
*[[learning disability]]<ref name="pmid22269775">{{cite journal| author=Strayhorn JC, Strayhorn JM| title=Lead exposure and the 2010 achievement test scores of children in New York counties. | journal=Child Adolesc Psychiatry Ment Health | year= 2012 | volume= 6 | issue= 1 | pages= 4 | pmid=22269775 | doi=10.1186/1753-2000-6-4 | pmc=3292821 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22269775  }} </ref>


===Neck===
===Neck===
Line 41: Line 48:


===Heart===
===Heart===
* Cardiovascular examination of patients with [disease name] is usually normal.
* Cardiovascular examination of patients with [[lead poisoning]] might experience [[chest pain]].
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 [[lead poisoning]] might reveal<ref name="pmid29651203">{{cite journal| author=Sachdeva C, Thakur K, Sharma A, Sharma KK| title=Lead: Tiny but Mighty Poison. | journal=Indian J Clin Biochem | year= 2018 | volume= 33 | issue= 2 | pages= 132-146 | pmid=29651203 | doi=10.1007/s12291-017-0680-3 | pmc=5891462 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29651203  }} </ref>:
 
* [[Abdominal pain]]
OR
* [[Nausea]]
*[[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 examination of patients with [disease name] is usually normal.
OR
*Point tenderness over __ vertebrae (e.g. L3-L4)
*Sacral edema
*Costovertebral angle tenderness bilaterally/unilaterally
*Buffalo hump
 
===Genitourinary===
* Genitourinary examination of patients with [disease name] is usually normal.
OR
*A pelvic/adnexal mass may be palpated
*Inflamed mucosa
*Clear/(color), foul-smelling/odorless penile/vaginal discharge
 
===Neuromuscular===
* Neuromuscular examination of patients with [disease name] 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 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
 
 
The symptoms of chronic lead poisoning include neurological problems, such as
reduced cognitive abilities
 
*[[Nausea]]
 
*[[Abdominal pain]]
 
*[[Irritability]]
 
*[[Insomnia]]
 
*[[Mettalic taste]]
 
*excess [[lethargy]]
 
*[[Hyperactivity]]
 
*[[Chest pain]]
 
* [[headache]]
 
* [[seizure]]
 
* [[coma]]
 
There are also associated gastrointestinal problems, such as
 
* [[constipation]]
* [[constipation]]
* [[diarrhea]]
* [[diarrhea]]
* [[vomiting]]
* [[vomiting]]
* [[poor appetite]]
* [[poor appetite]]
* [[weight loss]]
* [[weight loss]]


Other associated effects are
===Back===
* Back examination of patients with [[lead poisoning]] is usually normal.


* [[anemia]]
===Genitourinary===
* Genitourinary examination of patients with [[lead poisoning]] might show:
*[[Acute nephropathy]] - manifests with tubular defects, including [[phosphaturia]], [[glucosuria]] and [[amino aciduria]]. This combination of tubular defects is referred as [[Fanconi’s syndrome]].
*[[Chronic nephropathy]] - characterized histologically with chronic interstitial nephritis and is associated with [[gout]] and [[hypertension]].


* kidney problems
===Neuromuscular===
* Neuromuscular examination of patients with [[lead poisoning]] might manifest with the following:<ref name="pmid29523605">{{cite journal| author=Talbot A, Lippiatt C, Tantry A| title=Lead in a case of encephalopathy. | journal=BMJ Case Rep | year= 2018 | volume= 2018 | issue=  | pages=  | pmid=29523605 | doi=10.1136/bcr-2017-222388 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29523605  }} </ref> <ref name="pmid29078718">{{cite journal| author=Ying XL, Gao ZY, Yan J, Zhang M, Wang J, Xu J et al.| title=Sources, symptoms and characteristics of childhood lead poisoning: experience from a lead specialty clinic in China. | journal=Clin Toxicol (Phila) | year= 2018 | volume= 56 | issue= 6 | pages= 397-403 | pmid=29078718 | doi=10.1080/15563650.2017.1391392 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29078718  }} </ref>
* Patient is usually oriented to persons, place, and time
* [[Delirium]]
* [[Hallucinations]]
* Weakness of extensor muscles (eg, [[foot drop]], [[wrist drop]])
* [[Hypersomnolent]] or have difficulty falling asleep
* [[ataxia]]
* [[aggressiveness]]
* [[attention difficulty]]


* reproductive problems
===Extremities===
 
*[[Foot drop]]  
===Physical examination===
*[[Wrist drop]]  
 
*[[Peripheral neuropathy]]
* [[Burton's line]]
 
* [[Peripheral neuropathy]]
 
* [[Wrist drop]]
 
* [[learning disability]]
 
===Laboratory tests===
 
* Basophilic stippling of red blood cells
 
* [[Iron deficiency anemia]] (microcytosis and hypochromia)
 
* Elevated serum lead levels
 
* K-fluorescent X-ray metering can measure bone-lead.


Shown below is an image depicting basophilic stippling in a blood smear of a patient with lead poisoning.<br>
=
[[File:Lead poisoning - blood film.jpg|Basophilic stippling in a blood smear of a patient with lead poisoning]]


==References==
==References==

Latest revision as of 20:55, 21 June 2018

Lead poisoning Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Lead poisoning 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

Case Studies

Case #1

Lead poisoning physical examination On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Lead poisoning 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 Lead poisoning physical examination

CDC on Lead poisoning physical examination

Lead poisoning physical examination in the news

Blogs on Lead poisoning physical examination

Directions to Hospitals Treating Psoriasis

Risk calculators and risk factors for Lead poisoning physical examination

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

Overview

Patients with chronic lead poisoning usually appear very sick. Physical examination of patients with lead poisoning is usually remarkable for neurological[1], gastrointestinal[2], and hematological problems.[3]

Physical Examination

  • Physical examination of patients with lead poisoning is usually remarkable for:

Appearance of the Patient

Vital Signs

  • Tachycardia with regular pulse might be present due to anemia

Skin

HEENT

Neck

Lungs

  • Pulmonary examination of patients with lead poisoning is usually normal.

Heart

Abdomen

Abdominal examination of patients with lead poisoning might reveal[3]:

Back

Genitourinary

Neuromuscular

Extremities

=

References

  1. 1.0 1.1 Strayhorn JC, Strayhorn JM (2012). "Lead exposure and the 2010 achievement test scores of children in New York counties". Child Adolesc Psychiatry Ment Health. 6 (1): 4. doi:10.1186/1753-2000-6-4. PMC 3292821. PMID 22269775.
  2. Mottier DM, Cargnel E (2017). "[Abdominal pain as a presentation by lead poisoning. Case report]". Arch Argent Pediatr. 115 (2): e96–e98. doi:10.5546/aap.2017.e96. PMID 28318192.
  3. 3.0 3.1 3.2 Sachdeva C, Thakur K, Sharma A, Sharma KK (2018). "Lead: Tiny but Mighty Poison". Indian J Clin Biochem. 33 (2): 132–146. doi:10.1007/s12291-017-0680-3. PMC 5891462. PMID 29651203.
  4. 4.0 4.1 Talbot A, Lippiatt C, Tantry A (2018). "Lead in a case of encephalopathy". BMJ Case Rep. 2018. doi:10.1136/bcr-2017-222388. PMID 29523605.
  5. Nogué S, Culla A (2006). "Images in clinical medicine. Burton's line". N Engl J Med. 354 (20): e21. doi:10.1056/NEJMicm050064. PMID 16707743.
  6. Ying XL, Gao ZY, Yan J, Zhang M, Wang J, Xu J; et al. (2018). "Sources, symptoms and characteristics of childhood lead poisoning: experience from a lead specialty clinic in China". Clin Toxicol (Phila). 56 (6): 397–403. doi:10.1080/15563650.2017.1391392. PMID 29078718.

Template:WH Template:WS