Lead poisoning physical examination

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

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.

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:

Back

Genitourinary

  • Genitourinary examination of patients with lead poisoning is usually normal, but they might have some level or renal impairment.

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

There are also associated gastrointestinal problems, such as

Other associated effects are

  • kidney problems
  • reproductive problems

Physical examination

Laboratory tests

  • Basophilic stippling of red blood cells
  • 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.
Basophilic stippling in a blood smear of a patient with lead poisoning

References

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