Loefflers syndrome physical examination: Difference between revisions

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==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].
Usually, physical examination reveals no abnormality. Cutaneous features of hypereosinophilic syndrome. Lung [[auscultation]] might have [[Rales|crackle]]<nowiki/>s on [[physical examination]] (common), with or without [[Wheeze|wheezing]]. Hence, common physical examination findings of Löffler syndrome include [[Wheeze|wheezing]], [[rash]], and mild [[fever]].
 
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 [disease name] is usually normal.
Physical examination of patients with Löffler syndrome might be normal, but is usually remarkable for wheezing, rash, and mild fever.<ref name="pmid21062596">Te Booij M, de Jong E, Bovenschen HJ (2010) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=21062596 Löffler syndrome caused by extensive cutaneous larva migrans: a case report and review of the literature.] ''Dermatol Online J'' 16 (10):2. PMID: [https://pubmed.gov/21062596 21062596]</ref><ref name="pmid16612768">Chitkara RK, Krishna G (2006) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=16612768 Parasitic pulmonary eosinophilia.] ''Semin Respir Crit Care Med'' 27 (2):171-84. [http://dx.doi.org/10.1055/s-2006-939520 DOI:10.1055/s-2006-939520] PMID: [https://pubmed.gov/16612768 16612768]</ref><ref name="pmid21062596">Te Booij M, de Jong E, Bovenschen HJ (2010) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=21062596 Löffler syndrome caused by extensive cutaneous larva migrans: a case report and review of the literature.] ''Dermatol Online J'' 16 (10):2. PMID: [https://pubmed.gov/21062596 21062596]</ref><ref name="pmid24931460">Ekin S, Sertogullarindan B, Gunbatar H, Arisoy A, Yildiz H (2016) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=24931460 Loeffler's syndrome: an interesting case report.] ''Clin Respir J'' 10 (1):112-4. [http://dx.doi.org/10.1111/crj.12173 DOI:10.1111/crj.12173] PMID: [https://pubmed.gov/24931460 24931460]</ref> <ref name="pmid13480465">Caulet T (1957) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=13480465 [Loffler syndrome and pulmonary eosinophilia].] ''Gaz Med Fr'' 64 (20):1737-8 passim. PMID: [https://pubmed.gov/13480465 13480465]</ref><ref name="pmid5667987">(1968) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=5667987 Löffler's syndrome.] ''Br Med J'' 3 (5618):569-70. PMID: [https://pubmed.gov/5667987 5667987]</ref><ref name="pmid21007279">SASLAW MS, BOWMAN JA (1946) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=21007279 Loeffler's syndrome.] ''J Fla Med Assoc'' 32 ():373. PMID: [https://pubmed.gov/21007279 21007279]</ref><ref name="pmid21025484">SPECTOR HI (1945) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=21025484 Loeffler's syndrome (transient pulmonary infiltrations with eosinophilia); report of a case and a review of the available literature.] ''Dis Chest'' 11 ():380-91. PMID: [https://pubmed.gov/21025484 21025484]</ref><ref name="pmid21010826">GREIG ED (1945) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=21010826 On tropical eosinophilia associated with pulmonary signs (Loeffler's syndrome).] ''J Trop Med Hyg'' 48 ():149-51. PMID: [https://pubmed.gov/21010826 21010826]</ref>
 
OR
 
Physical examination of patients with [disease name] is usually remarkable for [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].


===Appearance of the Patient===
===Appearance of the Patient===
*Patients with [disease name] usually appear [general appearance].  
*Patients with Löffler syndrome might appear normal or ill.  


===Vital Signs===
===Vital Signs===


*High-grade / low-grade fever
*low-grade fever
*[[Hypothermia]] / hyperthermia may be present
*[[Tachycardia]] with regular pulse or (ir)regularly irregular pulse
*[[Tachycardia]] with regular pulse or (ir)regularly irregular pulse
*[[Bradycardia]] with regular pulse or (ir)regularly irregular pulse
*Tachypnea  
*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 Löffler syndrome s usually normal. Nevertheless, patients might develop a rash.
OR
* Cutaneous features of hypereosinophilic syndrome
*[[Cyanosis]]
*[[Jaundice]]
* [[Pallor]]
* Bruises
 
<gallery widths="150px">
 
UploadedImage-01.jpg | Description {{dermref}}
UploadedImage-02.jpg | Description {{dermref}}
 
</gallery>
 
===HEENT===
===HEENT===
* HEENT examination of patients with [disease name] is usually normal.
* HEENT examination of patients with Löffler syndrome 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 Löffler syndrome is usually normal.
OR
===Lungs===
*[[Jugular venous distension]]
Lung auscultation might have crackles on physical examination (common), with or without wheezing.
*[[Carotid bruits]] may be auscultated unilaterally/bilaterally using the bell/diaphragm of the otoscope
* Pulmonary examination of patients with might be normal.
*[[Lymphadenopathy]] (describe location, size, tenderness, mobility, and symmetry)
*[[Thyromegaly]] / thyroid nodules
*[[Hepatojugular reflux]]


===Lungs===
*Fine/coarse [[crackles]] upon auscultation of the lung
* Pulmonary examination of patients with [disease name] 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
*Rhonchi
*Vesicular breath sounds OR distant breath sounds
*Expiratory wheezing OR inspiratory wheezing with normal OR delayed expiratory phase
*[[Wheezing]] may be present
*[[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 Löffler syndrome 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 Löffler syndrome is usually normal.
OR
* Patients subsequently might complain of abdominal pain or other complications of parasitic infections.
*[[Abdominal distension]]
*[[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 Löffler syndrome 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 Löffler syndrome is usually normal.
OR
*A pelvic/adnexal mass may be palpated
*Inflamed mucosa
*Clear/(color), foul-smelling/odorless penile/vaginal discharge
 
===Neuromuscular===
===Neuromuscular===
* Neuromuscular examination of patients with [disease name] is usually normal.
* Neuromuscular examination of patients with Löffler syndrome 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===
* Extremities examination of patients with [disease name] is usually normal.
* Extremities examination of patients with Löffler syndrome is usually normal.
OR
*[[Clubbing]]
*[[Cyanosis]]
*Pitting/non-pitting [[edema]] of the upper/lower extremities
*Muscle atrophy
*Fasciculations in the upper/lower extremity
==Overview==
Usually, physical examination reveals no abnormality. Cutaneous features of hypereosinophilic syndrome. Lung auscultation might have crackles on physical examination (common), with or without wheezing.
==Physical Examination==
Usually, physical examination reveals no abnormality.
Cutaneous features of hypereosinophilic syndrome
===Lungs===
* Lung auscultation might have crackles on physical examination (common), with or without wheezing.  


*[[Cyanosis]] is barely reported 
==References==
==References==
{{reflist|2}}
{{reflist|2}}

Latest revision as of 14:25, 11 June 2019

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Soroush Seifirad, M.D.[2]

Overview

Usually, physical examination reveals no abnormality. Cutaneous features of hypereosinophilic syndrome. Lung auscultation might have crackles on physical examination (common), with or without wheezing. Hence, common physical examination findings of Löffler syndrome include wheezing, rash, and mild fever.

Physical Examination

Physical examination of patients with Löffler syndrome might be normal, but is usually remarkable for wheezing, rash, and mild fever.[1][2][1][3] [4][5][6][7][8]

Appearance of the Patient

  • Patients with Löffler syndrome might appear normal or ill.

Vital Signs

  • low-grade fever
  • Tachycardia with regular pulse or (ir)regularly irregular pulse
  • Tachypnea

Skin

  • Skin examination of patients with Löffler syndrome s usually normal. Nevertheless, patients might develop a rash.
  • Cutaneous features of hypereosinophilic syndrome

HEENT

  • HEENT examination of patients with Löffler syndrome is usually normal.

Neck

  • Neck examination of patients with Löffler syndrome is usually normal.

Lungs

Lung auscultation might have crackles on physical examination (common), with or without wheezing.

  • Pulmonary examination of patients with might be normal.
  • Fine/coarse crackles upon auscultation of the lung
  • Rhonchi
  • Wheezing may be present

Heart

  • Cardiovascular examination of patients with Löffler syndrome is usually normal.

Abdomen

  • Abdominal examination of patients with Löffler syndrome is usually normal.
  • Patients subsequently might complain of abdominal pain or other complications of parasitic infections.

Back

  • Back examination of patients with Löffler syndrome is usually normal.

Genitourinary

  • Genitourinary examination of patients with Löffler syndrome is usually normal.

Neuromuscular

  • Neuromuscular examination of patients with Löffler syndrome is usually normal.

Extremities

  • Extremities examination of patients with Löffler syndrome is usually normal.

References

  1. ↑ 1.0 1.1 Te Booij M, de Jong E, Bovenschen HJ (2010) Löffler syndrome caused by extensive cutaneous larva migrans: a case report and review of the literature. Dermatol Online J 16 (10):2. PMID: 21062596
  2. ↑ Chitkara RK, Krishna G (2006) Parasitic pulmonary eosinophilia. Semin Respir Crit Care Med 27 (2):171-84. DOI:10.1055/s-2006-939520 PMID: 16612768
  3. ↑ Ekin S, Sertogullarindan B, Gunbatar H, Arisoy A, Yildiz H (2016) Loeffler's syndrome: an interesting case report. Clin Respir J 10 (1):112-4. DOI:10.1111/crj.12173 PMID: 24931460
  4. ↑ Caulet T (1957) [Loffler syndrome and pulmonary eosinophilia.] Gaz Med Fr 64 (20):1737-8 passim. PMID: 13480465
  5. ↑ (1968) Löffler's syndrome. Br Med J 3 (5618):569-70. PMID: 5667987
  6. ↑ SASLAW MS, BOWMAN JA (1946) Loeffler's syndrome. J Fla Med Assoc 32 ():373. PMID: 21007279
  7. ↑ SPECTOR HI (1945) Loeffler's syndrome (transient pulmonary infiltrations with eosinophilia); report of a case and a review of the available literature. Dis Chest 11 ():380-91. PMID: 21025484
  8. ↑ GREIG ED (1945) On tropical eosinophilia associated with pulmonary signs (Loeffler's syndrome). J Trop Med Hyg 48 ():149-51. PMID: 21010826

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