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{{Renal artery stenosis}}
{{Renal artery stenosis}}
{{CMG}}
{{CMG}}  


==Overview==
==Overview==
A "whooshing" noise ([[bruit]]) can be heard over the abdomen.
A "whooshing" noise ([[bruit]]) can be heard over the abdomen.


Physical examination of patients with [disease name] is usually normal.
Physical examination of patients with renal artery stenosis is usually normal except for the bruit that is heard in most of the cases on auscultation.


OR
===Appearance of the Patient===


Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].
*General appearance of patients with renal artery stenosis appears stable with some discomfort seen in cases due to the resistant hypertension.
 
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===
*Patients with [disease name] usually appear [general appearance].  


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


*High-grade / low-grade fever
*High blood pressure with normal pulse pressure, tachycardia.
*[[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.
OR
*[[Cyanosis]]
*[[Jaundice]]
* [[Pallor]]
* Bruises


<gallery widths="150px">
*Skin examination of patients with renal artery stenosis is usually normal


UploadedImage-01.jpg | Description {{dermref}}
===HEENT===
UploadedImage-02.jpg | Description {{dermref}}


</gallery>
*HEENT examination of patients with renal artery stenosis is usually normal but in some cases vision changes or headache may be present as a complication of hypertension.


===HEENT===
===Neck===
* HEENT examination of patients with [disease name] 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 examination of patients with renal artery stenosis is usually normal
* Neck examination of patients with [disease name] 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.
 
OR
*Pulmonary examination of patients with renal artery stenosis is usually normal but in some cases there may be the presence of flash pulmonary edema.  
* Asymmetric chest expansion OR decreased chest expansion
*Fine/coarse [[crackles]] upon auscultation of the lung bases bilaterally
*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.
 
OR
*Cardiovascular examination of patients with renal artery stenosis's is usually normal with normal S1,S2, no murmurs, gallops.
*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.
 
OR
*Abdominal examination : Presence of bruit is a characteristic finding seen in patients with renal artery stenosis
*[[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.
 
OR
*Back examination of patients with renal artery stenosis  is usually normal.
*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.
 
OR
*Genitourinary examination of patients with renal artery stenosis is usually normal.
*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.
 
OR
*Neuromuscular examination of patients with renal artery stenosis is usually normal.
*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.
 
OR
*Extremities examination of patients with renal artery stenosis is usually normal.
*[[Clubbing]]
*[[Cyanosis]]
*Pitting/non-pitting [[edema]] of the upper/lower extremities
*Muscle atrophy
*Fasciculations in the upper/lower extremity


==References==
==References==

Revision as of 20:09, 20 December 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

A "whooshing" noise (bruit) can be heard over the abdomen.

Physical examination of patients with renal artery stenosis is usually normal except for the bruit that is heard in most of the cases on auscultation.

Appearance of the Patient

  • General appearance of patients with renal artery stenosis appears stable with some discomfort seen in cases due to the resistant hypertension.

Vital Signs

  • High blood pressure with normal pulse pressure, tachycardia.

Skin

  • Skin examination of patients with renal artery stenosis is usually normal

HEENT

  • HEENT examination of patients with renal artery stenosis is usually normal but in some cases vision changes or headache may be present as a complication of hypertension.

Neck

  • Neck examination of patients with renal artery stenosis is usually normal

Lungs

  • Pulmonary examination of patients with renal artery stenosis is usually normal but in some cases there may be the presence of flash pulmonary edema.
  • Fine/coarse crackles upon auscultation of the lung bases bilaterally

Heart

  • Cardiovascular examination of patients with renal artery stenosis's is usually normal with normal S1,S2, no murmurs, gallops.

Abdomen

  • Abdominal examination : Presence of bruit is a characteristic finding seen in patients with renal artery stenosis

Back

  • Back examination of patients with renal artery stenosis is usually normal.

Genitourinary

  • Genitourinary examination of patients with renal artery stenosis is usually normal.

Neuromuscular

  • Neuromuscular examination of patients with renal artery stenosis is usually normal.

Extremities

  • Extremities examination of patients with renal artery stenosis is usually normal.

References

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