Monoclonal gammopathy of undetermined significance physical examination

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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].

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 of patients with [disease name] is usually normal.

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 Patients with [disease name] usually appear [general appearance]. 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 examination of patients with [disease name] is usually normal. OR

Cyanosis Jaundice Pallor Bruises UploadedImage-01.jpg Description (Adapted from Dermatology Atlas)

Description (Adapted from Dermatology Atlas)

HEENT 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 [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 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 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 Cardiovascular examination of patients with [disease name] 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 S1 S2 S3 S4 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 Abdominal examination of patients with [disease name] is usually normal. OR

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