Rabies physical examination: Difference between revisions

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{{Rabies}}
{{Rabies}}


'''Editor-In-Chief:''' [[User:C Michael Gibson|C. Michael Gibson, M.S., M.D.]] [mailto:charlesmichaelgibson@gmail.com <nowiki>[1]</nowiki>]; '''Associate Editor(s)-in-Chief:'''
{{CMG}} {{AE}} {{IQ}}


== Overview[edit | edit source] ==
== 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].
Common physical examination findings of rabies include [[hyperpyrexia]] alternating with [[hypothermia]], [[tachycardia]], [[respiratory]] collapse, [[hypersalivation]], [[lacrimation]], [[sweating]], [[Pupillary dilation|dilatation of the pupils]] and [[bradycardia]]. Skin findings may include percussion myoedema, bite marks and [[bruises]].  


OR
== Physical Examination ==


Common physical examination findings of [disease name] include [finding 1], [finding 2], and [finding 3].
=== Vital Signs ===
 
* [[Hyperpyrexia]] alternating with [[hypothermia]]
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[edit | edit source] ==
* Physical examination of patients with [disease name] is usually remarkable for:[finding 1], [finding 2], and [finding 3].
* The presence of [finding(s)] on physical examination is diagnostic of [disease name].
* The presence of [finding(s)] on physical examination is highly suggestive of [disease name].
 
=== Appearance of the Patient[edit | edit source] ===
* Patients with [disease name] usually appear [general appearance].
 
=== Vital Signs[edit | edit source] ===
* Hyperpyrexia alternating with hypothermia
* [[Tachycardia]] 
* [[Tachycardia]] 
* [[Respiratory]] and [[vascular]] collapse
* [[Bradycardia]]


 
=== Skin ===
* 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[edit | edit source] ===
* Percussion myoedema (mounding of the muscle at the percussion site)<ref name="pmid2883526">{{cite journal |vauthors=Hemachudha T, Phanthumchinda K, Phanuphak P, Manutsathit S |title=Myoedema as a clinical sign in paralytic rabies |journal=Lancet |volume=1 |issue=8543 |pages=1210 |year=1987 |pmid=2883526 |doi= |url=}}</ref>
* Percussion myoedema (mounding of the muscle at the percussion site)<ref name="pmid2883526">{{cite journal |vauthors=Hemachudha T, Phanthumchinda K, Phanuphak P, Manutsathit S |title=Myoedema as a clinical sign in paralytic rabies |journal=Lancet |volume=1 |issue=8543 |pages=1210 |year=1987 |pmid=2883526 |doi= |url=}}</ref>
*  
* Bite marks
*  
* [[Bruises]]
* Bruises
 
* UploadedImage-01.jpg  Description [http://www.atlasdermatologico.com.br/ (Adapted from Dermatology Atlas)]
* UploadedImage-02.jpg  Description [http://www.atlasdermatologico.com.br/ (Adapted from Dermatology Atlas)]


=== HEENT[edit | edit source] ===
=== HEENT ===
* Hypersalivationlacrimation, sweating, "goose flesh" and dilatation of the pupils
* [[Hypersalivation]]
* Ophthalmoscopic exam may be abnormal with findings of ___
*[[Lacrimation]]
* Hearing acuity may be reduced
*[[Sweating]]
* [[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".)
*[[Pupillary dilation|Dilatation of the pupils]]
* [[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[edit | edit source] ===
=== Neck ===
* [[Jugular venous distension]]
* No abnormal findings
* [[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[edit | edit source] ===
=== Lungs ===
* Asymmetric chest expansion / Decreased chest expansion
* Fine/coarse [[crackles]] upon [[auscultation]] of the [[lung]] bases/apices unilaterally/bilaterally, if [[Aspirate|aspirated]].
* Lungs are hypo/hyperresonant
* [[Wheezing]] may be present due to [[aspiration]] or  [[chest]] [[infection]]
* Fine/coarse [[crackles]] upon auscultation of the lung bases/apices unilaterally/bilaterally
* Rhonchi
* Vesicular breath sounds / Distant breath sounds
* Expiratory/inspiratory wheezing with normal / delayed expiratory phase
* [[Wheezing]] may be present
* [[Egophony]] present/absent
* [[Bronchophony]] present/absent
* Normal/reduced [[tactile fremitus]]
* Normal/reduced [[tactile fremitus]]


=== Heart[edit | edit source] ===
=== Heart ===
* Chest tenderness upon palpation
* [[Heart sounds#First heart tone S1.2C the .22lub.22.28components M1 and T1.29|S1]] normal, soft
* PMI within 2 cm of the sternum (PMI) / Displaced point of maximal impulse (PMI) suggestive of ____
* [[Heart sounds#Second heart tone S2 the .22dub.22.28components A2 and P2.29|S2]] normal
* [[Heave]] / [[thrill]]
* [[Friction rub]]
* [[Heart sounds#First heart tone S1.2C the .22lub.22.28components M1 and T1.29|S1]]
* [[Heart sounds#Second heart tone S2 the .22dub.22.28components A2 and P2.29|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[edit | edit source] ===
=== Abdomen ===
* [[Abdominal distention]]
* [[Guarding]] may be present
* [[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[edit | edit source] ===
=== Genitourinary ===
* Point tenderness over __ vertebrae (e.g. L3-L4)
* No abnormal findings
* Sacral edema
* Costovertebral angle tenderness bilaterally/unilaterally
* Buffalo hump


=== Genitourinary[edit | edit source] ===
=== Neuromuscular ===
* A pelvic/adnexal mass may be palpated
* [[Opisthotonos]]
* Inflamed mucosa
* [[Altered mental status]]
* Clear/(color), foul-smelling/odorless penile/vaginal discharge
* Increased [[Tendon reflex|tendon reflexes]] with [[Extensor plantar reflexes|extensor plantar responses]]
*[[Flaccid paralysis]] with generalized [[areflexia]] when patient develops [[coma]]
* [[Nuchal rigidity]]
* Increased [[muscle tone]]
* [[Fasciculations]]


=== Neuromuscular[edit | edit source] ===
=== Extremities ===
* Opisthotonos
* Bite marks
* Altered mental status
* Muscle [[atrophy]]
* Glasgow coma scale is ___ / 15
* [[Fasciculations]] in the upper/lower extremity
* 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[edit | edit source] ===
* [[Clubbing]]
* [[Cyanosis]]
* Pitting/non-pitting [[edema]] of the upper/lower extremities
* Muscle atrophy
* Fasciculations in the upper/lower extremity
 
== References[edit | edit source] ==
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Latest revision as of 23:56, 29 July 2020

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

Overview

Common physical examination findings of rabies include hyperpyrexia alternating with hypothermia, tachycardia, respiratory collapse, hypersalivation, lacrimation, sweating, dilatation of the pupils and bradycardia. Skin findings may include percussion myoedema, bite marks and bruises.

Physical Examination

Vital Signs

Skin

  • Percussion myoedema (mounding of the muscle at the percussion site)[1]
  • Bite marks
  • Bruises

HEENT

Neck

  • No abnormal findings

Lungs

Heart

  • S1 normal, soft
  • S2 normal

Abdomen

Genitourinary

  • No abnormal findings

Neuromuscular

Extremities

References

  1. ↑ Hemachudha T, Phanthumchinda K, Phanuphak P, Manutsathit S (1987). "Myoedema as a clinical sign in paralytic rabies". Lancet. 1 (8543): 1210. PMID 2883526.

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