Rabies physical examination

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

Overview[edit | edit source]

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[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 
  • Respiratory and vascular collapse

Skin[edit | edit source]

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

HEENT[edit | edit source]

  • Hypersalivation
  • Lacrimation
  • Sweating
  • Dilatation of the pupils

Neck[edit | edit source]

Lungs[edit | edit source]

  • Asymmetric chest expansion / Decreased chest expansion
  • Lungs are hypo/hyperresonant
  • 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

Heart[edit | edit source]

  • 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 otoscope

Abdomen[edit | edit source]

Back[edit | edit source]

  • Point tenderness over __ vertebrae (e.g. L3-L4)
  • Sacral edema
  • Costovertebral angle tenderness bilaterally/unilaterally
  • Buffalo hump

Genitourinary[edit | edit source]

  • A pelvic/adnexal mass may be palpated
  • Inflamed mucosa
  • Clear/(color), foul-smelling/odorless penile/vaginal discharge

Neuromuscular[edit | edit source]

  • Opisthotonos
  • Altered mental status
  • Increased tendon reflexes with extensor plantar responses
  • Flaccid paralysis with generalized areflexia when patient develops coma
  • Nuchal rigidity
  • Increased muscle tone
  • Fasciculations

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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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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