COVID-19 physical examination

Jump to: navigation, search

For COVID-19 frequently asked outpatient questions, click here
For COVID-19 frequently asked inpatient questions, click here

COVID-19 Microchapters

Home

Frequently Asked Outpatient Questions

Frequently Asked Inpatient Questions

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating COVID-19 from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Study of Choice

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

X-ray

Echocardiography and Ultrasound

CT scan

MRI

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Interventions

Surgery

Primary Prevention

Secondary Prevention

Future or Investigational Therapies

Ongoing Clinical Trials

Case Studies

Case #1

COVID-19 physical examination On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of COVID-19 physical examination

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on COVID-19 physical examination

CDC on COVID-19 physical examination

COVID-19 physical examination in the news

Blogs on COVID-19 physical examination

Directions to Hospitals Treating Psoriasis

Risk calculators and risk factors for COVID-19 physical examination

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sabawoon Mirwais, M.B.B.S, M.D.[2]; Syed Hassan A. Kazmi BSc, MD [3]; Javaria Anwer M.D.[4]

Synonyms and Keywords: COVID physical exam, SARS CoV2 physical exam, SARS CoV2 physical examination, COVID-19 physical findings.

Overview

COVID-19 is a rapidly evolving situation and a heterogenous disease entity. A suspected or confirmed CVOVID-19 patient can have as common finding as fever and as unique yet significant finding as anosmia. Although, the common physical examination findings among patients infected with coronavirus include fever, cough, and shortness of breath.[1] The patient may just have abdominal pain and tenderness on examination.[2] The general appearance of the patient infected with coronavirus-19 depends on the severity of the illness. High clinical suspicion and careful physical exam are they key to early diagnosis and treatment of COVID-19 infection.

Physical Examination

Physical exam of a suspected or confirmed case of COVID-19 patient should be conducted in a private room, preferably a negative pressure one. The examiner should have PPE that includes gloves, gowns or aprons, masks, or respirators covering the mouth and nose, goggles, and face shields.[3] Due to the risk of aerosol spread of the SARS-CoV-2 virus, CDC recommends that protective eyewear (such as goggles or a face shield) should cover the front and sides of the face with no gaps between glasses and the face.[4] If possible and the patient is in no respiratory distress, patient should wear a surgical mask.[5]

Appearance of the Patient

Vital Signs

Skin

HEENT

Neck

Lungs

Lung examination findings in COVID-19
Physical exam Mild-moderate infection (Pneumonia)[29] Severe infection (ARDS)[30]
Inspection Tachypnea

Maybe normal respiratory rate

Dyspnea

Tachypnea [Respiratory rate (≥ 30 breaths/min) indicates severe disease]

Increased work of breathing using accessory muscles

lethargic and dehydrated patient

Palpation Increased vocal fremitus

Diminished chest expansion at the affected side

Decreased vocal fremitus (accompanying pneumothorax)

Diminished chest movements at the affected side

Percussion Dull percussion note Tympanic note if pneumothorax accompanies
Auscultation Decreased breath sounds if pleural effusion accompanies

Bronchial breath sounds (click here to listen)

Rhonchi

Rales and Crackles

Decreased breath sounds over a lung may indicate a
pneumothorax or endotracheal tube down the right main bronchus

Rhonchi

Rales may or may not be present

Heart

Abdomen

Back

Genitourinary

Neuromuscular

Chilblains in a COVID-19 patient commonly known as COVID toes- By Sapp - Own work, Public Domain, https://commons.wikimedia.org/w/index.php?curid=3297622

Extremities

References

  1. Zhu, Jieyun; Ji, Pan; Pang, Jielong; Zhong, Zhimei; Li, Hongyuan; He, Cuiying; Zhang, Jianfeng; Zhao, Chunling (2020). "Clinical characteristics of 3062 COVID‐19 patients: A meta‐analysis". Journal of Medical Virology. doi:10.1002/jmv.25884. ISSN 0146-6615.
  2. 2.0 2.1 Hadi A, Werge M, Kristiansen KT, Pedersen UG, Karstensen JG, Novovic S, Gluud LL (June 2020). "Coronavirus Disease-19 (COVID-19) associated with severe acute pancreatitis: Case report on three family members". Pancreatology. 20 (4): 665–667. doi:10.1016/j.pan.2020.04.021. PMC 7199002 Check |pmc= value (help). PMID 32387082 Check |pmid= value (help).
  3. "www.cdc.gov" (PDF).
  4. "Infection Control: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) | CDC".
  5. "Coronavirus (COVID-19) frequently asked questions | CDC".
  6. Guo T, Fan Y, Chen M, Wu X, Zhang L, He T; et al. (2020). "Cardiovascular Implications of Fatal Outcomes of Patients With Coronavirus Disease 2019 (COVID-19)". JAMA Cardiol. doi:10.1001/jamacardio.2020.1017. PMC 7101506 Check |pmc= value (help). PMID 32219356 Check |pmid= value (help).
  7. (PDF) https://www.cdc.gov/sars/about/fs-SARS.pdf. Missing or empty |title= (help)
  8. Guan, Wei-jie; Ni, Zheng-yi; Hu, Yu; Liang, Wen-hua; Ou, Chun-quan; He, Jian-xing; Liu, Lei; Shan, Hong; Lei, Chun-liang; Hui, David S.C.; Du, Bin; Li, Lan-juan; Zeng, Guang; Yuen, Kwok-Yung; Chen, Ru-chong; Tang, Chun-li; Wang, Tao; Chen, Ping-yan; Xiang, Jie; Li, Shi-yue; Wang, Jin-lin; Liang, Zi-jing; Peng, Yi-xiang; Wei, Li; Liu, Yong; Hu, Ya-hua; Peng, Peng; Wang, Jian-ming; Liu, Ji-yang; Chen, Zhong; Li, Gang; Zheng, Zhi-jian; Qiu, Shao-qin; Luo, Jie; Ye, Chang-jiang; Zhu, Shao-yong; Zhong, Nan-shan (2020). "Clinical Characteristics of Coronavirus Disease 2019 in China". New England Journal of Medicine. 382 (18): 1708–1720. doi:10.1056/NEJMoa2002032. ISSN 0028-4793.
  9. Allard, Nicolas; Maruani, Ari; Cret, Corina; Ameri, Alain (2020). "Acute hypothermia in Covid 19: A case report". eNeurologicalSci: 100248. doi:10.1016/j.ensci.2020.100248. ISSN 2405-6502.
  10. Tobin, Martin J. (2020). "Basing Respiratory Management of COVID-19 on Physiological Principles". American Journal of Respiratory and Critical Care Medicine. 201 (11): 1319–1320. doi:10.1164/rccm.202004-1076ED. ISSN 1073-449X.
  11. Cascella M, Rajnik M, Cuomo A, Dulebohn SC, Di Napoli R. PMID 32150360 Check |pmid= value (help). Missing or empty |title= (help)
  12. "People Who Are at Higher Risk for Severe Illness | Coronavirus | COVID-19 | CDC".
  13. Jimenez-Cauhe J, Ortega-Quijano D, Carretero-Barrio I, Suarez-Valle A, Saceda-Corralo D, Moreno-Garcia Del Real C, Fernandez-Nieto D (May 2020). "Erythema multiforme-like eruption in patients with COVID-19 infection: clinical and histological findings". Clin. Exp. Dermatol. doi:10.1111/ced.14281. PMID 32385858 Check |pmid= value (help).
  14. Recalcati, S. (2020). "Cutaneous manifestations in COVID‐19: a first perspective". Journal of the European Academy of Dermatology and Venereology. 34 (5). doi:10.1111/jdv.16387. ISSN 0926-9959.
  15. 15.0 15.1 Recalcati, S. (2020). "Cutaneous manifestations in COVID‐19: a first perspective". Journal of the European Academy of Dermatology and Venereology. 34 (5). doi:10.1111/jdv.16387. ISSN 0926-9959.
  16. Fernandez-Nieto, D; Ortega-Quijano, D; Segurado-Miravalles, G; Pindado-Ortega, C; Prieto-Barrios, M; Jimenez-Cauhe, J (2020). "Comment on: Cutaneous manifestations in COVID-19: a first perspective. Safety concerns of clinical images and skin biopsies". Journal of the European Academy of Dermatology and Venereology. doi:10.1111/jdv.16470. ISSN 0926-9959.
  17. Tammaro, A.; Adebanjo, G.A.R.; Parisella, F.R.; Pezzuto, A.; Rello, J. (2020). "Cutaneous manifestations in COVID‐19: the experiences of Barcelona and Rome". Journal of the European Academy of Dermatology and Venereology. doi:10.1111/jdv.16530. ISSN 0926-9959.
  18. Jimenez-Cauhe, Juan; Ortega-Quijano, Daniel; Prieto-Barrios, Marta; Moreno-Arrones, Oscar M.; Fernandez-Nieto, Diego (2020). "Reply to "COVID-19 can present with a rash and be mistaken for dengue": Petechial rash in a patient with COVID-19 infection". Journal of the American Academy of Dermatology. doi:10.1016/j.jaad.2020.04.016. ISSN 0190-9622.
  19. Manalo, Iviensan F.; Smith, Molly K.; Cheeley, Justin; Jacobs, Randy (2020). "A dermatologic manifestation of COVID-19: Transient livedo reticularis". Journal of the American Academy of Dermatology. doi:10.1016/j.jaad.2020.04.018. ISSN 0190-9622.
  20. Fernandez-Nieto, D.; Jimenez-Cauhe, J.; Suarez-Valle, A.; Moreno-Arrones, O.M.; Saceda-Corralo, D.; Arana-Raja, A.; Ortega-Quijano, D. (2020). "Characterization of acute acro-ischemic lesions in non-hospitalized patients: a case series of 132 patients during the COVID-19 outbreak". Journal of the American Academy of Dermatology. doi:10.1016/j.jaad.2020.04.093. ISSN 0190-9622.
  21. Piccolo, V.; Neri, I.; Filippeschi, C.; Oranges, T.; Argenziano, G.; Battarra, V.C.; Berti, S.; Manunza, F.; Fortina, A.B.; Di Lernia, V.; Boccaletti, V.; De Bernardis, G.; Brunetti, B.; Mazzatenta, C.; Bassi, A. (2020). "Chilblain‐like lesions during COVID‐19 epidemic: a preliminary study on 63 patients". Journal of the European Academy of Dermatology and Venereology. doi:10.1111/jdv.16526. ISSN 0926-9959.
  22. 22.0 22.1 Galván Casas, C.; Català, A.; Carretero Hernández, G.; Rodríguez‐Jiménez, P.; Fernández‐Nieto, D.; Rodríguez‐Villa Lario, A.; Navarro Fernández, I.; Ruiz‐Villaverde, R.; Falkenhain‐López, D.; Llamas Velasco, M.; García‐Gavín, J.; Baniandrés, O.; González‐Cruz, C.; Morillas‐Lahuerta, V.; Cubiró, X.; Figueras Nart, I.; Selda‐Enriquez, G.; Romaní, J.; Fustà‐Novell, X.; Melian‐Olivera, A.; Roncero Riesco, M.; Burgos‐Blasco, P.; Sola Ortigosa, J.; Feito Rodriguez, M.; García‐Doval, I. (2020). "Classification of the cutaneous manifestations of COVID ‐19: a rapid prospective nationwide consensus study in Spain with 375 cases". British Journal of Dermatology. doi:10.1111/bjd.19163. ISSN 0007-0963. line feed character in |title= at position 50 (help)
  23. 23.0 23.1 Krajewska J, Krajewski W, Zub K, Zatoński T (July 2020). "COVID-19 in otolaryngologist practice: a review of current knowledge". Eur Arch Otorhinolaryngol. 277 (7): 1885–1897. doi:10.1007/s00405-020-05968-y. PMC 7166003 Check |pmc= value (help). PMID 32306118 Check |pmid= value (help).
  24. Seah I, Agrawal R (April 2020). "Can the Coronavirus Disease 2019 (COVID-19) Affect the Eyes? A Review of Coronaviruses and Ocular Implications in Humans and Animals". Ocul. Immunol. Inflamm. 28 (3): 391–395. doi:10.1080/09273948.2020.1738501. PMC 7103678 Check |pmc= value (help). PMID 32175797 Check |pmid= value (help).
  25. Wu P, Duan F, Luo C, Liu Q, Qu X, Liang L, Wu K (March 2020). "Characteristics of Ocular Findings of Patients With Coronavirus Disease 2019 (COVID-19) in Hubei Province, China". JAMA Ophthalmol. doi:10.1001/jamaophthalmol.2020.1291. PMC 7110919 Check |pmc= value (help). PMID 32232433 Check |pmid= value (help).
  26. Fidan, Vural (2020). "New type of corona virus induced acute otitis media in adult". American Journal of Otolaryngology. 41 (3): 102487. doi:10.1016/j.amjoto.2020.102487. ISSN 0196-0709.
  27. Tobin, Martin J. (2019). "Why Physiology Is Critical to the Practice of Medicine". Clinics in Chest Medicine. 40 (2): 243–257. doi:10.1016/j.ccm.2019.02.012. ISSN 0272-5231.
  28. Semler MW, Wheeler AP, Thompson BT, Bernard GR, Wiedemann HP, Rice TW (April 2016). "Impact of Initial Central Venous Pressure on Outcomes of Conservative Versus Liberal Fluid Management in Acute Respiratory Distress Syndrome". Crit. Care Med. 44 (4): 782–9. doi:10.1097/CCM.0000000000001555. PMC 4792704. PMID 26741580.
  29. de Jongh TO, Thiadens HA (2011). "[Physical examination of the lungs in suspected pneumonia]". Ned Tijdschr Geneeskd (in Dutch; Flemish). 155: A2656. PMID 21329538.
  30. Gibson, Peter G; Qin, Ling; Puah, Ser Hon (2020). "COVID ‐19 acute respiratory distress syndrome ( ARDS ): clinical features and differences from typical pre‐ COVID ‐19 ARDS". Medical Journal of Australia. doi:10.5694/mja2.50674. ISSN 0025-729X. line feed character in |title= at position 6 (help)
  31. Siripanthong B, Nazarian S, Muser D, Deo R, Santangeli P, Khanji MY, Cooper LT, Chahal C (May 2020). "Recognizing COVID-19-related myocarditis: The possible pathophysiology and proposed guideline for diagnosis and management". Heart Rhythm. doi:10.1016/j.hrthm.2020.05.001. PMC 7199677 Check |pmc= value (help). PMID 32387246 Check |pmid= value (help). Vancouver style error: initials (help)
  32. Wong SH, Lui RN, Sung JJ (May 2020). "Covid-19 and the digestive system". J. Gastroenterol. Hepatol. 35 (5): 744–748. doi:10.1111/jgh.15047. PMID 32215956 Check |pmid= value (help).
  33. Poggiali E, Ramos PM, Bastoni D, Vercelli A, Magnacavallo A (2020). "Abdominal Pain: A Real Challenge in Novel COVID-19 Infection". Eur J Case Rep Intern Med. 7 (4): 001632. doi:10.12890/2020_001632. PMC 7162568 Check |pmc= value (help). PMID 32309266 Check |pmid= value (help).
  34. Abdalhadi A, Alkhatib M, Mismar AY, Awouda W, Albarqouni L (2020). "Can COVID 19 present like appendicitis?". IDCases. 21: e00860. doi:10.1016/j.idcr.2020.e00860. PMC 7265835 Check |pmc= value (help). PMID 32523872 Check |pmid= value (help).
  35. Li J, Fan JG (March 2020). "Characteristics and Mechanism of Liver Injury in 2019 Coronavirus Disease". J Clin Transl Hepatol. 8 (1): 13–17. doi:10.14218/JCTH.2020.00019. PMC 7132021 Check |pmc= value (help). PMID 32274341 Check |pmid= value (help).
  36. Wang, Shangqian; Zhou, Xiang; Zhang, Tongtong; Wang, Zengjun (2020). "The need for urogenital tract monitoring in COVID-19". Nature Reviews Urology. 17 (6): 314–315. doi:10.1038/s41585-020-0319-7. ISSN 1759-4812.
  37. Lee Y, Min P, Lee S, Kim SW (May 2020). "Prevalence and Duration of Acute Loss of Smell or Taste in COVID-19 Patients". J. Korean Med. Sci. 35 (18): e174. doi:10.3346/jkms.2020.35.e174. PMC 7211515 Check |pmc= value (help). PMID 32383370 Check |pmid= value (help).
  38. Menni, Cristina; Valdes, Ana M.; Freidin, Maxim B.; Sudre, Carole H.; Nguyen, Long H.; Drew, David A.; Ganesh, Sajaysurya; Varsavsky, Thomas; Cardoso, M. Jorge; El-Sayed Moustafa, Julia S.; Visconti, Alessia; Hysi, Pirro; Bowyer, Ruth C. E.; Mangino, Massimo; Falchi, Mario; Wolf, Jonathan; Ourselin, Sebastien; Chan, Andrew T.; Steves, Claire J.; Spector, Tim D. (2020). "Real-time tracking of self-reported symptoms to predict potential COVID-19". Nature Medicine. doi:10.1038/s41591-020-0916-2. ISSN 1078-8956.
  39. Dinkin M, Gao V, Kahan J, Bobker S, Simonetto M, Wechsler P, Harpe J, Greer C, Mints G, Salama G, Tsiouris AJ, Leifer D (May 2020). "COVID-19 presenting with ophthalmoparesis from cranial nerve palsy". Neurology. doi:10.1212/WNL.0000000000009700. PMID 32358218 Check |pmid= value (help).
  40. "Guillain-Barre Syndrome Clinical Presentation: History, Physical Examination".
  41. 41.0 41.1 Benameur, Karima; Agarwal, Ankita; Auld, Sara C.; Butters, Matthew P.; Webster, Andrew S.; Ozturk, Tugba; Howell, J. Christina; Bassit, Leda C.; Velasquez, Alvaro; Schinazi, Raymond F.; Mullins, Mark E.; Hu, William T. (2020). "Encephalopathy and Encephalitis Associated with Cerebrospinal Fluid Cytokine Alterations and Coronavirus Disease, Atlanta, Georgia, USA, 2020". Emerging Infectious Diseases. 26 (9). doi:10.3201/eid2609.202122. ISSN 1080-6040.
  42. "Cranial neuropathy soon after COVID-19 onset - American Academy of Ophthalmology".
  43. 43.0 43.1 Sedaghat Z, Karimi N (June 2020). "Guillain Barre syndrome associated with COVID-19 infection: A case report". J Clin Neurosci. 76: 233–235. doi:10.1016/j.jocn.2020.04.062. PMC 7158817 Check |pmc= value (help). PMID 32312628 Check |pmid= value (help).
  44. Gupta A, Paliwal VK, Garg RK (July 2020). "Is COVID-19-related Guillain-Barré syndrome different?". Brain Behav. Immun. 87: 177–178. doi:10.1016/j.bbi.2020.05.051. PMC 7239011 Check |pmc= value (help). PMID 32445789 Check |pmid= value (help).
  45. Sheraton M, Deo N, Kashyap R, Surani S (May 2020). "A Review of Neurological Complications of COVID-19". Cureus. 12 (5): e8192. doi:10.7759/cureus.8192. PMC 7243063 Check |pmc= value (help). PMID 32455089 Check |pmid= value (help).