Tuberculous pericarditis physical examination: Difference between revisions

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{{Tuberculous pericarditis}}
{{Tuberculous pericarditis}}


{{CMG}}; '''Associate Editor-In-Chief:''' [[Varun Kumar]], M.B.B.S.; [[Lakshmi Gopalakrishnan]], M.B.B.S.
{{CMG}}; '''Associate Editor-In-Chief:''' {{Fs}} [[Varun Kumar]], M.B.B.S.; [[Lakshmi Gopalakrishnan]], M.B.B.S.


==Overview==
==Overview==
Patients with tuberculous pericarditis usually appear [[Cachexia|Cachectic]]. They may have [[fever]], [[tachycardia]], [[pulsus paradoxus]], [[hypotension]], [[tachypnea]], [[JVP]] distension, [[kussmaul's sign]], [[lymphadenopathy]], [[ankle edama]], [[pleura]] dullness, decreased [[breath sounds]], [[pericardial]] knock, [[pericardial rub]], fine/coarse [[crackles]] upon auscultation of the lung, [[hepatomegaly]], [[Ascites, pleural effusion, and benign ovarian tumor.|ascites]], distant [[heart sounds]], displaced point of maximal impulse (PMI) suggestive of  [[cardiomegaly]], [[friction rub]], and [[Heart sounds#Fourth heart sound S4|S4]].
==Physical Examination==
==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===
===Appearance of the Patient===
*Patients with [disease name] usually appear [general appearance].  
*Patients with tuberculous pericarditis usually appear Cachectic.<ref name="pmid4593515">{{cite journal |vauthors=Fowler NO, Manitsas GT |title=Infectious pericarditis |journal=Prog Cardiovasc Dis |volume=16 |issue=3 |pages=323–36 |date=1973 |pmid=4593515 |doi=10.1016/s0033-0620(73)80004-0 |url=}}</ref><ref name="MayosiWiysonge2006">{{cite journal|last1=Mayosi|first1=Bongani M|last2=Wiysonge|first2=Charles Shey|last3=Ntsekhe|first3=Mpiko|last4=Volmink|first4=Jimmy A|last5=Gumedze|first5=Freedom|last6=Maartens|first6=Gary|last7=Aje|first7=Akinyemi|last8=Thomas|first8=Baby M|last9=Thomas|first9=Kandathil M|last10=Awotedu|first10=Abolade A|last11=Thembela|first11=Bongani|last12=Mntla|first12=Phindile|last13=Maritz|first13=Frans|last14=Blackett|first14=Kathleen Ngu|last15=Nkouonlack|first15=Duquesne C|last16=Burch|first16=Vanessa C|last17=Rebe|first17=Kevin|last18=Parish|first18=Andy|last19=Sliwa|first19=Karen|last20=Vezi|first20=Brian Z|last21=Alam|first21=Nowshad|last22=Brown|first22=Basil G|last23=Gould|first23=Trevor|last24=Visser|first24=Tim|last25=Shey|first25=Muki S|last26=Magula|first26=Nombulelo P|last27=Commerford|first27=Patrick J|title=Clinical characteristics and initial management of patients with tuberculous pericarditis in the HIV era: the Investigation of the Management of Pericarditis in Africa (IMPI Africa) registry|journal=BMC Infectious Diseases|volume=6|issue=1|year=2006|issn=1471-2334|doi=10.1186/1471-2334-6-2}}</ref>


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


*High-grade / low-grade fever
* [[Fever]]
*[[Hypothermia]] / hyperthermia may be present
* [[Tachycardia]]
*[[Tachycardia]] with regular pulse or (ir)regularly irregular pulse
* [[Pulsus paradoxus]]  
*[[Bradycardia]] with regular pulse or (ir)regularly irregular pulse
* Hypotension (in [[cardiac tamponade]])
*Tachypnea / bradypnea
*Tachypnea
*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.
* Skin examination of patients with tuberculous pericarditis is usually normal.
OR
*[[Cyanosis]]
*[[Jaundice]]
* [[Pallor]]
* Bruises
 
<gallery widths="150px">
 
UploadedImage-01.jpg | Description {{dermref}}
UploadedImage-02.jpg | Description {{dermref}}
 
</gallery>


===HEENT===
===HEENT===
* HEENT examination of patients with [disease name] is usually normal.
* HEENT examination of patients with tuberculous pericarditis 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===
* Neck examination of patients with [disease name] is usually normal.
 
OR
*[[Jugular venous distension]]
*[[Jugular venous distension]]
*[[Carotid bruits]] may be auscultated unilaterally/bilaterally using the bell/diaphragm of the otoscope
*[[Kussmaul's sign]]
*[[Lymphadenopathy]] (describe location, size, tenderness, mobility, and symmetry)
*[[Lymphadenopathy]]
*[[Thyromegaly]] / thyroid nodules
*[[Hepatojugular reflux]]


===Lungs===
===Lungs===
* Pulmonary examination of patients with [disease name] is usually normal.
 
OR
* Pleura dullness
* Asymmetric chest expansion OR decreased chest expansion
* Decreased breath sounds
*Lungs are hyporesonant OR hyperresonant
* Pericardial knock
*Fine/coarse [[crackles]] upon auscultation of the lung bases/apices unilaterally/bilaterally
* Pericardial rub
*Rhonchi
*Fine/coarse [[crackles]] upon auscultation of the lung  
*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
* Distant [[heart sounds]]
*Chest tenderness upon palpation
*Displaced point of maximal impulse (PMI) suggestive of cardiomegaly
*PMI within 2 cm of the sternum  (PMI) / Displaced point of maximal impulse (PMI) suggestive of ____
*[[Heave]] / [[thrill]]
*[[Friction rub]]
*[[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#Fourth heart sound S4|S4]]
*[[Heart sounds#Summation Gallop|Gallops]]
*[[Heart sounds#Summation Gallop|Gallops]]
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===Abdomen===
===Abdomen===
* Abdominal examination of patients with [disease name] is usually normal.
 
OR
*[[Hepatomegaly]]  
*[[Abdominal distension]]
*Ascites
*[[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.
* Back examination of patients with tuberculous pericarditis is usually normal.
OR
*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.
* Genitourinary examination of patients with tuberculous pericarditis is usually normal.
OR
*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.
* Neuromuscular examination of patients with tuberculous pericarditis 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===
* 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
===General===
[[Cachexia]] is often present.
===Vitals===
[[Fever]], [[Tachycardia]], [[pulsus paradoxus]] and hypotension(in [[cardiac tamponade]])
===Neck===
[[Jugular venous distension]] with a prominent Y descent and [[Kussmaul's sign]]
===Chest===
On [[percussion]] there is pleural dullness, [[decreased breath sounds]], a [[pericardial knock]], [[pericardial rub]] and distant [[heart sounds]]
===Abdomen===
[[Hepatomegaly]], [[ascites]]


===Extremities===
*Pitting [[edema]] of the lower extremities
[[Ankle edema]]


==References==
==References==

Latest revision as of 15:58, 19 December 2019

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Fahimeh Shojaei, M.D. Varun Kumar, M.B.B.S.; Lakshmi Gopalakrishnan, M.B.B.S.

Overview

Patients with tuberculous pericarditis usually appear Cachectic. They may have fever, tachycardia, pulsus paradoxus, hypotension, tachypnea, JVP distension, kussmaul's sign, lymphadenopathy, ankle edama, pleura dullness, decreased breath sounds, pericardial knock, pericardial rub, fine/coarse crackles upon auscultation of the lung, hepatomegaly, ascites, distant heart sounds, displaced point of maximal impulse (PMI) suggestive of cardiomegaly, friction rub, and S4.

Physical Examination

Appearance of the Patient

  • Patients with tuberculous pericarditis usually appear Cachectic.[1][2]

Vital Signs

Skin

  • Skin examination of patients with tuberculous pericarditis is usually normal.

HEENT

  • HEENT examination of patients with tuberculous pericarditis is usually normal.

Neck

Lungs

  • Pleura dullness
  • Decreased breath sounds
  • Pericardial knock
  • Pericardial rub
  • Fine/coarse crackles upon auscultation of the lung

Heart

Abdomen

Back

  • Back examination of patients with tuberculous pericarditis is usually normal.

Genitourinary

  • Genitourinary examination of patients with tuberculous pericarditis is usually normal.

Neuromuscular

  • Neuromuscular examination of patients with tuberculous pericarditis is usually normal.

Extremities

  • Pitting edema of the lower extremities

References

  1. ↑ Fowler NO, Manitsas GT (1973). "Infectious pericarditis". Prog Cardiovasc Dis. 16 (3): 323–36. doi:10.1016/s0033-0620(73)80004-0. PMID 4593515.
  2. ↑ Mayosi, Bongani M; Wiysonge, Charles Shey; Ntsekhe, Mpiko; Volmink, Jimmy A; Gumedze, Freedom; Maartens, Gary; Aje, Akinyemi; Thomas, Baby M; Thomas, Kandathil M; Awotedu, Abolade A; Thembela, Bongani; Mntla, Phindile; Maritz, Frans; Blackett, Kathleen Ngu; Nkouonlack, Duquesne C; Burch, Vanessa C; Rebe, Kevin; Parish, Andy; Sliwa, Karen; Vezi, Brian Z; Alam, Nowshad; Brown, Basil G; Gould, Trevor; Visser, Tim; Shey, Muki S; Magula, Nombulelo P; Commerford, Patrick J (2006). "Clinical characteristics and initial management of patients with tuberculous pericarditis in the HIV era: the Investigation of the Management of Pericarditis in Africa (IMPI Africa) registry". BMC Infectious Diseases. 6 (1). doi:10.1186/1471-2334-6-2. ISSN 1471-2334.

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