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| ==Overview== | | ==Overview== |
| The findings on the [[physical examination]] depend on the clinical manifestation of listeriosis (febrile [[gastroenteritis]], [[sepsis]], infection in pregnancy, [[central nervous system]] infection, or [[endocarditis]]). Common findings include [[fever]], [[tachycardia]], [[pallor]]. Signs of [[neurological]] involvement may range from [[altered mental state]], to [[paralysis]], [[respiratory failure]], and [[coma]]. | | The findings on the [[physical examination]] depend on the clinical manifestation of listeriosis. Common findings include [[fever]], [[tachycardia]], [[pallor]], and [[abdominal tenderness]]. Signs of [[neurological]] involvement may include [[altered mental state]], [[paralysis]], [[respiratory failure]], and [[coma]]. |
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| ==Physical Examination== | | ==Physical Examination== |
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| ===Appearance of the Patient=== | | ===Appearance of the Patient=== |
| A patient with [[listeriosis]] may be ill-looking. | | A patient with [[listeriosis]] may be ill-looking. |
| ===Vitals=== | | ===Vital Signs=== |
| ====Temperature==== | | ====Temperature==== |
| *A [[fever]] is often present | | *[[Fever]] |
| ====Pulse====
| | *[[Tachycardia]] |
| =====Rate=====
| | *[[Tachypnea]] |
| *[[Tachycardia]] may be present | | *[[Hypotension]] |
| =====Strength=====
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| *The pulse may be weak
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| ====Blood Pressure====
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| *[[Hypotension]] may be present | |
| ====Respiratory Rate====
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| *[[Tachypnea]] may be present | |
| ===Skin=== | | ===Skin=== |
| * [[Pallor]] may be present | | * [[Pallor]] may be present |
| ===Throat=== | | ===HEENT=== |
| * [[Mucous membranes]] may be dehydrated | | * [[Mucous membranes]] may be dehydrated |
| ===Abdomen=== | | ===Abdomen=== |
| *[[Abdominal distention]] may be present | | *[[Abdominal distention]] |
| *[[Abdominal tenderness]] may be present | | *[[Abdominal tenderness]] |
| | |
| ==Infection in Pregnancy==
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| Pregnant women with [[listeriosis]] often present with [[flu]]-like [[symptoms]].<ref name=WHO>{{cite web | title = Risk assessment of Listeria monocytogenes in ready-to-eat foods | url = http://whqlibdoc.who.int/publications/2004/9241562625_part1.pdf }}</ref>
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| ==Sepsis of Unknown Origin== | | ==Sepsis of Unknown Origin== |
| ===Vitals=== | | ===Vital Signs=== |
| ====Temperature====
| | *[[Fever]] |
| *A [[fever]] is often present | | *[[Tachycardia]] |
| *[[Hypothermia]] may be present | | *[[Tachypnea]] |
| ====Pulse====
| | *[[Hypotension]] |
| =====Rate=====
| | *Weak peripheral pulses |
| *[[Tachycardia]] is often present | |
| =====Strength=====
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| *Peripheral pulses may be weak
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| ====Blood Pressure====
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| *[[Hypotension]] may be present | |
| ====Respiratory Rate====
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| *[[Tachypnea]] may be present | |
| ===Skin=== | | ===Skin=== |
| *[[Cyanosis]] may be present | | *[[Cyanosis]] |
| * [[Pallor]] may be present | | * [[Pallor]] |
| ===Throat=== | | ===HEENT and Neck === |
| *Mucous membranes may be dehydrated | | *Mucous membranes may be dehydrated |
| ===Neck===
| | *[[Lymphadenopathy]] |
| *[[Lymph nodes]] may be present | |
| ===Abdomen=== | | ===Abdomen=== |
| *[[Abdominal tenderness]] may be present | | *[[Abdominal tenderness]] |
| ===Extremities===
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| *[[Cyanosis]] may be present
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| ===Neurologic=== | | ===Neurologic=== |
| * Mental status may be altered | | * Altered mental status |
| | * Papilledema on fundoscopic exam |
| | * Motor and sensory [[focal neurologic signs]] |
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| ==Meningoencephalitis== | | ==Central Nervous System Infection== |
| ===Appearance of the Patient=== | | ===Vital Signs=== |
| A patient with [[meningoencephalitis]] may have a wide range of presentations. These may range from mild focal neurologic signs to [[coma]].
| | *[[Fever]] |
| ===Vitals===
| | *[[Tachycardia]] |
| ====Temperature====
| | *[[Tachypnea]] |
| *A [[fever]] is often present | | *[[Hypotension]] |
| ====Pulse====
| | *Weak peripheral pulses |
| =====Rate=====
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| *[[Tachycardia]] may be present | |
| =====Strength=====
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| *The pulse may be weak
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| ====Blood Pressure====
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| *[[Hypotension]] may be present | |
| ====Respiratory Rate====
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| *[[Tachypnea]] may be present | |
| ===Skin=== | | ===Skin=== |
| * [[Pallor]] may be present | | * [[Pallor]] |
| * [[Skin rash]] may be present | | * [[Skin rash]] |
| ===Head=== | | ===HEENT and Neck=== |
| * Bulging fontanelles may be present (neonates) | | * Bulging fontanelles may be present (neonates) |
| | | * Papilledema on fundoscopic exam |
| ===Neck===
| | * [[Neck stiffness]] may be present (typically absent in neonates) |
| * [[Neck stiffness]] may be present | |
| ===Neurologic=== | | ===Neurologic=== |
| * [[Mental status]] may be altered | | * Altered [[mental status]] may be altered |
| * [[Coma]] may be present | | * Motor and sensory [[focal neurologic signs]] |
| * [[Seizures]] may be present
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| * [[Focal neurologic signs]] may be present
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| ==Encephalitis==
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| ===Appearance of the Patient===
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| A patient with [[encephalitis]] may have a wide range of presentations. These may range from personality changes, mild focal neurologic signs, to [[coma]].
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| ===Vitals===
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| ====Temperature====
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| *A [[fever]] is often present
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| ====Pulse====
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| =====Rate=====
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| *[[Tachycardia]] may be present
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| =====Strength=====
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| *The pulse may be weak
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| ====Blood Pressure====
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| *[[Hypotension]] may be present
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| ====Respiratory Rate====
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| *[[Tachypnea]] may be present
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| ===Skin===
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| * [[Pallor]] may be present
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| * [[Skin rash]] may be present
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| ===Head===
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| * Bulging fontanelles may be present (neonates)
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| ===Neck===
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| * [[Neck stiffness]] may be present
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| ===Throat===
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| * Mucosal [[rash]] may be present
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| ===Neurologic===
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| * [[Mental status]] may be altered
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| * [[Coma]] may be present
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| * [[Seizures]] may be present
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| * [[Focal neurologic signs]] may be present
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| * [[Autonomic dysfunction]] may be present | | * [[Autonomic dysfunction]] may be present |
| * [[Hemiparesis]] may be present | | * [[Hemiparesis]] may be present |
| * [[Ataxia]] may be present | | * [[Ataxia]] may be present |
| * [[Dystonia]] may be present | | * [[Dystonia]] may be present |
| | |
| ==Rhombencephalitis==
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| ===Vitals===
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| ====Temperature====
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| *A [[fever]] is often present
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| ====Pulse====
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| =====Rate=====
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| *[[Tachycardia]] may be present
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| =====Strength=====
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| *The pulse may be weak
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| ====Blood Pressure====
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| *[[Hypotension]] may be present
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| ====Respiratory Rate====
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| *[[Tachypnea]] may be present
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| ===Skin===
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| * [[Pallor]] may be present
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| * [[Skin rash]] may be present
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| ===Head===
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| * Bulging fontanelles may be present (neonates)
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| ===Neck===
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| * [[Neck stiffness]] may be present
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| ===Lungs===
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| [[Respiratory failure]] is present in half of the patients
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| ===Throat===
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| * Mucosal [[rash]] may be present
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| ===Neurologic===
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| * [[Mental status]] may be altered
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| * [[Coma]] may be present
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| * [[Seizures]] may be present
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| * [[Focal neurologic signs]] may be present
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| * [[Autonomic dysfunction]] may be present
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| * [[Hemiparesis]] may be present
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| * [[Ataxia]] may be present
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| * [[Dystonia]] may be present
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| * Tremor may be present
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| ==Brain Abscess==
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| ===Appearance of the Patient===
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| Patients often complain of [[headache]], [[drowsiness]], [[confusion]], [[speech difficulties]] and [[fever]] with a rapidly progressive course. These manifestations are a combination of increased [[intracranial pressure]] (due to a space-occupying lesion), infection, and focal neurologic brain tissue damage.
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| ===Vitals===
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| ====Temperature====
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| *A [[fever]] may be present
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| ====Pulse====
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| =====Rate=====
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| *[[Tachycardia]] may be present
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| =====Strength=====
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| *The pulse may be weak
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| ====Blood Pressure====
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| *[[Hypotension]] may be present
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| ====Respiratory Rate====
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| *[[Tachypnea]] may be present
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| ===Skin===
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| * [[Pallor]] may be present
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| * [[Skin rash]] may be present
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| ===Head===
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| * Bulging fontanelles may be present (neonates)
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| ===Eyes===
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| * [[Papilledema]] may be present
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| ===Neck===
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| * [[Neck stiffness]] may be present
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| ===Lungs===
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| [[Respiratory failure]] is present in half of the patients
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| ===Throat===
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| * Mucosal [[rash]] may be present
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| ===Neurologic===
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| * [[Mental status]] may be altered
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| * [[Coma]] may be present
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| * [[Speech difficulties]] may be present
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| * [[Seizures]] may be present
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| * [[Focal neurologic signs]] may be present
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| * [[Autonomic dysfunction]] may be present
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| * [[Hemiparesis]] may be present
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| * [[Ataxia]] may be present
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| * [[Dystonia]] may be present
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| * Tremor may be present
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| ==Spinal Cord Infection==
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| ===Vitals===
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| ====Temperature====
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| *A [[fever]] may be present
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| ====Pulse====
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| =====Rate=====
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| *[[Tachycardia]] may be present
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| =====Strength=====
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| *The pulse may be weak
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| ====Blood Pressure====
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| *[[Hypotension]] may be present
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| ====Respiratory Rate====
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| *[[Tachypnea]] may be present
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| ===Skin===
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| * [[Pallor]] may be present
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| * [[Skin rash]] may be present
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| ===Head===
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| * Bulging fontanelles may be present (neonates)
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| ===Eyes===
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| * [[Papilledema]] may be present
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| ===Neck===
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| * [[Neck stiffness]] may be present
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| ===Lungs===
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| [[Respiratory failure]] is present in half of the patients
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| ===Throat===
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| * Mucosal [[rash]] may be present
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| ===Abdomen===
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| * [[Bladder]] dysfunction may be present
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| * [[Bowel]] dysfunction may be present
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| ===Extremities===
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| * Decreased strength may be present
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| ===Neurologic===
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| * [[Mental status]] may be altered
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| * [[Coma]] may be present
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| * [[Seizures]] may be present
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| * [[Focal neurologic signs]] may be present
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| * [[Autonomic dysfunction]] may be present
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| * [[Hemiparesis]] may be present
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| * [[Ataxia]] may be present
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| * [[Dystonia]] may be present
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| * [[Tremor]] may be present
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| ==Endocarditis==
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| ===Vitals===
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| ====Temperature====
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| *A [[fever]] may be present
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| ====Pulse====
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| * Wide [[pulse pressure]] may be present due to [[aortic insufficiency]]
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| =====Rate=====
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| *[[Tachycardia]] may be present
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| =====Strength=====
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| *The pulse may be weak
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| ====Blood Pressure====
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| *[[Hypotension]] may be present
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| ====Respiratory Rate====
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| *[[Tachypnea]] may be present
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| ===Skin===
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| * [[Pallor]] may be present
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| * [[Skin rash]] may be present
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| *[[Petechiae]] are present in 10-40% of patients
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| *[[Splinter hemorrhages]] are present in 5-15% of patients
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| *[[Osler's nodes]] are present in 7-10% of patients
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| *[[Janeway lesion]]s are present in 6-10% of patients
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| ===Head===
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| * Bulging fontanelles may be present (neonates)
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| ===Eyes===
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| * [[Papilledema]] may be present
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| *[[Conjunctival hemorrhage]] may be present
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| *[[Roth's spot]]s in the [[retina]] may be present
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| ===Neck===
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| * [[Neck stiffness]] may be present
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| ===Heart===
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| *[[Murmur|Heart Murmur]](s) are present in 80-85% of patients, including that of [[aortic insufficiency]], [[tricuspid regurgitation]] and [[mitral regurgitation]]
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| ===Lungs===
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| * [[Respiratory failure]] is present in half of the patients
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| * [[Rales]] may be present
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| ===Throat===
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| * Mucosal [[rash]] may be present
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| * Patients in whom there is new acute onset of [[aortic regurgitation]], bobbing of the [[uvula]] may be present
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| ===Abdomen===
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| * [[Abdominal pain]] may be present due to [[mesenteric]] [[embolization]] or [[ileus]], both of which may manifest as [[reduced bowel sounds]]
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| * [[Splenomegaly]] may be present in 15-30% patients
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| * [[Left upper quadrant pain]] (LUQ pain) may be present, as a result of a [[splenic infarct]] from embolization
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| * [[Flank pain]] may be present as a result of an [[embolus to the kidney]]
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| * [[Bladder]] dysfunction may be present
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| * [[Bowel]] dysfunction may be present
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| ===Extremities===
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| * [[Janeway lesion]]s may be present
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| * [[Gangrene]] of fingers may be present
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| * [[Splinter haemorrhage]]s may be present
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| * [[Osler's node]]s may be present
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| ===Neurologic===
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| * [[Septic emboli]] may result in [[stroke]] and focal neurologic findings
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| * [[Mental status]] may be altered
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| * [[Seizures]] may be present
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| * [[Focal neurologic signs]] may be present
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| * [[Autonomic dysfunction]] may be present
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| * [[Hemiparesis]] may be present
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| * [[Tremor]] may be present
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| ==References== | | ==References== |