COVID-19 physical examination: Difference between revisions

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__NOTOC__
__NOTOC__
{{Main article|COVID-19}}
'''For COVID-19 frequently asked outpatient questions, click [[COVID-19 frequently asked outpatient questions|here]]'''<br>
'''For COVID-19 frequently asked inpatient questions, click [[COVID-19 frequently asked inpatient questions|here]]'''<br>
{{COVID-19}}
{{COVID-19}}
{{CMG}}; {{AE}} {{HK}}
{{CMG}}; {{AE}} {{Sab}}; {{HK}}; [[User:Javaria Anwer|Javaria Anwer M.D.]][mailto:javaria.anwer@gmail.com]
 
{{SK}}[[COVID physical exam]], [[SARS CoV2 physical exam]], [[SARS CoV2 physical examination]], [[COVID-19 physical findings]].


==Overview==
==Overview==
The [[pathognomonic]] [[physical examination]] findings in [[Patient|patients]] [[Infection|infected]] with coronavirus include [[fever]], [[Flu|flu-like-symptoms]], [[cough]], and [[body aches]]. General appearance of the [[patient]] [[Infection|infected]] with coronavirus depends on the [[incubation period]] of the [[illness]].
[[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 [[Patient|patients]] [[Infection|infected]] with coronavirus include [[fever]], [[cough]], and [[shortness of breath]].<ref name="ZhuJi2020">{{cite journal|last1=Zhu|first1=Jieyun|last2=Ji|first2=Pan|last3=Pang|first3=Jielong|last4=Zhong|first4=Zhimei|last5=Li|first5=Hongyuan|last6=He|first6=Cuiying|last7=Zhang|first7=Jianfeng|last8=Zhao|first8=Chunling|title=Clinical characteristics of 3062 COVID‐19 patients: A meta‐analysis|journal=Journal of Medical Virology|year=2020|issn=0146-6615|doi=10.1002/jmv.25884}}</ref> The patient may just have abdominal pain and [[tenderness]] on examination.<ref name="pmid32387082">{{cite journal |vauthors=Hadi A, Werge M, Kristiansen KT, Pedersen UG, Karstensen JG, Novovic S, Gluud LL |title=Coronavirus Disease-19 (COVID-19) associated with severe acute pancreatitis: Case report on three family members |journal=Pancreatology |volume=20 |issue=4 |pages=665–667 |date=June 2020 |pmid=32387082 |pmc=7199002 |doi=10.1016/j.pan.2020.04.021 |url=}}</ref> The general appearance of the [[patient]] [[Infection|infected]] with [[COVID-19|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.
 
The Cochrane Collaboration has reviewed both the [[COVID-19 history and symptoms|History and Symptoms]] | [[COVID-19 physical examination|Physical Examination]]<ref name="pmid33620086">{{cite journal| author=Struyf T, Deeks JJ, Dinnes J, Takwoingi Y, Davenport C, Leeflang MM | display-authors=etal| title=Signs and symptoms to determine if a patient presenting in primary care or hospital outpatient settings has COVID-19. | journal=Cochrane Database Syst Rev | year= 2021 | volume= 2 | issue=  | pages= CD013665 | pmid=33620086 | doi=10.1002/14651858.CD013665.pub2 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=33620086  }} </ref>.
 


==Physical Examination==
==Physical Examination==
The [[pathognomonic]] [[physical examination]] findings in [[Patient|patients]] [[Infection|infected]] with coronavirus include [[fever]], [[Flu|flu-like-symptoms]], [[cough]], and [[body aches]].
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 [[Personal protective equipment|PPE]] that includes gloves, gowns or aprons, masks, or respirators covering the mouth and nose, goggles, and face shields.<ref name="urlwww.cdc.gov">{{cite web |url=https://www.cdc.gov/HAI/pdfs/ppe/PPEslides6-29-04.pdf |title=www.cdc.gov |format= |work= |accessdate=}}</ref> 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.<ref name="urlInfection Control: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) | CDC">{{cite web |url=https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control-recommendations.html |title=Infection Control: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) &#124; CDC |format= |work= |accessdate=}}</ref> If possible and the patient is in no [[respiratory distress]], [[patient]] should wear a surgical mask.<ref name="urlCoronavirus (COVID-19) frequently asked questions | CDC">{{cite web |url=https://www.cdc.gov/coronavirus/2019-ncov/faq.html#Basics |title=Coronavirus (COVID-19) frequently asked questions &#124; CDC |format= |work= |accessdate=}}</ref>


===Appearance of the Patient===
===Appearance of the Patient===
*General appearance of the [[patient]] [[Infection|infected]] with [[SARS-CoV-2]] virus (cause of [[COVID-19]]) depends on the severity of the [[illness]] and the presence of infection associated complications involving different organ systems.
*[[Patient|Patients]] with mild [[disease]] may appear healthy.
*[[Patient|Patients]] will appear [[Illness|sick]], [[lethargic]], and [[Dyspnea|short of breath]] in severe [[disease]].
*Patient may appear [[dehydrated]] (decreased [[skin turgor]] and dry [[mucosa]]) due to increased [[respiratory rate]], [[nausea]] and [[vomiting]],
*[[Anxiety]] is an important accompanying factor with majority of patients visiting hospitals, provided the heterogeneous nature of the disease. A healthy patient may worry regarding contracting the infection while visiting the hospital or doctor's office.
*[[Cyanosis]] depicts severe [[hypoxemia]] and the need for supplemental oxygen.


* General appearance of the [[patient]] [[Infection|infected]] with coronavirus depends on the [[incubation period]] of the [[illness]].
=== Vital Signs ===
*[[Patient|Patients]] can appear healthy in the initial days of the contraction of the [[disease]].
*'''[[Pulse]]''':
*[[Patient|Patients]] will appear [[Illness|sick]], [[lethargic]], and [[Dyspnea|short of breath]] in the later stages of the [[disease]].
**[[Heart rate]]: A normal heart rate is between 60 and 100 bpm with a few exceptions such as athletes. A healthy asymptomatic patient may have a normal [[heart rate]] but that does not rule out infection. [[Sinus tachycardia]], the most common type of [[arrhythmia]] among [[COVID-19]] patients can be due to [[fever]], [[hypoxia]], [[shock]] due to [[sepsis]], and [[anxiety]]. Some pathologic causes of [[arrhythmias]] include [[Ventricular arrhythmias|ventricular tachyarrhythmia]]<ref name="pmid32219356">{{cite journal| author=Guo T, Fan Y, Chen M, Wu X, Zhang L, He T | display-authors=etal| title=Cardiovascular Implications of Fatal Outcomes of Patients With Coronavirus Disease 2019 (COVID-19). | journal=JAMA Cardiol | year= 2020 | volume=  | issue=  | pages=  | pmid=32219356 | doi=10.1001/jamacardio.2020.1017 | pmc=7101506 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32219356  }} </ref>, [[atrial fibrillation]] (pulse rate 100 to 175 bpm) and [[atrial flutter]] (pulse rate 150 bpm).
**Rhythm: [[Sinus tachycardia]] has a regular rhythm. An irregular pulse due to a few pathologic [[arrhythmia]]s can be due to [[atrial fibrillation]] and [[Ventricular arrhythmias|ventricular tachyarrhythmia]] and [[COVID-19-associated Guillain-Barre syndrome]].
**Volume: A low volume pulse indicates [[dehydration]] and the potential need to [[rehydration]] therapy.
**Character: A fast but weak pulse depicts [[shock]]. A raised, full and bounding pulse can be observed due to [[fever]] or simply patient [[anxiety]].
*'''[[Temperature]]''':[[Fever]] (>100.4°F )<ref>{{Cite web|url=https://www.cdc.gov/sars/about/fs-SARS.pdf|title=|last=|first=|date=|website=|archive-url=|archive-date=|dead-url=|access-date=}}</ref> is a common temperature finding (observed in 89% patients) with rest of the patients being a febrile. Temperature of the [[patient]] can be in any range (102°F-99.5°F) reported.<ref name="GuanNi2020">{{cite journal|last1=Guan|first1=Wei-jie|last2=Ni|first2=Zheng-yi|last3=Hu|first3=Yu|last4=Liang|first4=Wen-hua|last5=Ou|first5=Chun-quan|last6=He|first6=Jian-xing|last7=Liu|first7=Lei|last8=Shan|first8=Hong|last9=Lei|first9=Chun-liang|last10=Hui|first10=David S.C.|last11=Du|first11=Bin|last12=Li|first12=Lan-juan|last13=Zeng|first13=Guang|last14=Yuen|first14=Kwok-Yung|last15=Chen|first15=Ru-chong|last16=Tang|first16=Chun-li|last17=Wang|first17=Tao|last18=Chen|first18=Ping-yan|last19=Xiang|first19=Jie|last20=Li|first20=Shi-yue|last21=Wang|first21=Jin-lin|last22=Liang|first22=Zi-jing|last23=Peng|first23=Yi-xiang|last24=Wei|first24=Li|last25=Liu|first25=Yong|last26=Hu|first26=Ya-hua|last27=Peng|first27=Peng|last28=Wang|first28=Jian-ming|last29=Liu|first29=Ji-yang|last30=Chen|first30=Zhong|last31=Li|first31=Gang|last32=Zheng|first32=Zhi-jian|last33=Qiu|first33=Shao-qin|last34=Luo|first34=Jie|last35=Ye|first35=Chang-jiang|last36=Zhu|first36=Shao-yong|last37=Zhong|first37=Nan-shan|title=Clinical Characteristics of Coronavirus Disease 2019 in China|journal=New England Journal of Medicine|volume=382|issue=18|year=2020|pages=1708–1720|issn=0028-4793|doi=10.1056/NEJMoa2002032}}</ref> Although body temperature is a good screening tool, afebrile patients have been confirmed to have [[COVID-19]] infection. A recent non-peer reviewed case report describes acute [[hypothermia]] in a [[COVID-19]] patient.(30.2°F).<ref name="AllardMaruani2020">{{cite journal|last1=Allard|first1=Nicolas|last2=Maruani|first2=Ari|last3=Cret|first3=Corina|last4=Ameri|first4=Alain|title=Acute hypothermia in Covid 19: A case report|journal=eNeurologicalSci|year=2020|pages=100248|issn=24056502|doi=10.1016/j.ensci.2020.100248}}</ref>
*'''[[Respiratory rate]]''': Normal [[respiratory rate]] among adults is 12 to 16 breaths per minute. [[Tachypnea]](> 30 breaths/min) among [[COVID-19]] positive patient sis the response to lung [[inflammation]] or can be a sign of progressive [[respiratory failure]] and can be found in [[COVID-19-associated pneumonia]], [[ARDS]] and [[COVID-19-associated Guillain-Barre syndrome]]. A [[respiratory rate]] of > 28-30 / min, or dyspnea, warrant the administration of oxygen by of 40% [[venturi mask]]. [[Oxygen saturation]], [[respiratory rate]], [[CXR]] and importantly [[dyspnea]] help determine the need for invasive [[mechanical ventilation]].<ref name="Tobin2020">{{cite journal|last1=Tobin|first1=Martin J.|title=Basing Respiratory Management of COVID-19 on Physiological Principles|journal=American Journal of Respiratory and Critical Care Medicine|volume=201|issue=11|year=2020|pages=1319–1320|issn=1073-449X|doi=10.1164/rccm.202004-1076ED}}</ref>.
*'''[[Oxygen saturation]]''': SpO2 < 93-94% warrants the administration of oxygen by of 40% [[venturi mask]] and marks severe disease. In younger individuals, the arterial [[oxygen saturation]]  is more important than it appears. The deterioration of [[inflammatory]] lung injury is manifested by a decrease in oxygen saturation (< 93%) first, followed by [[dyspnea]] among younger individuals with no other comorbidities.<ref name="pmid32150360">{{cite journal |vauthors=Cascella M, Rajnik M, Cuomo A, Dulebohn SC, Di Napoli R |title= |journal= |volume= |issue= |pages= |date= |pmid=32150360 |doi= |url=}}</ref>
*'''[[Blood pressure]]''': Low [[blood pressure]] can be due to [[dehydration]], [[septic shock]], [[heart failure]] or pathologic [[arrhythmias]] associated with [[COVID-19]]. [[Hypertension]] is itself a risk for severe [[COVID-19]] infection.<ref name="urlPeople Who Are at Higher Risk for Severe Illness | Coronavirus | COVID-19 | CDC">{{cite web |url=https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html#serious-heart-conditions |title=People Who Are at Higher Risk for Severe Illness &#124; Coronavirus &#124; COVID-19 &#124; CDC |format= |work= |accessdate=}}</ref>


=== Vital Signs ===
===Skin===
*[[Skin]] [[Physical examination|examination]] of [[Patient|patients]] with COVID-19 includes the following lesions:
**Erythema multiforme-like<ref name="pmid32385858">{{cite journal |vauthors=Jimenez-Cauhe J, Ortega-Quijano D, Carretero-Barrio I, Suarez-Valle A, Saceda-Corralo D, Moreno-Garcia Del Real C, Fernandez-Nieto D |title=Erythema multiforme-like eruption in patients with COVID-19 infection: clinical and histological findings |journal=Clin. Exp. Dermatol. |volume= |issue= |pages= |date=May 2020 |pmid=32385858 |doi=10.1111/ced.14281 |url=}}</ref> Further studies are required to evaluate exact [[etiology]] these lesions to be [[COVID-19]], drug intake or any other conditions.
**Erythematous maculo-papular<ref name="Recalcati2020">{{cite journal|last1=Recalcati|first1=S.|title=Cutaneous manifestations in COVID‐19: a first perspective|journal=Journal of the European Academy of Dermatology and Venereology|volume=34|issue=5|year=2020|issn=0926-9959|doi=10.1111/jdv.16387}}</ref>: Acral eruption of [[erythema]]to‐violaceous [[papules]] and [[macules]], with possible [[bullous]] evolution, or digital [[swelling]] can be observed.
**[[Urticaria]]l<ref name="Recalcati20202">{{cite journal|last1=Recalcati|first1=S.|title=Cutaneous manifestations in COVID‐19: a first perspective|journal=Journal of the European Academy of Dermatology and Venereology|volume=34|issue=5|year=2020|issn=0926-9959|doi=10.1111/jdv.16387}}</ref><ref name="Fernandez-NietoOrtega-Quijano2020">{{cite journal|last1=Fernandez-Nieto|first1=D|last2=Ortega-Quijano|first2=D|last3=Segurado-Miravalles|first3=G|last4=Pindado-Ortega|first4=C|last5=Prieto-Barrios|first5=M|last6=Jimenez-Cauhe|first6=J|title=Comment on: Cutaneous manifestations in COVID-19: a first perspective. Safety concerns of clinical images and skin biopsies|journal=Journal of the European Academy of Dermatology and Venereology|year=2020|issn=09269959|doi=10.1111/jdv.16470}}</ref>
**[[Chickenpox]]-like<ref name="Recalcati20202" /><ref name="TammaroAdebanjo2020">{{cite journal|last1=Tammaro|first1=A.|last2=Adebanjo|first2=G.A.R.|last3=Parisella|first3=F.R.|last4=Pezzuto|first4=A.|last5=Rello|first5=J.|title=Cutaneous manifestations in COVID‐19: the experiences of Barcelona and Rome|journal=Journal of the European Academy of Dermatology and Venereology|year=2020|issn=0926-9959|doi=10.1111/jdv.16530}}</ref>
**[[Purpuric]] peri-flexural<ref name="Jimenez-CauheOrtega-Quijano2020">{{cite journal|last1=Jimenez-Cauhe|first1=Juan|last2=Ortega-Quijano|first2=Daniel|last3=Prieto-Barrios|first3=Marta|last4=Moreno-Arrones|first4=Oscar M.|last5=Fernandez-Nieto|first5=Diego|title=Reply to “COVID-19 can present with a rash and be mistaken for dengue”: Petechial rash in a patient with COVID-19 infection|journal=Journal of the American Academy of Dermatology|year=2020|issn=01909622|doi=10.1016/j.jaad.2020.04.016}}</ref>
**Transient [[Livedoid vasculitis|livedo reticularis]]<ref name="ManaloSmith2020">{{cite journal|last1=Manalo|first1=Iviensan F.|last2=Smith|first2=Molly K.|last3=Cheeley|first3=Justin|last4=Jacobs|first4=Randy|title=A dermatologic manifestation of COVID-19: Transient livedo reticularis|journal=Journal of the American Academy of Dermatology|year=2020|issn=01909622|doi=10.1016/j.jaad.2020.04.018}}
</ref>
**Acro-ischemic<ref name="Fernandez-NietoJimenez-Cauhe2020">{{cite journal|last1=Fernandez-Nieto|first1=D.|last2=Jimenez-Cauhe|first2=J.|last3=Suarez-Valle|first3=A.|last4=Moreno-Arrones|first4=O.M.|last5=Saceda-Corralo|first5=D.|last6=Arana-Raja|first6=A.|last7=Ortega-Quijano|first7=D.|title=Characterization of acute acro-ischemic lesions in non-hospitalized patients: a case series of 132 patients during the COVID-19 outbreak|journal=Journal of the American Academy of Dermatology|year=2020|issn=01909622|doi=10.1016/j.jaad.2020.04.093}}
</ref>: The lesion constitutes finger or toe [[cyanosis]], skin [[bullae]] and [[dry gangrene]].
**Chilblain-like<ref name="PiccoloNeri2020">{{cite journal|last1=Piccolo|first1=V.|last2=Neri|first2=I.|last3=Filippeschi|first3=C.|last4=Oranges|first4=T.|last5=Argenziano|first5=G.|last6=Battarra|first6=V.C.|last7=Berti|first7=S.|last8=Manunza|first8=F.|last9=Fortina|first9=A.B.|last10=Di Lernia|first10=V.|last11=Boccaletti|first11=V.|last12=De Bernardis|first12=G.|last13=Brunetti|first13=B.|last14=Mazzatenta|first14=C.|last15=Bassi|first15=A.|title=Chilblain‐like lesions during COVID‐19 epidemic: a preliminary study on 63 patients|journal=Journal of the European Academy of Dermatology and Venereology|year=2020|issn=0926-9959|doi=10.1111/jdv.16526}}</ref>:They constitute [[bilateral]] red-purple [[papules]] on the [[dorsum]] of the fingers and diffuse [[erythema]] on the [[subungual]] area of thumb. During the [[COVID-19]] disease course, pseudo‐chilblain patterns may appear.<ref name="Galván CasasCatalà2020">{{cite journal|last1=Galván Casas|first1=C.|last2=Català|first2=A.|last3=Carretero Hernández|first3=G.|last4=Rodríguez‐Jiménez|first4=P.|last5=Fernández‐Nieto|first5=D.|last6=Rodríguez‐Villa Lario|first6=A.|last7=Navarro Fernández|first7=I.|last8=Ruiz‐Villaverde|first8=R.|last9=Falkenhain‐López|first9=D.|last10=Llamas Velasco|first10=M.|last11=García‐Gavín|first11=J.|last12=Baniandrés|first12=O.|last13=González‐Cruz|first13=C.|last14=Morillas‐Lahuerta|first14=V.|last15=Cubiró|first15=X.|last16=Figueras Nart|first16=I.|last17=Selda‐Enriquez|first17=G.|last18=Romaní|first18=J.|last19=Fustà‐Novell|first19=X.|last20=Melian‐Olivera|first20=A.|last21=Roncero Riesco|first21=M.|last22=Burgos‐Blasco|first22=P.|last23=Sola Ortigosa|first23=J.|last24=Feito Rodriguez|first24=M.|last25=García‐Doval|first25=I.|title=
            Classification of the cutaneous manifestations of
            COVID
            ‐19: a rapid prospective nationwide consensus study in Spain with 375 cases
          |journal=British Journal of Dermatology|year=2020|issn=0007-0963|doi=10.1111/bjd.19163}}</ref>


*[[High fever]] (100.4°F )<ref>{{Cite web|url=https://www.cdc.gov/sars/about/fs-SARS.pdf|title=|last=|first=|date=|website=|archive-url=|archive-date=|dead-url=|access-date=}}</ref>
===HEENT===
*'''Head exam''': Patients with [[fluid retention]] due to [[COVID-19-associated acute kidney injury]] may have edema (especially [[periorbital|peri-orbital]]) and [[swelling]] of face and extremities. Cervical [[lymphadenopathy]] can be present although very few cases have been reported.<ref name="pmid32306118">{{cite journal |vauthors=Krajewska J, Krajewski W, Zub K, Zatoński T |title=COVID-19 in otolaryngologist practice: a review of current knowledge |journal=Eur Arch Otorhinolaryngol |volume=277 |issue=7 |pages=1885–1897 |date=July 2020 |pmid=32306118 |pmc=7166003 |doi=10.1007/s00405-020-05968-y |url=}}</ref>
*'''[[Eye exam]]''':  
**[[Conjunctivitis]]: has been reported but there is no well established data regarding this manifestation.<ref name="pmid32175797">{{cite journal |vauthors=Seah I, Agrawal R |title=Can the Coronavirus Disease 2019 (COVID-19) Affect the Eyes? A Review of Coronaviruses and Ocular Implications in Humans and Animals |journal=Ocul. Immunol. Inflamm. |volume=28 |issue=3 |pages=391–395 |date=April 2020 |pmid=32175797 |pmc=7103678 |doi=10.1080/09273948.2020.1738501 |url=}}</ref>
**[[Epiphora]]: Patients can have teary eyes due to [[conjunctivitis]] itself or foreign body sensation.<ref name="pmid32232433">{{cite journal |vauthors=Wu P, Duan F, Luo C, Liu Q, Qu X, Liang L, Wu K |title=Characteristics of Ocular Findings of Patients With Coronavirus Disease 2019 (COVID-19) in Hubei Province, China |journal=JAMA Ophthalmol |volume= |issue= |pages= |date=March 2020 |pmid=32232433 |pmc=7110919 |doi=10.1001/jamaophthalmol.2020.1291 |url=}}</ref>
**[[Papilledema]] can be due to increased [[Intracranial pressure|ICP]] or [[cranial nerve palsy]].
**Although there are no reports of blurred [[vision]] but [[visual acuity]] should be accessed.
*'''Ear exam''': A case report of [[COVID-19]] associated [[otitis media]] demonstartes [[hyperemia]] and bulging [[tympanic membrane]] among the patient. [[Audiometry|Audiometry]] and [[tympanometry]] can help investigate hearing sequelae.<ref name="Fidan2020">{{cite journal|last1=Fidan|first1=Vural|title=New type of corona virus induced acute otitis media in adult|journal=American Journal of Otolaryngology|volume=41|issue=3|year=2020|pages=102487|issn=01960709|doi=10.1016/j.amjoto.2020.102487}}</ref>
*'''Nasal exam''': [[Runny nose]] and [[nasal congestion]] are relatively common [[physical exam]] findings.
*'''Throat exam''': Throat [[congestion]], [[Tonsil]] [[edema]] have been reported.<ref name="pmid32306118">{{cite journal |vauthors=Krajewska J, Krajewski W, Zub K, Zatoński T |title=COVID-19 in otolaryngologist practice: a review of current knowledge |journal=Eur Arch Otorhinolaryngol |volume=277 |issue=7 |pages=1885–1897 |date=July 2020 |pmid=32306118 |pmc=7166003 |doi=10.1007/s00405-020-05968-y |url=}}</ref>


===Skin===
===Neck===
*On [[inspection]], a patient with severe [[hypoxia]] will be using accessory muscles for [[respiration visible]] on the [[neck]] exam. A direct sign of increased [[work of breathing]] is [[palpation]] of the [[sternomastoid]] and detecting the phasic contraction.<ref name="Tobin2019">{{cite journal|last1=Tobin|first1=Martin J.|title=Why Physiology Is Critical to the Practice of Medicine|journal=Clinics in Chest Medicine|volume=40|issue=2|year=2019|pages=243–257|issn=02725231|doi=10.1016/j.ccm.2019.02.012}}</ref>
*[[Jugular venous pressure]]:<ref name="pmid26741580">{{cite journal |vauthors=Semler MW, Wheeler AP, Thompson BT, Bernard GR, Wiedemann HP, Rice TW |title=Impact of Initial Central Venous Pressure on Outcomes of Conservative Versus Liberal Fluid Management in Acute Respiratory Distress Syndrome |journal=Crit. Care Med. |volume=44 |issue=4 |pages=782–9 |date=April 2016 |pmid=26741580 |pmc=4792704 |doi=10.1097/CCM.0000000000001555 |url=}}</ref>
**High JVP or [[Jugular venous pressure|Jugular Venous Distension]] (JVD) can be a sign of [[COVID-19-associated heart failure]] or [[COVID-19-associated myocarditis]].
**Low JVP: Demonstrates low [[Central venous pressure|CVP]] indication low intravascular volume. Among patients with [[COVID-19]] associated [[ARDS]], [[Central venous pressure|CVP]] guides the fluid management.


*[[Skin]] [[Physical examination|examination]] of [[Patient|patients]] with coronavirus [[infection]] is usually normal.
===Lungs===
{| class="wikitable"
! colspan=4 style="background: #4479BA; color: #FFFFFF; " align="center"|Lung examination findings in [[COVID-19]]
|-
!style="background: #4479BA; color: #FFFFFF; " align="center" |Physical exam
!style="background: #4479BA; color: #FFFFFF; " align="center" |Mild-moderate infection (Pneumonia)<ref name="pmid21329538">{{cite journal |vauthors=de Jongh TO, Thiadens HA |title=[Physical examination of the lungs in suspected pneumonia] |language=Dutch; Flemish |journal=Ned Tijdschr Geneeskd |volume=155 |issue= |pages=A2656 |date=2011 |pmid=21329538 |doi= |url=}}</ref>
!style="background: #4479BA; color: #FFFFFF; " align="center" |Severe infection (ARDS)<ref name="GibsonQin2020">{{cite journal|last1=Gibson|first1=Peter G|last2=Qin|first2=Ling|last3=Puah|first3=Ser Hon|title=
            COVID
            ‐19 acute respiratory distress syndrome (
            ARDS
            ): clinical features and differences from typical pre‐
            COVID
            ‐19
            ARDS
          |journal=Medical Journal of Australia|year=2020|issn=0025-729X|doi=10.5694/mja2.50674}}</ref>
|-
|style="background: #DCDCDC; |'''Inspection'''
|[[Tachypnea]]


===HEENT===
Maybe normal [[respiratory rate]]
|[[Dyspnea]]
[[Tachypnea]] [Respiratory rate (≥ 30 breaths/min) indicates severe disease]


* HEENT [[Physical examination|examination]] of [[patients]] [[Infection|infected]] with coronavirus is usually normal.
Increased work of breathing using accessory muscles


===Neck===
[[lethargic]] and [[dehydrated]] patient
|-
|style="background: #DCDCDC; |'''Palpation'''
|Increased [[vocal fremitus]]


*[[Neck]] [[Physical examination|examination]] of [[Patient|patients]] [[Infection|infected]] with coronavirus is usually normal.
Diminished chest expansion at the affected side


===Lungs===
|Decreased [[vocal fremitus]] (accompanying [[pneumothorax]]) <br>
Diminished chest movements at the affected side
|-
|style="background: #DCDCDC; |'''Percussion'''
|Dull percussion note
|Tympanic note if [[pneumothorax]] accompanies
|-
|style="background: #DCDCDC; |'''Auscultation'''
|Decreased [[breath sounds]] if [[pleural effusion]] accompanies
Bronchial breath sounds ([//www.wikidoc.org/images/8/8b/Bronchial_breathing_sound.mp3 click here] to listen)


* Coronavirus [[infection]] mimics the [[pulmonary examination]] findings of [[pneumonia]], such as:
[[Rhonchi]]
** Increased [[respiratory rate]]<ref name="pmid21329538">{{cite journal |vauthors=de Jongh TO, Thiadens HA |title=[Physical examination of the lungs in suspected pneumonia] |language=Dutch; Flemish |journal=Ned Tijdschr Geneeskd |volume=155 |issue= |pages=A2656 |date=2011 |pmid=21329538 |doi= |url=}}</ref>
**[[Percussion of the lungs|Percussion dullness]]
** Bronchial or decreased [[breath sounds]]


===Heart===
[[Rales]] and [[Crackles]]
|Decreased [[breath sounds]] over a lung may indicate a <br> [[pneumothorax]] or [[endotracheal tube]] down the right main [[bronchus]]


* [[Tachycardia]]
[[Rhonchi]]
[[Rales]] may or may not be present
|}


*  
===Heart===
*[[Pulse pressure]]: A narrow [[pulse pressure]] may indicate [[hypovolemic shock]] requiring [[Rehydration|fluid therapy]] or [[fulminant myocarditis]].
*'''[[Palpation]]''': The [[apical impulse]] may be displaced laterally if there is [[left ventricular dilation]] in [[COVID-19-associated myocarditis]] or [[COVID-19-associated heart failure]]. A [[parasternal heave]] may be observed depicting [[COVID-19-associated heart failure]].
*'''Cardiac [[auscultation]]''' may demonstrate [[tachycardia]] or [[arrhythmias]] (irregular beat).
**[[S3|S<sub>3</sub>]] or a[[summation gallop]] especially in significant [[Ventricular dysfunction|biventricular dysfunction]], [[COVID-19-associated heart failure]] or [[COVID-19-associated cardiogenic shock]]
**[[Mitral]] or [[tricuspid]] [[murmurs]] ([[holosystolic murmur]]s) may also be noted in the presence of significant [[ventricular dilation]] leading to [[Regurgitation|regurgitant]] flow across [[Atrioventricular valves|AV valves.]] Among [[COVID-19-associated heart failure]] and [[COVID-19-associated myocarditis]].
**[[Pericardial friction rub]] and low intensity [[heart sounds]] may be evident if [[pericardium]] is involved causing [[pericarditis]] and [[pericardial effusion|effusion]] respectively.<ref name="pmid32387246">{{cite journal |vauthors=Siripanthong B, Nazarian S, Muser D, Deo R, Santangeli P, Khanji MY, Cooper LT, Chahal CAA |title=Recognizing COVID-19-related myocarditis: The possible pathophysiology and proposed guideline for diagnosis and management |journal=Heart Rhythm |volume= |issue= |pages= |date=May 2020 |pmid=32387246 |pmc=7199677 |doi=10.1016/j.hrthm.2020.05.001 |url=}}</ref>


===Abdomen===
===Abdomen===
 
*Some [[Patient|patients]] with [[COVID-19]] may report [[abdominal pain]] but abdominal exam findings to be positive is very rare.<ref name="pmid32215956">{{cite journal |vauthors=Wong SH, Lui RN, Sung JJ |title=Covid-19 and the digestive system |journal=J. Gastroenterol. Hepatol. |volume=35 |issue=5 |pages=744–748 |date=May 2020 |pmid=32215956 |doi=10.1111/jgh.15047 |url=}}</ref> Based on three case reports describing patients' atypical [[COVID-19]] presenting complaints the following findings can be observed among patients:<ref name="pmid32309266">{{cite journal |vauthors=Poggiali E, Ramos PM, Bastoni D, Vercelli A, Magnacavallo A |title=Abdominal Pain: A Real Challenge in Novel COVID-19 Infection |journal=Eur J Case Rep Intern Med |volume=7 |issue=4 |pages=001632 |date=2020 |pmid=32309266 |pmc=7162568 |doi=10.12890/2020_001632 |url=}}</ref><ref name="pmid32387082">{{cite journal |vauthors=Hadi A, Werge M, Kristiansen KT, Pedersen UG, Karstensen JG, Novovic S, Gluud LL |title=Coronavirus Disease-19 (COVID-19) associated with severe acute pancreatitis: Case report on three family members |journal=Pancreatology |volume=20 |issue=4 |pages=665–667 |date=June 2020 |pmid=32387082 |pmc=7199002 |doi=10.1016/j.pan.2020.04.021 |url=}}</ref><ref name="pmid32523872">{{cite journal |vauthors=Abdalhadi A, Alkhatib M, Mismar AY, Awouda W, Albarqouni L |title=Can COVID 19 present like appendicitis? |journal=IDCases |volume=21 |issue= |pages=e00860 |date=2020 |pmid=32523872 |pmc=7265835 |doi=10.1016/j.idcr.2020.e00860 |url=}}</ref>
*[[Abdominal examination]] of [[Patient|patients]] infected with coronavirus is usually normal.
*'''[[Inspection]]''': Slight abdominal distension on day 4 of admission in a single case presenting as [[acute pancreatitis]].
*[[Middle East respiratory syndrome coronavirus infection causes|MERS-CoV infection]], during the 2012 outbreak, was characterized by mild [[abdominal tenderness]] in some cases.<ref>{{Cite web|url=https://www.cdc.gov/coronavirus/mers/about/symptoms.html|title=|last=|first=|date=|website=|archive-url=|archive-date=|dead-url=|access-date=}}</ref>
*'''[[Palpation]]''': One [[COVID-19]] positive patient had abdominal [[tenderness]] and [[rebound tenderness]] at the [[right iliac fossa]] with no diagnostic proof of [[acute appendicitis]]. Direct [[epigastric]] and [[periumbilical|peri-umbilical]] [[tenderness]] is reported in only one case. The presence of [[hepatomegaly]] among patients with [[COVID-19-associated hepatic injury]] maybe a forethought of [[organomegaly]].<ref name="pmid32274341">{{cite journal |vauthors=Li J, Fan JG |title=Characteristics and Mechanism of Liver Injury in 2019 Coronavirus Disease |journal=J Clin Transl Hepatol |volume=8 |issue=1 |pages=13–17 |date=March 2020 |pmid=32274341 |pmc=7132021 |doi=10.14218/JCTH.2020.00019 |url=}}</ref>
*'''[[Percussion]]''': No abnormal findings have been reported.
*'''[[Auscultation]]''': [[Decreased bowel sounds|Hypo]]/[[Increased bowel sounds|hyperactive bowel sounds]] have not been reported.


===Back===
===Back===
 
* [[Gait]] can be impaired and the patient will have [[flaccid paralysis]] among [[COVID-19-associated Guillain-Barre syndrome]] and [[COVID-19-associated polyneuritis cranialis]].
* [[Human back|Back]] [[examination]] of [[Patient|patients]] [[Infection|infected]] with coronavirus is usually normal.


===Genitourinary===
===Genitourinary===
 
* There are no reports of [[Genitourinary system|genitourinary]] manifestations of [[COVID-19]] but due to the association of [[SARS]] with [[orchitis]] due to [[autoimmune]] mechanisms, urologists recommend that [[Genitourinary system|genitourinary]] [[Physical examination|examination]] of [[Patient|patients]] [[Infection|infected]] with [[SARS-CoV-2]] virus (case of [[COVID-19]]) is usually not be missed.<ref name="WangZhou2020">{{cite journal|last1=Wang|first1=Shangqian|last2=Zhou|first2=Xiang|last3=Zhang|first3=Tongtong|last4=Wang|first4=Zengjun|title=The need for urogenital tract monitoring in COVID-19|journal=Nature Reviews Urology|volume=17|issue=6|year=2020|pages=314–315|issn=1759-4812|doi=10.1038/s41585-020-0319-7}}</ref>
* [[Genitourinary system|Genitourinary]] [[Physical examination|examination]] of [[Patient|patients]] [[Infection|infected]] with coronavirus is usually normal.


===Neuromuscular===
===Neuromuscular===
*'''Mental status exam''': [[Glasgow coma scale]] can gauge the conscious state of the patient. [[Confusion]] can be due to severe [[dehydration]], [[electrolyte]] imbalances such as among [[COVID-19-associated acute kidney injury]], [[COVID-19-associated encephalitis]], [[COVID-19-associated meningitis]] or [[COVID-19-associated stroke]]. Moreover, a patient can be [[unconscious]].
*'''[[Cranial Nerve]] exam''': Any [[cranial nerve]] can be involved with physical exam findings such as:
**[[Cranial nerves|Cranial Nerve 1]] or [[Olfactory nerve]] should be [[Cranial nerve examination|examined]] to evaluate for [[anosmia]]. Studies suggests that anosmia can be an important clue, helping the diagnosis of COVID-19 specially in the early stages.<ref name="pmid32383370">{{cite journal |vauthors=Lee Y, Min P, Lee S, Kim SW |title=Prevalence and Duration of Acute Loss of Smell or Taste in COVID-19 Patients |journal=J. Korean Med. Sci. |volume=35 |issue=18 |pages=e174 |date=May 2020 |pmid=32383370 |pmc=7211515 |doi=10.3346/jkms.2020.35.e174 |url=}}</ref> According to a study published [[anosmia]] and [[aguesia]] could be strong predictors of COVID-19 infection.<ref name="MenniValdes2020">{{cite journal|last1=Menni|first1=Cristina|last2=Valdes|first2=Ana M.|last3=Freidin|first3=Maxim B.|last4=Sudre|first4=Carole H.|last5=Nguyen|first5=Long H.|last6=Drew|first6=David A.|last7=Ganesh|first7=Sajaysurya|last8=Varsavsky|first8=Thomas|last9=Cardoso|first9=M. Jorge|last10=El-Sayed Moustafa|first10=Julia S.|last11=Visconti|first11=Alessia|last12=Hysi|first12=Pirro|last13=Bowyer|first13=Ruth C. E.|last14=Mangino|first14=Massimo|last15=Falchi|first15=Mario|last16=Wolf|first16=Jonathan|last17=Ourselin|first17=Sebastien|last18=Chan|first18=Andrew T.|last19=Steves|first19=Claire J.|last20=Spector|first20=Tim D.|title=Real-time tracking of self-reported symptoms to predict potential COVID-19|journal=Nature Medicine|year=2020|issn=1078-8956|doi=10.1038/s41591-020-0916-2}}</ref>
**[[Cranial nerve]] III: [[Ophthalmoparesis]].<ref name="pmid32358218">{{cite journal |vauthors=Dinkin M, Gao V, Kahan J, Bobker S, Simonetto M, Wechsler P, Harpe J, Greer C, Mints G, Salama G, Tsiouris AJ, Leifer D |title=COVID-19 presenting with ophthalmoparesis from cranial nerve palsy |journal=Neurology |volume= |issue= |pages= |date=May 2020 |pmid=32358218 |doi=10.1212/WNL.0000000000009700 |url=}}</ref>
**[[Facial nerve|CN-VII]]: [[facial weakness]] ( frequent finding) in [[Guillain-Barré syndrome|GBS]]. Other [[cranial nerves]] involved in the disease include CN- III, V, VI, IX, X and XII resulting in [[ptosis]], [[facial droop]], [[dysphagia]] and [[dysarthria]] and [[diplopia]].<ref name="urlGuillain-Barre Syndrome Clinical Presentation: History, Physical Examination">{{cite web |url=https://emedicine.medscape.com/article/315632-clinical#b3 |title=Guillain-Barre Syndrome Clinical Presentation: History, Physical Examination |format= |work= |accessdate=}}</ref>


* [[Neuromuscular]] [[Physical examination|examination]] of [[Patient|patients]] [[Infection|infected]] with coronavirus is usually normal.
[[File:Chilblains COVID.jpg|thumb|right|350px|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]]
*'''[[Sensory system exam]]''': Absent withdrawal to painful stimuli is observed in [[COVID-19-associated encephalitis|encephalitis]].<ref name="BenameurAgarwal2020">{{cite journal|last1=Benameur|first1=Karima|last2=Agarwal|first2=Ankita|last3=Auld|first3=Sara C.|last4=Butters|first4=Matthew P.|last5=Webster|first5=Andrew S.|last6=Ozturk|first6=Tugba|last7=Howell|first7=J. Christina|last8=Bassit|first8=Leda C.|last9=Velasquez|first9=Alvaro|last10=Schinazi|first10=Raymond F.|last11=Mullins|first11=Mark E.|last12=Hu|first12=William T.|title=Encephalopathy and Encephalitis Associated with Cerebrospinal Fluid Cytokine Alterations and Coronavirus Disease, Atlanta, Georgia, USA, 2020|journal=Emerging Infectious Diseases|volume=26|issue=9|year=2020|issn=1080-6040|doi=10.3201/eid2609.202122}}</ref> [[Hypesthesia]] associated with [[COVID]] has been reported.<ref name="urlCranial neuropathy soon after COVID-19 onset - American Academy of Ophthalmology">{{cite web |url=https://www.aao.org/editors-choice/cranial-neuropathy-soon-after-covid-19-onset |title=Cranial neuropathy soon after COVID-19 onset - American Academy of Ophthalmology |format= |work= |accessdate=}}</ref><ref name="pmid32312628">{{cite journal |vauthors=Sedaghat Z, Karimi N |title=Guillain Barre syndrome associated with COVID-19 infection: A case report |journal=J Clin Neurosci |volume=76 |issue= |pages=233–235 |date=June 2020 |pmid=32312628 |pmc=7158817 |doi=10.1016/j.jocn.2020.04.062 |url=}}</ref><ref name="pmid32445789">{{cite journal |vauthors=Gupta A, Paliwal VK, Garg RK |title=Is COVID-19-related Guillain-Barré syndrome different? |journal=Brain Behav. Immun. |volume=87 |issue= |pages=177–178 |date=July 2020 |pmid=32445789 |pmc=7239011 |doi=10.1016/j.bbi.2020.05.051 |url=}}</ref>
*'''[[Motor system exam]]''':
**''[[Muscle power]] and [[muscle tone]]'': [[Paresis]] and [[atonia]] due to direct muscle injury is associated with [[COVID-19]].<ref name="pmid32455089">{{cite journal |vauthors=Sheraton M, Deo N, Kashyap R, Surani S |title=A Review of Neurological Complications of COVID-19 |journal=Cureus |volume=12 |issue=5 |pages=e8192 |date=May 2020 |pmid=32455089 |pmc=7243063 |doi=10.7759/cureus.8192 |url=}}
</ref> [[Bilateral]] ascending [[flaccid paralysis]] or [[quadriparesis]] is observed in [[COVID-19-associated Guillain-Barre syndrome]].<ref name="pmid32312628">{{cite journal |vauthors=Sedaghat Z, Karimi N |title=Guillain Barre syndrome associated with COVID-19 infection: A case report |journal=J Clin Neurosci |volume=76 |issue= |pages=233–235 |date=June 2020 |pmid=32312628 |pmc=7158817 |doi=10.1016/j.jocn.2020.04.062 |url=}}</ref>
**''[[Gait]]'': Gait [[ataxia]] has also been reported among [[COVID-19]] cases but is very rare.
*Reflexes: Deep tendon [[areflexia]] or [[hyporeflexia]] is observed in [[COVID-19-associated Guillain-Barre syndrome]] and [[COVID-19-associated Miller-Fischer syndrome]]. A study describing three patients with [[COVID-19-associated encephalitis|encephalitis]] reports absent [[corneal reflex]], [[gag reflex]]es, [[oculocephalic reflex]], diminished [[deep tendon reflexes]] and [[myoclonus]] affecting [[bilateral]] arms and legs.<ref name="BenameurAgarwal2020">{{cite journal|last1=Benameur|first1=Karima|last2=Agarwal|first2=Ankita|last3=Auld|first3=Sara C.|last4=Butters|first4=Matthew P.|last5=Webster|first5=Andrew S.|last6=Ozturk|first6=Tugba|last7=Howell|first7=J. Christina|last8=Bassit|first8=Leda C.|last9=Velasquez|first9=Alvaro|last10=Schinazi|first10=Raymond F.|last11=Mullins|first11=Mark E.|last12=Hu|first12=William T.|title=Encephalopathy and Encephalitis Associated with Cerebrospinal Fluid Cytokine Alterations and Coronavirus Disease, Atlanta, Georgia, USA, 2020|journal=Emerging Infectious Diseases|volume=26|issue=9|year=2020|issn=1080-6040|doi=10.3201/eid2609.202122}}</ref>


===Extremities===
===Extremities===
 
*Patients with [[fluid retention]] due to [[COVID-19-associated acute kidney injury]], [[COVID-19-associated heart failure]], [[COVID-19-associated myocarditis]] or [[COVID-19-associated hepatic injury]] have [[pedal edema]] on examination.
* [[Extremities]] [[Physical examination|examination]] of [[Patient|patients]] [[Infection|infected]] with coronavirus is usually normal.
*[[COVID-19]] toes: As explained earlier, pseudo-[[chilblain]] patterns may appear on toes widely known as COVID toes. A patient presented with purple toes should be tested for [[COVID-19]] virus infection.<ref name="Galván CasasCatalà2020">{{cite journal|last1=Galván Casas|first1=C.|last2=Català|first2=A.|last3=Carretero Hernández|first3=G.|last4=Rodríguez‐Jiménez|first4=P.|last5=Fernández‐Nieto|first5=D.|last6=Rodríguez‐Villa Lario|first6=A.|last7=Navarro Fernández|first7=I.|last8=Ruiz‐Villaverde|first8=R.|last9=Falkenhain‐López|first9=D.|last10=Llamas Velasco|first10=M.|last11=García‐Gavín|first11=J.|last12=Baniandrés|first12=O.|last13=González‐Cruz|first13=C.|last14=Morillas‐Lahuerta|first14=V.|last15=Cubiró|first15=X.|last16=Figueras Nart|first16=I.|last17=Selda‐Enriquez|first17=G.|last18=Romaní|first18=J.|last19=Fustà‐Novell|first19=X.|last20=Melian‐Olivera|first20=A.|last21=Roncero Riesco|first21=M.|last22=Burgos‐Blasco|first22=P.|last23=Sola Ortigosa|first23=J.|last24=Feito Rodriguez|first24=M.|last25=García‐Doval|first25=I.|title=
            Classification of the cutaneous manifestations of
            COVID
            ‐19: a rapid prospective nationwide consensus study in Spain with 375 cases
          |journal=British Journal of Dermatology|year=2020|issn=0007-0963|doi=10.1111/bjd.19163}}</ref>


==References==
==References==
{{reflist|2}}
{{reflist|2}}

Latest revision as of 16:59, 6 March 2021

Main article: COVID-19

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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.

The Cochrane Collaboration has reviewed both the History and Symptoms | Physical Examination[3].


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.[4] 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.[5] If possible and the patient is in no respiratory distress, patient should wear a surgical mask.[6]

Appearance of the Patient

Vital Signs

Skin

HEENT

Neck

Lungs

Lung examination findings in COVID-19
Physical exam Mild-moderate infection (Pneumonia)[30] Severe infection (ARDS)[31]
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. ↑ Struyf T, Deeks JJ, Dinnes J, Takwoingi Y, Davenport C, Leeflang MM; et al. (2021). "Signs and symptoms to determine if a patient presenting in primary care or hospital outpatient settings has COVID-19". Cochrane Database Syst Rev. 2: CD013665. doi:10.1002/14651858.CD013665.pub2. PMID 33620086 Check |pmid= value (help).
  4. ↑ "www.cdc.gov" (PDF).
  5. ↑ "Infection Control: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) | CDC".
  6. ↑ "Coronavirus (COVID-19) frequently asked questions | CDC".
  7. ↑ 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).
  8. ↑ (PDF) https://www.cdc.gov/sars/about/fs-SARS.pdf. Missing or empty |title= (help)
  9. ↑ 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.
  10. ↑ 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.
  11. ↑ 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.
  12. ↑ Cascella M, Rajnik M, Cuomo A, Dulebohn SC, Di Napoli R. PMID 32150360 Check |pmid= value (help). Missing or empty |title= (help)
  13. ↑ "People Who Are at Higher Risk for Severe Illness | Coronavirus | COVID-19 | CDC".
  14. ↑ 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).
  15. ↑ 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. ↑ 16.0 16.1 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.
  17. ↑ 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.
  18. ↑ 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.
  19. ↑ 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.
  20. ↑ 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.
  21. ↑ 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.
  22. ↑ 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.
  23. ↑ 23.0 23.1 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)
  24. ↑ 24.0 24.1 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).
  25. ↑ 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).
  26. ↑ 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).
  27. ↑ 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.
  28. ↑ 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.
  29. ↑ 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.
  30. ↑ de Jongh TO, Thiadens HA (2011). "[Physical examination of the lungs in suspected pneumonia]". Ned Tijdschr Geneeskd (in Dutch; Flemish). 155: A2656. PMID 21329538.
  31. ↑ 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)
  32. ↑ 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)
  33. ↑ 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).
  34. ↑ 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).
  35. ↑ 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).
  36. ↑ 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).
  37. ↑ 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.
  38. ↑ 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).
  39. ↑ 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.
  40. ↑ 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).
  41. ↑ "Guillain-Barre Syndrome Clinical Presentation: History, Physical Examination".
  42. ↑ 42.0 42.1 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.
  43. ↑ "Cranial neuropathy soon after COVID-19 onset - American Academy of Ophthalmology".
  44. ↑ 44.0 44.1 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).
  45. ↑ 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).
  46. ↑ 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).
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