Cystic fibrosis physical examination: Difference between revisions

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{{Cystic fibrosis}}
{{Cystic fibrosis}}


{{CMG}}; {{AE}}  
{{CMG}}; {{AE}} {{SHH}}


==Overview==
==Overview==
Patients with [disease name] usually appear [general appearance]. Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].
In cystic fibrosis [[abdominal distension]] and [[Clubbing|digital clubbing]] may be detected. In HEENT [[Physical examination|examination]] there are [[Nasal polyp|nasal polyps]] and [[Medical sign|signs]] of [[rhinosinusitis]] ([[Pus|purulent]] nasal discharge, [[Mucous membrane|mucosal]] [[edema]], [[turbinate]] [[Hypertrophy (medical)|hypertrophy]] and [[tenderness]] on [[palpitation]] of the [[Paranasal sinus|sinuses]]). [[Respiratory examination|Lung examination]] may present hyperresonant [[Lung|lungs]], [[wheeze]] or [[crackles]] and [[productive cough]] with mucoid or [[Pus|purulent]] [[sputum]].
 
OR
 
Common physical examination findings of [disease name] include [finding 1], [finding 2], and [finding 3].
 
OR
 
The presence of [finding(s)] on physical examination is diagnostic of [disease name].
 
OR
 
The presence of [finding(s)] on physical examination is highly suggestive of [disease name].


==Physical Examination==
==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].
*The presence of [finding(s)] on physical examination is diagnostic of [disease name].
*The presence of [finding(s)] on physical examination is highly suggestive of [disease name].
===Appearance of the Patient===
===Appearance of the Patient===
*Patients with [disease name] usually appear [general appearance].  
*Patients with cystic fibrosis are usually well-appearing.  


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


*High-grade / low-grade fever
*[[Tachypnea]]<ref name="pmid2347215">{{cite journal |vauthors=Browning IB, D'Alonzo GE, Tobin MJ |title=Importance of respiratory rate as an indicator of respiratory dysfunction in patients with cystic fibrosis |journal=Chest |volume=97 |issue=6 |pages=1317–21 |date=June 1990 |pmid=2347215 |doi= |url=}}</ref>
*[[Hypothermia]] / hyperthermia may be present
*[[Hypertension|High blood pressure]] <ref name="pmid28811770">{{cite journal |vauthors=Aziz DA, Billoo AG, Qureshi A, Khalid M, Kirmani S |title=Clinical and laboratory profile of children with Cystic Fibrosis: Experience of a tertiary care center in Pakistan |journal=Pak J Med Sci |volume=33 |issue=3 |pages=554–559 |date=2017 |pmid=28811770 |pmc=5510102 |doi=10.12669/pjms.333.12188 |url=}}</ref>
*[[Tachycardia]] with regular pulse or (ir)regularly irregular pulse
*[[Bradycardia]] with regular pulse or (ir)regularly irregular pulse
*Tachypnea / bradypnea
*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 [[Physical examination|examination]] of patients with cystic fibrosis is usually normal.
OR
* Skin [[Rash|rashes]] (due to [[zinc deficiency]]) and [[Xeroderma|skin dryness]] (due to [[vitamin A deficiency]]) may present.<ref name="pmid190924372">{{cite journal |vauthors=Moskowitz SM, Chmiel JF, Sternen DL, Cheng E, Gibson RL, Marshall SG, Cutting GR |title=Clinical practice and genetic counseling for cystic fibrosis and CFTR-related disorders |journal=Genet. Med. |volume=10 |issue=12 |pages=851–68 |date=December 2008 |pmid=19092437 |pmc=2810953 |doi=10.1097/GIM.0b013e31818e55a2 |url=}}</ref><ref name="urlCystic Fibrosis - National Library of Medicine - PubMed Health">{{cite web |url=https://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0022782/ |title=Cystic Fibrosis - National Library of Medicine - PubMed Health |format= |work= |accessdate=}}</ref>
*[[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.
* [[Nasal polyp|Nasal polyps]]<ref name="pmid27329094">{{cite journal |vauthors=Mohd Slim MA, Dick D, Trimble K, McKee G |title=Paediatric nasal polyps in cystic fibrosis |journal=BMJ Case Rep |volume=2016 |issue= |pages= |date=June 2016 |pmid=27329094 |doi=10.1136/bcr-2016-214467 |url=}}</ref>
OR
*Signs of [[rhinosinusitis]] may include:<ref name="pmid25750676">{{cite journal |vauthors=Kang SH, Dalcin Pde T, Piltcher OB, Migliavacca Rde O |title=Chronic rhinosinusitis and nasal polyposis in cystic fibrosis: update on diagnosis and treatment |journal=J Bras Pneumol |volume=41 |issue=1 |pages=65–76 |date=2015 |pmid=25750676 |pmc=4350827 |doi=10.1590/S1806-37132015000100009 |url=}}</ref><ref name="pmid27466844">{{cite journal |vauthors=Le C, McCrary HC, Chang E |title=Cystic Fibrosis Sinusitis |journal=Adv. Otorhinolaryngol. |volume=79 |issue= |pages=29–37 |date=2016 |pmid=27466844 |doi=10.1159/000444959 |url=}}</ref>
* Abnormalities of the head/hair may include ___
** Purulent [[nasal discharge]]
* Evidence of trauma
** [[Mucosal]] [[edema]]
* Icteric sclera
** Inferior [[turbinate]] [[Hypertrophy (medical)|hypertrophy]]
* [[Nystagmus]]  
** [[Pain]] and [[tenderness]] on [[palpation]] of the involved [[sinus]]
* 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.
* Neck [[Physical examination|examination]] of patients with cystic fibrosis is usually normal.
OR
*[[Jugular venous distension]]
*[[Carotid bruits]] may be auscultated unilaterally/bilaterally using the bell/diaphragm of the otoscope
*[[Lymphadenopathy]] (describe location, size, tenderness, mobility, and symmetry)
*[[Thyromegaly]] / thyroid nodules
*[[Hepatojugular reflux]]
 
===Lungs===
===Lungs===
* Pulmonary examination of patients with [disease name] is usually normal.
Findings of [[Respiratory examination|lungs examination]] may include:<ref name="pmid288117702">{{cite journal |vauthors=Aziz DA, Billoo AG, Qureshi A, Khalid M, Kirmani S |title=Clinical and laboratory profile of children with Cystic Fibrosis: Experience of a tertiary care center in Pakistan |journal=Pak J Med Sci |volume=33 |issue=3 |pages=554–559 |date=2017 |pmid=28811770 |pmc=5510102 |doi=10.12669/pjms.333.12188 |url=}}</ref><ref name="pmid28096997">{{cite journal |vauthors=Salamone I, Mondello B, Lucanto MC, Cristadoro S, Lombardo M, Barone M |title=Bronchial tree-shaped mucous plug in cystic fibrosis: imaging-guided management |journal=Respirol Case Rep |volume=5 |issue=2 |pages=e00214 |date=March 2017 |pmid=28096997 |doi=10.1002/rcr2.214 |url=}}</ref>
OR
*[[Lung|Lungs]] are hyperresonant
* Asymmetric chest expansion / Decreased chest expansion
*[[Wheeze]] or [[crackles]]  
*Lungs are hypo/hyperresonant
*Productive [[cough]] with mucoid or [[Pus|purulent]] [[sputum]]
*Fine/coarse [[crackles]] upon auscultation of the lung bases/apices unilaterally/bilaterally
*Rhonchi
*Vesicular breath sounds / Distant breath sounds
*Expiratory/inspiratory wheezing with normal / delayed expiratory phase
*[[Wheezing]] may be present
*[[Egophony]] present/absent
*[[Bronchophony]] present/absent
*Normal/reduced [[tactile fremitus]]


===Heart===
===Heart===
* Cardiovascular examination of patients with [disease name] is usually normal.
* [[Circulatory system|Cardiovascular]] [[Physical examination|examination]] of patients with cystic fibrosis is usually normal.
OR
*Chest tenderness upon palpation
*PMI within 2 cm of the sternum  (PMI) / Displaced point of maximal impulse (PMI) suggestive of ____
*[[Heave]] / [[thrill]]
*[[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#Summation Gallop|Gallops]]
*A high/low grade early/late [[systolic murmur]] / [[diastolic murmur]] best heard at the base/apex/(specific valve region) may be heard using the bell/diaphgram of the otoscope
 
===Abdomen===
===Abdomen===
Abdominal examination of patients with [disease name] is usually normal.
*[[Abdominal distention]]<ref name="pmid28472055">{{cite journal |vauthors=Tabori H, Arnold C, Jaudszus A, Mentzel HJ, Renz DM, Reinsch S, Lorenz M, Michl R, Gerber A, Lehmann T, Mainz JG |title=Abdominal symptoms in cystic fibrosis and their relation to genotype, history, clinical and laboratory findings |journal=PLoS ONE |volume=12 |issue=5 |pages=e0174463 |date=2017 |pmid=28472055 |pmc=5417419 |doi=10.1371/journal.pone.0174463 |url=}}</ref>
 
OR
*[[Abdominal distention]]  
*[[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 examination of patients with [disease name] 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 system|Genitourinary]] [[Physical examination|examination]] of patients with cystic fibrosis 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]] [[Physical examination|examination]] of patients with cystic fibrosis 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.
* [[Clubbing|Digital clubbing]]<ref name="pmid190924372">{{cite journal |vauthors=Moskowitz SM, Chmiel JF, Sternen DL, Cheng E, Gibson RL, Marshall SG, Cutting GR |title=Clinical practice and genetic counseling for cystic fibrosis and CFTR-related disorders |journal=Genet. Med. |volume=10 |issue=12 |pages=851–68 |date=December 2008 |pmid=19092437 |pmc=2810953 |doi=10.1097/GIM.0b013e31818e55a2 |url=}}</ref>
OR
*[[Clubbing]]  
*[[Cyanosis]]
*Pitting/non-pitting [[edema]] of the upper/lower extremities
*Muscle atrophy
*Fasciculations in the upper/lower extremity


==References==
==References==
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[[Category: (name of the system)]]
 
[[Category:Medicine]]
[[Category:Up-To-Date]]
[[Category:Gastroenterology]]
[[Category:Pediatrics]]
[[Category:Pulmonology]]

Latest revision as of 20:11, 27 March 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Shaghayegh Habibi, M.D.[2]

Overview

In cystic fibrosis abdominal distension and digital clubbing may be detected. In HEENT examination there are nasal polyps and signs of rhinosinusitis (purulent nasal discharge, mucosal edema, turbinate hypertrophy and tenderness on palpitation of the sinuses). Lung examination may present hyperresonant lungs, wheeze or crackles and productive cough with mucoid or purulent sputum.

Physical Examination

Appearance of the Patient

  • Patients with cystic fibrosis are usually well-appearing.

Vital Signs

Skin

HEENT

Neck

  • Neck examination of patients with cystic fibrosis is usually normal.

Lungs

Findings of lungs examination may include:[8][9]

Heart

Abdomen

Genitourinary

Neuromuscular

Extremities

References

  1. ↑ Browning IB, D'Alonzo GE, Tobin MJ (June 1990). "Importance of respiratory rate as an indicator of respiratory dysfunction in patients with cystic fibrosis". Chest. 97 (6): 1317–21. PMID 2347215.
  2. ↑ Aziz DA, Billoo AG, Qureshi A, Khalid M, Kirmani S (2017). "Clinical and laboratory profile of children with Cystic Fibrosis: Experience of a tertiary care center in Pakistan". Pak J Med Sci. 33 (3): 554–559. doi:10.12669/pjms.333.12188. PMC 5510102. PMID 28811770.
  3. ↑ 3.0 3.1 Moskowitz SM, Chmiel JF, Sternen DL, Cheng E, Gibson RL, Marshall SG, Cutting GR (December 2008). "Clinical practice and genetic counseling for cystic fibrosis and CFTR-related disorders". Genet. Med. 10 (12): 851–68. doi:10.1097/GIM.0b013e31818e55a2. PMC 2810953. PMID 19092437.
  4. ↑ "Cystic Fibrosis - National Library of Medicine - PubMed Health".
  5. ↑ Mohd Slim MA, Dick D, Trimble K, McKee G (June 2016). "Paediatric nasal polyps in cystic fibrosis". BMJ Case Rep. 2016. doi:10.1136/bcr-2016-214467. PMID 27329094.
  6. ↑ Kang SH, Dalcin Pde T, Piltcher OB, Migliavacca Rde O (2015). "Chronic rhinosinusitis and nasal polyposis in cystic fibrosis: update on diagnosis and treatment". J Bras Pneumol. 41 (1): 65–76. doi:10.1590/S1806-37132015000100009. PMC 4350827. PMID 25750676.
  7. ↑ Le C, McCrary HC, Chang E (2016). "Cystic Fibrosis Sinusitis". Adv. Otorhinolaryngol. 79: 29–37. doi:10.1159/000444959. PMID 27466844.
  8. ↑ Aziz DA, Billoo AG, Qureshi A, Khalid M, Kirmani S (2017). "Clinical and laboratory profile of children with Cystic Fibrosis: Experience of a tertiary care center in Pakistan". Pak J Med Sci. 33 (3): 554–559. doi:10.12669/pjms.333.12188. PMC 5510102. PMID 28811770.
  9. ↑ Salamone I, Mondello B, Lucanto MC, Cristadoro S, Lombardo M, Barone M (March 2017). "Bronchial tree-shaped mucous plug in cystic fibrosis: imaging-guided management". Respirol Case Rep. 5 (2): e00214. doi:10.1002/rcr2.214. PMID 28096997.
  10. ↑ Tabori H, Arnold C, Jaudszus A, Mentzel HJ, Renz DM, Reinsch S, Lorenz M, Michl R, Gerber A, Lehmann T, Mainz JG (2017). "Abdominal symptoms in cystic fibrosis and their relation to genotype, history, clinical and laboratory findings". PLoS ONE. 12 (5): e0174463. doi:10.1371/journal.pone.0174463. PMC 5417419. PMID 28472055.

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