Dysphagia physical examination: Difference between revisions

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VisualWikitext

Latest revision as of 21:30, 29 July 2020

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Hamid Qazi, MD, BSc [2]

Overview

A speech language pathologist is most often the first person called upon to evaluate a patient with suspected dysphagia. During this informal examination, medical history is obtained, the mini-mental state examination is administered, and oral and facial sensorimotor function, speech, and swallowing are evaluated non-instrumentally.

Physical Examination

Physical examination of patients with dysphagia is dependent on the underlying cause.^[1] Please click the specified disease below to see the full physical exam.

Appearance of the Patient

Patients with dysphagia usually appear in discomfort.

Vital Signs

Normal

Skin

Skin examination of patients with dysphagia is usually normal.

HEENT

HEENT examination of patients with dysphagia is usually normal.

Neck

Neck examination of patients with dysphagia is usually normal, but may presents with masses or swelling of the neck depending on the underlying cause.
- Laryngeal Cancer
- Thyroid goiters
- Esophageal cancers

Lungs

Pulmonary examination of patients with dysphagia is usually normal.

Heart

Cardiovascular examination of patients with dysphagia is usually normal.

Abdomen

Abdominal examination of patients with dysphagia is usually normal.

Back

Back examination of patients with dysphagia is usually normal.

Genitourinary

Genitourinary examination of patients with dysphagia is usually normal.

Neuromuscular

Neuromuscular examination of patients with dysphagia is usually dependent on the underlying disease.
- Stroke
- Neuromuscular disorders

Extremities

Extremities examination of patients with dysphagia is usually normal.

References

↑ Cho, S. Y.; Choung, R. S.; Saito, Y. A.; Schleck, C. D.; Zinsmeister, A. R.; Locke, G. R.; Talley, N. J. (2015). "Prevalence and risk factors for dysphagia: a USA community study". Neurogastroenterology & Motility. 27 (2): 212–219. doi:10.1111/nmo.12467. ISSN 1350-1925.

Template:WH Template:WS

[ChoChoung2015-1] Cho, S. Y.; Choung, R. S.; Saito, Y. A.; Schleck, C. D.; Zinsmeister, A. R.; Locke, G. R.; Talley, N. J. (2015). "Prevalence and risk factors for dysphagia: a USA community study". Neurogastroenterology & Motility. 27 (2): 212–219. doi:10.1111/nmo.12467. ISSN 1350-1925.

[1]

@@ Line 2: / Line 2: @@
 {{Dysphagia}}
-{{CMG}}; {{AE}}
+{{CMG}}; {{AE}} {{HQ}}
 ==Overview==
-A Speech Language Pathologist is most often the first person called upon to evaluate a patient with suspected dysphagia.  During this informal examination, medical history is obtained, the [[mini-mental state examination]] is administered, and oral and facial sensorimotor function, speech, and swallowing are evaluated non-instrumentally.
+A speech language pathologist is most often the first person called upon to evaluate a patient with suspected dysphagia.  During this informal examination, medical history is obtained, the [[mini-mental state examination]] is administered, and oral and facial sensorimotor function, speech, and swallowing are evaluated non-instrumentally.
 ==Physical Examination==
-* Physical examination of patients with [disease name] is usually normal.
+Physical examination of patients with dysphagia is dependent on the underlying cause.<ref name="ChoChoung2015">{{cite journal|last1=Cho|first1=S. Y.|last2=Choung|first2=R. S.|last3=Saito|first3=Y. A.|last4=Schleck|first4=C. D.|last5=Zinsmeister|first5=A. R.|last6=Locke|first6=G. R.|last7=Talley|first7=N. J.|title=Prevalence and risk factors for dysphagia: a USA community study|journal=Neurogastroenterology & Motility|volume=27|issue=2|year=2015|pages=212–219|issn=13501925|doi=10.1111/nmo.12467}}</ref> Please click the specified disease below to see the full physical exam.
-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===
-*Patients with dysphagia usually appear anxious.
+*Patients with dysphagia usually appear in discomfort.
 ===Vital Signs===
-*High-grade / low-grade fever
+*Normal
-*[[Hypothermia]] / hyperthermia may be present
-*[[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 examination of patients with [disease name] is usually normal.
+* Skin examination of patients with dysphagia is usually normal.
-OR
-*[[Cyanosis]]
-*[[Jaundice]]
-* [[Pallor]]
-* Bruises
-<gallery widths="150px">
-UploadedImage-01.jpg | Description {{dermref}}
-UploadedImage-02.jpg | Description {{dermref}}
-</gallery>
 ===HEENT===
-* HEENT examination of patients with [disease name] is usually normal.
+* HEENT examination of patients with dysphagia is usually normal.
-OR
-* Abnormalities of the head/hair may include ___
-* Evidence of trauma
-* Icteric sclera
-* [[Nystagmus]]
-* Extra-ocular movements may be abnormal
-*Pupils non-reactive to light / non-reactive to accommodation / non-reactive to neither light nor accommodation
-*Ophthalmoscopic exam may be abnormal with findings of ___
-* Hearing acuity may be reduced
-*[[Weber test]] may be abnormal (Note: A positive Weber test is considered a normal finding / A negative Weber test is considered an abnormal finding. To avoid confusion, you may write "abnormal Weber test".)
-*[[Rinne test]] may be positive (Note: A positive Rinne test is considered a normal finding / A negative Rinne test is considered an abnormal finding. To avoid confusion, you may write "abnormal Rinne test".)
-* [[Exudate]] from the ear canal
-* Tenderness upon palpation of the ear pinnae/tragus (anterior to ear canal)
-*Inflamed nares / congested nares
-* [[Purulent]] exudate from the nares
-* Facial tenderness
-* Erythematous throat with/without tonsillar swelling, exudates, and/or petechiae
 ===Neck===
-* Neck examination of patients with [disease name] is usually normal.
+* Neck examination of patients with dysphagia is usually normal, but may presents with masses or swelling of the neck depending on the underlying cause.
-OR
+** [[Laryngeal cancer physical examination|Laryngeal Cancer]]
-*[[Jugular venous distension]]
+** [[Medullary thyroid cancer physical examination|Thyroid goiters]]
-*[[Carotid bruits]] may be auscultated unilaterally/bilaterally using the bell/diaphragm of the otoscope
+** Esophageal cancers
-*[[Lymphadenopathy]] (describe location, size, tenderness, mobility, and symmetry)
-*[[Thyromegaly]] / thyroid nodules
-*[[Hepatojugular reflux]]
 ===Lungs===
-* Pulmonary examination of patients with [disease name] is usually normal.
+* Pulmonary examination of patients with dysphagia is usually normal.
-OR
-* Asymmetric chest expansion / Decreased chest expansion
-*Lungs are hypo/hyperresonant
-*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===
-* Cardiovascular examination of patients with [disease name] is usually normal.
+* Cardiovascular examination of patients with dysphagia 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===
-Abdominal examination of patients with [disease name] is usually normal.
+Abdominal examination of patients with dysphagia is usually normal.
-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.
+* Back examination of patients with dysphagia is usually normal.
-OR
-*Point tenderness over __ vertebrae (e.g. L3-L4)
-*Sacral edema
-*Costovertebral angle tenderness bilaterally/unilaterally
-*Buffalo hump
 ===Genitourinary===
-* Genitourinary examination of patients with [disease name] is usually normal.
+* Genitourinary examination of patients with dysphagia is usually normal.
-OR
-*A pelvic/adnexal mass may be palpated
-*Inflamed mucosa
-*Clear/(color), foul-smelling/odorless penile/vaginal discharge
 ===Neuromuscular===
-* Neuromuscular examination of patients with [disease name] is usually normal.
+* Neuromuscular examination of patients with dysphagia is usually dependent on the underlying disease.
-OR
+** [[Ischemic stroke physical examination|Stroke]]
-*Patient is usually oriented to persons, place, and time
+** Neuromuscular disorders
-* 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 examination of patients with [disease name] is usually normal.
+* Extremities examination of patients with dysphagia is usually normal.
-OR
-*[[Clubbing]]
-*[[Cyanosis]]
-*Pitting/non-pitting [[edema]] of the upper/lower extremities
-*Muscle atrophy
-*Fasciculations in the upper/lower extremity
 ==References==
 {{Reflist|2}}
+{{WH}}
+{{WS}}
 [[Category:Needs content]]
@@ Line 164: / Line 52: @@
 [[Category:Gastroenterology]]
 [[Category:Otolaryngology]]
-[[Category:Primary care]]
-{{WH}}
-{{WS}}