Euthyroid sick syndrome physical examination: Difference between revisions

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{{Euthyroid sick syndrome }}
{{Euthyroid sick syndrome }}


{{CMG}}; {{AE}}  
{{CMG}}; {{AE}}{{Akshun}}
==Overview==
==Overview==
Patients with [[euthyroid]] sick syndrome usually appear ill. Physical examination of patients with [[euthyroid]] sick syndrome depends upon the underlying conditions.There are no typical findings for patients with euthyroid sick syndrome.  The physical findings may range from subtle signs of hypothyroidism to more severe signs of hypothyroidism. These findings reflects the status of the underlying condition of the patient.  
There are no specific [[physical examination]] findings associated with [[euthyroid]] sick syndrome. The [[physical examination]] findings in each [[patient]] depends upon the underlying cause of [[euthyroid]] sick syndrome such as [[Sepsis physical examination|sepsis]], [[ST elevation myocardial infarction physical examination|myocardial infarction]], [[Pneumonia/Physical examination|pneumonia]], [[Chronic renal failure physical examination|chronic renal failure]] and [[Cirrhosis physical examination|cirrhosis]].


==Physical Examination==
==Physical Examination==
The physical examination findings in each patient depends upon the underlying illness. There are no typical findings for patients with euthyroid sick syndrome. The physical findings may range from subtle signs of hypothyroidism to more severe signs of hypothyroidism. These findings reflects the status of the underlying condition of the patient.
There are no specific [[physical examination]] findings associated with [[euthyroid]] sick syndrome. The [[physical examination]] findings in each [[patient]] depends upon the underlying cause of [[euthyroid]] sick syndrome such as [[Sepsis physical examination|sepsis]], [[ST elevation myocardial infarction physical examination|myocardial infarction]], [[Pneumonia/Physical examination|pneumonia]], [[Chronic renal failure physical examination|chronic renal failure]] and [[Cirrhosis physical examination|cirrhosis]]. However, euthyroid sick syndrome presents with [[hypothyroidism]]. The [[physical examination]] findings in [[hypothyroidism]] are:<ref name="pmid21250088">{{cite journal |vauthors=Walker HK, Hall WD, Hurst JW, Smith TJ |title= Clinical Methods: The History, Physical, and Laboratory Examinations. 3rd edition. |journal= |volume= |issue= |pages= |year= |pmid=21250088 |doi= |url=}}</ref><ref name="pmid28808493">{{cite journal |vauthors=Sadek SH, Khalifa WA, Azoz AM |title=Pulmonary consequences of hypothyroidism |journal=Ann Thorac Med |volume=12 |issue=3 |pages=204–208 |year=2017 |pmid=28808493 |doi=10.4103/atm.ATM_364_16 |url=}}</ref><ref name="pmid28778931">{{cite journal |vauthors=Badran A, Moran C, Coles AJ |title=Hypothyroid ataxia complicating monoclonal antibody therapy |journal=Pract Neurol |volume= |issue= |pages= |year=2017 |pmid=28778931 |doi=10.1136/practneurol-2017-001713 |url=}}</ref>
====Appearance of the Patient====
* Patients with [[hypothyroidism]] usually appear [[Fatigue|fatigued]].


===Appearance of the Patient===
====Vital Signs====
*Patients with euthyroid sick syndrome usually appear ill and fatigued.
* [[Bradycardia]]
* [[Hypotension]]
* [[Hypothermia]]


===Vital Signs===
====Skin====
The vitals signs depend upon underlying condition. There can be:
* [[Dry skin]]
*High-grade / low-grade fever
* Coarse hair
*[[Hypothermia]] / hyperthermia may be present
*[[Tachycardia]]  
*[[Bradycardia]]
*Tachypnea / bradypnea
*Kussmal respirations may be present in advanced cardiovascular disorders
*Weak/bounding pulse / pulsus alternans / paradoxical pulse / asymmetric pulse
*High/low blood pressure


===Skin===
====Head====
*[[Cyanosis]]
* Puffy face
*[[Jaundice]]
* Coarse facial expression
* [[Pallor]]
* Bruises


<gallery widths="150px">
====Respiratory====
*[[Bradypnea]]
* [[Dyspnea]]


UploadedImage-01.jpg | Description {{dermref}}
====Heart====
UploadedImage-02.jpg | Description {{dermref}}
* Decreased [[systolic blood pressure]]
* Increased [[diastolic blood pressure]]
* [[Pericardial effusion]]
* [[S3 gallop]]


</gallery>
====Neurologic====
 
* Slowed speech
===HEENT===
* [[Reflexes|Slowed reflexes]]
* Abnormalities of the head/hair may include ___
* [[Ataxia]]
* Evidence of trauma
* Icteric sclera
* [[Nystagmus]]
* Extra-ocular movements may be abnormal
*Pupils non-reactive to light / non-reactive to accomodation / non-reactive to neither light nor accomodation
*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===
*[[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===
* 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===
*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 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===
*Point tenderness over __ vertebrae (e.g. L3-L4)
*Sacral edema
*Costovertebral angle tenderness bilaterally/unilaterally
*Buffalo hump
 
===Genitourinary===
*A pelvic/adnexal mass may be palpated
*Inflamed mucosa
*Clear/(color), foul-smelling/odorless penile/vaginal discharge
 
===Neuromuscular===
*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===
*[[Clubbing]]  
*[[Cyanosis]]  
*Pitting/non-pitting [[edema]] of the upper/lower extremities
*Muscle atrophy
*Fasciculations in the upper/lower extremity


==References==
==References==

Latest revision as of 19:30, 16 August 2017

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

Overview

There are no specific physical examination findings associated with euthyroid sick syndrome. The physical examination findings in each patient depends upon the underlying cause of euthyroid sick syndrome such as sepsis, myocardial infarction, pneumonia, chronic renal failure and cirrhosis.

Physical Examination

There are no specific physical examination findings associated with euthyroid sick syndrome. The physical examination findings in each patient depends upon the underlying cause of euthyroid sick syndrome such as sepsis, myocardial infarction, pneumonia, chronic renal failure and cirrhosis. However, euthyroid sick syndrome presents with hypothyroidism. The physical examination findings in hypothyroidism are:[1][2][3]

Appearance of the Patient

Vital Signs

Skin

Head

  • Puffy face
  • Coarse facial expression

Respiratory

Heart

Neurologic

References

  1. Walker HK, Hall WD, Hurst JW, Smith TJ. "Clinical Methods: The History, Physical, and Laboratory Examinations. 3rd edition". PMID 21250088.
  2. Sadek SH, Khalifa WA, Azoz AM (2017). "Pulmonary consequences of hypothyroidism". Ann Thorac Med. 12 (3): 204–208. doi:10.4103/atm.ATM_364_16. PMID 28808493.
  3. Badran A, Moran C, Coles AJ (2017). "Hypothyroid ataxia complicating monoclonal antibody therapy". Pract Neurol. doi:10.1136/practneurol-2017-001713. PMID 28778931.

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