Hemoptysis physical examination: Difference between revisions

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==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].
Physical examination of patients with hemoptysis might be normal. However, patients might show different findings depend on underlying causes. Patients with hemoptysis usually appear anxious and depend on the severity of [[bleeding]] they might be critically ill. Patients with hemoptysis usually have abnormal [[vital signs]] indicating [[dehydration]], other signs of [[mucosal bleeding]], purulent bloody [[sputum]], and abnormal [[Respiratory examination|lung exam]] indicating underlying [[Lung|pulmonary]] causes.
 
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.
*Physical examination of patients with hemoptysis might be normal. However, patients might show different findings depend on underlying causes.<ref name="LeeKim2015">{{cite journal|last1=Lee|first1=Myoung Kyu|last2=Kim|first2=Sang-Ha|last3=Yong|first3=Suk Joong|last4=Shin|first4=Kye Chul|last5=Kim|first5=Hyun Sik|last6=Yu|first6=Tae-Sun|last7=Choi|first7=Eun Hee|last8=Lee|first8=Won-Yeon|title=Moderate hemoptysis: recurrent hemoptysis and mortality according to bronchial artery embolization|journal=The Clinical Respiratory Journal|volume=9|issue=1|year=2015|pages=53–64|issn=17526981|doi=10.1111/crj.12104}}</ref><ref name="KhalilFedida2015">{{cite journal|last1=Khalil|first1=A.|last2=Fedida|first2=B.|last3=Parrot|first3=A.|last4=Haddad|first4=S.|last5=Fartoukh|first5=M.|last6=Carette|first6=M.-F.|title=Severe hemoptysis: From diagnosis to embolization|journal=Diagnostic and Interventional Imaging|volume=96|issue=7-8|year=2015|pages=775–788|issn=22115684|doi=10.1016/j.diii.2015.06.007}}</ref><ref name="BruzziRémy-Jardin2006">{{cite journal|last1=Bruzzi|first1=John F.|last2=Rémy-Jardin|first2=Martine|last3=Delhaye|first3=Damien|last4=Teisseire|first4=Antoine|last5=Khalil|first5=Chadi|last6=Rémy|first6=Jacques|title=Multi–Detector Row CT of Hemoptysis|journal=RadioGraphics|volume=26|issue=1|year=2006|pages=3–22|issn=0271-5333|doi=10.1148/rg.261045726}}</ref>
OR
*Patients with hemoptysis usually appear anxious and depend on the severity of [[bleeding]] they might be critically ill.  
*Physical examination of patients with [disease name] is usually remarkable for:[finding 1], [finding 2], and [finding 3].
*Patients with hemoptysis usually have abnormal [[vital signs]] indicating [[dehydration]], other signs of [[mucosal bleeding]], purulent bloody [[sputum]], and abnormal [[Respiratory examination|lung exam]] indicating underlying [[Lung|pulmonary]] causes.
*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 hemoptysis usually appear anxious.
*Patients with massive hemoptysis usually appear critically ill.


===Vital Signs===
===Vital Signs===
 
*Low-grade [[fever]]
*High-grade / low-grade fever
*[[Tachycardia]] with regular [[pulse]]
*[[Hypothermia]] / hyperthermia may be present
*[[Tachypnea]]
*[[Tachycardia]] with regular pulse or (ir)regularly irregular pulse
*[[Hypotension|Low blood pressure]] with normal [[pulse pressure]]
*[[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.
*[[Bruise|Bruises]]  
OR
*[[Telangiectasia]]  
*[[Cyanosis]]  
*Palpable [[purpura]]  
*[[Jaundice]]
*[[Rash]]  
* [[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.
* Purulent bloody [[sputum]]
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===
* Neck examination of patients with [disease name] is usually normal.
OR
*[[Jugular venous distension]]
*[[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.
*Decreased [[Respiratory examination|chest expansion]]
OR
*Coarse [[crackles]] upon [[auscultation]] of the [[lung]] bases unilaterally or bilaterally
* Asymmetric chest expansion / Decreased chest expansion
*Decreased [[breath sounds]]
*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
*[[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.
*[[Heart murmur|Systolic murmur]] / [[diastolic murmur]]
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.
OR
*[[Abdominal distention]]  
*[[Abdominal distention]]  
*[[Abdominal tenderness]] in the right/left upper/lower abdominal quadrant
*[[Abdominal tenderness]]
*[[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===
* Back examination of patients with [disease name] is usually normal.
* [[Human back|Back]] examination of patients with hemoptysis 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]] examination of patients with hemoptysis 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 examination of patients with hemoptysis 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.
* [[Pedal edema|Peripheral edema]]
OR
* [[Clubbing]] of the digits
*[[Clubbing]]  
* [[Joint]] effusions
*[[Cyanosis]]  
* Periarticular warmth
*Pitting/non-pitting [[edema]] of the upper/lower extremities
*Muscle atrophy
*Fasciculations in the upper/lower extremity


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
[[Category:Medicine]]
[[Category:Gastroenterology]]
[[Category:Up-To-Date]]
[[Category:Emergency medicine]]

Latest revision as of 22:03, 29 July 2020

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

Overview

Physical examination of patients with hemoptysis might be normal. However, patients might show different findings depend on underlying causes. Patients with hemoptysis usually appear anxious and depend on the severity of bleeding they might be critically ill. Patients with hemoptysis usually have abnormal vital signs indicating dehydration, other signs of mucosal bleeding, purulent bloody sputum, and abnormal lung exam indicating underlying pulmonary causes.

Physical Examination

  • Physical examination of patients with hemoptysis might be normal. However, patients might show different findings depend on underlying causes.[1][2][3]
  • Patients with hemoptysis usually appear anxious and depend on the severity of bleeding they might be critically ill.
  • Patients with hemoptysis usually have abnormal vital signs indicating dehydration, other signs of mucosal bleeding, purulent bloody sputum, and abnormal lung exam indicating underlying pulmonary causes.

Appearance of the Patient

  • Patients with hemoptysis usually appear anxious.
  • Patients with massive hemoptysis usually appear critically ill.

Vital Signs

Skin

HEENT

Neck

Lungs

Heart

Abdomen

Back

  • Back examination of patients with hemoptysis is usually normal.

Genitourinary

  • Genitourinary examination of patients with hemoptysis is usually normal.

Neuromuscular

  • Neuromuscular examination of patients with hemoptysis is usually normal.

Extremities

References

  1. ↑ Lee, Myoung Kyu; Kim, Sang-Ha; Yong, Suk Joong; Shin, Kye Chul; Kim, Hyun Sik; Yu, Tae-Sun; Choi, Eun Hee; Lee, Won-Yeon (2015). "Moderate hemoptysis: recurrent hemoptysis and mortality according to bronchial artery embolization". The Clinical Respiratory Journal. 9 (1): 53–64. doi:10.1111/crj.12104. ISSN 1752-6981.
  2. ↑ Khalil, A.; Fedida, B.; Parrot, A.; Haddad, S.; Fartoukh, M.; Carette, M.-F. (2015). "Severe hemoptysis: From diagnosis to embolization". Diagnostic and Interventional Imaging. 96 (7–8): 775–788. doi:10.1016/j.diii.2015.06.007. ISSN 2211-5684.
  3. ↑ Bruzzi, John F.; Rémy-Jardin, Martine; Delhaye, Damien; Teisseire, Antoine; Khalil, Chadi; Rémy, Jacques (2006). "Multi–Detector Row CT of Hemoptysis". RadioGraphics. 26 (1): 3–22. doi:10.1148/rg.261045726. ISSN 0271-5333.
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