Monkeypox physical examination: Difference between revisions

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===Skin===
===Skin===
Skin lesions develop after the prodrome (early set of symptoms). The United States Centers for Disease Control and Prevention described with following characteristics of lesions to identify monkeypox:  
Skin lesions develop after the prodrome (early set of symptoms). The United States Centers for Disease Control and Prevention described with following characteristics of lesions to identify monkeypox<ref name="urlClinical Recognition | Monkeypox | Poxvirus | CDC">{{cite web |url=https://www.cdc.gov/poxvirus/monkeypox/clinicians/clinical-recognition.html |title=Clinical Recognition &#124; Monkeypox &#124; Poxvirus &#124; CDC |format= |work= |accessdate=2022-06-15}}</ref>:  
*Relatively the same size and same stage of development on a single site of the body
*Relatively the same size and same stage of development on a single site of the body
*Well-circumscribed, deep seated, and often develop umbilication (resembles a dot on the top of the lesion)
*Well-circumscribed, deep seated, and often develop umbilication (resembles a dot on the top of the lesion)

Revision as of 10:46, 15 June 2022

Monkeypox Microchapters

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Bassel Almarie, M.D.

Overview

Physical Examination

Vital Signs

  • Low-grade fever (temperature, 100.8°F, 38.2°C)[1]
    • Fever before rash ​is a key characteristics to identifying monkeypox[2]

Skin

Skin lesions develop after the prodrome (early set of symptoms). The United States Centers for Disease Control and Prevention described with following characteristics of lesions to identify monkeypox[2]:

  • Relatively the same size and same stage of development on a single site of the body
  • Well-circumscribed, deep seated, and often develop umbilication (resembles a dot on the top of the lesion)
  • Disseminated rash is centrifugal (more lesions on extremities, face) ​
  • Includes palms and soles​
  • often painful until the healing phase when they become itchy (crusts)


Note: To describe a rash, always report additional details that include the color (e.g. erythematous), shape (e.g. flat / bullous), dermarcation (e.g. well-circumscribed / diffuse), location (e.g. truncal / on the face / on the extremities), enclosing fluid (e.g. vesicular / filled with pus, clear), and if possible smell (e.g. foul-smelling / odorless)

HEENT

  • 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 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

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
  • S1
  • S2
  • S3
  • S4
  • 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

Back

  • Point tenderness over __ vertebrae (e.g. L3-L4)
  • Sacral edema
  • Costovertebral angle tenderness bilaterally/unilaterally (may also be referred to as Murphy's punch sign, which is different from Murphy's sign that suggests cholecystitis. To avoid confusion, write "costovertebral angle tenderness")
  • Buffalo hump

Genitourinary

  • A pelvic/adnexal mass may be palpated
  • Inflamed mucosa
  • Clear/(color), foul-smelling/odorless penile/vaginal discharge

Write additional pathognomonic findings, such as discharge that resembles cottage cheese for C. albicans vulvovaginitis / fish-odor for T. vaginalis ifnection

Extremities

  • Clubbing
  • Cyanosis
  • Pitting/non-pitting edema of the upper/lower extremities
  • Muscle atrophy
  • Fasciculations in the upper/lower extremity

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)

References

  1. Fleischauer AT, Kile JC, Davidson M, Fischer M, Karem KL, Teclaw R; et al. (2005). "Evaluation of human-to-human transmission of monkeypox from infected patients to health care workers". Clin Infect Dis. 40 (5): 689–94. doi:10.1086/427805. PMID 15714414.
  2. 2.0 2.1 "Clinical Recognition | Monkeypox | Poxvirus | CDC". Retrieved 2022-06-15.

References