Polio physical examination: Difference between revisions

Jump to navigation Jump to search
VisualWikitext
m (Bot: Removing from Primary care)
 
(16 intermediate revisions by 3 users not shown)
Line 4: Line 4:


==Overview==
==Overview==
Most patients with a normal [[immune system]] will be [[asymptomatic]] and will have a normal [[physical exam]]. 4 to 8% of patients may develop abortive poliomyelitis, that may only show [[fever]] on the [[physical exam]].  1 to 2% of patients will manifest non-paralytic poliomyelitis, that may present with findings of [[nuchal rigidity]], and positive [[Kernig's sign|Kernig's]] and [[Brudzinski's sign|Brudzinski's]] signs.  Less than 1% of patients will have paralytic poliomyelitis.  This form of the disease may be manifested as: spinal paralytic poliomyelitis or bulbar paralytic paralysis. The spinal form may present with: [[fever]]; [[meningeal signs]]; [[weakness]] of the extremities; and asymmetrical flaccid paralysis, most frequently of the lower limbs. The bulbar form may present with: [[pharyngeal]] paralysis, with accumulation of [[secretions]], inability to swallow and sometimes [[respiratory arrest]].  When poliencephalitis occurs, [[seizures]] and spastic paralysis may be present.


==Physical Examination==
==Physical Examination==
About 95% of patients with an healthy [[immune system]] are asymptomatic and have a normal physical examination.<ref name=CDC>{{cite web | title = Poliomyelitis | url = http://www.cdc.gov/vaccines/pubs/pinkbook/polio.html }}</ref>
About 95% of patients with an healthy [[immune system]] are asymptomatic and have a normal physical examination.<ref name=CDC>{{cite web | title = Poliomyelitis | url = http://www.cdc.gov/vaccines/pubs/pinkbook/polio.html }}</ref>


4 to 8% of poliovirus infection may lead abortive poliomyelitis, a mild symptomatic disease with little findings on physical exam. 2 to 3 days of [[fever]] may be the only finding.<ref>{{cite book | last = Mandell | first = Gerald | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Churchill Livingstone/Elsevier | location = Philadelphia, PA | year = 2010 | isbn = 0443068399 }}</ref>
4 to 8% of poliovirus infection may lead abortive poliomyelitis, a mild symptomatic disease with little findings on physical exam. 2 to 3 days of [[fever]] may be the only finding.<ref name="mend">{{cite book | last = Mandell | first = Gerald | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Churchill Livingstone/Elsevier | location = Philadelphia, PA | year = 2010 | isbn = 0443068399 }}</ref>


[[Poliovirus]] [[infection]] may cause non-paralytic (1-2%) or paralytic (<1%) forms of the disease.  Physical findings in these forms of the disease may include:
[[Poliovirus]] [[infection]] may cause non-paralytic (1-2%) or paralytic (<1%) forms of the disease.  Physical findings in these forms of the disease may include:
===Non-Paralytic Poliomyelitis===
==Non-Paralytic Poliomyelitis==
[[Meningeal signs]] may be present on physical exam, such as:<ref>{{cite book | last = Mandell | first = Gerald | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Churchill Livingstone/Elsevier | location = Philadelphia, PA | year = 2010 | isbn = 0443068399 }}</ref>
[[Meningeal signs]] may be present on physical exam:<ref name="mend">{{cite book | last = Mandell | first = Gerald | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Churchill Livingstone/Elsevier | location = Philadelphia, PA | year = 2010 | isbn = 0443068399 }}</ref>
* [[Nuchal rigidity]]  
* [[Nuchal rigidity]]  
* [[Kernig's sign]]
* Positive [[Kernig's sign]]
* [[Brudzinski's sign]]
* Positive [[Brudzinski's sign]]


===Paralytic Poliomyelitis===  
==Paralytic Poliomyelitis==  
====Spinal Paralytic Poliomyelitis====
===Spinal Paralytic Poliomyelitis===
====Temperature====
*A [[fever]] is often present
====Extremities====
* [[Weakness]] of the extremities, predominantly of the proximal muscles, is characteristic of this form of the disease. Lower extremities are more often involved.
* Asymmetrical flaccid paralysis, predominantly of the proximal muscles, is characteristic of this form of the disease. Lower extremities are more often involved.
====Neurologic====
* [[Meningeal signs]] may be present on physical exam, such as:<ref name="mend">{{cite book | last = Mandell | first = Gerald | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Churchill Livingstone/Elsevier | location = Philadelphia, PA | year = 2010 | isbn = 0443068399 }}</ref>
:* [[Nuchal rigidity]]
:* [[Kernig's sign]]
:* [[Brudzinski's sign]]
* Initially [[hyperactive]] deep tendon [[reflexes]], that later become absent.
* Common combinations of limb involvement include:
:* One lower limb, followed by one upper limb
:* Both lower limbs, followed by both upper limbs
* [[Quadriplegia]] is a rare finding in infants.


<!--
===Bulbar Paralytic Poliomyelitis===
Frank paralysis occurs in roughly 0.1% of all poliovirus infections. A biphasic course with minor and major illnesses is observed in approxi- mately one third of children with paralytic poliomyelitis. The minor illness, coinciding with viremia, corresponds to the symptoms of abor- tive poliomyelitis and lasts 1 to 3 days. The patient appears to be recovering and remains symptom-free for 2 to 5 days before the abrupt onset of the major illness, which is heralded by symptoms and signs of meningitis, including fever, chills, headache, fever, malaise, vomit- ing, neck stiffness, and cerebrospinal fluid (CSF) pleocytosis. Adults usually experience a single phase of illness, with a prolonged prodrome of symptoms preceding the gradual onset of paralysis.28,29 The major illness begins with severe myalgias and occasionally localized cutane- ous hyperesthesia, paresthesias, involuntary muscle spasm, or muscular fasciculations. The meningismus and muscle pain are present for 1 to 2 days before frank weakness and paralysis ensue. The severity of the disease varies from weakness of a single portion of one muscle to complete quadriplegia. The paralysis is flaccid; deep tendon reflexes are initially hyperactive and then become absent. The most character- istic feature of the paralysis is its asymmetrical distribution, which affects some muscle groups while sparing others. Proximal muscles of the extremities tend to be more involved than distal muscles, the legs are more commonly involved than the arms, and the large muscle groups of the hand are at greater risk than the small ones. Any com- bination of limbs may be paralyzed, but the most common pattern is involvement of one leg, followed by one arm, or both legs and both arms. Quadriplegia is almost never observed in infants.29 Although occasional cases progress from the onset of weakness to complete quadriplegia and bulbar involvement in a few hours, more commonly the paralysis extends over 2 to 3 days. Progression of paralysis stops when the patient becomes afebrile.28 Paralysis of the bladder is usually associated with paralysis of the legs. It occurs in about 25% of adults but is uncommon in children. Sensory loss in poliomyelitis is very rare30 and its occurrence should strongly suggest some other diagnosis (e.g., Guillain-Barré syndrome).
====Neurologic====
* [[Pharyngeal]] [[paralysis]], evidenced by accumulation of [[secretions]] is often present in this form of the disease.<ref name="mend">{{cite book | last = Mandell | first = Gerald | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Churchill Livingstone/Elsevier | location = Philadelphia, PA | year = 2010 | isbn = 0443068399 }}</ref>
* Inability to swallow<ref name="mend">{{cite book | last = Mandell | first = Gerald | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Churchill Livingstone/Elsevier | location = Philadelphia, PA | year = 2010 | isbn = 0443068399 }}</ref>


-->
* In rare severe cases, [[respiratory]] centers may be affected, leading to inability to breathe.<ref name="mend">{{cite book | last = Mandell | first = Gerald | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Churchill Livingstone/Elsevier | location = Philadelphia, PA | year = 2010 | isbn = 0443068399 }}</ref>


====Bulbar Paralytic Poliomyelitis====
===Polioencephalitis===
 
====Neurologic====
====Polioencephalitis====
* [[Seizures]] are often present
 
* [[Spastic paralysis]] may be present
   
<!--
 
====Pulse====
=====Rate=====
*[[Tachycardia]] may be present
=====Rhythm=====
*The pulse is regular
*The pules is irregularly irregular
=====Strength=====
*The pulse may be weak
*The pulse may be bounding
*The pulse may be alternating in strength ([[pulsus alternans]])
*A [[paradoxical pulse]] may be present
 
=====Symmetry=====
*The pulses may be asymmetric
 
====Blood Pressure====
*[[Hypotension]] may be present
*[[Hypertension]] may be present
*A [[wide pulse pressure]] may be present
*A [[narrow pulse pressure]] may be present
 
====Respiratory Rate====
*[[Tachypnea]] may be present
*[[Bradypnea]] may be present
* [[Kussmaul respirations]] may be present
 
===Skin===
*[[Cyanosis]] may be present
*[[Jaundice]] may be present
* A rash may be present
* [[Pallor]] may be present
* Lesions may be present
 
===Head===
* Abnormalities of the head/hair may include ___
* There may be evidence of trauma
 
===Eyes===
*Icteric sclera may be present
* [[Nystagmus]] may be present.
* Extra-ocular movements may be abnormal
*Pupils may not react to light
*Ophthalmoscopic exam may be abnormal with findings of ___
 
===Ears===
* Hearing acuity may be reduced
*[[Weber test]] may be positive
*[[Rinne test]] may be positive
* There may be [[exudate]] from the ear canal
* There may be [[tenderness]] on movement of the pinnae
 
===Nose===
* Nares may be inflamed
* There may be [[epistaxis]]
* There may be [[purulent]] exudate from the nares
* There may be [[tenderness]] to percussion of the sinuses
* The nares may be congested
 
===Throat===
* The throat may be erythematous
* There may be [[exudate]] in the throat
* There may be [[petechiae]] seen in the throat
* There may be tonsillar inflammation
 
===Neck===
*[[Jugular venous pressure]] may be elevated
*[[Carotid bruits]] may be present
*[[Lymph nodes]] may be present
*[[Thyromegaly]] may be present
*[[Hepatojugular reflux]] may be present
 
===Lungs===
*[[Pulmonary edema]] and [[rales]] may be present
*[[Wheezing]] may be present
*Consolidation may be present with reduced breath sounds auscultated
*[[Rales]] may be present
*[[Egophony]] may be present
* Chest movement may be assymetric
 
===Heart===
*A [[heave]] may be present
*A [[thrill]] may be present
*A [[friction rub]] may be pressent
 
====Auscultation====
*[[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 [[systolic murmur]] best heard at the base may be present
*A [[systolic murmur]] best heard at the apex may be present
*A [[diastolic murmur]] may be present
 
===Abdomen===
*[[Abdominal distention]] may be present
*[[Abdominal tenderness]] may be present
*[[Rebound tenderness]] may be present
*An [[acute abdomen]] may be present
*An abdominal mass may be present
*Guarding may be present
*[[Hepatomegaly]] may be present
*[[Splenomegaly]] may be present
*Genitourinary exam if relevant
 
===Extremities===
*[[Clubbing]] may be present
*[[Cyanosis]] may be present
*[[Edema]] may be present
 
===Neurologic===
* Mental status may be altered
* Glasgow coma scale is ___
* Clonus may be present
* Hyperactive reflexes may be present
* There are deficits in cranial nerves ___
 
-->


==References==
==References==
{{Reflist|2}}
{{Reflist|1}}
[[Category:Primary care]]
[[Category:Disease]]
[[Category:Infectious disease]]
{{WH}}
{{WH}}
{{WS}}
{{WS}}
[[Category:Disease]]

Latest revision as of 23:46, 29 July 2020

Polio Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Poliovirus

Differentiating Polio from other Diseases

Epidemiology and Demographics

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

Treatment

Medical Therapy

Prevention

Future or Investigational Therapies

Case Studies

Case #1

Polio physical examination On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Polio physical examination

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Polio physical examination

CDC on Polio physical examination

Polio physical examination in the news

Blogs on Polio physical examination

Directions to Hospitals Treating Polio

Risk calculators and risk factors for Polio physical examination

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: João André Alves Silva, M.D. [2]

Overview

Most patients with a normal immune system will be asymptomatic and will have a normal physical exam. 4 to 8% of patients may develop abortive poliomyelitis, that may only show fever on the physical exam. 1 to 2% of patients will manifest non-paralytic poliomyelitis, that may present with findings of nuchal rigidity, and positive Kernig's and Brudzinski's signs. Less than 1% of patients will have paralytic poliomyelitis. This form of the disease may be manifested as: spinal paralytic poliomyelitis or bulbar paralytic paralysis. The spinal form may present with: fever; meningeal signs; weakness of the extremities; and asymmetrical flaccid paralysis, most frequently of the lower limbs. The bulbar form may present with: pharyngeal paralysis, with accumulation of secretions, inability to swallow and sometimes respiratory arrest. When poliencephalitis occurs, seizures and spastic paralysis may be present.

Physical Examination

About 95% of patients with an healthy immune system are asymptomatic and have a normal physical examination.[1]

4 to 8% of poliovirus infection may lead abortive poliomyelitis, a mild symptomatic disease with little findings on physical exam. 2 to 3 days of fever may be the only finding.[2]

Poliovirus infection may cause non-paralytic (1-2%) or paralytic (<1%) forms of the disease. Physical findings in these forms of the disease may include:

Non-Paralytic Poliomyelitis

Meningeal signs may be present on physical exam:[2]

Paralytic Poliomyelitis

Spinal Paralytic Poliomyelitis

Temperature

Extremities

  • Weakness of the extremities, predominantly of the proximal muscles, is characteristic of this form of the disease. Lower extremities are more often involved.
  • Asymmetrical flaccid paralysis, predominantly of the proximal muscles, is characteristic of this form of the disease. Lower extremities are more often involved.

Neurologic

  • Initially hyperactive deep tendon reflexes, that later become absent.
  • Common combinations of limb involvement include:
  • One lower limb, followed by one upper limb
  • Both lower limbs, followed by both upper limbs

Bulbar Paralytic Poliomyelitis

Neurologic

  • In rare severe cases, respiratory centers may be affected, leading to inability to breathe.[2]

Polioencephalitis

Neurologic

References

  1. ↑ "Poliomyelitis".
  2. ↑ 2.0 2.1 2.2 2.3 2.4 2.5 Mandell, Gerald (2010). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Churchill Livingstone/Elsevier. ISBN 0443068399.

Template:WH Template:WS

Retrieved from "https://www.wikidoc.org/index.php?title=Polio_physical_examination&oldid=1642320"