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==Overview==
{{aliah}}{{mitra}}{{allahyar}}
{{mitra chitsazan}}
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].
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].
File:Snowman-sign-1.jpg
==Physical Examination==
Physical examination of ,,,,,,,,, with [disease name] is usually normal.
OR
Physical examination of patients with [disease name] is usually remarkable for [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].
===Appearance of the Patient===
*Patients with PE usually appear normal/toxic.
===Vital Signs===
*High-grade
*Tachypnea / bradypnea
*Weak/bounding pulse / pulsus alternans / paradoxical pulse / asymmetric pulse
===Skin===
*[[Cyanosis]]
===HEENT===
*dilated pupils
*icteus
===Neck===
* Neck examination of patients with [disease name] is usually normal.
OR
*[[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===
* Pulmonary examination of patients with [disease name] is usually normal.
OR
* Asymmetric chest expansion OR decreased chest expansion
*Lungs are hyporesonant OR hyperresonant
*Fine/coarse [[crackles]] upon auscultation of the lung bases/apices unilaterally/bilaterally
*Rhonchi
*Vesicular breath sounds OR distant breath sounds
*Expiratory wheezing OR inspiratory wheezing with normal OR delayed expiratory phase
*[[Wheezing]] may be present
*[[Egophony]] present/absent
*[[Bronchophony]] present/absent
*Normal/reduced [[tactile fremitus]]
===Heart===
*a low grade late systolic murmur
===Abdomen===
* Abdominal examination of patients with PE is usually normal.
===Back==
===Genitourinary===
* Genitourinary examination of patients with [disease name] 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.
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 examination of patients with [disease name] 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: (name of the system)]]
==Overview==
Patients with pulmonary emboli(PE) usually appear toxic. Physical examination of patients with PE is usually remarkable for [finding 1], [finding 2], and [finding 3].
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 of patients with [disease name] is usually normal.
OR
Physical examination of patients with [disease name] is usually remarkable for [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].
===Appearance of the Patient===
*Patients with pE usually appear toxic/normal.
===Vital Signs===
*Low-grade fever
*[[Hyperthermia]] / hyperthermia may be present
*[[Tachycardia]] with regular pulse or (ir)regularly irregular pulse
*[[Bradycardia]] with regular pulse or (ir)regularly irregular pulse
*Tachypnea / bradypnea
===Skin===
* Skin examination of patients with PE 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.
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.
OR
*[[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===
* Pulmonary examination of patients with [disease name] is usually normal.
OR
* Asymmetric chest expansion OR decreased chest expansion
*Lungs are hyporesonant OR hyperresonant
*Fine/coarse [[crackles]] upon auscultation of the lung bases/apices unilaterally/bilaterally
*Rhonchi
*Vesicular breath sounds OR distant breath sounds
*Expiratory wheezing OR inspiratory wheezing with normal OR 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.
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 stethoscope
===Abdomen===
* Abdominal examination of patients with [disease name] is usually normal.
OR
*[[Abdominal distension]]
*[[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.
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.
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.
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 examination of patients with [disease name] 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: (name of the system)]]
This is my sandbox .
Hello .
[[File:Cardiomyopathy.jpg|left|200px]]
{| style="border: 0px; font-size: 90%; margin: 3px;" align=center
{| style="border: 0px; font-size: 90%; margin: 3px;" align=center
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Disease
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Disease
! align="center" style="background:#4479BA; color: #FFFFFF;" + |History
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Symptoms
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Symptoms
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Physical examination
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Physical examination
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! align="center" style="background:#4479BA; color: #FFFFFF;" + |CXR
! align="center" style="background:#4479BA; color: #FFFFFF;" + |CXR
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Echocardiography
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Echocardiography
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Cardiac catheterization
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: left;" valign="top" | '''[[Aortic valve stenosis]]'''
| style="background: #DCDCDC; padding: 5px; text-align: left;" valign="top" | '''[[Aortic valve stenosis]]'''  
| style="background: #DCDCDC; padding: 5px; text-align: left;" valign="top" |
| style="background: #DCDCDC; padding: 5px; text-align: left;" valign="top" |  
| style="background: #DCDCDC; padding: 5px; text-align: left;" valign="top" |  
*Exertional chest pain
*Exertional chest pain
*Dyspnea on exertion
*Dyspnea on exertion
*Decreased exercise tolerance
*Exertional syncope/pre-syncope
*Exertional syncope/pre-syncope
| style="background: #DCDCDC; padding: 5px; text-align: left;" valign="top" |  
| style="background: #DCDCDC; padding: 5px; text-align: left;" valign="top" |  
*Narrow pulse pressure
*Narrow pulse pressure
*Normal to anacrotic carotid pulse (parvus et tardus)
*Normal to anacrotic carotid pulse (parvus et tardus)
*
*S1 usually normal
| style="background: #DCDCDC; padding: 5px; text-align: left;" valign="top" |
*A systolic ejection click may be audible afer S1
*Single S2
*If severe: paradoxical splitting of S2
*S4 may be audible
| style="background: #DCDCDC; padding: 5px; text-align: left;" valign="top" |  
| style="background: #DCDCDC; padding: 5px; text-align: left;" valign="top" |  
*Mid-to-late peaking systolic ejection murmur
*Best heard at right intercostal space
*Radiates equally to the carotid arteries
*Decseases with Valsalva maneuver
| style="background: #DCDCDC; padding: 5px; text-align: left;" valign="top" |  
| style="background: #DCDCDC; padding: 5px; text-align: left;" valign="top" |  
*Left ventricular hypertrophy
*Left ventricular strain pattern
| style="background: #DCDCDC; padding: 5px; text-align: left;" valign="top" |  
| style="background: #DCDCDC; padding: 5px; text-align: left;" valign="top" |  
*Left ventricualar hypertrophy
*If heart failure is present: pulmonary congestion
*Aortic valve calcification may be visible
| style="background: #DCDCDC; padding: 5px; text-align: left;" valign="top" |  
| style="background: #DCDCDC; padding: 5px; text-align: left;" valign="top" |  
* '''Mild AS''': Aortic Vmax 2.0-2.9 m/s or mean ΔP <20 mmHg
* '''Moderate AS''': Aortic Vmax 3.0-3.9 m/s or mean ΔP 20-39 mmHg
* '''Severe AS''': Aortic Vmax ≥ 4 m/s or mean ΔP ≥40 mmHg;  AVA typically ≤ 1.0 cm<sup>2</sup> (or AVAi ≤ 0.6 cm<sup>2</sup>/m<sup>2)
* '''Very severe AS''': Aortic Vmax ≥ 5 m/s or mean ΔP ≥60 mmHg
*Ejection fraction (EF) may be normal or reduced
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: left;" valign="top" | '''[[Aortic valve sclerosis without stenosis]]'''
| style="background: #DCDCDC; padding: 5px; text-align: left;" valign="top" | '''[[Aortic valve sclerosis without stenosis]]'''
| style="background: #DCDCDC; padding: 5px; text-align: left;" valign="top" |
| style="background: #DCDCDC; padding: 5px; text-align: left;" valign="top" |
| style="background: #DCDCDC; padding: 5px; text-align: left;" valign="top" |  
| style="background: #DCDCDC; padding: 5px; text-align: left;" valign="top" |  
| style="background: #DCDCDC; padding: 5px; text-align: left;" valign="top" |  
| style="background: #DCDCDC; padding: 5px; text-align: left;" valign="top" |  
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| style="background: #DCDCDC; padding: 5px; text-align: left;" valign="top" |  
| style="background: #DCDCDC; padding: 5px; text-align: left;" valign="top" |  
| style="background: #DCDCDC; padding: 5px; text-align: left;" valign="top" |  
| style="background: #DCDCDC; padding: 5px; text-align: left;" valign="top" |  
| style="background: #DCDCDC; padding: 5px; text-align: left;" valign="top" |  
| style="background: #DCDCDC; padding: 5px; text-align: left;" valign="top" |
| style="background: #DCDCDC; padding: 5px; text-align: left;" valign="top" |
| style="background: #DCDCDC; padding: 5px; text-align: left;" valign="top" |
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: left;" valign="top" | '''[[Supravalvular stenosis]]'''
| style="background: #DCDCDC; padding: 5px; text-align: left;" valign="top" | '''[[Supravalvular stenosis]]'''
| style="background: #DCDCDC; padding: 5px; text-align: left;" valign="top" |
| style="background: #DCDCDC; padding: 5px; text-align: left;" valign="top" |
| style="background: #DCDCDC; padding: 5px; text-align: left;" valign="top" |  
| style="background: #DCDCDC; padding: 5px; text-align: left;" valign="top" |  
| style="background: #DCDCDC; padding: 5px; text-align: left;" valign="top" |  
| style="background: #DCDCDC; padding: 5px; text-align: left;" valign="top" |  
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| style="background: #DCDCDC; padding: 5px; text-align: left;" valign="top" |  
| style="background: #DCDCDC; padding: 5px; text-align: left;" valign="top" |  
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: left;" valign="top" | '''[[Hypertrophic obstructive cardiomyopathy]]'''
| style="background: #DCDCDC; padding: 5px; text-align: left;" valign="top" | '''[[Hypertrophic cardiomyopathy]]'''
| style="background: #DCDCDC; padding: 5px; text-align: left;" valign="top" |
| style="background: #DCDCDC; padding: 5px; text-align: left;" valign="top" |
| style="background: #DCDCDC; padding: 5px; text-align: left;" valign="top" |
| style="background: #DCDCDC; padding: 5px; text-align: left;" valign="top" |  
| style="background: #DCDCDC; padding: 5px; text-align: left;" valign="top" |  
| style="background: #DCDCDC; padding: 5px; text-align: left;" valign="top" |  
| style="background: #DCDCDC; padding: 5px; text-align: left;" valign="top" |  
| style="background: #DCDCDC; padding: 5px; text-align: left;" valign="top" |  
| style="background: #DCDCDC; padding: 5px; text-align: left;" valign="top" |  
| style="background: #DCDCDC; padding: 5px; text-align: left;" valign="top" | 
| style="background: #DCDCDC; padding: 5px; text-align: left;" valign="top" |  
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|}
|}
constrictive cardiomyopathy should be differentiated from  restrictive cardiomyopathy,
{| class="wikitable"
|+Differentiating restrictive cardiomyopathy from Other Diseases
| align="center" style="background: #4479BA;" | {{fontcolor|#FFF|'''Type of disease'''}}
| align="center" style="background: #4479BA;" | {{fontcolor|#FFF|'''History'''}}
| align="center" style="background: #4479BA;" | {{fontcolor|#FFF|'''Physical examination'''}}
| align="center" style="background: #4479BA;" | {{fontcolor|#FFF|'''Chest X-ray'''}}
| align="center" style="background: #4479BA;" | {{fontcolor|#FFF|'''ECG'''}}
| align="center" style="background: #4479BA;" | {{fontcolor|#FFF|'''2D echo'''}}
| align="center" style="background: #4479BA;" | {{fontcolor|#FFF|'''Doppler echo'''}}
| align="center" style="background: #4479BA;" | {{fontcolor|#FFF|'''CT'''}}
| align="center" style="background: #4479BA;" | {{fontcolor|#FFF|'''MRI'''}}
| align="center" style="background: #4479BA;" | {{fontcolor|#FFF|'''Catheterization hemodynamics'''}}
| align="center" style="background: #4479BA;" | {{fontcolor|#FFF|'''Biopsy'''}}
|-
|'''Restrictive cardiomyopathy'''<ref name="pmid29270320">{{cite journal |vauthors=Rammos A, Meladinis V, Vovas G, Patsouras D |title=Restrictive Cardiomyopathies: The Importance of Noninvasive Cardiac Imaging Modalities in Diagnosis and Treatment-A Systematic Review |journal=Radiol Res Pract |volume=2017 |issue= |pages=2874902 |date=2017 |pmid=29270320 |pmc=5705874 |doi=10.1155/2017/2874902 |url=}}</ref><ref name="pmid28885342">{{cite journal |vauthors=Hong JA, Kim MS, Cho MS, Choi HI, Kang DH, Lee SE, Lee GY, Jeon ES, Cho JY, Kim KH, Yoo BS, Lee JY, Kim WJ, Kim KH, Chung WJ, Lee JH, Cho MC, Kim JJ |title=Clinical features of idiopathic restrictive cardiomyopathy: A retrospective multicenter cohort study over 2 decades |journal=Medicine (Baltimore) |volume=96 |issue=36 |pages=e7886 |date=September 2017 |pmid=28885342 |pmc=6393124 |doi=10.1097/MD.0000000000007886 |url=}}</ref>
|Systemic disease (e.g., [[sarcoidosis]], [[hemochromatosis]]).
|
* ± [[Kussmaul sign]] [[S3 gallop|S3]] and [[S4]] [[Gallop rhythm|gallop]], [[murmurs]] of [[Mitral regurgitation|mitral]] and [[tricuspid regurgitation]]
|[[Atrial|Atrial dilatation]]
|[[Low QRS voltage|Low QRS voltages]] (mainly [[amyloidosis]]), [[Conduction disorders|conduction disturbances]], [[Nonspecific ST-Segment and T-Wave Changes|nonspecific ST abnormalities]]
|± Wall and valvular thickening, sparkling [[myocardium]]
|Decreased variation in [[mitral]] and/or [[tricuspid]] inflow ''E'' velocity, increased [[hepatic vein]] [[Inspiration|inspiratory]] [[diastolic]] flow reversal, presence of [[Mitral regurgitation|mitral]] and [[tricuspid regurgitation]]
|Normal [[pericardium]]
|Measurement of [[iron overload]], various types of LGE (late [[gadolinium]] enhancement)
|LVEDP – RVEDP ≥ 5 mmHg
RVSP ≥ 55 mmHg
RVEDP/RVSP ≤ 0.33
|May reveal underlying cause.
|-
|'''Constrictive pericarditis'''<ref name="pmid26613929">{{cite journal |vauthors=Biçer M, Özdemir B, Kan İ, Yüksel A, Tok M, Şenkaya I |title=Long-term outcomes of pericardiectomy for constrictive pericarditis |journal=J Cardiothorac Surg |volume=10 |issue= |pages=177 |date=November 2015 |pmid=26613929 |pmc=4662820 |doi=10.1186/s13019-015-0385-8 |url=}}</ref>
|
* Prior history of [[pericarditis]] or conditions affecting the [[pericardium]], such as uremia, HIV, TB, or radiation
|
*[[Pericardium|Pericardial]] knock
|
*[[Pericardial calcification]]
|
*[[Nonspecific ST-Segment and T-Wave Changes|Nonspecific ST and T abnormalities]], [[low QRS voltage]] (<50%)
|
* ± [[Pericardial]] thickening, [[respiratory]] [[ventricular]] septal shift.
|
* Increased variation in [[mitral]] and/or [[tricuspid]] inflow ''E'' velocity, [[hepatic vein]] [[Expiration|expiratory]] [[diastolic]] reversal ratio ≥ 0.79 medial ''e''′/lateral ''e''′ ≥ 0.91 (Annulus Reversus)
|
* Thickened/calcified [[pericardium]]
|
* Thickened pericardium
|
* LVEDP – RVEDP < 5 mmHg
* RVSP < 55 mmHg
* RVEDP/RVSP > 0.33
* Inspiratory decrease in RAP < 5 mmHg
* Systolic area index > 1.1 (Ref CP in the modern era)
* Left ventricular height of rapid filling wave > 7 mmHg
|
* Normal myocardium
|}
<references />

Latest revision as of 20:20, 11 June 2020

Overview

Alieh Bahjat,M.D. [1]Mitra Chitsazan, M.D.[2]Allahyar [3]


Template:Mitra chitsazan






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].

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].


File:Snowman-sign-1.jpg

Physical Examination

Physical examination of ,,,,,,,,, with [disease name] is usually normal.

OR

Physical examination of patients with [disease name] is usually remarkable for [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].

Appearance of the Patient

  • Patients with PE usually appear normal/toxic.

Vital Signs

  • High-grade
  • Tachypnea / bradypnea
  • Weak/bounding pulse / pulsus alternans / paradoxical pulse / asymmetric pulse


Skin

HEENT

  • dilated pupils
  • icteus




Neck

  • Neck examination of patients with [disease name] is usually normal.

OR

Lungs

  • Pulmonary examination of patients with [disease name] is usually normal.

OR

  • Asymmetric chest expansion OR decreased chest expansion
  • Lungs are hyporesonant OR hyperresonant
  • Fine/coarse crackles upon auscultation of the lung bases/apices unilaterally/bilaterally
  • Rhonchi
  • Vesicular breath sounds OR distant breath sounds
  • Expiratory wheezing OR inspiratory wheezing with normal OR delayed expiratory phase
  • Wheezing may be present
  • Egophony present/absent
  • Bronchophony present/absent
  • Normal/reduced tactile fremitus

Heart

  • a low grade late systolic murmur


Abdomen

  • Abdominal examination of patients with PE is usually normal.


=Back

Genitourinary

  • Genitourinary examination of patients with [disease name] 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.

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 examination of patients with [disease name] is usually normal.

OR

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

References

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Overview

Patients with pulmonary emboli(PE) usually appear toxic. Physical examination of patients with PE is usually remarkable for [finding 1], [finding 2], and [finding 3].

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 of patients with [disease name] is usually normal.

OR

Physical examination of patients with [disease name] is usually remarkable for [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].

Appearance of the Patient

  • Patients with pE usually appear toxic/normal.

Vital Signs

  • Low-grade fever
  • Hyperthermia / hyperthermia may be present
  • Tachycardia with regular pulse or (ir)regularly irregular pulse
  • Bradycardia with regular pulse or (ir)regularly irregular pulse
  • Tachypnea / bradypnea


Skin

  • Skin examination of patients with PE is usually normal.

OR

HEENT

  • HEENT examination of patients with [disease name] 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.

OR

Lungs

  • Pulmonary examination of patients with [disease name] is usually normal.

OR

  • Asymmetric chest expansion OR decreased chest expansion
  • Lungs are hyporesonant OR hyperresonant
  • Fine/coarse crackles upon auscultation of the lung bases/apices unilaterally/bilaterally
  • Rhonchi
  • Vesicular breath sounds OR distant breath sounds
  • Expiratory wheezing OR inspiratory wheezing with normal OR 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.

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
  • 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 stethoscope

Abdomen

  • Abdominal examination of patients with [disease name] is usually normal.

OR

Back

  • Back examination of patients with [disease name] 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.

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.

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 examination of patients with [disease name] is usually normal.

OR

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

References

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Hello .




Disease Symptoms Physical examination Cardiac murmur ECG CXR Echocardiography
Aortic valve stenosis
  • Exertional chest pain
  • Dyspnea on exertion
  • Decreased exercise tolerance
  • Exertional syncope/pre-syncope
  • Narrow pulse pressure
  • Normal to anacrotic carotid pulse (parvus et tardus)
  • S1 usually normal
  • A systolic ejection click may be audible afer S1
  • Single S2
  • If severe: paradoxical splitting of S2
  • S4 may be audible
  • Mid-to-late peaking systolic ejection murmur
  • Best heard at right intercostal space
  • Radiates equally to the carotid arteries
  • Decseases with Valsalva maneuver
  • Left ventricular hypertrophy
  • Left ventricular strain pattern
  • Left ventricualar hypertrophy
  • If heart failure is present: pulmonary congestion
  • Aortic valve calcification may be visible
  • Mild AS: Aortic Vmax 2.0-2.9 m/s or mean ΔP <20 mmHg
  • Moderate AS: Aortic Vmax 3.0-3.9 m/s or mean ΔP 20-39 mmHg
  • Severe AS: Aortic Vmax ≥ 4 m/s or mean ΔP ≥40 mmHg; AVA typically ≤ 1.0 cm2 (or AVAi ≤ 0.6 cm2/m2)
  • Very severe AS: Aortic Vmax ≥ 5 m/s or mean ΔP ≥60 mmHg
  • Ejection fraction (EF) may be normal or reduced
Aortic valve sclerosis without stenosis
Supvalvular stenosis
Supravalvular stenosis
Hypertrophic cardiomyopathy




constrictive cardiomyopathy should be differentiated from restrictive cardiomyopathy,


Differentiating restrictive cardiomyopathy from Other Diseases
Type of disease History Physical examination Chest X-ray ECG 2D echo Doppler echo CT MRI Catheterization hemodynamics Biopsy
Restrictive cardiomyopathy[1][2] Systemic disease (e.g., sarcoidosis, hemochromatosis). Atrial dilatation Low QRS voltages (mainly amyloidosis), conduction disturbances, nonspecific ST abnormalities ± Wall and valvular thickening, sparkling myocardium Decreased variation in mitral and/or tricuspid inflow E velocity, increased hepatic vein inspiratory diastolic flow reversal, presence of mitral and tricuspid regurgitation Normal pericardium Measurement of iron overload, various types of LGE (late gadolinium enhancement) LVEDP – RVEDP ≥ 5 mmHg

RVSP ≥ 55 mmHg

RVEDP/RVSP ≤ 0.33

May reveal underlying cause.
Constrictive pericarditis[3]
  • Thickened pericardium
  • LVEDP – RVEDP < 5 mmHg
  • RVSP < 55 mmHg
  • RVEDP/RVSP > 0.33
  • Inspiratory decrease in RAP < 5 mmHg
  • Systolic area index > 1.1 (Ref CP in the modern era)
  • Left ventricular height of rapid filling wave > 7 mmHg
  • Normal myocardium
  1. Rammos A, Meladinis V, Vovas G, Patsouras D (2017). "Restrictive Cardiomyopathies: The Importance of Noninvasive Cardiac Imaging Modalities in Diagnosis and Treatment-A Systematic Review". Radiol Res Pract. 2017: 2874902. doi:10.1155/2017/2874902. PMC 5705874. PMID 29270320.
  2. Hong JA, Kim MS, Cho MS, Choi HI, Kang DH, Lee SE, Lee GY, Jeon ES, Cho JY, Kim KH, Yoo BS, Lee JY, Kim WJ, Kim KH, Chung WJ, Lee JH, Cho MC, Kim JJ (September 2017). "Clinical features of idiopathic restrictive cardiomyopathy: A retrospective multicenter cohort study over 2 decades". Medicine (Baltimore). 96 (36): e7886. doi:10.1097/MD.0000000000007886. PMC 6393124. PMID 28885342.
  3. Biçer M, Özdemir B, Kan İ, Yüksel A, Tok M, Şenkaya I (November 2015). "Long-term outcomes of pericardiectomy for constrictive pericarditis". J Cardiothorac Surg. 10: 177. doi:10.1186/s13019-015-0385-8. PMC 4662820. PMID 26613929.