Narcolepsy physical examination

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

## Overview

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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].

Common physical examination findings of [disease name] include [finding 1], [finding 2], and [finding 3].

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].

## Physical Examination

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

Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].

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

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* Patients with [disease name] usually appear [general appearance].

### Vital Signs

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* High-grade / low-grade fever
* Hypothermia / hyperthermia may be present
* Tachycardia with regular pulse or (ir)regularly irregular pulse
* 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

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

* Cyanosis
* Jaundice
* Pallor
* Bruises

* Description (Adapted from Dermatology Atlas)

Description (Adapted from Dermatology Atlas)

* Description (Adapted from Dermatology Atlas)

### HEENT

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

* 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

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

* 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

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

* 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

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

* 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

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

* 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

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

* Point tenderness over __ vertebrae (e.g. L3-L4)
* Sacral edema
* Costovertebral angle tenderness bilaterally/unilaterally
* Buffalo hump

### Genitourinary

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

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

### Neuromuscular

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

* 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

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

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

## References

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