Physical examination template

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

## Introduction to the Physical Examination Page

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* The page name should be "(Disease name) physical examination", with only the first letter of the title capitalized.
* Goal:To describe in detail the various aspects of the physical examination with attention to how the disease you are describing may present.
* Remember this section is to describe what characteristics may be found on physical examination, not how to do a physical exam (unless you are including specialized signs, eg Chvostek's sign, in which case you may give a brief description).
* You may describe a physical exam finding that is commonly present in a disease without adding additional information (e.g. appendicitis physical exam - RLQ abdominal tenderness). In some cases, some unique findings are suggestive of specific aspects / complications of the disease. If present, it is preferable that you mention what these unique findings suggest or when they may be present (e.g. appendicitis physical exam - rebound tenderness may be suggestive of peritonitis).
* As with all microchapter pages linking to the main page, at the top of the edit box put {{CMG}}, your name template, and the microchapter navigation template you created at the beginning.
* Remember to create links within Wikidoc by placing [[square brackets]] around key words which you want to link to other pages. Make sure you makes your links as specific as possible. For example if a sentence contained the phrase anterior spinal artery syndrome, the link should be to anterior spinal artery syndrome not anterior or artery or syndrome. For more information on how to create links click here.
* Remember to follow the same format and capitalization of letters as outlined in the template below.
* Below you will see examples of what you may describe as part of the physical examination.

## Overview

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* The overview section should include the disease name in the first sentence.
* The goal is to summarize the physical examination page in several sentences. This section can be the same as the physical examination segment on the overview page.
* To see an example of an overview section on a physical examination page, click here.

### Template

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* First Sentences:

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].

* Examples:

Example 1: Patients with shigellosis usually appear lethargic. Physical examination of patients with shigellosis is usually remarkable for high-grade fever and signs of dehydration, such as tachycardia, tachypnea, hypotension, and dry mucus membranes.
Example 2: Common physical examination findings of cholecystitis include right upper abdominal tenderness and a positive Murphy sign.
Example 3: The presence of both upper motor neuron and lower motor neuron involvement on physical examination is diagnostic of amyotrophic lateral sclerosis.
Example 4: The presence of facial tenderness and fever on physical examination is highly suggestive of acute sinusitis.

## Preferred Template Statements

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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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### Appearance of the Patient

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* This section should give a general description of what a patient with the disease you are describing may look like.
* If patients typically appear normal, you may write: Patients are usually well-appearing.
* You may include a physical description such as obese, thin, cachectic, ill appearing, diaphoretic etc. Mention in which cases these findings are present (e.g. well-appearing in early stages of cancer, cachectic in late stage cancer)
* For an example of the appearance of a patient section in the physical examination page, click here.

### Vital Signs

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Note: Vital signs traditionally include the temperature, blood pressure, heart rate, respiratory rate. The vital signs may also include oxygen saturation (at room air) and blood glycemia.

* 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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* Cyanosis
* Jaundice
* Pallor
* Bruises

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)

* Description (Adapted from Dermatology Atlas)

Description (Adapted from Dermatology Atlas)

* Description (Adapted from Dermatology Atlas)

### HEENT

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* 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

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* 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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* 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

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* 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

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* Abdominal distention
* 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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* 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

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* 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

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

### Neuromuscular

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* 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

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* References should be cited for the material that you have put on your page. Type in {{reflist|2}}.This will generate your references in small font, in two columns, with links to the original article and abstract.
* For information on how to add references into your page, click here.