The Medical clinics of North America
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Many common endocrinopathies have classic physical examination findings that can help lead to the diagnosis and cause of disease. This article will discuss the common signs and symptoms seen in Cushing disease, adrenal insufficiency, hyperthyroidism, hypothyroidism, thyroid nodules, and polycystic ovary syndrome (PCOS). A knowledge of these findings and their corresponding diseases will help the clinician to develop a targeted examination for syndromes of excess or deficient cortisol, excess or deficient thyroid hormone, thyroid nodules, and PCOS.
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Movement disorders are commonly encountered by the general practitioner and can be divided into 2 broad categories: hypokinetic and hyperkinetic. The former involves loss or slowing of movement, whereas the latter is characterized by excessive and involuntary movements. ⋯ As no laboratory test or radiologic study is confirmatory for these disorders, diagnosis must be made clinically and the neurologic examination is indispensable. In this article, we discuss physical examination techniques that will help diagnose common movement disorders.
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Heart disease is the leading cause of death in the United States with an estimated 6 million adults living with heart failure. In patients with heart failure, the physical examination can provide important prognostic information and is also used to guide both diagnosis and management, including determining the need for inpatient versus outpatient management. Presenting symptoms include dyspnea, peripheral edema, orthopnea, paroxysmal nocturnal dyspnea, and bendopnea. In patients with suspected heart failure, a "head-to-toe" physical examination approach is recommended with the addition of special maneuvers such as the measurement of jugular venous pressure, valsalva maneuver, and hepatojugular reflux as needed.
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Dementia is a common disease worldwide and is largely underdiagnosed. A timely diagnosis of dementia is beneficial for both the patient and family for many reasons, and exclusion and treatment of other mimics of dementia are crucial to avoid long-term consequences. Making a diagnosis of dementia requires attention to subtle cues from both patients and other informants, as often patients and family members will not notice early signs and symptoms. ⋯ Specific subtypes of dementia, including Alzheimer's disease, vascular dementia, Lewy body dementia, frontotemporal dementia, and others, sometimes can be differentiated by unique physical examination findings. Timely referral to dementia specialists is useful in the management of this group of diseases. However, as the aging population grows and access to specialists is often limited, it is important for all physicians to understand how to make a diagnosis of dementia.
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Cirrhosis is a chronic condition resulting from inflammation and fibrosis of the liver. Patients with cirrhosis may have a myriad of physical examination findings that reflect the severity of the underlying liver disease. Although many signs and symptoms related to cirrhosis are nonspecific, such as abdominal pain, nausea, and malaise, some findings are more specific and point to complications of liver disease. In this article, key physical findings in patients with cirrhosis, including hepatomegaly, splenomegaly, jaundice, ascites, encephalopathy, dilated abdominal wall veins, spider nevi, palmar erythema, and others, are discussed.