The Medical clinics of North America
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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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Malignancy is the second leading cause of death in the United States, following heart disease. In most cancers, early detection is one of the most important factors in determining prognosis. ⋯ Instead, it discusses in depth some of the more frequently encountered physical examination findings that may suggest malignancy. Specifically, it covers lymphadenopathy, cutaneous findings related to various cancers, and malignancy related thrombosis.
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Med. Clin. North Am. · May 2022
ReviewChronic Obstructive Pulmonary Disease and the Physical Examination.
Performing a hypothesis-driven examination in patients with possible chronic obstructive pulmonary disease (COPD) is an important component of increasing the recognition and diagnosis of this avoidable and costly medical condition. Using known likelihood ratios for various physical examination maneuvers can be combined with known individual risk factors and symptoms to adjust a patient's post-test probability of having COPD and inform appropriate diagnostic work-up. Equally important is intentionality in history-taking and physical examination procedures for patients with known COPD to mitigate the decreased quality of life and mortality and to monitor response to treatment.
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Delirium is an acute and fluctuating disorder characterized by a disturbance in attention and cognition. Delirium is underdiagnosed by clinicians, but there are excellent diagnostic tools using history and physical examination that can assist clinicians in making the diagnosis in multiple settings (ie, CAM, CAM-ICU, 3D-CAM, bCAM, 4AT, and UB-CAM). Delirium is caused by underlying medical conditions and is often multifactorial, so a full diagnosis requires a careful assessment for a wide range of underlying conditions. Physical examination has not been well studied in this regard, but still can provide useful clues to the clinician.
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Med. Clin. North Am. · May 2022
ReviewPhysical Examination in Human Immunodeficiency Virus Disease.
Human immunodeficiency virus (HIV)-associated disease is known for its protean manifestations. However, many of the characteristic findings on physical examination are not associated with HIV infection per se but the numerous opportunistic infections (OIs) that are common in patients with advanced HIV disease. ⋯ OIs also cause skin, oropharyngeal, ocular, and neurologic manifestations. A skilled clinician can often recognize HIV disease based on the combination of these findings.