Approach to the Patient with a Murmur
Patients with valvular heart disease may present with or without symptoms. A thorough cardiac physical examination can identify patients who require further evaluation and management. Although the utility of different cardiac findings varies widely, diastolic murmurs indicate important underlying valvular pathology requiring further investigation, typically with echocardiography. The proper examination of patients with systolic murmurs, the most common murmurs in clinical practice, is fundamental to cost-effective care. We will review the key components of the cardiac examination and findings relevant to functional murmurs...
Source: Medical Clinics of North America - April 4, 2022 Category: Primary Care Authors: John Landefeld, Melody Tran-Reina, Mark Henderson Source Type: research
Physical 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. Common findings of acute HIV infection include fever, adenopathy, rash, and oral ulcers. Chronic HIV infection is associated with skin, rheumatologic, and neurologic manifestations. OIs also cause skin, oropharyngeal, ocular, and neurologic manifestations. A skilled clinician can often recognize HIV disease based on ...
Source: Medical Clinics of North America - April 4, 2022 Category: Primary Care Authors: Christopher L. Knight Source Type: research
Chronic 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 ...
Source: Medical Clinics of North America - April 4, 2022 Category: Primary Care Authors: Reeni Ann Abraham, Stephanie Kaye Brinker Source Type: research
Movement Disorders
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. A careful history will guide the examiner to the appropriate category of movement disorders. 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 diso...
Source: Medical Clinics of North America - April 4, 2022 Category: Primary Care Authors: Daniel Winkel, Lisa Bernstein Source Type: research
The Disease-Based Physical Examination
Despite a decline in both the quality and the quantity of teaching of the physical examination in medical schools and postgraduate training programs over the past 4 decades, the physical examination remains a vital component of the patient assessment. Unlike most laboratory and radiologic tests, the physical examination provides immediate, often essential information at the patient bedside. Since the exam follows the history, it provides an opportunity to test hypotheses initially generated while the history is taken. (Source: Medical Clinics of North America)
Source: Medical Clinics of North America - March 30, 2022 Category: Primary Care Authors: Paul Aronowitz Tags: Preface Source Type: research
