Sandbox MC

# Overview
Alieh Bahjat,M.D.
Mitra Chitsazan, M.D.Allahyar
Patients with  usually appear . Physical examination of patients with  is usually remarkable for , , and .
OR
Common physical examination findings of  include , , and .
OR
The presence of  on physical examination is diagnostic of .
OR
The presence of  on physical examination is highly suggestive of .
File:Snowman-sign-1.jpg

# Physical Examination
Physical examination of ,,,,,,,,, with  is usually normal.
OR
Physical examination of patients with  is usually remarkable for , , and .
OR
The presence of  on physical examination is diagnostic of .
OR
The presence of  on physical examination is highly suggestive of .

## Appearance of the Patient
- Patients with PE usually appear normal/toxic.

## Vital Signs
- High-grade
- Tachypnea / bradypnea
- Weak/bounding pulse / pulsus alternans / paradoxical pulse / asymmetric pulse

## Skin
- Cyanosis

## HEENT
- dilated pupils
- icteus

## Neck
- Neck examination of patients with  is usually normal.
OR
- 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
- Pulmonary examination of patients with  is usually normal.
OR
- 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
- a low grade late systolic murmur

## Abdomen
- Abdominal examination of patients with PE is usually normal.

# =Back

## Genitourinary
- Genitourinary examination of patients with  is usually normal.
OR
- A pelvic/adnexal mass may be palpated
- Inflamed mucosa
- Clear/(color), foul-smelling/odorless penile/vaginal discharge

## Neuromuscular
- Neuromuscular examination of patients with  is usually normal.
OR
- 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
- Extremities examination of patients with  is usually normal.
OR
- Clubbing
- Cyanosis
- Pitting/non-pitting edema of the upper/lower extremities
- Muscle atrophy
- Fasciculations in the upper/lower extremity