1/17
Recently finished service. Here are some of the physical findings my team and I saw in 7 days.
Starting with a classic.
Recently finished service. Here are some of the physical findings my team and I saw in 7 days.
Starting with a classic.
2/17
Kussmaul's sign. I was once told I'd see it a few times in my career. I see it every day.
This patient also has an S3 gallop. (Turn sound up.)
He was admitted with decompensated heart failure.
Kussmaul's sign. I was once told I'd see it a few times in my career. I see it every day.
This patient also has an S3 gallop. (Turn sound up.)
He was admitted with decompensated heart failure.
3/17
Next door we heard the other kind of gallop. An S4.
Next door we heard the other kind of gallop. An S4.
4/17
We saw a patient with mixed upper and lower motor neuron signs, suspected of having ALS. Here @PeteSullivanPDx demonstrates the jaw jerk reflex, an upper motor neuron sign.
We saw a patient with mixed upper and lower motor neuron signs, suspected of having ALS. Here @PeteSullivanPDx demonstrates the jaw jerk reflex, an upper motor neuron sign.
5/17
The patient also had atrophy and fasciculations (lower motor neuron signs).
The patient also had atrophy and fasciculations (lower motor neuron signs).
6/17
We heard mitral regurgitation.
We heard mitral regurgitation.
7/17
With textbook radiation toward the axilla.
With textbook radiation toward the axilla.
8/17
We saw nystagmus in a patient with Wernicke-Korsakoff syndrome.
We saw nystagmus in a patient with Wernicke-Korsakoff syndrome.
9/17
As well as a positive string sign of confabulation.
This might be the only publicly available recording of this sign.
As well as a positive string sign of confabulation.
This might be the only publicly available recording of this sign.
10/17
We heard pulmonic insufficiency. Listen carefully for a decrescendo diastolic murmur.
We heard pulmonic insufficiency. Listen carefully for a decrescendo diastolic murmur.
11/17
We saw this patient with an elevated JVP to the earlobe in the upright position. Her serum BNP was 17 pg/mL 🤔
We saw this patient with an elevated JVP to the earlobe in the upright position. Her serum BNP was 17 pg/mL 🤔
12/17
At the adjacent children's hospital, my 6 y/o cousin was hospitalized with bacterial pneumonia. We heard tubular breath sounds (think Darth Vader) over her R lung.
At the adjacent children's hospital, my 6 y/o cousin was hospitalized with bacterial pneumonia. We heard tubular breath sounds (think Darth Vader) over her R lung.
13/17
Compare that to the vesicular sounds (normal) of her unaffected left lung.
Compare that to the vesicular sounds (normal) of her unaffected left lung.
14/17
The tubular breath sounds were accompanied by textbook egophony. Listen as the scope goes back and forth between the normal lung and abnormal lung while our patient repeats "E". Can you hear the E to A change?
The tubular breath sounds were accompanied by textbook egophony. Listen as the scope goes back and forth between the normal lung and abnormal lung while our patient repeats "E". Can you hear the E to A change?
15/17
And finally, we saw markedly elevated JVP in our patient with cirrhosis, which, along with wide pulse pressure and Corrigan's pulse, ultimately lead to a diagnosis of high-output heart failure.
And finally, we saw markedly elevated JVP in our patient with cirrhosis, which, along with wide pulse pressure and Corrigan's pulse, ultimately lead to a diagnosis of high-output heart failure.
16/17
He continues to diurese very well. Now down about 70 lbs from admission.
He continues to diurese very well. Now down about 70 lbs from admission.
17/17
Physical diagnosis is alive and well at @OHSUIMRes and @OHSU_DHM.
You can find all of these media files and more at pdxpdx.com
Physical diagnosis is alive and well at @OHSUIMRes and @OHSU_DHM.
You can find all of these media files and more at pdxpdx.com
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