Physical Exam | ScienceGate

This case report describes the case of a 37-year-old man that noticed an intrascrotal right mass with 1 month of evolution. During physical exam presented with a large mass at the inferior portion of the right testicle, clearly separated from the testicle, with a tender consistency and mobile. An ultrasound was performed that showed a solid and subcutaneous nodular lesion, extra testicular, heterogeneous, measuring 7.2 cm. Pelvic magnetic resonance imageMRI showed a lesion compatible with a lipoma. The patient was subjected to surgical excision of the lesion by scrotal access, having histology revealed a lipoblastoma (LB) of the scrotum. Histological diagnosis was obtained by microscopic characteristics (well-circumscribed fatty neoplasm) and immunohistochemistry (stains for CD34, S100 protein and PLAG1 were positive; stains for MDM2 and CDK4 were negative). LB is extremely rare after adolescence in any location, being this first described case of intrascrotal LB described in adulthood.

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The role of point-of-care ultrasound in the diagnosis of pericardial effusion: a single academic center retrospective study

The Ultrasound Journal ◽

10.1186/s13089-021-00205-x ◽

2021 ◽

Vol 13 (1) ◽

Author(s):

Matthew G. Hanson ◽

Barry Chan

Keyword(s):

Pericardial Effusion ◽

Point Of Care ◽

Physical Exam ◽

Right Atrial ◽

Point Of Care Ultrasound ◽

X Ray ◽

Average Systolic Blood Pressure ◽

Time To Diagnosis ◽

Clinically Significant ◽

The Impact

Abstract Background Symptomatic pericardial effusion (PCE) presents with non-specific features and are often missed on the initial physical exam, chest X-ray (CXR), and electrocardiogram (ECG). In extreme cases, misdiagnosis can evolve into decompensated cardiac tamponade, a life-threatening obstructive shock. The purpose of this study is to evaluate the impact of point-of-care ultrasound (POCUS) on the diagnosis and therapeutic intervention of clinically significant PCE. Methods In a retrospective chart review, we looked at all patients between 2002 and 2018 at a major Canadian academic hospital who had a pericardiocentesis for clinically significant PCE. We extracted the rate of presenting complaints, physical exam findings, X-ray findings, ECG findings, time-to-diagnosis, and time-to-pericardiocentesis and how these were impacted by POCUS. Results The most common presenting symptom was dyspnea (64%) and the average systolic blood pressure (SBP) was 120 mmHg. 86% of people presenting had an effusion > 1 cm, and 89% were circumferential on departmental echocardiogram (ECHO) with 64% having evidence of right atrial systolic collapse and 58% with early diastolic right ventricular collapse. The average time-to-diagnosis with POCUS was 5.9 h compared to > 12 h with other imaging including departmental ECHO. Those who had the PCE identified by POCUS had an average time-to-pericardiocentesis of 28.1 h compared to > 48 h with other diagnostic modalities. Conclusion POCUS expedites the diagnosis of symptomatic PCE given its non-specific clinical findings which, in turn, may accelerate the time-to-intervention.

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744 Clinical factors associated with gestational latency in women with twins undergoing physical exam-indicated cerclage

American Journal of Obstetrics and Gynecology ◽

10.1016/j.ajog.2020.12.767 ◽

2021 ◽

Vol 224 (2) ◽

pp. S466

Author(s):

Nikita Sinha ◽

Emily S. Miller ◽

Ashish Premkumar

Keyword(s):

Physical Exam ◽

Clinical Factors ◽

Factors Associated

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923 What are the risks of maternal morbidity after physical exam-indicated cerclage?

American Journal of Obstetrics and Gynecology ◽

10.1016/j.ajog.2020.12.948 ◽

2021 ◽

Vol 224 (2) ◽

pp. S573

Author(s):

Beth L. Pineles ◽

Angela Stephens ◽

Aneesh Kothare ◽

Nihan Farooq ◽

Isabella Ciuffetelli Alamo ◽

...

Keyword(s):

Maternal Morbidity ◽

Physical Exam

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Editor's Response to “Rescuing the Physical Exam”

Wilderness and Environmental Medicine ◽

10.1016/j.wem.2010.02.001 ◽

2010 ◽

Vol 21 (2) ◽

pp. 174

Author(s):

Robert L. Norris

Keyword(s):

Physical Exam

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Complete Response After Definitive Radiotherapy for Node-Positive Head and Neck Cancer: The Use of Post-treatment Physical Exam Versus Computed Tomography in the Management of the Neck

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/j.ijrobp.2005.07.323 ◽

2005 ◽

Vol 63 ◽

pp. S186

Author(s):

S.L. Liauw ◽

R.J. Amdur ◽

C.G. Morris ◽

A. Mancuso ◽

W.M. Mendenhall

Keyword(s):

Computed Tomography ◽

Head And Neck Cancer ◽

Head And Neck ◽

Neck Cancer ◽

Complete Response ◽

Post Treatment ◽

Physical Exam ◽

Definitive Radiotherapy ◽

Node Positive

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A Descriptive Analysis of Traction Splint Utilization and IV Analgesia by Emergency Medical Services

Prehospital and Disaster Medicine ◽

10.1017/s1049023x17006859 ◽

2017 ◽

Vol 32 (6) ◽

pp. 631-635 ◽

Cited By ~ 2

Author(s):

Joshua Nackenson ◽

Amado A. Baez ◽

Jonathan P. Meizoso

Keyword(s):

Emergency Medical Services ◽

Blunt Trauma ◽

Injury Severity ◽

Femur Fracture ◽

Descriptive Analysis ◽

Penetrating Trauma ◽

Physical Exam ◽

Medical Services ◽

Prehospital Treatment ◽

Emergency Medical

AbstractStudy ObjectivesTraction splinting has been the prehospital treatment of midshaft femur fracture as early as the battlefield of the First World War (1914-1918). This study is the assessment of these injuries and the utilization of a traction splint (TS) in blunt and penetrating trauma, as well as intravenous (IV) analgesia utilization by Emergency Medical Services (EMS) in Miami, Florida (USA).MethodsThis is a retrospective study of patients who sustained a midshaft femur fracture in the absence of multiple other severe injuries or severe physiologic derangement, as defined by an injury severity score (ISS) <20 and a triage revised trauma score (T-RTS)≥10, who presented to an urban, Level 1 trauma center between September 2008 and September 2013. The EMS patient care reports were assessed for physical exam findings and treatment modality. Data were analyzed descriptively and statistical differences were assessed using odds ratios and Z-score with significance set at P≤.05.ResultsThere were 170 patients studied in the cohort. The most common physical exam finding was a deformity +/- shortening and rotation in 136 patients (80.0%), followed by gunshot wound (GSW) in 22 patients (13.0%), pain or tenderness in four patients (2.4%), and no findings consistent with femur fracture in three patients (1.7%). The population was dichotomized between trauma type: blunt versus penetrating. Of 134 blunt trauma patients, 50 (37.0%) were immobilized in traction, and of the 36 penetrating trauma victims, one (2.7%) was immobilized in traction. Statistically significant differences were found in the application of a TS in blunt trauma when compared to penetrating trauma (OR=20.83; 95% CI, 2.77-156.8; P <.001). Intravenous analgesia was administered to treat pain in only 35 (22.0%) of the patients who had obtainable IV access. Of these patients, victims of blunt trauma were more likely to receive IV analgesia (OR=6.23; 95% CI, 1.42-27.41; P=.0067).ConclusionAlthough signs of femur fracture are recognized in the majority of cases of midshaft femur fracture, only 30% of patients were immobilized using a TS. Statistically significant differences were found in the utilization of a TS and IV analgesia administration in the setting of blunt trauma when compared to penetrating trauma.NackensonJ, BaezAA, MeizosoJP. A descriptive analysis of traction splint utilization and IV analgesia by Emergency Medical Services.Prehosp Disaster Med. 2017;32(6):631–635.

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Ruling out intra-abdominal injuries in blunt trauma patients using clinical criteria and abdominal ultrasound

Revista do Colégio Brasileiro de Cirurgiões ◽

10.1590/0100-69912017006015 ◽

2017 ◽

Vol 44 (6) ◽

pp. 626-632 ◽

Cited By ~ 2

Author(s):

Flávia Helena Barbosa Moura ◽

José Gustavo Parreira ◽

Thiara Mattos ◽

Giovanna Zucchini Rondini ◽

Cristiano Below ◽

...

Keyword(s):

Blunt Trauma ◽

Abdominal Ultrasound ◽

Physical Exam ◽

Trauma Patients ◽

Abdominal Injuries ◽

Hemodynamic Stability ◽

Abdominal Ultrasonography ◽

Clinical Criteria ◽

Clinical Variables ◽

Abdominal Lesions

ABSTRACT Objective: to identify victims of blunt abdominal trauma in which intra-abdominal injuries can be excluded by clinical criteria and by complete abdominal ultrasonography. Methods: retrospective analysis of victims of blunt trauma in which the following clinical variables were analyzed: hemodynamic stability, normal neurologic exam at admission, normal physical exam of the chest at admission, normal abdomen and pelvis physical exam at admission and absence of distracting lesions (Abbreviated Injury Scale >2 at skull, thorax and/or extremities). The ultrasound results were then studied in the group of patients with all clinical variables evaluated. Results: we studied 5536 victims of blunt trauma. Intra-abdominal lesions with AIS>1 were identified in 144 (2.6%); in patients with hemodynamic stability they were present in 86 (2%); in those with hemodynamic stability and normal neurological exam at admission in 50 (1.8%); in patients with hemodynamic stability and normal neurological and chest physical exam at admission, in 39 (1.5%); in those with hemodynamic stability, normal neurological, chest, abdominal and pelvic physical exam at admission, in 12 (0.5%); in patients with hemodynamic stability, normal neurological, chest, abdominal and pelvic physical exam at admission, and absence of distracting lesions, only two (0.1%) had intra-abdominal lesions. Among those with all clinical variables, 693 had normal total abdominal ultrasound, and, within this group, there were no identified intra-abdominal lesions. Conclusion: when all clinical criteria and total abdominal ultrasound are associated, it is possible to identify a group of victims of blunt trauma with low chance of significant intra-abdominal lesions.

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