Physical examination finding | Possible etiology |
General | |
Obesity | Essential hypertension |
Truncal obesity | Cushing syndrome, corticosteroid therapy |
Growth retardation | Chronic kidney disease |
Vital signs | |
Tachycardia | Catecholamine excess (PCC or neuroblastoma) or hyperthyroidism |
BP differences in extremities | If upper extremity BP is greater than lower extremity BP, coarctation of aorta |
Head and neck | |
Elfin facies | Williams syndrome |
Moon facies | Cushing syndrome, corticosteroid therapy |
Thyroid enlargement or goiter | Hyperthyroidism |
Webbed neck | Turner syndrome |
Tonsillar hypertrophy | Sleep-disordered breathing, sleep apnea |
Eye | |
Retinal changes | Suggested severe hypertension and secondary etiology |
Papilledema | Increased intracranial pressure |
Skin | |
Pallor, flushing | Catecholamine excess (PCC and neuroblastoma) |
Acne, hirsutism, striae | Cushing syndrome, corticosteroid therapy |
Café-au-lait spots and/or neurofibromas | Neurofibromatosis |
Ash leaf spots and/or adenoma sebaceum | Tuberous sclerosis |
Rash | Lupus nephritis, Henoch-Schönlein purpura (IgA vasculitis) |
Acanthosis nigricans | Type 2 diabetes |
Chest | |
Widely spaced nipples | Turner syndrome |
Murmur | Coarctation of the aorta |
Apical heave | Left ventricular hypertrophy |
Abdomen | |
Abdominal bruit | Renovascular disease |
Mass | Hydronephrosis, polycystic kidney disease, kidney tumors, neuroblastoma |
Extremities | |
Traction/casts | Orthopedic manipulation |
Asymmetry of limbs | Beckwith-Wiedemann syndrome |
Arthritis | Henoch-Schönlein purpura (IgA vasculitis), collagen vascular disease (systemic lupus erythematous) |
Neurologic | |
Muscle weakness | Liddle syndrome, hyperaldosteronism |
Diminished pain response | Familial dysautonomia |
Genitalia | |
Ambiguous/virilization | Adrenal hyperplasia |
Advanced puberty | Intracranial tumors |
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