Adding instructions on how to do it as part of the diagnostic process for a specific disease is about as meaningful as including instructions for the doctor to make sure the patient has a pulse before diagnosing SEID.
The
ME Primer includes a Physical Examination worksheet that provides instructions for checking BP/pulse: (1) lying down; (2) immediately after standing; (3) after standing 3 min.; (4) after standing 5 min. (Caution: Someone should stand beside the patient.)
Physical Examination: Standard examination with attention to:
temp. _______;
pH: _______;
BP/pulse: 1. lying down:
BP_______/_______,
Pulse________;
2. immediately after standing:
BP _____/_____,
Pulse ______; 3. after standing 3 min.:
BP _____/_____,
Pulse _____ ; 4. after standing 5 min.: _______/_______,
Pulse ________ (Caution: Someone should stand beside the patient.)
Neurological
CNS: reflex examination: (neck flexion & extension may accentuate abnormalities from cervical myelopathic changes)
Neurocognitive: □ slowed thought, □ impaired concentration, □ difficulty remembering questions; □ cognitive fatigue: during assessment, serial 7 subtraction (subtracting by 7 from 100)_______________________ □ cognitive interference: (e.g. serial 7 subtraction done simultaneously with tandem walk)____________________
Pain/musculoskeletal: □ hyperalgesia, □ widespread, □ myofascial or radiating, □ muscle-tendon junctions, □ taut muscles; joints: □ inflammation, □ hypermobility, □ restricted movement; positive tender points ____/18; □ meets fibromyalgia criteria; muscle tone:
□ paretic, □ spastic; muscle strength ___________________________
Neurosensory, perceptual and motor disturbance: □ abnormal accommodation responses of the pupils, □ suborbital hyperpigmentation; tandem walk: □ forward, □ backwards;
□ Romberg test; □ reflex examination _____________
Immune: Tender lymphadenopathy: □ cervical, □ axillary, □ inguinal regions (more prominent in acute phase), □ flares with exertion; □ crimson crescents in the tonsillar fossa: □ demarcated along margins of both anterior and pharyngeal pillars, □ if patient has no tonsils, they assume a posterior position in the oropharynx; □ splenomegaly
GI: □ increased bowel sounds, □ abdominal bloating, □ abdominal tenderness: epigastrium (stomach), right lower quadrant (terminal ileum) and left lower quadrant (sigmoid colon) – most patients have tenderness in 2-3/3 areas
Cardiovascular & respiratory: □ arrhythmias: □ BP as above; □ mottling of extremities,
□ extreme pallor, □ Raynaud’s phenomenon, □ receded moons of finger nails (chronic phase)_______________________________