Objective physical signs to look for in substance use disorder

Body system	Findings
Dermatologic	Abscesses, rashes, cellulitis, thrombosed veins, jaundice, scars, track marks, pock marks from skin popping
Eye, ear, nose, and throat	Pupils pinpoint or dilated, yellow sclera, conjunctivitis, ruptured eardrums, otitis media, discharge from ears, rhinorrhea, rhinitis, excoriation or perforation of nasal septum, epistaxis, sinusitis, hoarseness or laryngitis
Mouth	Poor dentition, gum disease, abscesses
Cardiovascular	Murmurs, arrhythmias
Respiratory	Asthma, dyspnea, rales, chronic cough, hematemesis
Musculoskeletal and extremities	Pitting edema, broken bones, traumatic amputations, burns on fingers
Gastrointestinal	Hepatomegaly, hernias
Chest/breasts	Lumps, abscesses, scars, track marks in mammary vessels, enlarged lymph nodes in axilla
Pelvic exam	Assess uterus, cervix, cesarean delivery scars, labial tears or rectal contusions, sexually transmitted infections

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